Explore the vast range of titles available.

ABSTRACT Purpose: There is currently no validated instrument in Brazil specifically designed to assess the quality of life (QoL) of patients with ureteral stones. The Cambridge Ureteral Stone Patient-Reported Outcome Measure (CUSP) is a self-administered questionnaire that evaluates the QoL impact of ureteral stones over the preceding seven days. This study aimed to translate, culturally adapt, and validate the CUSP for Brazilian Portuguese (Br-CUSP) for clinical and research applications. Materials and Methods: The CUSP questionnaire was translated into Portuguese according to Guillemin's cross-cultural adaption guidelines. Patients with and without ureterolithiasis completed both the Br-CUSP and SF-12 questionnaires. Psychometric validation included assessment of internal consistency, test-retest reliability, convergent validity, and discriminant validity. Results: A total of 156 participants completed both questionnaires. No inconsistencies emerged during univariate analysis. Confirmatory factor analysis supported the six-factor model with satisfactory fit indices. All factor loadings exceeded 0.50. Internal consistency was high across all domains (Cronbach's α = 0.72 - 0.98; McDonald's ω = 0.73 - 0.98). Test-retest reliability demonstrated strong temporal stability. Inter-domain correlations (Spearman's p = 0.45 - 0.82) supported structural coherence. Convergent validity was confirmed through inverse correlations with SF-12 scores. Discriminant validity was demonstrated by significant score differences between patients with and without ureteral stone, with large effect sizes. Conclusions: The Brazilian Cambridge Ureteral Stone Patient-Reported Outcome Measure is a valid, reliable tool for assessing health-related quality of life in Brazilian patients with ureteral stones. Its implementation can enhance both clinical assessment and research into patient-centered outcomes in urolithiasis.

ABSTRACT Introduction: Some endourological surgeries require multiple screens to perform combined procedures, which can present ergonomic challenges (1, 2). Apple Vision Pro (AVP) is a spatial computing device developed by Apple that incorporates virtual reality (VR) for life-like simulations, realistic medical scenarios, interactive anatomical models, and augmented reality (AR) technologies (3). In health care, VR is used for pain management, physical therapy, psychological therapy, and surgical simulations, providing a controlled and safe environment for both patients and healthcare professionals (4). Objective: To demonstrate the step-by-step technique of the Mini-Endoscopic Combined Intra-Renal Surgery (Mini-ECIRS) procedure guided by ultrasound and using mixed reality technology with the Apple Vision Pro (multiscreen and 3D reconstruction). To the best of our knowledge, this is the first report of this procedure being performed with AVP assistance. Patient and Methods: We present the case of a 40-year-old female with a history of right lumbar pain for one year. A CT scan revealed a proximal ureteral stone (20mm) and a lower pole stone (14mm) on the right side, with a Guys's Score grade 2 4. In this case, we opted for Ultrasound-Guided Mini-ECIRS (5, 6). This choice allowed for precise puncture and dilation, ensuring effective treatment and minimal invasiveness, assisted by the Apple Vision Pro. This device is equipped with eight external cameras that capture the real world at a resolution of 4K, enhancing the surgeon's experience with unparalleled efficiency and ease of mixed reality. This advanced imaging allows for precise visualization and integration of digital elements into the physical environment, significantly improving the accuracy and effectiveness of surgical procedures. During this procedure, the multitude of equipment in the operating room often obstructs the view of the physical monitors, including ultrasound. However, this technology addresses these challenges by offering enhanced ergonomics, efficiency, and safety to the surgeon. By providing seamless integration of digital overlays and real-world visuals, it ensures that crucial information is always within the surgeon's line of sight, thereby improving operational precision and overall outcomes. The surgeon had no previous contact with the AVP and was assisted by an AVP expert urologist throughout the procedure. Results: The procedure was performed in the Barts flank-free position. Initially, ureterolithotomy was performed using holmium laser. After the dusting phase, an ultrasound-guided renal puncture was performed using a virtual screen, providing enhanced comfort and ergonomics for the surgeon. Throughout the procedure, the surgeon had simultaneous access to both screens (nephroscope and flexible ureteroscope), facilitating efficient location of any residual stones. The AVP functioned effectively, displaying multiple screens within its own interface, improving ergonomics during surgery and maintaining safety throughout the procedure. The surgery was performed uneventfully in 2 hours, and the patient was rendered stone-free on CT and was discharged on the first postoperative day. Conclusion: Apple Vision Pro provides multiscreen and 3D reconstruction capabilities, ensuring a comfortable, safe, and easily replicable procedure. Its advanced technology may be particularly beneficial for surgeries, such as Mini-ECIRS, which require simultaneous screens.

