Epidermal growth factor receptor (EGFR) overexpression is believed to be associated with bladder cancer (BC) progression and poor clinical outcomes. In vivo studies have linked EGFR subcellular trafficking and chemo-resistance to cisplatin-based chemotherapies. This has not been studied in the clinical adjuvant setting. We aimed to investigate the prognostic significance of EGFR expression in patients receiving cisplatin-based adjuvant chemotherapy following radical cystectomy for advanced BC. The database from the Urology and Nephrology Center at Mansoura University was reviewed. BC patients who were treated with radical cystectomy and adjuvant chemotherapy for adverse pathological features or node positive disease were identified. Patients who underwent palliative cystectomy, had histological diagnoses other than pure urothelial carcinoma, or received adjuvant radiotherapy were excluded from the study. Immunohistochemical staining for EGFR expression was performed on archived bladder specimens. The following in vitro functional analyses were performed to study the relationship of EGFR expression and chemoresponse. The study included 58 patients, among which the mean age was 57 years old. Majority of patients had node positive disease (n = 53, 91%). Mean follow up was 26.61 months. EGFR was overexpressed in 25 cystectomy specimens (43%). Kaplan-Meier analysis revealed that EGFR over-expression significantly correlated with disease recurrence (p = 0.021). Cox proportional hazard modeling identified EGFR overexpression as an independent predictor for disease recurrence (p = 0.04). Furthermore, in vitro experiments demonstrated that inhibition of EGFR may sensitize cellular responses to cisplatin. Our findings suggest that EGFR overexpression is associated with disease recurrence following adjuvant chemotherapy for advanced BC. This may aid in patient prognostication and selection prior to chemotherapeutic treatment for BC.

Article: Predictors and survival benefit of achieving pentafecta in a contemporary series of open radical cystectomy - Minerva Urology and Nephrology 2021 Jun 22 - Minerva Medica - Journals

Background: To investigate the incidence, timing, and risk factors of venous thromboembolic events (VTE) following radical cystectomy and urinary diversion in a large cohort of patients. Patients and Methods: The electronic data base of patients underwent radical cystectomy and urinary diversion in a tertiary referral center between January 2004 and February 2014 was retrospectively reviewed. Patients developed VTE namely deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90 days after surgery were identified and compared to those without VTE. Univariate and multivariate analyses were used to evaluate the predictors of the VTE. Results: Out of 1737 patients, 77 VTE have occurred in 70 (4%) patients. DVT and PE occurred in 34 (2%) and 43 (2.5%) patients, respectively. PE was the leading cause of mortality in 17 patients. The median (range) time for VTE was 11 days (1–92) with 39 (50.6%) events developed after the stoppage of thrombo-prophylaxis. On multivariate analysis, older age ≥60 years (OR = 1.9; p = 0.009), female gender (OR = 1.9; p = 0.02), morbid obesity (BMI ≥35 kg/m²) (OR = 2.4; p = 0.008) and preoperative platelet count (≥300.000/cc) (OR = 1.6; p = 0.045) were significant predictors for developing VTE. Conclusion: The overall incidence of VTE is 4% with more than half of events occurred after the stoppage of thromboprophylaxis highlighting the necessity of adopting an extended protocol. Independent predictors included older age, female gender, morbid obesity and preoperative thrombocytosis. These group of patients require particular attention for the prevention of this complication.

Purpose: To investigate the efficacy and safety of flexible ureteroscopy with thulium fiber laser lithotripsy for management of renal staghorn stones. Materials and Methods: Thirty-two patients with staghorn stones were recruited. Stone characteristics including: width, length, volume and density were analyzed. Ablation speed, laser efficacy and laser activity were recorded. The primary outcome was to assess stone free rate after the procedure using spiral CT scan. Results: The median stone volume was 7339 (3183–53838) mm³. Median operative and lasing time were 135 (70–200) and 117 (50–180) minutes, respectively. The mean total energy delivered was 63.9 ± 30 KJ with a median ablation speed of 1.3 (0.5–4.9) mm³/sec. Mean laser efficacy was 7.5 ± 3.6 Joules/mm³. A total of 12 complications occurred in 8 patients (25%). The median hospital stay was 7 (3.5–48) hours and 30 patients (93.7%) were discharged on the same day of surgery. After the first session, seventeen patients (53%) were stone free with no residual fragments while six (19%) patients had residuals £ 2 mm. Nine patients (28%) had residuals > 2 mm with median residual size of 4 (3–9) mm. A second intervention was required in 4 cases.The overall stone free rate after completion of treatment was 65.6%. Conclusion: Flexible ureteroscopy with thulium fiber laser lithotripsy is a safe and effective treatment option for staghorn stones with stone free rate comparable to standard PCNL with advantages of minimal morbidity, minimal blood loss and shorter hospital stay.

Objective: To compare en-bloc HoLEP with conventional lobe-by-lobe (LBL) HoLEP technique in terms of surgical efficiency, perioperative outcomes, and early continence recovery through a randomized controlled trial. Patients and methods: This single-center randomized controlled trial included patients with prostate volume >80 mL undergoing HoLEP for bladder outlet obstruction secondary to benign prostatic hyperplasia. Eligible patients were randomized to either en-bloc or LBL HoLEP. All procedures incorporated early apical release and sphincteric mucosal preservation. Assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. primary outcome was enucleation efficiency (resected weight/enucleation time). Secondary outcomes included operative efficiency, laser energy use, blood loss, hospital stay, complications, and functional outcomes (IPSS, QoL, Qmax, PVR, and transient stress urinary incontinence [SUI]). Results: A total of 123 patients were randomized (en-bloc: 60; LBL: 63). En-bloc HoLEP was associated with shorter enucleation time (62.5 vs. 74.3 min, P  = 0.02), operative time (78.6 vs. 94.9 min, P  = 0.0007), and lower laser energy use (135 vs. 154 KJ, P  = 0.014). Enucleation efficiency was comparable (1.25 ± 0.49 vs. 1.17 ± 0.62 g/min; P  = 0.42). Both techniques resulted in significant postoperative improvements in IPSS, QoL, Qmax, and PVR (all P  < 0.0001). Complication rates were similar (14.6% vs. 14%; P  = 0.8). At 3 months, transient SUI rates were low and comparable (3.8% en-bloc vs. 4% LBL; P  = 0.3). Conclusion: En-bloc HoLEP reduces enucleation time, operative time, and laser energy consumption compared to LBL HoLEP, while maintaining comparable safety, efficacy, and early continence outcomes when performed with modern technical refinements.