The application of indocyanine green in guiding prostate cancer treatment

Objective:Indocyanine green(ICG)with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography,blood flow evaluation,and liver function assessment.It has strong optical absorption in the near-infrared region,where light can penetrate deepest into biological tissue.We sought to review its value in guiding prostate cancer treatment.Methods:All related literature at PubMed from January 2000 to December 2020 were reviewed.Results:Multiple preclinical studies have demonstrated the usefulness of ICG in identifying prostate cancer by using different engineering techniques.Clinical studies have demonstrated the usefulness of ICG in guiding sentinel node dissection during radical prostatectomy,and possible better preservation of neurovascular bundle by identifying landmark prostatic arteries.New techniques such as adding fluorescein in additional to ICG were tested in a limited number of patients with encouraging result.In addition,the use of the ICG was shown to be safe.Even though there are encouraging results,it does not carry sufficient sensitivity and specificity in replacing extended pelvic lymph node dissection during radical prostatectomy.Conclusion:Multiple preclinical and clinical studies have shown the usefulness of ICG in identifying and guiding treatment for prostate cancer.Larger randomized prospective studies are warranted to further test its usefulness and find new modified approaches.

Miniaturised percutaneous nephrolithotomy:Its role in the treatment of urolithiasis and our experience

Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.

Use of a modified ureteral access sheath in semi-rigid ureteroscopy to treat large upper ureteral stones is associated with high stone free rates

Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).

Miniaturization in percutaneous nephrolithotomy:What is new?

Objective:To summarize recent advancements in mini-percutaneous nephrolithotomy(mini-PCNL)in surgical technique,stone removal strategy,lithotripsy,and surgical model from the current literature.Methods:We conducted a narrative review of relevant English-language articles up to October 2022 using the PubMed and Web of Science databases.The following keywords were used in the search:“percutaneous nephrolithotomy”,“minimally invasive percutaneous nephrolithotomy”,“mini-PCNL”,“mini-perc”,“mPCNL”,and“miniaturization”.Results:A series of new progress has been made in many aspects of mini-PCNL,such as further reduction of tract sizedneedle perc and further improvement of robotic-assisted PCNLdartificial intelligence-powered robotic devices.Conclusion:Many studies and trials have been conducted to reduce morbidity and increase the safety and effectiveness of mini-PCNL.It is crucial to realize that miniaturization of PCNL requires not only a smaller percutaneous tract size,but also an adjustment strategically in renal access,stone removal,lithotripsy,and surgical model in general.More large-scale prospective research needs to be carried out to further validate and optimize the safety and effectiveness of mini-PCNL.

Urolithiasis:From pathogenesis to management(part one)

Urolithiasis is a common condition that affects 5%-10%of the population globally[1].Once afflicted,urolithiasis tends to be recurrent,with up to 50%in most cases in 5 years since the first stone event[2].Despite the significant progress in understanding the pathogenesis and management of urolithiasis,the condition remains a significant public health concern.The aim of this special issue of the Asian Journal of Urology was to provide an update on the current state of knowledge regarding the pathogenesis,diagnosis,and management of urolithiasis.

Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men

The purpose of this study was to determine the diagnostic accuracy of serum inhibin B(INHB)as a predictor of the retrieval outcome of testicular haploid gametes(spermatids and testicular spermatozoa)in nonobstructive azoospermic men.Serum hormone levels,testicular volume,and histological evaluation were performed in 403 Chin ese non obstructive azoospermic men.Testicular haploid gamete was successfully retrieved in 213 of 403 patients(52.85%).The haploid gamete group always had higher INHB levels than the non-haploid gamete group.According to the receiver operating characteristic(ROC)curve analysis,INHB was a good predictor of testicular haploid gamete retrieval outcome in all patients(sensitivity:77.93%and specificity:91.58%)and patients with normal follicle-stimulating hormone(FSH;sensitivity:88.52%and specificity:70.83%).The area under the ROC curve(AUC)of INHB was similar to that of FSH in all patients or patients with normal FSH.In patients with elevated FSH,INHB was superior to FSH in predicting the presence of haploid gamete(AUC:0.73 vs 0.55,P<0.05),with a sensitivity of 60.00%and a specificity of 80.28%.It con eluded that serum INHB as an effective marker for spermatoge nesis was a sign ificant predictor of testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men.Especially,INHB is superior to FSH in predicting the presenee of haploid gamete in the patients with elevated FSH.

