Investigative and Clinical Urology最新文献

Purpose: Transurethral resection of bladder tumors (TUR-BT) requires follow-up evaluation by cystoscopy. We sought to evaluate the prognosis of non-muscle-invasive bladder cancer (NMIBC) patients within 6 months of surgery to identify the optimal timing for the first cystoscopy after TUR-BT.

Materials and methods: In this retrospective analysis, patients newly diagnosed with NMIBC were divided into two groups according to whether they underwent cystoscopy within 6 months after TUR-BT. We considered four outcomes: recurrence, progression, cancer-specific mortality, and all-cause mortality. Inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier analysis was performed to identify the difference in survival for each outcome stratified by cystoscopy status within 6 months after the first TUR-BT. We employed Cox regression models with IPTW to estimate the hazard ratios (HRs) of each outcome according to cystoscopy status.

Results: Among 40,678 patients, 11,940 (29.4%) did not undergo cystoscopy within 6 months. The risk of recurrence was higher for patients who underwent cystoscopy than those who did not (HR 1.32, 95% confidence interval [CI] 1.26-1.38, p<0.001). By contrast, the cystoscopy group had a lower risk of progression compared to the non-cystoscopy group (HR 0.70, 95% CI 0.65-0.76, p<0.001), with lower cancer-specific mortality (HR 0.62, 95% CI 0.56-0.68, p<0.001) and all-cause mortality (HR 0.58, 95% CI 0.56-0.60, p<0.001).

Conclusions: Cystoscopy within 6 months was associated with a higher risk of recurrence but a lower risk of progression and death. Therefore, regular cystoscopy after the first TUR-BT for NMIBC is essential to ensure favorable survival outcomes.

Purpose: To propose a novel surgical approach for managing inflammatory adhesions of the tunica vaginalis (TV) during vasoepididymostomy (VE), and to report surgical outcomes.

Materials and methods: A T-shaped incision of the TV was used to expose the epididymis and vas deferens in cases with adhesions between the TV and the testis. We retrospectively analyzed data from five patients who underwent microsurgical VE for obstructive azoospermia (OA) secondary to epididymal obstruction. Operative time, postoperative patency rate and semen analysis, and natural pregnancy rates were recorded. For comparison, 50 patients who underwent conventional longitudinal TV incision were included to assess operative time, while 46 and 36 of these patients were used to compare patency and pregnancy rates, respectively, with the T-shaped incision group.

Results: The T-shaped incision involves a longitudinal incision of the TV at the epididymal-testicular junction followed by an incision (T) in the direction towards the epididymis and vas deferens area. Among the five patients who underwent this approach, four (80.0%) had sperm detected in semen two months postoperatively, and their partners achieved natural pregnancy (4/5, 80.0%) within one year after VE. No postoperative wound infections occurred. No statistically significant differences were observed in mean operative time, patency rates, or pregnancy rates between the T-shaped and longitudinal incision groups.

Conclusions: The T-shaped TV incision is a feasible approach for VE in OA patients with inflammatory TV-testis adhesions, providing adequate epididymal access without compromising operative time or surgical outcomes.

Purpose: We developed a totally intracorporeal neobladder (ICNB) reconstruction technique, termed the Juntendo technique, which features a more spherical configuration by advancing from a hybrid neobladder reconstruction approach. In this report, we describe this ICNB procedure and its outcomes from our initial clinical experience.

Materials and methods: Between March 2022 and December 2024, 20 male patients underwent neobladder reconstruction (hybrid reconstruction in the first 10 and totally intracorporeal reconstruction in the other 10) following robot-assisted radical cystectomy. The reconstruction technique involved detubularization of a 40 cm ileal segment, formation of a spiral posterior wall plate for vertical traction resistance, and circumferential urethroileal anastomosis without a separate enterotomy. The ureters were anastomosed to a 10 cm afferent limb using the Wallace technique. Subsequently, clinical and perioperative outcomes were collected and compared between the hybrid and ICNB groups.

