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Existing compilations of data recorded in clinical trials involving cytokines as single compounds and in combination with each other and with cellular immuno-effectors or chemotherapeutic agents are analyzed. Antitumor activity for interferon alpha (IFN-α) and for interleukin-2 (IL-2) could be established at 14.5% and 13.7%, respectively, when used in single-agent regimens with considerable toxicity for IL-2 at high, intravenous doses. When IL-2 is combined with cellular effectors, these side effects together with the problems associated with the complexity of culture techniques when adding LAK (lymphokine-activated killer) cells or CTILs (cytotoxic tumor-infiltrating lymphocytes) impact unfavorably on future clinical application, and this combination must be considered investigational. IFN-α or IL-2 coupled with a chemotherapeutic agent only exhibited a limited advantage over single cytokine administration. The most promising combination seems to be IFN-α combined with IL-2, giving improved prospects for nearly 30% of the patients with metastatic renal cell cancer (RCC), simultaneously allowing for significant reduction of toxicity and for an outpatient treatment. A precise assessment of the underlying immunologic mechanisms is needed, as are controlled prospective and randomized trials comparing the various cytokines with each other and with conventional approaches in single and combination regimens with the ultimate purpose of defining the role of biotherapy within a clinical strategy for metastatic RCC before it can be considered a standard treatment modality.

Radical cystectomy (RC) is currently the standard of care for non-metastatic muscle invasive bladder cancer. Few studies compare methods of cutaneous continent urinary diversion (CCUD) following RC. The objective was to compare perioperative morbidity and functional outcomes of CCUD using an ileal pouch with a Mitrofanoff efferent versus a Miami ileocolic pouch in patients undergoing cystectomy of pelvic exenteration for bladder cancer. This retrospective two-centre study included all consecutive patients who underwent radical cystectomy or pelvic exenteration with CCUD for bladder cancer between 2001 and 2020 in two academic French hospitals with a median follow-up time of 5.4 years. Patients were divided into two groups according to the type of urinary diversion: Miami ileocolonic pouch (group A) and ileal pouch with Mitrofanoff/Monti principle (group B). Continence rate, ability to perform intermittent self-catheterisation, complications and health-related quality of life (HRQoL) measured by the bladder cancer index were evaluated. Thirty-one patients were included. Continence was achieved in 11 out of 14 patients (79%) in group A versus 12 out of 17 patients (71%) in group B (P = 0.3). A significantly higher rate of cutaneous tube stenosis was reported in group B compared to group A (eight (47%) vs. one (7%) patient, respectively; P = 0.02). HRQoL outcomes were similar in both groups except less digestive discomfort observed in group A. When comparing the ileal pouch with Mitrofanoff/Monti’s principle with a Miami pouch, no significant differences were found regarding continence rate, ability to self-catheterise, long-term complication rate and overall patient satisfaction.

In this prospective study a comparison of 4-versus 7-MHz transrectal ultrasonography for the detection of prostatic carcinoma is reported. A total of 150 prostates were biopsied due to suspicion of malignancy arising at either digital rectal examination, 4- and/or 7-MHz transrectal ultrasonography, or elevated serum prostate-specific antigen levels. Malignancies of the prostate were detected in 68 of the 147 eligible biopsy core specimens. The results show only marginal differences in the sensitivity, specificity, and predictive values for the two transducers.

The past decade has seen a better understanding of the physiology of erection and the pathophysiology of impotence as a result of considerable innovative research. These advances also introduce a new era in the diagnosis and treatment of impotence. Many functional tests and effective medical and surgical treatments are now available. With the sudden explosion of these many tests and therapies, clinicians are often confronted by questions such as: What constitues an adequate workup? What is the treatment of choice of arteriogenic impotence? Is nocturnal penile tumescence testing necessary? Is penile arteriography necessary? Over the past several years, the author has been using a patient's goal-directed approach to the diagnosis and treatment of impotence. This approach is based on (1) the most recent advances of diagnostic technique and therapy of impotence and (2) the patient's physical and mental health, motivation, and goal. This article briefly summarizes this practical patient's goal-directed management of impotence.

