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Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 22441

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Dr. Biagio Barone

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Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
Interests: urologic oncology; endourology; urolithiasis; andrology; laparoscopic urology; urology; human sexuality; extracorporeal shock wave lithotripsy; urological diagnostic techniques
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Dr. Matteo Ferro

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Division of Urology, European Institute of Oncology-IRCCS, 20141 Milan, Italy
Interests: cancer cells; cancer biology; prostate cancer; urology; prostate; bladder cancer; urologic oncology; cancer metastasis; oncology; doppler ultrasonography
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

The urological landscape has severely changed during the last year.

The advent of immunotherapies in urological cancers, as well as new, powerful lasers in the treatment of urolithiasis and benign prostatic hyperplasia, represent the cornerstones of this constant change. In addition, the wider use of minimally invasive techniques has led to substantial improvements in the oncological and functional outcomes, as well as the quality of life, of the affected patients.

The importance of these innovations is even higher considering the challenge of the increasing prevalence, in industrialized countries, of prostate and bladder cancer, stone disease, and lower urinary tract dysfunctions.

This Special Issue of Applied Sciences aims to publish contributions from distinguished authors who actively experience innovations in the urological panorama.

We, therefore, look forward to reviews, meta-analyses, and original articles on different aspects of the diagnosis, treatment, and prognosis of urological diseases.

Dr. Biagio Barone
Dr. Matteo Ferro
Guest Editors

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Keywords

bladder cancer
prostate cancer
kidney cancer
penile cancer
urolithiasis
benign prostatic hyperplasia
urethral strictures

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Research

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11 pages, 1896 KiB

Open AccessArticle

The Robotic Intracorporeal Vesuvian Orthotopic Neobladder (VON)—A New Technique for Continent Urinary Diversion: Initial Experience and Description of the Technique

by Dario Del Biondo, Giorgio Napodano, Biagio Barone, Mario Iacone, Marco Grillo, Nunzio Ottaviano, Bruno Piccoli, Ferdinando Di Giacomo, Dante Di Domenico and Sertac Yazici

Appl. Sci. 2022, 12(22), 11616; https://doi.org/10.3390/app122211616 - 16 Nov 2022

Cited by 2 | Viewed by 2391

Abstract

Orthotopic neobladder reconstruction is becoming an increasing option as a urinary diversion following cystectomy for bladder cancer. The purpose of the following article is to describe, step-by-step, our technique for the robotic intracorporeal neobladder, the Vesuvian Orthotopic Neobladder. The primary aim of this new surgical procedure is to simplify and speed up the reservoir reconstruction, while at the same time obtaining an appropriate reservoir capacity. The Vesuvian Orthotopic Neobladder was performed employing an intestinal tract of 36 cm which was successively shaped in order to form a reservoir with three horns (left, right, and caudal), formed via the use of a mechanical stapler. Both ureters were stented and anastomosed to the left and right horn while the urethral-neobladder anastomosis was performed with the caudal horn. In this initial experience, two male patients with non-metastatic muscle-invasive bladder cancer underwent radical cystectomy followed by Vesuvian Orthotopic Neobladder reconfiguration. The mean age was 58.5 ± 3.53 years while the mean overall operative time was 435 ± 35.35 min, with an average neobladder reconstruction time of 59 ± 4.24 min. No intraoperative or postoperative complications were reported. The new intracorporeal Vesuvian Orthotopic Neobladder technique is a feasible and good alternative to traditional robotic intracorporeal orthotopic bladder procedures, permitting us to reduce operative time and obtain a neobladder with a fair reservoir capacity. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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9 pages, 5148 KiB

Open AccessArticle

Characteristics of Sepsis or Acute Pyelonephritis Combined with Ureteral Stone in the United States: A Retrospective Analysis of Large National Cohort

by Francesco Del Giudice, Koo Han Yoo, Sinyeong Lee, Jin Kyu Oh, Hyuk Jin Cho, Sang Youn Kim, Gyeong Eun Min, Sang Hyub Lee, Wansuk Kim, Shufeng Li, Wuran Wei, Jianlin Huang, David R. Brown, Kyle Spradling, Satvir Basran, Federico Belladelli, Riccardo Autorino, Savio Domenico Pandolfo, Simone Crivellaro, Felice Crocetto, Matteo Ferro, Vincenzo Asero, Carlo Maria Scornajenghi, Eugenio Bologna, Alessandro Sciarra, Stefano Salciccia, Ettore De Berardinis, Gian Piero Ricciuti, Stefanie van Uem, Simon Conti and Benjamin I. Chung Show full author list Hide full author list

