International Journal of Urology最新文献

Objectives: To explore clinicopathological risk factors associated with the development of castration-resistant prostate cancer (CRPC) in patients who underwent robot-assisted radical prostatectomy (RARP).

Methods: This study was conducted in nine Japanese institutions between 2012 and 2021. Patients with clinically metastatic PCa, those who received neoadjuvant or adjuvant therapy, were excluded. Consequently, 2825 patients with PCa were analyzed. Persistent prostate-specific antigen (PSA) was determined as a level ≥ 0.2 ng/mL at 1 month postoperatively and consistently in subsequent measurements.

Results: Median follow-up was 42.0 months. Under follow-up, 493 (17.4%) and 25 (0.8%) patients progressed to biochemical recurrence and CRPC, respectively. One hundred and ninety-six patients received salvage radiation therapy, and 229 patients received salvage androgen deprivation therapy. Among the 25 patients with CRPC, the median time to CRPC was 31.8 months. Univariate analysis revealed that preoperative PSA level, biopsy grade group (GG) 5, percentage of positive cancer cores, GG5 in RARP specimens, pT3b, pN1, positive surgical margins, lymphovascular invasion (LVI), and persistent PSA levels were associated with CRPC development. Multivariate analysis revealed that biopsy GG5 (adjusted hazard ratio [aHR] 12.74, p < 0.001), LVI (aHR 3.90, p = 0.011), and persistent PSA levels (aHR 8.66, p < 0.001) were independently associated with CRPC development. Furthermore, using these three factors made it possible to stratify CRPC-free survival among patients with PCa who received RARP and confirmed external validation.

Conclusions: The combination of biopsy GG5, LVI, and persistent PSA levels may stratify the risk of developing CRPC in patients with PCa undergoing RARP.

Objectives: Transperineal prostate biopsy (TP-Bx) is increasingly preferred due to its lower infection risk and improved clinically significant prostate cancer detection rates. Its feasibility under local anesthesia provides both clinical and economic advantages. However, acute urinary retention (AUR) remains a significant post-procedure concern. This study aims to evaluate the impact of transperineal prostate biopsy performed under local anesthesia on voiding function using uroflowmetry parameters.

Materials and methods: A prospective observational study was conducted with 74 patients. TP-Bx was performed under local anesthesia using a freehand technique. Uroflowmetry parameters, including maximum urinary flow rate (Q_max, mL/s), average urinary flow rate (Q_ave, mL/s), voided volume (V_v, mL), and post-void residual volume (PVR), were assessed before and after the procedure to evaluate its impact on voiding function.

Results: The average changes in Q_max and Q_ave between pre and post procedure were 1.78 ± 4.33 and 0.63 ± 1.70, respectively. A significant reduction in Q_max and Q_ave was observed after TP-Bx (p < 0.001). PVR increased after TP-Bx (p < 0.001); however, these changes were mild and did not require catheterization.

Conclusion: With increasing experience, TP-Bx has become safer. The use of local anesthesia reduces anesthesia-related complications, and the historically feared risk of AUR appears lower than previously assumed. These findings support TP-Bx as a safe and effective diagnostic approach.

Objectives: To identify optimal candidates for Aquablation during the initial adoption phase by determining predictors of operative time and bladder irrigation volume to guide safe implementation.

Methods: We retrospectively analyzed 123 patients who underwent Aquablation between 2023 and 2025 during the initial implementation of this technique by Aquablation-naïve urologists at our institution. Patients with short operative times and low irrigation volumes were considered optimal candidates. Preoperative variables were assessed using multivariable linear regression. Because prostate volume (PV) demonstrated the strongest association with operative time and irrigation volume, post hoc exploratory locally estimated scatterplot smoothing (LOESS) analysis was performed to define a data-driven PV threshold, and perioperative outcomes were compared above and below this threshold.

Results: PV (median, 78 mL; interquartile range, 60-100 mL) was the only independent predictor of long operative times and great irrigation volumes. LOESS identified a PV threshold near 80 mL for bladder irrigation volume and 100 mL for operative time. Patients with PV < 100 mL had more favorable perioperative outcomes. Compared with PV ≥ 100 mL, PV < 100 mL had shorter operative times (median, 56 vs. 81 min; p < 0.05), lower irrigation volumes (median 9000 vs. 14 000 mL; p < 0.05), and smaller hemoglobin reductions (-0.9 vs. -1.6 mg/dL; p < 0.05); rates of Clavien-Dindo ≥ 3 adverse events, transfusion, and refulguration did not differ.

Conclusion: A PV < 100 mL appears to be a practical criterion for safe early adoption of Aquablation; accurate preoperative estimation of PV is therefore essential.

