International Urology and Nephrology最新文献

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.

Objective: We aimed to evaluate the association between T stage, N stage, and Gleason score with OS in metastatic prostate cancer (mPCa) patients.

Methods: Using the SEER database, we identified M1 prostate cancer patients. Kaplan-Meier survival analysis with Log-rank testing was performed, stratified by metastatic substages (M1a, M1b, M1c). Multivariable Cox regression models identified independent prognostic factors for overall survival (OS).

Results: A total of 170 mPCa patients were included, 60.0% had Gleason score ≥ 8, 74.7% presented with T3-T4 disease (versus 25.3% with localized T1-T2 tumors), and metastatic distribution included 68.8% M1b, 17.6% M1a, and 13.5% M1c. M1c patients demonstrated significantly worse prognosis (p = 0.033). Subgroup analyses revealed that advanced T stage significantly correlated with reduced OS in the overall M1 cohort (p = 0.015), M1b (p = 0.018), and M1c subgroups (p = 0.004), but not in M1a (p = 0.226). Nodal status showed no significant association with OS in any subgroup (M1a: p = 0.252; M1b: p = 0.762; M1c: p = 0.616). On multivariable Cox analysis, Gleason score ≥ 8 (HR = 2.65, 95%CI 1.21-5.79, p = 0.014), T4 stage (HR = 3.04, 95%CI 1.17-7.90, p = 0.023), and M1c substage (HR = 6.27, 95%CI 1.61-24.39, p = 0.008) emerged as independent predictors of poor survival.

Conclusion: Our study suggests that nodal staging may have limited biological rationale in PCa when synchronous distant metastases exist.

Background: End-stage kidney disease (ESKD) requires lifelong kidney replacement therapy (KRT), which significantly influences patients' quality of life (QoL). Primary KRT modalities include hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant (KTX), each with varying impacts on QoL and clinical outcomes. Comparative data regarding these modalities in the local context, is limited.

Objectives: This study aims to evaluate and compare the QoL and biochemical profiles of patients undergoing different KRT modalities in Brunei Darussalam.

Methods: A cross-sectional study was conducted in 2024 among 574 patients receiving HD, PD, or KTX across all government dialysis centers in Brunei. QoL was assessed using the validated SF-12 questionnaire, and biochemical parameters were collected from Brunei Darussalam Healthcare Information and Management System (BruHIMS). Sociodemographic and clinical data were used to profile and subgroups analysis.

Results: KTX patients reported the highest QoL scores and most favorable biochemical profiles, reinforcing transplantation as the optimal modality when available. Among dialysis patients, PD was associated with higher physical health scores than HD, suggesting better QoL. KTX patients were generally younger, with higher educational and employment levels. Significant differences in biochemical parameters such as hemoglobin, albumin, creatinine, urea, phosphate, and cholesterol were observed across modalities, indicating modality-specific clinical impacts.

Conclusion: The findings suggest that PD may be associated with slightly better QoL outcomes compared to HD. However, these differences were not statistically significant and should be interpreted with caution, particularly given the potential for residual confounding inherent in observational study designs. Future research should focus on examining the long-term QoL trajectories among PD patients and identifying strategies to optimize its clinical benefits in the management of ESKD in Brunei.

Purpose: Widespread antibiotic use has promoted a concerning rise in bacterial resistance. To counteract this trend and improve the effectiveness of antibiotic treatments, implementing antibiotic stewardship and an active surveillance system is crucial. Our primary aim was to analyze the local urinary bacterial spectrum and antibiotic resistance trends.

Methods: All positive urine culture results (9423) obtained between January 1, 2012 and December 31, 2023 at the Urology Department, University of Szeged were analyzed. Spearman's rank correlation test was then used to examine changes in bacterial spectrum, resistance trends of the five most common bacteria, and incidences of multidrug-resistant strains and nosocomial Clostridioides difficile infections.

Results: The proportion of Escherichia coli decreased significantly from 53 to 40% (p < 0.001), whereas that of Proteus mirabilis increased from 4 to 6% (p = 0.018). We observed significant decreases in E. coli for amoxicillin/clavulanic acid (p = 0.011), cefuroxime (p = 0.033), and gentamicin (p < 0.001); Enterococcus faecalis for gentamicin (p = 0.002); Klebsiella pneumoniae for amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, ciprofloxacin, gentamicin, and trimethoprim/sulfamethoxazole (p < 0.001); Pseudomonas aeruginosa for ciprofloxacin (p = 0.001) and gentamicin (p = 0.006); and P. mirabilis for amoxicillin/clavulanic acid (p = 0.018) and trimethoprim/sulfamethoxazole (p = 0.022). Only K. pneumoniae showed a significant increase in resistance trends (fosfomycin, p < 0.001). The incidence of extended-spectrum beta-lactamase-producing bacteria decreased significantly from 14.35% to 8.92% (p < 0.001), whereas that of C. difficile infections decreased by two-thirds.

