European urology focus最新文献

英文中文

Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial 前列腺动脉栓塞术与经尿道前列腺切除术治疗良性前列腺梗阻：一项随机、开放标签、非劣效性试验的 5 年结果。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.03.001

Gautier Müllhaupt , Lukas Hechelhammer , Nicole Graf , Livio Mordasini , Hans-Peter Schmid , Daniel S. Engeler , Dominik Abt

Background and objective

Prostatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up.

Methods

We conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests.

Key findings and limitations

Of the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was −7.78 points after PAE and −11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] −0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference −5.71, 95% CI −10.72 to −0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79–300.51; p = 0.001).

Conclusions and clinical implications

The improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling.

Patient summary

In this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP.

This trial is registered on ClinicalTrials.gov as NCT02054013.

背景和目的：前列腺动脉栓塞术（PAE）和经尿道前列腺切除术（TURP）是治疗下尿路症状/良性前列腺梗阻（LUTS/BPO）的两种手术方案。我们的目的是比较 PAE 和 TURP 在长期随访中治疗下尿路症状/良性前列腺梗阻的有效性和安全性：我们在瑞士一家三级医疗中心进行了一项随机、开放标签、单中心试验。主要结果是PAE与TURP术后国际前列腺症状评分（IPSS）的变化。次要结果包括基线、3、6、12、24 和 60 个月时评估的患者报告结果、功能测量和不良事件。采用双侧 Mann-Whitney 检验和 t 检验测试了从基线到 5 年变化的组间差异：在2014年至2017年随机接受治疗的103名难治性LUTS/BPO患者中，18/48的患者接受了PAE治疗，38/51的患者接受了TURP治疗，他们都接受了60个月的随访。从基线到5年，PAE术后IPSS平均降低-7.78分，TURP术后平均降低-11.57分（差异3.79分，95%置信区间[CI] -0.66至8.24；P = 0.092）。除勃起功能外，TURP 在大多数患者报告的次要结果方面更胜一筹。5年后，PAE在客观参数方面不如TURP有效，如最大尿流率的改善（3.59 vs 9.30 ml/s，差异-5.71，95% CI -10.72至-0.70；P = 0.027）和排尿后残余尿量的减少（27.81 vs 219.97 ml；差异192.15，95% CI 83.79至300.51；P = 0.001）：结论：PAE术后5年的LUTS/BPO改善效果不如TURP术。患者总结：在这项研究中，我们展示了前列腺动脉栓塞术（PAE）与经尿道前列腺切除术（TURP）治疗引起排尿症状的良性前列腺增生的长期效果对比。PAE 对经过适当选择的患者显示出良好的长期疗效，但与经尿道前列腺切除术相比，其改善效果并不明显。该试验已在 ClinicalTrials.gov 登记为 NCT02054013。

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引用次数: 0

Reply to Marco Moschini, Francesco Montorsi, Giuseppe Rosiello, Andrea Salonia, and Alberto Briganti’s Letter to the Editor re: Stamatios Katsimperis, Lazaros Tzelves, Zafer Tandogdu, et al. Complications After Radical Cystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials with a Meta-regression Analysis. Eur Urol Focus 2023;9:920–9 回复 Marco Moschini、Francesco Montorsi、Giuseppe Rosiello、Andrea Salonia 和 Alberto Briganti 致编辑的信：Stamatios Katsimperis、Lazaros Tzelves、Zafer Tandogdu 等：《根治性膀胱切除术后的并发症》：随机对照试验的系统回顾和元回归分析》（A Systematic Review and Meta-analysis of Randomized Controlled Trials with a Meta-regression Analysis）。Eur Urol Focus 2023;9:920-9.

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.05.003

Stamatios Katsimperis , Lazaros Tzelves , Zafer Tandogdu , Anthony Ta , Robert Geraghty , Themistoklis Bellos , Ioannis Manolitsis , Nikolaos Pyrgidis , Gerald Bastian Schulz , Ashwin Sridhar , Gregory Shaw , John Kelly , Andreas Skolarikos

引用次数: 0

Interleukins in Urine and Blood as Markers of Infection and as Risk Factors for Systemic Conditions 尿液和血液中的白细胞介素是感染的标志物，也是全身性疾病的风险因素。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.09.016

Richard Luxton , Janice Kiely , Marcus Drake

Interleukins are a diverse group of cytokines that play a crucial role in controlling immune responses and have potential as biomarkers. This mini review evaluates 12 recent papers linking urinary interleukins to both urinary infection and systemic diseases. While measurement of serum interleukins can indicate systemic inflammation, urinary interleukins provide more specific insights into renal or urinary tract inflammation. Urinary interleukins such as IL-8, IL-18, and IL-1β show promise for diagnosing urinary tract infections and other conditions. However, their diagnostic utility is complicated by their wide distribution in the body and patient-related factors. Advances in analytical techniques have enhanced the sensitivity and speed of interleukin measurement, improving their clinical utility.