Appl. Sci. 2022, 12(21), 10718; https://doi.org/10.3390/app122110718 - 22 Oct 2022

Cited by 3 | Viewed by 2259

Abstract

To identify the characteristics of patients with sepsis or acute pyelonephritis (APN) combined with ureteral calculi and to analyze the risk factors in its causation. Methods: We included patients with sepsis or APN caused by ureteral calculi who received treatment in the United States from January 2003 to December 2017 using the Optum® deidentified Clinformatics® Datamart. Demographic factors and risk factors for the receipt of sepsis or APN were subsequently analyzed for statistical significance. Results: Of 467,502 urinary stone patients, age-matched multivariate analysis revealed that a history of urinary tract infection (OR 11.31, 95% CI 10.68–11.99, p < 0.0001) and female gender (OR 2.73, 95% CI 2.62–2.84, p < 0.0001) were significantly related to an increased risk of sepsis or APN. Conversely, a previous past medical history of urolithiasis (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) and cancer (OR 0.91, 95% CI 0.87–0.95, p < 0.0001) were associated with a decreased risk of sepsis or APN. With regards to comorbidities, when more than one comorbidity was present, there was an additive effect with higher OR point estimates, rising to 11.31 (10.68–11.99) when three or more comorbidities present. History of urinary tract infection and female gender are risk factors for sepsis or APN in patients with ureteral calculi. Conclusions: This large national cohort reveals the characteristics of sepsis or APN combined with ureteral stone and provides an important baseline for the treatment of urolithiasis in the future. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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9 pages, 1128 KiB

Open AccessArticle

Multiparametric MRI Fusion-Guided Prostate Biopsy for Detection of Clinically Significant Prostate Cancer Eliminates the Systemic Prostate Biopsy

by Augustinas Matulevičius, Arnas Bakavičius, Albertas Ulys, Mantas Trakymas, Jurgita Ušinskienė, Ieva Naruševičiūtė, Rasa Sabaliauskaitė, Kristina Žukauskaitė, Sonata Jarmalaitė and Feliksas Jankevičius

Appl. Sci. 2022, 12(19), 10151; https://doi.org/10.3390/app121910151 - 9 Oct 2022

Cited by 2 | Viewed by 2628

Abstract

The primary objective of this study was to demonstrate the high accuracy of multiparametric magnetic resonance imaging and ultrasound fusion (mpMRI/US)-guided targeted prostate biopsy for the detection of clinically significant prostate cancer (PCa) and to show that adapted systematic biopsy (AdSB) does not provide additional benefit in detecting clinically significant prostate cancer (PCa). In total, 283 patients have been included in the study. All patients underwent the mpMRI/US biopsies, which have been performed with the “BioJet” fusion system (D&K Technologies, Barum, Germany) using the transperineal approach by a single interventional radiologist. Lesion-targeted and systematic biopsies have been done when 2–4 cores have been taken from each PI-RADS 3–5 lesion, followed by AdSB. This study demonstrated that targeted prostate biopsy is sufficient for safe and sensitive identification of clinically significant PCa in primary biopsy-naïve cases without the need to perform adapted systematic biopsy. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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12 pages, 1412 KiB

Open AccessArticle

Recent Trends in the Diagnostic and Surgical Management of Benign Prostatic Hyperplasia in the U.S. from 2004 to 2017: Annual Changes in the Selection of Treatment Options and Medical Costs

by Francesco Del Giudice, Jin Kyu Oh, Satvir Basran, Edouard Nicaise, Phil Hyun Song, Wansuk Kim, Sang Youn Kim, Gyeong Eun Min, Koo Han Yoo, Hyuk Jin Cho, Sinyeong Lee, Alessandro Sciarra, Stefano Salciccia, Ettore De Berardinis, Vincenzo Asero, Carlo Maria Scornajenghi, Benjamin Pradere, Wojciech Krajewski, Andrea Gallioli, Matteo Ferro, Felice Crocetto, Savio Domenico Pandolfo, Riccardo Autorino, Federico Belladelli, Andrea Mari, Gian Maria Busetto, Shufeng Li, Simone Crivellaro and Benjamin Inbeh Chung Show full author list Hide full author list