Prostate multiparametric MRI (mpMRI) is an indispensable diagnostic tool in the clinical management of patients suspected of prostate cancer (PCa). This mpMRI consists of T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI). This review first outlines the importance of preparation techniques in mpMRI examinations and the evolution, current status, and latest technologies of these imaging techniques. It then addresses the clinical applications of diffusion tensor imaging, particularly its potential in surgical strategies for radical prostatectomy. Additionally, this review addresses the issues and clinical application potential of biparametric MRI, which omits DCE-MRI, in PCa diagnosis. It also discusses countermeasures for category 3 lesions with insufficient positive rates for clinically significant PCa in the Prostate Imaging-Reporting and Data System (PI-RADS) diagnostic criteria for prostate mpMRI, as well as the current status of MRI-ultrasound fusion guided prostate targeted biopsy in clinical practice using prostate mpMRI as a guide.

Prostate-specific antigen (PSA) testing has long been central to prostate cancer detection but is limited by poor specificity, resulting in overdiagnosis and unnecessary prostate biopsies. Although PSA derivatives such as percentage free PSA and the Prostate Health Index (PHI) have improved diagnostic performance, substantial uncertainty persists, particularly in patients with equivocal magnetic resonance imaging (MRI) findings. Cancer-associated alterations in PSA glycosylation have emerged as a promising strategy to address these limitations. Percentage α2,3-linked sialylated PSA (S2,3PSA%) reflects tumor-associated glycoform changes that differ from those observed in benign prostatic conditions. This review summarizes the biological basis, analytical development, and clinical evidence supporting S2,3PSA% as a novel biomarker for prostate cancer diagnosis. We highlight key studies demonstrating that S2,3PSA% improves discrimination of clinically significant prostate cancer and provides complementary information when combined with PHI and MRI. Recent data further indicate that integrated diagnostic approaches incorporating S2,3PSA%, PHI, and PI-RADS scoring can meaningfully reduce unnecessary prostate biopsies without compromising detection of clinically significant disease. Beyond diagnostic accuracy, emerging evidence suggests that S2,3PSA%-guided risk stratification in screening settings may also reduce the number of unnecessary MRI examinations and biopsies, thereby contributing to more efficient use of healthcare resources and potential cost savings. We also discuss the potential role of S2,3PSA% in prostate cancer screening and active surveillance. Collectively, current evidence supports S2,3PSA% as a biologically informed biomarker that helps reduce diagnostic uncertainty inherent to PSA-based decision-making and facilitates more individualized and resource-conscious prostate cancer care.

Objectives: Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease. In this study, we aimed to evaluate the efficacy of photodynamic diagnosis (PDD)-assisted transurethral resection of the bladder (TURBT) using the recently validated International Bladder Cancer Group (IBCG) risk stratification model for IR-NMIBC.

Methods: We conducted a single-center retrospective analysis of 193 patients with IR-NMIBC who underwent either PDD-assisted with oral 5-aminolevulinic acid (n = 69) or white-light (WL) TURBT (n = 126) between 2009 and 2023. We performed 1:1 propensity score matching (PSM) to balance baseline characteristics. Recurrence-free survival (RFS) was compared between the groups using the Kaplan-Meier method with subgroup analyses based on IBCG risk strata (IR-low, IR-intermediate/high).

Results: After PSM, 69 patients with well-balanced characteristics remained in each group. PDD was associated with a significantly improved RFS compared with WL-TURBT in the overall cohort (p = 0.016). Using subgroup analysis, this benefit was most pronounced in the IR-low risk group (p = 0.025), whereas no significant difference was found in the IR-intermediate/high-risk group (p = 0.14). Regarding multivariate analysis, PDD was an independent predictor of improved RFS in both the entire IR cohort (hazard ratio [HR]: 0.421, p = 0.009) and IR-low subgroup (HR: 0.361, p = 0.047).

Conclusions: PDD-assisted TURBT significantly improved the recurrence outcomes in patients with IR-NMIBC, with the greatest benefit observed in the IR-low risk subgroup. These findings support a stratified approach in which PDD is a cornerstone of management of IR-low patients, while highlighting the need for further research to optimize treatment strategies for IR-intermediate/high patients.

Objectives: In 2025, the National Comprehensive Cancer Network (NCCN) updated the definition of very high-risk (VHR) prostate cancer to include individuals meeting at least two of the following: clinical stage ≥ T3, prostate-specific antigen ≥ 40 ng/mL, and Gleason Grade Group (GG) ≥ 4. This revision alters group classification and may impact surgical outcomes. We aimed to compare oncological outcomes under the earlier and 2025 definitions in individuals undergoing robot-assisted radical prostatectomy (RARP) without perioperative systemic therapy.

Methods: We retrospectively reviewed 1879 individuals who underwent RARP at two institutions between July 2012 and November 2022. Of these, 641 classified as high risk or above were analyzed: historical high risk (Group 1: n = 377), reclassified from VHR to high risk (Group 2: n = 119), and VHR per 2025 criteria (Group 3: n = 145).