Patient summary

This review highlights research showing that measurement of molecules associated with the immune system in urine samples can help in diagnosing and monitoring disease affecting the urinary tract and kidneys. These urine tests can provide more specific information about infections than blood tests can.

白细胞介素是一类多种多样的细胞因子，在控制免疫反应方面发挥着至关重要的作用，并具有作为生物标志物的潜力。这篇微型综述评估了最近 12 篇将尿白细胞介素与泌尿感染和全身性疾病联系起来的论文。虽然血清白细胞介素的测量可显示全身性炎症，但尿白细胞介素能更具体地揭示肾脏或泌尿道炎症。IL-8、IL-18 和 IL-1β 等尿白细胞介素有望用于诊断尿路感染和其他疾病。然而，由于它们在体内的广泛分布以及与患者相关的因素，它们的诊断效用变得复杂起来。分析技术的进步提高了白细胞介素测量的灵敏度和速度，从而改善了其临床应用。患者摘要：这篇综述重点介绍了尿样中与免疫系统相关分子的测量有助于诊断和监测影响尿路和肾脏的疾病的研究结果。与血液检测相比，这些尿液检测能提供更具体的感染信息。

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引用次数: 0

Re: Steven Monda, Manolis Pratsinis, Hansen Lui, et al. Secondary Bladder Cancer After Prostate Cancer Treatment: An Age-matched Comparison Between Radiation and Surgery. Eur Urol Focus. In press. http://doi.org/10.1016/j.euf.2023.09.002 Re：Steven Monda、Manolis Pratsinis、Hansen Lui 等：《前列腺癌治疗后的继发性膀胱癌》：放射治疗与手术治疗的年龄匹配比较》。欧洲泌尿聚焦》。http://doi.org/10.1016/j.euf.2023.09.002

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.01.015

Yu-Hsiang Lin, Han-Yu Tsai, Shu-Han Tsao

引用次数: 0

Association of 5α-Reductase Inhibitors with Depression and Suicide: A Mini Systematic Review and Meta-analysis 5α-还原酶抑制剂与抑郁和自杀的关系：小型系统回顾与元分析》。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.04.009

Alessandro Uleri , Jean Nicolas Cornu , Andrea Gobbo , Thomas R.W. Herrmann , Cosimo De Nunzio , Hashim Hashim , Michael Baboudjian

5α-Reductase inhibitors (5-ARIs) are widely prescribed for treatment of benign prostatic obstruction and androgenic alopecia. Several studies with controversial findings regarding 5-ARI exposure have been published over a number of years, and concerns were recently raised about the potential risks of depression and suicide associated with 5-ARIs. To investigate this association, we conducted a systematic review of the literature and a meta-analysis. Five studies involving 2 213 600 patients met our inclusion criteria. We found no statistically significant association between 5-ARI exposure and the risk of depression (adjusted hazard ratio [aHR] 1.30, 95% confidence interval [CI] 0.85–2.00; p = 0.23) or suicide (aHR 1.30, 95% CI 0.65–2.61; p = 0.45). Subgroup analyses for finasteride and dutasteride revealed similar results. When restricting the analysis to patients without a prior diagnosis of depression, we observed similar findings (aHR for suicide 1.00, 95% CI 0.68–1.46; p = 0.98).

Patient summary

We reviewed study data for more than two million patients taking drugs called 5α-reductase inhibitors (5-ARIs), which are widely prescribed for urinary problems caused by benign prostate enlargement and for male-pattern hair loss. In a pooled analysis we found no evidence of an association between 5-ARI use and the risk of depression or suicide.

