Thiago Camelo Mourão

Purpose of review: This scoping review protocol aims to map evidence on clinical presentation, diagnostic evaluation, underlying mechanisms, and management of lower urinary tract symptoms (LUTS) in men aged 19–50 years, and to identify gaps requiring further study and consensus. Recent findings: Recent literature indicates LUTS in younger men cannot be adequately interpreted using frameworks centered on benign prostatic enlargement. Reported causes include bladder dysfunction, bladder outlet obstruction, urethral disease, pelvic floor dysfunction, neurologic conditions, behavioral factors, pain syndromes, and systemic disorders. Studies vary in age definitions, symptom classification, diagnostic testing, urodynamic criteria, and treatment approaches, limiting comparability and synthesis. Summary: The review will follow JBI methodology for scoping reviews and will be reported using PRISMA-ScR. Results will be summarized using descriptive statistics, evidence maps, tables, and narrative synthesis. The review will clarify diagnostic and treatment strategies, evidence gaps, and inform a Delphi consensus on LUTS in young men.

Background/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making.

Purpose: With multi-institutional collaboration, the purpose of this study was to analyze geographical differences of renal cell carcinoma with tumor thrombus between patients in North America, Central/South America, and South Korea. Materials and methods: Patients with renal cell carcinoma and a tumor thrombus who underwent nephrectomy plus thrombectomy were retrospectively analyzed. Patients were from North America, Central/South America, and South Korea. All comparisons were done based on the region where a patient had their surgery and follow-up. Chi-squared test, analysis of variance, Kaplan-Meier survival with log-rank test, and Cox regression analysis were used. Results: A total of 478 patients were included, 212 from North America, 209 from Central/South America, and 57 from South Korea. Of note, thrombus level was different using the Neves classification system between regions (p<0.001), with a greater thrombus level in Central/South America. Surgical approach differed, with laparoscopic cases done most often in Central/South America and robotic in North America (p<0.001). Tumor grade was lowest in South Korea (p<0.001) and stage (p<0.001) greatest in Central/South America. Overall survival was greater in South Korea compared to Central/South America (p=0.026). Cancer-specific survival was greater in South Korea relative to North America and Central/South America (p=0.026). Conclusions: Patients from North America, Central/South America, and South Korea diagnosed with renal cell carcinoma and tumor thrombus do not present the same and have different outcomes peri-/post-operatively. This includes important variables which have impacts on patient morbidity and mortality. Considering increased efforts on health equity in urology,

PURPOSE: This study aims to analyze the trends in mortality rates from penile cancer (PeC) and the treatment modalities adopted in Brazil over recent years. MATERIALS AND METHODS: Death records for PeC cases (International Classification of Diseases, version 10 C60) and treatment modalities were extracted from the DATASUS database. A joinpoint regression analysis was conducted to examine the data. RESULTS: A total of 7,848 deaths due to PeC were recorded in Brazil between 1996 and 2020. Increasing mortality trends were observed, with an average annual percentage change (AAPC) of 0.91 (0.6-1.2; P < .001). The North and Northeast regions had the highest age-standardized mortality rates (ASMRs) and AAPCs. From 2008 to 2020, the ASMR in the Northeast region remained stable, whereas the North region surpassed it. The Southeast region exhibited a significant downward trend, with an AAPC of –0.91 (–1.3 to -0.5; P < .001). Penile biopsies declined and were more frequent in the southeastern region. A total of 8,498 penile amputations were performed, with 39.4% and 29.1% conducted in the Southeast and Northeast regions, respectively. CONCLUSION: Brazil has experienced increasing mortality trends in PeC over the past 2 decades. Low schooling, married, and young men from the North or Northeast regions represent the majority of deaths. Urgent efforts are needed to enhance the diagnosis and treatment of PeC to prevent and reduce mortality rates in the country.

Background and Objective: Some countries in Latin America (LA) may have the greatest increase in the incidence of renal cell carcinoma (RCC) in both sexes in the coming decades, according to some projections. Increasing efforts to study prognostic factors related to RCC may shorten the regional discrepancies, particularly in the scenario of scarce literature in LA, in comparison to Europe or North America. The evaluation of RCC prognosis allows a greater capacity to anticipate outcomes, in addition to a better understanding of tumor biology and the orientation of the proposed treatment. Herein, we provide a review of the main prognostic factors described in different stages of the disease, considering the progress of publications on kidney cancer in LA. Methods: The PubMed database was used to identify studies on this theme, particularly those from LA. Studies by the Latin American Renal Cancer Group (LARCG) and the Latin American Cooperative Oncology Group (LACOG) were included. Key Content and Findings: Overall, tumor-related factors such as pathological stage, tumor size, nuclear grade, and histological subtype had the most important independent prognostic impact. Nevertheless, grouping these data with clinical, demographic, and biomolecular parameters can lead to a better prognosis analysis. Finally, the authors acknowledge the efforts of some nonprofit regional organizations in the activities and studies of RCC in different settings. Conclusions: Anatomical and histological prognostic factors for RCC have been widely studied for decades. In recent years, biomolecular factors have attracted considerable attention.

Purpose of Review The physiological aspects of renin–angiotensin system (RAS) components are described in this review. Additionally, we present the main results of studies that could indicate an association between alterations in these components and cancer, particularly renal cell carcinoma (RCC). Recent Findings The RAS undergoes a series of homeostatic and modulatory processes that extend to hypertrophy, hyperplasia, fibrosis, and remodeling, as well as angiogenesis, pro-inflammatory responses, cell differentiation, stem cell programming, and hematopoiesis. Summary The link between cancer-related inflammation and RAS signaling converge in the response to tumor hypoxia and oxidative stress mechanisms, particularly with the angiotensin type 1 receptor leading to activation of transcription factors such as nuclear factor κB (NF-κB), as well as members of the signal transducer and activation of transcription (STAT) family and HIF1⍺. Dysregulation of the physiological actions of RAS in the microenvironment of inflammation and angiogenesis promotes tumor cell growth.