Practice Policy Statement (BPPS) for Urodynamic Antimicrobial Prophylaxis in high-risk patients. Methods: After institutional review board approval, 489 patients who underwent urodynamics (UDS) in the absence of antibiotic prophylaxis were retrospectively reviewed. Patients were stratified according to the SUFU BPPS risk factors (neurogenic lower urinary tract dysfunction [NLUTD], elevated postvoid residual [PVR], immunosuppression, age over 70, catheter use, and orthopedic implants). χ 2 , Fisher's exact test, Student t test, and univariate and multiple logistic regression analyses were used to assess the associations between these risk factors and postprocedural urinary tract infection (UTI). Results: Twenty-two (4.5%) patients developed symptomatic postprocedural UTI. Univariate analysis revealed statistical differences in the incidence of UTI in patients with elevated PVR and NLUTD groups. The variables that were associated with UTI on multivariate analysis were elevated PVR (odds ratio [OR]: 4.91, 95% confidence interval [CI], 1.92-12.56, P = .001) and NLUTD (OR: 4.84, 95% CI, 1.75-3.37, P = .002). The data analysis for all other high-risk groups failed to show significant correlations with UTI on univariate or multivariate analysis. Patients with three risk factors were more likely to develop UTI than patients with 1 or 2 risk factors. No patient developed pyelonephritis, sepsis, or joint infection. Conclusions: Elevated PVR, NLUTD, and possessing three risk factors were significant predictors for post-UDS UTI. All other risk factors were not associated with postprocedural UTI. Morbidity associated with UTI was low. Antimicrobial prophylaxis for these conditions should be reconsidered.

Two variants of renal angiomyolipoma (AML)—classic and epithelioid—have been described. Although the epithelioid variant has been reported to demonstrate an aggressive clinical behavior, classic AML is usually benign. Herein, we report a case of a 42-year-old asymptomatic woman with a lipomatous variant of renal AML associated with an inferior vena cava thrombus managed with radical nephrectomy and caval thrombectomy.

Oxidative stress (OXS) has been recently considered as one of anticancer strategies by taking advantage of higher vulnerability of cancer cells (than normal cells) to OXS. In fact, the successful outcomes using OXS have been reported in several cancer cases. A medicinal mushroom extract, PE isolated from Poria mushroom, has been shown to have anticancer/antitumor activity, although its anticancer mechanism has not been fully understood but may involve OXS. We investigated if PE might have anticancer effect on human bladder cancer cells through OXS in vitro. A dose-dependent (0-200 µg/ml of PE) study was first performed to assess cell viability using MTT assay. PE led to a significant reduction in cell viability with the IC 50 (50% inhibitory concentration) of 100 µg/ml. A possible anticancer role of OXS was then assessed by lipid peroxidation (LPO) assay. The results indicated that PE indeed exerted ~2.1-fold greater OXS (than controls) on the cells. The anticancer mechanism of PE was further explored, focusing on glycolysis, metabolic signaling pathways, and apoptosis. Two glycolytic parameters, hexokinase (HK) activity and cellular ATP level, have significantly declined, suggesting the inhibition of glycolysis. Coupled with the reduced ATP level, AMP-activated protein kinase (AMPK) was activated, while protein kinase B (Akt) was inactivated and concomitantly mammalian target of rapamycin (mTOR) was inhibited. These results imply the growth cessation, followed by cell death. Western blot analysis also revealed that such cell death was more likely linked to apoptosis, indicated by the bcl-2 down-regulation and the Bax up-regulation. Therefore, PE is a natural anticancer agent with prooxidant activity exerting OXS, which leads to inhibition of glycolysis, modulations of metabolic signaling pathways, and ultimately apoptosis. It may have clinical implications in oral and/or intravesical administration for a safer and better therapeutic option for bladder cancer.

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