Investigative and Clinical Urology最新文献

Purpose: Changes in bladder contractility due to aging are among the important causes of lower urinary tract symptoms (LUTS) in elderly males. The purpose of this study was to observe changes in bladder contractility due to aging in male patients taking medications commonly used to treat LUTS in clinical practice.

Materials and methods: Male patients aged over 40 years who underwent urodynamic studies for LUTS from January 2012 to December 2024 were included. The bladder outlet obstruction (BOO) index was used to distinguish between males with BOO and those without BOO. Changes in bladder contractility according to age in each group were analyzed using the bladder contractility index. The Pearson correlation coefficient (r) was used to calculate the strength of the linear relationship between age and the variables.

Results: A total of 449 male patients who underwent urodynamic studies for LUTS were eligible for this study (311 in the BOO group and 138 in the BOO group). Age and the maximum flow rate were inversely related in both groups. Age and bladder contractility were significantly correlated in the non-BOO group (p=0.021) but not in the BOO group (p=0.057).

Conclusions: This study revealed that BOO might act as a confounding variable in measuring the contractility of an aged bladder. Excluding the effect of BOO, bladder contractility significantly decreases with age. Therefore, when male LUTS are treated, changes in bladder contractility due to aging vary depending on BOO.

Purpose: This study aimed to investigate the relationship between truncal muscle mass, particularly the skeletal truncal muscle mass index (sTMI), and overactive bladder (OAB) symptoms in adult men, using bioelectrical impedance analysis (BIA).

Materials and methods: We retrospectively analyzed health screening data from 5,475 men aged ≥40 years collected between 2014 and 2022. OAB was defined as an OAB Symptom Score (OABSS) ≥3 and urgency score ≥2, with moderate-to-severe OAB defined as OABSS ≥6 and urgency score ≥2. Body composition metrics, including fat-free mass (FFM), total muscle mass (TMM), and truncal muscle mass (whole and skeletal), were measured via BIA. The sTMI was calculated by dividing skeletal truncal muscle mass by body mass index (BMI). Logistic regression and receiver operating characteristic (ROC) analyses were conducted to assess predictors of OAB.

Results: The overall OAB prevalence was 10.6%. In univariate analysis, FFM (odds ratio [OR] 0.983, p=0.013), TMM (OR 0.982, p=0.010), and sTMI (OR 0.447, p=0.025) were inversely associated with OAB symptoms. However, in multivariate analysis, only sTMI remained a significant independent predictor of moderate-to-severe OAB (OR 0.486, p=0.036). ROC analysis showed that sTMI had better predictive performance for severe OAB (area under the curve [AUC] 0.721) compared to age (AUC 0.706).

Conclusions: sTMI, a BIA-based index reflecting truncal skeletal muscle normalized to BMI, is an independent predictor of moderate-to-severe OAB in men. This suggests a potential role of muscle composition in OAB pathophysiology and risk stratification.

Purpose: This study evaluated inter-/intra-reader agreement with the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 to improve the detection rate of prostate cancer.

Materials and methods: We enrolled 210 patients who underwent multiparametric magnetic resonance imaging (mpMRI) for clinically suspected or diagnosed prostate cancer. Four readers, including two urologists, viewed patients' mpMRI and scored PI-RADS between two sessions, including the time for feedback and training after the first reading session. Inter- and intra-reader agreements were evaluated using Fleiss' kappa coefficient (κ), agreement coefficient 1 (AC1), and percentage of agreement (PA).

Results: The overall inter-reader agreement between all readers was moderate (κ=0.466, AC1=0.522, and PA=0.610). The overall inter-reader agreement improved in the second session. The agreement for peripheral zone (PZ) lesions was higher than that for transitional zone (TZ) lesions. At a PI-RADS cut-off of 4, the agreement for PZ lesions was almost perfect (PA=0.888) and higher than that for TZ lesions. The inter-reader agreement for lesions with a PI-RADS ≥4 and Gleason score ≥7 was almost perfect (AC1=0.960 and PA=0.964). The intra-reader agreement for lesions overall and PI-RADS ≥4 lesions were substantial (AC1=0.601) and almost perfect (PA=0.876), respectively.