Results: The median follow-up was 59.8 months. Five-year biochemical recurrence-free survival rates were 71.1%, 44.7%, and 29.8%; metastasis-free survival rates were 99.6%, 94.1%, and 88.9% for the three groups, respectively. Group 2 showed worse outcomes than Group 1. Exploratory analyses indicated that within Group 3, having > 4 biopsy cores with GG 4-5 was associated with significantly worse recurrence outcomes, whereas those without this factor had results closer to Group 2.

Conclusions: In conclusion, both the revised high-risk and VHR categories include heterogeneous populations. Refinement of risk stratification in the surgical setting may help identify subsets requiring tailored perioperative and multimodal strategies.

Objectives: To anatomically and histologically define the adipose and fascial structures posterior and lateral to the kidney and propose a compartment-based anatomical model aligned with intraoperative observations.

Methods: Seven cadavers were used for macroscopic and histological analyses. In the macroscopic analysis, the spatial relationships between the perirenal fat (PeRF), pararenal fat, posterior renal fascia (PRF), and extraperitoneal fascia (EPF) were examined. Histological observations focused on the distribution and continuity of adipose compartments and the organization of the surrounding dense fibrous connective tissue.

Results: Macroscopically, the EPF covered the anteromedial pararenal fat and extended posteriorly to the kidney. Upon incision, a small amount of adipose tissue was observed directly beneath it. Removing this TAC exposes the peritoneum and PRF with a clear demarcation between them. Histological analysis confirmed that the posterior renal and EPF were distinct, with dense connective tissue structures enclosing a separate TAC. This compartment extended anteriorly between the PeRF and peritoneum, and laterally between the peritoneum and EPF. These extensions converge near the peritoneal reflection in the lateral renal region, forming a characteristic triradiate configuration of adipose tissue.

Conclusions: Our findings challenge the classical notion that the renal fascia is a single continuous layer, supporting a compartment-centered anatomical model. The posterior and lateral regions of the kidney contain a distinct third adipose compartment, bordered by the posterior renal and extraperitoneal fasciae. This model offers improved anatomical clarity and may aid understanding during laparoscopic, retroperitoneoscopic, and robot-assisted surgeries.

Retraction: R. Zahran, A. Ghozy, S. S. Elkholy, F. El-Taweel, and M. Abu El-Magd, "Combination Therapy with Melatonin, Stem Cells and Extracellular Vesicles is Effective in Limiting Renal Ischemia-Reperfusion Injury in a Rat Model," International Journal of Urology 27, no. 1 (2020): 1039-1049. https://doi.org/10.1111/iju.14345. The above article, published online on 14 August 2020 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor-in-Chief Naoya Masumori; the Japanese Urological Association; and John Wiley & Sons Australia, Ltd. A third party reported that images of comet assays in Figure 6 showed evidence of manipulation. An investigation by the publisher found evidence of image manipulation in Figure 1b and Figure 6 as well as evidence of splicing in Figures 5e and 7c. The authors did not respond to an inquiry and request for original data by the publisher. The retraction has been agreed to because the evidence of image manipulation fundamentally compromises the editors' confidence in the results presented. The authors did not respond to the notice regarding the retraction.

Background: Cytomegalovirus (CMV) infection remains a key opportunistic complication after kidney transplantation. We evaluated risk factors for CMV reactivation in a universal preemptive strategy for the recent patient cohort including immunologically crossmatch positive high-risk recipients who underwent Intravenous Immunoglobulin (IVIG)-based desensitization with rituximab (Rit).

Methods: In this retrospective cohort study, 395 adult KTx recipients treated between 2019 and 2021 were enrolled. All 395 recipients were divided into 3 groups as follows: group 1 receiving IVIG (+)/Rit (+), n = 32 (8.1%); group 2 Rit (+) only, n = 270 (68.6%); group 3 receiving none, n = 93 (23.5%). The purpose of this study is to examine the influence of immunosuppressants including IVIG and/or Rit on CMV infection.

Results: Totally, CMV antigenemia was observed in 51 of 395 recipients (12.9%). Among them, 8 out of 32 recipients in group 1 (25.0%) showed CMV antigenemia, 29 out of 270 recipients in group 2 (10.7%), and 14 out of 93 recipients in group 3 (15.1%). There was a higher tendency of CMV antigenemia incidence in group 1, compared to groups 2 and 3, although not statistical significance. Univariate and multivariate logistic regression identified pre-transplant CMV-IgG seronegativity (OR 2.58; 95% CI 1.36-4.88; p = 0.004) and Immunological high-risk (OR 2.56; 95% CI 1.10-5.95; p = 0.038) as independent risk factors for CMV reactivation.

Conclusions: Seronegative status and immunosuppression against high immunological risk increased reactivation risk. Prophylactic treatment could be useful to prevent postoperative early complication in highly sensitized recipients using IVIG.