Publications by authors named "Athanasios G Papatsoris"

90 Publications

The Impact of COVID-19 Disease on Urology Practice.

Surg J (N Y) 2021 Apr 3;7(2):e83-e91. Epub 2021 Jun 3.

Department of Urology/General Surgery, Areteion Hospital, Athens, Greece.

The diagnosis and timely treatment of cancer patients should not be compromised during an infectious disease pandemic. The pandemic of coronavirus disease 2019 (COVID-19) has serious implications on urology practice and raises particular questions for urologists about the management of different conditions. It was recommended to cancel most of the elective urological surgeries. Urological cancers surgeries that should be prioritized are radical cystectomy for selective tumors, orchiectomy for suspected testicular tumors, nephrectomy for c T3 + , nephroureterectomy for high-grade disease, and radical adrenalectomy for tumors >6 cm or adrenal carcinoma. Most prostatectomies can be delayed without compromising the survival rate of patients. Urological emergencies should be treated adequately even during this pandemic. There is a potential risk of coronavirus diffusion during minimally invasive procedures performed. It is crucial to use specific precautions when urologists performed those type of surgeries. It was also recommended to suspend the kidney transplantation program during the COVID-19 pandemic except for specific cases. In this review, we discussed the triage of urological surgeries, the risk of minimally invasive urological procedure, the kidney transplantation challenges, the systemic therapies, intravesical instillation of Bacillus Calmette-Guérin (BCG), endourology, teleconferencing, and telemedicine application in urology during the COVID-19 pandemic.
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http://dx.doi.org/10.1055/s-0041-1725155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175122PMC
April 2021

Perspectives on urological care in multiple sclerosis patients.

Intractable Rare Dis Res 2021 May;10(2):62-74

Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Lower urinary tract dysfunction due to MS includes a dysfunction of the storage phase or dysfunction of the voiding phase or a detrusor-sphincter dyssynergia. Baseline evaluation includes a voiding chart, an ultrasound scan of the urinary tract, urine culture, and an urodynamic study. For storage symptoms, antimuscarinics are the first-line treatment, and clean intermittent catheterization (CIC) is indicated if there is concomitant incomplete bladder emptying. Intradetrusor injections with botulinum toxin A (BTX-A), are recommended for refractory cases. Urinary diversion is rarely indicated. For patients with voiding symptoms, CIC and alpha-blockers are usually offered. Sexual dysfunction in patients with MS is multifactorial. Phosphodiesterase type 5 inhibitors are first-line therapies for MS-associated erectile dysfunction in both male and female patients. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic tests, and management of MS. Lastly, the urologic outcomes and therapies are reviewed.
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http://dx.doi.org/10.5582/irdr.2021.01029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122310PMC
May 2021

Green urine due to Pseudomonas urinary tract infection: An unusual occurence.

Am J Emerg Med 2021 Apr 5. Epub 2021 Apr 5.

Department of Urology/General Surgery, Areteion Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.ajem.2021.03.089DOI Listing
April 2021

Perspectives on urological care in spina bifida patients.

Intractable Rare Dis Res 2021 Feb;10(1):1-10

Department of Urology/General Surgery, Areteion Hospital, Athens, Greece.

Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed.
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http://dx.doi.org/10.5582/irdr.2020.03077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882087PMC
February 2021

Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization.

Neurourol Urodyn 2021 02 21;40(2):672-679. Epub 2021 Jan 21.

Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Aims: To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs.

Methods: We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients.

Results: After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation.

Conclusions: Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.
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http://dx.doi.org/10.1002/nau.24607DOI Listing
February 2021

Erectile dysfunction in common neurological conditions: A narrative review.

Arch Ital Urol Androl 2020 Dec 21;92(4). Epub 2020 Dec 21.

Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut.

Neurogenic erectile dysfunction (NED) can be defined as the inability to achieve or maintain an erection due to central or peripheral neurologic disease. Neurologic diseases can also affect the physical ability and psychological status of the patient. All these factors may lead to a primary or secondary NED. Medication history plays an important role since there are many drugs commonly used in neurologic patients that can lead to ED. The assessment of NED in these patients is generally evolving with the application of evoked potentials technology in the test of somatic and autonomic nerves, and functional magnetic resonance imaging. With the electrophysiological examinations, neurogenic causes can be determined. These tools allow to categorize neurologic lesion and assess the patient prognosis. The first-line treatment for NED is phosphodiesterase inhibitors. Second-line treatments include intracavernous and intraurethral vasoactive injections. Third-line treatments are penile prostheses. The efficacy and safety of each treatment modality depend on the specific neurologic condition. This review discusses the physiology, pathophysiology, diagnosis, and treatment of ED in multiple peripheral and central neurologic conditions, as well as for future research.
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http://dx.doi.org/10.4081/aiua.2020.4.371DOI Listing
December 2020

Novel anticancer therapy in BCG unresponsive non-muscle-invasive bladder cancer.

