International Journal of Urology最新文献

Background: Studies comparing oncological outcomes between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) are often limited by bias because of their multi-institutional and multiple surgeon design. Studies from a single institution and single surgeon are uncommon.

Objective: To compare oncological outcomes between RARP and ORP at a single institution by a single surgeon.

Design, setting and participants: A retrospective cohort study of 2376 men with localized prostate cancer who underwent either RARP or ORP, from 1995 to 2020 at single institution, by one surgeon was done. The first 100 cases were discounted in both cohorts to account for the learning curve.

Measurements: Positive surgical margin (PSM) and biochemical recurrence (BCR) rates were measured for each cohort.

Results: A total of 1566 men underwent ORP and 810 underwent RARP. BCR rates of 29.2% were found in the ORP group versus 19.5% in the RARP group (p < 0.001). PSM rates of 15.4% were found in the ORP group versus 9.0% in the RARP group (p < 0.001). A multivariate analysis of preoperative prostate specific antigen (PSA) and tumor stage (T) shows no statistically significant association with recurrence when controlled for surgical technique.

Conclusions: RARP produces better oncological outcomes when compared to ORP when performed by one experienced surgeon at a single institution.

Patient summary: In this large study of men with prostate cancer still localized to the prostate. We found that better cancer removal and chances of cancer recurrence are reduced by a robot-assisted prostate removal technique, compared to the traditional open technique.

Objectives: Limited data exist on surgical outcomes following artificial urinary sphincter (AUS) implantation in patients with a history of urethroplasty for urethral stricture. This study aimed to evaluate the surgical outcomes of AUS implantation in such patients, focusing on the risk of urethral erosion.

Methods: We retrospectively reviewed 14 male patients who developed severe urinary incontinence following urethroplasty for urethral stricture and subsequently underwent AUS implantation at our center between March 2012 and January 2024. Patients underwent either excision and primary anastomosis (EPA) or non-transecting anastomotic urethroplasty (NTAU), followed by AUS implantation using either the standard or transcorporeal approach, depending on periurethral adhesions and corpus spongiosum condition. Outcomes were assessed regularly after AUS implantation, focusing on complications, especially urethral erosion.

Results: The median follow-up period after AUS implantation was 46 months. Erosion occurred in 4 of 14 patients (28.6%), all of whom had undergone EPA, while no cases of erosion were observed in patients treated with NTAU. The 12-, 36-, and 60-month AUS survival rates were 100.0%, 90.9%, and 71.6%, respectively. Patients who underwent the transcorporeal approach had comparable erosion rates to those who received the standard approach (p = 0.60).

Conclusion: Patients with a history of urethroplasty face a high risk of AUS erosion. Whether urethral transection during urethroplasty influences urethral erosion following AUS implantation requires further accumulation of cases.

Objectives: To evaluate the surgical and patient-reported outcomes of YV-plasty in patients with refractory bladder neck stenosis (BNS) following transurethral prostate surgery.

Methods: This retrospective study reviewed five patients who underwent YV-plasty for BNS between January 2021 and October 2023. The surgical procedure involved a midline lower abdominal incision to expose the bladder neck. A V-shaped incision was made in the anterior bladder wall to create a bladder flap. The bladder neck was then incised from the apex of the V-shape to the healthy urethra, forming a Y-shaped incision. Fibrotic tissue was excised, and the posterior side of the urethra and bladder were anastomosed. The bladder flap was mobilized and sutured to the healthy urethra using 4-0 PDS interrupted sutures. Follow-up assessments included uroflowmetry, postvoid residual urine volume measurement (PVR), and questionnaires on daily pad use and patient satisfaction. Success was defined as cystourethroscope passage through the anastomosis without resistance and no need for additional procedures.

Results: The median patient age was 69. All patients had a history of failed endoscopic treatments. The median follow-up was 13 months, with all considered successful. The median postoperative maximum flow rate was 26.6 mL/s, and the median PVR was 12 mL. Postoperatively, two (40%) were pad-free, and three (60%) used 1-2 pads daily. Three (60%) patients were 'very satisfied,' one (20%) 'satisfied,' while one (20%) was 'dissatisfied.'

Conclusions: Y-V-plasty is an effective option for refractory BNS, improving urinary function and quality of life.

Objectives: To evaluate the efficacy of staged urethroplasty for complex anterior urethral strictures from both surgical and patient-reported outcome perspectives.

