research and report in urology

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Published by Taylor & Francis

Online ISSN: 2253-2447

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Aims and scope

Publishes open access research on the pathology and pathophysiology of urological disease, investigation and treatment, pharmacology of drugs used in therapy.

• Research and Reports in Urology is an international, peer-reviewed, open access, online journal.
• Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease; Investigation and treatment of urological disease; Pharmacology of drugs used for the treatment of urological disease
• Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies.
• Issues of patient safety and quality of care will also be considered.

For a full list of the subject areas this journal covers, please visit the journal website.

Recent articles

The treatment paradigm for high risk localized and advanced kidney cancer has been characterized by ongoing changes, with the introduction of vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) and later with immune checkpoint blockade. In this article, we review how current evidence informs our decision-making on post-checkpoint inhibitor systemic therapies, the role of adjuvant and/or neoadjuvant therapies, and the role of cytoreductive nephrectomy in the evolving systemic therapy landscape. While some studies support a post-checkpoint inhibitor benefit from the VEGFR TKIs cabozantinib or axitinib, the benefit of doublet therapies including a VEGF receptor inhibitor and a checkpoint inhibitor remains an area of active investigation, with the combination of lenvatinib plus pembrolizumab showing promise but with a Phase III trial of the combination of atezolizumab plus cabozantinib showing no benefit over cabozantinib alone. The role of adjuvant therapy in patients with high-risk disease who have undergone cytoreductive nephrectomy and potentially metastasectomy is also an area of continuing interest. While the S-TRAC study demonstrated a disease-free survival benefit for adjuvant sunitinib, no overall survival benefit was shown, and multiple other studies of adjuvant VEGFR TKI therapy have been negative. Subsequently, adjuvant pembrolizumab has shown a benefit in overall survival, whereas trials of neoadjuvant and adjuvant nivolumab, adjuvant atezolizumab, and adjuvant ipilimumab plus nivolumab have all been negative. Finally, the role for cytoreductive nephrectomy continues to be an area of active debate. The CARMENA study raised important questions about the role of cytoreductive nephrectomy given the advances in VEGFR TKI therapy but was characterized by accrual difficulties and a significant number of patients not receiving treatment according to the study protocol. Two ongoing studies (NORDIC-SUN and PROBE) seek to further address the role of cytoreductive nephrectomy in the doublet therapy era.

• Full-text available

Aim To review our 10 years of experience with the endoscopic treatment of vesicoureteral reflux (VUR) in children, emphasizing the long-term efficacy of the “combined STING-HIT” technique. Materials and Methods A retrospective study was performed including all children with symptomatic VUR undergoing the cystoscopic injection of bulking agents from January 2013 to December 2022 in our pediatric tertiary referral center. Three different endoscopic techniques were adopted: the “combined STING-HIT” technique, the STING technique, and the HIT technique. Treatment success was defined as symptom remission and VUR resolution on the voiding cystourethrogram (VCUG) performed at the 3-month follow-up. Results In the study period, 140 (F:M = 64:76) patients and 228 ureters were treated at a median patient age of 3 (2.0–6.0) years. After a single endoscopic treatment, VUR resolved in 203 (88%) ureters. The VUR resolution rate after a single endoscopic treatment was 95% (n=70/74) in case of I–II VUR, 88% (n=87/99) in case of III VUR; 83% (n=38/46) in case of IV VUR; 89% (n=8/9) in case of V VUR (p-value: 0.174). Overall, one or two endoscopic treatments succeeded in 219 (96%) ureters. The overall VUR resolution rate following one or two endoscopic treatments was 100% (74/74) in case of I–II VUR, 93% (n=92/99) in case of III VUR; 96% (n=44/46) in case of IV VUR; 100% (n=9/9) in case of V VUR (p-value: 0.083). Despite not being statistically significant, the VUR resolution rate was higher for the “combined STING-HIT” technique, both after one (92%: n=110/119; versus 85%; n=62/73 versus 86%; n=31/36; p-value: 0.225) or two (98%: n=116/119; versus 95%; n=69/73 versus 94%; n=34/36; p-value: 0.469) endoscopic treatments. Conclusion The endoscopic approaches were highly successful for the treatment of VUR in children. The “combined STING-HIT” technique was a safe and effective procedure, being associated with the higher resolution rate.

Background Since its introduction over two decades ago, the surgical laser has served in the lithotripsy of urinary calculi, resection of bladder tumours, bladder neck incisions, and prostate enucleation. Concerns regarding the safe use of holmium lasers have resulted in potentially excessive and overly precautious theatre regulations. We aimed to evaluate the preconceived impressions and practice patterns at a single site surrounding laser use in endourology. Methods We designed a three-part online questionnaire that could be accessed using a smart device or computer. This survey was distributed to all theatre staff involved in laser surgery at our single site, including surgical, nursing, and anaesthetic staff of varying seniority. It asked questions regarding holmium laser safety, provided an up-to-date summary of published literature surrounding the safe use of lasers, and finally gave participants further option to alter the answers to several previously encountered questions. Results A total of 54 theatre staff completed the survey, including 17 theatre nurses (31.5%), 10 urology consultants (18.5%), 8 urology registrars (14.8%), 7 anaesthetic registrars (13%), 4 anaesthetic consultants (7.4%). About 51.9% of participants believed that current laser safety protocols were adequate, with 38.9% finding them excessive. After reading recently published information on laser safety, 22.2% thought current laser safety measures were adequate (57% decrease) and 77.8% found them to be excessive (100% increase). About 74.1% of participants found that laser safety goggles impair their vision and that 79.6% would choose not to wear them if they were optional. Conclusion Strict laser safety guidelines reflect an overestimated risk associated with using holmium laser in operating theatres. Laser safety regulations should be re-evaluated to align with current research and potential hazards inherent to the device. In doing so, a more effective distribution of staff could enable greater access to laser surgery, thereby reducing patient morbidity and hospital wait times.

