MF Urologijos klinika (04.41)

Introduction & Objectives: Although pelvic lymph node dissection (PLND) is the most accurate method for lymphatic staging in prostate cancer, its therapeutic benefit remains controversial. We investigated oncologic outcomes in high‑risk prostate cancer patients who underwent radical prostatectomy (RP) with or without PLND. Materials & Methods: We retrospectively analyzed patients who underwent RP for localized or locally advanced prostate cancer at a single tertiary center from 01/01/2001 to 12/31/2022. Propensity score analysis was used to create comparable groups. Inclusion criteria for analysis included at least one high-risk prostate cancer feature: preoperative PSA ≥20 ng/mL, postoperative ISUP ≥4, or pathologic stage ≥ pT3a. Patients with incomplete data were excluded. Patients were divided into group 1: omission of PLND, and group 2: performance of PLND. Propensity score matching (1:1) generated two cohorts of 282 patients each. Kaplan–Meier and cumulative incidence functions estimated 15- year clinical progression (CP), cancer-specific mortality (CSM), and overall mortality (OM). Hazard ratios (HR) with 95% confidence intervals (CI) are reported. Analyses were conducted with SAS 9.4. A two-sided p-value < 0.05 was considered statistically significant. Results: Median follow‑up was 119 months (IQR 71–164). Median age was 64 years (60–68) and median PSA - 7.9 ng/mL (5.8–10.3). The study groups were similar regarding preoperative PSA (p =0,8, pathological ISUP (p = 0,6) and pathological stage (p = 0,4). Positive surgical margin (R1) occurred in 230 patients (40.8%). Median number of removed lymph nodes was 8 (IQR 5–14); 35/282 patients had lymph node involvement (12.4%). Overall, the 15‑year cumulative CP rate was 19.4%, CSM 5.6% and OM 26.7%. In multivariable analysis, pathological ISUP and pathological T stage were predictors for CP; age and R1 predicted CSM; and age, pathological ISUP 5 and pT2 predicted OM (p < 0.05). PLND was not found as significant predictor in any analysis. The main goal of the analysis was to compare oncological outcomes between the two groups. 15-year cumulative CP rates were 25.6% (95% CI 18.9–34.6%) in group 1 and 31.3% (95% CI 24.0–40.8%) in group 2 (p = 0.317); CSM was 8.6% (95% CI 4.8–15.1%) versus 8.8% (95% CI 5.2–15.0%) (p = 0.9); OM was 40.2% (95% CI 33.4–48.4%) versus 41.6% (95% CI 34.6–50.0%) (p = 0.77). Conclusions: In this propensity score–matched cohort of patients with high‑risk features, PLND at the time of RP was not associated with improved long-term oncologic outcomes compared with omission of PLND. These findings do not support a therapeutic benefit of PLND in high-risk patients undergoing RP.

Purpose Prostate cancer associated 3 (PCA3) and TMPRSS2:ERG fusion (T:E) are established urinary RNA biomarkers for detecting clinically significant prostate cancer (csPCa, Grade Group ≥ 2). Large within-subject paired studies directly comparing post-DRE and non-DRE urine collection are lacking. Using a multicenter cohort with samples collected from the same patients, we evaluated the effect of urine collection method on PCA3 and T: E diagnostic performance.

Methods In a multicenter prospective study paired post-DRE and non-DRE whole-urine samples were collected before systematic biopsy. PCA3, T:E, and reference PSA RNAs were quantified in 373 post-DRE and 355 non-DRE eligible specimens. Logistic regression models combining PCA3, T:E, PSA density, and age were developed for post-DRE (PD2) and non-DRE (ND2) cohorts and evaluated by cross-validated receiver operating characteristic (ROC) analysis and decision curve analysis.

Results PD2 outperformed ND2 in discrimination (AUC 0.78 versus 0.73) and net benefit. At ~ 95% sensitivity, PD2 specificity was 32% versus 23% for ND2. In the paired-sample analysis (n = 333), adding PCA3 and T:E to clinical variables improved AUC from 0.70 to 0.80 for post-DRE urine (p = 0.003), while gains were non-significant for non-DRE urine. Post-DRE specimens showed markedly higher RNA yields (median ~ 20-fold higher PCA3 and T:E copy numbers).

Conclusions Post-DRE whole urine collection increased biomarker RNA yield and significantly improved csPCa diagnostic accuracy versus non-DRE whole urine. PCA3 and T:E provided meaningful additive value only in post-DRE specimens, supporting its preferred use. As biopsies were performed without MRI guidance, future studies in MRI-integrated pathways would further characterize clinical utility.

Background. In patients with metastatic hormone-sensitive prostate cancer (mHSPC), darolutamide significantly improved radiological progression-free survival versus placebo (hazard ratio [HR] 0·54, 95% CI 0·41-0·71) in the phase 3 ARANOTE study. In addition to survival, symptom control and health-related quality of life (HRQoL) are important factors in treatment decision making; we therefore report pain, HRQoL, and safety outcomes from the ARANOTE trial.

