European urology focus最新文献

{"title":"Sterile Water Versus Glycine in Transurethral Resection of Bladder Tumors—Immunogenic and Clinical Implications","authors":"Haim Herzberg ,&nbsp;Roi Babaoof ,&nbsp;Ron Marom ,&nbsp;Yotam Veredgorn ,&nbsp;Ziv Savin ,&nbsp;Karin Lifshitz ,&nbsp;Shmulik Noefeld ,&nbsp;Rinat Lasmanovitz ,&nbsp;Shayel Bercovich ,&nbsp;Tomer Lamhoot ,&nbsp;Sharon Amir ,&nbsp;Avi Beri ,&nbsp;David Margel ,&nbsp;Jack Baniel ,&nbsp;Roy Mano ,&nbsp;Ofer Yossepowitch","doi":"10.1016/j.euf.2024.03.002","DOIUrl":"10.1016/j.euf.2024.03.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>We compared the oncologic outcomes of patients with non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TUBRT) using sterile water vs glycine irrigation. The tumoricidal and immunogenic effects of these solutions on urothelial cancer cell lines were investigated.</div></div><div><h3>Methods</h3><div>The medical records of 530 consecutive patients who underwent TURBT using sterile water or glycine irrigation for NMIBC were reviewed. Recurrence and progression rates were evaluated using time dependent analyses.Bladder cancer cell lines (RT4, T24 and 5637) were treated with glycine and sterile water. Cell viability was evaluated with the XTT assay. Cell membrane calreticulin levels were evaluated with flow cytometry. Extracellular high mobility group box 1 (HMGB1) and heat shock 70 (HSP70) protein levels were evaluated using western blots.</div></div><div><h3>Key findings and limitations</h3><div>After propensity score matching each study arm comprised 161 patients. Median follow-up was 13.6 months (IQR 6.2, 24.5). The 2-year recurrence free survival was significantly lower in the sterile water vs glycine group (43% vs 71%, respectively, p&lt;0.0001). Similarly, the 2-years progression free survival was significantly lower in the sterile water vs glycine group (85% vs 94%, respectively, p&lt;0.014). Sterile water treatment resulted in the lowest number of viable cells. Early and late immunogenic cell death markers were markedly elevated in cells treated with glycine.</div></div><div><h3>Conclusions and clinical implications</h3><div>Sterile water compared to glycine irrigation during TURBT for NMIBC was associated with higher recurrence and progression rates. Possible explanation for these findings is the diminished immune response associated with sterile water reflected in a comparatively lesser expression of immune response inducers.</div></div><div><h3>Patient summary</h3><div>We compared two irrigation fluids in non–muscle-invasive bladder cancer surgery: glycine and sterile water. Glycine outperformed sterile water in cancer recurrence, possibly boosting immunogenicity over sterile water.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 796-804"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Francesco Pellegrino, Armando Stabile, Gabriele Sorce, et al. Added Value of Prostate-Specific Antigen Density in Selecting Prostate Biopsy Candidates Among Men with Elevated Prostate-specific Antigen and PI-RADS ≥3 Lesions on Multiparametric Magnetic Resonance Imaging of the Prostate: A Systematic Assessment by PI-RADS Score. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2023.10.006","authors":"Alessio Guidotti,&nbsp;Daniele Fiasconaro,&nbsp;Antonio Nacchia,&nbsp;Riccardo Lombardo,&nbsp;Giorgio Franco,&nbsp;Cosimo De Nunzio","doi":"10.1016/j.euf.2023.12.006","DOIUrl":"10.1016/j.euf.2023.12.006","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 864-865"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139069635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Primary Staging of Selected Renal Tumours: Initial Experience in a Multicentre Cohort","authors":"Arsalan Tariq ,&nbsp;Adam Pearce ,&nbsp;Handoo Rhee ,&nbsp;Samuel Kyle ,&nbsp;Sheliyan Raveenthiran ,&nbsp;Anita Pelecanos ,&nbsp;Chun Loo Gan ,&nbsp;Jeffrey C. Goh ,&nbsp;David Wong ,&nbsp;Rhiannon McBean ,&nbsp;Phillip Marsh ,&nbsp;Steven Goodman ,&nbsp;Nigel Dunglison ,&nbsp;Rachel Esler ,&nbsp;Anojan Navaratnam ,&nbsp;John W. Yaxley ,&nbsp;Paul Thomas ,&nbsp;David A. Pattison ,&nbsp;Matthew J. Roberts","doi":"10.1016/j.euf.2023.12.004","DOIUrl":"10.1016/j.euf.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Accurate primary staging of renal cancer with conventional imaging is challenging. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) may serve to improve the accuracy of renal cancer staging.</div></div><div><h3>Objective</h3><div>To determine clinicopathological and management differences for primary renal cancer staged with PSMA PET/CT in comparison to conventional imaging.