ObjectivesThis study aims to develop a prognostic model that estimates the post‐operative risk of cancer‐specific mortality in patients with bladder cancer who underwent radical cystectomy (RC).MethodsWe analyzed the data from patients with bladder cancer who had undergone radical cystectomy without receiving adjuvant chemotherapy across 36 institutions in the Japan Urological Oncology Group. The data were randomly split into training (N = 1348) and validation sets (N = 674) in a 2:1 ratio. Twenty‐five variables were analyzed, and a multivariable Cox regression model predicting cancer‐specific mortality was developed and validated. Prognostic scores were categorized into good and poor prognostic groups based on the upper tertile. The performance of the model was compared against the CheckMate 274 risk classification as a reference, which is used for determining the indication of adjuvant nivolumab therapy.ResultsThe final model incorporated eight variables. In the validation set, it outperformed the CheckMate 274 risk classification with superior time‐dependent area under the curves (5‐year: 0.81 vs. 0.67) and was well‐calibrated. Furthermore, our model reclassified 27.8% of patients categorized as high‐risk by the CheckMate 274 risk classification into the good prognosis group.ConclusionsWe developed and validated a prognostic model for patients with bladder cancer who underwent RC. This model will be beneficial in identifying patients with poor prognosis and those who are potential candidates for clinical trials of adjuvant therapy.
{"title":"Development and validation of a model to predict the outcomes of radical cystectomy in patients with bladder cancer","authors":"Wataru Fukuokaya, Jun Miki, Rikiya Taoka, Ryoichi Saito, Yoshiyuki Matsui, Shingo Hatakeyama, Takashi Kawahara, Ayumu Matsuda, Taketo Kawai, Minoru Kato, Tomokazu Sazuka, Takeshi Sano, Fumihiko Urabe, Soki Kashima, Hirohito Naito, Yoji Murakami, Naotaka Nishiyama, Hiroyuki Nishiyama, Hiroshi Kitamura, Takahiro Kimura","doi":"10.1111/iju.15585","DOIUrl":"https://doi.org/10.1111/iju.15585","url":null,"abstract":"ObjectivesThis study aims to develop a prognostic model that estimates the post‐operative risk of cancer‐specific mortality in patients with bladder cancer who underwent radical cystectomy (RC).MethodsWe analyzed the data from patients with bladder cancer who had undergone radical cystectomy without receiving adjuvant chemotherapy across 36 institutions in the Japan Urological Oncology Group. The data were randomly split into training (<jats:italic>N</jats:italic> = 1348) and validation sets (<jats:italic>N</jats:italic> = 674) in a 2:1 ratio. Twenty‐five variables were analyzed, and a multivariable Cox regression model predicting cancer‐specific mortality was developed and validated. Prognostic scores were categorized into good and poor prognostic groups based on the upper tertile. The performance of the model was compared against the CheckMate 274 risk classification as a reference, which is used for determining the indication of adjuvant nivolumab therapy.ResultsThe final model incorporated eight variables. In the validation set, it outperformed the CheckMate 274 risk classification with superior time‐dependent area under the curves (5‐year: 0.81 vs. 0.67) and was well‐calibrated. Furthermore, our model reclassified 27.8% of patients categorized as high‐risk by the CheckMate 274 risk classification into the good prognosis group.ConclusionsWe developed and validated a prognostic model for patients with bladder cancer who underwent RC. This model will be beneficial in identifying patients with poor prognosis and those who are potential candidates for clinical trials of adjuvant therapy.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249784","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":"Monitoring prostate cancer after low‐dose‐rate hemigland brachytherapy with delta‐radiomics of diffusion‐weighted magnetic resonance imaging","authors":"Kotaro Shimada, Motohiro Fujiwara, Daisuke Hirahara, Eichi Takaya, Soichiro Yoshida, Yasuhisa Fujii","doi":"10.1111/iju.15581","DOIUrl":"https://doi.org/10.1111/iju.15581","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183311","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}
ObjectivesThe expressions of complement component C5a and NLRP3 inflammasome and the antiproliferative effect of resveratrol in benign prostatic hyperplasia (BPH) model rat were analyzed to clarify the BPH proliferative mechanism.MethodsThis study used the pathological stromal‐dominant BPH model rat by urogenital sinus implantation (UGS). Expression of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 using rat BPH tissues at 2, 3, and 8 weeks (n = 6, respectively) after UGS implantation were analyzed by qRT‐PCR, western blotting analysis, and immunohistochemical (IHC) analysis. Serum IL‐1β levels in BPH model and sham rats were measured by enzyme‐linked immunosorbent assay. Furthermore, resveratrol, as the NLRP3 pathway inhibitor, was administered to BPH model rat to assess the antiproliferative effect on the BPH proliferative process. The proliferative effect on prostate was evaluated by Ki‐67 protein expression.ResultsThe expression levels of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 in qRT‐PCR, western blotting, and IHC were significantly upregulated in BPH tissues compared to control prostate tissues and showed increases with time (all p < 0.05). Serum IL‐1β levels in BPH model rats had significantly increased compared to sham rats. On IHC, deposition of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 was abundant in stromal areas of BPH. The administration of resveratrol significantly decreased prostate weight and expressions of NLRP3, IL‐1β, IL‐18, and Ki‐67 (all p < 0.05).ConclusionsNLRP3 inflammasome activation by complement C5a produces IL‐1β and IL‐18 through Caspase‐1 during the BPH proliferative process. NLRP3 inflammasome have the possibilities to be a therapeutic target for BPH proliferation by inhibiting the NLRP3 inflammasome pathway.
