Investigative and Clinical Urology最新文献

Purpose: The robotic-assisted laparoscopic approach for creation of an appendicovesicostomy is in common practice now. We describe our modifications ("Gundeti's 10 step modification") to the conventional open technique for adopting the robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy (RALMA), and study our long-term outcomes.

Materials and methods: This was a retrospective review of prospectively collected data and electronic medical record review from 2008 to 2023. Children with failure to empty the bladder with normal bladder capacity who underwent RALMA incorporating our "Gundeti's 10 step modification" were included. The demographic, clinical, and postoperative details were analyzed. All were followed up annually, to monitor the continence and redo surgery rates. Success was defined as postoperative stomal continence and failure was considered in those who underwent redo procedures.

Results: Twenty-seven children were included with a mean age of 9.4 years. The mean hospitalization, estimated blood loss, and operative time were 5.27 days, 18.05 mL, and 236 minutes. The complications were suprafascial stenosis (11.1%), subfascial stenosis (3.7%), and channel incontinence (7.4%). Three children required redo procedures (11.1%). The mean follow-up was 69.41 months, and all 27 children are continent at the last follow-up (100.0%).

Conclusions: Our proposed modifications, i.e., "Gundeti's 10 step modification" allows a success rate of 92.6% for continence and 89.0% based on redo surgery rates, thereby proving it to be a safe and feasible option amongst the paediatric population.

Purpose: Radical cystectomy (RC), which is the standard of care for muscle-invasive and high-grade noninvasive bladder cancer, is accompanied by postoperative renal function deterioration. We aimed to evaluate the effect of serum albumin level on postoperative renal function decline after RC.

Materials and methods: A total of 272 patients with estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m² who underwent RC between October 2003 and December 2020 were included. Acute kidney injury (AKI) was defined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria, while postoperative chronic kidney disease (CKD) progression was defined as an eGFR <60 mL/minute/1.73 m² at ≥3 months after RC.

Results: In our cohort, 20 (7.4%) and 99 (36.4%) patients experienced postoperative AKI and CKD progression, respectively, with a median follow-up period of 51.5 months. The median preoperative serum albumin level and eGFR were 4.1 g/dL and 82.0 mL/minute/1.73 m², respectively. Preoperative serum albumin less than the median (4.1 g/dL) was associated with postoperative AKI (odds ratio [OR] 3.76, p=0.027) and CKD progression (OR 2.87, p<0.001) after adjusting for other factors.

Conclusions: Serum albumin level <4.1 g/dL was associated with short- and long-term renal function decline after RC, suggesting that close monitoring of renal function after RC might be considered in these patients.

Purpose: To develop and validate an artificial intelligence (AI)-based personalized outcome prediction model for upper-urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy.

Materials and methods: Data from patients who underwent radical nephroureterectomy between 2010 and 2020 across three hospitals were retrospectively analyzed. A model was developed using one tertiary center's data and externally validated with data from two other hospitals. An AI model using XGBoost as risk estimator and bootstrapped Weibull Accelerated Failure Time model for 10-year survival probability was employed. Hyperparameter tuning used Optuna method. Model efficacy was assessed using concordance index, average Brier score, D-calibration, and six-month interval time-dependent area under the curve (AUC).

Results: Of 1,039 patients, 627 qualified after excluding 50 with neoadjuvant chemotherapy. Model development used 564 patients (507 training, 57 test) with 9:1 stratified random split, plus 63 for internal validation and 362 for external validation. Significant parameters included preoperative glomerular filtration rate (p<0.001), hydroureteronephrosis (p=0.013), pathological N stage (p<0.001), concurrent carcinoma in situ (p<0.001), disease progression (p<0.001), and survival rate (p<0.001). Disease-free survival (DFS) model's concordance index: internal validation 0.789, external validations 0.734 and 0.771. Overall survival (OS) model's concordance index: internal validation 0.819, external validations 0.780 and 0.771. Mean time-dependent AUC was 0.66-0.77 for DFS and 0.67-0.80 for OS during 10-year periods.

Conclusions: AI-based model effectively predicts disease-free and OS outcomes for upper-urinary tract urothelial carcinoma patients with post-radical nephroureterectomy, showcasing robust performance across multicenter settings.

