Utility of enhanced CT for patients with suspected uncomplicated renal colic and no acute findings on non-enhanced CT

AIM: To evaluate the utility of contrast-enhanced computed tomography (CECT) for patients with suspected uncomplicated renal colic (URC) and no abnormalities on non-enhanced computed tomography (NECT). MATERIALS AND METHODS: The hospital institutional review board and ethics committee approved this retrospective study with a waiver of informed consent. Between January 2016 and April 2017, all consecutive adult patients who consulted at the adult Emergency Department (ED) with suspected URC and who had undergone both NECT and CECT were included retrospectively. The primary endpoint was prevalence of CECT-only diagnosis without acute findings on NECT. The risk factors for an acute finding were identified by logistic regression analysis. RESULTS: Among 126 patients with suspected URC, 12 were excluded. Among the 76 patients with no acute findings on NECT, CECT led to find acute lesions in 14/76 (18%) cases, but only 2/76 (3%) resulted in a change of management. Predictive factors of abnormal finding on CECT were: low renal clearance and high leukocyte count with OR 0.96 (95% confidence interval [CI]: 0.93-0.99), p=0.0189 and OR 5.79 (95% CI: 1.55-21.64), p=0.0091, respectively. CONCLUSIONS: In most cases, NECT is sufficient for screening patients with suspected URC. If leucocytosis and low renal function are present, stronger consideration may be given to CECT

Vibegron in overactive bladder: a comprehensive review of efficacy, safety and patient-reported outcomes

Introduction Overactive bladder (OAB) is a prevalent and potentially debilitating syndrome that significantly impairs quality of life. Mirabegron and vibegron are β3-adrenoceptor (β3AR) agonists that provide a different mechanism of action to antimuscarinic medications. Vibegron has high β3AR selectivity and enhances detrusor relaxation without compromising voiding function. This review summarises the clinical and real-world evidence supporting the efficacy, safety and patient-reported benefits of vibegron in OAB. Methods A comprehensive search of the PubMed database was conducted in December 2024 using the keyword "vibegron". This search yielded 123 entries, which were subsequently screened by title for relevance to the objectives of this narrative review. All relevant articles identified through this process were included. Results Pivotal phase III trials have demonstrated significant reductions in urgency, urinary frequency and urgency urinary incontinence with vibegron, with rapid onset of action and a more favourable tolerability profile than antimuscarinics. The benefits of vibegron were consistent across diverse patient populations, including older adults and those with concomitant benign prostatic hyperplasia. Real-world data further suggest that vibegron is associated with improved adherence and persistence compared with other OAB therapies. Additionally, cardiovascular safety studies confirm that vibegron has no clinically significant effects on blood pressure or heart rate. While comparative trials with mirabegron indicate similar efficacy, vibegron’s higher β3AR selectivity and lack of cytochrome P450 interactions offer advantages in specific patient groups. Ongoing research, including real-world phase IV studies, aims to further define the long-term effectiveness and safety of vibegron in clinical practice. Conclusion Vibegron represents an important advance in the pharmacologic management of OAB, providing a well-tolerated and effective alternative to existing therapies

The learning curve for robot-assisted partial nephrectomy: impact of surgical experience on perioperative outcomes

Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo >= 2 postoperative complication (CD >= 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of RAPNs performed by each surgeon before each patient's operation. Median WIT was 14 min and the rate of CD >= 2 and PSMs was 15% and 4%, respectively. At multivariable regression analyses adjusted for case mix, EXP resulted associated with shorter WIT (p = 2-free postoperative course (p = 0.001), but not with PSMs (p = 0.7). The relationship between EXP and WIT emerged as nonlinear, with a steep slope reduction within the first 100 cases and a plateau observed after 150 cases. Conversely, the relationship between EXP and CD >= 2-free course resulted linear, without reaching a plateau, even after 300 cases.Patient summary: Perioperative outcomes after robot-assisted partial nephrectomy (RAPN) are importantly and individually affected by surgeon's experience. After 150 RAPNs, no further improvement is observed with respect to ischemia time, but the learning curve appears endless with respect to complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.</p

