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Abstract We assessed the feasibility, efficacy and long-term results of endoscopic management using Neodymium-YAG (Nd-YAG) laser as a day care procedure in patients with post-traumatic supraprostatic and prostatic strictures. Three patients with post-traumatic prostatic and supraprostatic obliterative strictures underwent Nd-YAG laser core through urethrotomy as a day care procedure. Patient age ranged between 12 and 14 years. Mean duration of injury was 16 months. The length of stricture was assessed by bi-directional endoscopy prior to the procedure in all cases. Core through procedure was carried out using Nd-YAG laser under the guidance of a cystoscope placed antegradely. Patients were discharged on the same day with urethral catheter. Foley catheters were removed at 6 weeks. Nd-YAG laser core through procedure was carried out successfully in all cases with negligible blood loss in a mean time of 48 min. There were no intraoperative or postoperative complications. Patients were discharged on the same day. Follow-up cystogram was conducted at 6 weeks and urethroscopy at months. At a mean follow-up of 23 months, patients were asymptomatic and voiding well. Nd-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic prostatic and supraprostatic strictures. It can be carried out as a day care procedure in carefully selected patients and has no complications. [ABSTRACT FROM AUTHOR]

The article presents a case report of rhabdomyolysis after radical laparoscopic nephrectomy and reviews several studies to highlight the risk factors involved and offers possible preventive strategies. Development of Rhabdomyolysis after lengthy surgeries in patients with high body mass index, obesity, and lateral decubitus position is discussed. Information on peri-operative precautions and patient selection, surgeon's limitations, is also presented.

This article discusses the role of regulatory T-cells (Tregs) in infectious pancreatic necrosis, a complication of acute pancreatitis. The study found that Treg activation disrupts the barrier function of the duodenum, allowing bacteria to enter the pancreatic necrosis. The researchers focused on the expression of the co-inhibitory molecule Programmed-death 1 (PD-1) on Tregs and found that PD-1 expression correlated with the level of Tregs. They also conducted experiments on mouse models and found that blocking PD-1 reduced the translocation of bacteria into the pancreas. The study suggests that PD-1 blockage could be a potential therapeutic strategy for infectious pancreatic necrosis, but further research is needed. [Extracted from the article]

Human commensal species take advantage of anthropogenic conditions that are less likely to be challenged by the selective pressures of natural environments. Their morphological and physiological phenotypes can therefore dissociate from habitat characteristics. Understanding how these species adjust their morphological and physiological traits across latitudinal gradients is fundamental to uncovering the eco‐physiological strategies underlying coping mechanisms. Here, we studied morphological traits in breeding Eurasian tree sparrows (ETSs; Passer montanus) among low‐latitude (Yunnan and Hunan) and middle‐latitude (Hebei) localities in China. We then compared body mass; lengths of bill, tarsometatarsus, wing, total body, and tail feather; and baseline and capture stress‐induced levels of plasma corticosterone (CORT) and the metabolites including glucose (Glu), total triglyceride (TG), free fatty acid (FFA), total protein, and uric acid (UA). None of the measured morphological parameters varied with latitude except in the Hunan population, which demonstrated longer bills than those in other populations. Stress‐induced CORT levels significantly exceeded baseline levels and decreased with increasing latitude, but total integrated CORT levels did not vary with latitude. Capture stress‐induced significantly increased Glu levels and decreased TG levels, independent of site. However, the Hunan population had significantly higher baseline CORT, baseline and stress‐induced FFA levels, but lower UA levels, which differed from other populations. Our results suggest that rather than morphological adjustments, physiological adjustments are mainly involved in coping mechanisms for middle‐latitude adaptation in ETSs. It is worth investigating whether other avian species also exhibit such dissociation from external morphological designs while depending on physiological adjustments. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the outcomes and learning curve of extraperitoneal endoscopic radical prostatectomy (EERP) using cumulative summation charts from a single tertiary referral centre. PATIENTS AND METHODS The data from 300 consecutive men with localized prostate cancer who underwent EERP at Western General Hospital, Edinburgh, UK, between February 2006 and July 2009 were prospectively maintained in a database. The data collected included demographic details, perioperative outcomes, complications and follow-up for functional and oncology outcomes. The learning curve was analysed using generalized linear models for complication rate, operative time and blood loss, using procedure experience. RESULTS The mean ( SD , range) operative duration was 160.52 (40.84, 100-310) min, and the intraoperative blood loss was 229.3 (172, 20-1000) mL. There was no conversion to open surgery and no patient required intraoperative blood transfusion. Only one of 250 (0.3%) patients required a blood transfusion after EERP. The median (range) hospital stay was 3 (2-20) days and the median catheterization time before cystography was 9 days. There was evidence that the complication rate reduced as experience was gained (odds ratio 0.98, 95% confidence interval, CI, 0.97-0.99; P = 0.002), with the estimated probability of a complication decreasing from 29% for the first to < 1% for the 250th procedure. Also there was evidence of a decrease in operative duration ( ? 0.0020 rate parameter on log scale; 95% CI ? 0.0024 to ? 0.0017; P < 0.001) and blood loss ( ? 0.01 rate parameter on log scale; 95% CI ? 0.003 to ? 0.0002; P = 0.021). The positive surgical margin rate in pT2 disease decreased from 27% in the first 50 to 14.7% in the last 50 operated cases. The continence rate and biochemical recurrencefree rate at a minimum follow-up of 1 year for the first 100 patients was 89% and 94%, respectively. CONCLUSION The results from this series suggest that the benefits of minimally invasive surgery for localized prostate cancer (EERP) can be replicated after mentored fellowship training of a surgeon. The complication rate reduced substantially as experience was gained, suggesting a continuous surgical learning curve. [ABSTRACT FROM AUTHOR]

