Investigative and Clinical Urology最新文献

Purpose: To assess long-term outcomes of vesicostomy on bladder capacity (BC) and voiding function in non-neurogenic bladder, and explore the association between kidney ultrasonographic findings and renal function.

Materials and methods: Thirty-four patients under 2 years at the time of vesicostomy formation (2005-2020) with ≥3 years of follow-up were reviewed. Patients were further stratified based on neurogenic bladder status. Twenty-one patients were non-neurogenic. A subgroup analysis of 7 patients under 3 months with primary vesicoureteral reflux (VUR) and compromised renal function was conducted.

Results: The median age at vesicostomy formation was 1.0 months (interquartile range [IQR] 0.0-3.5); the median duration of vesicostomy was 16.0 months (IQR 8.0-21.0). At a median age of 93.0 months (IQR 59.5-117.5), all patients achieved spontaneous micturition and continence. Eleven patients (52.4%) showed bell-shaped voiding patterns. Five patients showed interrupted (n=2) or plateau (n=3) patterns. With the exemption one patient, all patients with primary VUR showed bell-shaped curves. None initiated clean intermittent catheterization during follow-up. The median BC-to-estimated BC in patients with non-neurogenic bladder and primary VUR was 0.9 (IQR 0.7-1.1) and 0.9 (IQR 0.8-1.1), respectively. Three patients underwent revision due to prolapse. The glomerular filtration rate (GFR) was improved by 68.9% compared to the baseline (p=0.045). Parenchymal abnormalities on kidney ultrasonography were associated with decrease in GFR.

Conclusions: Vesicostomy in non-neurogenic bladder patients was associated with recovery of BC, preservation of continence, and improved renal function. Parenchymal abnormalities on ultrasonography predicted lower GFR.

Purpose: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases.

Materials and methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre-COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed.

Results: The patients' median age was from 13 years (range, 1-19 years) to 13 years (range, 1-16 years) between the pre-COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre-COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7-120.0] vs. 20.0 hours [1.3-288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5-124.3] vs. 28.5 hours [6.1-293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0-13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1-7.3 mL) in pre-COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes.

Conclusions: The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.

Purpose: Prostate cancer that progresses despite androgen deprivation therapy, known as metastatic castration-resistant prostate cancer (mCRPC) is notoriously difficult to treat. While abiraterone acetate (AA) is a standard therapy, repurposing drugs like silodosin, a selective α1A-adrenoceptor antagonist, offers promising potential.

Materials and methods: PC-3 human prostate cancer cells were treated with silodosin, AA, or their combination. Cell viability was assessed via CCK-8 assay, apoptosis by Annexin V-FITC/PI flow cytometry, and drug interaction using CompuSyn to determine combination index (CI) and dose reduction index (DRI).

Results: Both silodosin and AA reduced cell viability concentration-dependently (half-maximal inhibitory concentration [IC₅₀]: 44.16 mM and 66.90 µM, respectively). Combination therapy yielded the lowest viability (18.03%±5.73%), significantly outperforming AA (41.79%±13.11%) and silodosin (45.35%±11.51%) alone. Silodosin induced greater apoptosis (80.94%±15.88%) than AA (22.93%±7.41%), while the combination further enhanced apoptosis (87.41%±12.25%). At ¼ IC₅₀ doses, the combination retained efficacy using markedly reduced concentrations-16.72 µM AA (8-fold reduction) and 11.04 mM silodosin (5-fold reduction). CI values across fractional effects remained <1, confirming synergism, with favorable DRI values indicating enhanced efficacy at lower doses.

Conclusions: Silodosin exhibits potent effects in reducing cell viability and promoting apoptosis in androgen-insensitive prostate cancer cells, comparable to AA. When combined, both agents demonstrate synergistic effects with reduced dosing requirements. These findings support further investigation of silodosin as a potential therapeutic in mCRPC.

Purpose: This study aimed to evaluate whether the pathological findings from repeat transurethral resection of bladder (re-TURB) predict Bacillus Calmette-Guérin (BCG) response in patients with T1 high-grade bladder cancer.

Materials and methods: We analyzed patients with bladder cancer enrolled in the prospective patient registry system of Seoul National University, SUPER-UC, from March 2016 to May 2022. Patients with T1 high-grade cancer who underwent re-TURB and BCG instillation were identified. Re-TURB pathology and its relationship with BCG response were analyzed.

