Background: Prostate cancer (PCa) is the second most frequent cause of cancer-related death in men worldwide. It is a heterogeneous disease at molecular and clinical levels which makes its prognosis and treatment outcome hard to predict. The epithelial-to-mesenchymal transition (EMT) marks a key step in the invasion and malignant progression of PCa. We sought to assess the co-expression of epithelial cytokeratin 8 (CK8) and mesenchymal vimentin (Vim) in locally-advanced PCa as indicators of EMT and consequently predictors of the progression status of the disease. Methods: Co-expression of CK8 and Vim was evaluated by immunofluorescence (IF) on paraffin-embedded tissue sections of 122 patients with PCa who underwent radical prostatectomies between 1998 and 2016 at the American University of Beirut Medical Center (AUBMC). EMT score was calculated accordingly and then correlated with the patients' clinicopathological parameters and PSA failure. Results: The co-expression of CK8/Vim (EMT score), was associated with increasing Gleason group. A highly significant linear association was detected wherein higher Gleason group was associated with higher mean EMT score. In addition, the median estimated biochemical recurrence-free survival for patients with <25% EMT score was almost double that of patients with more than 25%. The validity of this score for prediction of prognosis was further demonstrated using cox regression model. Our data also confirmed that the EMT score can predict PSA failure irrespective of Gleason group, pathological stage, or surgical margins. Conclusion: This study suggests that assessment of molecular markers of EMT, particularly CK8 and Vim, in radical prostatectomy specimens, in addition to conventional clinicopathological prognostic parameters, can aid in the development of a novel system for predicting the prognosis of locally-advanced PCa.

Inflammation is a critical component of tumorigenesis, and many cancers arise from sites of infection, chronic irritation, and inflammation. Inflammatory cytokines triggered by tumors alter hematologic components, including neutrophil, lymphocyte, and monocyte counts. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios have been shown to be valuable prognostic markers in various types of cancers, including bladder cancer. Risk stratification based on clinicopathologic data is insufficient to support treatment-related choices in patients with bladder cancer. Novel prognostic markers are therefore needed. An elevated pretreatment lymphocyte-to-monocyte ratio (LMR) is reportedly associated with improved overall survival (OS) and a longer time to treatment recurrence (TTR) in some types of cancers. However, these data are lacking in patients with bladder cancer. The aim of the present study was to investigate the effect of the preoperative LMR on OS and TTR in a cohort of patients with bladder cancer.

Purpose: Several case series have demonstrated the safety and feasibility of outpatient robot-assisted radical prostatectomy (RARP) in well-selected patients; however, the patient perspective of this practice has not been well explored. In this study, we explored patients' perspectives on the potential barriers and benefits of outpatient RARP. Materials and Methods: We developed a multidimensional questionnaire to assess socioeconomic status, presence of caretaker at home, preferred transportation to the emergency room in case of chest pain or postsurgical complications, readiness for discharge at postanesthesia care unit (PACU), and potential barriers for discharge. In addition, patients were asked to provide an estimate of overnight hospitalization costs and their willingness to pay out-of-pocket expenses for their overnight stay. Patients who underwent RARP between August 1, 2018, and April 30, 2019, were asked to fill the questionnaire within the first week following their operation. Results: During our study, 157/292 (53.8%) of men undergoing RARP from a single high-volume robotic surgeon completed the survey. Patients who completed <80% of the survey ( n = 5) were excluded from the final analysis. Thirty-seven (24.3%) patients felt that they would have been ready for discharge immediately from PACU, and 48 (31.6%) patients after extended recovery and before midnight. Only 17.8% ( n = 27) of the patients claim that they experienced a medical intervention in the hospital that could not have been managed at home. The main barriers for same-day discharge were pain (55.9%, 80/143), catheter discomfort (44.7%, 64/143), insufficient education about catheter care (31.4%, 45/143), postoperative nausea and vomiting (15.3%, 22/143), and medical complications (13.2%, 19/143). Conclusions: Two-thirds of patients following RARP did not feel ready to be discharged on the day of their surgery. Further research is necessary to identify patients who may benefit from this approach to reduce health care costs while minimizing patient postoperative morbidity.