To assess the performance of prostate health index (PHI) and prostate cancer antigen 3 (PCA3) when added to the PRIAS or Epstein criteria in predicting the presence of pathologically insignificant prostate cancer (IPCa) in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS). An observational retrospective study was performed in 188 PCa patients treated with laparoscopic or robot-assisted RP but eligible for AS according to Epstein or PRIAS criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements. Multivariate logistic regression analyses and decision curve analysis were carried out to identify predictors of IPCa using the updated ERSPC definition. At the multivariate analyses, the inclusion of both PCA3 and PHI significantly increased the accuracy of the Epstein multivariate model in predicting IPCa with an increase of 17 % (AUC = 0.77) and of 32 % (AUC = 0.92), respectively. The inclusion of both PCA3 and PHI also increased the predictive accuracy of the PRIAS multivariate model with an increase of 29 % (AUC = 0.87) and of 39 % (AUC = 0.97), respectively. DCA revealed that the multivariable models with the addition of PHI or PCA3 showed a greater net benefit and performed better than the reference models. In a direct comparison, PHI outperformed PCA3 performance resulting in higher net benefit. In a same cohort of patients eligible for AS, the addition of PHI and PCA3 to Epstein or PRIAS models improved their prognostic performance. PHI resulted in greater net benefit in predicting IPCa compared to PCA3.

To identify predictive factors for satisfactory treatment outcome of the patients with IC/BPS using urine biomarkers and machine-learning models. The IC/BPS patients were prospectively enrolled and provide urine samples. The targeted analytes included inflammatory cytokines, neurotrophins, and oxidative stress biomarkers. The patients with overall subjective symptom improvement of ≥ 50% were considered to have satisfactory results. Binary logistic regression, receiver-operating characteristic (ROC) curve, machine-learning decision tree, and random forest models were used to analyze urinary biomarkers to predict satisfactory results. Altogether, 57.4% of the 291 IC/BPS patients obtained satisfactory results. The patients with satisfactory results had lower levels of baseline urinary inflammatory cytokines and oxidative biomarkers than patients without satisfying results, including interleukin-6, monocyte chemoattractant protein-1 (MCP-1), C–X–C motif chemokine 10 (CXCL10), oxidative stress biomarkers 8-hydroxy-2'-deoxyguanosine (8-OHDG), 8-isoprostane, and total antioxidant capacity (TAC). Logistic regression and multivariable analysis revealed that lower levels of urinary CXCL10, MCP-1, 8-OHDG, and 8-isoprostane were independent factors. The ROC curve revealed that MCP-1 level had best area under curve (AUC: 0.797). In machine-learning decision tree model, combination of urinary C–C motif chemokine 5, 8-isoprostane, TAC, MCP-1, and 8-OHDG could predict satisfactory results (accuracy: 0.81). The random forest model revealed that urinary 8-isoprostance, MCP-1, and 8-OHDG levels had the most important influence on accuracy. Machine learning decision tree model provided a higher accuracy for predicting treatment outcome of patients with IC/BPS than logistic regression, and levels of 8-isoprostance, MCP-1, and 8-OHDG had the most important influence on accuracy.

The inflatable penile prosthesis has served to provide a physiological erection and physiological flaccidity to a large number of impotent patients with a high degree of satisfaction. The mechanical and surgical complications have continued to decrease in incidence since the first implantation in February, 1973. Computer generated life table methods of analysis now provide us with a known experience of the incidence, the extent, and the nature of any surgical or mechanical complications. With these methods and close monitoring we see significant improvements in our overall results. Improvements in the prosthesis have steadily reduced mechanical failure and increased mechanical reliability to the point that our expectations for the next 10 years are for excellent results in a very high percentage of patients. The improvements in both technique as well as instrumentation have significantly reduced surgical complications. Our infection rate was 2.4% in 1300 implantations. Since 60% of these were due to Staphylococcus epidermidis, and since this is the most common airborne organism found in the operating room, we are hopeful that the use of the Surgical Isolation Barrier System (SIBS) will reduce our infection rate well below 1% for the next decade. The newer IPP 700 addresses all of the mechanical problems that have been identified in the last 10 years of experience with this prosthesis. We have now implanted over 100 patients with the new IPP 700 inflatable penile implant since it became available to us in February of 1983, and we have seen no failures whatsoever during the past 4 months. Our perception of this device is that it is truly superior.