Results: Out of a total of 2,673 patients with bladder cancer, 539 had T1 high-grade bladder cancer. Among these, 251 patients underwent subsequent re-TURB and BCG instillation. Of the 251 patients, 210 (83.7%) were male, and TURB was performed as the initial procedure in 232 cases (92.4%). In the TURB specimens of T1 high-grade cancer, concomitant carcinoma in situ (CIS), lymphovascular invasion, and variant histology were observed in 27 (10.8%), 54 (21.5%), and 29 (11.6%) cases, respectively. However, these factors were not associated with BCG failure after re-TURB. Re-TURB pathology showed chronic inflammation (51.8%), CIS (17.5%), Ta (15.5%), and T1 (15.1%). These findings were significantly correlated with BCG responsiveness. Notably, BCG failure was reported in 20.8% of patients with chronic inflammation, which showed the best response, compared to patients with T1 pathology, where BCG failure was observed in 47.4% of cases (p=0.011).

Conclusions: The pathological results of re-TURB play a critical role in determining the BCG response in patients with T1 high-grade bladder cancer.

Purpose: The study aims to retrospectively examine performance of general anesthesia in percutaneous radiofrequency ablation (RFA) of renal cell carcinoma (RCC) and to assess the long-term outcomes.

Materials and methods: Between September 2012 and August 2019, 87 patients (68 males and 19 females; mean age, 61 years) with biopsy-proven T1a RCC underwent computed tomography-guided RFA under general anesthesia. Anesthetic time, minimal alveolar concentration (MAC), and post-anesthetic complications were recorded. Primary effectiveness and local tumor progression (LTP)-free and metastasis-free survival rates were calculated. Major complications following RFA were assessed. A Kaplan-Meier analysis was used to determine the long-term survival rate.

Results: General anesthesia and RFA were performed with 100% technical success. The mean time of general anesthesia was 127 minutes (range, 63-248 minutes). The mean MAC was 0.88±0.15. There was no complication related to general anesthesia. Primary effectiveness was 100%, and the 5-year LTP-free or metastasis-free rate was 97.7% (85/87). One major RFA complication occurred in a patient with ureter stricture that was detected during a follow-up examination.

Conclusions: Low-MAC general anesthesia during RFA procedures is appropriate for precise RCC targeting. This type of pain control could influence the long-term outcomes of RCC patients.

Purpose: Urinary biomarkers have been proposed to play an integral role in detecting recurrent non-muscle invasive bladder carcinoma (NMIBC). This review delineates the diagnostic accuracy of such biomarkers and management strategies in the event of discordance between biomarker findings and flexible cystoscopy, the current gold standard for NMIBC surveillance.

Materials and methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, literature searches were conducted across PubMed, Embase, Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials), focusing on studies comparing urinary biomarkers to cystoscopy. The inclusion criteria were based on the PICOS (Patient Intervention Comparison Outcome Study type) model. The quality of included studies was assessed using the QUADAS-2 tool.

Results: A total of 23 studies were included, encompassing 21 types of urinary biomarkers. The analysis revealed significant variability in diagnostic performance. Sensitivity ranged from 14.8% to 94.3%, specificity from 33.3% to 99.2%, positive predictive value from 9.9% to 100%, and negative predictive value from 35.3% to 98.8%. Heterogeneity was observed across studies, indicating variability in different biomarker performance. Genetic biomarkers demonstrated higher diagnostic accuracy compared to protein-based markers. However, their clinical utility needs further validation.

Conclusions: Urinary biomarkers could complement, rather than replace cystoscopy, in the surveillance of NMIBC, potentially reducing the frequency of invasive procedures. In cases of discordance, an algorithm focusing on shared decision-making and tailored surveillance strategies can be undertaken. Large-scale multicentric studies are needed to confirm their efficacy and establish standardized clinical protocols.

Purpose: This study aimed to evaluate the feasibility, safety, and perioperative outcomes of the supine anterior retroperitoneal approach (SARA) using the da Vinci single-port (SP) robotic system for partial nephrectomy (PN) and retroperitoneal organ surgeries.

Materials and methods: From December 2023 to December 2024, 35 retroperitoneal surgeries, including 25 PN and 10 other procedures (e.g., adrenalectomy, pyeloplasty, ureterectomy), were performed via SARA with the da Vinci SP system by a single surgeon. Patient demographics, operative details, renal function, and postoperative recovery parameters were analyzed.

Results: The mean patient age was 60.3 years, with a body mass index of 24.8. The mean operative time was 203.1 minutes, and mean console time was 141.9 minutes. Estimated blood loss was 330.4 mL, with minimal hemoglobin drop and renal function decline. No conversions to open surgery or major complications were observed. Postoperative pain was mild (mean numeric rating scale 2.5), and bowel function returned within 1.7 days. Tumor size averaged 3.5 cm, with most being clear cell carcinoma. SARA proved effective for upper and lower pole masses, and for adrenal or ureteral surgeries.

Conclusions: The SARA technique using the da Vinci SP robotic system is a safe and feasible approach for PN and various retroperitoneal procedures. It allows for minimal invasiveness, low complication rates, and rapid recovery. Further studies are needed to validate these findings and define the learning curve.