Appl. Sci. 2022, 12(17), 8697; https://doi.org/10.3390/app12178697 - 30 Aug 2022

Cited by 7 | Viewed by 2914

Abstract

Background: Transurethral resection of the prostate (TURP) is the gold-standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate (PVP), holmium laser, thulium laser enucleation of the prostate (HoLEP or ThuLEP)), and minimally invasive treatment options (e.g., UroLift) are increasingly replacing TURP. This study seeks to report the annual incidence, management trends, and costs of BPH procedures in the U.S. Methods: Data analyses of U.S. health insurance claims from 2004 to 2017, collected from the de-identified Optum Clinformatics Claims Database, were performed to determine the number of BPH patients and the treatment selected. Results: A total of 51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6571 in 2017. The mean patient age (±SD) increased from 67.6 years old (±8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and a post-void residual urine check for workup prior to surgical management. TURP was the most-common, and PVP was the second-most-common BPH procedure. Medical and total treatment costs increased, while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. Conclusions: Our study demonstrates a recent trend in BPH management that replaces the traditional TURP technique with alternative methods. Due to rising costs, future studies should assess whether these newer methods are cost effective over the long term. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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9 pages, 367 KiB

Open AccessArticle

Correlation between Bladder Neck Preservation, Positive Surgical Margins, and Biochemical Recurrence in Laparoscopic and Open Radical Prostatectomy: A Prospective Cohort Study

by Boris M. Kajmakovic, Milos Petrovic, Petar Bulat, Uros Bumbasirevic, Bogomir Milojevic, Zoran Bukumiric, Djordje Cvijanovic, Daniel Skrijelj, Aleksandar Jovanovic, Adi Hadzibegovic, Sanja Ratkovic and Zoran Dzamic

Appl. Sci. 2022, 12(16), 8304; https://doi.org/10.3390/app12168304 - 19 Aug 2022

Viewed by 1625

Abstract

Background: Bladder neck preservation (BNP) has been adopted in open (ORP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP). However, there are concerns that this technique can compromise oncological outcome and increase positive surgical margins (PSM). The aim was to evaluate the outcome of BNP, focusing on surgical and pathological outcomes, as well as biochemical recurrence (BCR). Methods: We prospectively collected demographic and clinical data from 170 consecutive patients who underwent ORP and LRP between 2014 and 2020. ORP was performed in 63 patients, and the rest underwent LRP. BNP was performed in 85 patients. Results: PSM were found in 24.7% of patients. Of patients with BNP, 22.4% had PSM. There was no significant statistical difference between patients with or without BNP in the form of PSM. Base-positive margins were detected in 9.4% of patients with BNP and in 5.9% of patients without BNP with no statistical significance. Bioptic Gleason score, clinical stage, and preoperative PSA were statistically significantly correlated with PSM. BCR was more common in patients without BNP (23.5%) vs. non-BNP (21.2%). The only statistically significant predictor of BCR was PSM. Conclusion: This study suggests that BNP in RP is not associated with an increased level of PSM. Preoperative PSA, bioptic Gleason score, and clinical T stage of disease were identified as predictors of PSM occurrence. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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Review

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21 pages, 3156 KiB

Open AccessReview

Dual-Energy CT Applications in Urological Diseases

by Michaela Cellina, Maria Vittoria Bausano, Daniele Pais, Vittoria Chiarpenello, Marco Costa, Zakaria Vincenzo, Maurizio Cè, Carlo Martinenghi, Giancarlo Oliva and Gianpaolo Carrafiello

