Investigative and Clinical Urology最新文献

Purpose: To evaluate whether using flexible and navigable suction ureteral access sheath can obviate insertion of double J stent and establish the safety of overnight ureteric catheter placement as alternative following flexible ureteroscopy for kidney stones.

Materials and methods: Five hundred forty adults were prospectively enrolled across 25 centers (from April 2023 to January 2024). Patients were divided into group 1 (overnight ureteric catheter), and group 2 (double J stent). Surgeons could choose either modality as per their discretion. One-to-one propensity score-matching for age, sex, pre-stenting, Hounsfield units, stone volume and location was performed. Thirty-day computed tomography scan was done to estimate stone-free status.

Results: After matching, 120 patients were included in each group. Group 1 had significantly shorter lasing, ureteroscopy, surgical time. Median day 1 loin pain score was similar (1 [1, 2] in both groups). Median postoperative stay was shorter in group 1 (0 days [0, 1] vs. 1 day [0, 2], p<0.001). One patient in group 2 required a blood transfusion. Incidence of fever was similar (5.0% vs. 0.8%). Loin/abdominal pain requiring medication occurred in one patient in group 2. Stent-related symptoms occurred in 2 patients in group 1. Three patients (2.5%) in group 1 and 2 patients (1.7%) in group 2 required readmission. Thirty-day stone-free status was higher in group 1 patients (79.2% vs. 56.7%).

Conclusions: In selected patients after thorough inspection to ensure no injury or residual fragments remain, placing an overnight ureteric catheter can be a safe alternative to a double J stent.

Purpose: This study aimed to evaluate the performance of three artificial intelligence (AI) models-ChatGPT, Gemini, and Copilot-in addressing clinically relevant questions about onabotulinum toxin and sacral neuromodulation (SNM) for the management of overactive bladder (OAB).

Materials and methods: A set of 30 questions covering mechanisms of action, indications, contraindications, procedural details, efficacy, and safety profiles was posed to each AI model. Responses were assessed by a panel of four urology specialists using predefined criteria: accuracy, completeness, clarity, and consistency. A multi-dimensional scoring framework evaluated the performance across five dimensions: factual accuracy, relevance, clarity/coherence, structure, and utility. Responses were scored on a 4-point Likert scale, and statistical analyses were conducted using one-way ANOVA to compare model performance.

Results: ChatGPT achieved the highest mean score (3.98/4) across all dimensions, with statistically significant differences compared to Gemini (3.20/4) and Copilot (2.60/4) (p=0.001 for all dimensions). ChatGPT excelled particularly in clinical application, procedure, and safety categories, consistently delivering accurate and comprehensive answers. No statistically significant differences were found between Gemini and Copilot in most categories.

Conclusions: ChatGPT demonstrated superior performance in generating accurate, complete, and clinically relevant responses for OAB management, highlighting its potential as a reliable tool for both healthcare professionals and patients. However, the variability observed in Gemini and Copilot underscores the need for further refinement of these models. Future studies should explore real-world integration of AI models into clinical workflows to enhance patient care and decision-making.

Purpose: It was aimed to clarify the casual connection between prostate cancer (PCa) and arthritis by utilizing two-sample Mendelian randomization (MR) analysis and data from National Health and Nutrition Examination Survey (NHANES) database.

Materials and methods: This study utilized NHANES data. Through association analysis and risk stratification analysis, the association between arthritis and PCa were examined. MR analysis was performed to elucidate the causal relationship between arthritis and PCa. Sensitivity analysis and Steiger directionality test confirmed the reliability of the MR analysis results.

Results: A total of 23,608 (PCa:controls=413:23,195) participants after a sample exclusion and variable definition process were screened in NHANES database. Adjustments across three diverse models consistently revealed a notable influence of arthritis on PCa progression. Arthritis was identified as a risk factor for PCa (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.36-2.62, p<0.001). Subsequent analysis indicated that in the arthritis-adjusted model with multiple covariates, the area under the curve of the receiver operating characteristic curve was 0.94. The inverse variance weighting method of MR analysis showed a causal relationship between rheumatoid arthritis (RA) and PCa (OR 1.090, 95% CI 1.053-1.128, p<0.001) as well as osteoar-thritis and PCa (OR 1.002, 95% CI 1.001-1.004, p=0.002). This suggested that RA and osteoarthritis were risk factors for PCa. The heterogeneity (p>0.05), horizontal pleiotropy (p>0.05), leave-one-out and Steiger test confirmed reliability of MR results.

Conclusions: NHANES database and MR analyses identified arthritis as a risk factor for PCa, offering fresh avenues for preventive and therapeutic approaches.

Purpose: To evaluate the pathological correlation and prognostic significance of tissue stiffness measured by shear wave elastography (SWE) in bladder cancer.