Purpose: This study compared the real-world effectiveness of androgen receptor pathway inhibitors (ARPIs)-abiraterone acetate, apalutamide, and enzalutamide-as treatment intensification in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Materials and methods: This multicenter retrospective cohort study analyzed 219 patients with mHSPC who received first-line ARPIs combined with androgen deprivation therapy. We evaluated progression-free survival to metastatic castration-resistant prostate cancer (PFS to mCRPC) and prostate-specific antigen (PSA) response within 12 weeks and investigated the prognostic impact of early PSA response on clinical outcomes.

Results: The cohort comprised patients receiving abiraterone acetate (n=94, 42.9%), apalutamide (n=91, 41.6%), and enzalutamide (n=34, 15.5%) with an 18.8-month median follow-up. The 2-year PFS to mCRPC rates demonstrated no significant difference between the groups (abiraterone acetate: 74.1%; apalutamide, 81.4%; enzalutamide, 85.6%; p=0.482). However, apalutamide and enzalutamide achieved superior rates of PSA decline to ≤0.2 ng/mL within 12 weeks compared with abiraterone acetate (44.0% and 55.9% vs. 25.5%, respectively) and significantly shorter median time to PSA nadir (7.2 and 7.5 months vs. 12.2 months; p<0.001). A PSA reduction of ≥90% within 12 weeks was observed in 87.2%, 94.5%, and 97.1% of patients receiving abiraterone acetate, apalutamide, and enzalutamide, respectively. Multivariate analysis identified early PSA response as an independent prognostic factor for improved PFS to mCRPC regardless of ARPI selection.

Conclusions: Abiraterone acetate, apalutamide, and enzalutamide showed comparable PFS to mCRPC outcomes, while significant differences in early PSA kinetics were observed, with early PSA response serving as a crucial prognostic factor in mHSPC patients.

Purpose: Percutaneous nephrolithotomy (PCNL) necessitates that the urologist comprehensively understands the stone's location and its relation to the intrarenal anatomy. We evaluated the use of virtual reality (VR) as a preoperative tool for planning for PCNL surgery and its assessment for training among residents in PCNL.

Materials and methods: This prospective, randomized control trial took place between May 2021 to June 2022. Resident and consultant surgeons rated their understanding of the anatomy with computed tomography (CT) alone and after CT+VR. The CT scans from patients randomized to the intervention group created a patient-specific three-dimensional VR model (Anatomage software version 6.02).

Results: The trial enrolled 90 participants and was randomized to the control group (CT alone) and the VR group. The mean age of the participants was 42.09±13.48 years. There were 63 males (70.0%) and 27 females (30.0%). Residents had an improved understanding of the location of the stone, size of the stone, shape, orientation of the calyx, optimal entry of the calyx, and navigation. Residents had a better ability to formulate a surgical plan with VR models. The consultant surgeon's assessment showed CT and VR had non-significant results for understanding based on the above parameters. Preoperative evaluation in patients in the VR group with S.T.O.N.E score >8 showed a statistically significant better understanding of consultants (p<0.05). They recommend VR to colleagues if patients have a S.T.O.N.E score >8 (p<0.05).

Conclusions: VR improved the understanding of PCNL for residents in all cases and consultants in complex anatomy cases.

Purpose: Recurrent stress incontinence (SUI) in patients with an artificial urinary sphincter (AUS) is a diagnostic challenge. History, physical exam and office cystoscopy are often inadequate for determining the cause of device related issues. Our objective is to describe our experience with contrast use in the AUS and how this can aid in diagnosing mechanical failure.

Materials and methods: A retrospective evaluation of patients undergoing primary AUS placement from 1983 to 2022 was performed. We present our surgical technique for AUS placement and standard workup algorithm for patients with recurrent SUI. In our practice, standard evaluation includes history and physical, flexible cystoscopy with the cuff deactivated, and X-ray film of the abdomen and pelvis. Patients with device malfunction are identified via loss of contrast from the AUS system on X-ray. Device survival is presented via Kaplan-Meier method.

Results: During the study, 1,635 patients underwent primary AUS placement with a median (interquartile range [IQR]) follow-up of 4.26 years (1.0, 9.0). Of these, 220 patients (13.5%) were found to have mechanical failure with loss of contrast from the AUS system on X-ray imaging. The median time to mechanical device failures was 4.98 years (IQR 2.4, 9.2). Devices free of mechanical malfunction was 97.6% at 1 year and 89.6% at 5 years.

Conclusions: The differential diagnosis of recurrent SUI after AUS includes multiple device related issues. Filling the AUS with iso-osmotic contrast is an effective way to diagnose mechanical failure. We present our technique as a useful adjunct for other AUS surgeons.