Conclusions: Readers achieved moderate agreement for PI-RADS version 2.1 and benefitted from training sessions. Feedback, training, and multidisciplinary discussions also improved inter-reader agreement. Our study can provide guidance, updates, and further steps for the standardization and improvement of PI-RADS scoring.

Purpose: Cystoscopy is a commonly performed outpatient urological procedure, with post-procedural urinary tract infections (UTIs) being a key concern. It is generally safe, but high-risk individuals (e.g., diabetics, chronic obstructive pulmonary disease [COPD], immunodeficiency) have a higher risk for potential UTIs. This study evaluates the effectiveness of antibiotic prophylaxis in preventing post-cystoscopy UTIs.

Materials and methods: A prospective observational study was conducted in 2023, enrolling 300 adult patients undergoing ambulatory flexible cystoscopy who were divided into two cohorts: cystoscopy with and without antibiotic prophylaxis. The primary outcome was UTI incidence within four weeks post-procedure, defined by a positive urine culture (>10⁵ CFU/mL) and accompanying symptoms, antibiotic prescriptions, or emergency visits. Positive urine cultures confirmed the primary outcomes.

Results: The study involved 300 patients: 150 received antibiotic prophylaxis (Cohort A), and 150 did not (Cohort B), showing no significant differences in clinical and demographic variables. UTI incidence was 9.3% in Cohort A and 10.0% in Cohort B, with no statistically significant difference (p=0.510). No cases of urinary sepsis were observed. Risk factors such as diabetes, ischemic heart disease, and COPD were evenly distributed across both cohorts.

Conclusions: Antibiotic prophylaxis did not significantly reduce post-cystoscopy UTI rates. These findings suggest that routine prophylactic antibiotic use may be unnecessary in low-risk patients, reinforcing the need for antibiotic stewardship. Further large-scale studies are warranted to refine clinical guidelines.

Purpose: Intravesical bacillus Calmette-Guerin (BCG) instillation is a cornerstone treatment for non-muscle-invasive bladder cancer (NMIBC) but is frequently associated with significant local and systemic adverse effects. This study aimed to investigate the effects of Uro-Vaxom (UVX) on BCG-related infectious adverse events and oncologic outcomes in patients with NMIBC.

Materials and methods: This retrospective cohort study included 251 NMIBC patients who underwent BCG induction therapy following transurethral resection of bladder tumors at a single institution. Patients were stratified into two groups: those not receiving UVX (non-UVX group, n=142) and those receiving UVX (UVX group, n=109). Clinical and oncologic parameters, including the frequency of antibiotic use, treatment discontinuation rates, and early recurrence rates following BCG therapy, were compared between the groups.

Results: Antibiotic use during BCG treatment was significantly lower in the UVX group compared to the non-UVX group (p<0.001). Furthermore, BCG discontinuation due to urinary tract infection (UTI) was observed exclusively in the non-UVX group (p=0.003). Although tumor recurrence rates within one year were lower in the UVX group, this difference did not reach statistical significance (p=0.212). Multivariate analysis did not identify UVX use as a significant predictor of early recurrence or bacteriuria.

Conclusions: The administration of UVX during BCG therapy in NMIBC patients was associated with reduced antibiotic use and a lower BCG discontinuation rate due to UTI, thereby improving treatment adherence. These findings highlight the potential role of UVX as a valuable adjunct to BCG therapy to optimize patient outcomes.

Purpose: The purpose of this study is to compare the accuracy of two commonly used questionnaires in diagnosing acute cystitis, i.e., the urinary tract infection symptom assessment (UTISA) and the acute cystitis symptom score (ACSS) questionnaires.

