Roman Zachoval

Background: In 2022, the European Union recommended piloting organised prostate cancer screening. Subsequently, the Czech Republic launched a nationwide pilot programme fully reimbursed by public health insurance in January 2024 to reduce the high incidence of late-stage prostate cancer and the widespread unorganised prostate-specific antigen (PSA) testing. Objective: To describe the strategy, methodology, and first results of the Czech nationwide prostate cancer screening pilot programme. Methods: We analysed data from the first 12 months of the programme, which targets men aged 50–69 years without a previous prostate cancer diagnosis. General practitioners and urologists offer men an initial PSA test. Those with PSA ≥3.0 µg/l are referred to certified urologists, based on urology assessment selected for magnetic resonance imaging (MRI) and, if indicated, targeted biopsy. Reported key indicators are PSA testing coverage and overall use of pre-biopsy MRI. Key Findings and Limitations: Screening was offered to 150,498 men; PSA results were available for 146,109 (97.1%), 8.8% of whom had ≥3.0 µg/l. Within 6 months, 67.2% with PSA ≥3.0 µg/l underwent urological evaluation. From 2023 to 2024, the 2-year PSA testing rate rose from 47.4% to 53.3%, and pre-biopsy MRI use from 28.0% to 38.3% (10.3 percentage-point difference, 95% CI 8.3–12.2). Data on diagnostic outcomes are not yet analysed. Conclusions and Clinical Implications: These results demonstrate the feasibility of transforming widespread unorganised PSA testing to an organised screening programme with improved adherence to the recommended diagnostic pathway. Further evaluation to assess outcomes and efforts to reduce opportunistic testing will follow. Advancing Practice: What does this study add?: This is the first population-level evaluation of a nationwide organised prostate cancer screening programme in Central Europe. The findings demonstrate the feasibility of integrating a structured screening programme with PSA testing in routine primary care into a national health system. The programme improved adherence to guideline-based diagnostic pathways. Patient Summary: This report presents the initial results of a new nationwide, organised prostate cancer screening programme in the Czech Republic. The programme contributed to increased screening coverage in the target population (50-69 years) and improved the use of MRI before biopsy, which is now the recommended practice.

Several prognostic markers, including tumor‐infiltrating lymphocytes, which have been recently identified in penile squamous cell carcinoma (pSCC), have focused mostly on T cells. The prognostic role of B cells and tertiary lymphoid structures (TLSs) has not yet been sufficiently described. We examined whole tissue sections histopathologically for TLSs and immunohistochemically for CD20 and CD138. The B‐cell immunoscore (B‐IS) divided the cohort into five categories based on the expression of these two B‐cell/plasma cell markers (CD20 and CD138, respectively). Patients with fewer TLSs had worse overall survival (OS) [hazard ratio (HR) = 2.17; 95% CI: 0.94–5; p = 0.069]. A significant association was identified between a high TLS diameter and the presence of a lymphocytic infiltrate [odds ratio (OR) = 2.2442; 95% CI: 1.1022–4.55; p = 0.0208]. Patients with low B‐IS (HR = 1.89, 95% CI: 1.18–3.03, p = 0.008), a low number of CD20 ⁺ cells in the tumor center (HR = 1.67, 95% CI: 1.04–2.7, p = 0.035), and a low number of CD20 ⁺ cells at the tumor invasion front (HR = 1.69, 95% CI: 1.06–2.78; p = 0.028) had significantly worse OS. High B‐ISs were strongly associated with a mutated p53 profile detected by immunohistochemistry (OR = 4.76, 95% CI: 1.32–25, p = 0.011), low T‐cell immunoscores (OR = 0.49; 95% CI: 0.23–1.03; p = 0.051), and brisk lymphocytic infiltration (OR = 2.0417, 95% CI: 1.01–4.76; p = 0.037). High CD20 ⁺ cell counts at the invasion front were associated with histological grade 3 disease (OR = 2.44, 95% CI 1.15–5.26, p = 0.015). An association was also observed between low B‐IS and mutations in KMT2D (OR 0.31, 95% CI: 0.07–1.21, p = 0.057) and EGFR (OR = ∞, 95% CI: 0.86–∞, p = 0.053). In conclusion, high numbers of tumor‐infiltrating B cells within TLSs represent a favorable prognostic marker in pSCC. These findings emphasize the need to identify novel microscopic prognostic markers during pathological assessment to guide early and appropriate therapeutic strategies.

Understanding the temporal variability of the microbiome is critical for translating associations of the microbiome with health and disease into clinical practice. The aim of this study is to assess the extent of temporal variability of the human urinary microbiota. A pair of catheterized or mid-stream urine samples were collected from study participants at 3–40-month interval. DNA was extracted and the bacterial V4 hypervariable region of the 16S rRNA gene was sequenced on the Illumina MiSeq platform. The alpha and beta diversity of paired samples was analyzed using Chao1 and Shannon indices and PERMANOVA. A total of 63 participants (43 men and 20 women with a mean age of 63.0 and 57.1 years, respectively) were included in the final analysis. An average of 152 ± 128 bacterial operational taxonomic units (OTUs) were identified in each urine sample from the entire cohort. There was an average of 41 ± 32 overlapping OTUs in each sample pair, accounting for 66.3 ± 29.4% of the relative abundance. There was a clear correlation between the number of overlapping OTUs and the relative abundance covered. The difference in Chao1 index between paired samples was statistically significant; the difference in Shannon index was not. Beta diversity did not differ significantly within the paired samples. Neither age nor sex of the participants influenced the variation in community composition. With a longer interval between the collections, the relative abundance covered by the overlapping OTUs changed significantly but not the number of OTUs. The abundance of bacterial taxa present in both collections fluctuated, but the proportion of these taxa in the community was about two-thirds of the total bacterial community. No significant intraindividual differences in beta diversity were observed between the two urine samples. Data Summary: The raw DNA sequences together with anonymized sample metadata have been deposited at the NCBI SRA under the accession number PRJNA1093489. Processing scripts are deposited at a public repository https://doi.org/10.5281/zenodo.12556460 . Processed sequencing files and tables including full taxonomic assignment are deposited at https://doi.org/10.6084/m9.figshare.26046355 . Importance: This study represents a comprehensive investigation dedicated specifically to the subject of urinary microbiome (UM) temporal stability. Our dataset (n = 63) consists of a relatively large group of patients of one ethnic origin but varying ages and both sexes. Additionally, samples from individual participants are separated by different lengths of time. This approach allows us to assess the effects of three variables on the stability of human UM. Our findings demonstrate that, while the relative abundance of dominant bacteria varies, repeated collections generally share more than 60% of the bacterial community. Furthermore, we observe little variation in the alpha and beta diversity of the microbial community in human urine. These results help to understand the dynamics of human UM and enable interpretation of future studies.

