International Journal of Urology最新文献

英文中文

Outcomes of Nivolumab-Plus-Ipilimumab in Metastatic Renal Cell Carcinoma: Second Interim Analysis of the J-ENCORE Study nivolumab + ipilimumab治疗转移性肾细胞癌的结果：J-ENCORE研究的第二次中期分析

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-25 DOI: 10.1111/iju.70281

Tomokazu Sazuka, Katsunori Tatsugami, Suguru Shirotake, Shuzo Hamamoto, Masahiro Nozawa, Kazuyuki Numakura, Atsushi Mizokami, Tsunenori Kondo, Sei Naito, Takashige Abe, Kojiro Ohba, Go Kimura, Shunta Onodera, Katsumi Yamaguchi, Hirotsugu Uemura

Objectives

J-ENCORE is a multicenter prospective observational study in Japan involving advanced or metastatic renal cell carcinoma patients receiving nivolumab-plus-ipilimumab (NIVO+IPI) as first-line treatment. The minimum 1-year observation revealed the efficacy and safety of NIVO+IPI comparable to those in CheckMate 214, and evaluated patient characteristics across subgroups for response and early progression. This minimum 2-year observation focuses on the post-treatment status after NIVO+IPI discontinuation.

Methods

The objective response rate (ORR), response duration, progression-free survival (PFS), overall survival (OS), treatment-related adverse events (TRAEs), treatment-free status, and second-line treatment were evaluated.

Results

The study included 274 patients (median age, 68 years; 24.8% aged ≥ 75 years; 15.7% had an Eastern Cooperative Oncology Group performance status ≥ 2; 58.0%, intermediate risk; 42.0%, poor risk) from 37 sites, with a median follow-up of 35.4 (range, 24.4–47.0) months. The ORR was 37.6%, with a median real-world duration of response at 17.1 months; 30.2% had real-world PFS ≥ 24 months, and the OS rate at 24 months was 67.2%. TRAEs of any grade, grade 3/4, and grade 5 occurred in 77.4%, 42.7%, and 1.1% of patients, respectively. Furthermore, 11.1% experienced late-onset TRAEs 28–100 days after discontinuation. For patients discontinuing NIVO+IPI due to adverse events, median treatment-free survival was 7.4 months; 34.9% had a treatment-free interval ≥ 12 months. Second-line treatment ORR was 22.0%, with cabozantinib as the most common choice.

Conclusions

We determined the long-term real-world effectiveness and safety of NIVO+IPI, providing beneficial information on post-treatment status.

Trial Registration

UMIN Clinical Trials Registry number: UMIN000036772; ClinicalTrials.gov identifier: NCT04043975

J-ENCORE是一项在日本进行的多中心前瞻性观察性研究，研究对象为接受nivolumab + ipilimumab （NIVO+IPI）作为一线治疗的晚期或转移性肾癌患者。至少1年的观察显示NIVO+IPI的有效性和安全性与CheckMate 214相当，并评估了亚组患者的反应和早期进展特征。这项至少2年的观察主要关注NIVO+IPI停药后的治疗状态。方法：评估客观缓解率（ORR）、缓解持续时间、无进展生存期（PFS）、总生存期（OS）、治疗相关不良事件（TRAEs）、无治疗状态、二线治疗。结果：研究纳入了来自37个地点的274例患者（中位年龄68岁；24.8%年龄≥75岁；15.7%的患者在东方肿瘤合作组的表现状态≥2；58.0%为中危；42.0%为低危），中位随访35.4个月（范围24.4-47.0）。ORR为37.6%，实际反应持续时间中位数为17.1个月；30.2%的患者真实PFS≥24个月，24个月OS率为67.2%。任何级别、3/4级和5级trae分别发生在77.4%、42.7%和1.1%的患者中。此外，11.1%的患者在停药后28-100天出现迟发性trae。对于因不良事件而停止NIVO+IPI治疗的患者，中位无治疗生存期为7.4个月；34.9%患者无治疗间隔≥12个月。二线治疗ORR为22.0%，卡博赞替尼是最常见的选择。结论：我们确定了NIVO+IPI的长期实际有效性和安全性，提供了治疗后状态的有益信息。试验注册：UMIN临床试验注册号：UMIN000036772；ClinicalTrials.gov识别码：NCT04043975。

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引用次数: 0

Editorial Comment of Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis 经尿道前列腺切除术男性抗生素预防：系统回顾和网络荟萃分析。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-25 DOI: 10.1111/iju.70294

