International Urology and Nephrology最新文献

Blood pressure variability (BPV), fluctuations in blood pressure across beat-to-beat, 24-h, day-to-day, and visit-to-visit timescales, has emerged as a risk marker that is independent of mean blood pressure. Frailty, a multidimensional syndrome of diminished physiological reserve, shares core biology with BPV, including vascular aging, impaired baroreflex function, autonomic dysregulation, and chronic low-grade inflammation. This narrative review synthesizes mechanistic, epidemiologic, and clinical evidence linking BPV and frailty. Mechanistically, arterial stiffness and endothelial dysfunction attenuate baroreflex buffering and transmit excess pulsatile load, while autonomic imbalance and inflammaging destabilize hemodynamics, compromise cerebral autoregulation, and promote sarcopenia and functional decline. Across cohorts of community-dwelling older adults and high-risk groups (e.g., chronic kidney disease and hemodialysis), higher short- and long-term BPV correlates with prevalent frailty and predicts incident frailty, cognitive decline, falls, cardiovascular events, renal progression, and mortality, often with effect sizes on par with traditional risk factors. Ambulatory blood pressure monitoring best captures short-term and circadian variability (including nocturnal patterns), home monitoring informs day-to-day variability, and clinic series quantify visit-to-visit variability; average real variability appears particularly informative in older hypertensive populations. Clinically, incorporating BPV into assessment may refine frailty screening and risk stratification, revealing vulnerability that is not apparent from mean blood pressure alone. Therapeutic implications include prioritizing long-acting antihypertensive regimens that stabilize BPV, optimizing adherence and lifestyle (exercise, diet, stress reduction), and addressing metabolic and inflammatory drivers, while recognizing that interventional evidence targeting BPV per se remains limited. Key gaps include heterogeneous BPV metrics and frailty definitions, limited standardization of measurement protocols, and a paucity of trials testing whether reducing BPV improves functional outcomes. Future work should not only harmonize BPV phenotyping and frailty definitions, but also investigate whether stabilizing BPV translates into tangible improvements in functional status, falls, and survival. Incorporating digital health tools, such as continuous monitoring and AI-driven analytics, may facilitate early detection of hemodynamic instability and its integration into frailty care models.

Purpose: To evaluate the feasibility and safety of ileal ureteral replacement (IUR) for long-segment ureteral strictures secondary to urogenital tuberculosis (UGTB).

Method: 11 patients with complex tuberculous ureteral strictures underwent IUR across three tertiary centers between March 2015 and January 2024. Surgical approaches included open (n = 2), laparoscopic (n = 4), and robotic-assisted (n = 5). Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected.

Result: 11 patients (8 males, 3 females) with a mean age of 38.3 ± 13.1 years were included. Two patients had bilateral involvement, and nine patients had unilateral involvement. Four patients underwent concomitant ileocystoplasty. The mean stricture length was 19.0 ± 6.3 cm, and the median length of ileum harvested was 25 cm. The mean operative time was 283.9 ± 28.1 min. The median estimated blood loss was 150 mL. The median postoperative hospital stay was 15 days, with the robotic approach significantly reducing hospitalization time (p = 0.015). During the median follow-up of 36 months, all patients achieved ureteral patency. The mean preoperative and latest estimated glomerular filtration rate were 82.0 ± 24.1 and 74.7 ± 22.9 mL/min/1.73 m² (p = 0.062), respectively. Complications were reported in 8 patients, primarily metabolic acidosis (6/11) and urinary tract infections (4/11). Metabolic acidosis was associated with renal function decline (p = 0.015). Two patients experienced major complications, consisting of ileus and incision infection respectively.

Conclusion: IUR is a safe and effective last resort for patients with complex ureteral strictures secondary to UGTB. High complication rates and long-term metabolic risks limit its application, necessitating strict patient selection and rigorous lifelong management.

Purpose: This study aimed to identify preoperative metabolic and radiological predictors of adherent perinephric fat (APF) and to develop a predictive scoring system for its assessment.

Methods: We conducted a prospective study of consecutive patients with renal tumors undergoing open or minimally invasive partial nephrectomy (PN). APF was intraoperatively defined as the need for subcapsular renal dissection to isolate the tumor. Patient characteristics were compared according to APF presence. Multivariable logistic regression analysis was performed, and the resulting model was used to develop a predictive scoring system.

