Operative time prediction is crucial for efficient operating room scheduling. This study developed and validated an operative time prediction system for robot-assisted laparoscopic radical prostatectomy using data from two institutions.
Methods
Retrospectively identified 557 and 150 patients who underwent RARP at Tohoku University Hospital and Miyagi Cancer Center were analyzed. The following variables were collected as explanatory variables for the prediction system: Age, height, body mass index, comorbidities, performance status, prostate volume, tumor extent of local invasion, grade group, prostatitis, preoperative treatment, history of intraperitoneal surgery, lymphadenectomy, and nerve-sparing. In addition, the observed operative time was collected as a source variable for the objective variable. The observed operative time was calculated as the sum of components related to institutional, operator, and patient factors. Approximation curves were applied to the first two components, while a random forest-based machine learning model was applied to the latter, resulting in the development of an integrated prediction system.
Results
The normalized root mean square error between the observed and predicted operative times was 0.107 in internal validation and 0.148 in external validation, demonstrating greater reliability than the expected operative time by operators in advance. Factors that are known to impact operative time, such as lymphadenectomy, grade group, prostate volume, and body mass index, were identified as contributing variables.
Conclusions
The system provides a reliable and robust prediction focusing on factors known to impact operative time. It has the potential to improve the efficiency of operating room scheduling.
{"title":"Operative Time Prediction by Machine Learning for Robot-Assisted Laparoscopic Radical Prostatectomy","authors":"Yu Suzuki, Shinya Sonobe, Yoshihide Kawasaki, Saori Ikumi, Eichi Takaya, Carlos Makoto Miyauchi, Tomoya Kobayashi, Junya Iwazaki, Hisanobu Adachi, Naoki Kawamorita, Akihiro Ito","doi":"10.1111/iju.70292","DOIUrl":"10.1111/iju.70292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Operative time prediction is crucial for efficient operating room scheduling. This study developed and validated an operative time prediction system for robot-assisted laparoscopic radical prostatectomy using data from two institutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospectively identified 557 and 150 patients who underwent RARP at Tohoku University Hospital and Miyagi Cancer Center were analyzed. The following variables were collected as explanatory variables for the prediction system: Age, height, body mass index, comorbidities, performance status, prostate volume, tumor extent of local invasion, grade group, prostatitis, preoperative treatment, history of intraperitoneal surgery, lymphadenectomy, and nerve-sparing. In addition, the observed operative time was collected as a source variable for the objective variable. The observed operative time was calculated as the sum of components related to institutional, operator, and patient factors. Approximation curves were applied to the first two components, while a random forest-based machine learning model was applied to the latter, resulting in the development of an integrated prediction system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The normalized root mean square error between the observed and predicted operative times was 0.107 in internal validation and 0.148 in external validation, demonstrating greater reliability than the expected operative time by operators in advance. Factors that are known to impact operative time, such as lymphadenectomy, grade group, prostate volume, and body mass index, were identified as contributing variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The system provides a reliable and robust prediction focusing on factors known to impact operative time. It has the potential to improve the efficiency of operating room scheduling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In addition to pathological diagnosis, the identification of a diagnostic index to determine indolent and index cancers will be useful for prostate cancer diagnosis. The present study aimed to provide evidence that quantification of DNA methylation levels at specific gene positions can serve as an indicator for the diagnosis of prostate cancer malignancy.
Methods
First, we attempted to identify genomic positions where cancer cells could be discriminated from normal cells using prostate-derived cultured cells by quantification of DNA methylation levels with methylation-specific PCR (MSP). Using needle biopsy tissue from patients with prostate cancer bisected by a tissue divider, we quantified DNA methylation levels at four candidate loci identified in cultured cells and analyzed the pathology. Finally, we examined the correlation between DNA methylation levels and gene expression levels in nearby genomic regions using identical tissue from patients with prostate cancer.
Results
Quantitative analysis using prostate-derived cultured cells and needle biopsy tissue from prostate cancer patients showed that DNA methylation levels at CpG sites near four genes (BCAT1, C3orf37, PCDHA1-8, and RAI1) were significantly higher in cancer than in normal. In particular, DNA methylation levels near the C3orf37 gene were higher in high-grade cancers compared to intermediate-grade cancers, showing a significant correlation with cancer grade. In addition, a correlation tendency between DNA methylation levels and gene expression levels was found at the PCDHA1 locus among the four genetic loci.