Introduction Around 15% of cases of acute kidney injury (AKI) progress to chronic kidney disease (CKD). Although human placenta-derived mesenchymal stromal cells (hpMSCs) demonstrate anti-inflammatory properties, their long-term effects are unclear. This study aimed to evaluate the preventive effect of hpMSCs on AKI-to-CKD progression and to assess biomarkers sensitivity and correlation. Methods hpMSCs were isolated, cultured, and characterised by yield, viability, phenotype and immunosuppressive potency. A rat model of ischaemia-reperfusion injury (IRI): both renal pedicles were clamped for 60 minutes. The cells group (IRI-hpMSCs) received 3×105 hpMSCs in each kidney. Control groups received phosphate buffer solution (PBS), IRI only, or no intervention (healthy). Blood (creatinine), urine (KIM-1 and cystatin C) and kidney samples were collected on days 0, 3, 7, 21–28, 56 (n ≥ 3 per timepoint; total n = 57). Serum creatinine was measured in surviving animals. Kidney histology included scoring of acute tubular necrosis (ATN), tubular dilatation (TD), casts, loss of brush border (LBB), and interstitial fibrosis and tubular atrophy (IFTA), with injury quantified by renal injury score (RIS). Calculated correlations. Statistical analysis was performed using SPSS 17.0 and GraphPad Prism 7.04 with non-parametric tests (p < 0.05) and survival curve analysis. Results hpMSCs showed consistent viability, expressed MSC markers, and dose-dependently suppressed T-cell proliferation. hpMSCs significantly improved kidney function, with a lower median of serum creatinine levels on day 7 (vs. IRI p = 0.014; vs. PBS p = 0.034). Cystatin C levels were reduced on day 3, and KIM-1 levels were lower on day 14 vs. PBS in the cells group. Histology revealed that hpMSCs reduced renal injury in both early and late phases. On day 3, the cells group showed significantly less ATN, reduced cast formation, and absence of focal coagulative necrosis by day 7. On days 21–28, RIS, TD, LBB, cast formation, and IFTA were significantly lower in the cells group compared to both controls. IFTA was significantly lower in the cells group on day 56 (vs. IRI, p = 0.018; vs. PBS, p = 0.049). Serum creatinine normalized on day 28 and 56, but fibrosis persisted only in controls. Despite the limited sample size, several strong correlations were found between early urinary biomarkers and later histological IFTA scores. In the IRI-PBS group, higher KIM-1 (day 14) and cystatin C (day 3) levels were significantly associated with increased IFTA at day 28, but inversely correlated with IFTA at day 56, suggesting possible prolonged kidney damage or delayed regeneration. An increase in cystatin C on day 3 is strongly associated with an increase in IFTA on day 56 in the IRI group, statistically significant. Notably, in the placental cell group, cystatin C elevation (day 3) showed a strong inverse correlation with IFTA at day 28, indicating potential early regenerative effects. At the end of the study, 100% of the rats in the cells group survived, compared to 68% in the PBS group (p = 0.010) and 72% in the IRI group (p = 0.021).

Background: An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor, sometimes with urinary bladder involvement (though this is extremely uncommon). Due to its rarity, the exact etiology and optimal treatment strategy remain unclear. Methods: A review of the existing literature on IMT of the urinary bladder was performed. Results: We report a case of a 32-year-old female presenting with frequent urination, hematuria with clots, and lower abdominal pain for one month. Initially misdiagnosed as acute cystitis, the symptoms persisted despite antibiotic therapy. Laboratory findings revealed severe anemia, and imaging studies identified a large bladder mass. Transurethral resection of the bladder tumor (TURB) was performed, and a 96 g mass was removed. Histopathological examination confirmed IMT of the urinary bladder (IMTUB) with positive immunohistochemical staining for ALK, vimentin, and actin. Follow-up at 30 months showed no recurrence, with annual cystoscopy and CT scans confirming remission. Conclusions: IMTUB should be considered in young patients presenting with hematuria and lower urinary tract symptoms. Early diagnosis through cystoscopy, imaging, and histopathological confirmation is essential for appropriate management. TURB remains the gold standard for treatment, with ALK inhibitors providing additional therapeutic options in select cases. Long-term follow-up is necessary due to the unknown malignant potential of IMTUB.