The article offers step-by-step instructions for a circumferential suture in the bladder neck to facilitate surgical anastomosis during radical retropubic prostatectomy (RRP), along with images of the novel suturing technique.

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task‐specific and two global‐rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter‐rater reliability was also assessed. Results: We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P = 0.226). There was excellent intraclass correlation (ICC) overall between the two experts' judgements, ICC = 0.841 (95% confidence interval 0.767–0.893; P < 0.001, n = 88). Conclusions: We have developed the novel GAUES tool for cystoscopic, URS and TUR skills. Overall, we demonstrated good face, content and construct validity and excellent reliability, suggesting that the GAUES tool can be useful for endourological skills assessment. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task‐specific and two global‐rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter‐rater reliability was also assessed. Results: We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P = 0.226). There was excellent intraclass correlation (ICC) overall between the two experts' judgements, ICC = 0.841 (95% confidence interval 0.767–0.893; P < 0.001, n = 88). Conclusions: We have developed the novel GAUES tool for cystoscopic, URS and TUR skills. Overall, we demonstrated good face, content and construct validity and excellent reliability, suggesting that the GAUES tool can be useful for endourological skills assessment. [ABSTRACT FROM AUTHOR]

Background: Anxiety and stress like mental illnesses are the common outcomes of viral epidemics and pandemics. Novel coronavirus disease 2019 (COVID‐19) outbreak caused by the severe acute respiratory syndrome coronavirus virus 2 (SARS‐CoV‐2) was first reported in Wuhan, China, and then spread all over the world in a short time. Objectives: To highlight and discuss the impact of COVID‐19 pandemic on mental or psychological health. Method: Literature search and collection of the information were performed using PubMed, the reports from the World health organization, and the Center for disease control and prevention. Results: COVID‐19 infection has already been declared as a global pandemic, which in association with infodemic has increased the risk of psychiatric/psychological disorders. A large population of the world is prone to develop anxiety, depressive disorders, and other mental abnormalities. Therefore, timely psychological interventions and preventive strategies are required. Moreover, the infection has been reported to be linked with cerebrovascular conditions; therefore, patients with underlying cerebrovascular diseases should be given attention. Conclusion: COVID‐19‐mediated mental health complications and cerebrovascular conditions may cause a huge burden on healthcare communities in the future. Therefore, timely intervention and the development or application of preventive strategies are required to decrease the risk of neurological consequences. [ABSTRACT FROM AUTHOR]

