International Urology and Nephrology最新文献

Background: Haemodialysis (HD) and online haemodiafiltration (OLHDF) are the main in-centre treatments for kidney failure. Both rely on high water and energy use and produce substantial greenhouse gas emissions. OLHDF provides superior solute clearance and improved survival compared with high-flux HD, but its environmental burden remains less defined. Clarifying these differences supports evidence-based and sustainable treatment decisions.

Methods: A process-based life cycle assessment (LCA) was performed at the Nephrology, Dialysis and Kidney Transplant Unit, AOU Policlinico di Modena, Italy, in 2024, following ISO 14040 and 14,044 standards. The functional unit was one patient year of treatment, equal to 156 sessions. System boundaries included procurement, water treatment, session operations, travel and waste management. Modelling used OpenLCA with Ecoinvent 3.11 and the Italian electricity grid factor of 0.25 kg CO2 per kWh. Scenarios assessed HD-only, OLHDF-only and the real-world Modena treatment mix. Sensitivity analysis varied the share of OLHDF, session frequency, grid intensity and reverse-osmosis (RO) recovery rate and included a reduced-flow OLHDF prescription.

Results: The annual footprint was 4469 kg CO2-eq, 60,290 MJ and 1364 m3 world-eq deprived water per patient year. HD generated 4427 kg CO2-eq and OLHDF 4548 kg CO2-eq, reflecting slightly higher electricity and water consumption and greater plastic use in OLHDF. Travel contributed 71% of total emissions and procurement 21%. Sensitivity analysis showed changes in RO efficiency and electricity mix had stronger effects than treatment type.

Conclusions: HD and OLHDF have comparable environmental profiles. Clinical outcomes should drive modality choice, while sustainability gains depend on improving transport, water recovery, energy management and renewable integration.

Purpose: To evaluate the efficacy of long-term outcomes and compare the differences between oral mucosal grafts (OMGs) and colonic mucosal grafts (CMGs) in the treatment of complex long-segment urethral stenosis.

Methods: We conducted a retrospective analysis of patients with long-segment urethral strictures (> 10 cm) who underwent one-stage urethroplasty using either CMGs or OMGs at multiple institutions between 2000 and 2020 in China. Urethral reconstruction with CMGs was performed in 69 patients, while OMG-based urethroplasty was conducted in 225 patients. The primary measure of success was defined as normal voiding and urethrogram results without the need for any postoperative interventions, such as dilations.

Results: In the CMG group, urethroplasty procedures ranged from 11 to 21 cm in length (mean: 17.3 cm), achieving an overall success rate of 85.5% (59/69) with a mean follow-up duration of 145 months (range: 20-258 months). For the OMG group, urethroplasty lengths ranged from 11 to 20 cm (mean: 13.6 cm), with an overall success rate of 81.8% (184/225) and a mean follow-up duration of 58 months (range: 13-150 months). A key limitation of the study was the absence of tools to assess patients' quality of life.

Conclusion: Our findings suggest that both CMGs and OMGs are excellent materials for substitution urethroplasty, with both techniques proving effective for managing severe panurethral strictures. The most common complication was meatal stenosis, particularly in patients with lichen sclerosis (LS).

Objective: To evaluate and summarize evidence related to preventing recurrence in patients with urinary tract stones, providing guidance for clinical healthcare professionals in managing recurrence prevention.

Methods: Literature on recurrence prevention in patients with urinary tract stones was systematically retrieved from domestic and international databases using the "6S" model, followed by quality assessment, evidence extraction, and synthesis.

Results: A total of 14 studies were included, comprising 2 guidelines, 4 systematic reviews, 3 meta-analyses, 2 expert consensus documents, 2 evidence summaries, and 1 clinical decision aid. Sixteen best evidence recommendations were identified across personnel training, assessment, nutrition, medication, and follow-up.

Conclusion: This evidence-based review summarizes the best available evidence for preventing recurrence in patients with urinary tract stones, providing evidence-based guidance for clinical healthcare providers.