Tomasz Syryło

Vectors based on adeno-associated viruses (AAVs) are widely used as a delivery system in gene therapy. However, preexisting immunity against AAV remains a major limitation. This study examines the prevalence of AAV genomes and anti-AAV2 immunity in a Polish cohort of adult patients undergoing planned surgical interventions, which serves as a random sample of the general Polish population. The presence of AAV capsid sequences was analyzed in tissue samples using PCR and endogenous AAVs were detected in 33.95% of samples. Anti-AAV2 IgG antibodies were measured by a single point ELISA and were present in 80.93% of patients. Neutralizing activity was evaluated using an AAV2 transduction inhibition assay in HEK293T cells, revealing a 60% reduction in functional activity by patients’ sera. Tissue AAV PCR-positivity was associated with stronger neutralizing activity although the correlation with seropositivity was not as strong. These results suggest that pre-existing humoral immunity against AAV is common in the Polish adult population, indicating frequent exposure to naturally occurring AAVs. The findings provide important data on pre-existing anti-AAV immunity—a key factor considered in clinical trials and gene therapy development. Furthermore, the identification of naturally occurring AAV variants in human tissues points to the potential use of new sources of capsids with potentially distinct biological properties, which could contribute to the advancement of gene therapies.

Background and Objectives: Flank bulging is a recognized consequence of open renal surgery through a lumbotomy, but its clinical relevance and relationship with postoperative sensory changes are not well defined. We assessed the frequency and clinical burden of postoperative flank bulging, its overlap with sensory disturbances, and procedure-related factors associated with its occurrence. Materials and Methods: We reviewed 407 patients who underwent open renal surgery through a subcostal lumbotomy between 2018 and 2023. Flank bulging was the primary outcome. We also recorded scar hypoesthesia, wider areas of sensory loss, and whether patients found the resulting deformity bothersome. Factors associated with bulging were explored using multivariable logistic regression, with a separate analysis comparing nephron-sparing surgery (NSS) and radical nephrectomy. Results: Flank bulging was found in 88 patients (21.6%). Scar hypoesthesia occurred in 14.0% and more extensive sensory loss in 7.1%. Sensory abnormalities showed a strongly nested clinical pattern: all patients with scar hypoesthesia had flank bulging, and all extended sensory deficits occurred among patients with both bulging and scar hypoesthesia. All patients with scar hypoesthesia also had bulging, while wider sensory loss was seen only when both were present. Among patients for whom this information was available, 52.9% described the bulging as bothersome. It was more common after NSS than after radical nephrectomy (27.0% vs. 16.3%). The difference persisted after adjustment for age and sex (aOR 2.05, 95% CI 1.17–3.59), corresponding to an adjusted absolute risk difference of 11.8 percentage points (95% CI 2.4–20.8). Conclusions: About one in five patients developed flank bulging after open renal surgery through a lumbotomy, and many of those affected found it bothersome. The accompanying sensory changes raise the possibility that nerve injury contributes to this complication, although our data cannot establish the underlying mechanism. The higher rate observed after NSS compared with radical nephrectomy also warrants further study. Prospective assessment with standardized imaging and more detailed operative data may help explain these findings and identify factors that could reduce the risk of postoperative bulging.

Urinary tract infections are among the most common bacterial diseases in adults and, in some cases, may lead to the development of urosepsis, defined as a septic syndrome originating from the urinary tract. In civilian healthcare settings, urosepsis is generally straightforward to recognise and manage; however, military medicine presents additional challenges, such as delayed evacuation, limited diagnostic capabilities, and restricted therapeutic resources. The aim of this study was to analyse the epidemiology, diagnostic criteria, and therapeutic strategies in urosepsis, based on a literature review of PubMed, Scopus, and Web of Science databases (2019–2025), as well as current international guidelines (Sepsis-3, Surviving Sepsis Campaign, European Association of Urology). Particular emphasis was placed on rapid diagnostic methods, simplified risk-assessment tools, and treatment procedures feasible, for example, in field hospitals. Urosepsis is the most common septic syndrome in urology, which accounts for approximately 25% of all sepsis episodes. Under field conditions, the use of simplified clinical criteria (fever, hypotension, altered mental status) and bedside tests (urinalysis, basic inflammatory markers) is of primary importance, as complex clinical scoring systems such as SOFA or qSOFA are often impractical. Management requires immediate initiation of empirical antibiotic therapy, fluid resuscitation, early administration of vasopressors, and rapid removal of the source of infection. Early recognition using simple criteria, prompt initiation of empirical treatment, and adaptation of therapeutic procedures to field conditions are critical for improving patient outcomes.

Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) is widely used in prostate cancer diagnosis, but biopsy findings may still underestimate tumor aggressiveness. This study evaluated the association of Prostate Imaging Reporting and Data System (PI-RADS) assessment with clinically significant prostate cancer (csPCa) and histopathological upgrading after radical prostatectomy. Methods: The retrospective analysis comprised 564 patients who underwent mpMRI–transrectal ultrasound fusion-guided biopsy followed by radical prostatectomy between 2021 and 2025. All included patients subsequently underwent radical prostatectomy, so the cohort represents a surgically selected population. Clinical variables, PI-RADS score, biopsy ISUP Grade Group, and final prostatectomy pathology were assessed. Clinically significant disease was defined as ISUP Grade Group ≥ 2. Histopathological upgrading was defined as an increase of at least one ISUP Grade Group between biopsy and final prostatectomy pathology. Results: csPCa was found in 385 patients (68.3%). Patients with csPCa had higher prostate-specific antigen density (PSAD) values than those without csPCa. PI-RADS score was significantly associated with csPCa and remained independently associated with csPCa in multivariable analysis. Histopathological upgrading occurred in 164 patients (29.1%), and PI-RADS score was also independently associated with upgrading. Model discrimination was limited. Conclusions: Preoperative mpMRI with PI-RADS assessment was associated with both csPCa and biopsy underestimation. Although PI-RADS was independently associated with both outcomes, its modest discriminatory performance indicates that it should be interpreted together with other clinical and pathological parameters rather than as a standalone predictive tool.

Background: Modern radiotherapy techniques have improved the safety of prostate cancer treatment, but acute gastrointestinal and genitourinary toxicity remains a common clinical problem. Early identification of patients who are likely to develop treatment-related adverse effects may help optimize supportive care. This study evaluated the relationships between clinical characteristics, radiotherapy planning parameters, systemic inflammatory biomarkers, and acute pelvic toxicity during hypofractionated radiotherapy. Materials and Methods: We retrospectively analyzed 142 patients with histologically confirmed prostate cancer who underwent external beam radiotherapy at the Provincial Integrated Hospital in Płock, Poland, between October 2024 and March 2026. Clinical, laboratory, and radiotherapy planning data were obtained from institutional electronic records. Laboratory analyses included CRP, creatinine, total leukocyte, neutrophil, lymphocyte, erythrocyte and platelet counts, hemoglobin, and hematocrit. Rectal and bladder toxicity was prospectively graded according to the RTOG/EORTC criteria at 2 and 4 weeks after treatment initiation. Correlation and multivariable regression analyses were performed to identify factors associated with acute treatment-related toxicity. Results: Radiotherapy significantly reduced leukocyte and lymphocyte counts (both p < 0.001) and produced smaller reductions in erythrocyte count, hemoglobin, hematocrit, and absolute neutrophil count (all p < 0.05). Patients who reported rectal or urinary symptoms early during treatment generally continued to experience toxicity later in the treatment course. Rectal and bladder toxicities were positively correlated, indicating that patients with toxicity affecting one pelvic organ frequently developed symptoms in the other. Routine inflammatory biomarkers and most dosimetric parameters showed limited independent value for predicting clinically relevant acute toxicity. Conclusions: Early gastrointestinal and genitourinary toxicity appears to be a useful clinical indicator of persistent treatment-related symptoms during hypofractionated prostate radiotherapy. Early rectal and bladder toxicity was associated with toxicity later during treatment, whereas routine laboratory markers and most dosimetric parameters showed limited independent associations with acute pelvic toxicity.

