Distinct Adverse Clinical Outcomes of Small and Large Cribriform Patterns on Gleason 7 Prostate Cancer: A Preliminary Study

OBJECTIVE

We aimed to evaluate the effect of large and small cribriform morphology on survival following radical prostatectomy.

METHODS

We included 30 patients who underwent radical prostatectomy with curative intent between 2015 and 2022. Patients with the final pathology of Gleason 7 were included. Patients' radical prostatectomy specimens were reviewed by an experienced genitourinary pathologist. The diverse growth patterns of Gleason grade 4 were specified as poorly formed/fused glands, cribriform glands, and glomeruloid glands. The cribriform morphology was subdivided into small and large cribriform. Large cribriform growth morphology was defined by its size, which was double that of benign prostate glands. Small and large cribriform glands' percentages were indicated semiquantitatively. The cribriform morphology subtype present at 50% and higher was defined as the dominant pattern. The effect of histopathological patterns on biochemical recurrence and clinical progression was analyzed.

RESULTS

Thirteen patients were small cribriform pattern dominant (group 1), whereas 14 of the patients were large cribriform pattern dominant (group 2). Pathological T, N stages, and surgical margin positivity were similar between groups. Biochemical recurrence and clinical progression rates were significantly higher in group 2. The large cribriform dominant patients had worse 2-year biochemical recurrence-free survival than small cribriform dominant patients (45.5% vs. 66.7%). In the univariate analysis, International Society of Urological Pathology grade, Gleason pattern 4 percentage, large cribriform pattern dominancy, and pT stage were predictors for biochemical recurrence-free survival. International Society of Urological Pathology grade was the only independent predictor for biochemical recurrence-free survival.

CONCLUSION

Large cribriform pattern dominancy is associated with worse biochemical recurrence-free survival in Gleason 7 prostate cancer.

Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines

OBJECTIVE

The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines.

METHODS

Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms.

RESULTS

Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism.

CONCLUSION

It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery

OBJECTIVE

To investigate the effect of the diameter of UAS used during RIRS on operative parameters, perioperative ureteral injury, and ureteral stricture development.

MATERIAL AND METHOD

The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to UAS diameter (9.5/11.5 Fr (Group 1) and 12/14 Fr (Group 2)) were used during the operation. At the end of the operation, ureteral injury was checked visually using semi-rigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images used to newly developed ureteral dilation.

RESULTS

There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p=0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p=0.371).

CONCLUSION

The results of our study showed that the use of a 12/14 Fr UAS in patients who are not previously stented, increases the risk of high grade ureteral injuries, however, despite this increase there is no difference in ureteral stricture formation.

Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers

BACKGROUND

A novel infection, COVID-19, emerged in China and soon became a global pandemic. Pandemic conditions have resulted in stress in the workplace and led to anxiety among healthcare workers (HCWs), having negative impacts on different aspects of their lives, including their sexual function.

AIM

To evaluate the changes in the anxiety status of HCWs during the COVID-19 pandemic and the impact of anxiety on their sexual functions.

METHODS

This is a longitudinal study based on an online survey conducted from April 2020 to February 2021 in hospitals designated as pandemic healthcare centers. An online survey link was sent to HCWs that provided consent for participation in the study. The anxiety status of the participants was assessed using the State Anxiety Inventory, and sexual function was evaluated using the International Index of Erectile Function-15 for men and Female Sexual Function Index for women.

OUTCOMES

Scores obtained at the beginning of the pandemic were compared with those obtained at 6 months into the pandemic to determine the changes in the anxiety levels and sexual functions of the HCWs.

RESULTS

A total of 399 HCWs participated in the survey, and the median age was 32 (20-60) years. Compared to the beginning of the pandemic, there was a significant increase in the State Anxiety Inventory score of the female and male HCWs at the sixth month of the pandemic. Among the women, the mean total Female Sexual Function Index score was 23.55 ± 8.69 at the beginning of the pandemic and 21.42 ± 8.91 at the sixth month, and there was a significant decrease in all parameters except pain. Among the men, the International Index of Erectile Function-15 total score was 62.75 ± 12.51 at the beginning of the pandemic and 55.1 ± 12.87 at the sixth month, indicating a significant decrease in all parameters.

CLINICAL IMPLICATIONS

Considering that the pandemic will continue for a long time, more psychological support should be provided, and interventions should be made to protect the mental health of HCWs.

STRENGTHS & LIMITATIONS

The strength of the study is that it had a fairly high number of participants across several institutions. However, being conducted in one country and the sample not being randomly selected and being based on voluntariness can be considered as limitations.

CONCLUSION

Our results show that the COVID-19 pandemic has led to an increase in the anxiety levels of both female and male HCWs, and this situation has negatively affected their sexual functions. Eroglu U, Balci M, Coser S, et al, Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers. J Sex Med 2022;19:182-187.

An analysis of three different prostate cancer risk calculators applied prior to prostate biopsy: A Turkish cohort validation study

The study aimed to investigate the best-performing of three risk calculators (RCs) for the Turkish population in predicting cancer-free status and high-risk prostate cancer (PCa) in patients undergoing transrectal ultrasound-guided prostate biopsy. The electronic medical records of 527 patients who underwent prostate biopsy for the first time due to PSA of 0.3-50 ng/dl and/or cancer suspicion at digital rectal examination (DRE) between January 2017 and December 2020 were retrieved retrospectively. The predictive power of the RCs in the biopsy and the surgical cohort was calculated by two urologists using European Randomised Study of Screening for Prostate Cancer (ERSPC) RC, the North American Prostate Cancer Prevention Trial-RC (PCPT-RC), and the Prostate Biopsy Collaborative Group (PBCG)-RC. All three RCs were successful in predicting PCa and high-risk disease at ROC analysis (p < 0.0001). Of these three nomograms, PBCG-RC outperformed PCPT-RC 2.0 and ERSPC-RH in predicting benign pathology outcomes at biopsy. A better performance of PBCG-RC was also observed in terms of prediction of high-risk disease at biopsy. Using any of the available RCs prior to biopsy is of greater assistance to prostate-specific antigen and DRE than examination alone. The study results show that PBCG-RC performed before biopsy has a higher predictive power than the other two RCs.

Mixed epithelial and stromal tumor of the kidney treated with minimally invasive surgery

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney tumor that tends to occur in middle-aged and older women and is characterized by a distinctive histological appearance. Most of them were incidentally detected. A 26-year-old female patient was referred to in our clinic due to intermittent left lower back pain for 2 months and left renal mass. Abdominal computed tomography showed a cystic enhanced heterogenic left renal mass about 5 cm in the largest diameter was extending from the renal pelvis to the ureter and causing gross hydronephrosis of the left kidney. The mass treated with transperitoneal laparoscopic nephroureterectomy and bladder cuff resection. Histopathological evaluation revealed MESTK. In our patient, MESTK successfully and without any complication be treated by minimally invasive surgery. We believe that the fact that the tumor can mimic the urothelial-cell carcinoma of the kidney in radiological appearance, as seen in our case, should be taken into consideration.