International Journal of Urology最新文献

Background: Active surveillance (AS) offers a strategy to limit unnecessary treatment of prostate cancer while maintaining oncologic safety, yet its adoption in Japan remains limited. To provide Japan-specific evidence, we evaluated the clinical outcomes of patients undergoing AS at our institution.

Methods: We retrospectively reviewed 86 patients who selected AS between 2012 and 2024. Eligibility criteria included ≤ cT2a disease, prostate-specific antigen (PSA) level of ≤ 10 ng/mL, Gleason score (GS) of 3 + 3, and 2 or fewer positive cores, with selected inclusion of GS 3 + 4 or 4 + 3 based on patient preference. AS discontinuation was based on clinical or pathological progression or patient preference. This study was approved by the institutional review board of Gunma University (approval no. IRB2025-033, 2310).

Results: The mean observation period was 48 months. No prostate cancer-specific deaths occurred. AS persistence rates were 89% at 1 year, 55% at 5 years, and 27% at 10 years. Older age (≥ 75 years) was associated with longer AS persistence (p = 0.021). Overall, 69% of patients underwent repeat biopsy, most commonly at 1 year. Pathological upgrading occurred in 35% at the first and second repeat biopsies and in 20% at the third. Acceptance of the 1-year repeat biopsy increased from 46% in the early period (2012-2016) to 64% in the later period (2017-2024).

Conclusions: AS demonstrated favorable long-term safety and durability. Improving adherence to repeat biopsy protocols may further enhance AS management in Japan. REGISTRY AND REGISTRATION NO.

Of the study/trial: N/A.

Objectives: This study aims to determine the impact of the number of relevant factors for high-complexity tumors on perioperative outcomes of robot-assisted partial nephrectomy (RAPN).

Methods: The 308 patients who underwent RAPN for renal hilar, completely endophytic, or clinical T1b tumors were defined as the complex tumor group (CTG), and the other 752 were defined as the non-complex tumor group (NCTG). The CTG patients were further classified on the basis of their number of relevant factors for high-complexity tumors into the one-factor and multiple-factor subgroups. Perioperative outcomes were compared for each group.

Results: The median times using the robotic system were 187 and 167 min (p = 0.0006), median warm ischemic times (WITs) were 24 and 20 min (p < 0.0001), Grade 3 or higher complication rates were 6.2% and 2.5% (p = 0.0038), median preserved renal function rates at 1 month postoperatively were 78.9% and 85.2% (p < 0.0001), and trifecta achievement rates were 55.2% and 76.9% (p < 0.0001), respectively. RFS was significantly worse in CTG than in NCTG (5-year RFS was 92.6% and 97.4%, respectively). In the one- and multiple-factor subgroups, the median times using the robotic system were 184 and 222 min (p = 0.0003), median WITs were 23 and 28 min (p = 0.0002), median preserved renal function rates at 1 month postoperatively were 80.1% and 73.1% (p = 0.0036), and trifecta achievement rates were 59.9% and 37.9% (p = 0.0014), respectively.

Conclusions: RAPN for high-complexity tumors may show different perioperative outcomes depending on the number of relevant factors. Recurrence appears to be more frequent in high-complexity tumors.

Objective: To evaluate the effect of tertiary lymphoid structure (TLS)-like lymphocyte aggregates in radical cystectomy (RC) specimens on the survival outcomes of patients with bladder cancer.

Methods: We included 110 patients who underwent RC for urothelial carcinoma of the bladder. Hematoxylin and eosin-stained slides of RC specimens were evaluated for immune-related pathological results including the presence of TLS-like lymphocyte aggregates. Survival outcomes between groups were compared. The effects of various parameters on non-urinary tract recurrence-free survival (NUTRFS) were evaluated.