Materials and methods: From April 2021 to December 2022, we enrolled female patients with suspected symptoms of acute cystitis as the patient group. As a control group, we included asymptomatic females who came to the hospital for health check-ups. We calculated the accuracy of the two questionnaires in diagnosing acute cystitis and compared the difference in the area under the curve (AUC) of the two through the DeLong test.

Results: A total of 89 and 43 participants were recruited for the patient and control groups, respectively. Both questionnaires include six symptoms: frequency, urgency, dysuria, incomplete bladder emptying, lower abdominal pain, and hematuria to diagnose acute cystitis. However, UTISA includes lower back pain as the 7th symptom. The sensitivity, specificity, and AUC of UTISA and ACSS were 85.4% versus 75.3% (p=0.091), 93.0% versus 93.0% (p>0.999), and 0.96 (95% CI 0.92-0.99) versus 0.90 (95% CI 0.83-0.94) (p<0.001), respectively.

Conclusions: UTISA questionnaire demonstrates higher diagnostic accuracy compared to ACSS questionnaire. ACSS has lower sensitivity probably due to its limited assessment of low back pain and the objective definition of the severity of frequency that prevents patients from responding based on subjective severity.

Purpose: Parameters predicting intravesical bacillus Calmette-Guerin (BCG) treatment response in non-muscle-invasive bladder cancer (NMIBC) are limited. This study investigated the effectiveness of tumor invasion patterns in predicting intravesical BCG treatment response, which are known to have prognostic value for NMIBC.

Materials and methods: Data of 167 primary, stage T1 high-grade NMIBC patients evaluated retrospectively. All transurethral resection samples were re-evaluated for confirmation of pathological variables and determination of invasion patterns. Binary logistic regression analysis applied to obtain determinants of BCG response. Kaplan-Meier curves and log-rank test used to assess relationship between variables and time to recurrence and time to progression.

Results: Tumor invasion pattern was nodular in 83 (49.7%), trabecular in 20 (12.0%) and infiltrative in 64 patients (38.3%). Multivariate analysis revealed multifocality (p=0.001), trabecular invasion (p=0.001) and infiltrative invasion (p=0.001) were independent predictors of poor BCG response. Log-rank test determined infiltrative invasion has higher impact on time to recurrence (p<0.001) and nodular invasion has significantly lower risk for time to progression (p=0.013), during the median follow-up period of 15 months.

Conclusions: Invasion patterns are significantly correlated with BCG response. Assessment of this easily applicable parameter can differ patients who may benefit from BCG treatment and can be used as a prognostic indicator.

Purpose: Prostate biopsy remains the key step in prostate cancer detection. In recent years, the PrecisionPoint™ Transperineal Access System (PPTAS) has been described as an effective and safe method for performing transperineal biopsy under local anaesthesia (LA). The authors report on the real-world experience of the procedure.

Materials and methods: Following introduction and familiarity with the PPTAS biopsy method, patients undergoing prostate biopsy for suspected prostate cancer were provided with validated questionnaires to rate their pain and discomfort following the procedure. The experience of LA administration and the experience of the biopsies were rated separately and prospectively. In addition, the number of cores, maximum core length (MCL), detection rate, and complication rate were retrospectively collected.

Results: One hundred three patients were recruited to the study, and a final number of 86 completed patient-reported outcome measures (PROMs) forms were analysed. The procedure was described as tolerable by 97.7%, causing discomfort in 70.9%-88.4%. The grade of pain or discomfort in 73.3%-87.2% was <4 on the pain scale, with only 5.8%-9.3% describing a pain grade >5 on the pain scale. The number of cores, MCL, detection rate, and complication rate were within accepted rates.

Conclusions: In a real-world setting, the procedure showed satisfactory PROMs with good patient tolerability and a low grade of pain. Also, it showed a good biopsy quality, detection rate, and complications rate, meaning PPTAS should be considered by centers seeking to streamline the prostate cancer detection pathway for patients.