International Journal of Urology最新文献

Objectives: To explore the role and mechanism of miR-30a-5p in the progression of Wilms tumor.

Methods: TARGET-WT and GSE50505 matrix files were downloaded to analyze the differences of miRs between Wilms tumor and normal renal tissues. miRDB, miRTarBase, and TARGET-WT databases were applied to predict the target genes of miR. qRT-PCR was applied to determine the expression of the target miR in Wilms tumor/adjacent normal renal tissues as well as G401/WiT49/HEK-293T cells. The interaction of miR-30a-5p with cyclinE2 (CCNE2) was confirmed by correlation analysis, qRT-PCR, Western blot, and double luciferase assay respectively. CCK-8, colony formation, cell cycle assay, Transwell, and wound healing assay were applied to determine the influence of miR-30a-5p on the proliferation or migration of G401/WiT49 cells. Furthermore, a mouse transplanted tumor model was constructed to explore the function of miR-30a-5p on Wilms' tumor growth in vivo.

Results: miR-30a-5p was down-regulated and CCNE2 was up-regulated in Wilms tumor tissues and G401/WiT49 cells compared to the control, respectively. Double luciferase reporter assay showed that miR-30a-5p could target the 3'UTR of CCNE2. Over-expression or knockdown of miR-30a-5p modulated the CCNE2 mRNA and protein expressions as well as the expressions of p-Rb and E2F1 downstream of CCNE2 in G401/WiT49 cells. The rescue experiment indicated that miR-30a-5p regulates the proliferation of G401/WiT49 through CCNE2. Furthermore, upregulation of miR-30a-5p restrained the growth rate of transplanted tumors in nude mice.

Conclusions: miR-30a-5p participates in regulating the proliferation of Wilms tumor cells by suppressing the CCNE2/p-Rb/E2F1 axis.

Objectives: Adrenocortical carcinoma (ACC) is a rare, aggressive tumor with high recurrence rates after surgery. Although radiotherapy (RT) has historically been underutilized in ACC, modern RT techniques have renewed interest in its potential role for improving local control (LC). This study evaluated long-term outcomes and prognostic factors in high-risk localized ACC treated with adjuvant RT and mitotane.

Methods: In this multicenter retrospective study, 23 patients with localized, high-risk ACC who underwent complete surgical resection followed by adjuvant RT between 2003 and 2023 were analyzed. All received mitotane, and 21.6% also received platinum-based chemotherapy. RT was delivered using image-guided IMRT or VMAT to a median dose of 50.4 Gy, targeting the tumor bed with or without regional lymphatics. Survival was estimated using the Kaplan-Meier method, and prognostic factors were assessed with Cox regression analyses.

Results: At a median follow-up of 84.7 months, the 5-year LC, overall survival (OS), and disease-free survival (DFS) rates were 85.5%, 58.6%, and 45.6%. Locoregional recurrence occurred in two patients (8.6%), with isolated local failure in one (4.3%). Distant metastasis (DM) developed in 47.8% and was the predominant failure pattern. On univariable analysis, age > 55 years predicted worse OS and DFS, while female sex independently predicted inferior DFS. Treatment was well tolerated, with no grade ≥ 3 RT-related toxicities.

Conclusions: Adjuvant RT achieves excellent LC with minimal toxicity in high-risk localized ACC. These exploratory findings, limited by small cohort size, retrospective design, and absence of a comparator group, warrant confirmation in larger prospective multicenter studies.

Background: Acute scrotum is a common pediatric urological emergency, with testicular torsion requiring prompt surgical intervention to prevent irreversible ischemic damage. In Japan, large-scale multicenter data on diagnostic and management practices remain limited.

Methods: This multicenter retrospective study reviewed pediatric patients (aged 0-21 years) presenting with acute scrotal pain across 15 institutions in the Kyushu-Okinawa region between 2014 and 2023. Clinical characteristics, diagnostic workup, initial facility type, specialty of first-contact physician, and care pathway were analyzed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with testicular salvage.

Results: A total of 906 patients were included (median age, 11 years). Final diagnoses were epididymitis (41.9%), testicular torsion (26.8%), torsion of the testicular appendage (12.1%), and other causes (19.2%). Among torsion patients (n = 243), ultrasonography was performed in 98.8%, TWIST scoring in 31.7%, and inter-facility transfer was required in 66.7%. Multivariable analysis identified three independent predictors of testicular salvage: Time from symptom onset to skin incision < 6 h (OR 3.38, 95% CI 1.56-7.36, p = 0.002), age ≥ 10 years (OR 2.77, 95% CI 1.28-5.75, p = 0.009), and same-hospital treatment (OR 2.74, 95% CI 1.23-6.07, p = 0.013).

Conclusions: Frequent inter-facility transfers significantly reduce testicular salvage rates, underscoring the importance of timely surgical management within the same hospital. Regional standardized protocols, provider education, and public health awareness campaigns are warranted to minimize preoperative delay and improve outcomes for pediatric testicular torsion.

Objectives: Nocturnal enuresis is common in early childhood. While daytime bladder control typically precedes nighttime continence, the temporal relationship between early daytime bladder control and subsequent bedwetting remains unclear. We investigated whether daytime bladder control status at age 2.5 years-as indicated by diaper use-is associated with bedwetting at age 4.5 years in a Japanese nationwide cohort.

Methods: We analyzed data from the Japanese Longitudinal Survey of Newborns in the 21st Century (2010 cohort). Daytime bladder control was assessed at age 2.5 years through caregiver-reported diaper use, and bedwetting frequency at age 4.5 years through parental questionnaires. Modified Poisson regression estimated risk ratios (RRs), adjusting for birth-related factors, socioeconomic status, daycare attendance, and developmental milestones.

Results: Among 32 168 children, 26 651 (82.8%) still used diapers at 2.5 years. Bedwetting prevalence at 4.5 years was 42.2%: 34.5% in children who achieved daytime bladder control at 2.5 years versus 43.9% in those still using diapers. After multivariable adjustment, incomplete daytime bladder control at 2.5 years was associated with higher bedwetting risk (adjusted RR 1.25; 95% CI, 1.20-1.31). Multinomial regression revealed dose-response relationships: odds ratios 1.41 (95% CI, 1.30-1.52) for "sometimes" and 1.58 (95% CI, 1.42-1.77) for "often" bedwetting.

Conclusions: Daytime bladder control status at 2.5 years was associated with a 25% increased bedwetting risk at 4.5 years. This association likely reflects individual differences in bladder control maturation rather than causal effects. While daytime bladder control may serve as a developmental marker, its validity as an intervention target remains unestablished.

Objectives: 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.