</div></div><div><h3>Design, setting, and participants</h3><div>We conducted a retrospective cohort study of PSMA PET/CT scans performed for primary staging of renal cancer and incidental renal lesions at three sites in Brisbane, Australia between June 2015 and June 2020. Clinical characteristics, imaging, and histopathology were reviewed.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Clinicopathological and management differences according to staging modality (PSMA PET/CT, conventional imaging) were assessed. Descriptive statistics were used to report demographics and clinical parameters. Nonparametric methods were used for statistical analysis. Fisher’s exact test was used for comparison of small-cell size categorical variables.</div></div><div><h3>Results and limitations</h3><div>From a total of 120 PSMA PET/CT scans, 61 were included (52 staging, 9 incidental) for predominantly males (74%) with a mean age of 65.1 yr (standard deviation 12.0). Most primary lesions (40/51) were clear-cell renal cell carcinoma (ccRCC; 98% PSMA-avid), eight were non-ccRCC (75% PSMA-avid), and three were non-RCC (oncocytoma; 67% PSMA-avid). PSMA PET identified a greater number of presumed metastatic lesions than conventional imaging (195 vs 160). A management change was observed for 32% of patients (20% major, 12% minor). Limitations include the retrospective design and selection bias, lack of blinding to PSMA reporting, and the use of different PSMA radiotracers.</div></div><div><h3>Conclusions</h3><div>PSMA PET/CT detected more metastases than conventional imaging and most renal cancers were PSMA-avid, resulting in a management change for one-third of the patients.</div></div><div><h3>Patient summary</h3><div>We looked at a newer type of scan called PSMA PET/CT for first staging of kidney cancer. We found that this detects more metastasis and helps in decisions on changes in treatment for some patients. This type of imaging is a useful addition to conventional scans in tricky cases and may help in better selection of suitable treatments, but more studies are required.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 770-778"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Synchronous versus Metachronous Metastasis on Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with First-line Immune Checkpoint Inhibitor–based Combinations","authors":"Georges Gebrael ,&nbsp;Luis Meza ,&nbsp;Xiaochen Li ,&nbsp;Zeynep Zengin ,&nbsp;Nicolas Sayegh ,&nbsp;Hedyeh Ebrahimi ,&nbsp;Nishita Tripathi ,&nbsp;Daniela Castro ,&nbsp;Benjamin Mercier ,&nbsp;Regina Barragan-Carrillo ,&nbsp;Haoran Li ,&nbsp;Alexander Chehrazi-Raffle ,&nbsp;Umang Swami ,&nbsp;Abhishek Tripathi ,&nbsp;Neeraj Agarwal ,&nbsp;Benjamin L. Maughan ,&nbsp;Sumanta K. Pal","doi":"10.1016/j.euf.2024.03.006","DOIUrl":"10.1016/j.euf.2024.03.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>The impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC).</div></div><div><h3>Methods</h3><div>Data for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis &gt;3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed.</div></div><div><h3>Key findings and limitations</h3><div>Our analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; <em>p</em> = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; <em>p</em> = 0.001). Similarly, patients with synchronous metastasis had lower DCR compared to metachronous metastasis (58.7% vs. 78.4%; <em>p</em> = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR.</div></div><div><h3>Conclusions and clinical implications</h3><div>In this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC.</div></div><div><h3>Patient summary</h3><div>Our study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 812-817"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Urinary Tract Infection and the Ongoing Quest for Solutions","authors":"Marcus J. Drake ,&nbsp;Florian Wagenlehner","doi":"10.1016/j.euf.2024.10.001","DOIUrl":"10.1016/j.euf.2024.10.001","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 681-682"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Narek Shaverdian and Reshma Jagsi. When Headlines Harm Patients With Cancer. JAMA Oncol 2023;9:1611–2","authors":"Francesco Montorsi ,&nbsp;Marco Moschini ,&nbsp;Mario de Angelis ,&nbsp;Alberto Briganti ,&nbsp;Andrea Gallina ,&nbsp;Nazareno Suardi ,&nbsp;Federico Dehò","doi":"10.1016/j.euf.2024.03.008","DOIUrl":"10.1016/j.euf.2024.03.008","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Page 868"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Infection Management in Frail or Comorbid Older Individuals","authors":"Kathrin Bausch ,&nbsp;Fabian P. Stangl ,&nbsp;Jacqui Prieto ,&nbsp;Gernot Bonkat ,&nbsp;Jennifer Kranz","doi":"10.1016/j.euf.2024.08.007","DOIUrl":"10.1016/j.euf.2024.08.007","url":null,"abstract":"<div><div>Urinary tract infection (UTI) is common among older individuals, especially those with frailty and comorbidity. Asymptomatic bacteriuria is also common in this group and does not require treatment. UTI diagnosis is complicated by atypical signs and symptoms such as confusion or functional decline. This necessitates a more holistic assessment according to a diagnostic algorithm that includes nonspecific symptoms to avoid overdiagnosis or underdiagnosis. Treatment strategies for UTI in older people generally align with those for younger people, with some exceptions. Prophylaxis is similar to that for postmenopausal women. However, it is crucial to carefully consider comorbidities, polypharmacy, and the risk of potential adverse events.