Conclusions
Quantitative analysis of DNA methylation at CpG sites near the C3orf37 gene appears to be a promising approach to distinguish between index and indolent prostate cancer cells.
目的：在病理诊断的基础上，鉴别出一种诊断指标来判断前列腺癌的惰性和指标性，将有助于前列腺癌的诊断。本研究旨在提供证据，量化特定基因位置的DNA甲基化水平可作为前列腺癌恶性诊断的指标。方法：首先，我们试图通过甲基化特异性PCR （methyl- specific PCR， MSP）定量DNA甲基化水平，在前列腺来源的培养细胞中确定癌细胞与正常细胞区分的基因组位置。利用组织分裂器对前列腺癌患者的穿刺活检组织进行切片，我们量化了培养细胞中鉴定的四个候选位点的DNA甲基化水平，并分析了病理学。最后，我们使用来自前列腺癌患者的相同组织检查了DNA甲基化水平与附近基因组区域基因表达水平之间的相关性。结果：对前列腺癌患者的前列腺源性培养细胞和穿刺活检组织进行定量分析显示，癌症患者的四个基因（BCAT1、C3orf37、PCDHA1-8和RAI1）附近的CpG位点的DNA甲基化水平显著高于正常患者。特别是，与中度癌症相比，高级别癌症中C3orf37基因附近的DNA甲基化水平更高，显示出与癌症级别的显著相关性。此外，在4个遗传位点中，PCDHA1位点的DNA甲基化水平与基因表达水平存在相关趋势。结论：定量分析C3orf37基因附近CpG位点的DNA甲基化似乎是区分指数和惰性前列腺癌细胞的一种有希望的方法。
{"title":"DNA Methylation Levels at the C3orf37 Loci Correlate With Prostate Cancer Grade","authors":"Satoshi Sako, Saya Ito, Takashi Ueda, Yusuke Gabata, Hikaru Takahashi, Junki Murashita, Masayoshi Okumi, Fumiya Hongo, Osamu Ukimura","doi":"10.1111/iju.70299","DOIUrl":"10.1111/iju.70299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In addition to pathological diagnosis, the identification of a diagnostic index to determine indolent and index cancers will be useful for prostate cancer diagnosis. The present study aimed to provide evidence that quantification of DNA methylation levels at specific gene positions can serve as an indicator for the diagnosis of prostate cancer malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First, we attempted to identify genomic positions where cancer cells could be discriminated from normal cells using prostate-derived cultured cells by quantification of DNA methylation levels with methylation-specific PCR (MSP). Using needle biopsy tissue from patients with prostate cancer bisected by a tissue divider, we quantified DNA methylation levels at four candidate loci identified in cultured cells and analyzed the pathology. Finally, we examined the correlation between DNA methylation levels and gene expression levels in nearby genomic regions using identical tissue from patients with prostate cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Quantitative analysis using prostate-derived cultured cells and needle biopsy tissue from prostate cancer patients showed that DNA methylation levels at CpG sites near four genes (<i>BCAT1</i>, <i>C3orf37</i>, <i>PCDHA1</i>-8, and <i>RAI1</i>) were significantly higher in cancer than in normal. In particular, DNA methylation levels near the <i>C3orf37</i> gene were higher in high-grade cancers compared to intermediate-grade cancers, showing a significant correlation with cancer grade. In addition, a correlation tendency between DNA methylation levels and gene expression levels was found at the <i>PCDHA1</i> locus among the four genetic loci.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Quantitative analysis of DNA methylation at CpG sites near the <i>C3orf37</i> gene appears to be a promising approach to distinguish between index and indolent prostate cancer cells.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Anatomy of Adipose Compartments and Fascial Structures in the Posterolateral Region of the Kidney With Special Focus on the Thin Adipose Compartment","authors":"Atsuhiko Ochi, Satoru Muro, Sho Mitsumaru, Akimoto Nimura, Keiichi Akita","doi":"10.1111/iju.70303","DOIUrl":"10.1111/iju.70303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malpractice litigation is an increasing concern in surgical specialties, with significant psychological and behavioral consequences. Defensive medicine is a frequent response, but data in urology are scarce. This study evaluated malpractice-related stress and defensive medical practices among Turkish urologists.