{"title":"Proliferative mechanism of benign prostatic hyperplasia by NLRP3 inflammasome through the complement pathway","authors":"Junya Hata, Kanako Matsuoka, Yuki Harigane, Kei Yaginuma, Hidenori Akaihata, Satoru Meguro, Ruriko Honda‐Takinami, Akifumi Onagi, Yuichi Sato, Soichiro Ogawa, Motohide Uemura, Yoshiyuki Kojima","doi":"10.1111/iju.15576","DOIUrl":"https://doi.org/10.1111/iju.15576","url":null,"abstract":"ObjectivesThe expressions of complement component C5a and NLRP3 inflammasome and the antiproliferative effect of resveratrol in benign prostatic hyperplasia (BPH) model rat were analyzed to clarify the BPH proliferative mechanism.MethodsThis study used the pathological stromal‐dominant BPH model rat by urogenital sinus implantation (UGS). Expression of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 using rat BPH tissues at 2, 3, and 8 weeks (<jats:italic>n</jats:italic> = 6, respectively) after UGS implantation were analyzed by qRT‐PCR, western blotting analysis, and immunohistochemical (IHC) analysis. Serum IL‐1β levels in BPH model and sham rats were measured by enzyme‐linked immunosorbent assay. Furthermore, resveratrol, as the NLRP3 pathway inhibitor, was administered to BPH model rat to assess the antiproliferative effect on the BPH proliferative process. The proliferative effect on prostate was evaluated by Ki‐67 protein expression.ResultsThe expression levels of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 in qRT‐PCR, western blotting, and IHC were significantly upregulated in BPH tissues compared to control prostate tissues and showed increases with time (all <jats:italic>p</jats:italic> < 0.05). Serum IL‐1β levels in BPH model rats had significantly increased compared to sham rats. On IHC, deposition of C5a, NLRP3, Caspase‐1, IL‐1β, and IL‐18 was abundant in stromal areas of BPH. The administration of resveratrol significantly decreased prostate weight and expressions of NLRP3, IL‐1β, IL‐18, and Ki‐67 (all <jats:italic>p</jats:italic> < 0.05).ConclusionsNLRP3 inflammasome activation by complement C5a produces IL‐1β and IL‐18 through Caspase‐1 during the BPH proliferative process. NLRP3 inflammasome have the possibilities to be a therapeutic target for BPH proliferation by inhibiting the NLRP3 inflammasome pathway.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183322","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}
Alessandro Innocenti, Gaianluca Niccolai, Andrea Pizzo
{"title":"Comment to The “V‐I penoscrotal reconfiguration”: A simple technique for the surgical treatment of congenital webbed penis","authors":"Alessandro Innocenti, Gaianluca Niccolai, Andrea Pizzo","doi":"10.1111/iju.15583","DOIUrl":"https://doi.org/10.1111/iju.15583","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183312","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}
Fangyi Lin, Grigori Vaserman, Evan Spencer, Muhammad Choudhury, John Phillips
ObjectiveThe objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic.MethodsAfter IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 (“pre‐COVID”) and from 01/02/2020 to 12/31/2022 (“COVID”). We identified demographics, origin hospitals, ICD‐10 pre‐ and post‐transfer diagnoses, distance of transfer, and post‐transfer CPT codes.ResultsDuring the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the “pre‐COVID” cohort and 111/160 (70%) made up the “COVID” cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre‐COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre‐COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 – 2.58, p < 0.01). Different diagnosis upon re‐evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09–0.97, p = 0.05).ConclusionsLong‐distance transfer, even >100 miles (which we termed “mega‐transfers”), was a new pandemic‐related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter‐institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.