Primary bladder large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive neoplasm with high recurrence rates and poor prognosis. Traditional management has heavily relied on radical cystectomy, which, despite its aggressiveness, often results in unsatisfactory outcomes. Emerging evidence suggests the potential for less invasive, bladder-sparing approaches, yet detailed reports and long-term outcomes remain scarce. We report a groundbreaking case of a 59-year-old male diagnosed with primary bladder LCNEC, managed through a pioneering bladder-sparing multimodal treatment. This novel strategy included transurethral resection followed by a tailored chemoradiation protocol, resulting in exceptional disease control and preservation of bladder function over a 20-month follow-up period, without evidence of recurrence. This case underscores the viability of bladder conservation strategies as a legitimate alternative to radical cystectomy for managing LCNEC, presenting a beacon of hope for patients wishing to preserve bladder functionality. It prompts a reevaluation of traditional treatment paradigms and advocates for further research into multimodal, organ-sparing approaches for this challenging malignancy.

We report rare case of concomitant left nutcracker syndrome and right ureteropelvic junction obstruction (UPJO) on adult female patient diagnosed by CT urogram after she presented with intermittent bilateral flank pain. For this we did Anderson-Hynes pyeloplasty for right ureteropelvic obstruction, it was laparoscopic initially but due to difficulty of stenting it is changed to open. She had smooth post-op course then discharged on 3rd post-op day. Symptoms of nutcracker syndrome are not that much bothersome for the patient so we planned to follow her conservatively.

Purpose Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower bleeding risks. However, CVP lacks a postoperative pathological examination for prostate cancer. Concomitant prostate biopsy and CVP may complement this disadvantage; however, the risk of bleeding associated with this procedure remains unclear. This study aimed to evaluate the safety of a concomitant prostate biopsy and CVP. Patients and Methods This retrospective study included 106 men who had undergone CVP in Nerima General Hospital. Prostate biopsies and CVP were performed simultaneously on 16 patients. We defined the “hemorrhage group” by a >5% decrease in hemoglobin the day after surgery. Preoperative and operative indices were evaluated based on the association with the hemorrhage group. Results Participants in the concomitant biopsy group were older (p = 0.001), had larger prostates (p = 0.014), a lower rate of prostate biopsy history (p = 0.046), longer postoperative urinary catheter duration (p = 0.024), and a higher rate of decline in hemoglobin levels the day after surgery (p = 0.023). Patients in the hemorrhage group (n = 20, 18.9%) showed a significantly higher rate of concomitant biopsy and CVP (p = 0.006). Multivariate analysis showed that concomitant prostate biopsy (p = 0.009, odds ratio = 4.61) was the sole statistically significant predictive factor for hemorrhage. Conclusion Concomitant prostate biopsy and CVP of the prostate may increase the risk of bleeding.

Objective To assess the correlation of attenuation value measured as HU in Non-contrast computed tomography, stone size, location, fibre size and stone composition with Holmium: yttrium-aluminium garnet (Ho: YAG) laser parameters including, cumulative laser energy and final laser time. Materials and Methods We prospectively analyzed 118 patients undergoing flexible/semirigid ureteroscopy and Holmium: YAG laser lithotripsy from October 2022 to October 2023 at Mogadishu Urological Centre. Our study parameters encompass preoperative stone characteristics determined in NCCT (stone size, attenuation value, and stone location), fibre size, cumulative laser energy and time, overall operative time, and postoperative stone composition analysis. Results There were 118 patients eligible for our prospective study. In the logistic regression model for retrograde intrarenal surgery with a fibre size of 272 μm, cumulative laser energy showed a significant difference among stone size, location, fibre size, and calcium oxalate stones (P > 0.05). However, no significant difference was noticed in the attenuation value (P = 0.078) (R2 = 0.053). Our analysis showed a positive significance among all the parameters (P < 0.05) for laser time. In logistic regression for a rigid ureteroscope with a fibre size of 365 μm, cumulative laser energy showed a significant difference between the location stone and fibre size (P < 0.05) (R2 = 0.09). However, no significant difference was seen among stone size, attenuation value, and calcium oxalate stones (P > 0.05). For laser time, our analysis showed a positive significance among all parameters except the calcium oxalate stones, which showed no significant difference (P > 0.05). Conclusion Our study showed that stone location, hardness, and fibre size are the most critical factors influencing the outcome of Ho: YAG laser parameters. The study revealed that CaOMH stones require more time to disintegrate into smaller ones, while PH-dependent stones such as carbonate apatite may require less time to fragment.

• Literature Review

About 75% of bladder cancers are detected as non-muscle invasive. High-risk patients have high progression risk. Although the standard is transurethral resection of bladder tumor plus full dose intravesical BCG for one to 3 years, due to the high risk of progression, radical cystectomy may be considered in specific cases. Although radical cystectomy is still the best approach for high-grade NMIBC from an oncological perspective, its high morbidity and impact on quality of life motivate studies of new strategies that may reduce the need for cystectomy. We carried out a mini-review whose objectives were: 1 - to identify bladder-sparing alternatives that are being studied as possible treatment for patients with intermediate and high-risk NMIBC; 2 - understand the evidence that exists regarding success rate, follow-up, and side effects of different strategies. Several studies have sought alternatives for bladder preservation, including immunotherapy, intravesical chemotherapy, chemo-hyperthermia, antibody-drug conjugates, viral genetic therapy, and others with promising results. The selection of an optimal therapy for high-risk NMIBC that can reduce the need for cystectomy, with low toxicity and high efficacy, is of paramount importance and remains an issue, however, several known medications are being tested as bladder-preserving alternatives in this scenario and have shown promise in studies.

Purpose This study aimed to report the outcomes of hypospadias repair performed at a tertiary-level hospital during 2018 to 2021. Methods A retrospective chart review of 119 patients was performed. Results The most frequent coronal hypospadias cases were distal. However, the most common scrotal hypospadias cases were proximal. The average age at the time of the first surgery was 2.4 years (standard deviation, ±2.3 years). The tubularised incised plate technique was performed for 57 of these 119 patients. Urethral fistula was the most common complication associated with distal and proximal cases (23.96% and 30.43%, respectively). No significant correlation was observed between any complication and the surgical technique. Based on the logistic regression model, the duration of urethral stenting was statistically significant (p=0.025), indicating that a urinary catheter duration of more than 5 days resulted in a 2.9-times increased risk of postoperative urethral fistula. Conclusion Prolonged urethral stenting for more than 5 days may result in subsequent urethral fistula development. Neither the severity of hypospadias nor the surgical technique seems to affect postoperative complications.