Results: The estimated blood loss or operative time did not significantly differ between the two groups. In both cohorts, no major perioperative complications occurred, and postoperative renal function remained stable. Both groups also achieved high continence rates. At 3-6 months postoperatively, the ICNB group obtained mean values of 174.9 mL for the neobladder volume, 24.2 mL/s for the maximum flow rate, and 10 mL for the post-void residual volume.

Conclusions: ICNB reconstruction using the Juntendo technique is safe and feasible as the hybrid approach while also yielding favorable early functional outcomes. Studies involving larger patient cohorts and longer follow-up periods is warranted for further validation of this technique.

Purpose: With the introduction of the AUA Quality Registry (AQUA), physician practice styles and adherence to clinical guidelines are under closer scrutiny. While adherence is critical for optimal healthcare, it has not been studied in men's health. This survey-based study assessed adherence to American Urological Association (AUA) clinical guidelines on erectile dysfunction (ED), Peyronie's disease, priapism, infertility, and ejaculatory disorders among members of the New York section of the AUA.

Materials and methods: An anonymous questionnaire was emailed to members, covering five non-oncologic men's health guideline categories. Each category included two to four specific guidelines, with responses recorded on a Likert scale. Respondents could provide rationale for their answers or omit questions if they did not treat a specific condition.

Results: Among 82 urologists, most treated ED and ejaculatory dysfunction but less commonly treated Peyronie's, priapism, and infertility. Some guidelines were frequently not followed. For instance, 57% never prescribed tramadol or α1-adrenoreceptor antagonists for premature ejaculation after first-line therapy failure. Half never performed in-office intracavernosal injection tests for Peyronie's. For priapism, 52% never used ultrasound in initial evaluations, and 45% rarely referred men with ED to mental health professionals.

Conclusions: This pilot study highlights generally high adherence to AUA guidelines but identifies gaps in areas driven by expert opinion. Findings suggest a need for targeted educational initiatives, particularly in Peyronie's diagnosis and mental health integration for ED, to enhance patient care and outcomes. Such initiatives are crucial in refining the approach to men's health, ultimately enhancing patient care and outcomes.

Purpose: Active surveillance is the preferred management for most renal angiomyolipomas (AMLs) but no risk-adapted follow-up strategy has been established. We aimed to assess the dynamics associated with hemorrhagic complications (HC) and tumor growth (TG) at long-term follow-up of AMLs.

Materials and methods: A single-center retrospective study was conducted, enrolling patients with an AML diagnosed by computed tomography or magnetic resonance imaging. Kaplan-Meier analyses were performed to estimate HC risk and multivariate logistic regression analyses were carried out to evaluate predictors of TG and HC.

Results: A total of 150 patients were included. The median follow-up was 64.5 months (interquartile range [IQR] 25-102). Median tumor size at diagnosis was 14 mm (IQR 8-26). During follow-up, 12 patients (8.0%) required selective angioembolization, including 6 in whom the procedure was urgent due to spontaneous bleeding. At 5 years of follow-up, we found a 4.5% risk of HC and 3.6% of patients had a clinically significant growth rate of ≥3 mm/year. The existence of a rich blood supply (odds ratio [OR] 11.10, 95% confidence interval [CI] 1.68-23.54), and the size of AMLs at diagnosis (OR 1.02, 95% CI 1.01-1.04) were predictors for HC.

Conclusions: Renal AMLs have a minimal size progression and a very low risk of HC, allowing use of active surveillance as a first-line approach. Imaging features, such as the existence of a rich blood supply, could be useful in identifying patients at higher risk of bleeding for the purpose of risk-adapted decision making.

