International Urology and Nephrology最新文献

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.

Purpose: Prostate cancer is frequently managed with radical prostatectomy (RP), which can offer excellent oncological control but with significant genitourinary morbidity. High-intensity focused ultrasound (HIFU) has emerged as a less-invasive alternative. We performed a systematic review and meta-analysis to compare the oncological, functional, and safety outcomes of HIFU versus RP in men with localized prostate cancer.

Methods: Following PRISMA guidelines, we searched Medline, Embase, and Cochrane through December 2024 for comparative studies of HIFU and RP. Fourteen studies (including two randomized trials) met inclusion criteria. The primary endpoint was salvage therapy-free survival (STFS). Secondary outcomes included biochemical recurrence, metastasis-free survival, functional outcomes, and complications. Random-effect models were applied, and meta-regression explored sources of heterogeneity.

Results: Overall, HIFU was associated with lower STFS (odds ratio [OR]: 0.65, p = 0.02) although biochemical recurrence and metastasis-free survival did not differ significantly between treatments. Focal HIFU showed fewer major complications (OR: 0.36) and significantly better erectile function preservation (OR: 6.03), but minor complications were slightly more frequent. High heterogeneity was partly explained by study design and follow-up duration. Limitations include substantial heterogeneity, variable definitions of outcomes, and relatively short follow-ups in some studies.

Conclusion: For selected patients, biochemical recurrence and metastasis-free survival did not differ significantly between treatments although HIFU was associated with lower STFS. Particularly as focal therapy, it shows the potential to achieve oncologic outcomes comparable to radical prostatectomy while enhancing erectile function preservation, urinary continence, and reducing major complications. Further long-term prospective studies are warranted to solidify these findings.

Purpose: To compare the short- and long-term complication profiles of Rezum and Urolift using standardized approaches.

Methods: We analyzed published data from the pivotal randomized trials of Rezum and Urolift. The severity of complications was independently graded by urologists using the Accordion Severity Grading System, developed by the American College of Surgeons National Surgical Quality Improvement Program. Short- (3 months) and long-term (5 years) complication rates were assessed. Long-term complications included medical retreatment, surgical retreatment, and surgical implant removal. We calculated the weighted postoperative morbidity index (PMI) values (0-1 scale) for each procedure and performed Monte Carlo simulations to account for uncertainty in complication rates and severities.

Results: Short-term PMI values were similar between the Rezum (0.091) and Urolift (0.092) groups, with dysuria, hematuria, pain, and urinary urgency most commonly reported. Over 5 years, the cumulative complication rates were 15.4% for Rezum and 33.6% for Urolift. The associated 5-year PMI was 0.055 for Rezum and 0.165 for Urolift, indicating a three-fold higher long-term severity-weighted complication burden with Urolift. Monte Carlo simulations confirmed the robustness of these findings.

Conclusions: This study identified significant differences in the long-term complication profiles of Rezum and Urolift when considering both the incidence and severity of postoperative complications. These findings may help guide clinical decision-making when selecting minimally invasive surgical options for BPH/LUTS treatment.