Results: Among the 110 patients, TLS-like lymphocyte aggregates were identified in 65 (59.1%). Immunohistochemical evaluation of TLS-like lymphocyte aggregates in five selected patients using antibodies against CD4, CD8, and CD20 demonstrated that all lesions contained organized structures with T lymphocytes surrounding the B lymphocytes, consistent with TLSs. The median follow-up duration was 39.8 months (interquartile range, 14.7-79.3 months). Analyses of overall survival, cancer-specific survival, and NUTRFS showed that patients with TLS-like lymphocyte aggregates had significantly better outcomes than those without such aggregates. In both univariable and multivariable Cox proportional hazards analyses for NUTRFS, the presence of TLSs remained an independent and statistically significant prognostic factor, along with pathological T stage and lymph node status (hazard ratio 0.25, 95% confidence interval 0.12-0.52), indicating a favorable prognosis in patients with TLS-like lymphocyte aggregates.

Conclusions: The findings of this study suggest that the presence of TLS-like lymphocyte aggregates observed on routinely used hematoxylin and eosin-stained slides of RC specimens may be an important predictor of survival outcomes after RC.

Objectives: Enfortumab vedotin (EV) is the standard treatment for locally advanced or metastatic urothelial carcinoma (la/mUC), though skin toxicities are problematic. We evaluated whether prophylactic corticosteroid premedication is associated with reduced toxicity and survival outcomes.

Methods: We retrospectively analyzed 157 patients with la/mUC receiving EV monotherapy, stratified by prophylactic intravenous dexamethasone (6.6 mg) premedication (pre-EV steroid, n = 20) or not (no pre-EV steroid, n = 137). Endpoints included the incidence of EV-related adverse events (AEs), objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances.

Results: Corticosteroid premedication was associated with a significantly lower incidence of skin AEs (10% vs. 62.7%, p < 0.001) and a reduced number of cumulative AEs (median 1 vs. 2, p = 0.018). The ORR were comparable. However, patients with steroid premedication showed inferior OS compared to those without (median OS 10.3 vs. 17.4 months, p = 0.008), while PFS showed no significant difference. Multivariable analysis confirmed corticosteroid premedication as an independent predictor of reduced skin AEs (OR 0.08, p = 0.001); however, it was associated with worse OS (HR 1.91, p = 0.048), with no significant impact on PFS. In the IPTW-adjusted analysis, corticosteroid premedication remained significantly associated with worse OS.

Conclusions: Corticosteroid premedication reduces skin toxicities during EV monotherapy, but its impact on survival remains uncertain and requires validation in larger studies.

Objectives: To examine pregnancy and delivery outcomes in women who underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, a novel surgical technique designed to reduce cesarean section (CS) complications.

Methods: A retrospective review at three institutions identified women who conceived after augmentation cystoplasty (AC). Data included pregnancy-related complications (hydronephrosis, urinary tract infections, and urinary incontinence), delivery-related outcomes, and intraoperative findings at CS.

Results: Six pregnancies occurred in five patients after AC; three underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, while two underwent conventional ileocystoplasty. Median age at AC was 11 years (range, 7-14 years). Hydronephrosis (4 pregnancies, 66.7%) and pyelonephritis (3, 50%) were most frequent, but no patient required nephrostomy or ureteral stenting. Urinary incontinence worsened in two pregnancies but resolved postpartum. Magnetic resonance imaging (MRI) before delivery provided anatomical information on four pregnancies. All deliveries were by CS, including five emergency procedures. In both ileocystoplasty patients, the uterus was covered by the mesentery of the augmented ileal segment, requiring a high uterine incision and careful vascular pedicle preservation. In contrast, the uterus was free of mesenteric coverage in sigmoid colon cystoplasty patients, and no intraoperative vascular pedicle or bladder injuries occurred.

Conclusions: Pregnancy and delivery after AC require multidisciplinary management. Pre-delivery MRI may facilitate delivery planning. In this limited cohort, sigmoid colon cystoplasty with retroperitoneal mesentery placement appeared to allow safe cesarean delivery without vascular pedicle or augmented bladder injury. Larger studies are warranted to confirm these preliminary findings.