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.

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.

Background: To evaluate the efficacy and the safety of flexible ureteroscopic laser incision and internal drainage in the treatment of parapelvic cysts and investigate the key variables affecting the collapse effect after cyst surgery.

Methods: A retrospective analysis was conducted on the clinical data of 45 patients diagnosed with parapelvic cysts and treated with laser incision and internal drainage at West China Hospital of Sichuan University from January 2018 to December 2024. The reduction ratio of the maximum transverse diameter of the cysts pre- and post-operation was utilized as the criterion for assessing therapeutic efficacy. Scatter plots illustrating the postoperative reduction ratio and the preoperative maximum transverse diameter of the cysts, along with the receiver operating characteristic (ROC) curve, were constructed. The postoperative collapse of the cysts and the reduction ratio of their maximum transverse diameter were statistically described. Univariate and multivariate logistic regression analyses were employed to identify the variables affecting the efficacy of incision and internal drainage in cysts post-operation.

Results: A cohort of 45 patients was monitored over a median duration of 12 months. These patients were categorized into two groups based on a postoperative reduction threshold of 50%: 9 patients were classified into the ineffective operation group, while 36 patients were classified into the successful operation group. At the 3-month follow-up, the success rate was determined to be 80%, with no cases of recurrence at 12 months. Univariate and multivariate analyses identified the maximum transverse diameter of the preoperative cyst as an independent predictor of surgical success (OR = 9.41, 95% CI 1.33-66.83, P = 0.025). Further regression analysis indicated that when the preoperative cyst's maximum transverse diameter exceeded 6 cm, the reduction ratio of the cyst's transverse diameter progressively decreased following internal drainage. Sensitivity, specificity, and area under the curve (AUC) of the ROC curve cutoff point were 77.8%, 72.2%, and 0.75, respectively.

Conclusion: The maximum transverse diameter of the cyst prior to surgery may serve as an independent factor influencing the efficacy of laser incision and internal drainage treatment for parapelvic cysts. This factor exhibits a negative correlation with the postoperative success rate. Specifically, when the cyst's diameter exceeds 6 cm, the likelihood of cyst collapse diminishes progressively.

Purpose: Chromophobe renal cell carcinoma (ChRCC) is a rare subtype of renal cancer, characterized by distinct clinical and genetic features. Existing studies on ChRCC are limited, and there is a critical need to explore the prognostic factors and treatment outcomes in this patient population. We used machine learning (ML) to build prognostic models and developed the first predictive web-based tool for survival.

Methods: The SEER database (2000-2020) was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. We also performed Kaplan-Meier survival analysis.

Results: Our study analyzed 10,700 patients with ChRCC and identified metastasis and tumor size as significant predictors of survival. Subtotal nephrectomy was associated with the highest survival rates. Chemotherapy and radiotherapy were infrequently used but were associated with worse survival outcomes, particularly in patients with metastasis. The developed ML models demonstrated high accuracy in predicting survival, and a web-based tool offered real-time survival predictions based on patient-specific data.

Conclusion: Our study identified key prognostic factors and developed a machine learning-based web tool for personalized survival predictions. Metastasis and tumor size are critical in determining patient outcomes, with subtotal nephrectomy showing the highest survival rate.