Purpose: Although neoadjuvant chemotherapy (NAC) may benefit upper tract urothelial carcinoma (UTUC) treatment, most studies are retrospective and affected by selection bias, as healthier patients are more likely to receive NAC. We therefore aimed to investigate NAC’s impact on cancer specific mortality (CSM) in an other-cause mortality (OCM) matched cohort Methods: The Surveillance, Epidemiology, and End Results database was queried to identify patients with histological diagnosis of UTUC (pT1-4N0-3M0) at radical nephoureterectomy (RNU) between 2007–2021. Patients who underwent systemic therapy before RNU were classified as having received NAC. Cox regression was used to calculate the 5 year-OCM risk, which was used to construct a 1:3 propensity-score matched cohort. Then, in the matched cohort, we performed competing risk regression analysis to investigate the impact of NAC on CSM. Results: We included 4,936 patients, 388 (7.9%) of whom underwent NAC. Median (interquartile range) age at diagnosis was 72 (64–79) years. The 5-year OCM rate was 26.4% versus 37.1% (p=0.004) in patients who received NAC men versus in those who did not receive NAC, but that difference became not statistically significant after matching (p=0.9). The standardized mean difference was 0.0003 for OCM risk, indicating a good match. In the matched cohort, patients in the NAC-group were more likely to be younger (67 vs. 73, p<0.0001), to be diagnosed more recently (2018 vs. 2015, p<0.0001) and to have a pN+UTUC (28.8% vs. 12.3%, p<0.0001), compared to no-NAC group. At MVA analysis, patients who did not undergo NAC had a significantly higher CSM-risk (hazard ratio,1.78; 95% confidence interval, 1.27–2.51; p<0.01), than their counterpart who received NAC. Conclusion Compared to patients who did not receive NAC, those who received NAC seems to have a reduced CSM-risk for UTUC, when matched with their calculated OCM-risk. However, to establish it as the optimal treatment strategy for UTUC, additional prospective randomized studies are needed.

In the current era of the early diagnosis of prostate cancer (PCa) and the development of minimally invasive surgical techniques, erectile dysfunction (ED) represents an important issue, with up to 68% of patients who undergo radical prostatectomy (RP) complaining of postoperative erectile function (EF) impairment. In this context, it is crucial to comprehensively consider all factors possibly associated with the prevention of post-RP ED throughout the entire clinical management of PCa patients. A careful assessment of both oncological and functional baseline characteristics should be carried out for each patient preoperatively. Baseline EF, together with age and the overall burden of comorbidities, has been strongly associated with the chance of post-RP EF recovery. With this goal in mind, internationally validated psychometric instruments are preferable for ensuring proper baseline EF evaluations, and questionnaires should be administered at the proper time before surgery. Careful preoperative counselling is also required, both to respect the patient's wishes and to avoid false expectations regarding eventual recovery of baseline EF. The advent of robotic surgery has led to improvements in the knowledge of prostate surgical anatomy, as reflected by the formal redefinition of nerve-sparing techniques. Overall, comparative studies have shown significantly better EF outcomes for robotic RP than for open techniques, although data from prospective trials have not always been consistent. Preclinical data and several prospective randomized trials have demonstrated the value of treating patients with oral phosphodiesterase 5 inhibitors (PDE5is) after surgery, with the concomitant potential benefit of early re-oxygenation of the erectile tissue, which appears to be crucial for avoiding the eventual penile structural changes that are associated with postoperative neuropraxia and ultimately result in severe ED. For patients who do not properly respond to PDE5is, proper counselling regarding intracavernous treatment should be considered, along with the further possibility of surgical treatment for ED involving the implantation of a penile prosthesis.
Comorbidity ; Early Diagnosis ; Erectile Dysfunction* ; Humans ; Male ; Passive Cutaneous Anaphylaxis ; Penile Prosthesis ; Phosphodiesterase 5 Inhibitors ; Prospective Studies ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Psychometrics ; Robotics

Benign prostatic hyperplasia (BPH) is highly prevalent in older men and causes substantial adverse effects on health. The pathogenesis of this disease is not totally clear. Recent reports have suggested a possible relationship between metabolic syndrome (MetS) and BPH. Single components of MetS (obesity, dyslipidemia, hypertension, and insulin resistance) as well as the syndrome itself may predispose patients to a higher risk of BPH and lower urinary tract symptoms (LUTS). This may stem from changes in insulin resistance, increased autonomic activity, impaired nitrergic innervation, increased Rho kinase activity, pro-inflammatory status, and changes in sex hormones that occur in association with MetS. However, the exact underlying mechanisms that regulate the potential relationship between MetS and BPH/LUTS still need to be clarified. Increased physical activity and dietary strategies may help in decreasing the incidence of MetS and its impact on BPH/LUTS. However, differences in the definitions used to address the examined predictors and endpoints preclude the possibility of arriving at definitive conclusions.
Dyslipidemias ; Gonadal Steroid Hormones ; Humans ; Hypertension ; Incidence ; Insulin ; Insulin Resistance ; Lower Urinary Tract Symptoms ; Male ; Motor Activity ; Prostatic Hyperplasia ; rho-Associated Kinases