Expert Rev Anticancer Ther 2020 11 20;20(11):965-983. Epub 2020 Sep 20.

Head of Oncology Department, Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon.

Introduction: Many patients with non-muscle-invasive bladder cancer (NMIBC) failed intravesical BCG therapy. Currently, radical cystectomy is the recommended standard of care for those patients. There is unfortunately no effective other second-line therapy recommended.

Areas Covered: In this review, we present the topics of BCG unresponsive NMIBC; definition, prognosis, and further treatment options: immunotherapy, intravesical chemotherapy, gene therapy, and targeted individualized therapy.

Expert Opinion: There are major challenges of the management of NMIBC who failed BCG therapy as many patients refuse or are unfit for radical cystectomy. Multiple new modalities currently under investigation in ongoing clinical trials to better treat this category of patients. Immunotherapy, especially PD-1/PD-L1 inhibitors, offers exciting and potentially effective strategies for the treatment of BCG unresponsive NMIBC. As the data expands, it is sure that soon there will be established new guidelines for NMIBC.
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http://dx.doi.org/10.1080/14737140.2020.1822743DOI Listing
November 2020

Reply to correspondence: Intradermal sterile water injection for acute renal colic pain. MS 23569R1.

Am J Emerg Med 2021 05 28;43:275. Epub 2020 Jun 28.

Faculty of Medical Sciences, Department of Urology, Lebanese University, Beirut, Lebanon.

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http://dx.doi.org/10.1016/j.ajem.2020.06.049DOI Listing
May 2021

Seizure as the first manifestation of transitional cell carcinoma of the renal pelvis.

J Surg Case Rep 2020 Jul 14;2020(7):rjaa126. Epub 2020 Jul 14.

Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Upper tract urothelial carcinoma (UTUC) is a rare genitourinary entity of the renal pelvis and the ureter characterized by an aggressive behavior. Cisplatin-based chemotherapy is the first-line therapy of metastatic UTUC. However, a large number of patients with metastatic UTUC are considered ineligible for cisplatin. Immunotherapy emerged as a promising treatment in this setting. Brain metastasis from UTUC is unusual, occurring most often in the presence of systemic metastases. Local therapies such as stereotactic radiosurgery, neurosurgical resection and whole-brain radiotherapy (WBRT) remain the main therapeutic options for brain metastasis. We report a case of a 65-year-old male patient presenting with generalized tonic-clonic seizure. Imaging studies confirmed the presence of multiple brain metastasis. During an evaluation for the primary, he was found to be having metastatic UTUC of the renal pelvis. The brain metastases were treated by hippocampal sparing WBRT with minimal neurotoxicity. The primary tumor was treated by pembrolizumab.
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http://dx.doi.org/10.1093/jscr/rjaa126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365028PMC
July 2020

The authors reply: ISWI vs diclofenac for renal colic.

Am J Emerg Med 2020 09 22;38(9):1939. Epub 2020 May 22.

Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

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http://dx.doi.org/10.1016/j.ajem.2020.05.057DOI Listing
September 2020

Update on cystine stones: current and future concepts in treatment.

Intractable Rare Dis Res 2020 May;9(2):71-78

Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard. Gladbeck, Germany.

Cystine stones are relatively uncommon compared with other stone compositions, constituting just 1% to 2% of adult urinary tract stone diseases, and accounting for up to 10% of pediatric stone diseases. Two responsible genes of cystinuria have been identified, the SLC3A1 and the SLC7A9. Cystinuria is diagnosed by family history, stone analysis, or by measurement of urine cystine excretion. Current treatments for cystinuria include increased fluid intake to increase cystine solubility by maintaining daily urine volume of greater than 3 Liter (L). Limiting sodium and protein intake can decrease cystine excretion. When conservative therapy fails, then pharmacologic therapy may be effective. Alkaline urine pH in the 7.0-7.5 range will reduce cystine solubility and can be achieved by the addition of alkali therapy. If these measures fail, cystine-binding thiol drugs such as tiopronin and D-penicillamine are considered. These compounds bind cysteine and prevent the formation of less soluble cystine. These drugs, however, have poor patient compliance due to adverse effects. Captopril can be useful in the treatment of cystine stones but the drug has not been tested in rigorous clinical trials. Novel potential therapies such as alpha-lipoic acid and crystal growth inhibitors (L-cystine dimethyl ester (L-CDME) and L-cystine methyl ester (L-CME)) were developed and tested in animals. Those therapies showed promising results. Compliance with treatment was associated with a lower rate of cystine stone formation.
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http://dx.doi.org/10.5582/irdr.2020.03006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263987PMC
May 2020

Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial.

Am J Emerg Med 2021 06 29;44:395-400. Epub 2020 Apr 29.

Faculty of Medical Sciences, Department of Urology, Lebanese University, Beirut, Lebanon. Electronic address:

Objectives: We aimed to evaluate the efficacy of intracutaneous sterile water injection (ISWI) to relieve the pain of acute renal colic compared with diclofenac and placebo.

Methods: The study included 150 patients presented to the Emergency Department with renal colic randomized into 3 groups: control group received intracutaneous injections of 0.5 cm isotonic saline in the flank, group A received intracutaneous injections of 0.5 cm ISWI in the flank, and group B received an intramuscular injection of 75 mg Diclofenac in the gluteal region. The severity of the pain was assessed by a visual analogue scale system at baseline and 30, 45 min, and 60 min after injections. Subjects with inadequate pain relief at 1 h received rescue analgesia.

Results: The mean baseline pain score was 9.6 ± 0.61 in the ISWI group, 9.72 ± 0.64 in the diclofenac group and 9.26 ± 0.89 in the control group. The mean pain score at 30 min of the control group was reduced to 6.9 ± 1.56. This mean at 30 min after ISWI and diclofenac injections were reduced to 1.98 ± 1.41 and 1.88 ± 1.19 respectively. The mean of pain sore of the ISWI and diclofenac group at 45 and 60 min was constant. Rescue analgesics at 1 h were required by 47 patients receiving the saline injection and by 4 patients and by 7 patients receiving ISWI and diclofenac injection respectively.

Conclusions: ISWI and diclofenac were equally effective for the pain relief of acute renal colic.
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http://dx.doi.org/10.1016/j.ajem.2020.04.079DOI Listing
June 2021

Management of stent-related symptoms with the use of α-blockers: A meta-analysis.

Arab J Urol 2020 14;18(1):14-21. Epub 2019 Nov 14.

1st Department of Urology, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

: To assess the effectiveness of α-blockers at reducing stent-related morbidity compared to placebo using the Ureteric Symptom Score questionnaire (USSQ) at particular time points as originally set by the developers of the USSQ. : We conducted the study following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Eligible articles were identified by a search of the Medical Literature Analysis and Retrieval System Online (MEDLINE) database for the period from 1 January 2006 to 30 November 2018. The search strategy included specific keywords and only articles in English were considered eligible. A meta-analysis of randomised controlled trials was done according to methodological quality, placebo-control use, and USSQ completion at the time points of 1 and 4 weeks after insertion, and 4 weeks after stent removal. The mean differences with 95% confidence intervals were calculated for outcomes, with a  < 0.05 considered statistically significant. : In all, eight papers were included for analysis. At 1 week after stent insertion, α-blockers were associated with a significant decrease in the USSQ Urinary Index score (UIS), Pain Index score, General Health Index score (GHIS), Sex Index score, and Work Index score (WIS). At 4 weeks after stent insertion, α-blockers were associated with a significant decrease in the UIS, GHIS and WIS only, whilst at 4 weeks after stent removal, α-blockers were associated with a significant decrease in the UIS and GHIS. : The oral administration of α-blockers or their combinations have been shown to relieve stent morbidity, especially during the early period of stenting. The use of selective agents can therefore be considered; however, there is still the need for uniformly designed multi-centre randomised studies. MD: mean difference; QoL: quality of life; RCT: randomised controlled trial; SRS: stent-related symptoms; USSQ: Ureteric Symptom Score questionnaire.
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http://dx.doi.org/10.1080/2090598X.2019.1690824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006658PMC
November 2019

Risk for Venous Thromboembolic Events in Patients With Advanced Urinary Tract Cancer Treated With First-Line Chemotherapy.

