International Urology and Nephrology最新文献

Background: In prostate cancer (PCa) patients treated with radical prostatectomy (RP), multidisciplinary tumor boards (MDT) issue recommendations to undergo adjuvant (aRT) or salvage radiotherapy (sRT). However, reliable data regarding the adherence rate to MDT recommendations and subsequently its impact on oncological outcomes are scarce.

Methods: We retrospectively identified patients treated with RP within a certified prostate cancer center between 2012 and 2016, receiving an MDT recommendation to undergo adjuvant or salvage radiotherapy following RP due to adverse pathological features (non-organ confined disease, positive surgical margin, positive lymph node). Patients with a follow-up < 3 years were excluded. Among patients recommended to undergo aRT, adherence rate was calculated. Patients adherent vs. non-adherent to aRT recommendation were compared regarding biochemical recurrence (BCR), PSA failure following aRT or sRT, and cancer-specific (CSS) and overall survival (OS).

Results: Of 802 patients, 408 (51.5%) were recommended to undergo aRT. Among those, 121 (30%) received aRT, whereas 287 (70%) were non-adherent to aRT-MDT recommendation. In multivariable logistic regression models, age, performance status and presence of adverse pathological features represented statistically significant predictors to undergo aRT. Rates of BCR (40.4 vs. 66.6%) as well as subsequent median time of PSA failure following radiotherapy (83 vs. 42 months) favored patients adherent to aRT recommendations (both p < 0.001). No differences were recorded in CSS and OS analyses regarding adherence to aRT recommendations.

Conclusion: Solely a fraction of patients followed the recommendation to undergo aRT. Patients adherent to aRT recommendation demonstrated lower rates of subsequent PCa recurrences, albeit not (yet) translating into CSS/OS differences.

Purpose: Prostate cancer is a common malignancy in men, with radical prostatectomy (RP) being a major treatment option. This study investigates post-prostatectomy rehospitalisation rates and risk factors in a cohort of South Australian men who underwent RP from 2002 to 2021 (n = 5105).

Methods: Post-prostatectomy rehospitalisation rates at 30 and 90 days were measured from hospital discharge data, with reasons determined from ICD-10 codes. Rates per 1000 person-time were estimated, accounting for the length of follow-up. Zero inflated negative binomial regression analyses were used to identify sociodemographic and clinical factors associated with the number of hospital encounters following RP.

Results: Approximately 13% of patients had at least one hospital visit within 90 days post-prostatectomy. Common reasons for early rehospitalisation (within 30 days) were urinary obstruction (3.2%), haematuria (2.6%), and urinary tract infection (2.5%). Older age (aged 75 + vs < 60: incidence rate ratio (IRR) 2.23, 95% CI: 1.88-2.64), highest comorbidity burden (3 + vs 0: IRR 2.33, 95% CI: 1.80-3.01), and high risk clinical characteristics (PSA > 20 vs < 10 ng/mL: IRR 1.67, 95% CI: 1.34-2.08 and Gleason score 9-10 vs < 7: IRR 1.39, 95% CI: 1.06-1.84) were associated with higher rehospitalisation rates. Conversely, men who were treated from 2016-2021 had 39% lower rehospitalisation rates (IRR 0.61, 95% CI: 0.53-0.71) compared with patients treated from 2002-2005.

Conclusion: These findings highlight the importance of considering patient characteristics and tailoring post-surgical care plans to minimise rehospitalisation. The reduction in rehospitalisation over time may reflect advancements in surgical techniques, better patient selection or improved surgeon experience.

We comment on the recent study by Fröhlich et al., which evaluated the influence of adherence to multidisciplinary tumor board (MDT) recommendations on oncological outcomes in high-risk prostate cancer patients following radical prostatectomy. While this study contributes valuable real-world data, we highlight several limitations. Notably, psychosocial factors influencing adherence, such as fear of toxicity and socioeconomic concerns, were not addressed. Additionally, selection bias may have influenced the observed benefits of adjuvant radiotherapy, warranting the use of propensity score methods in future analyses. Finally, the lack of improvement in overall survival despite better biochemical recurrence-free survival raises questions about the clinical relevance of surrogate endpoints. We advocate for broader, patient-centered approaches and methodological rigor in future investigations.