</div></div><div><h3>Patient summary</h3><div>We provide recommendations for the management of urinary tract infection (UTI) in older individuals who are frail and have multiple medical conditions. These patients may have signs and symptoms that are not typical for UTI. Treatment plans for these vulnerable patients should take interactions with other drugs and possible side effects into account.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 731-733"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control","authors":"Alec Zhu ,&nbsp;Mary O. Strasser ,&nbsp;Timothy D. McClure ,&nbsp;Sofia Gereta ,&nbsp;Emily Cheng ,&nbsp;Kshitij Pandit ,&nbsp;Jim C. Hu","doi":"10.1016/j.euf.2024.04.008","DOIUrl":"10.1016/j.euf.2024.04.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>There is an absence of high-level evidence comparing oncologic endpoints for partial gland ablation, and most series use prostate-specific antigen (PSA) rather than biopsy endpoints. Our aim was to compare oncologic outcomes between partial gland cryoablation (PGC) and radical prostatectomy (RP) for prostate cancer.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center analysis of subjects treated with PGC (<em>n</em> = 98) or RP (<em>n</em> = 536) between January 2017 and December 2022 as primary treatment for intermediate-risk (Gleason grade group [GG] 2–3) prostate cancer. Oncologic endpoints included surveillance biopsies per protocol after PGC in comparison to serial PSA testing after RP. The primary outcome was treatment failure, defined as a need for any salvage treatment or development of metastatic disease. Treatment failure and survival analyses were conducted using Cox proportional-hazard regression and Kaplan Meier survival curves.</div></div><div><h3>Key findings and limitations</h3><div>After applying the inclusion/exclusion criteria, the PGC (<em>n</em> = 75) and RP (<em>n</em> = 298) groups were compared. PGC patients were significantly older (71 vs 64 yr; <em>p</em> &lt; 0.001), but there were no differences in PSA, biopsy GG, or treatment year between the groups. The PGC group had higher rates of treatment failures at 24 mo (33% vs 11%; <em>p</em> &lt; 0.001) and 48 mo (43% vs 14%; <em>p</em> &lt; 0.001). One PGC patient (2.1%) and one RP patient (0.7%) developed metastases by 48-mo follow-up (<em>p</em> = 0.4). On adjusted analysis, PGC was associated with a higher risk of treatment failure (hazard ratio 4.6, 95% confidence interval 2.7–7.9; <em>p</em> &lt; 0.001). Limitations include observational biases associated with the retrospective study design.</div></div><div><h3>Conclusions</h3><div>This is the first comparative effectiveness study of cancer control outcomes for PGC versus RP. The results demonstrate an almost fivefold higher risk of treatment failure with PGC during short-term follow-up.</div></div><div><h3>Patient summary</h3><div>We compared cancer control outcomes for patients with intermediate-risk prostate cancer treated with partial gland cryoablation versus radical prostatectomy. We found that partial gland cryoablation had an almost fivefold higher risk of treatment failure. Men with prostate cancer should be counseled regarding this difference in treatment failure.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 843-850"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Levels of MicroRNA-371a-3p for Predicting the Histology of Postchemotherapy Residual Masses of Germ Cell Tumours","authors":"Klaus-Peter Dieckmann ,&nbsp;Francesca Grobelny ,&nbsp;Armin Soave ,&nbsp;Yue Che ,&nbsp;Tim Nestler ,&nbsp;Cord Matthies ,&nbsp;Julia Heinzelbecker ,&nbsp;Alexander Winter ,&nbsp;Axel Heidenreich ,&nbsp;Tabea Niemzok ,&nbsp;Cansu Dumlupinar ,&nbsp;Markus Angerer ,&nbsp;Christian Wülfing ,&nbsp;Pia Paffenholz ,&nbsp;Gazanfer Belge","doi":"10.1016/j.euf.2024.05.002","DOIUrl":"10.1016/j.euf.2024.05.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>Serum levels of microRNA-371a-3p (M371) represent a novel and sensitive biomarker of germ cell tumours (GCTs). This study analysed the utility of M371 to identify viable cancer (VC) in postchemotherapy (pc) residual masses with the underlying goal of avoiding overtreatment.