International Journal of Urology最新文献

Objective: We evaluated the incidence of and risk factors for postoperative infections after robotic-assisted radical prostatectomy (RARP) according to the type and duration of prophylactic antibiotic administration.

Methods: A total of 1038 patients underwent RARP at our institution from 2010 to 2021; 1026 patients (201 in the cefazolin [CEZ] group and 825 in the ampicillin/sulbactam [ABPC/SBT] group) were analyzed, and 12 who used other antibiotics were excluded. The primary endpoint was the incidence of urinary tract infection (UTI), surgical site infection (SSI), and remote infection (RI). T-tests, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed. Multivariate logistic regression analysis was performed to evaluate the effect of type and duration of prophylactic antibiotic administration.

Results: The incidence of UTI was 2.5% (5/201) in the CEZ group and 3.2% (26/825) in the ABPC/SBT group, with no significant difference between groups (p = 0.622). The rates of SSI and RI were comparable between groups (p = 0.680 and 0.906, respectively). Although the duration of antimicrobial therapy was longer in the ABPC/SBT group (p < 0.001), there was no significant difference in the incidence of UTI/SSI/RI after PSM and IPTW (all p > 0.05). Multivariate logistic regression analysis showed that neither the type of antibiotic nor the duration of administration affected the incidence of UTI/SSI/RI.

Conclusion: The risk of postoperative UTI/SSI/RI after RARP did not change with the type and duration of antimicrobial therapy.

Objectives: Prostatic urethral lift (PUL) for benign prostatic hyperplasia has recently been initiated in Asia; therefore, few studies with real-world data have been reported. This study evaluated the efficacy and safety of PUL using Japanese real-world multicenter data.

Methods: Indications for PUL were based on relevant guidelines in Japan. The preoperative patient status, postoperative progress at 1 and 3 months, and perioperative complications were evaluated. Also, we compared preoperative urinary retention and nonurinary retention patients, and prostate volumes <30, 30 to <50, and ≥50 mL.

Results: A total of 160 patients were included in the study. The mean age was 75 years and the mean prostate volume was 44 mL. The International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual volume significantly improved 1 and 3 months postoperatively compared to preoperatively. The catheter-free rates in the preoperative urinary retention group were 58.1%, 72.1%, 83.7%, and 88.4% on postoperative days 1, 7, 30, and 90, respectively. The catheter-free rates in the nonurinary retention group were 94.9%, 98.3%, and 100% on postoperative days 1, 7, and 14, respectively. The group with a prostate volume ≥50 mL had a longer operation time and used significantly more implants; however, no difference was observed in the postoperative urinary status among the three groups.

Conclusions: PUL can be considered a safe and effective procedure for both preoperative urinary retention and nonurinary retention patients with prostate volumes <100 mL in older patients with comorbidities.

Objectives: This study aimed to investigate the long-term effectiveness and safety of transvaginal mesh surgery for pelvic organ prolapse at a high-volume center in Japan.

Methods: Patients who underwent transvaginal mesh surgery between March 2010 and August 2015 were included and followed up for 5 years. As no mesh kits were available in our country, we used a self-cut polypropylene mesh (Japanese-style transvaginal mesh) for the procedures. Objective anatomical restoration and complications were evaluated during outpatient examinations.

Results: Overall, 711 patients were included in this study. Over 5 years, the recurrence rate of stage 2 or higher prolapse at the operated compartment was 8.6% (61 cases), whereas that at the other compartments was 12.8% (91 cases). The frequency of recurrence was highest at 3 months and decreased with each passing year in both compartments. During the follow-up period, 28 patients (three at the operated compartment and 25 at the other compartments) required reoperation owing to recurrence. Overall, there were 13 cases of mesh exposure (1.8%), including two (0.28%) in the bladder, 10 (1.4%) in the vagina, and one (0.14%) in the rectum. Urinary incontinence surgery was performed in 69 patients (9.7%) during the follow-up period.

Conclusions: The frequencies of recurrence requiring reoperation and mesh-related complications were low, and vaginal mesh exposure was mostly asymptomatic. Therefore, the Japanese-style transvaginal mesh is safe and effective.

In the over 80 years since androgens were found to play a pivotal role in prostate cancer (PCa) progression, androgen deprivation therapy (ADT) has been a cornerstone in treating advanced PCa. Castration-resistant PCa persists, however, with some of these tumors evolving to androgen receptor (AR)-independent forms like neuroendocrine PCa. The development of novel diagnostic and therapeutic approaches to PCa is therefore crucial. This review provides an overview of recent basic research in PCa, focusing on two main areas: PCa cells and their tumor microenvironments. The first section describes current knowledge on the intricate mechanisms of AR signaling pathways, emphasizing the roles of coactivators and chromatin state alterations in gene regulation. Genomic analyses have revealed recurrent mutations and copy number alterations critical for precision medicine. Liquid biopsy has become a promising tool for real-time tumor monitoring, identifying genetic alterations in circulating-tumor DNA or extracellular vesicles. The second section describes the tumor microenvironment of PCa, highlighting its immunosuppressive landscape and the potential of combining ADT with immunotherapy. Advanced techniques, including single-cell RNA sequencing and spatial transcriptomics offer insights into cellular heterogeneity and interactions within the tumor microenvironment, paving the way for novel therapeutic strategies. Integration of these diverse research areas will provide a comprehensive understanding of the current state and future directions of PCa research, underscoring the importance of personalized medicine and the dynamic nature of cancer treatment strategies.