Yoshikazu Togo

引用次数: 0

Beyond Libido and Mood: Toward a Circadian and Metabolic Perspective on Testosterone Regulation 超越性欲和情绪：从生理和代谢角度看睾酮调节。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-25 DOI: 10.1111/iju.70300

Yu-Hsiang Lin, Jau-Yuan Chen, Chien-Lun Chen

引用次数: 0

Editorial Comment on Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis 经尿道前列腺切除术男性抗生素预防：系统回顾和网络荟萃分析。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-24 DOI: 10.1111/iju.70295

Takanori Sekito, Hidetada Hirakawa, Takuya Sadahira

<p>Transurethral resection of the prostate remains a cornerstone surgical therapy for benign prostatic hyperplasia; however, postoperative urinary tract infection (UTI) and urosepsis continue to pose challenges. The systematic review and network meta-analysis by Oliveira et al. address the important clinical issue of determining optimal antimicrobial prophylaxis regimens to reduce postoperative infectious complications in this population [<span>1</span>]. By synthesizing randomized trials and indirect comparisons among multiple antimicrobial classes, their analysis demonstrates that prophylaxis markedly lowers postoperative bacteriuria, septicemia/bacteremia, fever, and length of stay compared with no antimicrobial use, with varying protective effects across antimicrobial classes depending on the outcome measured. Importantly, extending prophylaxis (> 72 h) did not provide consistent additional benefit and was associated with a nonsignificant trend toward higher septicemia/bacteremia risk, highlighting the importance of avoiding unnecessary antimicrobial exposure. This comprehensive work advances previous pairwise meta-analyses by ranking regimens through network methodology and clarifying that short perioperative regimens targeting common uropathogens achieve the best balance between efficacy and safety.</p><p>Beyond reinforcing the value of prophylaxis, this study highlights several stewardship-relevant insights. More intensive or prolonged regimens did not further reduce infection risk, supporting guideline-based minimalist approaches. Recent best practice guidelines recommend single-dose prophylaxis for most urologic procedures, with no additional postoperative dosing, citing no added benefit from extended regimens and a potential for increased antimicrobial resistance [<span>2</span>]. Moreover, the recent multicenter randomized trial suggested that, despite shorter antimicrobial prophylaxis application, microbiologically documented postoperative UTI rates tended to be lower and showed little difference between single-dose and multi-day regimens. While the study did not reach its planned sample size and cannot provide a confirmatory answer regarding noninferiority, the findings support the plausibility that prophylaxis duration could safely be reduced to the necessary minimum in transurethral prostate surgery [<span>3</span>].</p><p>In Oliveira et al.'s meta-analysis, variation in infection definitions and resistance reporting across the included trials limits the generalizability of the findings to modern practice, where multidrug-resistant organisms are becoming increasingly prevalent. A further consideration involves preoperative asymptomatic bacteriuria (ASB), which was not addressed in the meta-analysis but remains clinically relevant. Recent data in the holmium laser enucleation of prostate, another major transurethral surgery, suggest that untreated ASB does not increase postoperative UTI or urosepsis, suggesting doubts about the n

经尿道前列腺切除术仍然是良性前列腺增生的基石手术治疗；然而，术后尿路感染（UTI）和尿脓毒症继续构成挑战。Oliveira等人的系统综述和网络荟萃分析解决了确定最佳抗菌预防方案以减少该人群术后感染并发症的重要临床问题[10]。通过综合随机试验和多种抗菌素的间接比较，他们的分析表明，与不使用抗菌素相比，预防可显著降低术后菌尿、败血症/菌血症、发烧和住院时间，不同抗菌素类别的保护作用因测量结果而异。重要的是，延长预防（72小时）并没有提供一致的额外益处，并且与败血症/菌血症风险升高的不显著趋势相关，这突出了避免不必要的抗菌药物暴露的重要性。这项全面的工作通过网络方法对方案进行排名，并阐明针对常见尿路病原体的短期围手术期方案在疗效和安全性之间取得了最佳平衡，从而推进了之前的两两荟萃分析。除了强调预防的价值之外，本研究还强调了一些与管理相关的见解。更强化或更长时间的治疗方案没有进一步降低感染风险，支持基于指南的最低限度治疗方法。最近的最佳实践指南建议在大多数泌尿外科手术中使用单剂量预防，术后不增加剂量，理由是延长治疗方案没有额外的益处，而且可能增加抗菌素耐药性。此外，最近的多中心随机试验表明，尽管抗菌素预防应用时间较短，但微生物记录的术后尿路感染发生率往往较低，单剂量和多日方案之间差异不大。虽然这项研究没有达到计划的样本量，也不能提供关于非效性的确认性答案，但研究结果支持了预防持续时间可以安全地减少到经尿道前列腺手术所需的最低限度的可能性。在Oliveira等人的荟萃分析中，在纳入的试验中，感染定义和耐药性报告的差异限制了研究结果在现代实践中的普遍性，在现代实践中，多重耐药生物正变得越来越普遍。进一步的考虑涉及术前无症状细菌尿（ASB），这在meta分析中没有得到解决，但仍具有临床相关性。另一种主要经尿道手术——钬激光前列腺切除术的最新数据表明，未经治疗的ASB不会增加术后尿路感染或尿脓毒症，这表明在这些经尿道手术前普遍治疗的必要性受到质疑[10]。目前欧洲泌尿外科协会的指南建议在进行破粘膜泌尿外科手术前筛查和治疗ASB，并强调根据个体风险和局部耐药数据进行定制治疗[10]。虽然Oliveira等人提供了一个有价值的预防策略排名，但临床医生应该在抗菌药物管理框架内解释这些结果——根据机构抗生素图选择药物，将持续时间限制在单一术前剂量，并避免不必要的广谱暴露。持续的管理工作和精心设计的前瞻性试验对于完善预防政策至关重要，确保在不加速普通经尿道前列腺手术抗菌素耐药性的情况下预防感染。关户孝典：构思，写作-原稿，平川秀田：写作-审查和编辑，田平拓哉：写作-审查和编辑。作者声明无利益冲突。Alessandro V. Oliveira等人。经尿道前列腺切除术男性的抗生素预防：系统回顾和网络荟萃分析。Doi: https://doi.org/10.1111/iju.70276。