Conclusion: Antibiotic stewardship based on accurate surveillance can counteract the increasing trend of antibiotic resistance and help manage urinary tract infections in the future, as well as might reduce the incidence of multidrug-resistant strains and C. difficile.

Background: Overactive bladder (OAB) is a common condition in children, affecting 5-12% of children between the ages of 5 and 10 years. It is characterized by urinary urgency, frequency, and nocturia, often leading to incontinence. OAB significantly impacts a child's emotional and social development, causing anxiety, low self-esteem, and social withdrawal. Oxybutynin is the standard treatment for overactive bladder in children, but side effects like dry mouth, constipation, and cognitive issues can make it difficult for patients to stick with the therapy.

Methods: This study systematically reviewed and analyzed existing research to evaluate and compare the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) versus oxybutynin for treating overactive bladder in children. We performed an electronic search of PubMed, Cochrane, and other databases up to April 2023 to identify randomized controlled trials (RCTs) that reported outcomes related to symptom improvement and adverse effects in children with OAB. We included studies based on the PICO criteria: pediatric patients (under 18 years), OAB treatment (TENS or Oxybutynin), and outcomes such as urinary urgency and incontinence. The risk ratios were calculated to compare the two treatments, and heterogeneity was assessed using the I² statistics.

Results: The search found six relevant studies and three of these were suitable for the meta-analysis. The results showed that TENS was much more effective than oxybutynin in improving symptoms, with a risk ratio of 1.93 (95% CI 1.35-2.74). TENS also caused fewer side effects compared to oxybutynin, with a risk ratio of 0.09 (95% CI 0.03-0.30). There was no variation between the studies (I² = 0), indicating that the results were consistent across all trials.

Conclusion: TENS has been shown to be both more effective and safer than oxybutynin for treating overactive bladder in children. It leads to greater improvement in symptoms and is linked to fewer side effects. These results indicate that TENS may be a better option, especially for children who have difficulty tolerating medication due to adverse reactions.

Background: Despite the growing interest in stem cell therapy for kidney disease research, there remains a lack of comprehensive and systematic bibliometric analyses in this field. This study aimed to summarize the progress in stem cell therapy for kidney disease through bibliometric analysis, providing insights into the development and direction of the field.

Methods: Publications related to kidney disease and stem cell therapy in the last 17 years were retrieved from the Web of Science Core Collection (WOSCC) database on July 15, 2025. In conducting a comprehensive bibliometric analysis, a variety of bibliographic elements were meticulously collected to map the landscape of research within a specific field.

Results: Between January 1, 2009, and July 15, 2025, a total of 3,914 articles on stem cell therapy research in kidney disease were published across 186 academic journals by 19,195 authors from 3906 institutions in 90 countries. The volume of publications has shown a steady increase over this period. The United States and China lead in both publication and citation counts. Harvard University and University of California System are the most active institutions in this research domain. Lilach O. Lerman from the Mayo Clinic College of Medicine and Science was noted for the highest number of significant publications and received the most co-citations. The analysis revealed key research themes, including pluripotent stem cells, exosomes, and extracellular vesicles.

Conclusion: This study provided a comprehensive bibliometric and knowledge mapping analysis of stem cell therapy in kidney disease research landscape, offering valuable insights into the trends, key contributors, and thematic focus areas within the field. By delineating the evolution of this research, this study aims to guide future scholarly endeavors and enhance our understanding of stem cell therapeutic potential.

Background: To investigate the prognostic significance of visceral fat to predict recurrence-free survival in patients with localized clear cell renal cell carcinoma (ccRCC).

Methods: This study included patients with localized ccRCC who had undergone curative surgery. Visceral, subcutaneous fat and the relative visceral fat area (rVFA) were quantified utilizing preoperative CT images. The association between rVFA and recurrence-free survival (RFS) was explored using restricted cubic splines, Cox proportional hazards regression, and Kaplan-Meier survival analysis. The predictive capability of rVFA was evaluated using the Boruta algorithm, a predictive model was developed using the random survival forest (RSF) with results visualized via Shapley additive explanations (SHAP).

Results: Four hundred and forty six patients were included. The follow-up median duration was 48.5 months, during which 57 patients experienced metastasis or death. Restricted cubic spline model revealed a nonlinear association between rVFA and tumor progression, exhibiting a U-shaped curve trend with an inflection point at 0.40. Beyond this threshold, rVFA was significantly correlated with an increased risk of progression. The RSF model yielded an area under the curve (AUC) of 0.89 for predicting 1-year RFS, 0.73 for 3-year RFS, and 0.75 for 5-year RFS. Both Boruta and SHAP analyses identified rVFA as a significant predictive feature.

Conclusions: A U-shaped association between rVFA and risk of tumor recurrence was observed among patients with ccRCC. A high rVFA is significantly correlated with an increased risk of adverse events, thus indicating that rVFA is a potential indicator for predicting the prognosis of ccRCC.