Introduction Benign prostatic hyperplasia (BPH) is a histopathological diagnosis characterized by the increase in stromal cells and epithelial cells of the prostate gland in the transitional zone surrounding the urethra. Obesity is the risk factor of BPH. The most frequent cause of obesity is a high-fat diet (HFD). Obesity and HFD lead to pro-inflammatory conditions. One of the pathomechanisms for the occurrence of BPH is a low-degree inflammatory factor, one of which is the level of monocyte chemoattractant protein-1/MCP-1. This study aims to determine the influence of HFD on the incidence of obesity and inflammatory factors (monocyte chemoattractant protein-1/MCP-1 levels) on the histopathological picture of the prostate. Methods Experimental research was performed on male Wistar rats with each of the 6 rats given normal fat (ND) and HFD intake and terminated at 8 weeks and 6 rats given each ND and HFD were terminated at 16 weeks. The determination of obesity was determined based on Lee’s criteria which were categorized as obese if the Lee index >0.3 and non-obese if ≤0.3. Examination of circulating MCP-1 was carried out by the ELISA method and determination of prostatic hyperplasia was done by calculating the percentage of prostate glands that had a large per-field cystic dilatation on light microscopy examination. All data are analyzed statistically with the Fisher Exact Test and Spearman Correlation Test. Results Of the 12 rats that were given ND, none of them became obese according to Lee’s criteria, on the other hand, of the 12 rats that were given HFD 8 became obese (66.7%, p = 0.001). Serum MCP-1 levels and the percentage of prostate glands that had cystic dilatation were significantly higher in mice receiving HFD than ND; both at week-8 (MCP-1; 18.87 vs 15.66) and (prostate gland experiencing cystic dilatation; 63.46% vs 47.24%) and week-16 (MCP-1; 21.27 vs 21.27) and (prostate gland experiencing cystic dilatation; 67.79% vs 56.39%). Spearman correlation analysis showed that only circulating MCP-1 levels were significantly correlated (p < 0.05) to the percentage of the prostate gland that had cystic dilatation; especially in week 16 (r = 0.713 and p < 0.001). At 8 weeks, it was not statistically significant (r = 0.406 and p = 0.095). Conclusion High fat intake has been shown to increase the risk of obesity, but obesity does not increase inflammatory status and the incidence of prostate glands with cystic dilatation. On the other hand, high-fat intake increases inflammatory status which in turn causes prostate glands to develop cystic dilatation.

Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed “novel” biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients’ postoperative care.

February 2024

Objective Evaluation of the outcome of the miniaturized percutaneous nephrolithotomy in the treatment of nephrolithiasis with a lateral position based on the principle of a right triangle under the guidance of a C-Arm without contrast fluid. Materials and Methods Sixty-nine cases of Mini-PCNL with the assistance of a vacuum-assisted sheath in the lateral position were performed at Central Hospital from March 2021 to August 2022. Percutaneous renal access was under the guidance of a non-rotational C-arm without contrast medium, and we determined the puncture location and depth of the needle based on the principle of right triangles. Results The median age was 51.6 ± 12.5 years, and males accounted for 68.1% of the cases. 60.9% of all patients had normal weight. The median stone surface area was 361.1mm2, and 59.4% of all cases were graded as 2 regarding Guy’s stone score. The successful renal access rate was 100%. The tunnel access from the middle and lower calyx accounted for 94.2%. The median access duration, fluoroscopy duration, and hospital length of stay were 271.7 seconds, 14.79 seconds, and 6.3 days, respectively. The complete stone clearance rate was 78.3%. Bleeding complications occurred in 2 patients without mortality. Three patients required an additional procedure. Conclusion The puncture technique into the renal calyxes based on the principle of the right triangle under the guidance of a non-rotational C-Arm without contrast medium in PCNL is a fast, exact, and safe technique.

Purpose This study examines the readability of online medical information regarding cloacal exstrophy (CE). We hypothesize that inappropriate levels of comprehension are required in these resources, leading to poor understanding and confusion amongst caregivers. Methods The Google and Bing search engines were used to search the terms “cloacal exstrophy” and “cloacal exstrophy treatment”. The first 100 results for each were collected. Each webpage was analyzed for readability using four independent validated scoring systems: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG). Results Forty-seven unique webpages fit the inclusion criteria. Mean readability scores across all websites were GFI, 14.6; SMOG score, 10.8; DCI, 9.3; and FKG, 11.8, correlating to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade, respectively. There were significant differences across all readability formulas. Non-profit websites were significantly less readable than institutional and commercial webpages (GFI p = 0.012, SMOG p = 0.018, DCI p = 0.021, FKG p = 0.0093). Conclusion Caregiver-directed health information regarding CE and its treatment available online is written at the 11th grade reading level or above. Online resources pertaining to CE must be simplified to be effective.

January 2024

Background With widespread adoption of technological advancements in everyday life, patients are now increasingly able and willing to obtain information about their health conditions, treatment options, and indeed expected outcomes via the convenience of any device than can access the worldwide web. This introduces another aspect of patient care in the provision of healthcare for the modern doctor. ChatGPT is the first of an increasing number of self learning programs that have been released recently which may revolutionize and impact healthcare delivery. Methods The aim of this study is to obtain an objective measure of the readability of information provided on ChatGPT when compared with current validated patient information sheets provided by government health institutions in Western Australia. The same structured questions were input into the program for three major urological malignancies (urothelial, renal, and prostate), with the response generated evaluated with a validated readability scoring system – Flesch-Kincaid reading ease score. The same scoring system was then applied to current patient information sheets in circulation from Cancer Council Australia and UpToDate. Results Findings in this study looking at ease of readability of information provided on ChatGPT as compared to other government bodies and healthcare institutions confirm that they are non-inferior and may be a useful tool or adjunct to the traditional clinic based consultations. Ease of use of the information generated from ChatGPT was increased further when the question was modified to target an audience of 16 years of age, the average level of education attained by an Australian. Discussion Future research can be done to look into incorporating the use of similar technologies to increase efficiency in the healthcare system and reduce healthcare costs.