{"title":"Rise of long‐distance urology transfer during the COVID‐19 pandemic: Identifying factors to enhance transfers of care efficiency and clinical outcomes","authors":"Fangyi Lin, Grigori Vaserman, Evan Spencer, Muhammad Choudhury, John Phillips","doi":"10.1111/iju.15577","DOIUrl":"https://doi.org/10.1111/iju.15577","url":null,"abstract":"ObjectiveThe objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic.MethodsAfter IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 (“pre‐COVID”) and from 01/02/2020 to 12/31/2022 (“COVID”). We identified demographics, origin hospitals, ICD‐10 pre‐ and post‐transfer diagnoses, distance of transfer, and post‐transfer CPT codes.ResultsDuring the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the “pre‐COVID” cohort and 111/160 (70%) made up the “COVID” cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre‐COVID period (<jats:italic>p</jats:italic> = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre‐COVID period (<jats:italic>p</jats:italic> = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 – 2.58, <jats:italic>p</jats:italic> < 0.01). Different diagnosis upon re‐evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09–0.97, <jats:italic>p</jats:italic> = 0.05).ConclusionsLong‐distance transfer, even >100 miles (which we termed “mega‐transfers”), was a new pandemic‐related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter‐institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183314","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}
Masato Shirai, Masataka Sano, Yuta Anno, Keisuke Ishikawa, Ayumu Taniguchi, Akimasa Kure, Yuka Uesaka, Taiji Nozaki, Shinichiro Fukuhara, Atsushi Iwasa, Kazuhiro Kobayashi, Jun Kato, Akira Tsujimura
ObjectivesThe vacuum erection device (VED) is a second‐line treatment tool recommended in erectile dysfunction (ED) guidelines but has long been unavailable in Japan. A new VED, Vigor 2020® (A & HB Company Limited, Tokyo, Japan), has now been manufactured and received medical approval from the Pharmaceuticals and Medical Devices Agency in Japan. We conducted a retrospective observational study of ED patients who used Vigor 2020 in clinical practice.MethodsWe analyzed male ED patients aged ≥20 years treated with Vigor 2020 in our outpatient clinics. The primary endpoint was improvement of erection as evaluated by an Erection Hardness Score (EHS) of ≥1 point. Secondary endpoints were improvement of sexual function and adverse events as evaluated by the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ‐EjD).ResultsThirty‐three patients (mean age, 57.21 [27–86] years) could be evaluated before and after using Vigor 2020. Among the 16 patients with baseline EHS ≤2, 14 (93.33%) improved by ≥1 point, and 10 of these 16 patients (62.50%) improved to EHS ≥3 and could insert vaginally. Significant improvement was observed for IIEF total score and for the MSHQ‐EjD in patients with an EHS of ≥3 after use of Vigor 2020. No patient experienced significant adverse events.ConclusionsThe Vigor 2020 may be an efficacious treatment tool for ED. Patients with significant ED experienced not only significant improvement of erection but also improvement of ejaculation with its use.
