International Journal of Urology最新文献

Background: C-reactive protein (CRP) is a prognostic biomarker for clear cell renal cell carcinoma (ccRCC). However, there may be potential racial heterogeneity in distribution and prognostic impact of CRP level. We investigated potential racial differences in distribution and prognostic impact of preoperative CRP among Asian (AS), African American (AA), and Caucasian (CAUC) patients with non-metastatic ccRCC (nmccRCC).

Methods: We retrospectively analyzed 1991 nmccRCC cases (AS/AA/CAUC: n = 968/223/800) undergoing nephrectomy from the international multi-institutional database. We investigated CRP distributions and optimal cut-off values for predicting recurrence-free survival (RFS) and overall survival (OS) using Cox regressions for each racial group. Subgroup analyses considered comorbidities, pathological T stage, and Fuhrman grade.

Results: Preoperative CRP distributions differed significantly among the races, with median values of 0.90 mg/L (interquartile range, 0.40-2.33) for AS, 5.00 mg/L (1.98-12.20) for AA, and 3.55 mg/L (1.41-8.48) for CAUC (p < 0.01). Optimal cut-off values for RFS were 1.2 mg/L in AS, 2.8 mg/L in AA, and 1.7 mg/L in CAUC, showing C-indices of 0.77, 0.71, and 0.77, respectively. For OS, they were 1.6 mg/L in AS, 8.3 mg/L in AA, and 9.3 mg/L in CAUC, yielding C-indices of 0.77, 0.70, and 0.74, respectively. Subgroup analyses revealed varying reference ranges of CRP levels among races (1.1-2.2/2.7-5.0/1.5-3.4 mg/L for RFS, and AS/AA/CAUC: 0.9-3.0/8.0-12.7/8.0-10.4 mg/L for OS, respectively).

Conclusion: The preoperative CRP distributions and their optimal cut-off values for predicting patient prognosis differed significantly among the races. Using race-specific cut-off values, CRP demonstrated consistently high-prognostic accuracies, which may improve tailored patient management in nmccRCC.

Introduction: Bowel regimens (BR) before radical cystectomy (RC) are currently not recommended by Enhanced Recovery After Surgery (ERAS) protocols, as prior studies have shown BRs lead to worsened outcomes. However, many of those studies have used historic literature before recent surgical advancements such as minimally invasive RC and have not investigated the impact BRs have by type of urinary diversion. Our goal is to determine the outcomes of preoperative BR in patients undergoing RC based on diversion type using a modern patient cohort.

Methods: RCs performed between 2019 and 2020 with BR information available were identified in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). Patients were grouped by type of BR received: no BR, both mechanical bowel preparation (MBP) and preoperative oral antibiotic BR (OABR), MBP only, and OABR only. We conducted propensity score matching based on factors influencing the operative approach. Baseline demographics and 30-day complication rates were compared between matched groups. We analyzed hospital length of stay (LOS) via multivariate regression with a Poisson distribution.

Results: In total, 2054 RCs were identified with 2.4% receiving OABR, 21.3% receiving MBP, 5.3% receiving both, and 71.0% receiving no BR. For patients with ileal conduit diversions, outcomes with BRs appeared mixed, as OABR leads to increased LOS. For patients with neobladder diversions, BRs were not associated with any worsened outcomes and were associated with reduced length of stay.

Conclusions: BRs such as OABR may associated with improved outcomes in patients receiving RC with neobladder diversion, a finding that warrants further investigation.

Objective: To analyze the recent status of laparoscopic adrenalectomy for benign adrenal tumors, focusing on the relationship between the number of surgeries and complication rates per facility.

Methods: Data were obtained from the Diagnosis Procedure Combination database, covering surgeries performed between April 2012 and March 2020. The inclusion criteria were laparoscopic adrenalectomy for benign adrenal tumors. Basic characteristics and outcomes, including anesthesia time, blood transfusion, and medical costs, were analyzed. The facilities were divided into five categories in increments of five adrenalectomies per year. The relationship between the number of surgeries per facility and complication rates was analyzed using the Cochran-Armitage trend test and chi-square tests with the Holm method applied for multiple comparisons.

Results: A total of 15 174 laparoscopic adrenalectomies for benign adrenal tumors were performed across 543 facilities during the 9-year study period. The number of adrenalectomies performed annually was <5, 5-9, 10-14, 15-19, ≥20 in 434 (79.9%), 58 (10.7%), 28 (5.2%), 12 (2.2%), and 11 (2.0%) facilities, respectively, showing that only 51 facilities (9.4%) conducted 10 or more surgeries per year. The overall complication rate was 9.1%. A trend was demonstrated showing that facilities with a higher number of surgeries per year had reduced complication rates. Facilities with 20 or more surgeries per year had the shortest anesthesia times and the lowest medical costs. No significant differences were found in blood transfusion rates or in-hospital mortality.

Conclusion: Laparoscopic adrenalectomy for benign adrenal tumors can be performed at lower complication rates in facilities with a higher number of surgeries.

Objective: Our study assessed the correlation between discrepancies in clinical and pathological T stages and overall survival (OS) in patients with upper urinary tract urothelial carcinoma (UTUC), including renal pelvis (UCP) and ureter (UCU) carcinoma, treated with radical surgery.

Methods: We utilized data from the Japanese Hospital-Based Cancer Registry (HBCR) to identify UTUC cases (n = 2376), consisting of UCP cases (n = 1196) and UCU cases (n = 1180), diagnosed with cTa-3N0M0 between 2012 and 2013. All cases were histologically confirmed and treated solely with radical surgery, excluding any chemotherapy or radiotherapy. We investigated the correlation between stage classification discrepancies and OS.