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引用次数: 0

Editorial Comment to Benefits of Preemptive Living Kidney Transplantation: Reduced Rates of Cerebro-Cardiovascular Events and Neoplasm Development 抢先活肾移植的益处：降低脑血管事件和肿瘤发生的几率。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-23 DOI: 10.1111/iju.70296

Masayoshi Okumi

引用次数: 0

Immediate Postoperative cfDNA Elevation Predicts Pain After Robot-Assisted Radical Prostatectomy 术后cfDNA即刻升高预测机器人辅助根治性前列腺切除术后疼痛。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-21 DOI: 10.1111/iju.70297

Noritaka Ishii, Tohru Yoneyama, Satoko Minakawa, Sakae Konishi, Hirotake Kodama, Takuma Narita, Jotaro Mikami, Naoki Fujita, Teppei Okamoto, Hayato Yamamoto, Atsushi Imai, Chikara Ohyama, Shingo Hatakeyama

Objective

Cell-free DNA (cfDNA) is a potential biomarker of surgical invasiveness, but its relationship with postoperative outcomes remains unclear. This study evaluated whether total cfDNA levels measured immediately after robot-assisted radical prostatectomy (RARP) predict postoperative outcomes, including surgical stress markers, pain, and complications.

Methods

We retrospectively analyzed 80 patients who underwent RARP at Hirosaki University Hospital. Total cfDNA levels were measured preoperatively and immediately postoperatively. Postoperative pain intensity was assessed on postoperative days 1–3 using the numerical rating scale (NRS). Patients were categorized into mild pain (NRS < 4) and moderate-to-severe pain (NRS ≥ 4) groups. Associations between cfDNA and NRS were evaluated and compared with conventional surgical stress markers (operative time, estimated blood loss, white blood cell count, C-reactive protein, and oxidative stress).

Results

The cfDNA ratio was higher in the NRS ≥ 4 group than in the NRS < 4 group (p = 0.029). In adjusted analyses, cfDNA ≥ 2.00 was associated with greater odds of moderate-to-severe pain (odds ratio 2.90, 95% confidence interval 1.09–7.72). Conventional markers—including CRP, white blood cell count, operative time, and blood loss—were not associated with pain. Oxidative-stress indices showed only weak correlations with NRS and were not correlated with cfDNA. Limitations include the retrospective, single-center design, and modest sample size.

Conclusions

Immediate postoperative cfDNA is significantly associated with postoperative pain severity and may serve as a rapid, sensitive biomarker for early pain prediction. The cfDNA ratio could support the development of personalized perioperative pain-management strategies. A prospective validation is warranted.

