International Journal of Urology最新文献

Objective: Cell-free DNA (cfDNA) is a potential biomarker of surgical invasiveness, but its relationship with postoperative outcomes remains unclear. This study evaluated whether total cfDNA levels measured immediately after robot-assisted radical prostatectomy (RARP) predict postoperative outcomes, including surgical stress markers, pain, and complications.

Methods: We retrospectively analyzed 80 patients who underwent RARP at Hirosaki University Hospital. Total cfDNA levels were measured preoperatively and immediately postoperatively. Postoperative pain intensity was assessed on postoperative days 1-3 using the numerical rating scale (NRS). Patients were categorized into mild pain (NRS < 4) and moderate-to-severe pain (NRS ≥ 4) groups. Associations between cfDNA and NRS were evaluated and compared with conventional surgical stress markers (operative time, estimated blood loss, white blood cell count, C-reactive protein, and oxidative stress).

Results: The cfDNA ratio was higher in the NRS ≥ 4 group than in the NRS < 4 group (p = 0.029). In adjusted analyses, cfDNA ≥ 2.00 was associated with greater odds of moderate-to-severe pain (odds ratio 2.90, 95% confidence interval 1.09-7.72). Conventional markers-including CRP, white blood cell count, operative time, and blood loss-were not associated with pain. Oxidative-stress indices showed only weak correlations with NRS and were not correlated with cfDNA. Limitations include the retrospective, single-center design, and modest sample size.

Conclusions: Immediate postoperative cfDNA is significantly associated with postoperative pain severity and may serve as a rapid, sensitive biomarker for early pain prediction. The cfDNA ratio could support the development of personalized perioperative pain-management strategies. A prospective validation is warranted.

Objectives: To analyze prostate cancer (PCa) screening results using serum prostate-specific antigen (PSA) among elderly males in rural Songjiang District, Shanghai, and explore a suitable screening model for rural residents.

Methods: From June 2022 to June 2024, data was collected from Songjiang Hospital affiliated with Shanghai Jiaotong University School of Medicine and community health service centers in Shanghai's Songjiang District. This was achieved through free clinics and annual physical examination data, specifically targeting PSA screening among residents. For individuals with PSA levels ≥ 10 ng/mL and those with PSA levels between 4 and 10 ng/mL accompanied by an abnormal fPSA/tPSA ratio, prostate biopsy was suggested. The clinical characteristics of PCa patients were analyzed, and follow-up was conducted via telephone, combined with the family doctor visit model, along with enhanced publicity and education measures.

Results: Among 17 198 screened residents, 2491 (14.48%) had abnormal PSA levels. Ultimately, 417 underwent biopsy, confirming PCa in 171 residents (puncture positive rate: 41.00%). The overall PCa detection rate was 0.99%. Pathologically, PCa was primarily adenocarcinoma (98.24%). Among 146 diagnosed patients receiving treatment, the majority (84.93%) were medium or high-risk. Optimizing the screening model significantly increased outpatient visits proportion in the later period.

Conclusion: PSA-based screening significantly increases PCa detection rates and can improve patient prognosis. The epidemiological profile indicates PCa patients in this rural area are predominantly medium and high-risk, underscoring the critical need for strengthened early screening and health education measures.

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.

Objectives: To compare sexual rehabilitation outcomes in prostate cancer patients with preexisting erectile dysfunction (ED) undergoing simultaneous vs. delayed inflatable penile prosthesis (PP) placement during robot-assisted radical prostatectomy (RARP).

Methods: Fifty-six patients with refractory ED and prostate cancer (2011-2023) were included. Simultaneous RARP and inflatable PP placement was done in 29 patients. Twenty-seven patients underwent RARP followed by delayed inflatable PP placement after a mean of 3.28 years. The same surgeon performed both RARP and inflatable PP implantation. Modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), EORTC Sexual Health Scores, and penile length changes were evaluated at 1 year.

Results: Mean age of the simultaneous and delayed PP group was 64.41 and 62.66 years, respectively. The simultaneous group had a higher percentage of severe ED (55.2% vs. 25.9%). At 1 year, simultaneous group patients had significantly better mean Modified EDITS (79.1 vs. 61.1, p < 0.001) and better EORTC Sexual Health scores (62.5 vs. 47.1, p < 0.001). Penile length loss was significantly less in the simultaneous group compared to the delayed group (0.32 ± 0.29 cm vs. 1.43 ± 0.36 cm, p < 0.001). Positive surgical margin (13.7% vs. 18.5%) and biochemical recurrence at 2 years (10.3% vs. 14.8%) showed no significant difference between the simultaneous and delayed PP groups, respectively. No major complications were observed in either group.

Conclusion: Simultaneous inflatable PP with RARP is safe and provides early sexual rehabilitation, improves patients' quality of life and maintains penile length without compromising surgical and oncological outcomes.

Objective: To evaluate the efficacy and safety of clomiphene citrate for late-onset hypogonadism by assessing changes in serum testosterone levels and Aging Males Symptoms scores over 1 year.

Materials and methods: This retrospective study comprised 54 men (44.2 ± 0.9 years old) with hypogonadal symptoms. Clomiphene citrate was given as 50 mg tablets every other day for a maximum of 1 year. Blood test results and scores of the Aging Males Symptoms rating scale were basically obtained every 3 months. Factors defining elevated testosterone levels were analyzed among pretreatment endocrinological data and age. Adverse events were directly confirmed by the physicians.

Results: Serum testosterone levels increased and remained high over 1 year. Similarly, the score of the Aging Males Symptoms rating scale appeared to decline over 1 year. However, the score regarding sexual dysfunction did not show significant improvement. Multiple regression analysis showed that luteinizing hormone was the only independent factor influencing testosterone elevation. No adverse events occurred in our patients.

Conclusions: This is the first study, to our knowledge, showing the efficacy of treatment with clomiphene citrate for late-onset hypogonadism based on the Aging Males Symptoms rating scale score. Because acceptable efficacy and no adverse events were found for 1 year, we emphasize that clomiphene citrate should be one alternative treatment for testosterone replacement in young patients desiring children or patients who are overly concerned about testicular atrophy, especially those with a low serum luteinizing hormone level.