Clin Genitourin Cancer 2020 08 8;18(4):e457-e472. Epub 2020 Jan 8.

Hematology-Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background: Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs.

Patients And Methods: Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed.

Results: A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score.

Conclusion: Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group.
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http://dx.doi.org/10.1016/j.clgc.2019.12.021DOI Listing
August 2020

Established and recent developments in the pharmacological management of urolithiasis: an overview of the current treatment armamentarium.

Expert Opin Pharmacother 2020 Jan 12;21(1):85-96. Epub 2019 Nov 12.

Department of Urology, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon.

: Urolithiasis is a common, highly recurrent disease with increasing prevalence worldwide. There are many dietary and pharmacological measures to prevent kidney stones.: Herein, the authors explore medical expulsive therapy as well as pharmacological therapies to prevent/treat urolithiasis.: All stone formers should be advised to increase their fluid intake sufficiently to achieve a urine volume of at least 2.5 L/day. In the case of hypercalciuria, a thiazide diuretic should be prescribed while in cases of hypocitraturia, potassium citrate should be given. In the case of hyperoxaluria, the treatment depends on the type of hyperoxaluria. Pyridoxine or calcium supplements with a meal can be offered. For uric acid stone formers, alkali therapy is the standard of care whereas allopurinol can be beneficial in hyperuricosuric stone formers. For cystine stone formers, increased fluid intake, restriction of sodium and animal protein ingestion, and urinary alkalinization are the standard therapies used. Cystine binding thiol drugs such as tiopronin and D-penicillamine are reserved for patients where a conservative approach fails. For struvite stone formers, optimal management is the complete stone removal. Acetohydroxamic acid may be offered only after surgical options have been exhausted, for patients with residual stones but it has many side effects.
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http://dx.doi.org/10.1080/14656566.2019.1685979DOI Listing
January 2020

The efficacy and safety of string stents after retrograde intrarenal surgery for urolithiasis.

Minerva Urol Nefrol 2020 Aug 7;72(4):451-463. Epub 2019 May 7.

Second Department of Urology, Sismanoglio General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Introduction: Ureteral stent insertion is frequently chosen after upper tract endourological procedures. The use of stents carrying a suture string is sometimes used to facilitate the extraction of the stent. In this systematic review and meta-analysis, we aimed to provide stronger evidence for the efficacy of string stents, by comparing them to non-string stents, in matters of patients' quality of life (QoL), stent-related symptoms (SRS) and complications.

Evidence Acquisition: A systematic review was conducted on PubMed, SCOPUS, Cochrane, EMBASE and Web of Science. The studies included were only comparative randomized controlled trials which included at least one group with tethered ureteral stent and one group with standard stent after the performance of endoscopic surgery for lithiasis of upper urinary tract. Primary endpoints were QoL expressed as general health, urinary symptoms as well as impact on work performance and SRS, expressed by VAS score. Secondary endpoints included complications such as stent migration, stent dislodgement, urinary tract infections (UTIs), emergency room visits and retained stent.

Evidence Synthesis: We identified nine studies to be included in the qualitative synthesis and 3 randomized controlled trials to be included in the quantitative synthesis and the meta-analysis. The statistical difference in the stent related QoL was insignificant. General health was less affected in the non-string group. The urinary symptoms and the impact on work performance were similar between the groups. VAS pain score during the time that the patients were stented was insignificantly less in the non-string group, while VAS pain score was higher in the non-string group at extraction. Stent dislodgement was more frequent in the string group. There was no difference between the groups concerning the rate of UTIs.

Conclusions: Non-string stents affected less the patients' QoL, in terms of general health and urinary symptoms, caused less stent related pain in cases of stent in situ and caused stent dislodgment in fewer patients. On the contrary, string stents caused less pain at extraction. All the aforementioned differences did not reach statistical difference.
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http://dx.doi.org/10.23736/S0393-2249.19.03426-XDOI Listing
August 2020

Is there an effective therapy of interstitial cystitis/bladder pain syndrome?

Expert Opin Pharmacother 2019 08 9;20(12):1417-1419. Epub 2019 May 9.

2nd Department of Urology, Sismanogleion General Hospital, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece.

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http://dx.doi.org/10.1080/14656566.2019.1615056DOI Listing
August 2019

Management of advanced prostate cancer: A systematic review of existing guidelines and recommendations.

Cancer Treat Rev 2019 Feb 1;73:54-61. Epub 2018 Dec 1.