Purpose: Henna artists are frequently exposed to para-phenylenediamine (PPD), a common hair dye component, raising concerns about its nephrotoxic effects. This study investigates the association between long-term PPD exposure and chronic kidney disease (CKD) among henna artists in Sudan.

Methods: A cross-sectional study included 138 female henna artists with over 10 years of professional exposure. Clinical assessments, laboratory tests, and kidney biopsies in selected cases were conducted. Data were analyzed using SPSS to compare female artists with and without CKD.

Results: The mean age of participants was 36.4 ± 8.1 years, with 15.8 ± 6.3 years in the profession. CKD was diagnosed in 27 (19.6%) participants, with persistent hematuria in 19 (70.4%), combined hematuria and proteinuria in 8 (29.6%), and elevated creatinine in 5 (18.5%). Kidney biopsies from 23 participants revealed the presence of chronic tubulointerstitial nephritis in 14 (60.9%), focal segmental glomerulosclerosis in 6 (26.1%), and membranoproliferative glomerulonephritis in 3 (13%) participants. CKD was more common among the unmarried (P = 0.033), those with lower education (P = 0.019), those who worked longer hours (P = 0.015), use high-concentration PPD formulations (P < 0.0001), and work in family parlors rather than professional salons (P = 0.023). CKD was also linked to PPD-induced skin reactions (P < 0.05) and the presence of normochromic normocytic anemia (P = 0.024).

Conclusion: This study suggests an association between prolonged PPD exposure and CKD risk among female henna artists. These findings underscore the need for greater awareness and further investigation into PPD's nephrotoxic effects.

Purpose: To investigate the association between systemic inflammation and activities of daily living (ADL) in older patients with chronic kidney disease (CKD) in the acute phase.

Methods: This observational, retrospective cohort study included patients with CKD aged 65 years and older with unscheduled admissions to the nephrology department between January 2019 and February 2022. Patients who underwent maintenance hemodialysis therapy; died during hospitalization; were treated in other departments; experienced serious events during hospitalization; or did not receive rehabilitation during hospitalization were excluded. Systemic inflammation was assessed by the modified Glasgow Prognostic Score (mGPS) on admission, and ADL was assessed by functional independence measure (FIM) at discharge.

Results: A total of 89 patients (median age, 80 years [interquartile range, 75-84 years]) were included in the analysis. An mGPS score of 0, 1, and 2 was assigned to 41 (46.1%), 15 (16.9%), and 33 (37.1%) patients, respectively. In multivariable analysis, the mGPS (SE = 2.16; β =  - 0.25; P = 0.001) was significantly associated with the FIM score at discharge. On the other hand, albumin (ρ = 0.093; 95% CI, - 0.12 to 0.30; P = 0.384) and CRP level (ρ =  - 0.176; 95% CI; - 0.37 to 0.03; P = 0.098) were not significantly correlated with the FIM score at discharge.

Conclusion: Among older patients with CKD in the acute phase, systemic inflammation assessed using the mGPS may be useful for predicting ADL.

Purpose: (i) Describe renal vascular anatomy in Vietnamese donors with 256-slice MSCT; (ii) relate imaging to operative metrics and early outcomes of trans-peritoneal laparoscopic donor nephrectomy (LDN).

Methods: All consecutive living kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024 were prospectively enrolled. Eligibility required compliance with national donation criteria, informed consent, and complete clinical documentation. MSCT data (vessel number, length, diameter, variants) and surgical variables (trocar use, warm-ischemia time, blood loss, complications) were extracted from electronic records.

Results: 166 donors (41.6 ± 10.2 yr, 59% female) were analyzed. MSCT showed a single renal artery in 77.3% of kidneys and ≥ 2 arteries in 22.7%; multiple veins were more common on the right (14.7%). The left renal vein was far longer than the right (66.0 ± 14.0 vs 25.3 ± 7.4 mm, p < 0.001). Vessel number was predicted correctly in 95.8% of cases although pedicle length was over-estimated by 3-9 mm (p < 0.001). All nephrectomies were completed laparoscopically. Mean operative time was 118 ± 23 min; warm-ischemia time 4.5 ± 1.1 min; blood loss 70 ± 33 mL with no transfusions. Intra-operative morbidity was 4.2% (minor only) and 30-day morbidity 9.6%, almost entirely self-limited lymphatic leaks. Drains were removed after 3.5 ± 0.7 days; donors were discharged after 7.2 ± 2.0 days; creatinine fell from 110 to 92 µmol L⁻¹ within one month.