Background Many emerging uropathogens are currently identified by multiplex polymerase chain reaction (M-PCR) in suspected UTI cases. Standard urine culture (SUC) has significantly lower detection rates, raising questions about whether these organisms are associated with UTIs and truly cause inflammation. Objective To determine if microbes detected by M-PCR were likely causative of UTI by measuring inflammatory biomarkers in the urine of symptomatic patients. Design, Setting, and Participants Midstream voided urine was collected from subjects ≥60 years presenting to urology clinics with symptoms of UTI (n = 1132) between 01/2023 and 05/2023. Microbe detection was by M-PCR and inflammation-associated biomarker (neutrophil gelatinase-associated lipocalin, interleukin 8, and interleukin 1β) was by enzyme-linked immunosorbent assay. Biomarker positivity was measured against individual and groups of organisms, E. coli and non-E. coli cases, emerging uropathogens, monomicrobial and polymicrobial cases. Outcome Measurements and Statistical Analysis Distributions were compared using 2-sample Wilcoxon Rank Sum test with 2-tailed p-values < 0.05 considered statistically significant. Results and Limitations M-PCR was positive in 823 (72.7%) specimens with 28 of 30 (93%) microorganisms/groups detected. Twenty-six of twenty-eight detected microorganisms/groups (93%) had ≥2 biomarkers positive in >66% of cases. Both non-E. coli cases and E. coli cases had significant biomarker positivity (p < 0.05). Limitations were that a few organisms had low prevalence making inferences about their individual significance difficult. Conclusion The majority of microorganisms identified by M-PCR were associated with active inflammation measured by biomarker positivity, indicating they are likely causative of UTIs in symptomatic patients. This includes emerging uropathogens frequently not detected by standard urine culture.

Lower urinary tract dysfunction not only interferes with the health-related quality of life of patients but may also lead to acute kidney injury and infections. To assess the bladder, urodynamic studies (UDS) have been implemented but the use of catheters leads to discomfort for the patient. Catheter-free long-term UDS would be useful and a potential solution could be ambulatory wireless devices that communicate via telemetry. Such sensors can detect pressure or volume. Numerous types of potential catheter-free sensors have been proposed for bladder monitoring. Despite substantial innovation in the manufacturing of implantable biomedical electronic systems, such sensors have remained at the laboratory stage due to a number of critical challenges. These challenges primarily concern hermeticity and biocompatibility, sensitivity and artifacts, drift, telemetry, and energy management. Having overcome these challenges, catheter-free ambulatory urodynamic monitoring could combine a synchronized intravesical pressure sensor with a volume analyzer but only the steps of cystometry and volume measurement are currently sufficiently reproducible to simulate UDS results. The measurement of volume by infrared optical sensors, in the form of abdominal patches, appears to be promising and studies are underway to market a telemetric ambulatory urodynamic monitoring system that includes an intravesical pressure sensor. There has been considerable progress in wearable and conformable electronics on many fronts, and continued collaboration between engineers and urologists could quickly overcome current challenges. In addition, to the diagnosis of UDS, such sensors could be useful in the development of a long-term closed-loop neuromodulation system. In this review, we explore the various types of catheter-free bladder sensors, inherent challenges and solutions to overcome these challenges, and the clinical potential of such long-term implantable sensors.

December 2023

Here we present two cases of post-operative obstructive renal failure following major abdomino-pelvic sarcoma surgery. In both cases, prophylactic ureteric stents were inserted to aid the identification and protection of the ureters during resection of these complex retroperitoneal masses. In case one, obstructive renal failure occurred following ureteric stent removal on day 0 post-operatively. In case two, obstructive renal failure developed on day 1 post-operatively despite having a ureteric stent in situ. Here we propose that a combination of reflex anuria/ureteric edema and papillary sloughing led to the obstructive renal failure in both cases. Re-insertion of bilateral ureteric stents in case one, and replacement of a right ureteric stent in case two saw prompt excretion of urine and sloughy debris with rapid improvement of renal function. This article presents these cases in detail and further reviews the use of prophylactic ureteric stents in major abdomino-pelvic surgery along with the current guidelines for their usage.

Background Prostate cancer is often considered a disease of older men and this indeed fits with its peak incidence between 65–79 years of age. Reports of prostate cancer in men younger than 40 years of age and the outcomes of this age group following treatment are few in the literature. Here, we present the case of an unusual diagnosis of high grade prostate cancer in a very young man and outline early outcomes following treatment with robotic-assisted radical prostatectomy. Case Presentation A 35-year-old male, intermittently taking finasteride for hair loss, was found to have an elevated prostate-specific antigen (PSA) of 12.5ng/mL leading to an incidental diagnosis of high grade prostate cancer. Targeted trans-perineal prostate biopsy found Gleason 4+5=9 acinar adenocarcinoma, without cribriform architecture but with features suspicious for extracapsular extension. Robotic radical prostatectomy with bilateral pelvic lymph node dissection was performed and found Gleason 4+5=9 adenocarcinoma with focal cribriform architecture, extra prostatic extension and clear margins, stage pT3a N0 M0. PSA was undetectable at 12 months, continence was immediate, and the patient reported strong erections soon after surgery. Family history of prostate cancer and genetic testing were both negative. Conclusion This case highlights that not all clinically significant cancers will be identified by following PSA screening guidelines starting at 50 years of age (or 40 years of age for men with a family history of prostate cancer). While high grade prostate cancer in a man less than 40 years of age is uncommon, the literature suggests the incidence is increasing. Our case alongside series in the literature indicate that these men have better functional outcomes and equal oncological outcomes with early surgical intervention for localized disease when compared to the older population.