目的：游离DNA （Cell-free DNA, cfDNA）是外科手术侵袭性的潜在生物标志物，但其与术后预后的关系尚不清楚。这项研究评估了机器人辅助根治性前列腺切除术（RARP）后立即测量的总cfDNA水平是否能预测手术结果，包括手术应激标志物、疼痛和并发症。方法：回顾性分析在广崎大学医院行RARP手术的80例患者。术前和术后立即测定总cfDNA水平。术后1-3天采用数值评定量表（NRS）评估术后疼痛强度。结果：NRS≥4组的cfDNA比值高于NRS组。结论：术后立即cfDNA与术后疼痛严重程度显著相关，可作为早期疼痛预测的快速、敏感的生物标志物。cfDNA比值可以支持个性化围手术期疼痛管理策略的发展。有必要进行前瞻性验证。

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引用次数: 0

Preliminary Analysis of Prostate Cancer Screening Results and Exploration of Screening Model for Elderly Males in Rural Areas of Songjiang District, Shanghai 上海市松江区农村老年男性前列腺癌筛查结果初步分析及筛查模式探索

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-21 DOI: 10.1111/iju.70274

Daocheng Fang, Shumei Bi, Lingfeng Wu, Chao Wang, Hui Wen

Objectives

To analyze prostate cancer (PCa) screening results using serum prostate-specific antigen (PSA) among elderly males in rural Songjiang District, Shanghai, and explore a suitable screening model for rural residents.

Methods

From June 2022 to June 2024, data was collected from Songjiang Hospital affiliated with Shanghai Jiaotong University School of Medicine and community health service centers in Shanghai's Songjiang District. This was achieved through free clinics and annual physical examination data, specifically targeting PSA screening among residents. For individuals with PSA levels ≥ 10 ng/mL and those with PSA levels between 4 and 10 ng/mL accompanied by an abnormal fPSA/tPSA ratio, prostate biopsy was suggested. The clinical characteristics of PCa patients were analyzed, and follow-up was conducted via telephone, combined with the family doctor visit model, along with enhanced publicity and education measures.

Results

Among 17 198 screened residents, 2491 (14.48%) had abnormal PSA levels. Ultimately, 417 underwent biopsy, confirming PCa in 171 residents (puncture positive rate: 41.00%). The overall PCa detection rate was 0.99%. Pathologically, PCa was primarily adenocarcinoma (98.24%). Among 146 diagnosed patients receiving treatment, the majority (84.93%) were medium or high-risk. Optimizing the screening model significantly increased outpatient visits proportion in the later period.

Conclusion

PSA-based screening significantly increases PCa detection rates and can improve patient prognosis. The epidemiological profile indicates PCa patients in this rural area are predominantly medium and high-risk, underscoring the critical need for strengthened early screening and health education measures.

目的：分析上海市松江区农村老年男性前列腺癌（PCa）的血清前列腺特异性抗原（PSA）筛查结果，探讨适合农村居民的前列腺癌筛查模式。方法：于2022年6月至2024年6月收集上海交通大学医学院附属松江医院和上海市松江区社区卫生服务中心的数据。这是通过免费诊所和年度体检数据实现的，特别是针对居民的PSA筛查。对于PSA水平≥10 ng/mL和PSA水平在4 ~ 10 ng/mL之间并伴有fPSA/tPSA比值异常的个体，建议进行前列腺活检。分析PCa患者的临床特点，通过电话随访，结合家庭医生就诊模式，并加强宣传教育措施。结果：17198名筛查居民中，PSA异常2491人（14.48%）。最终，417人接受了活检，171人证实了PCa（穿刺阳性率：41.00%）。总PCa检出率为0.99%。病理上以腺癌为主（98.24%）。146例确诊接受治疗的患者中，绝大多数（84.93%）为中高危人群。优化筛选模型后，后期门诊就诊比例显著提高。结论：psa筛查可显著提高前列腺癌检出率，改善患者预后。流行病学资料显示，该农村地区PCa患者主要为中高危人群，强调了加强早期筛查和健康教育措施的迫切需要。

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引用次数: 0

RETRACTION: Autologous Platelet-Rich Plasma Covering Urethroplasty Versus Dartos Flap in Distal Hypospadias Repair: A Prospective Randomized Study 自体富血小板血浆覆盖尿道成形术与Dartos皮瓣修复尿道下裂远端：一项前瞻性随机研究。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-21 DOI: 10.1111/iju.70290

RETRACTION: A Y. Mahmoud, S. Gouda, I. Gamaan and M. A. Baky Fahmy, “Autologous Platelet-Rich Plasma Covering Urethroplasty Versus Dartos Flap in Distal Hypospadias Repair: A Prospective Randomized Study,” International Journal of Urology 26, no. 4 (2019): 475-480, https://doi.org/10.1111/iju.13912.