目标真空勃起装置 (VED) 是勃起功能障碍 (ED) 指南推荐的二线治疗工具，但在日本长期以来一直没有供应。新型真空勃起器 Vigor 2020® (A & HB Company Limited, Tokyo, Japan) 现已生产，并获得了日本药品和医疗器械管理局的医疗认证。我们对门诊中使用 Vigor 2020 治疗的年龄≥20 岁的男性 ED 患者进行了回顾性观察研究。主要终点是通过勃起硬度评分（EHS）≥1 分来评估勃起改善情况。次要终点是性功能和不良事件的改善，通过国际勃起功能指数（IIEF）和男性性健康问卷（MSHQ-EjD）评估射精功能障碍。在基线 EHS ≤2 的 16 名患者中，14 人（93.33%）的 EHS 改善了≥1 点，其中 10 人（62.50%）的 EHS 改善了≥3 点，可以经阴道插入。使用 Vigor 2020 后，EHS ≥3 的患者的 IIEF 总分和 MSHQ-EjD 均有显著改善。结论 Vigor 2020 可能是治疗 ED 的有效工具。使用 Vigor 2020 后，患有严重 ED 的患者不仅能明显改善勃起，还能改善射精。
{"title":"Efficacy of a new vacuum erection device (Vigor 2020) for erectile dysfunction: A retrospective study in Japan","authors":"Masato Shirai, Masataka Sano, Yuta Anno, Keisuke Ishikawa, Ayumu Taniguchi, Akimasa Kure, Yuka Uesaka, Taiji Nozaki, Shinichiro Fukuhara, Atsushi Iwasa, Kazuhiro Kobayashi, Jun Kato, Akira Tsujimura","doi":"10.1111/iju.15574","DOIUrl":"https://doi.org/10.1111/iju.15574","url":null,"abstract":"ObjectivesThe vacuum erection device (VED) is a second‐line treatment tool recommended in erectile dysfunction (ED) guidelines but has long been unavailable in Japan. A new VED, Vigor 2020<jats:sup>®</jats:sup> (A & HB Company Limited, Tokyo, Japan), has now been manufactured and received medical approval from the Pharmaceuticals and Medical Devices Agency in Japan. We conducted a retrospective observational study of ED patients who used Vigor 2020 in clinical practice.MethodsWe analyzed male ED patients aged ≥20 years treated with Vigor 2020 in our outpatient clinics. The primary endpoint was improvement of erection as evaluated by an Erection Hardness Score (EHS) of ≥1 point. Secondary endpoints were improvement of sexual function and adverse events as evaluated by the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ‐EjD).ResultsThirty‐three patients (mean age, 57.21 [27–86] years) could be evaluated before and after using Vigor 2020. Among the 16 patients with baseline EHS ≤2, 14 (93.33%) improved by ≥1 point, and 10 of these 16 patients (62.50%) improved to EHS ≥3 and could insert vaginally. Significant improvement was observed for IIEF total score and for the MSHQ‐EjD in patients with an EHS of ≥3 after use of Vigor 2020. No patient experienced significant adverse events.ConclusionsThe Vigor 2020 may be an efficacious treatment tool for ED. Patients with significant ED experienced not only significant improvement of erection but also improvement of ejaculation with its use.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183325","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}
IntroductionThe aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot‐assisted surgery (robot‐assisted radical cystectomy, RARC), including the stent‐free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function.MethodsBetween 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups.ResultsThe patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high‐risk cases with ASA‐PS ≥3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent‐free rate were comparable between the ORC and RARC groups. Throughout a median follow‐up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3‐year survival rates were similar across both groups.ConclusionsCUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent‐free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.
{"title":"Retroperitoneal cutaneous ureterostomy following radical cystectomy: A multicenter comparative study of robotic versus open surgery","authors":"Yutaro Sasaki, Kyotaro Fukuta, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Junya Furukawa","doi":"10.1111/iju.15580","DOIUrl":"https://doi.org/10.1111/iju.15580","url":null,"abstract":"IntroductionThe aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot‐assisted surgery (robot‐assisted radical cystectomy, RARC), including the stent‐free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function.MethodsBetween 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups.ResultsThe patients in the RARC group were significantly older (<jats:italic>p</jats:italic> = 0.007) and had a significantly higher proportion of high‐risk cases with ASA‐PS ≥3 (<jats:italic>p</jats:italic> = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (<jats:italic>p</jats:italic> < 0.001) and a reduced transfusion rate (<jats:italic>p</jats:italic> = 0.003). Postoperative complication rates and the stent‐free rate were comparable between the ORC and RARC groups. Throughout a median follow‐up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3‐year survival rates were similar across both groups.ConclusionsCUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent‐free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183324","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}
ObjectivesThe objective of this study is to evaluate the safety and efficacy of neoadjuvant degarelix acetate and low‐dose estramustine phosphate for high−/very high‐risk prostate cancer.MethodsOverall, 187 patients diagnosed with National Comprehensive Cancer Network high−/very high‐risk cTanyN0M0 localized prostate cancer who consented to undergo robot‐assisted radical prostatectomy after receiving neoadjuvant chemohormonal therapy for 6 months were prospectively enrolled between December 2017 and March 2023. Adverse events, perioperative and histopathological outcomes, and biochemical recurrence‐free survival rates were examined. Survival analysis compared the estramustine phosphate completion and reduction groups.ResultsThirty‐six patients discontinued neoadjuvant therapy in <5 months owing to adverse events (n = 34) or other reasons (n = 2). Eleven were excluded for being in the postoperative castration range. Of the 140 patients who underwent surgery, 124 continued with two tablets of estramustine phosphate and 16 with one tablet. Overall, 82 patients were very high‐risk. Histopathological outcomes were significantly worse in the very high‐risk group than those in the high‐risk group. Very high‐risk status and estramustine phosphate reduction were significant factors in biochemical recurrence in multivariate analysis. The biochemical recurrence‐free survival rate in very high‐risk patients was significantly lower in the estramustine phosphate dose reduction group than in the completion group but not significant in high‐risk patients. Major adverse events were anemia (n = 174), elevated transaminase levels (n = 68), and deep vein thrombosis (n = 24). Severe adverse events included acute coronary syndrome (n = 4) and pulmonary embolism (n = 3).ConclusionsDose compliance with estramustine phosphate predicted biochemical recurrence in patients with very high‐risk prostate cancer undergoing robot‐assisted radical prostatectomy with neoadjuvant chemohormonal therapy.
