International Journal of Urology最新文献

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 The above article, published online on 04 February 2019, in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Naoya Masumori; the Japanese Urological Association; and John Wiley & Sons Australia, Ltd.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.

Purpose: To investigate the safety and efficacy of mini-endoscopic combined intrarenal surgery (ECIRS) in older patients with renal and ureteral stones.

Methods: Consecutive patients with renal or ureteral stones who underwent mini-ECIRS were retrospectively analyzed at three Japanese tertiary care institutions between 2015 and 2021. Data on patient backgrounds, stone characteristics, and postoperative indications were collected and evaluated. After matching preoperative and intraoperative factors in older patients and other groups, postoperative factors were assessed using univariate analysis.

Results: The final analysis included data from 1303 single-session mini-ECIRS of 1432 cases collected. The patients were divided into two groups: those aged > 75 and those aged < 75 years, with 121 and 1182 patients. From each group, 112 cases matched for eight factors, performance status, body mass index, sex, hydronephrosis, percutaneous nephrostomy, pyuria, preoperative urinary tract infection, and preoperative ureteral stenting, were selected. The univariate analysis was performed on postoperative factors between the groups of matched older and matched non-older patients, and there was no significant difference in any factor, including postoperative hospitalization duration, complications, and stone-free rate (SFR).

Conclusions: To the best of our knowledge, this multicenter cohort study is the first to compare the efficacy and safety of the mini-ECIRS between older patients and other groups. It was discovered that surgery could be performed with a similar quality even in patients aged 75 and older compared to that in other groups.

Background and objective: The PEACE-3 trial demonstrated overall survival benefit for enzalutamide plus radium-223 versus enzalutamide alone in metastatic castration-resistant prostate cancer (mCRPC), but survival curves showed initial crossing followed by progressive separation, indicating non-proportional hazards. We aimed to characterize the time-dependent treatment effects through comprehensive analysis.

Methods: Individual patient datas (IPD) were reconstructed from published Kaplan-Meier curves of the PEACE-3 trial. Time-dependent treatment effects were evaluated by restricted mean survival time (RMST) analysis at predefined time points (18-72 months), time-dependent Cox regression with treatment-by-time interaction, piecewise Cox regression across 6 time intervals, landmark analyses, and Fleming-Harrington weighted log-rank tests.

Results: A total of 446 IPDs were reconstructed. Validation confirmed consistency with the original trial. During the initial 18 months, combination therapy showed no survival advantage (RMST difference: -0.36 months, 95% CI, -0.90 to 0.18, p = 0.20) and was associated with increased hazard (HR = 2.14, 95% CI, 1.48-3.10, p < 0.001). Significant survival benefits were observed after 60 months, with RMST differences of 4.34 months (95% CI, 0.49-8.19, p = 0.03) at 60 months and 6.25 months (95% CI, 1.56-10.95, p = 0.01) at 72 months. Time-dependent Cox regression confirmed a significant treatment-by-time interaction (p < 0.01). Piecewise analysis revealed the most substantial benefit for 60-72 months (HR = 0.20, 95% CI, 0.05-0.77, p = 0.02). Landmark analyses consistently demonstrated increasing treatment benefit with longer follow-up.

Conclusions: Enzalutamide plus radium-223 demonstrates delayed but substantial survival benefit in mCRPC, becoming statistically significant after 60 months with over 6 months survival advantage at 72 months. REGISTRY AND THE REGISTRATION NO.

Of the study/trial: Not applicable.

Background and objective: Treatment selection for metastatic castration-sensitive prostate cancer (mCSPC) remains challenging, as reliable and practical biomarkers predicting response to androgen receptor pathway inhibitor (ARPI)-based therapy are limited. We evaluated whether prostate-specific antigen (PSA) and Ki-67 expression in diagnostic biopsy specimens can predict oncologic outcomes in patients with mCSPC treated with ARPI-androgen deprivation therapy (ADT) doublet therapy, and whether these biomarkers can guide optimal treatment selection.

Methods: This retrospective multicenter study included 58 patients with mCSPC who received ARPI-ADT doublet therapy between 2018 and 2024. Immunohistochemical staining for PSA and Ki-67 was performed on diagnostic biopsy specimens. Receiver operating characteristic curve analyses were used to determine optimal cutoff values for predicting progression to castration-resistant prostate cancer (CRPC). Survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards models. Exploratory analyses included patients treated with triplet therapy (ADT + docetaxel + darolutamide) or upfront docetaxel.

Results: Low PSA expression, high Ki-67 expression, and a bone metastasis extent of disease (EOD) score ≥ 3 were independently associated with shorter CRPC-free survival (CRPC-FS). Stratification by risk factors (0, 1, or 2) showed a stepwise decline in CRPC-FS. In exploratory analyses, triplet therapy achieved the longest CRPC-FS and progression-free survival 2 among high-risk patients, whereas no significant differences among treatment modalities were observed in the low-risk group.

Conclusion: Immunohistochemical PSA and Ki-67 expression provide practical prognostic information for patients with metastatic castration-sensitive prostate cancer. Combined assessment with EOD ≥ 3 identifies a high-risk subgroup with unfavorable clinical outcomes.