Investigative and Clinical Urology最新文献

Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, particularly among women and catheterized patients, leading to diminished quality of life and increased healthcare utilization. A central factor in rUTI pathogenesis is bacterial persistence despite seemingly appropriate antibiotic therapy. Unlike classical antibiotic resistance, persistence involves phenotypic adaptations that allow uropathogens to evade both host immune responses and antimicrobial agents. This review examines the multifactorial mechanisms underlying bacterial persistence, including intracellular survival strategies, biofilm formation, antibiotic tolerance, and host immune evasion. An improved understanding of these processes is essential for developing novel, targeted therapeutic strategies that go beyond traditional antimicrobial approaches and address the root causes of recurrence.

Purpose: To assess whether radical nephroureterectomy (RNU) confers oncologic and perioperative benefit in patients aged 80 years or older with upper tract urothelial carcinoma (UTUC).

Materials and methods: This retrospective cohort study included 710 patients who underwent RNU at a tertiary center from 2003 to 2022. Patients were stratified into octogenarian (OG) (≥80 years, n=96) and non-octogenarian (NOG) (<80 years, n=614) groups. Demographics, perioperative variables, and oncologic outcomes were compared. Multivariate Cox regression was performed for overall survival and cancer-specific survival (CSS).

Results: OG had a higher rate of hypertension (72.9% vs. 50.2%) and lower body mass index (23.6 kg/m² vs. 24.5 kg/m², p=0.028), with similar pathologic stage and tumor grade compared to NOG. OG were more likely to undergo minimally invasive surgery (84.3% vs. 75.3%, p<0.001). Overall complication rate was higher in OG (68.8% vs. 55.2%, p=0.013), but major complications were not (5.2% vs. 3.3%, p=0.340). At median follow-up of 43.6 months, no difference in CSS was found. Positive surgical margin was the only independent predictor of CSS.

Conclusions: RNU can be safely and effectively performed in well-selected OG with UTUC. Age ≥80 years was not associated with inferior CSS outcomes or increased major morbidity.

Purpose: Urachal cyst is a type of congenital anomaly that may undergo malignant transformation. Partial cystectomy with en-bloc resection of the urachus is appropriate treatment for urachal remnants. We performed near infrared ray-guided surgery (NIRGS) for the accurate localization of tumor margins using the Firefly^® technology of the da Vinci surgical system and intraoperative cystoscopy. In the normal visible light mode, we could not recognize the cystoscopic light. However, after changing to the Firefly^® mode, the near infrared rays transmitted through the bladder wall were visible as green images.

Materials and methods: The patient is a 76-year-old woman. She was referred to urology for a tumor at the dome of the bladder. Cystoscopy revealed a round submucosal mass at the dome of the bladder. The possibility of a urachal tumor could not be excluded. Since she was already diagnosed with rectal cancer and scheduled to undergo robot-assisted laparoscopic proctosigmoidectomy, we performed robot-assisted partial cystectomy during the same operative session.

Results: The rectum was removed by a surgeon with robot-assistance. Then we detached the median umbilical ligament from just below the umbilicus toward the bladder. Both medial umbilical ligaments were dissected from abdominal wall to the dome of the bladder. A simultaneous cystoscopic light depicted the bladder boundaries of the mass with the Firefly^® mode. There was no residual tumor at the resected margin, and pathological findings revealed that the urachal cyst was benign.

Conclusions: Robot-assisted partial cystectomy for urachal tumors is technically feasible. NIRGS should be considered in selected cases.

Purpose: Transurethral resection of bladder tumor for large tumors (≥5 cm) is challenging, even for experienced surgeons, due to increased risks of transfusion, bladder perforation, and incomplete resection. We developed a sequential strategy involving preoperative selective arterial embolization (SAE) followed by transurethral resection to address these challenges.

Materials and methods: This retrospective study evaluated patients who underwent preoperative SAE followed by transurethral resection for non-muscle-invasive bladder cancer at two tertiary hospitals between 2021 and 2024. Potential candidates were patients newly diagnosed with large bladder tumors (longest diameter of the main mass ≥5 cm) and suspected non-muscle-invasive bladder cancer on preoperative studies.

Results: Eleven patients (mean age, 73.2 years) were included in this study. The mean tumor size was 5.78 cm (range, 5.0-8.0 cm). SAE was performed on the day of surgery in seven cases (63.6%) and 1-4 days before surgery in four cases (36.4%), and complete tumor resection was successfully achieved in all cases. The mean operative time was 78.8 minutes (range, 33-149 minutes). No complications related to transurethral resection or SAE, including the need for transfusion or reoperation, were observed. Pathology results revealed Ta in six cases and T1 in five cases. Disease recurrence occurred in six patients (54.5%); however, none demonstrated disease progression during a median follow-up of 24 months (range, 6-44 months).

