Urology research & practice最新文献

Objective: The complex patient dynamic in India leads to diverse presentations of renal cell carcinoma, ranging from incidental small renal masses to large palpable renal masses. Minimally invasive surgical approaches pose challenges for patients with large renal masses (≥7 cm), prompting many urologists to opt for open radical nephrectomy. However, open surgery is associated with higher morbidity due to prolonged visceral exposure and increased intraoperative bleeding. Large renal masses often exhibit significant neovascularity, complicating dissection and elevating intraoperative blood loss risk. This problem led the authors to devise a novel hybrid technique of laparoscopic-assisted open radical nephrectomy (HLO-RN), which helps to decrease morbidity. In this article, the authors discuss this novel hybrid technique incorporating the benefits of both open and laparoscopic approaches (HLO-RN). Methods: The authors conducted an observational study to report the authors'. HLO-RN, in 5 patients with large renal masses (≥7 cm) suggestive of renal cell carcinoma. Patients with morbid obesity (BMI ≥40) were excluded. The hybrid technique involves initial laparoscopy, followed by open flank incision after vessel clipping. Conversion-to-open procedure can be adjusted based on intraoperative conditions. In patients with inferior vena cava (IVC) thrombus extension, conversion-to-open procedure is made after sequential clamping of renal vessels and IVC with or without hepatic mobilization. All the patients were followed for 6 months. Various parameters including patient characteristics, renal mass characteristics, staging, mean duration of laparoscopic and open procedures, intraoperative and postoperative complications, and duration of hospitalstay and duration to return to normal activity were recorded. Results: Five patients (mean age: 61.2 years) were included, with 2 presenting with venous tumor thrombus extension. The mean renal mass size was 10.7 cm (range: 7.8-14 cm). One patient with IVC Level I thrombus required open conversion after sequential vessel clamping due to significant neovascularity. Partial laparoscopic mobilization was feasible in the remaining patients. Procedure durations averaged 35.8 minutes (laparoscopic) and 35.6 minutes (open). All procedures were performed by the same senior urologist team. Patients were extubated immediately post-surgery, with one requiring intensive care unit admission for 1 day. No surgical site infections or major postoperative complications occurred. The drop in hemoglobin in this study was 0.84 g/dL. Conclusion: The authors' novel HLO-RN technique is a practical and feasible approach for large renal masses, including those with IVC thrombus extension. By reducing intra-operative blood loss and open procedure duration, this hybrid technique significantly decreases perioperative morbidity.

Objective: This retrospective cross-sectional study aimed to compare functional and surgical outcomes after open simple prostatectomy (OSP) between patients who underwent prior transurethral resection of the prostate (TURP) and those who did not. Methods: Between March 2009 and April 2019, 723 patients underwent TURP, of whom 20 (2.7%) subsequently underwent OSP (Group 1). This group was matched with a group of patients who had solely undergone OSP (Group 2), with matching criteria including age, prostate-specific antigen level, prostate volume, and prostate weight. Results: Group 1 showed a statistically significant lower decrease in hemoglobin levels after surgery (p = .006); however, no significant differences were observed between the groups in terms of operation time (P=.508), hospital stay (P=.065), transfusion rate (P=.331), enucleated prostate volume (P=.733), or changes in creatinine levels (P =.418). Regarding early postoperative complications, the 2 groups showed no significant difference (0.349). Late postoperative complications occurred in 30% of Group 1 and 33% of Group 2, which was not significantly different either (P = .241). Both groups achieved similar early continence rates (88%) within the first 6 months after surgery. Late continence rates (after 6 months) were also comparable, with 94% in Group 1 and 88% in Group 2. Finally, no significant differences were found in patient satisfaction levels, measured on a qualitative scale ranging from "dissatisfied" to "highly satisfied." Conclusion: Prior TURP did not significantly affect the surgical or functional outcomes of subsequent OSP, with comparable results observed between patients with and with- out a history of TURP.

Objective: A histotopographic research study was performed to justify the ventral approach for nontransecting anastomotic bulbar urethroplasty. Methods: The study included 10 preparations of the male penis, including the bulbous sections of the urethra with no signs of structural damage. The material was obtained during autopsy from men aged 36-60 years old. The features of the blood supply and innervation of the bulbous urethra were carefully examined, revealing the advantages of the proposed method. Results: The authors obtained data providing sufficient evidence for the safety and histotopographic validity of the ventral approach with preservation of the dorsal and lateral parts of the corpus spongiosum of the urethra. Conclusion: The choice of urethroplasty for bulbous urethral strictures less than 2 cm in length requires in-depth knowledge of the anatomy of the vascular and autonomic nerve fibers of the spongious body of the bulbous urethra, as well as the course of the cavernous nerves along its dorsal semicircle. In carefully selected patients with short (<2 cm in length) strictures of the bulbous urethra without spongiofibrosis, it is possible to avoid anastomotic urethroplasty with total transection of the spongious body by choosing nontransecting excision and primary anastomosis (ntEPA), which allows to preserve innervation and blood supply in the urethra to a greater extent. In this regard, the ventral ntEPA technique seems promising, as it is likely that the neurovascular structures in the urethra are mostly located outside the area of this zone-in the lateral frequent. However, definitive conclusions are possible after further scientific research in this area.