PurposeTo perform a feasibility phase study of a panel of putative protein biomarkers and determine whether it can identify and predict tumor recurrence in patients with non-muscle-invasive bladder cancer (NMIBC) on follow-up.MethodsWe prospectively analyzed the urine of 152 patients previously treated for NMIBC. Quantitative expression of plasminogen activator inhibitor-1 (PAI-1), DJ-1, apolipoprotein A-I (apoA-1), matrix metallopeptidase-9 (MMP-9), and interleukin-8 (IL-8) was assessed by enzyme-linked immunosorbent assay and compared amongst patients with and without bladder cancer recurrence at urine collection and during 3 years of follow-up. Tumor recurrence was confirmed by pathologic analysis. We performed a prediction analysis, excluding patients with recurrence at the start of the study, and assessed the influence of previous use of intravesical BCG on the level of biomarkers.ResultsMedian follow-up time was 47 months (interquartile range 39–50 months). Sixteen patients (10.5%) were diagnosed with recurrence at the start of the study, and 21 (15.4%) were diagnosed during the study. Three biomarker proteins (apoA-1, MMP-9, and IL-8) appear to hold diagnostic potential [odds ratio (OR) = 12.9; 95% CI 3.5–47.4]; while, PAI-1 and IL-8 predict recurrence (OR = 4.1; 95% CI 1.4–11.4). Previous use of intravesical BCG did not affect biomarker levels.ConclusionIn the feasibility phase, the panel of urine biomarkers analyzed detected and predicted recurrence of NMIBC and provided reliable results in patients who had previously used intravesical BCG. Validation studies are required to confirm the panel clinical utility.

Background The imbalance between the action of the tissue inhibitors of matrix metalloproteinases (TIMPs) and the matrix metalloproteinases (MMPs) is one component of metastasis physiology. TIMP-1 overrides MMP-9 activity in cancer and might be regulated by miR-618. The aims of this study were to clarify whether TIMP-1 expression is modified by miR-618 and to clarify the effect of miR-618 expression on the invasion of prostate cancer cells. We also studied miR-618 expression in surgical specimens of patients with localized prostate cancer submitted to open radical prostatectomy. Methods After transfection of miR-618 or its antagonist in DU145 cells, qRT-PCR for TIMP-1/MMP-9 and both ELISA and zymography for MMP-9 were performed. Total miRNA was extracted from surgical specimens of PCa, and miR-618 expression was examined for correlations with Gleason score, pathological status and biochemical recurrence. Results DU145 cells transfected with miR-618 had a 76% reduction in TIMP-1 expression relative to control cells ( p  = 0.003). miR-618 inhibition reduced MMP-9 expression by 31% ( p  = 0.032) and MMP-9 absorbance evaluated with ELISA assay ( p  = 0.06).Zymography suggested higher MMP-9 activity in DU145 cells transfected with miR-618 than those transfected with miR-618 inhibitor, but the difference was not significant ( p  = 0.55). However, miR-618 expression was lower in surgical specimens of patients with Gleason score > 7 ( p  = 0.08) and more advanced disease ( p  = 0.07). Conclusions In vitro, miR-618 overexpression decreases TIMP-1 and miR-618 inhibition decreases MMP-9, suggesting that miR-618 might be an oncomiR. However, the analysis of clinical samples of localized prostate cancer revealed an inconsistent pattern, as increased miR-618 expression was associated with lower Gleason score and pathological status. Further studies are needed to address whether miR-618 is a context-dependent miRNA.

Introduction: Prostate cancer has a high incidence in men and is the second cause of cancer death among americans male. microRNA (miR) is becoming a potential new prognostic factor for prostate cancer. Single nucleotide polymorphisms (SNPs) are common polymorphisms, characterized by a single exchange of nitrogen based in the DNA. This polymorphism is present in the miRs, altering their function. Objective: To evaluate the role of SNP rs1834306 of miR100 and rs2910164 of miR146a in the development and prognosis of prostate cancer. Methods: One hundred patients diagnosed with prostate cancer and 68 controls were selected. The identification of SNP was rated by quantitative polymerase chain reaction from blood samples, and the analysis was performed within the presence of SNP and the prognostic variables. Results: In the SNP rs1834306 (miR100), a smaller presence of the polymorphic homozygous genotype was identified in patients with PSA >10 ng/mL, (P=0.03); when evaluating only the presence of the polymorphic allele G (P=0.09) it was compared to the presence of the wild type allele A. Among the patients with prostate cancer, SNP rs2910164 (miR146A), the polymorphic allele was more frequent in patients with a Gleason score ⩾7 than in patients with a Gleason score <7, (P=0.043). In patients with prostate cancer, miR100 was overexpressed in those with pT3 staging compared to pT2 and among those who had biochemical recurrence (P = 0.004 and P = 0.011, respectively). Conclusions: SNP of miR146a acts as a poor prognostic factor (Gleason ⩾7), and the SNP of miR100 is linked to better prognostic data (PSA <10). MiR100 was overexpressed in prostate cancer with worse prognostic factors.