Appl. Sci. 2023, 13(13), 7653; https://doi.org/10.3390/app13137653 - 28 Jun 2023

Cited by 2 | Viewed by 2945

Abstract

Dual-energy computed tomography (DECT) is a medical imaging technique that uses two different energy levels of X-rays to provide more detailed information about the composition of tissues and materials within the body. DECT technology is still relatively new but different applications have been developed for the urological field. For example, it can be used to analyze the composition of stones to determine whether they are likely to be made up of calcium oxalate, uric acid, or other minerals. This information can help guide treatment decisions, as different types of stones may require different approaches to treatment. The availability of iodine maps helps the differentiation between benign and malignant tumors of the urinary tract, including the bladder, kidneys, and ureters. The iodine maps generated by DECT can provide information on tumor vascularity, which can help in staging and determining the aggressiveness of the tumor. DECT can assess blood flow in the kidneys and detect vascular disorders such as renal artery stenosis or aneurysms. This can be critical for early detection and management of these disorders, which can reduce the risk of renal failure and improve outcomes. DECT is a valuable tool in the urological field that can provide clinicians with detailed and accurate information for the diagnosis and treatment planning of various urological conditions. In this narrative review, we propose an overview of the possible application of DECT in the field of urological diseases. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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13 pages, 280 KiB

Open AccessReview

Diagnostic Protocol, Outcomes and Future Perspectives of the Vesical Imaging-Reporting and Data Systems (VI-RADS), a Narrative Review

by Luigi Napolitano, Simona Ippoliti, Peter Fletcher, Martina Caruso, Luigi Cirillo, Roberto Miano, Enrico Finazzi Agrò, Roberto La Rocca, Ferdinando Fusco, Davide Arcaniolo and Luca Orecchia

Appl. Sci. 2023, 13(12), 7331; https://doi.org/10.3390/app13127331 - 20 Jun 2023

Viewed by 1376

Abstract

Bladder cancer (BC) is common worldwide, and has aggressive features and high rates of relapse despite treatments. Approximately 30% of patients present with muscle invasive disease, and therefore, high risk of metastasis. This review provides an overview of the state of the art for the ‘Vesical Imaging Reporting and Data System’ (VI-RADS). This scoring system presents a tool for the local staging of BC and has been validated across several institutions. We discuss the current application and the potential future clinical implications of VI-RADS in BC diagnosis, management and follow-up. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

16 pages, 893 KiB

Open AccessReview

The Role of miRNA in the Management of Localized and Advanced Renal Masses, a Narrative Review of the Literature

by Luigi Napolitano, Luca Orecchia, Carlo Giulioni, Umberto Carbonara, Giovanni Tavella, Leonardo Lizzio, Deborah Fimognari, Antonio De Palma, Alberto Gheza, Antonio Andrea Grosso, Ugo Falagario, Stefano Parodi, Vittorio Fasulo, Federico Romantini, Giuseppe Rosiello, Silvia Viganò, Salvatore Rabito, Tommaso Ceccato, Mirko Pinelli, Graziano Felici, Francesco De Vita, Francesco Prata, Francesco Dibitetto, Matteo Tedde, Federico Piramide, Fabio Traunero, Mario De Michele, Michele Morelli, Pietro Piazza and Rocco Simone Flammia Show full author list Hide full author list

Appl. Sci. 2023, 13(1), 275; https://doi.org/10.3390/app13010275 - 26 Dec 2022

Cited by 8 | Viewed by 2112

Abstract

Renal cell carcinoma (RCC) is the most common form of kidney cancer with 403,262 diagnoses and 170,000 deaths worldwide in 2018. Although partial or radical nephrectomy can be considered a successful treatment in early-stage or localized RCC, in advanced-stage disease, there is a high risk of metastasis or recurrence with a significantly poorer prognosis. Metastatic RCC is generally resistant to both chemotherapy and radiotherapy, and, despite several novel therapeutic agents, disease progression and mortality rates remain high. It is necessary to identify new diagnostic and therapeutic strategies for the management of this cancer. Knowledge of microRNA (miRNA) has consistently increased in the last year. miRNAs play an important role in several biological processes, such as cell proliferation, differentiation, and cell death. Due to this, miRNAs have been identified as an important key in different diseases, especially in cancer, and several studies show miRNAs as attractive tools and targets for novel therapeutic approaches. Recently several miRNAs (including miR-22, miR-203, miR-301 and miR-193a-3p) have been linked to dysregulated molecular pathways involved with the proliferation of cancerous cells and resistance to therapeutic agents. In the present study, recent data from studies assessing the application of miRNAs as biomarkers, therapeutic targets, or modulators of response to treatment modalities in RCC patients are analyzed. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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20 pages, 4342 KiB