{"title":"Dose compliance of estramustine phosphate in neoadjuvant chemohormonal therapy combined with degarelix acetate predicts the biochemical recurrence in patients with very high‐risk prostate cancer who underwent robot‐assisted radical prostatectomy","authors":"Takanari Kambe, Toshinari Yamasaki, Akihiro Yamamoto, Akihiko Nagoshi, Tasuku Fujiwara, Yuta Mine, Hiroki Hagimoto, Atsushi Igarashi, Hidetoshi Kokubun, Shiori Murata, Naoki Akagi, Yuto Hattori, Yohei Abe, Naofumi Tsutsumi, Noboru Shibasaki, Mutsushi Kawakita","doi":"10.1111/iju.15579","DOIUrl":"https://doi.org/10.1111/iju.15579","url":null,"abstract":"ObjectivesThe objective of this study is to evaluate the safety and efficacy of neoadjuvant degarelix acetate and low‐dose estramustine phosphate for high−/very high‐risk prostate cancer.MethodsOverall, 187 patients diagnosed with National Comprehensive Cancer Network high−/very high‐risk cTanyN0M0 localized prostate cancer who consented to undergo robot‐assisted radical prostatectomy after receiving neoadjuvant chemohormonal therapy for 6 months were prospectively enrolled between December 2017 and March 2023. Adverse events, perioperative and histopathological outcomes, and biochemical recurrence‐free survival rates were examined. Survival analysis compared the estramustine phosphate completion and reduction groups.ResultsThirty‐six patients discontinued neoadjuvant therapy in <5 months owing to adverse events (<jats:italic>n</jats:italic> = 34) or other reasons (<jats:italic>n</jats:italic> = 2). Eleven were excluded for being in the postoperative castration range. Of the 140 patients who underwent surgery, 124 continued with two tablets of estramustine phosphate and 16 with one tablet. Overall, 82 patients were very high‐risk. Histopathological outcomes were significantly worse in the very high‐risk group than those in the high‐risk group. Very high‐risk status and estramustine phosphate reduction were significant factors in biochemical recurrence in multivariate analysis. The biochemical recurrence‐free survival rate in very high‐risk patients was significantly lower in the estramustine phosphate dose reduction group than in the completion group but not significant in high‐risk patients. Major adverse events were anemia (<jats:italic>n</jats:italic> = 174), elevated transaminase levels (<jats:italic>n</jats:italic> = 68), and deep vein thrombosis (<jats:italic>n</jats:italic> = 24). Severe adverse events included acute coronary syndrome (<jats:italic>n</jats:italic> = 4) and pulmonary embolism (<jats:italic>n</jats:italic> = 3).ConclusionsDose compliance with estramustine phosphate predicted biochemical recurrence in patients with very high‐risk prostate cancer undergoing robot‐assisted radical prostatectomy with neoadjuvant chemohormonal therapy.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183326","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}
ObjectiveArtery and vein (AV) clamps can control venous bleeding in the surgical field and prevent carbon dioxide embolism, especially when large veins are expected to open. However, whether AV clamps cause more renal damage than artery‐only (AO) clamps remains unclear. This study aimed to compare renal function and blood loss in surgeries using AO and AV clamps based on high RENAL nephrometry scores (RNS) in robot‐assisted partial nephrectomy (RAPN).MethodsWe retrospectively analyzed the medical records of 500 patients who underwent RAPN between March 2016 and December 2021. We performed 1:1 propensity matching for these patients.ResultsA total of 340 patients with pathological malignancies who were followed up for at least 12 months were included in this analysis. A total of 291 patients with AO clamping and 49 patients with AV clamping were included. Overall, the AV clamp group had higher total RNSs and larger diameters than the AO clamp group. Propensity score‐matched analysis included 37 patients in each clamp group. The median warm ischemia times of the AV and AO clamps were 25 and 22 min, respectively, with no significant difference. There were no statistically significant differences between the groups in the amount of blood loss, rate of acute kidney injury (AKI), or renal function at 1, 3, or 12 months post‐RAPN.ConclusionCompared with the AO clamp, the AV clamp did not have a detrimental impact on blood loss or renal dysfunction. Consequently, AV clamps may be considered for patients presenting with moderate‐to‐high‐complexity RNSs.