Purpose This study aimed to evaluate what objectives are most important to men undergoing radical prostatectomy to allow treating physicians to personalize perioperative counselling and improve patient quality of life outcomes. Materials and Methods A predefined search protocol of the Medline and Embase databases was performed from database inception to May 2023. The search was limited to English language and full text. All articles with a specific consideration of patient objectives, preferences or reasons for decision to undergo radical prostatectomy were included for review. Results Ten articles out of 375 screened met inclusion criteria for review. All 10 articles utilized a qualitative design and originated across 5 countries across the developed world. A common theme of men placing importance on having their tumor physically removed was found. Methodologies allowing free response beyond predefined categories identified a breadth of considerations including personal circumstance, personal belief and current function in the decision-making process. An investigation on radical prostatectomy performed robotically found some men placed preference on the quicker treatment time with surgery compared to radiation therapy, reflective of shorter recovery times with the robotic approach. Conclusion Variability in results across studies highlights the heterogeneity in patient preferences. Directed investigation of patient objectives with an open-ended questioning approach would personalize the perioperative experience and may improve patient satisfaction and quality of life outcomes.

Objective This study investigates the efficacy of physical therapy in treating chronic prostatitis grounded on the glandular duct blockage theory. Methods The study includes patients who were diagnosed and treated for chronic prostatitis between November 2022 and July 2023 at Renhui clinic in Jiangmen, Guangdong and Renhui frontline clinic in Shenzhen Guangdong. The recorded data includes the frequency of physical therapies including prostate massages, rectal probe high-frequency vibration treatment, and low-intensity extracorporeal shockwave therapy (Li-ESWT). Post-treatment urine sediment was collected for microscopic examination, and the scores of each patient on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the Premature Ejaculation Diagnostic Tool (PEDT) were recorded pre- and post-treatment in order to calculate the effectiveness rate. Results The study involved a total of 48 patients, of which 26 were diagnosed with premature ejaculation. On average, each patient received 2.1 prostate massages, underwent 4.1 rectal probe high-frequency vibration treatments, and 8.3 Li-ESWT sessions. Following treatment, the initial microscopic examination of the urine sediment revealed aged white blood cell clusters, prostate calculi clusters, and inactive sperm clusters, all appearing in the shape of glandular tubes. The mean NIH-CPSI scores pre- and post-treatment were 27.2±6.9 and 18.0±6.6, respectively, indicating an effectiveness rate of 81.3%. The average PEDT scores pre- and post-treatment were 14.5±3.5 and 10.5±4.2, respectively, with an effectiveness rate of 53.8%. Conclusion Unblocking obstructed glandular ducts might provide a novel therapeutic strategy for treating chronic prostatitis.

Robotic-assisted radical prostatectomy (RARP) is the gold standard for localized prostate cancer. Several RARP approaches were developed and described over the years, aimed at improving oncological and functional outcomes. In 2010, Galfano et al described a new RARP technique, known as Retzius-sparing RARP (RS-RARP), a posterior approach through the Douglas space that spares the anterior support structures involved with urinary continence and sexual potency. This approach has been used increasingly in many centers around the world comparing its results with those of the most used standard anterior approach. Several randomized controlled trials, systematic reviews and meta-analyses demonstrated an important advantage relative to standard anterior RARP in terms of early urinary continence recovery, with comparable perioperative and long-term oncological outcomes. Several surgeons are concerned regarding RS-RARP because it appears to increase the risk of positive surgical margins (PSMs). However, this statement is based on low-certainty evidence. Indeed, the available studies compared the results of surgeons who had an initial experience with posterior RARP with those who had a solid experience with anterior RARP. Recent evidence strongly suggests that RS-RARP is feasible and safe not only in low- and intermediate-risk prostate cancer patient but also in challenging scenario such as high-risk setting, salvage prostatectomy and after transurethral resection of the prostate.

Purpose Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain disorder. Patients with IC/BPS often experience “flares” of symptom exacerbation throughout their lifetime, initiated by triggers, such as urinary tract infections. This study sought to determine whether neonatal bladder inflammation (NBI) alters the sensitivity of adult rat bladders to microbial antigens. Methods Female NBI rats received intravesical zymosan treatments on postnatal days P14-P16 while anesthetized; Neonatal Control Treatment (NCT) rats were anesthetized. In adults, bladder and spinal cord Toll-like receptor type 2 and 4 (TLR2, TLR4) contents were determined using ELISAs. Other rats were injected intravesically with lipopolysaccharide (LPS; mimics an E. coli infection; 25, 50, 100, or 200 μg/mL) or Zymosan (mimics yeast infection; 0.01, 0.1, 1, and 10 mg/mL) solutions on the following day. Visceromotor responses (VMRs; abdominal contractions) to graded urinary bladder distention (UBD, 10–60 mm Hg, 20s) were quantified as abdominal electromyograms (EMGs). Results Bladder TLR2 and TLR4 protein levels increased in NBI rats. These rats displayed statistically significant, dose-dependent, robustly augmented VMRs following all but the lowest doses of LPS and Zymosan tested, when compared with their adult treatment control groups. The NCT groups showed minimal responses to LPS in adults and minimally increased EMG measurements following the highest dose of Zymosan. Conclusion The microbial antigens LPS and Zymosan augmented nociceptive VMRs to UBD in rats that experienced NBI but had little effect on NCT rats at the doses tested. The greater content of bladder TLR2 and TLR4 proteins in the NBI group was consistent with increased responsiveness to their agonists, Zymosan and LPS, respectively. Given that patients with IC/BPS have a higher incidence of childhood urinary tract infections, this increased responsiveness to microbial antigens may explain the flares in symptoms following “subclinical” tract infections.

November 2023

Prostate cancer is the most common non-cutaneous cancer among American men. Multiple mechanisms are involved in tumorigenesis and progression to metastases. While androgen deprivation therapy remains the cornerstone of treatment, progression to castration-resistant disease becomes inevitable. Aberrant pathway activations of PI3K/AKT due to PTEN loss, epithelial–mesenchymal transition pathways, homologous recombination repair, and DNA repair pathway mechanisms of resistance and cross-talk lead to opportunities for therapeutic targeting in metastatic castration-resistant prostate cancer. This review focuses on mechanisms of progression and key trials that evaluate the drugs and combinations that exploit these pathways.