The above article, published online on 04 February 2019, in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Naoya Masumori; the Japanese Urological Association; and John Wiley & Sons Australia, Ltd. The retraction has been agreed upon following concerns raised by a third-party regarding duplication of images previously published in another article by a different group of authors. An investigation confirmed the images were duplicated and used to represent a different scientific context. The authors acknowledged that the images were inappropriately used and apologized for this misuse. The editors consider the results and conclusions invalid. The authors disagree with the retraction.

引用本文：A. Y. Mahmoud， S. Gouda， I. Gamaan， M. A. Baky Fahmy，“自体富血小板血浆覆盖尿道成形术与Dartos皮瓣修复尿道下裂远端：一项前瞻性随机研究”，国际泌尿外科杂志，26,no. 1。4 (2019): 475-480, https://doi.org/10.1111/iju.13912。上述文章于2019年2月4日在线发表在Wiley在线图书馆（wileyonlinelibrary.com）上，经该杂志总编辑Naoya Masumori；日本泌尿学会；及John Wiley & Sons Australia有限公司由于第三方对另一组作者先前在另一篇文章中发表的重复图像提出了担忧，因此同意撤回。一项调查证实，这些图像是重复的，并被用来代表不同的科学背景。作者承认这些图片被不恰当地使用，并为这种滥用道歉。编辑认为结果和结论无效。作者不同意撤稿。

引用次数: 0

A Comparative Study of Simultaneous and Delayed Penile Prosthesis During Robot-Assisted Radical Prostatectomy 机器人辅助根治性前列腺切除术中同步与延迟阴茎假体的比较研究。

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-21 DOI: 10.1111/iju.70285

Ignacio Moncada, Pramod Krishnappa, Agustín Fraile-Poblador, Pietro Moscatiello, Claudia Zaccaro, Julmar Paul Ascencios-Vargas, Iñigo López-Diez, Juan Ignacio Martinez-Salamanca, Javier Romero Otero

Objectives

To compare sexual rehabilitation outcomes in prostate cancer patients with preexisting erectile dysfunction (ED) undergoing simultaneous vs. delayed inflatable penile prosthesis (PP) placement during robot-assisted radical prostatectomy (RARP).

Methods

Fifty-six patients with refractory ED and prostate cancer (2011–2023) were included. Simultaneous RARP and inflatable PP placement was done in 29 patients. Twenty-seven patients underwent RARP followed by delayed inflatable PP placement after a mean of 3.28 years. The same surgeon performed both RARP and inflatable PP implantation. Modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), EORTC Sexual Health Scores, and penile length changes were evaluated at 1 year.

Results

Mean age of the simultaneous and delayed PP group was 64.41 and 62.66 years, respectively. The simultaneous group had a higher percentage of severe ED (55.2% vs. 25.9%). At 1 year, simultaneous group patients had significantly better mean Modified EDITS (79.1 vs. 61.1, p < 0.001) and better EORTC Sexual Health scores (62.5 vs. 47.1, p < 0.001). Penile length loss was significantly less in the simultaneous group compared to the delayed group (0.32 ± 0.29 cm vs. 1.43 ± 0.36 cm, p < 0.001). Positive surgical margin (13.7% vs. 18.5%) and biochemical recurrence at 2 years (10.3% vs. 14.8%) showed no significant difference between the simultaneous and delayed PP groups, respectively. No major complications were observed in either group.

Conclusion

Simultaneous inflatable PP with RARP is safe and provides early sexual rehabilitation, improves patients' quality of life and maintains penile length without compromising surgical and oncological outcomes.

目的：比较机器人辅助根治性前列腺切除术（RARP）中同步与延迟充气阴茎假体（PP）置入术中既有勃起功能障碍（ED）的前列腺癌患者的性康复结果。方法：选取2011-2023年56例难治性ED合并前列腺癌患者。29例患者同时行RARP和充气PP放置。27例患者在平均3.28年后接受RARP，随后延迟充气PP放置。同一位外科医生同时进行RARP和充气PP植入。改良勃起功能障碍治疗满意度量表（EDITS）、EORTC性健康评分和阴茎长度变化在1年后进行评估。结果：同期PP组和延迟PP组的平均年龄分别为64.41岁和62.66岁。同时组出现严重ED的比例更高（55.2%比25.9%）。1年时，同期组患者改良后的平均编辑率显著提高（79.1比61.1,p）。结论：同步充气PP与RARP是安全的，可以提供早期性康复，改善患者的生活质量，在不影响手术和肿瘤预后的情况下保持阴茎长度。

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引用次数: 0

Acknowledgment 鸣谢

IF 2.2 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology

Pub Date : 2025-11-20 DOI: 10.1111/iju.70277

引用次数: 0

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