The lowermost Carboniferous rocks in the Cockburnspath area of east Berwickshire (southern Scotland) are interpreted as coastal floodplain sediments. A lower mudstone-dominated unit is composed of silty mudstones and shales with subordinate sandstones and argillaceous ferroan dolomites (cementstones). These are interpreted as distal floodplain sediments with periodic crevasse-splay depositions (cementstones). These are interpreted as distal floodplain sediments with periodic crevasse-splay deposition. The dark grey colour of the mudrocks suggests depositions in reducing condition, probably in floodplain lakes. Most of the cementstones are concretionary, some with septarian cracks, suggesting an early digenetic origin. An immature palaeosol suggest periodic pedogenesis under improved drainage. A synsedimentary erosion surface indicates incision of a valley into the floodplain, presumably in response to base-level lowering. An upper sandstone-dominated unit starts with fine-grained rippled sandstones, cut by small channel sandstones. These are interpreted as floodplain lake deposits fed by crevasse channels. A distinctive conglomerate with cementstone clasts, wood fragments and fish remains is interpreted as a major overbank deposits, dumped into a pre-existing floodplain lake. A bivalve fuana was established in the overlying mudstone, followed by a thin limestone with a restricted marine fossil assemblage, showing that seawater flooding of the lakes occurred at times. Mudrocks throughout the sequence contain no pyrite, except for the marine band which has an organic-carbon/sulphur ratio and degree of pyritization value typical of marine sediments. The concretionary cementstones have δ[sup13]C values around −4 to −6‰ PDB which are interpreted as indicative of anaerobic oxidation of organic matter. The combined geochemical data suggest a significant involvement of iron reduction in cementstone formation, although the δ[sup13]C values... [ABSTRACT FROM AUTHOR]

On the Qinghai‐Tibet Plateau, extreme environmental conditions have imposed intense selective pressure on the evolution of phenotypic traits of wild animals. To date, limited information is available on behavioral and ecological traits concerning niche differentiation among sympatric animals on the Qinghai‐Tibet Plateau, especially during winter when the environments are most severe. Here, we studied the seasonal variations in habitat occurrence, territorial behavior, and diet in two sympatric snow finches (the white‐rumped snow finch, Onychostruthus taczanowskii, WRSF; and the rufous‐necked snow finch, Pyrgilauda ruficollis, RNSF) to determine convergence and divergence of ecological traits in such severe climatic conditions. Our results showed that: (i) WRSF occupied rural areas as a dominant species throughout the annual cycle while RNSF occupied the rural areas in summer and then shifted to human‐occupied areas in winter and spring; (ii) WRSFs exhibited robust aggressive behavior and territoriality during winter relative to RNSFs; (iii) the diets of both species varied with the season but did not vary between species except that WRSF ate significantly more seeds but RNSF consumed more starchy material derived from human food waste during winter. Therefore, the separations in the spatial niche and territoriality between WRSF and RNSF, especially in winter, may contribute to alleviating the pressure of interspecific competition, and promoting the coexistence of the two sympatric snow finches in the extreme environments on the Qinghai‐Tibet Plateau. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between periprostatic adipose tissue (PPAT) adipokine expression and prostate cancer (PCa) aggressiveness using both pathological features of radical prostatectomy (RP) and multiparametric magnetic resonance imaging (MRI) variables. Patients and Methods: Sixty‐nine men were recruited to assess immunohistochemical expression of tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) of periprostatic fat of RP specimens. Per cent immunopositivity was quantified on scanned slides using the Aperio Positive Pixel Count algorithm for PPAT TNFα, VEGF and androgen receptors. Periprostatic fat volume (PFV) was segmented on contiguous T1‐weighted axial MRI slices from the level of the prostate base to apex. PFV was normalized to prostate volume (PV) to account for variations in PV (normalized PFV = PFV/PV). MRI quantitative values (Kep, Ktrans and apparent diffusion coefficient) were measured from the PCa primary lesion using Olea Sphere software. Patients were stratified into three groups according to RP Gleason score (GS): ≤6, 7(3 + 4) and ≥7(4 + 3). Results: The mean rank of VEGF and TNFα was significantly different between the groups [H(2) = 11.038, P = 0.004] and [H(2) = 13.086, P = 0.001], respectively. Patients with stage pT3 had higher TNFα (18.2 ± 8.95) positivity than patients with stage pT2 (13.27 ± 10.66; t [67] = −2.03, P = 0.047). TNFα expression significantly correlated with Ktrans (ρ = 0.327, P = 0.023). TNFα (P = 0.043), and VEGF (P = 0.02) correlated with high grade PCa (GS ≥ 7) in RP specimens and also correlated significantly with upgrading of GS from biopsy to RP histology. Conclusions: The expression levels of TNFα and VEGF on immunostaining significantly correlated with aggressivity of PCa. As biomarkers, these indicate the risk of having high grade PCa in men undergoing RP. [ABSTRACT FROM AUTHOR]