Methods: This retrospective study included 100 patients who underwent staged urethroplasty for anterior urethral strictures between May 2011 and June 2023. Anatomical success was defined as the ability to pass cystourethroscopy without resistance and the patient's ability to void without additional interventions. Patient-reported outcomes were evaluated using validated questionnaires, including the urethral stricture surgery patient-reported outcome measure, sexual health inventory for men (SHIM), and EuroQol 5-dimension (EQ-5D), administered pre-and postoperatively.

Results: At a median follow-up of 53 months, the anatomical success rate was 89.0%. Seventeen (17.0%) required revision surgery between stages. Perioperative complications occurred in 13 (13.0%). Significant improvements were observed in maximum flow rate (p < 0.0001), postvoid residual volume (p = 0.0006), total lower urinary tract symptoms (LUTS) scores (p < 0.0001), LUTS-specific quality of life (QOL) score (p < 0.0001), EQ-5D index score (p < 0.0001), and EQ-5D visual analog scale score (p < 0.0001). SHIM scores showed no significant change (p = 0.59). Overall, 93.5% of patients reported being either "satisfied" or "very satisfied" with the outcomes.

Conclusion: Staged urethroplasty demonstrates high anatomical success rates and significant improvements in urinary function and QOL without compromising erectile function. The high patient satisfaction rate supports its efficacy in treating complex anterior urethral strictures.

Background: C-reactive protein (CRP) is a prognostic biomarker for clear cell renal cell carcinoma (ccRCC). However, there may be potential racial heterogeneity in distribution and prognostic impact of CRP level. We investigated potential racial differences in distribution and prognostic impact of preoperative CRP among Asian (AS), African American (AA), and Caucasian (CAUC) patients with non-metastatic ccRCC (nmccRCC).

Methods: We retrospectively analyzed 1991 nmccRCC cases (AS/AA/CAUC: n = 968/223/800) undergoing nephrectomy from the international multi-institutional database. We investigated CRP distributions and optimal cut-off values for predicting recurrence-free survival (RFS) and overall survival (OS) using Cox regressions for each racial group. Subgroup analyses considered comorbidities, pathological T stage, and Fuhrman grade.

Results: Preoperative CRP distributions differed significantly among the races, with median values of 0.90 mg/L (interquartile range, 0.40-2.33) for AS, 5.00 mg/L (1.98-12.20) for AA, and 3.55 mg/L (1.41-8.48) for CAUC (p < 0.01). Optimal cut-off values for RFS were 1.2 mg/L in AS, 2.8 mg/L in AA, and 1.7 mg/L in CAUC, showing C-indices of 0.77, 0.71, and 0.77, respectively. For OS, they were 1.6 mg/L in AS, 8.3 mg/L in AA, and 9.3 mg/L in CAUC, yielding C-indices of 0.77, 0.70, and 0.74, respectively. Subgroup analyses revealed varying reference ranges of CRP levels among races (1.1-2.2/2.7-5.0/1.5-3.4 mg/L for RFS, and AS/AA/CAUC: 0.9-3.0/8.0-12.7/8.0-10.4 mg/L for OS, respectively).

Conclusion: The preoperative CRP distributions and their optimal cut-off values for predicting patient prognosis differed significantly among the races. Using race-specific cut-off values, CRP demonstrated consistently high-prognostic accuracies, which may improve tailored patient management in nmccRCC.

Introduction: Bowel regimens (BR) before radical cystectomy (RC) are currently not recommended by Enhanced Recovery After Surgery (ERAS) protocols, as prior studies have shown BRs lead to worsened outcomes. However, many of those studies have used historic literature before recent surgical advancements such as minimally invasive RC and have not investigated the impact BRs have by type of urinary diversion. Our goal is to determine the outcomes of preoperative BR in patients undergoing RC based on diversion type using a modern patient cohort.

Methods: RCs performed between 2019 and 2020 with BR information available were identified in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). Patients were grouped by type of BR received: no BR, both mechanical bowel preparation (MBP) and preoperative oral antibiotic BR (OABR), MBP only, and OABR only. We conducted propensity score matching based on factors influencing the operative approach. Baseline demographics and 30-day complication rates were compared between matched groups. We analyzed hospital length of stay (LOS) via multivariate regression with a Poisson distribution.

Results: In total, 2054 RCs were identified with 2.4% receiving OABR, 21.3% receiving MBP, 5.3% receiving both, and 71.0% receiving no BR. For patients with ileal conduit diversions, outcomes with BRs appeared mixed, as OABR leads to increased LOS. For patients with neobladder diversions, BRs were not associated with any worsened outcomes and were associated with reduced length of stay.

Conclusions: BRs such as OABR may associated with improved outcomes in patients receiving RC with neobladder diversion, a finding that warrants further investigation.