No abstract

Bladder cancer (BC) remains the most common malignancy of urinary tract. Sex-related differences in BC epidemiology, diagnosis, therapy, and outcomes have been reported. Throughout the recent years, extensive research has been devoted to genetic and molecular alterations in BC. Apart from the molecular background, another related concept which has been speculated to contribute to gender diversities in BC is the role of urinary pathogens in bladder carcinogenesis. Microbiome studies, fueled by the availability of high-throughput DNA-based techniques, have shown that perturbation in the microbiome is associated with various human diseases. The aim of this review is to comprehensively analyze the current literature according to sex-related differences in the microbiome composition in BC.

Differences in the epidemiology, diagnosis and outcomes according to gender in patients diagnosed with non-muscle invasive bladder cancer (NMIBC) has been widely reported. In this article we present gender-specific differences in NMIBC in terms of epidemiology, risk factors, first clinical presentation, management and clinical outcomes based on systematically review evidence of existing literature. A literature search of English-language publications that included an analysis of the association of gender differences in patients with NMIBC was performed using PubMed. Sixty-four studies were selected for analysis with consensus of all authors. The incidence and mortality for urothelial bladder cancer (UBC) are higher in men, whereas cancer specific mortality to incidence ratio is significantly lower for men than for women. This phenomenon could be partially explained by differences in exposure to bladder cancer carcinogens. However female gender is associated with higher stage at presentation. Thirteen studies with a total of 11,069 patients diagnosed with NMIBC were included for analysis according to outcomes. In studies that found statistically significant differences in outcomes between sexes, female gender was reported as risk factor for disease recurrence, progression or cancer specific mortality. None of included studies found worse outcomes in men when compared to women with NMIBC. Results of our review suggest that female gender in patients diagnosed with NMIBC is associated—though inconsistently—with higher stage at presentation and poorer outcomes. Numerous factors may influence gender gap in incidence rate, clinical management and reported outcomes. Consensus on comparable data collection in routine practice and prospective trials including clinical outcomes are required to identify gender-specific differences in patients diagnosed with NMIBC.

Background and objectives: The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. Materials and Methods: The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3–54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Results: Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). Conclusions: BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life.

Beyond laboratory, imaging and endoscopic procedures, new diagnostic tools are increasingly being sought for the diagnosis of upper urinary tract urothelial carcinoma (UTUC), especially those that are non-invasive. In this systematic review, we aimed to determine the effectiveness of non-invasive tests in the diagnosis of UTUC. PubMed and Embase electronic databases were searched to identify studies assessing effectiveness of non-invasive tests in the primary diagnosis of UTUC. The study protocol was registered with PROSPERO (CRD42020216480). Among 10,084 screened publications, 25 were eligible and included in the analysis. Most of them were conducted on small samples of patients and the control groups were heterogenous. The test used in the largest number of studies was voided urinary cytology, which has poor sensitivity (11–71.1%) with favorable specificity (54–100%). Fluorescence in situ hybridization in diagnostic cytology showed higher sensitivity (35–85.7%) with equally good specificity (80–100%). There were also studies on the use of tests known to diagnose bladder cancer such as NMP22, uCYT or BTA test. Other urine or blood tests have been the subject of only isolated studies, with varying results. To conclude, currently there is a lack of high-quality data that could confirm good effectiveness of non-invasive tests used in the diagnosis of UTUC.

Sex-specific differences in outcomes of patients diagnosed with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) have been reported with controversial findings. This study aims to investigate sex-specific diversities in the treatment and oncologic outcomes of primary HR-NMIBC in a multicenter setting. A multicenter retrospective analysis of 519 patients (388 men and 131 women) treated with transurethral resection (TUR) for primary HR-NMIBC was performed. Univariable and multivariable Cox regression models were used to investigate the association of clinico-pathologic features and generate hazard ratios (HRs). Second-look TUR (reTUR) was performed in 406 (78%) patients. A total of 218 (42%) of patients were subjected to an induction course of intravesical BCG (Bacillus Calmette–Guérin) plus maintenance therapy. The median follow-up was 44 months. Among the entire cohort, 238 (46%) and 86 patients (17%) had recurred and progressed to muscle-invasive disease (MIBC), respectively. Female sex was associated with increased risk of disease recurrence in the entire cohort: HR = 1.94, 95% CI = 1.48–2.55, p < 0.001 and HR = 1.91, 95% CI = 1.39–2.60, p < 0.001 in univariate and multivariate analysis, respectively. In patients subjected to reTUR and treated additionally with BCG, female sex was associated with increased risk of disease recurrence in univariate analysis (HR 1.81, 95% CI 1.07–3.06, p = 0.03), but not in multivariate analysis (HR 1.99, 95% CI 0.98–4.02, p = 0.06). There was no difference between sexes with regard to disease progression. HR-NMIBC diagnosed in females is associated with higher risk of disease recurrence when compared to males.