Purpose: Owing to concerns about overdiagnosis and overtreatment associated with prostate-specific antigen (PSA) screening for early prostate cancer detection, recent guidelines have lowered the PSA cutoff value for recommending biopsy. This study aimed to evaluate the diagnostic accuracy of a lower PSA cutoff value in Korean men and to explore whether additional clinically useful criteria can be proposed.

Materials and methods: A retrospective cohort study of 17,539 Korean men who underwent their first prostate biopsy due to lower urinary tract symptoms was conducted at six tertiary hospitals between 2011 and 2019. The diagnostic performance of various PSA and PSA density (PSAD) cutoff values across age groups was evaluated by analyzing the data on demographics, PSA levels, PSAD, and biopsy results.

Results: Among the participants, 44.1% were diagnosed with prostate cancer, of whom 73.7% had clinically significant cancer (Gleason score ≥7). No significant differences in cancer detection rates were found between PSA levels of 3-4 ng/mL and 4-5 ng/mL across age groups. PSAD further increased the area under the receiver operating characteristic curve by 5.5%-11.4%.

Conclusions: These findings suggest that diagnostic yield may not be impacted by merely lowering the PSA cutoff. Rather, combining PSA, PSAD, and patient age enhances screening accuracy while minimizing unnecessary biopsies and overdiagnosis. Our results highlight the need for more data to refine national screening guidelines and promote a more tailored approach to prostate cancer screening in Korea.

Purpose: Benign prostatic hyperplasia (BPH) is a major disease that causes lower urinary tract symptoms (LUTS) such as abdominal pressure, urgency, residual urine, weak urination, and delayed urination in elderly men. We attempted to identify risk factors for the development of BPH-LUTS, including particulate matter (PM).

Materials and methods: We utilized customized research database of the National Health Insurance Corporation. A total of 2,200,546 subjects were included, consisting of BPH-LUTS (n=601,291) and non-BPH-LUTS (n=1,599,255). We classified the PM₁₀ exposure level based on median PM₁₀ value (56.3 µg/m³). We assessed using multivariate Cox proportional hazard regression analysis to find an association of incidence of BPH-LUTS and PM₁₀ exposure.

Results: PM₁₀ exposure is a risk factor to develop BPH-LUTS. All subgroups were vulnerable to even moderate PM₁₀ exposure: age, waist circumference, body mass index, smoking, alcohol consumption, physical activity, dyslipidemia, diabetes, and high blood pressure. The hazard ratio was from 1.019 (60s group) to 1.097 (exercise 3 or more times a week). Interestingly, when total cholesterol levels or fasting blood sugar or high blood pressure were normal, the risk of BPH was higher in those with high PM₁₀ compared to those with low PM₁₀. Even if those who exercise more than three times a week, high PM₁₀ exposure may increase their risk of BPH.

Conclusions: This study is significant that, based on Korean standards, even normal PM₁₀ exposure is a risk factor for the development of BPH-LUTS. This study provides a basis for establishing health policies related to exposure to PM.

Benign prostatic obstruction (BPO), often caused by benign prostatic hyperplasia (BPH), significantly affects quality of life in aging men. While transurethral resection of the prostate remains a standard surgical treatment, its invasiveness and associated side effects have led to the development of minimally invasive surgical therapies (MIST) as alternatives. This narrative review summarizes current evidence on established and emerging MIST options, including Rezum, iTind, UroLift, CoreTherm, TPLA (transperineal laser ablation), Optilume BPH, and new stent-based, first-line interventional therapies (FITs), such as Zenflow Spring, Butterfly, ProVee System, Urocross, and FloStent. These therapies aim to relieve lower urinary tract symptoms with fewer complications, reduced recovery time, and better preservation of sexual function. Each technique varies in mechanism-thermal, mechanical, or pharmacological-and is suited to specific prostate anatomies and patient profiles. Clinical data support their efficacy in improving International Prostate Symptom Score, peak urinary flow rate, and quality of life scores, with durability ranging from one to five years depending on the modality. Adverse events are generally mild and transient, while rates of ejaculatory and erectile dysfunction remain low across most interventions. FITs offer potential for temporary or long-term decompression with minimal procedural requirements. Overall, MIST broaden the therapeutic landscape for men with symptomatic BPO, particularly those who are unfit or unwilling to undergo conventional surgery. As the field evolves, these interventions contribute to a more personalized, function-preserving approach in BPH management.