5α-还原酶抑制剂（5-ARIs）被广泛用于治疗良性前列腺阻塞和雄激素性脱发。多年来，一些关于5-ARI暴露的研究结果引起了争议，最近，人们对5-ARI可能带来的抑郁和自杀风险表示担忧。为了调查这种关联，我们对文献进行了系统回顾和荟萃分析。共有五项研究符合我们的纳入标准，涉及 2213600 名患者。我们发现，5-ARI 暴露与抑郁（调整后危险比 [aHR] 1.30，95% 置信区间 [CI] 0.85-2.00；p = 0.23）或自杀（aHR 1.30，95% CI 0.65-2.61；p = 0.45）风险之间没有统计学意义上的显著关联。对非那雄胺和度他雄胺进行的亚组分析显示了相似的结果。当将分析范围限制在既往未被诊断为抑郁症的患者时，我们也观察到了类似的结果（自杀的 aHR 为 1.00，95% CI 为 0.68-1.46；p = 0.98）。患者总结：我们回顾了200多万名服用5α还原酶抑制剂（5-ARIs）的患者的研究数据，这些药物被广泛用于治疗良性前列腺增生引起的排尿问题和男性脱发。在一项汇总分析中，我们没有发现使用 5-ARI 与抑郁或自杀风险之间存在关联的证据。

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引用次数: 0

Diagnostic Utility of Artificial Intelligence–assisted Transperineal Biopsy Planning in Prostate Cancer Suspected Men: A Prospective Cohort Study 人工智能辅助经会阴活检规划对前列腺癌疑似患者的诊断效用：前瞻性队列研究

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.04.007

Karsten Guenzel , Georg Lukas Baumgaertner , Anwar R. Padhani , Johannes Luckau , Uwe Carsten Lock , Tomasz Ozimek , Stefan Heinrich , Jakob Schlegel , Jonas Busch , Ahmed Magheli , Julian Struck , Hendrik Borgmann , Tobias Penzkofer , Bernd Hamm , Stefan Hinz , Charlie Alexander Hamm

Background and objective

Accurate magnetic resonance imaging (MRI) reporting is essential for transperineal prostate biopsy (TPB) planning. Although approved computer-aided diagnosis (CAD) tools may assist urologists in this task, evidence of improved clinically significant prostate cancer (csPCa) detection is lacking. Therefore, we aimed to document the diagnostic utility of using Prostate Imaging Reporting and Data System (PI-RADS) and CAD for biopsy planning compared with PI-RADS alone.

Methods

A total of 262 consecutive men scheduled for TPB at our referral centre were analysed. Reported PI-RADS lesions and an US Food and Drug Administration–cleared CAD tool were used for TPB planning. PI-RADS and CAD lesions were targeted on TPB, while four (interquartile range: 2–5) systematic biopsies were taken. The outcomes were the (1) proportion of csPCa (grade group ≥2) and (2) number of targeted lesions and false-positive rate. Performance was tested using free-response receiver operating characteristic curves and the exact Fisher-Yates test.

Key findings and limitations

Overall, csPCa was detected in 56% (146/262) of men, with sensitivity of 92% and 97% (p = 0.007) for PI-RADS– and CAD-directed TPB, respectively. In 4% (10/262), csPCa was detected solely by CAD-directed biopsies; in 8% (22/262), additional csPCa lesions were detected. However, the number of targeted lesions increased by 54% (518 vs 336) and the false-positive rate doubled (0.66 vs 1.39; p = 0.009). Limitations include biopsies only for men at clinical/radiological suspicion and no multidisciplinary review of MRI before biopsy.

Conclusions and clinical implications

The tested CAD tool for TPB planning improves csPCa detection at the cost of an increased number of lesions sampled and false positives. This may enable more personalised biopsy planning depending on urological and patient preferences.

Patient summary

The computer-aided diagnosis tool tested for transperineal prostate biopsy planning improves the detection of clinically significant prostate cancer at the cost of an increased number of lesions sampled and false positives. This may enable more personalised biopsy planning depending on urological and patient preferences.

背景和目的：准确的磁共振成像（MRI）报告对于经会阴前列腺活检（TPB）计划至关重要。尽管已获批准的计算机辅助诊断 (CAD) 工具可以帮助泌尿科医生完成这项任务，但目前还缺乏证据表明临床意义重大的前列腺癌 (csPCa) 检测得到了改善。因此，我们旨在记录使用前列腺成像报告和数据系统（PI-RADS）和计算机辅助诊断系统（CAD）制定活检计划与仅使用 PI-RADS 相比的诊断效用：方法：分析了在我们的转诊中心计划进行前列腺活检的 262 名男性患者。在制定 TPB 计划时使用了 PI-RADS 病变报告和美国食品药品管理局批准的 CAD 工具。PI-RADS和CAD病变是TPB的目标，同时进行了4次（四分位间范围：2-5次）系统活检。结果为：(1) csPCa（等级组≥2）的比例；(2) 目标病变的数量和假阳性率。使用自由响应接收器操作特征曲线和精确的 Fisher-Yates 检验对结果进行了检验：总体而言，56% 的男性（146/262）检测到了 csPCa，PI-RADS 和 CAD 引导的 TPB 敏感性分别为 92% 和 97% (p = 0.007)。4%的患者（10/262）仅通过 CAD 导向活检发现了 csPCa；8%的患者（22/262）发现了额外的 csPCa 病变。但是，目标病变的数量增加了 54%（518 对 336），假阳性率增加了一倍（0.66 对 1.39；p = 0.009）。局限性包括仅对临床/放射学怀疑的男性进行活检，以及活检前未对 MRI 进行多学科审查：经测试的用于 TPB 计划的 CAD 工具提高了 csPCa 的检测率，但代价是增加了取样病灶的数量和假阳性。患者总结：经会阴前列腺活检计划中测试的计算机辅助诊断工具提高了具有临床意义的前列腺癌的检出率，但代价是增加了病灶取样数量和假阳性率。根据泌尿外科医生和患者的偏好，这可能会使活检计划更加个性化。