Inhibition of LIM kinase reduces contraction and proliferation in bladder smooth muscle

Overactive bladder(OAB)is the most bothersome symptom in lower urinary tract symptoms(LUTS).Current pharmacologic treatment aims to inhibit detrusor contraction;however,shows unsatisfied efficacy and high discontinuation rate.LIM kinases(LIMKs)promote smooth muscle contraction in the prostate;however,their function in the bladder smooth muscle remains unclear.Here,we studied effects of the LIMK inhibitors on bladder smooth muscle contraction and proliferation both in vitro and in vivo experiments.Bladder expressions of LIMKs are elevated in OAB rat detrusor tissues.Two LIMK inhibitors,SR7826 and LIMKi3,inhibit contraction of human detrusor strip,and cause actin filament breakdown,as well as cell proliferation reduction in cultured human bladder smooth muscle cells(HBSMCs),paralleled by reduced cofilin phosphorylation.Silencing of LIMK1 and LIMK2 in HBSMCs resulted in breakdown of actin filaments and decreased cell proliferation.Treatment with SR7826 or LIMKi3 decreased micturition frequency and bladder detrusor hypertrophy in rats with bladder outlet obstruction.Our study suggests that LIMKs may promote contraction and proliferation in the bladder smooth muscle,which could be inhibited by small molecule LIMK inhibitors.LIMK inhibitors could be a potential therapeutic strategy for OAB-related LUTS.

Association between 5α-reductase inhibitors therapy and incidence, cancer-specific mortality,and progression of prostate cancer: evidence from a meta-analysis

5a-reductase inhibitors(5-ARI)are widely employed for the treatment of benign prostatic hyperplasia.It has been noted that 5-ARI exhibit the potential to attenuate the risk of prostate cancer,but consistent agreement has not been achieved.Moreover,the effect of 5-ARI on cancer-specific mortality and progression of prostate cancer remains unclear.Therefore,the goal of the current meta-analysis was to elucidate the impact of 5-ARI on the incidence and progression of prostate cancer.We searched for all studies assessing the effect of 5-ARI on risk of prostate cancer in PubMed,Embase,Medline,and Cochrane Library databases.Pooled relative risk(RR)and corresponding 95%confidence intervals(CIs)were accepted to evaluate the association between 5-ARI and the risk of prostate cancer.Synthetic results implied that subjects who accepted 5-ARI compared with the placebo group experienced a distinctly weakened overall incidence of prostate cancer(RR=0.74;95%C l:0.66-0.82;P<0.001).Subgroup analyses further revealed that 5-ARI reduction of the incidence of prostate cancer was limited to low-grade(Gleason score 2-6;RR=0.68;95%C l:0.57-0.81;P<0.001)and intermediate-grade tumors(Gleason score 7;RR=0.81;95%C l:0.67-0.97;P=0.023),but not high-grade tumors(Gleason score>7;RR=1.19;95%Cl:0.98-1.43;P=0.069).The results also showed that 5-ARI treatment did not significantly alter prostate cancer-specific mortality(RR=1.0;95%C l:0.95-1.05;P=0.916).In addition,it was worth noting that 5-ARI treatment acted in a protective role that presented a dramatic benefit to delay the progression of low-risk tumors(RR=0.58;95%C l:0.43-0.78;P<0.001).

Reversing cold tumors to hot: An immunoadjuvant-functionalized metalorganic framework for multimodal imaging-guided synergistic photoimmunotherapy

Immunotherapy assays using immunoadjuvants and tumor antigens could greatly increase the survival rates of patients with malignant tumors.As effective carriers,metal-organic frameworks(MOFs)have been widely utilized in cancer therapy due to their remarkable histocompatibility and low toxicity.Herein,we constructed a multimodal imaging-guided synergistic cancer photoimmunotherapy by employing a specific MOF(MIL101-NH2)as the core carrier;the MOF was dual-dressed with photoacoustic and fluorescent signal donors(indocyanine green,ICG)and immune adjuvants(cytosine-phosphate-guanine sequence,CpG)and named ICGCpG@MOF.This nanocarrier could passively target the tumor site through the EPR effect and achieve multimodal imaging(fluorescence,photoacoustic,photothermal and magnetic resonance imaging)of the tumor.Synergistic cancer photoimmunotherapy was achieved via simultaneous photodynamic and photothermal methods with 808 nm laser irradiation.ICG-CpG@MOF achieved the GSH-controlled release of immunoadjuvant into the tumor microenvironment.Furthermore,the released tumor-associated antigen along with CpG could induce the transformation of tumor cells from cold to hot by activating the immune system,which significantly enhanced tumor cytotoxicity and achieved high cure rates with minimal side-effects.This strategy utilizing multimodal imaging and synergistic cancer photoimmunotherapy provides a promising approach for the diagnosis and treatment of cancer.