Open AccessSystematic Review

Ultrasound Elastography for the Differentiation of Benign and Malignant Solid Renal Masses: A Systematic Review and Meta-Analysis

by Maurizio Cè, Andrea Cozzi, Michaela Cellina, Eliana Schifano, Daniele Gibelli, Giancarlo Oliva, Sergio Papa, Luca Dughetti, Giovanni Irmici and Gianpaolo Carrafiello

Appl. Sci. 2023, 13(13), 7767; https://doi.org/10.3390/app13137767 - 30 Jun 2023

Viewed by 1354

Abstract

The incidental finding of small renal masses in CT and MRI examinations can present a diagnostic challenge. Renal cell carcinoma (RCC) and angiomyolipoma (AML) are the most common incidental malignant and benign renal lesions but may present with similar US features. US elastography is a non-invasive technique that can assess tissue elasticity, has shown promising results in many clinical settings, and could be able to differentiate between benign and malignant renal lesions based on tissue stiffness. The purpose of this article is to systematically review the applications of US elastography in the characterization of solid renal masses and to derive and compare the summary estimates of different stiffness values across different lesion subtypes. In December 2022, a systematic search was carried out on the MEDLINE (PubMed) and EMBASE databases to retrieve studies on the application of US elastography in the characterization of solid renal masses. After article selection by three researchers, 14 studies entered qualitative synthesis. A total of 1190 patients were included, and the elastography data of 959 lesions were examined: 317/959 (33%) benign and 642/959 (67%) malignant. Among the malignancies, 590 (91%) were RCC, whereas, among the 317 benign lesions, 244 (77%) were AML. All lesions were classified using a histopathological (biopsy or operative specimen) or imaging (US follow-up/CT/MRI) reference standard. After data extraction and methodological quality evaluation, quantitative synthesis was performed on 12 studies, 4 using strain elastography (SE) and 8 using shear wave elastography (SWE), with single- and double-arm random-effects meta-analyses. Lesion stiffness measured with SE was available in four studies, with an RCC strain ratio higher than the AML strain ratio both in an indirect comparison (Cochran’s Q test p = 0.014) and in a direct comparison (p = 0.021). Conversely, the SWE measurements of RCC and AML stiffness did not significantly differ either at an indirect comparison (p = 0.055) or direct comparison (p = 0.114). Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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11 pages, 572 KiB

Open AccessSystematic Review

Confocal Laser Endomicroscopy for Bladder Cancer Detection: Where Do We Stand?

by Angelo Naselli, Andrea Guarneri and Giacomo Maria Pirola

Appl. Sci. 2022, 12(19), 9990; https://doi.org/10.3390/app12199990 - 5 Oct 2022

Cited by 2 | Viewed by 1700

Abstract

Introduction: Confocal laser endomicroscopy (CLE) is a relatively new technology that allows for a real-time in situ microscopic characterization of tissue lesions, being able to discriminate between low- and high-grade ones. After a first period of slow diffusion caused by technological limitations and elevated costs, CLE applications are rapidly spreading in different branches of medicine, and there is mounting evidence of its advantages for the management of different tumors such as bladder cancer (BCa), from both a diagnostic and a clinical point of view. In this systematic review (SR), we evaluate the state-of-the-art CLE for BCa management. Material and methods: We performed an SR and quality assessment analysis of the current literature in this regard following the PRISMA guidelines. All data were independently verified by two different authors and discrepancies were solved by a third author. Moreover, a quality-assessment analysis according to QUADAS-2 criteria was performed to evaluate the studies selected for SR. Results: A total of 158 articles were retrieved; of which 79 were rejected and 38 were removed as duplicates. After article selection, seven prospective studies were assessed for data extraction. These accounted for 214 patients overall, with a correspondence rate between CLE and histopathological examination ranging from 54.6 to 93.6%. Regarding quality assessment, three out five prospective studies have at least a high risk of bias in one QUADAS-2 domain, whereas the applicability always has a low risk of bias. Conclusion: Despite actual technical limitations, the preliminary results of this appealing technology are encouraging and should prompt further investigations. Full article

(This article belongs to the Special Issue Novel Advances in the Diagnosis, Treatment and Prognosis of Urological Diseases)

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