Background and Objectives: Urosepsis is a common cause of sepsis in adults and is associated with substantial morbidity and mortality, particularly when urinary obstruction delays timely source control. The roles of diagnostic uncertainty at presentation, microbiological phenotypes (including multidrug resistance), and biomarkers in shaping management pathways and outcomes warrant further evaluation. Materials and Methods: This retrospective, single-center, observational study included 154 consecutive adult patients hospitalized for urosepsis. Sepsis was defined according to the Sepsis-3 criteria. Baseline clinical modifiers at admission were encoded as binary variables (e.g., malignancy, urinary tract obstruction/altered anatomy, immunocompromised status, acute kidney injury [AKI], and diagnostic uncertainty). Microbiology was standardized into pathogen groups (Gram-negative, Gram-positive, or no isolate), infection complexity (mono- vs. polymicrobial), and multidrug-resistant organism (MDRO) status. Procedures were categorized as no procedure, urinary tract decompression, or other source controls. Biomarkers (C-reactive protein [CRP], procalcitonin [PCT], and creatinine) were analyzed at admission and, when available, during hospitalization. The primary outcomes were in-hospital mortality, ICU admission, and absence/delay of source control. Results: The median age was 68 years, and 60.4% of patients were male. The in-hospital mortality and ICU admission rates were 7.1% and 3.9%, respectively. Diagnostic uncertainty was present in 9.8% and was associated with a higher likelihood of no invasive intervention (86.7% vs. 43.9%, p = 0.002) and a lower rate of urinary tract decompression (13.3% vs. 45.3%, p = 0.01). Gram-negative pathogens predominated (50.0%), and MDROs were identified in 18.2% and were associated with prior urological interventions (53.6% vs. 24.6%, p = 0.003) and higher admission PCT levels (8.6 vs. 3.2 ng/mL, p = 0.04). Bacteremia was associated with mortality (14.5% vs. 2.2%, odds ratio [OR] 7.64, p = 0.007). Mortality was higher in Gram-positive infections (21.7% vs. 4.6%, OR 5.79, p = 0.012) and in patients with AKI at admission (25.0% vs. 5.7%; OR, 5.54; p = 0.043). Conclusions: Urosepsis exhibits distinct clinical and microbiological phenotypes that influence its management and outcomes. Diagnostic uncertainty at presentation was associated with reduced early source control measures, whereas MDRO infections were clustered with prior urological interventions and higher systemic inflammatory burdens. Bacteremia, Gram-positive pathogens, and AKI at admission were associated with an increased in-hospital mortality risk. These findings support a multidimensional early assessment strategy integrating clinical presentation, microbiological risk, biomarkers, and rapid evaluation of obstruction to facilitate timely source control.

Background: Persistent sexual and psychological symptoms after finasteride discontinuation have been reported; however, factors associated with symptom severity remain insufficiently characterized. Methods: This cross-sectional study included 129 adult men with prior finasteride exposure for male pattern hair loss or benign prostatic hyperplasia. Sexual function, depressive symptoms, and anxiety were assessed using the International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Associations between clinical variables (age, treatment duration, cumulative exposure, and indication) and symptom severity were evaluated using univariate and multivariable regression analyses. Results: The median treatment duration was 24 months (IQR: 12.5–36), and the median time from discontinuation to evaluation was 8 months (IQR: 1–17). Erectile function remained stable over time (mean IIEF: 15.2 ± 0.46 at baseline vs. 15.4 ± 0.47 at 6 months). Depressive symptoms decreased from 12.4 ± 0.41 to 9.1 ± 0.41, and anxiety scores from 3.29 ± 0.23 to 2.54 ± 0.20 over the same period, without normalization in most patients. In multivariable analyses, higher cumulative exposure and older age were independently associated with lower IIEF scores and higher PHQ-9 and GAD-7 scores. Conclusions: In this symptomatic cohort, greater cumulative finasteride exposure and older age were associated with more severe sexual and psychological symptoms after treatment discontinuation. These findings highlight the need for prospective studies to better define risk factors and long-term outcomes.