This review examines diagnostic methods for prostate cancer, focusing on the role of digital rectal examination (DRE) alongside modern advancements like prostate-specific antigen (PSA) testing, Prostate Health Index (PHI), magnetic resonance imaging (MRI), and prostate-specific membrane antigen positron emission tomography (PSMA-PET), particularly in the context of Korea's aging population and healthcare challenges. Technological advancements have significantly improved prostate cancer diagnosis. PSA testing, while widely used, suffers from low specificity, often resulting in unnecessary biopsies. PHI addresses PSA's limitations, offering enhanced accuracy, particularly in the "gray zone" of PSA levels. MRI has revolutionized diagnostic precision, enabling detailed staging and targeted biopsies, but its cost and limited availability restrict widespread use. Emerging tools like PSMA-PET and AI (artificial intelligence)-driven diagnostics promise further improvements but remain costly and complex, limiting their routine application. Despite these advancements, DRE continues to serve as an accessible and cost-effective tool, particularly in low-resource settings or where advanced diagnostics are unavailable. In Korea, where prostate cancer is often diagnosed at more aggressive stages, and universal health insurance emphasizes cost efficiency, DRE retains value as part of a multimodal approach. Concerns about DRE's reproducibility and discomfort remain, but its utility in specific high-risk populations justifies its inclusion in diagnostic strategies. DRE, despite its limitations, remains a valuable tool in Korea's prostate cancer diagnostic landscape, particularly within a comprehensive, cost-effective, and context-sensitive screening strategy.

Purpose: This study aimed to evaluate and optimize microbial DNA extraction methods from urine, a non-invasive sample source, to enhance DNA quality, purity, and reliability for urinary microbiome research and biomarker discovery in bladder cancer.

Materials and methods: A total of 302 individuals (258 with genitourinary cancers and 44 with benign urologic diseases) participated in this study. Urine samples were collected via sterile catheterization, resulting in 445 vials for microbial analysis. DNA extraction was performed using three protocols: the standard protocol (SP), water dilution protocol (WDP), and chelation-assisted protocol (CAP). DNA quality (concentration, purity, and contamination levels) was assessed using NanoDrop spectrophotometry. Microbial analysis was conducted on 138 samples (108 cancerous and 30 benign) using 16S rRNA sequencing. Prior to sequencing on the Illumina MiSeq platform, Victor 3 fluorometry was used for validation.

Results: WDP outperformed other methods, achieving significantly higher 260/280 and 260/230 ratios, indicating superior DNA purity and reduced contamination, while maintaining reliable DNA yields. CAP was excluded due to poor performance across all metrics. Microbial abundance was significantly higher in WDP-extracted samples (p<0.0001), whereas SP demonstrated higher alpha diversity indices (p<0.01), likely due to improved detection of low-abundance taxa. Beta diversity analysis showed no significant compositional differences between SP and WDP (p=1.0), supporting the reliability of WDP for microbiome research.

Conclusions: WDP is a highly effective and reliable method for microbial DNA extraction from urine, ensuring high-quality and reproducible results. Future research should address sample variability and crystal precipitation to further refine microbiome-based diagnostics and therapeutics.

Purpose: Prostate cancer ranks as the second most common cancer in men globally, representing a significant cause of cancer-related mortality. Metastasis, the spread of cancer cells from the primary site to distant organs, remains a major challenge in managing prostate cancer. Pyruvate dehydrogenase kinase 4 (PDK4) is implicated in the regulation of aerobic glycolysis, emerging as a potential player in various cancers. However, its role in prostate cancer remains unclear. This study aims to analyze PDK4 expression in prostate cancer cells and human samples, and to explore the gene's clinical significance.

Materials and methods: PDK4 expression was detected in cell lines and human tissue samples. Migration ability was analyzed using Matrigel-coated invasion chambers. Human samples were obtained from the Kyungpook National University Chilgok Hospital.

Results: PDK4 expression was elevated in prostate cancer cell lines compared to normal prostate cells, with particularly high levels in DU145 and LnCap cell lines. PDK4 knockdown in these cell lines suppressed their invasion ability, indicating a potential role of PDK4 in prostate cancer metastasis. Furthermore, our results revealed alterations in epithelial-mesenchymal transition markers and downstream signaling molecules following PDK4 suppression, suggesting its involvement in the modulation of invasion-related pathways. Furthermore, PDK4 expression was increased in prostate cancer tissues, especially in castration-resistant prostate cancer, compared to normal prostate tissues, with PSA and PDK4 expression showing a significantly positive correlation.

Conclusions: PDK4 expression in prostate cancer is associated with tumor invasion and castration status. Further validation is needed to demonstrate its effectiveness as a therapeutic target.