Objectives: To identify areas of agreement and disagreement in the implementation of multi‐parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway. Materials and Methods: Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California‐Los Angeles (UCLA‐RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9‐point scale. A panel median score of ≥7 constituted ‘agreement’ for an item; for an item to reach ‘consensus’, a panel majority scoring was required. Results: Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy. Conclusions: Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high‐quality prostate mpMRI as a diagnostic test before biopsy in men at risk. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on whether photodynamic diagnostic flexible ureterorenoscopy suitable for a patient presenting with chronic actinic dermatitis.

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The idea of using photosensitizing agents to enhance visualization of cancer tissue dates back to 1900. 5-Aminolevulinic acid (5-ALA) was first suggested for photodynamic diagnosis (PDD) of transitional cell cancer (TCC) of the bladder in 1992. Since then, PDD with intravesical application of 5-ALA or its ester hexaminolevulinate (Hexvix) has proven to be superior over standard white-light cystoscopy in detection of carcinoma in situ and dysplasia as well as enhancing margins of TCC. PDD of upper urinary tract TCC is under-studied because of trouble with delivery of the photosensitizer. Fluorescence after oral 5-ALA was initially reported in 1956. Oral 5-ALA for photodynamic therapy was suggested for upper urinary tract TCC in 1998 and for refractory non-muscle invasive bladder cancer in 2001. A study in 2012 on oral and intravesical application of 5-ALA for bladder PDD showed no difference in diagnostic accuracy for each modality. To our knowledge our series is the first report on use of oral 5-ALA for PDD in detection of upper urinary tract tumours. We published our initial results in 2010. We think that our recent audit is quite encouraging. PDD ureterorenoscopy resulted in detection of additional urothelial tumours that could have been missed by the conventional white-light endoscopy. We suggest that this technique should be used in large multicentre trials to replicate our results. OBJECTIVE To evaluate the diagnostic accuracy of photodynamic diagnostic ureterorenoscopy after oral administration of 5-aminolevulinic acid (5-ALA) for upper urinary tract urothelial cancers., PATIENTS AND METHODS In this audit, twenty-six patients underwent thirty-nine procedures (cystoscopy/ureterorenoscopy) following oral administration of 5-ALA for photodynamic diagnosis (PDD)., Twenty mg/kg body weight of 5-ALA was given orally 3-4 hours prior to the planned endoscopic visualisation., Following standard white light cystoscopy and ureterorenoscopy, photodynamic diagnostic endoscopy was performed using D-light system (Olympus PDD cystoscope and 7.5Fr KARL STORZ PDD Flex-X ureterorenoscope) to detect fluorescence., Biopsies were carried out from all suspicious areas, noting if lesions were detected under white or blue light or both., RESULTS A total of sixty-two biopsies were performed for suspicious urothelial lesions (35 bladder, 26 ureter/renal pelvis and 1 from prostatic urethra)., Of the 35 bladder biopsies, 11 lesions were seen under both white and blue light and 91% of these were malignant., While 24 (68.5%) biopsies were taken from lesions seen only under blue light and 45.8% of these were malignant., Similarly, of the 26 ureteric/renal pelvicalyceal biopsies, 11 were concurrent in both white and blue light and 100% of these were malignant., While 10 (38.5%) lesions were seen only under blue light and 70% of these were malignant., CONCLUSIONS Photodynamic diagnosis using oral 5-ALA is safe and feasible with additional advantages of detecting lesions not visualised with conventional white light endoscopy., This may translate into more complete treatment thereby decreasing subsequent recurrences and possibly progression of the upper urinary tract urothelial cancers. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Cancer tissue is stiffer than normal tissue, a fact known for many years. This has been measured using ultrasound (US) technology and is termed as elastosonography (ES). There have been reports of this technique being used in the detection of prostate cancer; however, no definite guidelines for its clinical application exist. The present review, for the first time synthesises published data of transrectal ES (TRES) using diagnostic review methodology. TRES increases prostate cancer detection as compared with grey-scale US. Also, the study highlights limitations and strengths of data in this area and includes recommendations for future research. To assess the diagnostic performance of transrectal elastosonography (TRES) for the detection of prostate cancer. Two reviewers independently extracted the data from each study. Quality was assessed with a validated quality assessment tool for diagnostic accuracy studies. Diagnostic accuracy of TRES in relation to current standard references (transrectal ultrasonography [TRUS] biopsies and histopathology of radical prostatectomy [RP] specimens) was estimated. A bivariate random effects model was used to obtain sensitivity and specificity values. Hierarchical summary receiver operating characteristic (HSROC) were calculated. In all, 16 studies (2278 patients) were included in the review. Using histopathology of the RP specimen as reference standard, the pooled data of four studies showed that the sensitivity of TRES ranged between 0.71 to 0.82 and the specificity ranged between 0.60 to 0.95 (pooled diagnostic odds ratio [DOR] 19.6; 95% confidence interval [CI] 7.7-50.03). The sensitivity varied from 0.26 to 0.87 and specificity varied from 0.17 to 0.76 (pooled DOR 2.141; 95% CI 0.525 to -8.737) using TRUS biopsies (minimum of 10) as a reference standard. The quality of most studies was modest. SROC estimated 0.8653 area under the curve predicting high chances of detecting prostate cancer. There were no health economics or health-related quality of life of the participants reported in the studies and all the studies used compressional technique with no reported standardisation. The TRES technique appears to improve the detection of prostate cancer compared with systematic biopsy and shows a good accuracy in comparison with histopathology of the RP specimen. However, studies lacked standardisation of the technique, had poor quality of reporting and a large variation in the outcomes based on the reference standards and techniques used. [ABSTRACT FROM AUTHOR]