Prevalence of and Predictive Factors for Burnout Among French Urologists in Training

The burnout rate among young doctors currently seems to be increasing [1]. It is essential to be able to diagnose and prevent this condition to better take care of young caregivers. Burnout is defined as a “feeling of intense exhaustion, loss of control and inability to achieve concrete results at work” according to the World Health Organisation. The assessment questionnaire used most often is the Maslach Burnout Inventory (MBI), which covers (1) emotional exhaustion, (2) depersonalisation, and (3) personal accomplishment [2]

Acute suppression of mitochondrial ATP production prevents apoptosis and provides an essential signal for NLRP3 inflammasome activation

How mitochondria reconcile roles in functionally divergent cell death pathways of apoptosis and NLRP3 inflammasome-mediated pyroptosis remains elusive, as is their precise role in NLRP3 activation and the evolutionarily conserved physiological function of NLRP3. Here, we have shown that when cells were challenged simultaneously, apoptosis was inhibited and NLRP3 activation prevailed. Apoptosis inhibition by structurally diverse NLRP3 activators, including nigericin, imiquimod, extracellular ATP, particles, and viruses, was not a consequence of inflammasome activation but rather of their effects on mitochondria. NLRP3 activators turned out as oxidative phosphorylation (OXPHOS) inhibitors, which we found to disrupt mitochondrial cristae architecture, leading to trapping of cytochrome c. Although this effect was alone not sufficient for NLRP3 activation, OXPHOS inhibitors became triggers of NLRP3 when combined with resiquimod or Yoda-1, suggesting that NLRP3 activation requires two simultaneous cellular signals, one of mitochondrial origin. Therefore, OXPHOS and apoptosis inhibition by NLRP3 activators provide stringency in cell death decisions

Pathogenic and targetable genetic alterations in 70 urachal adenocarcinomas

Urachal cancer (UrC) is a rare but aggressive malignancy often diagnosed in advanced stages requiring systemic treatment. Although cytotoxic chemotherapy is of limited effectiveness, prospective clinical studies can hardly be conducted. Targeted therapeutic treatment approaches and potentially immunotherapy based on a biological rationale may provide an alternative strategy. We therefore subjected 70 urachal adenocarcinomas to targeted next-generation sequencing, conducted in situ and immunohistochemical analyses (including PD-L1 and DNA mismatch repair proteins (MMR)) and evaluated the microsatellite instability (MSI) status. The analytical findings were correlated with clinicopathological and outcome data and Kaplan-Meier and univariable/multivariable Cox regression analyses were performed. The patients had a mean age of 50 years, 66% were male and a 5-year overall survival (OS) of 58% and recurrence-free survival (RFS) of 45% was detected. Sequence variations were observed in TP53 (66%), KRAS (21%), BRAF (4%), PIK3CA (4%), FGFR1 (1%), MET (1%), NRAS (1%), and PDGFRA (1%). Gene amplifications were found in EGFR (5%), ERBB2 (2%), and MET (2%). We detected no evidence of MMR-deficiency (MMR-d)/MSI-high (MSI-h), whereas 10 of 63 cases (16%) expressed PD-L1. Therefore, anti-PD-1/PD-L1 immunotherapy approaches might be tested in UrC. Importantly, we found aberrations in intracellular signal transduction pathways (RAS/RAF/PI3K) in 31% of UrCs with potential implications for anti-EGFR therapy. Less frequent potentially actionable genetic alterations were additionally detected in ERBB2 (HER2), MET, FGFR1, and PDGFRA. The molecular profile strengthens the notion that UrC is a distinct entity on the genomic level with closer resemblance to colorectal than to bladder cancer. This article is protected by copyright. All rights reserved

Piezo is essential for amiloride-sensitive stretch-activated mechanotransduction in larval Drosophila dorsal bipolar dendritic sensory neurons

Date of Acceptance: 05/06/2015Peer reviewedPublisher PD