Results: A total of 200 patients were included in the analysis, of whom 34 (17%) had APF. On multivariable analysis, presence of perinephric fat stranding (p = 0.003), posterior perinephric fat thickness ≥ 25 mm (p < 0.001), serum urea ≥ 33 mg/dl (p = 0.004), albumin ≤ 4.3 g/dl (p = 0.007), and HDL cholesterol ≤ 53 mg/dl (p = 0.019) were predictors of APF. A model incorporating these five variables achieved an area under the receiver operating characteristic curve of 0.92. These parameters were subsequently integrated into the novel SHARP-U (Stranding, HDL cholesterol, Albumin, Renal Perinephric fat thickness, Urea) score, ranging from 0 to 7, to predict the presence of APF.

Conclusion: The SHARP-U score provides a simple and reliable tool for preoperative prediction of APF in patients undergoing partial nephrectomy. Early identification of individuals at risk may aid surgical planning and patient counseling. External prospective validation of the SHARP-U score is warranted to confirm its clinical applicability.

Background: Targeted-release budesonide (TRF-budesonide) is a therapy developed to deliver corticosteroid to ileal Peyer's patches and has demonstrated efficacy in randomized trials (NEFIGAN, NefIgArd) for patients with immunoglobulin A nephropathy (IgAN). We performed a systematic review and meta-analysis to evaluate the efficacy and safety of budesonide formulations in IgAN.

Methods: We searched PubMed, Embase, and Cochrane through September 10, 2025. Eligible studies assessed budesonide in biopsy-proven IgAN. Outcomes included change in eGFR, percentage and absolute change in urine protein-to-creatinine ratio (UPCR), and adverse events. Random-effects meta-analyses were performed.

Results: Nine studies (total N = 465; two RCTs) were included. In the comparative analysis of placebo-controlled trials, TRF-budesonide significantly attenuated eGFR decline compared to placebo (weighted mean difference [WMD] 4.53 mL/min/1.73 m²; 95% CI 3.08-5.99). In the single-arm analysis assessing absolute change from baseline, the pooled mean eGFR increase was 3.07 mL/min/1.73m² (95% CI 0.12-6.03). Regarding proteinuria, TRF-budesonide significantly reduced UPCR compared to placebo (percentage change MD - 28.96%; 95% CI - 45.94 to - 11.99). Safety analysis showed budesonide was associated with a higher risk of adverse events versus placebo (RR 1.18; 95% CI 1.01-1.38). In uncontrolled cohorts, pooled adverse event rates were 40% for TRF-budesonide and 44% for enteric-coated formulations.

Conclusions: Current evidence indicates that TRF-budesonide improves kidney function and reduces proteinuria in adults with IgAN, but conclusions are tempered by limited RCT data, heterogeneity, short follow-up, and sparse histologic end points. Larger, longer randomized trials with standardized outcomes are needed to confirm long-term benefit and safety.

Purpose: The aim of the present study was to evaluate the performance and safety of high molecular weight (HMW) sodium hyaluronate (40 mg/50 mL) for interstitial cystitis/bladder pain syndrome (IC/BPS) in real-world clinical practice.

Methods: This prospective, multicenter European study was conducted in patients with the clinical diagnosis of IC/BPS. Participants received weekly intravesical instillations for 12 weeks. The primary endpoint was responder rate at end of treatment/week 12, defined as any improvement in IC/BPS symptoms on the 7-point Patient Global Assessment (PGA) scale. Secondary endpoints included changes in bladder symptoms and quality of life assessed by visual analog scales (VAS), questionnaires, and voiding diaries at week 12 and 24.

Results: Seventy-one (N = 74) patients enrolled were part of the full analysis set (mean [SD] age: 51.8 [16.9] years; 98.6% female) and 73/74 patients were in the safety set (mean [SD] age: 51.9 [17.2] years; 98.6% female). Total responder rate was 90.1% (90% CI: 82.3, 95.3) at week 12 and 78.9% (90% CI: 69.4, 86.5) at week 24. Significant improvements from baseline were observed in VAS scores for urinary urgency and bladder pain at week 12 (-42.0; -39.3) and week 24 (-49.2; -49.2). Quality of life scores also improved significantly (+ 17.1; + 27.2, all P < .0001). Twenty patients (27.4%) reported 37 adverse events (AEs), including seven treatment-related AEs (incidents). No treatment-related serious AEs occurred and all incidents were resolved.

Conclusions: Intravesical HMW sodium hyaluronate improved IC/BPS symptoms and quality of life through week 24 in most patients with a favorable safety profile.

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.