Study Type - Symptom prevalence (prospective cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Evidence that transurethral resection of the prostate (TURP) leads to erectile dysfunction (ED) is conflicting. Several studies claimed significant risk of ED after TURP for benign prostatic hyperplasia with some reporting complete loss of erection. Several studies have been retrospective or have not considered levels of pre-operative ED. ED associated with lower urinary tract symptoms frequently precedes TURP. TURP did not adversely affect erectile function. Pre-operative ED can be improved by TURP and long-term erectile function is maintained following TURP. The improvement was corroborated by the partners in the short, medium and long-term and was statistically significant. OBJECTIVE [ABSTRACT FROM AUTHOR]

The present study was designed to assess the responsiveness of hypothalamic–pituitary–gonadal axis to kisspeptin administration with increasing age in men. Human kisspeptin‐10 was administered in single iv bolus dose (1 µg/kg BW) to healthy adult, middle and advanced age men. Serial blood samples were collected for 30 min pre‐ and 120 min post‐kisspeptin injection periods at 30‐min interval. Analysis of plasma LH by ELISA showed a significant (p < 0.05) increase after kisspeptin‐10 administration in all groups, whereas plasma testosterone concentration was significantly elevated (p < 0.05) after kisspeptin‐10 injection only in the adult men group. Present results suggest that in men, central hypothalamic–pituitary axis remains active and shows responsiveness to kisspeptin stimulation across life. However, Leydig cell responsiveness to kisspeptin‐induced LH decreases with age in men. [ABSTRACT FROM AUTHOR]