Zachoval R. V?voj technik endoskopick? enukleace prostaty. V tomto ?l?nku je pod?n chronologick? souhrn v?voje endoskopick? enukleace prostaty, od holmiov? enukleace, p?es bipol?rn? a thuliovou enukleaci a? po enukleaci prostaty zelen?m lasere...

Background. Since the discovery of the human urinary microbiota (UM), alterations in microbial community composition have been associated with various genitourinary conditions. The aim of this exploratory study was to examine possible associations of UM with clinical conditions beyond the urinary tract and to test some of the conclusions from previous studies on UM. Methods. Catheterised urine samples from 87 men were collected prior to endoscopic urological interventions under anaesthesia. The composition of the bacterial community in urine was characterized using the hypervariable V4 region of the 16S rRNA gene. Samples from 58 patients yielded a sufficient amount of bacterial DNA for analysis. Alpha diversity measures (number of operational taxonomic units, ACE, iChao2, Shannon and Simpson indices) were compared with the Kruskal–Wallis test. Beta diversity (differences in microbial community composition) was assessed using non-metric dimensional scaling in combination with the Prevalence in Microbiome Analysis algorithm. Results. Differences in bacterial richness and diversity were observed for the following variables: age, diabetes mellitus, dyslipidemia, smoking status and single-dose preoperative antibiotics. Differences in microbial community composition were observed in the presence of chronic kidney disease, lower urinary tract symptoms and antibiotic prophylaxis. Conclusions. UM appears to be associated with certain clinical conditions, including those unrelated to the urinary tract. Further investigation is needed before conclusions can be drawn for diagnostics and treatment.

Zachoval R, Krhut J. "Warning time" a jeho role v medikament?zn? l??b? pacient? s hyperaktivn?m mo?ov?m m?ch??em. C?l: C?lem pr?ce bylo zjistit v?znam "warning time" p?i hodnocen? efektivity l??by syndromu hyperaktivn?ho mo...

The relationship between lower urinary tract dysfunctions and urinary leakage from ureterocystoneoanastomosis in male patients after kidney transplantation

Monitoring of pathogen resistance profiles is necessary to guide empirical antibiotic therapy before culture and sensitivity results become available. The aim of this study was to describe current antibiotic resistance patterns of five most frequent causative uropathogens in a Department of Urology of a tertiary referral centre in Central Europe over a period of nine years. The Hospital Department of Clinical Microbiology database was used to extract data on all positive urine samples from inpatients in the Department of Urology between 2011 and 2019. Numbers of susceptible and resistant isolates per year were calculated for five most frequent uropathogens: Escherichia coli, Enterococcus spp., Klebsiella spp., Pseudomonas aeruginosa, and Proteus spp. Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin, colistin, and vancomycin. High resistance rates of Gram-negative uropathogens were demonstrated to most common antimicrobials, with statistically significant increasing or decreasing trends in some cases. No carbapenem-resistant Enterobacteriaceae were isolated. Vancomycin-resistant Enterococcus spp. strains were rare in our population.

Software-based MRI/TRUS fusion biopsy depends on the coordination of several steps, and inter-examiner differences could influence the results. The aim of this bicentric prospective study was to compare the detection rates of MRI/TRUS fusion targeted biopsy (TG) and systematic biopsy (SB), and the detection rates of examiners with different levels of previous experience in prostate biopsy. A total of 419 patients underwent MRI based on a suspicion of prostate cancer with elevated PSA levels. MRI was positive in 395 patients (221 in the first biopsy group [FB] and 174 in the repeated biopsy group [RB]). A subsequent TG, followed by a SB, was performed on these patients by four different examiners. In the detection of clinically significant prostate cancer, a significant difference was found for TG+SB against SB in the RB group (35.1% vs. 25.3%, P=0.047). In the detection of clinically insignificant prostate cancer, the SB had a significantly higher detection rate than TG in both subgroups (FB: 11.9% vs. 4.7%, P=0.008; RB: 13.8% vs. 6.9%, P=0.034). A significant difference was found between the four examiners in the FB for TG (P=0.028), SB (P=0.036), and TG+SB (P=0.017). MRI/TRUS TG in combination with SB had significantly higher detection rates than SB in the RB group only. Differences in detection rates between examiners were dependent on the level of previous experience with TRUS guided biopsy.

Zachoval R. Urogenit?ln? tuberkul?za. Urogenit?ln? tuberkul?za (TB) je definov?na jako infek?n? z?n?tliv? onemocn?n? urogenit?ln?ho syst?mu (ledvin, mo?ov?ch cest nebo mu?sk?ch ?i ?ensk?ch pohlavn?ch org?n?), izolovan?ho nebo kombinovan?ho, zp...