Background/Objectives: An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy. This study assessed the concordance of Gleason scores between MRI–TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological factors associated with post-procedural Gleason score upgrading. Methods: This retrospective analysis involved patients who underwent transperineal MRI–TRUS fusion biopsy followed by radical prostatectomy from 2020 to 2025. Concordance, upgrading, and downgrading of the Gleason score were assessed by comparing biopsy results with the final histopathological examination. Clinical parameters (age, PSA level, prostate volume, and PSA density) and histopathological features of biopsies (Gleason score and percentage of prostate lobes affected by cancer) were analyzed. Multivariate logistic regression models were stratified by PSA level (10 ng/mL). Results: Gleason score concordance was found in 53.1% of the 603 patients analyzed, upgrading in 29.9%, and downgrading in 17.1%. Higher Gleason scores on biopsy were independently associated with a lower risk of upgrading in the entire cohort and in both PSA subgroups. Larger tumor extent on biopsy was associated with a lower risk of upgrading, with heterogeneous dependencies between prostate lobes. The other clinical parameters showed no independent association with upgrading. Conclusions: Gleason score upgrading remains common after radical prostatectomy. The risk of this progression is primarily related to the histopathological features of the biopsy rather than to baseline clinical parameters, reflecting the limitations of biopsy as a sampling method and the biological heterogeneity of prostate cancer.

Background and objectives: Ischemic priapism is a rare but serious adverse effect of trazodone, associated with a high risk of long-term sexual dysfunction. While its urological consequences are well described, psychiatric and psychosocial outcomes remain insufficiently explored. This study assessed psychiatric and sexual sequelae following trazodone-associated ischemic priapism and compared clinical characteristics with trazodone-treated patients without priapism. Materials and Methods: In this single-center observational study, 268 adult patients receiving trazodone were analyzed, including 17 patients with ischemic priapism and 251 controls. Data on episode duration and urological management were collected. Psychiatric status and sexual functioning were evaluated through structured clinician-led interviews informed by validated psychometric frameworks during hospitalization and at 1-, 3-, and 6-month follow-up. Nonparametric analyses and Spearman rank correlations were applied. Results: Patients with priapism were significantly older than controls (44.1 ± 5.1 vs. 39.0 ± 4.4 years; p < 0.0001), while trazodone dose distribution did not differ between groups. The mean episode duration was 26.5 ± 16 h (median 24 h). Older age and longer ischemic duration were independently associated with increased treatment intensity, whereas trazodone dose was not. Persistent depressive and anxiety symptoms and impaired sexual functioning were observed in a subset of patients during follow-up. Conclusions: Trazodone-associated ischemic priapism is not only an acute urological emergency but may also lead to sustained psychiatric and sexual sequelae. Interdisciplinary follow-up should be considered to address long-term psychosocial outcomes.

Modern crisis management requires resilient communication systems capable of operating independently from public telecommunication infrastructure during emergencies. This paper analyzes Standalone Non-Public Networks (SNPN) based on 5G New Radio technology as an autonomous solution for crisis communication. The research determines optimal SNPN configurations ensuring communication continuity in disaster scenarios while maintaining operational and budget constraints. The methodology employs advanced ray-tracing propagation models and three-dimensional environmental analysis in the 4 GHz band, incorporating adaptive beamforming and satellite backhaul integration. Results demonstrate that localized SNPN deployments provide superior interference management and critical redundancy compared to public networks. Implementation of Ultra-Reliable Low-Latency Communications (URLLC) and network slicing enables effective prioritization of rescue traffic. Strategic base station positioning achieves optimal balance between coverage, performance, and cost efficiency. The study confirms that software-defined SNPN architectures significantly enhance communication resilience against external failures, ensuring operational continuity when terrestrial infrastructure is compromised.