Purpose: Quantification of stiffness changes may provide important diagnostic information and aid in the early detection of cancers. Shear wave elastography is an imaging technique that assesses tissue stiffness using acoustic radiation force as an alternate to manual palpation reported previously with quasistatic elastography. In this study, the elastic properties of tissue mimicking materials, including agar, polyacrylamide (PAA), and silicone, are evaluated with an objective to determine material characteristics which resemble normal and cancerous prostate tissue. Methods: Acoustic properties and stiffness of tissue mimicking phantoms were measured using compressional mechanical testing and shear wave elastography using supersonic shear imaging. The latter is based on the principles of shear waves generated using acoustic radiation force. The evaluation included tissue mimicking materials (TMMs) within the prostate at different positions and sizes that could mimic cancerous and normal prostate tissue. Patient data on normal and prostate cancer tissues quantified using biopsy histopathology were used to validate the findings. Pathologist reports on histopathology were blinded to mechanical testing and elastographic findings. Results: Young's modulus values of 86.2 ± 4.5 and 271.5 ± 25.7 kPa were obtained for PAA mixed with 2% Al2O3 particles and silicone, respectively. Young's modulus of TMMs from mechanical compression testing showed a clear trend of increasing stiffness with an increasing percentage of agar. The silicone material had higher stiffness values when compared with PAA with Al2O3. The mean Young's modulus value in cancerous tissue was 90.5 ± 4.5 kPa as compared to 93.8 ± 4.4 and 86.2 ± 4.5 kPa obtained with PAA with 2% Al2O3 phantom at a depth of 52.4 and 36.6 mm, respectively. Conclusions: PAA mixed with Al2O3 provides the most suitable tissue mimicking material for prostate cancer tumor material, while agar could form the surrounding background to simulate normal prostate tissue. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Upper urinary tract transitional cell carcinoma (UUT-TCC) is an aggressive disease. The mainstay in the treatment of UUT-TCC is surgical intervention, with oncological control the primary objective. UUT-TCCs have been conventionally treated with radical nephroureterectomy (NU). This procedure involves removal of the kidney, ureter and ipsilateral excision of a bladder cuff. Whilst open NU has traditionally been the approach used, laparoscopic NU (LNU) is now an increasingly popular and established approach for UUT-TCC. It is argued that LNU reduces postoperative morbidity without compromising oncological efficacy. With technological evolution, robotic NU has now been attempted in some centres as well. In addition, several techniques have been described to manage the bladder cuff with no agreement as to the most efficacious approach. In a further attempt to reduce morbidity and safeguard nephrons, there have been advocates of a number of nephron-sparing techniques, e.g. ureteroscopic management, percutaneous approaches, and distal ureterectomy. These approaches obviously raise concern on oncological efficacy with requirement for more stringent long-term surveillance protocols. This study comprehensively reviews and summarises the evidence comparing various surgical techniques in the management of UUT-TCC. The review additionally evaluates and critically appraises the quality of evidence available, which currently informs practice. Surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC) has significantly changed over the past two decades. Data for several new surgical techniques, including nephron-sparing surgery (NSS), is emerging., The study systematically reviewed the literature comparing (randomised and observational studies) surgical and oncological outcomes for various surgical techniques, MEDLINE, EMBASE, Cochrane Library, CINAHL, British Nursing Index, AMED, LILACS, Web of Science, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, ISI proceedings, and PubMed were searched to identify suitable studies. Data were extracted from each identified paper independently by two reviewers (B.R. and B.S.) and cross checked by a senior member of the team., The data analysis was performed using the Cochrane software Review manager version 5. Comparable data from each study was combined in a meta-analysis where possible. For dichotomous data, odds ratios with 95% confidence intervals (CIs) were estimated based on the fixed-effects model and according to an intention-to-treat analysis. If the data available were deemed not suitable for a meta-analysis it was described in a narrative fashion., One randomised control trial (RCT) and 19 observational studies comparing open nephroureterectomy (ONU) and laparoscopic NU (LNU) were identified. The RCT reported the LNU group to have statistically significantly less blood loss (104 vs 430 mL, P < 0.001) and mean time to discharge (2.30 vs 3.65 days, P < 0.001) than the ONU group. At a median follow-up of 44 months, the overall 5-year cancer-specific survival (CSS; 89.9 vs 79.8%) and 5-year metastasis-free survival rates (77.4 vs 72.5%) for the ONU were better than for LNU, respectively, although not statistically significant., A meta-analysis of the observational studies favoured LNU group for lower urinary recurrence ( P < 0.001) and distant metastasis. The meta-analyses for local recurrence for the two groups were comparable., One retrospective study comparing ONU with a percutaneous approach for grade 2 disease reported no significant differences in CSS rates (53.8 vs 53.3 months)., Three retrospective studies compared NSS and radical NU, and reported no significant differences in overall CSS and recurrence-free survival between the two approaches., Five retrospective studies compared various techniques of en bloc excision of the lower ureter. No technique was reported to be better (operative and oncological) than any other., This review concludes that there is a paucity of good quality evidence for the various surgical approaches for UUT-TCC. The techniques have been assessed and reported in many retrospective single-centre studies favouring LNU for better perioperative outcomes and comparable oncological safety. The reported observational studies data is further supported by one RCT. [ABSTRACT FROM AUTHOR]