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Innovations in Phage Therapy for Urinary Tract Infection 噬菌体疗法治疗尿路感染的创新。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.07.006

Lorenz Leitner, Thomas M. Kessler, Shawna E. McCallin

Urinary tract infections (UTIs) are among the most common infections. Increasing rates of multidrug-resistant bacteria are complicating treatment, necessitating alternative strategies. Bacteriophages (phages) are viruses that only target and kill bacteria, and this specific lytic activity can be harnessed therapeutically. Bioengineering holds innovative potential for the use of phages as diagnostic and therapeutic tools for rapid targeted treatments. However, phage therapy and phage products are not currently approved by regulatory agencies in the Western world and can only be applied under specific regulatory frameworks in individual countries. Further basic and clinical research is essential to address the challenges of phage therapy and to explore its value in combating UTIs.

Patient summary

Urinary tract infections (UTIs) are becoming more difficult to treat because of antibiotic resistance. Bacteriophages are viruses that kill bacteria and have promise for UTI treatment, but more research and regulatory approval are needed before they become more widely available.

尿路感染（UTI）是最常见的感染之一。越来越多的细菌对多种药物产生抗药性，使治疗变得更加复杂，因此有必要采取替代策略。噬菌体（噬菌体）是一种只针对并杀死细菌的病毒，这种特殊的溶菌活性可用于治疗。生物工程具有创新潜力，可将噬菌体用作诊断和治疗工具，进行快速靶向治疗。然而，噬菌体疗法和噬菌体产品目前尚未获得西方国家监管机构的批准，只能在个别国家的特定监管框架下应用。要解决噬菌体疗法面临的挑战并探索其在抗击 UTIs 方面的价值，必须开展进一步的基础和临床研究。患者摘要：由于抗生素耐药性的存在，尿路感染（UTI）越来越难以治疗。噬菌体是一种能杀死细菌的病毒，有望用于UTI治疗，但在更广泛地应用之前，还需要更多的研究和监管部门的批准。

引用次数: 0

Urinary Microbiome Research Has Not Established a Conclusive Influence: Revisiting Koch’s Postulates 泌尿系统微生物组研究尚未确立结论性影响：重温科赫假设

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.07.005

Glenn T. Werneburg , Jennifer Southgate

引用次数: 0

Novel Antibiotics for Urinary Tract Infection (UTI): The EAGLE 2 and EAGLE-3 Trials for Uncomplicated UTI, and the CERTAIN-1 Trial for Complicated UTI 治疗尿路感染 (UTI) 的新型抗生素：针对非复杂性 UTI 的 EAGLE 2 和 EAGLE-3 试验，以及针对复杂性 UTI 的 CERTAIN-1 试验。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.07.014

Florian Wagenlehner

引用次数: 0

Update on APPEAL, an International Randomized Controlled Trial Evaluating Ciprofloxacin Versus Placebo in Patients Undergoing Shockwave Lithotripsy for Urolithiasis 评估环丙沙星与安慰剂在接受冲击波碎石术治疗尿路结石患者中应用情况的国际随机对照试验 APPEAL 的最新进展。

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus

Pub Date : 2024-09-01 DOI: 10.1016/j.euf.2024.07.011

Kari A.O. Tikkinen , Sara V. Tornberg , Jani Ruotsalainen , Borna Tadayon Najafabadi , Saana Horstia , Sakineh Hajebrahimi , Arto Mikkola , Mohamed Abdelkareem , Patrick O. Richard , Kathrin Bausch , Sameer Parpia , Gordon H. Guyatt , Philippe D. Violette

引用次数: 0

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