Results: Among UCP and UCU patients, cT2N0M0 had the highest discrepancy rates between clinical and pathological stages (68% and 51%), while cT3N0M0 had the lowest (21% and 20%). Among UCP and UCU patients with cTa/is/1N0M0, those with up-staging showed significantly worse OS compared to same-staging (HR 1.7 and 2.5, p = 0.001 and <0.001, respectively). In UCU patients with cT2N0M0, the 5-year OS rates were 41.9% for up-staging, 63.7% for same-staging, and 76.4% for down-staging, with significantly worse survival in the up-staged group. Among UCP and UCU patients with cT3N0M0, the 5-year OS rates were 29.3% and 7.7% for those with up-staging, 53.7% and 30.6% for those with same staging, and 79.6% and 65.4% for those with down-staging.

Conclusion: Using a large real-world cohort, we found stage discrepancies to be a significant independent prognostic factor in non-metastatic UTUC patients. Treatment should be carefully selected, considering T-staging discrepancies and prognosis.

Objectives: To evaluate the success rate of shock wave lithotripsy and identify predictors of stone-free status after shock wave lithotripsy for ureteral stones, focusing on the impact of stones remaining in the same location for 2 months (SSL2).

Methods: A retrospective analysis was conducted on 501 patients with ureteral stones treated with shock wave lithotripsy by expert surgeons (each with over 1000 shock wave lithotripsy operations) at a single Japanese institution in 2020. Logistic regression analysis identified predictors of stone-free status, including stone length, skin-to-stone distance, stone density (Hounsfield Unit), Hounsfield Unit above/below the stone, stone position, and duration of stone at the same location (SSL2).

Results: Ninety patients were excluded, resulting in 411 patients undergoing an average of 1.15 ± 0.4 sessions (range: 1-4). 344 patients (83.7%) achieved stone-free status after a single session. The overall 1-month stone-free rate was 71.4%, and the 3-month stone-free rate was 88.8%. Stone at the same location ≥2 months (SSL2) was an independent predictor of 1-month stone-free status (odds ratio = 2.25, 95%CI: 1.10-4.57, p = 0.025), while mean stone density ≥ 813 HU was an independent predictor of 3-month stone-free status (odds ratio = 2.66, 95% CI: 1.10-6.45, p = 0.03).

Conclusion: Stone at the same location ≥2 months (SSL2) was a potent predictor of 1-month and 3-month stone-free status. This condition is associated with impacted stones and can aid in decision-making for shock wave lithotripsy treatment selection.

Objectives: This study aimed to evaluate predictors of late biochemical recurrence in patients with no recurrence at 5 years after radical prostatectomy (RP).

Methods: We retrospectively investigated patients who underwent RP for prostate cancer in our institute from 1999 to 2016, selecting those with no biochemical recurrence at 5 years post-RP. These patients did not receive neoadjuvant and adjuvant hormone therapy. Following RP, patients were regularly monitored using ultra-sensitive prostate-specific antigen (PSA) measurements, with a detection limit of 0.01 ng/mL. Biochemical recurrence was defined as PSA level ≥0.2 ng/mL, confirmed by subsequent PSA >0.2 ng/mL.

Results: Among 581 patients who underwent RP, 312 with no biochemical recurrence at 5 years post-RP were selected. The median follow-up period was 123 months. The 10-year biochemical recurrence-free survival rate for this cohort was 89.6%. Patients with a PSA value <0.02 ng/mL at 5 years post-RP had a 10-year biochemical recurrence-free survival rate of 98.5%. Multivariable regression analysis identified Grade Group ≥4 and PSA value ≥0.02 ng/mL at 5 years post-RP as independent predictors of late biochemical recurrence (hazard ratio 2.23, 95% confidence interval 1.06-4.71, p = 0.035; hazard ratio 37.5, 95% confidence interval 11.6-121.3, p < 0.001, respectively). Patients with Grade Group of 4 or more had a significantly reduced PSA doubling time at biochemical recurrence compared to those with Grade Group of 3 or less.

Conclusions: Among patients whose PSA levels remain below 0.02 ng/mL at 5 years after RP, the risk of subsequent late biochemical recurrence is very low. Utilizing ultra-sensitive PSA measurements at the 5-year mark can provide useful information regarding the need for follow-up beyond 5 years.

Objective: Urinary continence after radical prostatectomy is a crucial aspect of patient quality of life. The aim of this study was to identify the factors influencing urinary continence after robot-assisted laparoscopic radical prostatectomy, focusing on the role of anterior reconstruction.

Methods: We collected clinical data from 375 patients at a single institution. Logistic regression analyses for urinary continence rate at 1, 3, 6, and 12 months postoperatively were performed on the entire patient population to determine the influencing factors. Anterior and posterior reconstruction was performed until August 2017, transitioning to posterior reconstruction only. The impact of anterior reconstruction on postoperative urinary continence was evaluated using logistic regression model adjusted by inverse-probability treatment weighting in nerve-sparing and non-nerve-sparing subgroups, respectively.

Results: For the entire cohort, the urinary continence rates at 1, 3, 6, and 12 months were 34.7%, 57.6%, 73.1%, and 83.5%, respectively. Anterior reconstruction significantly influenced early urinary continence recovery, and membrane urethral length correlated with continence rates at all postoperative time points. After adjustment using the IPTW method, the chronological trend of urinary continence recovery rate in relation to anterior reconstruction was similar between patients with and without nerve sparing.

Conclusions: Anterior reconstruction contributes to early recovery from urinary incontinence after robot-assisted laparoscopic prostatectomy. However, the impact for continence rate 12 months after surgery is limited.