</div></div><div><h3>Methods</h3><div>A multicentric, prospective diagnostic study was conducted in 180 GCT patients undergoing pc resection of residual masses. A correlation of M371 measurement results with the histological presence of VC in masses was found. A receiver operating characteristic analysis was performed for exploring the performance characteristics of the test.</div></div><div><h3>Key findings and limitations</h3><div>The sensitivity was found to be 68.9%, specificity 99.3%, area under the curve 0.813, positive predictive value 0.969, and negative predictive value 0.905; sensitivity is significantly associated with the percentage of VC in the mass. In specimens with ≤10% VC, there were 33.3% elevated M371 levels as opposed to 85.7% in specimens with &gt;50% VC. Teratoma and somatic-type malignancy do not express M371. A lack of a central pathological review is a limitation.</div></div><div><h3>Conclusions and clinical implications</h3><div>The M371 test can identify 68.9% of patients with VC in pc masses. However, cases with &lt;10% VC in the mass may escape detection. Teratoma does not express M371. The test alone cannot correctly identify patients requiring pc surgery, but it may be a tool for scheduling the extent of surgery.</div></div><div><h3>Patient summary</h3><div>The microRNA-371a-3p (M371) test can identify about two-thirds of patients with viable cancer in residual metastatic masses following chemotherapy for germ cell tumours. Only masses with high percentages of viable cancer cells can be identified, and the histological subtype teratoma remains undetected with the test.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 851-857"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Kidney Environment Parameters on Antibiotic Efficacy Against Uropathogenic Escherichia coli","authors":"Anne-Christine Aust ,&nbsp;Markus Weigel ,&nbsp;Jan-Paul Herrmann ,&nbsp;Olga Shevchuk ,&nbsp;Daniel Robert Engel ,&nbsp;Ulrich Dobrindt ,&nbsp;Torsten Hain ,&nbsp;Florian Wagenlehner","doi":"10.1016/j.euf.2024.07.007","DOIUrl":"10.1016/j.euf.2024.07.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urinary tract infections (UTIs) are common infections affecting the urinary system, predominantly caused by bacterial pathogens, with <em>Escherichia coli</em> being the most frequent pathogen. Infections of the kidney (eg, pyelonephritis) are severe and challenging to treat, due to the specific tissue microenvironment. In this study, the influence of different parameters mimicking the kidney environment on the effectiveness of antibiotics prescribed for pyelonephritis on the growth of uropathogenic strains was analyzed.</div></div><div><h3>Methods</h3><div>To investigate the influence of different factors mimicking the kidney environment, we tested the effect of different kidney-representative concentrations of sodium chloride and urea, and different pH values on the efficacy of ertapenem, levofloxacin, and ceftriaxone. The effectiveness was assessed by determining the minimal inhibitory concentrations (MICs) against various <em>E. coli</em> strains.</div></div><div><h3>Key findings and limitations</h3><div>The study revealed that pH significantly influences the MIC values of levofloxacin. Acidification of the pH led to an increase of the MIC values, while an alkaline pH had the opposite effect. The influence of sodium chloride and urea concentrations was strain and antibiotic specific. Since three different antibiotics were tested in this study, further research with additional antibiotics is warranted.</div></div><div><h3>Conclusions and clinical implications</h3><div>These results suggest that the physicochemical conditions within the kidney can substantially influence the success of antibiotic therapy for pyelonephritis. Therefore, it is crucial for clinicians to consider these factors when selecting and dosing antibiotics. Further research is needed to evaluate a broader range of antibiotics and additional environmental parameters, to develop a more comprehensive understanding of how the kidney environment affects antimicrobial activity. This knowledge will be vital in optimizing treatment strategies for pyelonephritis, ultimately improving patient outcomes.</div></div><div><h3>Patient summary</h3><div>The physicochemical conditions within the kidney influence the success of antibiotic therapy for pyelonephritis. Our findings are vital in optimizing treatment strategies and will ultimately improve patient outcomes.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 742-750"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}