Background The ability to metastasize is one of the most important characteristics of neoplastic cells. An imbalance between the action of some matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs drives the invasion process. Some studies have suggested that MMP-2 is involved in metastasis, while other studies have reported that collagen production by cancer cells might also contribute to motility. However, decreased expression of microRNA-29b (miR-29b), which may control MMP-2 and collagen gene expression, has been shown in prostate cancer (PCa). The objectives of the present study were to clarify whether MMP-2 as well as collagens I and III (encoded by COL1A1 and COL3A1, respectively) are controlled by miR-29b and to determine whether metastasis is altered by this relationship. Methods PCa DU145 and PC-3 cells were transfected with 100 μL of OPTI-MEM I containing 100 nmol of miR-29b (or its inhibitor) along with 1.5 μL of lipofectamine. Positive and negative controls were prepared using the same protocol. MMP-2, COL1A1 and COL3A1 messenger RNA (mRNA) levels were evaluated via real-time polymerase chain reaction (qRT-PCR). For qRT-PCR, 6 × 10 4  cells were used. Invasion studies were conducted with Matrigel assays, which simulate invasion of the extracellular matrix by neoplastic cells. After transfection of 3 × 10 4 cells, invasion was allowed to proceed for 48 h. Invasive cells were counted under an optical microscope. Each experiment was performed in triplicate. Results MMP-2 mRNA was not expressed in DU145 cells after transfection with miR-29b. After transfection of cells with the miR-29b inhibitor, COL1A1 (p = 0.02) and COL3A1 (p = 0.06) mRNA expression was increased in DU145 cells, and a large number of transfected DU145 and PC3 cells invaded the Matrigel membrane. Conclusions In vitro studies showed that reducing the amount of miR-29b may lead to higher PCa cell invasion via a process that is independent of MMP-2. Collagen expression, controlled by miR-29b, may facilitate this motility process. Thus, the present study suggests that collagen production plays an active role in metastasis control and restoration of miR-29b levels may decrease metastasis. Altogether, these findings support further exploration of drug therapy targeting this aspect of the metastasis circuit.

Our aim was to evaluate the role of 20 genetic polymorphisms in the development and prognosis of sporadic and familial PC. A case-control study of 185 patients who underwent radical prostatectomy from 1997 to 2011. These patients were divided into two groups based on their family history. Gleason grade, PSA value and pathological TNM 2002 stage were used as prognostic factors. Blood samples from 70 men without PC were used as controls. The SNPs were genotyped using a TaqMan® SNP Genotyping Assay Kit. Considering susceptibility, the polymorphic allele in the SNP rs2660753 on chromosome 3 was significantly more prevalent in controls (p = 0.01). For familial clustering, the polymorphic homozygote genotype of the SNP rs7931342 was five times more frequent in patients with familial PC compared to sporadic PC (p = 0.01). Regarding the SNP 1447295, the polymorphic homozygote genotype was more prevalent in patients with organ-confined PC (p = 0.05), and most importantly, the polymorphic allele occurred more frequently in patients without biochemical recurrence (p = 0.01). Kaplan-Meier analysis showed a median biochemical recurrence free survival of 124.2 compared to 85.6 months for patients with the wild-type allele (p = 0.007). Our findings provide the evidence for the association of 20 recently highlighted SNPs and their susceptibility, familial clustering, staging, Gleason score and biochemical recurrence of PC. We believe that the association between these SNPs and PC may contribute to the development of alternative tools that can facilitate the early detection and prognosis of this disease.

Purpose To compare the Comprehensive Complication Index (CCI) to the Clavien–Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population. Methods We conducted a retrospective cohort study involving patients 60 years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications. Results We included 244 patients with a median age of 65 [63–69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy’s classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications. Conclusion Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy’s classification, and history of UTI as predictors of postoperative complications after this procedure in this population.

Purpose To identify predictors of sepsis following percutaneous nephrolithotomy in patients with neurogenic bladder, without investigating causal pathways. Methods We retrospectively analyzed a consecutive sample of patients with neurogenic bladder who underwent percutaneous nephrolithotomy at our referral center between 2009 and 2020. We also systematically searched PubMed until February 2025 for studies that investigated neurogenic patients undergoing this procedure. We then performed a single-arm meta-analysis of postoperative sepsis, including our own data, and meta-regressions to search for predictors. Results In our cohort, sepsis rate was 6% [1%; 19%], 2/36 patients. The Charlson Comorbidity Index was the only predictor ( p  = 0.02). In the meta-cohort (13 cohorts, 2,369 patients), the combined sepsis rate was 12% [7%; 17%], despite high heterogeneity (I 2 = 75%), with no evidence of publication bias ( p  = 0.09). We identified younger age ( p  = 0.04), non-urethral urinary diversions ( p  = 0.04)—particularly ileal conduits ( p  < 0.001)—and non-traumatic etiologies ( p  = 0.02), especially spina bifida ( p  = 0.009), as predictors of sepsis. Conclusion We recommend the development of a targeted antibiotic prophylaxis protocol, tailored to these predictors, for patients with neurogenic bladder undergoing percutaneous nephrolithotomy. We motivate further research on causal pathways.

Purpose We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. Methods From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. Results Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR ( p  < 0.001) were significantly lower, and POD10 ( p  = 0.092) and POD30 ( p  = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m 2 , p  = 0.019 [1.021–1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p  = 0.028 [1.25–51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p  = 0.042 [1.00–1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p  = 0.026 [0.016–0.773; 0.113]. Conclusions Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.