2nd Department of Urology, National and Kapodistrian University of Athens, School of Medicine, Sismanoglio Hospital, Athens, Greece.

The therapeutic landscape of advanced prostate cancer is continuously changing under the light of new available treatment options and the improved understanding of the molecular characteristics of the disease. The lack of high quality evidence regarding the sequencing of these treatments along with the earlier implementation of these therapeutic approaches during the course of the disease have created issues of dispute regarding the optimal treatment of patients with advanced prostate cancer. Therefore, we conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and present a comprehensive analysis of the available treatment options in each of the stages of advanced prostate cancer, as well as the supportive treatments available for these patients.
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http://dx.doi.org/10.1016/j.ctrv.2018.11.005DOI Listing
February 2019

Is there an appropriate strategy for treating co-morbid irritable bowel syndrome and bladder pain syndrome?

Expert Opin Pharmacother 2019 Mar 27;20(4):411-414. Epub 2018 Dec 27.

g Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS) , Tehran University of Medical Sciences , Tehran , Iran.

Introduction: Two of the most frequent components of chronic pelvic pain syndrome (CPPS) are irritable bowel syndrome (IBS) and bladder pain syndrome (BPS), characterized by considerable overlapping symptoms and pathophysiology. Currently, its management is challenging meaning there is high the demand for novel efficient therapeutics to aid patient care and to tackle the socioeconomic burden of IBS and BPS. As there are presently no sufficient treatment strategies, identifying the mechanisms that result in their main symptoms is the opportunity for developing appropriate therapies. Areas covered: Herein, the authors explore the potential common treatment strategies for co-morbid IBS and BPS and highlight the absolute need for further research of these deliberating clinical entities. Expert opinion: In the future, the authors summise that the discovery of predictive molecular biomarkers combined with clinical phenotypic categorization will likely allow for more definitive differentiation of patients and thus for better treatment options. Furthermore, it has been suggested that effective IBS treatment strategies would be of great value to co-morbid IBS and BPS therapy.
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http://dx.doi.org/10.1080/14656566.2018.1559821DOI Listing
March 2019

Perspectives on the current and emerging chemical androgen receptor antagonists for the treatment of prostate cancer.

Expert Opin Pharmacother 2019 Feb 21;20(2):163-172. Epub 2018 Nov 21.

c 2nd Department of Urology, Sismanogleion General Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece.

Introduction:  Prostate cancer is the most common cancer in men. Regardless of the initial treatment of localized disease, almost all patients develop castration resistant prostate cancer (CRPC). A better understanding of the molecular mechanisms behind castration resistance has led to the approval of novel oral androgen receptor (AR) antagonists, such as enzalutamide and apalutamide. Indeed, research has accelerated with numerous agents being studied for the management of CRPC. Areas covered: Herein, the authors present currently used and emerging AR antagonists for the treatment of CRPC. Emerging agents include darolutamide, EZN-4176, AZD-3514, and AZD-5312, apatorsen, galeterone, ODM-2014, TRC-253, BMS-641988, and proxalutamide. Expert opinion: Further understanding of the mechanisms leading to castration resistance in prostate cancer can reveal potential targets for the development of novel AR antagonists. Current novel agents are associated with modest clinical and survival benefit, while acquired resistance and safety issues are under continuous evaluation. The combination of AR antagonists used and ideal sequencing strategies are key tasks ahead, along with the investigation of molecular biomarkers for future personalized targeted therapies. In the future, the challenge will be to determine an AR antagonist with the best combination of outcome and tolerability.
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http://dx.doi.org/10.1080/14656566.2018.1548611DOI Listing
February 2019

Bridging pharmacotherapy and minimally invasive surgery in interstitial cystitis/bladder pain syndrome treatment.

Expert Opin Pharmacother 2018 Aug 3;19(12):1369-1373. Epub 2018 Aug 3.

c 2nd Department of Urology, Sismanogleion General Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece.