Objective: Dysfunctional voiding (DV) is an often-underdiagnosed condition primarily affecting younger patients with lower urinary tract symptoms (LUTS). Characterized by a lack of coordination between the detrusor muscle and the external urethral sphincter, DV commonly manifests as urinary frequency, urgency, and incontinence. Despite its significant impact, urodynamic studies (UDS), the gold standard for diagnosis, are frequently inaccessible in remote or under-resourced areas. This study investigates non-invasive clinical parameters to facilitate provisional DV diagnosis. Methods: A retrospective analysis of 813 patients who underwent UDS for LUTS over 3 years (2021-2024) was conducted. Excluding those with neurological disorders or urethral strictures, 516 patients were evaluated, identifying 67 with DV. Parameters were examined across 2 age groups: under 50 years and 50 years or older, focusing on symptomatology, uroflowmetry, and associated conditions. Statistical analyses, including Chi-square tests and multivariate logistic regression, were employed to identify significant predictors. Results: Of the 67 patients diagnosed with DV, 64 were under 50 years of age. Statistically significant associations were found between DV and increased diurnal frequency, pre-existing heightened anxiety, obstructive uroflowmetry patterns, constipation, and hypertonic anal sphincter. The proposed non-invasive criteria-SHADE (Staccato/obstructive voiding pattern, Heightened anxiety, Age <50, Diurnal frequency, Exclusion of stricture or neurological disease)-demonstrated over 95% positive predictive value for DV. Conclusion: Early and accurate diagnosis of DV can be enhanced through non invasive clinical criteria, particularly in settings where urodynamic testing is limited. Implementing the SHADE criteria can facilitate prompt, targeted management of DV, improving patient outcomes in resource-constrained environments.

Objective: This study aimed to compare the effectiveness of vardenafil, a phosphodi-esterase-5 inhibitor, and tamsulosin, an alpha-blocker, in the management of ureteral srtent-elated symptoms. Methods: A total of 208 patients who underwent ureteric stent placement after the removal of ureteric stones were enrolled and randomly divided to receive either var- denafil 10 mg daily or tamsulosin 0.4 mg daily for a duration of 3 weeks. The validated Ureteral Stent Symptom Questionnaire (USSQ) was used to assess patients at baseline and after 3 weeks from starting the medications. Results: This study compared tamsulosin and vardenafil in 208 patients (101 vs. 107) with a mean age of 45.07 ± 9.5 years, predominantly male (67.4%); both groups were similar in baseline characteristics (P >.05). A notable statistical significant reduction in total scores from the first visit to the fourth visit (vardenafil: 136.03 to 85.01; tamsulosin: 129.9 to 97). Vardenafil showed a statistically significant improvement (P <.001) compared to tamsulosin across all USSQ domains except body pain, which has statistically significant improvement in the tamsulosin group. During the follow-up visits, vardenafil had statistically significant improvement in all USSQ domains; however, tamsu- losin had statistically significant improvement in all USSQ domains except in sexual health (P =.5). Side effects were mild, with retrograde ejaculation and hypotension in the tamsulosin group and headaches in the vardenafil group. Conclusion: Vardenafil showed promising results in controlling stent-related symptoms and can be considered an alternative or adjunct medication to tamsulosin in the management of stent-related symptoms; however, this needs further exploration in larger, multi-center studies to validate these findings and optimize patient outcomes in clinical practice.

Objective: Urinary tract infections are burdensome for patients. Social media is increasingly used as a platform for patients and public to seek and share support. The study aimed to evaluate what patients encounter when they turn to Instagram for urinary tract infection-related support and advice. Methods: The first 200 posts appearing on the "top posts" section of Instagram for 6 key hashtags (#UTI, #UTIs, #urinarytractinfection, #urinarytractinfections, #bladderin- fection, #bladderinfections) were selected. Thematic analysis (TA) was used to identify themes present in the Instagram captions. Results: Across 1200 posts analyzed, 5 main themes were identified. 1) "We can help…," this was largely commercial advertising with the promotion of healthcare clinics. 2) "I'm suffering," which contained first-person narratives about an unpleasant experience with a disease or treatment as well as frustration at health services. 3)!"Warning signs," posts describing signs or symptoms that the creator claims indicate poor health. 4)!"Remedies," these posts detailed therapies to try, often herbal. 5) "Avoid and change," which covered triggers to avoid symptom flare ups. Conclusion: There is a large amount of content on social media related to UTIs. Urologists should be aware that patients may have sought out advice using these platforms and may therefore have received misinformation and products that have been advertised but lack scientific evidence.

Objective: Sorcin, a signaling molecule, has recently emerged as a significant focus within cancer research. This study aimed to compare histopathology results with serum sorcin level and tissue sorcin immunohistochemical expression in patients who underwent radical prostatectomy (RP). Methods: A total of 81 patients who underwent RP between December 2017 and June 2019 due to prostate cancer (PCa) and had not received any previous treatment were included in the study. Patients attended regular follow-up appointments for at least 24 months. In order to compare serum sorcin levels, the control group consisted of 67 healthy men. Demographic data of participants were recorded. In the PCa group, pathology data from both Transrectal ultrasound-guided biopsy and RP were documented. Results: Prostate-specific antigen (PSA) and sorcin levels of PCa patients were found to be higher than the control group (P < .001, P = .02). In the comparison of sorcin levels and sorcin staining percentages of PCa patients with histopathological and clinical findings; while sorcin levels were found to be higher in patients with positive lymph nodes (P = .018) and with biochemical recurrence (P = .049), no significant difference was found in any histopathological finding in terms of sorcin staining percentages. In an receiver operating characteristic curve analysis calculation for sorcin levels in PCa patients, AUC = 0.563 and when the cut-off value was taken as 0.415 ng/mL, 59.3% sensitivity 60.1% specificity was determined. Conclusion: Sorcin was found to be higher in PCa compared to healthy males. In addition, high International Society of Urological Pathology grade groups were observed in patients with high sorcin levels.