With the advent of new therapeutic modalities, management of metastatic castrate-sensitive prostate cancer (mCSPC) has been in flux. From androgen-deprivation therapy to docetaxel to androgen receptor–signaling inhibitors, each agent has heralded a new treatment paradigm. As such, the optimal first-line therapy for mCSPC remains incompletely defined. This review provides a narrative of recent advances to systemic therapy within the mCSPC treatment space, particularly with regard to expansion to triplet therapy.

Bladder neck contracture is a recognised complication associated with radical prostatectomy. The management can be challenging, especially when refractory to initial intervention strategies. For the patient, the burden of disease is high and continence status cannot be overlooked. This review serves to provide an overview of the management of this recognised clinical pathology. Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists. For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery. These elements underline the need for a tailored and a patient centred approach.

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This chapter presents history, economic statistics, and federal government directories of Kemerovo Oblast. Kemerovo Oblast, known as the Kuzbass, is situated in southern central Russia. Krasnoyarsk Krai and Khakasiya lie to the east, Tomsk Oblast to the north, Novosibirsk Oblast to the west, and Altai Krai and the Republic of Altai to the south-west. Kemerovo was founded in 1918 and became the administrative centre of the Oblast upon its formation on 26 January 1943. The city is at the centre of Russia's principal coal mining area. In 2015 Kemerovo Oblast's gross regional product (GRP) amounted to 842,619m. roubles, equivalent to 309,637 roubles per head. The Oblast's main industrial centres are at Kemerovo, Novokuznetsk, Prokopyevsk, Kiselyovsk and Leninsk-Kuznetskii. Kemerovo Oblast's agriculture consists mainly of potato and grain production, animal husbandry and beekeeping. The sector employed 3.6% of the workforce and contributed 4.0% of GRP in 2015.

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Report on Contract for Deed Lending

Contracts for deed are a form of seller financing, where the seller retains legal title of a home until the borrower completes the payments. Contracts for deed are also known by other names, sometimes including “land contracts,” “installment land contracts,” “land sales contracts,” or “bonds for deed.” During the contract term, the borrower typically assumes the responsibilities of homeownership, including repairs, property taxes, and improvements. The contracts usually provide for forfeiture in event of any default in the contract terms, such as missed payments. Upon forfeiture, the seller may repossess the home and retain all accumulated equity and payments, including the buyer’s downpayment and improvements made to the property. Buyers’ exercise of their rights regarding the property is often complicated because the contract showing the buyer’s interest is not recorded. Key findings of this report follow:

• Substandard housing, title defects, and inflated prices can create problems for homebuyers.
• Contract for deed loans were long marketed to Black borrowers.
• Driven by investors, contract for deed loans surged during the Great Recession.
• Today, contract for deed loans are disproportionally concentrated in low-income, Black, Hispanic, immigrant, and some religious communities.
• Contracts for deed can harm housing markets by causing or perpetuating substandard housing stock, inflated home prices, and less access to mainstream mortgage credit.

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New research from EGC's Gender and Growth Gaps project featured in the 2024 World Development Report

August 2, 2024: The World Bank’s 2024 World Development Report – focusing on the "Middle-Income Trap" – features research by EGC's Gender and Growth Gaps project: a new Global Gender Distortions Index which quantifies the economic growth potential from closing gender gaps in the labor market.

EGC Gender and Growth Gaps Research Featured in World Bank’s 2024 World Development Report

By Adam Walker August 2, 2024

The 2024 WDR focuses on the "Middle-Income Trap", a situation where growth slows when countries hit middle-income levels, and the leap to high-income status requires entirely new levers for economic transformation. 

It featured the Global Gender Distortions Index, which EGC researchers are developing under the Gender and Growth Gaps project to measure economic growth losses due to gender gaps in the labor market. The GGDI links gender gap changes to productivity growth by improving the allocation of women’s talent, quantifying how much a country's GDP could grow from better women's labor market opportunities. The index considers labor demand distortions, which create wage and productivity discrepancies, and occupational preferences influenced by social norms. Using wage, labor supply, and employment differences, the GGDI estimates productivity losses or gains, allowing cross-time and location comparisons to inform policy decisions.

"Integrating women into the labor market is widely believed to be beneficial not only for women but for the entire economy," explained Pinelopi Koujianou Goldberg , the Elihu Professor of Economics and Global Affairs and Professor of Management, and member of the Gender and Growth Gaps program faculty. "The GGDI operationalizes this idea. It is the product of a successful collaboration between Yale’s Economic Growth Center and the World Bank, and we hope that it will help guide policy decisions – especially in developing countries where gender gaps in the labor market remain significant."

The GGDI will be computed for 30 countries over the next 24 months, serving as a dynamic economic barometer. 

Read more and download the 2024 WDR at the World Bank's website .

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Harris Energizes Democrats in Transformed Presidential Race

1. the presidential matchup: harris, trump, kennedy, table of contents.

• Other findings: Both Harris and Trump are viewed more favorably than a few months ago
• Voting preferences among demographic groups
• How have voters shifted their preferences since July?
• Harris’ supporters back her more strongly than Biden’s did last month
• Large gap in motivation to vote emerges between the candidates’ younger supporters
• Harris and Trump have gained ground with their own coalitions
• Share of ‘double negatives’ drops significantly with change in presidential candidates
• Views of Biden have changed little since his withdrawal from the 2024 presidential race
• Acknowledgments
• The American Trends Panel survey methodology

Nationally, Vice President Kamala Harris and former President Donald Trump are essentially tied among registered voters in the current snapshot of the presidential race: 46% prefer Harris, 45% prefer Trump and 7% prefer Robert F. Kennedy Jr.

Following Biden’s exit from the race, Trump’s support among voters has remained largely steady (44% backed him in July against Biden, while 45% back him against Harris today). However, Harris’ support is 6 percentage points higher than Biden’s was in July . In addition to holding on to the support of those who backed Biden in July, Harris’ bump has largely come from those who had previously said they supported or leaned toward Kennedy.