Purpose: The integration of video-based learning into surgical education highlights the need for high-quality instructional content, especially for complex procedures such as percutaneous nephrolithotomy (PCNL). This study aimed to systematically evaluate and compare the educational quality of YouTube videos demonstrating supine and prone PCNL techniques.

Materials and methods: A comprehensive YouTube search was conducted between January 6 and 19, 2025, using the keywords "supine PCNL," "prone PCNL," "supine percutaneous nephrolithotomy," and "prone percutaneous nephrolithotomy." Eligible videos were assessed using three validated scoring systems: Global Quality Score (GQS), the DISCERN instrument (a validated tool for assessing the quality of health information), and the JAMA (Journal of the American Medical Association) criteria, along with a novel tool, the PCNL-Edu Score (educational score). A total of 120 videos (60 supine, 60 prone) were included.

Results: Supine PCNL videos demonstrated significantly higher DISCERN reliability scores (p=0.037), GQS scores (p=0.001), and PCNL-Edu Scores (p=0.018) compared to prone PCNL videos. Subgroup analyses showed no significant differences in educational quality based on video source (academic/individual) or video type (educational/surgical demonstration). In correlation analyses, video length positively correlated with PCNL-Edu Scores in both groups (prone: p=0.004, supine: p=0.001), whereas popularity metrics such as views (prone: p=0.069, supine: p=0.061) and likes (prone: p=0.183, supine: p=0.225) were not significantly associated with educational quality.

Conclusions: Supine PCNL videos currently offer superior instructional quality on YouTube. The PCNL-Edu Score provides a focused framework for evaluating surgical videos and underscores the need for standardized guidelines to improve video-based surgical education.

Purpose: To investigate the association between metabolic syndrome (MetS) and nocturia in a nationally representative U.S. adult population, focusing on individual metabolic components and subgroup differences by age and sex.

Materials and methods: We analyzed data from 8,518 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2014. Nocturia was defined as ≥2 nighttime voids. MetS was defined by the presence of ≥3 National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to assess associations, adjusting for demographic and behavioral covariates.

Results: Overall, 23.3% of participants had MetS and 29.6% reported nocturia. MetS was independently associated with nocturia (adjusted odds ratio [OR] 1.387, 95% confidence interval 1.236-1.557). A dose-response relationship was observed, with nocturia risk increasing. Central obesity (OR 1.564), elevated fasting glucose (OR 1.397), and elevated blood pressure (OR 1.311) showed the strongest associations. RCS analyses revealed linear associations for waist circumference and systolic blood pressure, and nonlinear associations for diastolic blood pressure and glucose. Sex-specific analyses revealed distinct nonlinear patterns, particularly for waist circumference among male participants and triglyceride levels among female participants. The association remained consistent across most age and sex groups, except in males aged 20-40 years.

Conclusions: MetS and its components are independently associated with nocturia. The observed sex-specific differences suggest that metabolic contributors to nocturia may differ by sex supporting nocturia as a potential clinical marker of underlying cardiometabolic dysfunction.

Purpose: We aimed to investigate the prevalence and genotype distribution of human papillomavirus (HPV) among Korean males and explore implications for targeted vaccination strategies.

Materials and methods: A total of 44,065 males underwent HPV testing between March 2014 and February 2022 using the Anyplex™ II HPV 28 system, detecting 19 high-risk (HR) and 9 low-risk (LR) HPV types. Additionally, data from 507 male patients at local clinic (2017-2022) were analyzed to compare genotype prevalence between those with (WAT group) and without (WAT X group) genital warts.

Results: Overall HPV positivity was 59.1%. HPV 6 (33.3%) and HPV 11 (11.0%) were the most prevalent LR genotypes, while HPV 16 (5.2%) dominated HR infection. Multiple HPV genotype co-infection occurred in 49.3% of positive cases, with 11.3% involving multiple HR types. Younger males (teens, 20s) exhibited higher HR-HPV positivity, although total HPV positivity peaked in the 40s (60.1%). Non-9-valent HR genotypes (HPV 53, 51, 39, 66) accounted for 27.6%-35.0% of infections annually. At local clinic, HPV 43 was significantly associated with genital warts (p=0.017).

Conclusions: These data support including males in national HPV vaccination strategies using the current 9-valent vaccine and underscore the need for ongoing genotype surveillance to monitor non-vaccine high-risk types and inform public health policy, and support inclusion of males in national HPV vaccination strategies using the current 9-valent vaccine.