目的 动静脉（AV）夹可控制手术野的静脉出血并防止二氧化碳栓塞，尤其是在大静脉预期开放的情况下。然而，动静脉夹是否会比单纯动脉（AO）夹造成更多的肾损伤仍不清楚。本研究旨在根据机器人辅助肾部分切除术（RAPN）中高RENAL肾血压评分（RNS），比较使用AO和AV夹钳手术中的肾功能和失血量。方法我们回顾性分析了2016年3月至2021年12月期间接受RAPN手术的500名患者的病历。结果共有 340 名随访至少 12 个月的病理恶性肿瘤患者被纳入本次分析。共有 291 名患者采用了 AO 夹钳，49 名患者采用了 AV 夹钳。总体而言，与 AO 夹钳组相比，AV 夹钳组的 RNS 总量更高，直径更大。倾向评分匹配分析在每个钳夹组都纳入了 37 名患者。房室夹钳和 AO 夹钳的中位温暖缺血时间分别为 25 分钟和 22 分钟，无显著差异。结论与 AO 夹钳相比，房室夹钳对失血量或肾功能障碍没有不利影响。因此，对于中度至高度复杂的 RNS 患者，可以考虑使用房室夹钳。
{"title":"Comparison of renal function between the artery and vein clamp and artery‐only clamp in robot‐assisted partial nephrectomy for moderate‐ to high‐complexity renal masses: A propensity‐matched study","authors":"Kentaro Muraoka, Ryosuke Jikuya, Koichi Uemura, Takuya Kondo, Tomoyuki Tatenuma, Mitsuru Komeya, Hiroki Ito, Yusuke Ito, Hisashi Hasumi, Kazuhide Makiyama","doi":"10.1111/iju.15567","DOIUrl":"https://doi.org/10.1111/iju.15567","url":null,"abstract":"ObjectiveArtery and vein (AV) clamps can control venous bleeding in the surgical field and prevent carbon dioxide embolism, especially when large veins are expected to open. However, whether AV clamps cause more renal damage than artery‐only (AO) clamps remains unclear. This study aimed to compare renal function and blood loss in surgeries using AO and AV clamps based on high RENAL nephrometry scores (RNS) in robot‐assisted partial nephrectomy (RAPN).MethodsWe retrospectively analyzed the medical records of 500 patients who underwent RAPN between March 2016 and December 2021. We performed 1:1 propensity matching for these patients.ResultsA total of 340 patients with pathological malignancies who were followed up for at least 12 months were included in this analysis. A total of 291 patients with AO clamping and 49 patients with AV clamping were included. Overall, the AV clamp group had higher total RNSs and larger diameters than the AO clamp group. Propensity score‐matched analysis included 37 patients in each clamp group. The median warm ischemia times of the AV and AO clamps were 25 and 22 min, respectively, with no significant difference. There were no statistically significant differences between the groups in the amount of blood loss, rate of acute kidney injury (AKI), or renal function at 1, 3, or 12 months post‐RAPN.ConclusionCompared with the AO clamp, the AV clamp did not have a detrimental impact on blood loss or renal dysfunction. Consequently, AV clamps may be considered for patients presenting with moderate‐to‐high‐complexity RNSs.","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183323","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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