Harris performs best among the same demographic groups as Biden. But this coalition of voters is now much more likely to say they strongly support her: In July, 43% of Biden’s supporters characterized their support as strong – today, 62% of Harris’ do.

Overall, many of the same voting patterns that were evident in the Biden-Trump matchup from July continue to be seen today. Harris fares better than Trump among younger voters, Black voters, Asian voters and voters with college degrees. By comparison, the former president does better among older voters, White voters and voters without a college degree.

But Harris performs better than Biden across many of these groups – making the race tighter than it was just a few weeks ago.

• In July, women’s presidential preferences were split: 40% backed Biden, 40% preferred Trump and 17% favored Kennedy. With Harris at the top of the ticket, 49% of women voters now support her, while 42% favor Trump and 7% back Kennedy.
• Among men, Trump draws a similar level of support as he did in the race against Biden (49% today, compared with 48% in July). But the share of men who now say they support Harris has grown (to 44% today, up from 38% last month). As a result, Trump’s 10-point lead among men has narrowed to a 5-point lead today.

Race and ethnicity

Harris has gained substantial ground over Biden’s position in July among Black, Hispanic and Asian voters. Most of this movement is attributable to declining shares of support for Kennedy. Trump performs similarly among these groups as he did in July.

• 77% of Black voters support or lean toward Harris. This compares with 64% of Black voters who said they backed Biden a few weeks ago. Trump’s support is unchanged (13% then vs. 13% today). And while 21% of Black voters supported Kennedy in July, this has dropped to 7% in the latest survey.
• Hispanic voters now favor Harris over Trump by a 17-point margin (52% to 35%). In July, Biden and Trump were tied among Hispanic voters with 36% each.
• By about two-to-one, Asian voters support Harris (62%) over Trump (28%). Trump’s support among this group is essentially unchanged since July, but the share of Asian voters backing Harris is 15 points higher than the share who backed Biden in July.
• On balance, White voters continue to back Trump (52% Trump, 41% Harris), though that margin is somewhat narrower than it was in the July matchup against Biden (50% Trump, 36% Biden).

While the age patterns present in the Harris-Trump matchup remain broadly the same as those in the Biden-Trump matchup in July, Harris performs better across age groups than Biden did last month. That improvement is somewhat more pronounced among voters under 50 than among older voters.

• Today, 57% of voters under 30 say they support Harris, while 29% support Trump and 12% prefer Kennedy. In July, 48% of these voters said they backed Biden. Trump’s support among this group is essentially unchanged. And 12% now back Kennedy, down from 22% in July.
• Voters ages 30 to 49 are now about evenly split (45% Harris, 43% Trump). This is a shift from a narrow Trump lead among this group in July.
• Voters ages 50 and older continue to tilt toward Trump (50% Trump vs. 44% Harris).

With Harris now at the top of the Democratic ticket, the race has become tighter.

Much of this is the result of shifting preferences among registered voters who, in July, said they favored Kennedy over Trump or Biden.

Among the same group of voters surveyed in July and early August, 97% of those who backed Biden a few weeks ago say they support or lean toward Harris today. Similarly, Trump holds on to 95% of those who supported him a few weeks ago.

But there has been far more movement among voters who previously expressed support for Kennedy. While Kennedy holds on to 39% of those who backed him in July, the majority of these supporters now prefer one of the two major party candidates: By about two-to-one, those voters are more likely to have moved to Harris (39%) than Trump (20%). This pattern is evident across most voting subgroups.

In July, Trump’s voters were far more likely than Biden’s voters to characterize their support for their candidate as “strong” (63% vs. 43%). But that gap is no longer present in the Harris-Trump matchup.

Today, 62% of Harris voters say they strongly support her, while about a third (32%) say they moderately support her. Trump’s voters are just about as likely to say they strongly back him today as they were in July (64% today, 63% then).

Kennedy’s voters make up a smaller share of voters today than a month ago – and just 18% of his voters say they strongly support him, similar to the 15% who said the same in July.

Across demographic groups, strong support for Harris is higher than it was for Biden

Among women voters who supported Biden in July, 45% said they did so strongly. That has grown to 65% today among women voters who support Harris.

Increased intensity of support is similar among men voters who back the Democratic candidate: In July, 42% of men voters who supported Biden said they did so strongly. This has since grown to 59% of Harris’ voters who are men.

Across racial and ethnic groups, Harris’ supporters are more likely than Biden’s were to say they back their candidates strongly.

Among White voters, 43% who supported Biden in July did so strongly. Today, Harris’ strong support among White voters sits at 64%.

A near identical share of Harris’ Black supporters (65%) characterize their support for her as strong today. This is up from the 52% of Biden’s Black supporters who strongly backed him in July. Among Harris’ Hispanic supporters, 56% support her strongly, while 45% of Asian Harris voters feel the same. Strong support for Harris among these voters is also higher than it was for Biden in July.

Across all age groups, Harris’ strength of support is higher than Biden’s was. But the shift from Biden is less pronounced among older Democratic supporters than among younger groups.

Still, older Harris voters are more likely than younger Harris voters to describe their support as strong. For instance, 51% of Harris’ voters under 50 say they strongly support her, while 71% of Harris supporters ages 50 and older characterize their support as strong.

Today, about seven-in-ten of both Trump supporters (72%) and Harris supporters (70%) say they are extremely motivated to vote.

Motivation to vote is higher in both the Democratic and Republican coalitions than it was in July .

These shifts have occurred across groups but are more pronounced among younger voters.

Today, half of voters under 30 say they are extremely motivated to vote, up 16 points since July. Motivation is up 11 points among voters ages 30 to 49 and 50 to 64, and up 6 points among those ages 65 and older.

Among the youngest voters, the increased motivation to vote is nearly all driven by shifts among Democratic supporters.