Methods
A cross-sectional online survey was conducted between June and July 2025 among practicing urologists in Turkey. The questionnaire, developed according to the CHERRIES checklist, included demographics, malpractice experiences, anxiety related to litigation, and defensive attitudes. Defensive practices were assessed using the validated Turkish version of the Defensive Medicine Attitude Scale. Statistical analyses were performed with Chi-square, Fisher's Exact, Mann–Whitney U, and Kruskal–Wallis tests.
Results
A total of 152 urologists participated. The largest age group was 30–39 years (32.9%), and 44.7% had ≥ 20 years of experience. Overall, 73% had malpractice lawsuit experience (personal or colleague), and 91.4% reported litigation-related anxiety. High compensation concerns were significantly associated with avoidance of patients likely to sue (p = 0.032) and complex patients (p < 0.001). Senior physicians and those with academic titles more often spent time with patients (p = 0.012, p = 0.014).
Conclusion
Malpractice stress and defensive medicine are highly prevalent among Turkish urologists. These behaviors reflect physicians' psychological burden and influence clinical decision-making. Professional support and legislative reforms are essential to mitigate malpractice-related stress and reduce defensive practices.
{"title":"Malpractice Stress Syndrome and Defensive Medicine in Surgical Specialties: Evidence From Urologists in Turkey","authors":"Alper Şimşek, Aykut Başer","doi":"10.1111/iju.70302","DOIUrl":"10.1111/iju.70302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Malpractice litigation is an increasing concern in surgical specialties, with significant psychological and behavioral consequences. Defensive medicine is a frequent response, but data in urology are scarce. This study evaluated malpractice-related stress and defensive medical practices among Turkish urologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional online survey was conducted between June and July 2025 among practicing urologists in Turkey. The questionnaire, developed according to the CHERRIES checklist, included demographics, malpractice experiences, anxiety related to litigation, and defensive attitudes. Defensive practices were assessed using the validated Turkish version of the Defensive Medicine Attitude Scale. Statistical analyses were performed with Chi-square, Fisher's Exact, Mann–Whitney U, and Kruskal–Wallis tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 152 urologists participated. The largest age group was 30–39 years (32.9%), and 44.7% had ≥ 20 years of experience. Overall, 73% had malpractice lawsuit experience (personal or colleague), and 91.4% reported litigation-related anxiety. High compensation concerns were significantly associated with avoidance of patients likely to sue (<i>p</i> = 0.032) and complex patients (<i>p</i> < 0.001). Senior physicians and those with academic titles more often spent time with patients (<i>p</i> = 0.012, <i>p</i> = 0.014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Malpractice stress and defensive medicine are highly prevalent among Turkish urologists. These behaviors reflect physicians' psychological burden and influence clinical decision-making. Professional support and legislative reforms are essential to mitigate malpractice-related stress and reduce defensive practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Outcomes of Nivolumab-Plus-Ipilimumab in Metastatic Renal Cell Carcinoma: Second Interim Analysis of the J-ENCORE Study","authors":"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","doi":"10.1111/iju.70281","DOIUrl":"10.1111/iju.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We determined the long-term real-world effectiveness and safety of NIVO+IPI, providing beneficial information on post-treatment status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN Clinical Trials Registry number: UMIN000036772; ClinicalTrials.gov identifier: NCT04043975</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iju.70281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial Comment of Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis","authors":"Yoshikazu Togo","doi":"10.1111/iju.70294","DOIUrl":"10.1111/iju.70294","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Libido and Mood: Toward a Circadian and Metabolic Perspective on Testosterone Regulation","authors":"Yu-Hsiang Lin, Jau-Yuan Chen, Chien-Lun Chen","doi":"10.1111/iju.70300","DOIUrl":"10.1111/iju.70300","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<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。
{"title":"Editorial Comment on Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis","authors":"Takanori Sekito, Hidetada Hirakawa, Takuya Sadahira","doi":"10.1111/iju.70295","DOIUrl":"10.1111/iju.70295","url":null,"abstract":"<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","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iju.70295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial Comment to Benefits of Preemptive Living Kidney Transplantation: Reduced Rates of Cerebro-Cardiovascular Events and Neoplasm Development","authors":"Masayoshi Okumi","doi":"10.1111/iju.70296","DOIUrl":"10.1111/iju.70296","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Immediate Postoperative cfDNA Elevation Predicts Pain After Robot-Assisted Radical Prostatectomy","authors":"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","doi":"10.1111/iju.70297","DOIUrl":"10.1111/iju.70297","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cfDNA ratio was higher in the NRS ≥ 4 group than in the NRS < 4 group (<i>p</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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