Background Several centers have reported their experience with single-port robotic partial nephrectomy (SP-RAPN) however, it is uncertain if utilization of this platform represents an improvement in outcomes as compared to multiport robot-assisted partial nephrectomy (MP-RAPN). To evaluate this, we performed a meta-analysis to compare the perioperative, oncological, and functional outcomes between SP-RAPN and MP-RAPN. Methods For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 1, 2023. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The odds ratio (OR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results Of the 374 retrieved abstracts, eight studies were included in the final analysis, comprising a total cohort of 1,007 cases of robot-assisted partial nephrectomy (453 SP-RAPN cases and 554 MP-RAPN cases). Compared to MP-RARP, the SP-RAPN group had a significantly longer ischemia time (MD = 4.6 minutes, 95% CI 2.8 to 6.3, p<0.001), less estimated blood loss (MD = -12.4 mL, 95% CI -24.6 to -0.3, p=0.045), higher blood transfusion rate (OR = 2.97, 95% CI 1.33 to 6.65, p=0.008), and higher postoperative eGFR at 6 months (MD = 4.9 mL/min, 95% CI 0.2 to 9.7, p=0.04). There were no significant differences in other outcomes between the two approaches, including the intraoperative complication, minor postoperative complication (Clavien-Dindo I-II), major postoperative complication (Clavien-Dindo III-V), conversion to radical nephrectomy, pain score at day #1, pain score on discharge, morphine milligram equivalent (MME) usage, hospital stay, positive surgical margins and postoperative eGFR. Conclusions Initial studies have demonstrated that SP-RAPN is a safe and feasible approach to performing partial nephrectomy, albeit with inferior outcomes for ischemia time and blood transfusion rates.

Introduction: Renal solitary fibrous tumors (SFTs) are spindle cell neoplasms of mesenchymal origin, and very rare with only 46 cases reported worldwide to date. It is crucial to differentiate this tumor from other tumors of the kidney, so as to avoid unnecessary treatment. Therefore, our objective was to review reports of renal SFTs, their clinical presentations, imaging methods, and surgical management, updated to 2013. Material and Methods: We retrospectively reviewed articles published in the USA, Europe, and Asia from 1996 to date using PubMed, Medscape, Medline, and several major journals. We report on areas of controversy and well-established guidelines. Results: We reviewed 58 articles which confirmed, with a high level of evidence-based medicine, that the male-to-female ratio is equal and their most common presentation is an incidental finding on a radiological study, in which it is difficult to differentiate them from renal cell carcinoma. Nephrectomy is the gold standard treatment, with almost no recurrence. Conclusions: In symptomatic patients, complete surgical resection of renal SFTs may provide a very good outcome, with almost no recurrence.

Percutaneous Nephrolithotomy is the standard surgical procedure used to remove large kidney stones. PCNL procedures have a steep learning curve; a physician needs to complete between 36 and 60 procedures, to achieve clinical proficiency. Marion Surgical K181 is a virtual reality surgical simulator, which emulates the PCNL procedures without compromising the well-being of patients. The simulator uses a VR headset to place a user in a realistic and immersive operating theater, and haptic force-feedback robots to render physical interactions between surgical tools and the virtual patient. The simulator has two modules for two different aspects of PCNL kidney stone removal procedure: kidney access module where the user must insert a needle into the kidney of the patient, and a kidney stone removal module where the user removes the individual stones from the organ. In this paper, we present user trials to validate the face and construct validity of the simulator. The results, based on the data gathered from 4 groups of users independently, indicate that Marion's surgical simulator is a useful tool for teaching and practicing PCNL procedures. The kidney stone removal module of the simulator has proven construct validity by identifying the skill level of different users based on their tool path. We plan to continue evaluating the simulator with a larger sample of users to reinforce our findings.