• In July, 38% of 18- to 29-year-old Trump voters said they were extremely motivated to vote. Today, a similar share of his voters (42%) report that level of motivation.
• But 18- to 29-year-old Harris supporters are far more likely to say they are extremely motivated to vote than Biden’s supporters in this age group were about a month ago. Today, 61% of Harris’ voters under 30 say this. In July, 42% of voters under 30 who supported Biden said they were extremely motivated to vote.

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Have questions about buying, selling or renting during COVID-19? Learn more

Sellers lose their advantage, but lower rates may revive market competition (July 2024 Market Report)

Competition for homes and price appreciation tapered off faster than normal in July as high housing costs continued to stymie shoppers. But recent drops in mortgage rates should spur more competition as we head into fall. 

Sellers lose the upper hand

Sellers gave up an advantage over buyers in July on the national scale, as the Zillow market heat index moved into neutral territory for the first time since December. This marks the first July the national market has been neutral since 2019 – in each of the past two years, the market moved into neutral ground in October. 

One sign of decreased competition is homes taking longer to sell. Homes that went pending in July typically did so after 18 days on the market. That’s almost a week longer than last July. 

Inventory continues to accumulate, and now stands nearly 25% above last year’s levels, marking the eighth straight month the year-over-year inventory gap has widened. The inventory shortfall compared to pre-pandemic norms shrank a bit and is now down 31.5%, the smallest deficit since October 2020. 

More options for buyers means less intense competition for each home. That’s evident in the growing share of home sellers cutting their prices. More than 26% of homes on Zillow received a price cut in July, the highest share for any July since at least 2018, when the dataset began. 

What happens next? 

If this relief from mortgage rates holds, we should see more buyers re-starting their hunt for a home. By the end of July, lower rates made a new homeowner’s mortgage payment on the typical home just under $200 more than it would take to rent the same kind of property. That’s shrunk from a $247 gap as recently as April. Now, lower rates in August are making buying even more attractive by comparison. 

Lower rates aren’t likely to encourage a comparable wave of current homeowners to sell. Zillow surveys show 80% of recent sellers were influenced by major life events, such as a change in their household size or working situation. New listings typically surge in spring and then taper off as homeowners aim to sell, buy another house, and be moved in before school and the fall holidays begin. 

More demand without a corresponding increase in supply would likely mean competition ramping back up, or at least a delay in the usual post-summer cooldown. 

Home values

• The typical U.S. home is worth $362,156. 
• The typical monthly mortgage payment, assuming 20% down, is $1,900. That is up 3.4% from last year and has increased by 111.1% since pre-pandemic.
• Home values climbed month over month in 34 of the 50 largest metro areas in July. Gains were biggest in Providence (1%), New York (0.9%), Hartford (0.9%), Buffalo (0.9%) and Cleveland (0.8%).
• Home values fell, on a monthly basis, in 13 major metro areas in July. The largest monthly drops were in San Jose (-0.4%), Austin (-0.4%), Phoenix (-0.3%), San Francisco (-0.2%) and Pittsburgh (-0.2%).
• Home values are up from year-ago levels in 44 of the 50 largest metro areas. Annual price gains are highest in San Jose (10.6%), Hartford (9.1%), San Diego (7.8%), Providence (7.4%) and New York (6.8%).
• Home values are down from year-ago levels in four major metro areas: New Orleans (-5.3%), Austin (-4.6%), San Antonio (-2.9%) and Birmingham (-0.7%).

New listings & total inventory

• New listings decreased 6.3% month over month in July.
• New listings increased 6% compared to last year.
• New listings are 24.7% lower than pre-pandemic levels.
• Total inventory (the number of listings active at any time during the month) increased 1.3% month over month in July. 
• There were 24.6% more listings active in July compared to last year.
• Inventory levels are 31.5% lower than pre-pandemic levels.

Price cuts & share sold above list

• 26.2% of listings in July had a price cut. That is up 1.8 percentage points (ppts) month over month.
• There are 4.5 ppts more listings with a price cut compared to last year.
• 35.4% of homes sold above their list price last month. That is up 0.2 ppts month over month.
• 5 ppts fewer homes sold above their list price compared to last year.

Newly pending listings

• Newly pending listings decreased by 1.2% in July from the prior month.
• Newly pending listings increased by 1% from last year.
• Median days to pending, the typical time from the initial list date to moving to pending status for homes that went under contract, was at 18 days in July. That is up three days from the month before and up six days from last year. 

Market heat index

• Zillow’s market heat index shows the nation is currently a neutral market.
• The strongest sellers markets in the country are Buffalo , Hartford, San Jose, Boston and San Francisco.
• The strongest buyers markets in the country are New Orleans, Miami, Austin, Memphis and Jacksonville.
• Asking rents increased by 0.4% month over month in July . The pre-pandemic average rent growth for this time of year is 0.6%.
• Rents are now up 3.4% from last year.
• Rents fell, on a monthly basis, in one major metro area: Austin (-0.2%).
• Rents are up from year-ago levels in 48 of the 50 largest metro areas. Annual rent increases are highest in Hartford (7.9%), Cleveland (7.3%), Providence (6.7%), Louisville (6.6%) and Richmond (6%).
• One-Third of Property Managers are Offering Concessions as Rental Market Cools

Zillow Home Value and Home Sales Forecast (June 2024)

Price Cuts Abound as Home Sellers See Inventory Piling Up (June 2024 Market Report)

The Rental Market Slowdown is Leveling Off (June 2024 Rental Market Report)

• July 2024 Housing Starts: Housing Starts Fall, Single Family Starts At Lowest Level Since April 2023
• Support Growing for Middle Housing
• Mortgage Rates Fell This Week On Exaggerated Recession Fears
• Mortgage Rates Fell This Week As Wage Inflation Moderates More Than Expected
• Luxury Home Values Are Rising Faster Than Typical Homes for the First Time in Years
• A $1 Million Starter Home is the Norm in 237 Cities
• Mortgage Rates Rebounded Slightly This Week Ahead of Key Inflation Report
• June 2024: New home Sales Fell Again Despite Easing Mortgage Rates
• June 2024 Existing Home Sales: Sales Fell as Buyers and Sellers Wait On The Sideline For An Improvement In Housing Affordability