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a painful and debilitating clinical entity which is challenging to diagnose and even more difficult to treat. Unfortunately, none of the existing oral and intravesical medications have been established as effective and therefore relevant research is ongoing. Areas covered: In this review, the authors present established and emerging treatment options for IC/BPS in terms of medication and minimal invasive procedures. Both American and European Urological Association Guidelines recommend multimodal behavioral techniques alongside oral (e.g. amitriptyline and pentosan polysulfate sodium) or minimally invasive treatments (e.g. dimethyl sulfoxide, botulinum toxin, chondroitin sulfate, triamcinolone, hyaluronic acid, and lidocaine). Novel treatment modalities include immunomodulating drugs, stem cell therapy, nerve growth factor, and ASP6294. Expert opinion: IC/BPS is still a pathophysiological enigma with multifactorial etiopathogenesis that may be controlled but not completely cured. Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy. Combined phenotypic categorization with specific biomarkers could help toward better treatment.
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http://dx.doi.org/10.1080/14656566.2018.1505865DOI Listing
August 2018

Paraffinoma, siliconoma and Co: Disastrous consequences of failed penile augmentation-A single-centre successful surgical management of a challenging entity.

Andrologia 2018 Dec 11;50(10):e13109. Epub 2018 Jul 11.

2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

The purpose of this study was to present our series of patients with disastrous consequences of failed penile self-augmentation and suggested surgical reconstruction. Ten patients with median age of 23 years and a variety of penile and scrotal deformities due to injections of several substances had undergone successful surgical reconstruction of external genitalia. The injections were self-performed in nine cases and the patients reported from 4 to 20 substance injections throughout the penile shaft. Three patients presented with fibrotic scirrhous masses in their scrotum, although they did not report any injections in scrotal area. All patients underwent extended penile-shaft skin excision, while all palpable scrotal lesions were removed in one-by-one fashion, as an attempt to destroy the less possible scrotal tissue. All patients were discharged on first post-operative day and reassessed at 2 months post-operatively. As a result, penile self-augmentation with injected substances may cause severe complications. Our proposed single-staged procedure seems safe and effective.
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http://dx.doi.org/10.1111/and.13109DOI Listing
December 2018

Apalutamide: the established and emerging roles in the treatment of advanced prostate cancer.

Expert Opin Investig Drugs 2018 Jun 18;27(6):553-559. Epub 2018 Jun 18.

c 2nd Department of Urology, Sismanoglio General Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece.

Introduction: Prostate cancer (PCa) is the most common cancer in elderly males. Androgen deprivation therapy (ADT) is still the cornerstone of initial treatment; however, the vast majority of patients develop castration-resistant prostate cancer (CRPC). Several studies with numerous androgen receptor (AR)-directed agents have emerged since the approval of abiraterone acetate and enzalutamide. One of these agents is apalutamide, which seems to be a promising AR antagonist for the treatment of CRPC. Areas covered: The authors review Phase I, II, and III studies for apalutamide, in a large spectrum of PCa (from low-risk to metastatic CRPC [mCRPC]) patients as sole treatment or in the setting of combined therapy. Expert opinion: Apalutamide is an oral, investigational, AR antagonist that targets the AR ligand-binding domain and prevents AR nuclear translocation, DNA binding, and transcription of AR gene targets. It has shown favorable safety profile and therapeutic index in Phase I studies, good tolerance and efficacy in patients with high-risk CRPC in Phase II studies. Also, results were promising in a recent phase III study in patients with non-mCRPC who were at high risk for the development of metastasis. These data may offer potential advantages over the second-generation antiandrogens.
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http://dx.doi.org/10.1080/13543784.2018.1484107DOI Listing
June 2018

The Impact of Technique Standardization on Total Operating and Fluoroscopy Times in Simple Endourological Procedures: A Prospective Study.

J Endourol 2018 08 2;32(8):747-752. Epub 2018 Jul 2.

2 2nd Department of Urology, Sismanogleion Hospital, School of Medicine, National and Kapodistrian University of Athens , Maroussi, Greece .

Purpose: To present the positive impact of technique standardization on successful outcome, fluoroscopy, and total operating time (TOT) shortening in a prospective study.

Methods: Six experienced endourologists participated. To assess whether the adaptation of standardized surgical steps improved their methodology with time, 253 patients were prospectively divided in three consecutive 1-month groups. Patients underwent stent placement and exchange and total operating and fluoroscopy times (FTs) were recorded. All surgeons were unaware of their mean recorded results until the end of the study. At the end of the third month, we evaluated if the suggested technique standardization established a decrease for both FT and TOT. Statistical significance was set to p < 0.05.

Results: Total operating and FTs were significantly reduced with time between all groups of patients. For stent placement, TOT showed significant reduction between Groups A and C (p < 0.001), while between other group comparisons did not reach significance. FT showed a significant reduction (p < 0.001) in all group comparisons. For stent exchange, TOT reached significant improvement (p = 0.003) between Groups A and C, whereas between other groups was insignificant. FT improvement was significant between Groups A and C (p < 0.001) and Groups B and C (p < 0.001), but insignificant between Groups A and B.