Conclusions: Our early experiences demonstrated that preoperative SAE followed by transurethral resection for large non-muscle-invasive bladder cancers may be a feasible approach for achieving complete resection without complications.

Purpose: This study evaluated the clinical impact of escalating tamsulosin dosage from 0.2 to 0.4 mg in men with benign prostatic hyperplasia (BPH) who exhibited inadequate responses to the lower dose.

Materials and methods: A retrospective review was performed on 57 patients treated at Seoul National University Bundang Hospital in 2022. Uroflowmetry parameters, International Prostate Symptom Score (IPSS), and postvoid residual volume (PVR) were compared before and after dose escalation. Subgroup analysis was conducted by age, prostate volume, and concomitant 5-alpha-reductase inhibitor use.

Results: The mean maximum urinary flow rate value improved significantly from 14.4 to 17.7 mL/s (p<0.001), with consistent benefits across subgroups. No significant changes were observed in IPSS or PVR overall, although PVR decreases were significant in prostates >50 mL.

Conclusions: Escalating tamsulosin from 0.2 to 0.4 mg can meaningfully improve urinary flow in certain BPH patients, particularly those with larger prostates or concomitant 5-alpha-reductase inhibitor therapy.

Purpose: In this study, we aimed to analyze the uroflowmetry findings in community-dwelling adult males and examine the relationship between maximum urine flow rate (Qmax) and factors such as age, prostate size, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and voided volume.

Materials and methods: Data were collected from 75,199 males aged >24 years through community health screenings conducted by the Korea Prostate & Voiding Health Association. After applying the exclusion criteria, 12,891 males with complete data were included in this analysis. Uroflowmetry, IPSS, transrectal ultrasonography, and PSA tests were performed.

Results: The mean patient age was 74.66±9.10 years, mean IPSS was 14.59±8.11, mean prostate size was 30.50±14.44 mL, mean PSA was 1.79±3.94 ng/mL, and mean Qmax was 14.21±6.34 mL/s. Significant associations were found between Qmax and age (p<0.001), IPSS (p<0.001), prostate size (p<0.001), PSA level (p<0.001), and voided volume (p<0.001). Qmax decreased with increasing age, IPSS, prostate size, and PSA, but increased with larger voided volumes.

Conclusions: This large-scale community-based study provides valuable insights into the relationship between uroflowmetry results and various factors in adult males. These findings can serve as a reference for evaluating uroflowmetry results in clinical settings and contribute to a better understanding of lower urinary tract symptoms in the general male population.

Purpose: To compare the diagnostic performance of white light cystoscopy (WLC), photodynamic diagnosis (PDD), and narrow-band imaging (NBI) in the detection of non-muscle invasive bladder cancer (NMIBC) through a network meta-analysis of randomized controlled trials (RCTs).

Materials and methods: A systematic literature search of PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science was conducted in February 2024. RCTs comparing WLC, NBI, and PDD in patients with NMIBC were included. Six RCTs comprising 2,439 patients were analyzed. Diagnostic outcomes evaluated included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-positive rate, and carcinoma in situ (CIS) sensitivity. A random-effects network meta-analysis was performed using Stata software. Risk of bias was assessed using the RoB 2 tool.

Results: Both NBI and PDD demonstrated significantly improved sensitivity compared to WLC (odds ratio [OR] for NBI 7.66, 95% confidence interval [CI] 2.91-20.19; OR for PDD 7.85, 95% CI 3.76-16.38). PDD showed the highest CIS sensitivity (OR 13.37, 95% CI 4.38-40.89). WLC had the highest specificity (OR for PDD 0.29, 95% CI 0.08-1.00). NBI achieved the highest NPV (OR 8.28, 95% CI 1.34-51.28), while PDD showed the lowest PPV (OR 0.16, 95% CI 0.09-0.29). SUCRA (surface under the cumulative ranking curve) rankings supported these findings.

Conclusions: NBI and PDD improve NMIBC detection sensitivity over WLC, notably PDD for CIS, despite lower specificity. WLC remains the most specific, and NBI offers a favorable balance between sensitivity and diagnostic precision.