Introduction Testicular metastasis from prostate cancer (PCa) is an extremely rare phenomenon mostly observed in patients with high-grade disease. It occurs in approximately 0.5% of patients with metastatic disease. Case Presentation We present a 63-year-old man with a history of locally advanced PCa (cT3bN1M0) characterized by pure adenocarcinoma, ISUP Grade Group 3, and an initial PSA of 11.8 ng/mL. The patient underwent external beam radiation therapy (50 Gy /25 fr), high-dose-rate brachytherapy (9 Gy/2 fr) and ADT with a PSA nadir of 0.07 ng/mL. Five months after completing ADT, the PSA level began to rise to 3.28 ng/ml. CT and prostate MRI revealed a heterogeneous contrast-enhancing mass within the left testis, resembling a primary testicular tumor. Testicular cancer tumor markers were normal. The patient underwent left radical orchofuniculectomy. Histopathological and immunohistochemical analysis confirmed a highgrade metastatic prostate adenocarcinoma with cribriform growth pattern (ISUP Grade Group 5). Following the surgery, PSA level dropped to 0.04 ng/mL and remained stable for nearly two years, with a recent slight rise to 0.38 ng/mL. CT, MRI and bone scintigraphy have shown no evidence of recurrence. ADT is planned if PSA rises. Discussion Testicular metastasis in PCa may present either as an isolated lesion or as a part of widespread metastatic involvement. The interval between definitive treatment and the development of testicular metastasis can vary widely, ranging from several months up to 22 years. Clinically, testicular involvement may be asymptomatic or manifest as a painful palpable mass, swelling, or even mimic orchitis. The introduction of PSMA/PET-CT has proven particularly valuable in such cases, demonstrating high sensitivity in detecting metastatic lesions even at rare sites. The primary management approach is radical orchiectomy, with most reported cases of isolated testicular metastasis subsequently managed with ADT. However, in our case, ADT was not initiated immediately; instead, the patient was placed under close biochemical surveillance, potentially avoiding or delaying the systemic therapy and its adverse effects. Conclusions This case highlights the rarity of testicular metastasis from PCa and suggests that vigilant monitoring of PSA level may be a suitable alternative to immediate systemic therapy in selected patients.

Background: Transrectal ultrasound-guided prostate biopsy remains the gold standard in diagnosing prostate cancer, but is associated with infectious and non-infectious complications. Increasing fluoroquinolone resistance and regulatory restrictions have prompted evaluation of alternative prophylactic strategies, including fluoroquinolone-sparing agents and targeted prophylaxis. This study compared ciprofloxacin and fosfomycin as empirical prophylactic agents, focusing on microbiological concordance, clinical outcomes, and patient-reported outcomes. Methods: In this prospective observational study, 265 men undergoing transrectal ultrasound-guided prostate biopsy received empirical antibiotic prophylaxis with either ciprofloxacin (n = 146) or fosfomycin trometamol (n = 119). Rectal swabs were obtained prior to biopsy, and antimicrobial susceptibility was analyzed post hoc. Infectious and non-infectious complications were recorded. Lower urinary tract symptoms (IPSS), erectile function (IIEF-5), and patient-reported quality of life were assessed before and after biopsy. Results: Microbiological concordance between administered prophylaxis and rectal flora susceptibility was higher in the ciprofloxacin group than in the fosfomycin group (80.1% vs. 65.0%, p = 0.007), while resistance rates were similar (10.9% vs. 10.2%). Post-biopsy fever occurred in 5.3% of patients, and hospitalization was required in 3.1%, with no significant differences between prophylaxis groups. IPSS increased significantly after biopsy (p < 0.001), while IIEF-5 scores remained unchanged. Patients with microbiological concordance reported significantly better post-biopsy quality of life (p = 0.006). Conclusions: Ciprofloxacin and fosfomycin showed similar safety profiles as empirical prophylaxis before transrectal prostate biopsy. Although ciprofloxacin achieved higher microbiological concordance, fosfomycin remains a viable alternative. The link between microbial concordance and improved patient-reported quality of life underscores the importance of targeted prophylaxis and supports antimicrobial stewardship in prostate cancer diagnostics.

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background/Objectives: The role of extended pelvic lymph node dissection (ePLND) in prostate cancer remains uncertain. Sentinel lymph node (sLN) mapping improves diagnostic precision, yet some patients have no detectable sentinel nodes (“untraceable” sLNs). This study evaluates whether untraceable sLNs predict the absence of lymph node invasion (LNI) and can guide surgical decision-making during radical prostatectomy (RP) with ePLND. Methods: Patients with intermediate- or high-risk prostate cancer and with no radiologically evident LNI were included in the study. A 99mTc-nanocolloid was used as an sLN tracer. RP with sLN dissection and ePLND was performed <20 h after injection. Patients were categorized into two groups: Group 1, traceable sLNs and Group 2, untraceable sLNs (no radiological or intraoperative signal). Results: A total of 53 patients were included. LNI was present in 10 patients (18.9%). Group 1 had 41 patients (77.4%), and Group 2 had 12 patients (22.6%). None of the patients in Group 2 had LNI following ePLND, whereas 10 of 41 patients (24.4%) in Group 1 were node-positive (p = 0.016). Baseline clinical and pathological characteristics were comparable between groups. A total of 17/53 of men (32.1%) experienced biochemical recurrence, overall, with higher observed events in Group 1 (15/41, 36.6%) vs. Group 2 (2/12, 16.7%). However, this difference did not reach statistical significance (p = 0.2). Conclusions: A proportion of PCa patients have no radiologically or intraoperatively detectable sLNs, and none of the patients with untraceable sLNs exhibited LNI following ePLND. These findings suggest that untraceable sLNs may correlate with an extremely low probability of nodal invasion and could serve as a criterion for safely omitting ePLND in selected patients.