Conclusions: Even in experienced hands, the adaptation of technique standardization results in significant decrease of total operating and FTs and it is independent from feedback regarding their time performance.
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http://dx.doi.org/10.1089/end.2018.0265DOI Listing
August 2018

Tamsulosin, Solifenacin, and Their Combination for the Treatment of Stent-Related Symptoms: A Randomized Controlled Study.

J Endourol 2017 01 29;31(1):100-109. Epub 2016 Nov 29.

2 Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens , Maroussi, Greece .

Purpose: To properly use the Ureteric Symptom Score Questionnaire (USSQ) to evaluate, in a randomized control study, the effect of tamsulosin, solifenacin, and their combination in improving symptoms and quality of life in patients with indwelling ureteral stents.

Materials And Methods: After institutional review board approval, 260 patients with a ureteral stent were randomly assigned to receive tamsulosin 0.4 mg, solifenacin 5 mg, or placebo and further randomized to receive their combination. The validated USSQ was completed 1 and 4 weeks after stent insertion and 4 weeks after stent removal. Kruskal-Wallis test, chi-squared test (or Fisher's exact test), one-way analysis of variance, and T-test (or Wilcoxon rank-sum test if not normal data) were used for statistical analysis. The results were considered significant at p < 0.05.

Results: Patients receiving tamsulosin or solifenacin expressed significantly lower urinary (p < 0.001), pain (p < 0.001 with stent in situ), and general health index (p = 0.002 in first and p < 0.001 in fourth week with stent in situ) scores. Sexual life and quality of work were also positively influenced. Patients on combination therapy expressed lower urinary (p < 0.001) and pain (p < 0.001) scores in the fourth week with stent in situ and work performance in the first week and with stent in situ (p = 0.001) and after stent removal (p = 0.005). No patients had to discontinue medication due to side effects.

Conclusions: Stent-related morbidity is a reality in the majority of patients. Simple medication, such as tamsulosin and solifenacin alone or in combination, improves stent-related symptoms and has a positive impact on quality of life.
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http://dx.doi.org/10.1089/end.2016.0663DOI Listing
January 2017

Phase I and II therapies targeting the androgen receptor for the treatment of castration resistant prostate cancer.

Expert Opin Investig Drugs 2016 Jun 22;25(6):697-707. Epub 2016 Mar 22.

a University Department of Urology , Sismanoglio Hospital , Athens , Greece.

Introduction: Prostate cancer is the most common cancer in elderly males. Regardless of the initial hormonal treatment in metastatic disease, a significant proportion of patients develop castration resistant prostate cancer (CRPC). A better understanding of the molecular mechanisms behind castration resistance has led to the approval of oral medications such as abiraterone acetate and enzalutamide. Relevant research is accelerated with numerous agents being tested for the management of CRPC.

Areas Covered: The authors present Phase I and II studies targeting the androgen receptor for the treatment of CRPC. Three groups of agents are identified according to the mechanism of action. These include the CYP-17 modulators (Orteronel, Galeterone, VT-464 and CFG-920), novel antiandrogens (Apatorsen, ARN-509, ODM-201, EZN-4176, AZD-3514) and bipolar androgen therapy.

Expert Opinion: Further understanding of the mechanisms leading to castration resistance in prostate cancer can reveal potential targets for the development of novel anti-cancer agents. Except for the development of novel antiandrogens and CYP-17 modulators, bipolar androgen therapy is an interesting therapeutic approach. The combinations of the novel agents tested in Phase I and II studies with established agents is another field of interest. The real challenge is to distinguish a novel anti-cancer agent with acceptable tolerability and the best outcome.
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http://dx.doi.org/10.1517/13543784.2016.1162784DOI Listing
June 2016

Intravesical treatment of bladder pain syndrome/interstitial cystitis: from the conventional regimens to the novel botulinum toxin injections.

Expert Opin Investig Drugs 2014 Jun 22;23(6):751-7. Epub 2014 Apr 22.

University of Athens, Areteion Hospital, 2nd Department of Surgery , Athens , Greece.

Introduction: Bladder pain syndrome (BPS) includes interstitial cystitis (IC) and is often used as a synonym of it (i.e., BPS/IC). It is associated with lower urinary tract symptoms as well as with negative cognitive, behavioral, sexual and/or emotional consequences. Unfortunately, none of the numerous existing oral and intravesical treatments have been effective for all of the BPS subtypes and therefore relevant research is ongoing.