Prostate cancer exhibits marked ethnic differences in genetic architecture. Although polygenic risk scores (PRS) and germline genetic testing have shown clinical utility in European populations, their applicability to Asian populations remains limited. This review synthesizes evidence published between 2020 and 2025 on PRS and germline genetics in Asian prostate cancer cohorts, focusing on Chinese, Japanese, and Korean populations. Recent studies demonstrate that population-specific PRS models effectively stratify prostate cancer risk in Asian men, with individuals in the highest decile showing a 4- to 5-fold increased risk. The 2025 BARCODE1 trial reported a 40.0% cancer detection rate, with 55.1% clinically significant disease, among PRS-selected European men, highlighting the need for population-specific validation in Asians. Germline profiling indicates that 25.1%-29% of Chinese patients harbor deleterious variants, most frequently involving BRCA2. Ethnic-specific susceptibility variants have also been identified, including HOXB13 G132E in Asians, contrasting with the G84E variant predominant in Europeans. The 2022 Hong Kong Consensus provides the first comprehensive guideline tailored to germline testing in Asian populations. Despite these advances, current PRS models primarily predict disease incidence rather than aggressive phenotypes. Key challenges include smaller genome-wide association study sample sizes, limited prospective validation, and heterogeneous clinical and research infrastructure across Asia. In conclusion, while substantial progress has been made in characterizing genetic risk in Asian prostate cancer, European-derived models show reduced accuracy. Future priorities include large-scale multiethnic collaborations, prospective validation studies, and development of predictors for aggressive disease.

Purpose: Despite rising sexually transmitted infection (STI) incidence globally, evidence on the burden among adolescents remains limited. This study examined trends in the prevalence and medical costs of STIs among Korean youth aged 15-24 from 2010 to 2023, with a focus on age- and gender-specific disparities.

Materials and methods: Using national health insurance claims data from the HIRA (Health Insurance Review & Assessment Service), we identified STI cases by ICD-10 (10th revision of the International Classification of Diseases) codes and calculated annual age-standardized and age-specific prevalence rates based on census data. Sex-stratified analyses were performed, and medical expenditures were estimated and converted to US dollars.

Results: Over 2010-2023, STI prevalence among Korean youth rose by 22.9%, peaking in 2019. Rates were consistently higher in the 20-24 group than in the 15-19 group, with human immunodeficiency virus (HIV), genital warts, and mycoplasma showing four- to eight-fold differences. Chlamydia (21.8%) and gonorrhea (18.5%) accounted for the largest share of youth cases. While HIV and nongonococcal urethritis were predominantly male, mycoplasma, chlamydia, and genital herpes were more common in females. Total medical costs reached US$121.9 million, with 77.5% incurred by males, largely driven by nongonococcal urethritis.

Conclusions: STI prevalence among Korean youth has risen steadily despite a shrinking youth population, with substantial gender and age disparities in both disease patterns and medical costs. These findings highlight the urgent need for comprehensive, youth-centered sexual health education and improved access to confidential sexual and reproductive health services in Korea.

Purpose: Active surveillance (AS) is recommended for men with low-risk prostate cancer, but institutional variability exists in eligibility criteria, confirmatory biopsy policies, and monitoring schedules. This study assessed whether protocol heterogeneity influences surveillance duration, treatment transition, and surgical pathology outcomes.

Materials and methods: We retrospectively reviewed 232 men who initiated AS between 2014 and 2016 at three institutions with distinct protocols: Hospital A (Gleason Grade Group [GGG] 1-2, prostate-specific antigen [PSA] <15 ng/mL, confirmatory biopsy only if clinically indicated), Hospital B (GGG 1-2 within core limits, PSA <20 ng/mL, biennial biopsy), and Hospital C (GGG 1 within core limits, one confirmatory biopsy within 1-2 years, then biopsy if clinically indicated). Kaplan-Meier and Cox regression assessed AS continuation and treatment transition, while final GGG and pathologic stage were compared among men undergoing radical prostatectomy (RP).

Results: Median AS duration was 38.5 months. Five-year AS retention differed significantly: 53.2% (Hospital A), 79.8% (Hospital B), and 59.1% (Hospital C). Treatment transition occurred in 23.2%, 18.1%, and 44.0% of patients, respectively (p=0.003). Hospital B showed the lowest hazard of transition (hazard ratio [HR] 0.49 vs. Hospital A), whereas Hospital C had a higher hazard for RP (HR 1.87 vs. Hospital A). Final GGG and stage did not differ among RP specimens.

Conclusions: Institutional heterogeneity in AS protocols significantly influenced surveillance duration and treatment timing but not adverse pathology. Flexibility in protocol design may be acceptable if supported by confirmatory biopsy and risk-adapted monitoring, underscoring the need for evidence-based standardization.