Conclusion: 256-slice MSCT provides highly accurate vascular mapping that correlates closely with intra-operative findings. When combined with trans-peritoneal LDN, it yields short operative times, low complication rates, and rapid donor recovery, supporting its routine use in living donor programs in resource-constrained settings.

Purpose: Globally, epidemiological data on sex chromosomal disorders of sex development (DSDs) remain scarce, prompting this study to examine their global disease burden and health inequalities, with a focus on Klinefelter syndrome (KS) and Turner syndrome (TS).

Methods: We collected data on the incidence and prevalence of KS and TS from the GBD 2021 and analyzed by location, age, and socio-demographic index (SDI), using estimated annual percentage changes, Spearman's correlation analysis, health inequality analysis, and Bayesian age-period-cohort prediction models. The slope index of inequality and concentration index were employed to assess absolute and relative health inequalities across countries with varying SDI levels.

Results: In 2021, there were 68,357 incident cases of KS with an incidence rate of 102.12, and the prevalent cases reached 1,121,754, with an age-standardized prevalence rate (ASPR) of 29.68. For TS, there were 23,929 incident cases, with an incidence rate of 38.32, and 531,784 prevalent cases, with an ASPR of 14.47. The ASPR of KS showed an upward trend, while that of TS exhibited a downward trend. The prevalence of DSDs declined with age, most notably in the 0-9 age groups, with the slowest decline observed in high SDI regions. The highest incidence rate was in Sub-Saharan Africa, while the most significant growth was concentrated in Europe. Correlation analysis revealed a negative association or "U-shaped" relationship between the incidence rate of sex chromosomal DSDs and SDI. Inequality analysis indicated that low SDI countries bear a disproportionate burden, with SDI-related inequalities worsening over time, particularly in incidence rates. The burden of KS is forecast to grow modestly by 2036, contrasting with TS's expected gradual decline.

Conclusions: Globally, KS has shown increasing impact among sex chromosomal DSDs, contrasting with TS. Persistent disparities across SDI regions highlight urgent needs for enhanced screening and long-term care in low SDI areas to reduce inequalities.

Purpose: To systematically evaluate the incidence of bladder neck contracture (BNC) following surgical treatments for benign prostate hyperplasia (BPH).

Methods: A systematic search of PubMed, Embase, and CENTRAL was conducted to identify randomized, prospective trials reporting BNC following BPH surgery up to October 29, 2024. Eligible studies included adults, compared two surgical methods, and had at least two years of follow-up, to ensure adequate time for BNC development. Proportions were pooled and risk ratios were produced using random effects models.

Results: Eleven studies comprising 1,536 patients with 2-year follow-up were included. The pooled incidence of BNC following all included BPH surgeries was 3% (95% CI 2-5). The BNC rate was 9% (95% CI 4-15) for photosensitive photo-selective vaporization of the prostate (PVP), 3% (95% CI 2-5) for transurethral resection of the prostate (TURP), and 3% (95% CI 1-5) for holmium laser enucleation of the prostate (HoLEP). TURP and HoLEP were not associated with an increased risk of BNC compared to alternative treatments including transurethral incision of the prostate, HoLEP, PVP, thulium laser resection of the prostate, diode laser vaporization of the prostate or laparoscopic simple prostatectomy for TURP, and TURP, open prostatectomy, and bipolar enucleation of the prostate for HoLEP. We observed log risk ratios, regarding BNC formation, of 0.19 (95% CI - 0.70 to 1.08) and - 0.34 (95% CI - 1.41 to 0.73), for TURP and HoLEP, respectively. Smaller prostate size and anticoagulant use were linked to BNC formation. The preferred treatment for BNC was bladder neck/prostate incision or re-resection.

Conclusions: BNC is a relatively uncommon complication following surgical treatment for BPH. HoLEP and TURP are not associated with an increased risk of BNC compared to other methods of surgical treatment, while smaller prostate size may be a potential risk factor. Further research is needed to identify modifiable factors and assess outcomes of emerging treatments.