Areas Covered: In this review, the authors analyze the existing literature for the intravesical treatment of BPS/IC with focus on the novel administration of botulinum toxin (BTX). Several intravesical drugs have been studied in the past, including lidocaine, heparin, pentosan polysulfate sodium, dimethyl sulfoxide, chondroitin sulfate, hyaluronic acid as well as investigational drugs such as GM-0111. Recently, intravesical submucosal injections of BTX have been studied in patients with BPS/IC.

Expert Opinion: Most of the recent studies use BTX-A with no serious adverse effects and with satisfactory results in patients who do not respond to oral or standard intravesical therapy. Nevertheless, there is no consensus regarding the best dosage scheme of BTX, the injection sites and the treatment intervals. BTX intravesical administration in patients with BPS/IC is a safe and efficient treatment option; yet the level of evidence of the initial studies is not high. There is still the need for large randomized controlled studies so that a consensus can be reached for the ideal BTX dosage, injection sites and intervals between treatments.
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http://dx.doi.org/10.1517/13543784.2014.909406DOI Listing
June 2014

Modified S-ileal neobladder for continent urinary diversion: functional and urodynamic results after 20 years of follow-up.

Urol Int 2014 9;93(1):43-8. Epub 2014 Apr 9.

2nd Department of Surgery, Aretaieion Hospital, University of Athens, Athens, Greece.

Objective: To report continence and urodynamic findings after radical cystectomy and urinary diversion with modified S-ileal neobladder between January 1993 and January 2013.

Patients And Methods: 181 patients were enrolled. Continence status, reservoir sensation, compliance, capacity and activity were assessed.

Results: Daytime continence was reported by 88.0, 98.4 and 99.2%, while nighttime continence was reported by 70.2, 94.0 and 95.8% of our patients at 6 months, 5 years and 20 years, respectively. Enterocystometric capacity and maximum reservoir pressure were 366 vs. 405 ml and 502 ml, and 29 vs. 18 and 11 cm H2O, at 6 months, 5 years and 20 years, respectively. Median post-void residual urine volume was 32 ml at 6 months, 50 ml at 5 years and 120 ml at 20 years.

Conclusions: The modified S-ileal neobladder technique has a very good long-lasting functional outcome, with high day- and nighttime continence levels as well as high acceptability rates from our patients.
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http://dx.doi.org/10.1159/000356283DOI Listing
April 2015

Why should I do research? Is it a waste of time?

Arab J Urol 2014 Mar 17;12(1):68-70. Epub 2013 Sep 17.

2nd Department of Urology, Sismanogleion Hospital, University of Athens, Greece.

Objectives: To answer the questions 'Why should I do research? Is it a waste of time?' and present relevant issues.

Methods: Medline was used to identify relevant articles published from 2000 to 2013, using the following keywords 'medicine', 'research', 'purpose', 'study', 'trial', 'urology'.

Results: Research is the most important activity to achieve scientific progress. Although it is an easy process on a theoretical basis, practically it is a laborious process, and full commitment and dedication are of paramount importance. Currently, given that the financial crisis has a key influence in daily practice, the need to stress the real purpose of research is crucial.

Conclusion: Research is necessary and not a waste of time. Efforts to improving medical knowledge should be continuous.
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http://dx.doi.org/10.1016/j.aju.2013.08.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434536PMC
March 2014

The economics of abiraterone acetate for castration-resistant prostate cancer.

Expert Rev Pharmacoecon Outcomes Res 2014 Apr 25;14(2):175-9. Epub 2014 Feb 25.

University Department of Urology, Sismanoglio General Hospital, Athens, Greece.

Abiraterone acetate is an oral medication that has recently been granted approval for the treatment of metastatic castration resistant prostate cancer (mCRPC) prior and/or after chemotherapy with docetaxel. In this article we assess the economics of abiraterone acetate in mCRPC. Relevant studies demonstrated that abiraterone acetate had a minimal budget impact on health plans. A relevant advantage was the cost savings due to the lack of chemotherapy-related side effects as well as the ease of administration. The results of cost/benefit comparative studies with other novel agents (i.e. cabazitaxel, enzalutamide, sipuleucel-T) are warranted as well as the close collaboration between urologists and medical oncologists.
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http://dx.doi.org/10.1586/14737167.2014.891444DOI Listing
April 2014
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