International Urology and Nephrology最新文献

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.

Purpose: To assess the efficacy and safety of amino acid peritoneal dialysis (AA-PD) in improving nutritional status among continuous ambulatory peritoneal dialysis (CAPD) patients with malnutrition in a real-world setting.

Methods: A prospective self-control study was conducted across five hospitals in China. Patients aged 18-75 years with malnutrition [serum albumin < 35 g/L, prealbumin < 300 mg/L, or Subjective Global Assessment (SGA) score > 7] were enrolled. Each patient used one bag of 2 L 1.1% AA-PD solution to replace the 1.5% dextrose solution for the overnight dwell. All patients received routine nutritional management at their respective centers. Primary outcomes were changes in serum albumin and prealbumin levels. Secondary outcomes included SGA, normalized protein nitrogen appearance (nPCR, as a protein intake indicator), hand grip strength, mid-arm muscle circumference (MAMC), and body mass index (BMI). Clinical symptoms and adverse events were also monitored.

Results: A total of 149 patients were enrolled, with 142 (95.3%) completing at least one efficacy assessment. After 6 months of AA-PD treatment, serum albumin increased from a baseline of 30.4-34.55 g/L (P < 0.001), and prealbumin increased from 302.8 to 348.7 mg/L (P < 0.001). SGA, nPCR, and hand grip strength improved significantly, while MAMC and BMI remained stable. The improvement in albumin level was independent of diet protein intake. Symptoms like anorexia, fatigue, and nausea decreased. A total of 53 patients (35.57%) experienced 56 treatment-emergent adverse events, of which only 3 mild events (2.01%) were considered related to AA-PD treatment. Additionally, 31 patients (20.81%) experienced a total of 31 serious adverse events, all of which were determined to be unrelated to AA-PD treatment. Although adverse events were generally mild with no AA-PD discontinuation, an acidosis tendency was noted.

Conclusion: AA-PD can improve serum levels of albumin and prealbumin, as well as clinical symptoms. However, relying solely on 6 months of AA-PD treatment is not sufficient to significantly improve medium- and long-term indicators. Treatment-related adverse reactions are generally mild, but acidosis still needs to be monitored.

Background: The present study evaluated Survivin and Ki-67 immunohistochemical expression in squamous cell carcinoma of the penis and its association with clinicopathological features and outcomes.

Patients and methods: A retrospective cohort study, from 1998 to 2016, was conducted at a tertiary hospital in Brazil, utilizing a convenience sample. The study collected clinical characteristics, pathological features, and outcomes. Immunohistochemical expressions of Survivin and Ki-67 were performed on formalin-fixed paraffin-embedded specimens from patients with PSCC. Survivin positivity (Survivin +) was defined as any staining in more than 5% of tumor cells, while Ki-67 positivity was defined as any staining in more than 10%. The Mann-Whitney U test and Fisher's exact test were used to perform the associations. Kaplan-Meier curves with log-rank were used to estimate survival.

Results: Forty patients undergoing partial or total penectomy were selected, with five subsequently excluded. Among the remaining 35 patients, 15 (42.8%) were Ki-67 positive, and 9 (25.7%) were Survivin + . Ki-67 expression did not demonstrate association with higher tumor grade (73.3% for grades II and III vs. 55% for grade II in the Ki-67 < 10% group; p = 0.06), larger lesions (p = 0.05), or survival outcomes (HR 1.66; 95% CI 0.56-4.98; p = 0.36). Survivin + was more common in grade II and III than grade I (77.8% vs. 22.1; p = 0.027), and Survivin + patients were correlated with worse overall survival (HR 3.73; 95%CI 1.25-11.12; p = 0.01).

Conclusion: Ki-67 expression does not seem to have an impact on clinicopathological features and overall survival. The expression of survivin seems to be promising in detecting penile squamous cell carcinoma patients with a worse prognosis.

Objective: To evaluate the effects of hyperbaric oxygen therapy (HBOT) on inflammation, oxidative stress, and bladder damage in a cyclophosphamide (CP)-induced hemorrhagic cystitis (HC) rat model.

Methods: Forty male Wistar albino rats received a single intraperitoneal dose of 200 mg/kg CP to induce HC. Rats were assigned to either the HBOT or control groups and sacrificed on days 3, 7, and 14. The HBOT group received 6, 14, or 28 sessions of 100% oxygen at 2.4 ATA for 90 min. Outcomes included mortality, weight loss, bladder weight, macroscopic edema and hemorrhage scores, histopathology, Ki-67 immunostaining, and levels of cytokines (IL-1β, IL-4, IL-6, MCP-1, TNF-α) and malondialdehyde in bladder tissue, serum, and urine. Cytokines were quantified using the Luminex assay and malondialdehyde by ELISA.

Results: Mortality and weight loss were similar between groups. On day 3, the HBOT group showed significantly lower bladder weights and hemorrhage scores (p < 0.01), with no significant differences in edema. On day 7, IL-1β and MCP-1 levels were higher in the HBOT group (p = 0.02). Malondialdehyde levels were significantly elevated in the control group on day 3. Histopathological and other cytokine findings showed no significant differences.

Conclusions: HBOT may provide early but transient benefits in alleviating HC based on macroscopic findings; however, these effects were not supported by sustained histopathological or molecular improvements. The high-dose CP model may have masked the potential therapeutic effects of HBOT. Further studies using lower or fractionated CP dosing and extended observation periods are warranted to better evaluate the therapeutic potential of HBOT.