International Journal of Urology最新文献

Objectives: To evaluate the feasibility and surgical outcomes of simultaneous urethral reconstruction for synchronous urethral strictures (SUS) and analyze the surgical techniques employed for different stricture combinations.

Methods: Twenty-two male patients with SUS who underwent urethral reconstruction between February 2018 and July 2023 were retrospectively reviewed. Stricture locations and lengths were evaluated using cystoscopy and urethrography after urethral rest for at least 3 months. Multiple reconstruction techniques were employed based on stricture characteristics, including anastomotic urethroplasty, substitution urethroplasty, staged urethroplasty, perineal urethrostomy, and deep lateral incision of the bladder neck. Anatomical success was defined as the ability to pass a cystoscope without resistance and void without additional interventions.

Results: The median age was 72, with iatrogenic causes accounting for 77.2%. The most common stricture combination was strictures at the penoscrotal junction and proximal bulbar urethra (59.1%). Two (9.1%) had strictures in three locations, and one (4.5%) had strictures in four locations. A total of 15 different combinations of reconstruction techniques were utilized to address various stricture patterns. Overall, 86.4% were treated in one stage. The median operation time was 177 min, and the median blood loss was 72 mL. At a median follow-up of 31 months, anatomical success was achieved at 77.3%. No perioperative complications were observed.

Conclusions: Simultaneous repair of SUS is feasible using various reconstructive techniques tailored to each stricture site. The high prevalence of iatrogenic etiology and previous transurethral treatments emphasize the importance of appropriate initial management of urethral strictures.

May this new year of 2025 be one in which all wishes and goals of relatives to the International Journal of Urology (IJU) come true!

Thanks to all authors and relatives of IJU, IJU has been even promoting during these years. In order to contribute to sustainable significant publication to advance the academic promotion of urological fields, IJU is going to publish the special issue every year in addition to the standard issue. IJU aims to up-to-date urological findings generated from not only Asia but also all over the world through the standard as well as specially scheduled issues, and IJU has played an important role in the progress of the world urological fields by showing outstanding academic activities of the field of urology especially in Asian countries. I would express my sincere appreciation for the excellent support to IJU from all members of the Japanese Urological Association (JUA), Urological Association of Asia (UAA), and the readers of IJU all over the world. Fortunately, there is an increased number of submitted urological case reports to IJU Case Reports, which was recognized as an essential journal of case report in urology in the world.

Recent developments in the field of urology, from prevention, diagnosis, minimally invasive treatment, new drug therapy, cutting-edge surgery, radiation therapy, and multidisciplinary treatment, have surpassed other fields in progress, and at the same time, there have been remarkable advances in basic research that will support these clinical practices. IJU is the most suitable journal for papers on a wide range of research themes in urology.

Every year, IJU Editorial Board Meeting has been held at the time of the JUA annual meeting in order to introduce its specific feature and further develop IJU and IJU Case Reports to the JUA and UAA members. The next annual meeting of JUA will be held in Fukuoka in 2025, and then, in Kyoto in 2026. At the time of the IJU Editorial Board Meeting, excellent reviewers and significant authors of highly cited articles will be honored as the “Reviewer of the Year” and “Top cited article award.” From the bottom of my heart, I appreciate their significant contributions and efforts to IJU as well as IJU Case Reports and congratulate hereby.

In this year 2025, I heartfully look forward to your submission of your valuable articles to standard and/or special issues of IJU and IJU Case Reports.

None declared.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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