Materials and methods: Patients with microscopic or macroscopic hematuria diagnosed with bladder tumors were included. SWE measurements were performed using a Samsung Medison RS80A Prestige ultrasonography device, with ten valid measurements taken for each tumor. Tumor specimens were collected via transurethral resection (transurethral resection of the bladder tumor) for histopathological analysis. Microvessel density (MVD) was assessed by immunohistochemical staining with anti-CD34 antibody using the hot-spot method. Correlations between tissue stiffness, MVD and tumor stage and grade were analyzed, and receiver operating characteristic (ROC) analysis determined the optimal SWE cutoff for differentiating tumor characteristics.

Results: A total of 65 bladder urothelial carcinoma patients were included in the study (43 high-grade, 22 low-grade). SWE and MVD were significantly higher in the high-grade group (p=0.001, p=0.002, respectively). ROC analysis showed SWE could differentiate tumor grades (area under ROC curve=0.837, p<0.001), with a cut-off of 4.25 kPa (74% sensitivity, 86% specificity). Stiffness was also higher in recurrence (p=0.007). A strong positive correlation between SWE and MVD was found (rho=0.767, p<0.001). SWE may be a reliable, non-invasive tool for assessing tumor grade and recurrence risk.

Conclusions: SWE may be a reliable, non-invasive preoperative marker for bladder cancer, aiding in tumor characterization and clinical decision-making.

Purpose: Desmopressin, frequently prescribed for nocturia, is associated with an elevated risk of hyponatremia. This study examined the incidence and risk factors of hyponatremia in male patients with benign prostatic hyperplasia using nationwide Korean health data.

Materials and methods: From the National Health Insurance Service database, we analyzed data on desmopressin and hyponatremia in Korean adults with benign prostatic hyperplasia between 2011 and 2012. The patients were followed-up until December 2020. We tested the effects of desmopressin on hyponatremia risk using propensity score-matched Cox regression models and Kaplan-Meier survival analysis.

Results: Among 33,533 patients, the incidence of hyponatremia was 6.0%, 4.5%, and 5.0% in the desmopressin, alpha-blocker, and combination therapy groups, respectively. After propensity score matching, desmopressin use was not significantly associated with an increased risk of hyponatremia (hazard ratio 1.273, 95% confidence interval 0.988-1.640; p=0.062). Significant predictors of hyponatremia included advanced age, chronic heart failure, peripheral vascular disease, and renal disease.

Conclusions: Desmopressin prescription following careful patient selection and regular monitoring does not significantly increase the risk of hyponatremia compared to other lower urinary tract symptom treatments. Therefore, it remains a viable and effective option for managing nocturia, particularly in patients with nocturnal polyuria. However, clinicians should implement routine monitoring protocols, including serum sodium checks, particularly in high-risk populations, to ensure the safe and effective use of desmopressin.

Purpose: We aimed to evaluate the effect of long-term oral OM-89 therapy on the urinary microflora in patients with urolithiasis.

Materials and methods: Patients underwent surgical removal of urinary stones followed by no OM-89 treatment for six months or daily OM-89 administration. Urine culture and urinary polymerase chain reaction (PCR) were performed at the baseline visit (V1) and at 2 months (V2) and 6 months (V3) after the operation.

Results: A total of 113 patients completed the study. The rate of urinary bacteria detection by urine culture at V3 did not differ between OM-89 treated and untreated groups (p>0.999); however, the PCR detection rate tended to be higher in OM-89 untreated group than in OM-89 treated group (p=0.052). Escherichia coli and Enterococcus spp. were the bacteria most commonly detected via both urine culture and PCR at all timepoints. Risk factors for the detection of bacteria by urine culture at V3 were positive culture at V1 (p=0.048) and female sex (p=0.048), whereas positive PCR at V3 was associated with female sex (p=0.023), positive PCR at V2 (p<0.001), and no OM-89 treatment (p=0.038). The use of OM-89 was associated with decreased rates of bacterial detection by PCR at V2 and a further decrease at V3.

Conclusions: Long-term immunization with OM-89 could further decrease the frequency of urinary bacterial colonization after surgical removal of urinary stones. OM-89 could be used as a complementary therapy if a retrieved stone is suspected to be related to infection.

Purpose: To assess the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic immune-inflammation response index (SIRI) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

Materials and methods: One hundred seven patients were retrospectively enrolled. Chi-square (χ²) tests were adopted to assess the association of the inflammatory ratios and indexes to clinical risk factors. Overall survival (OS), metastasis-free survival (MFS), local, lymph node, and contralateral recurrence-free survival (RFS) were estimated by the Kaplan-Meier method and the corresponding curves were compared using log-rank test. Univariate and multivariate survival analysis were performed using general linear models to identify risk factors for prognosis.

Results: NLR, MLR, PLR, SII, and SIRI were predictive of OS (p=0.024, p=0.025, p=0.004, p=0.006, and p=0.03, respectively). Besides, PLR was predictive of local (p<0.001) and lymph node RFS (p=0.014) and SII was associated to lymph node and contralateral RFS prediction (p=0.034 and p=0.023, respectively). All candidate markers adding high NLR+high MLR+high PLR combination were independent risk factors of OS. PLR was an independent risk factor of local and lymph node RFS whereas the above cited combination and NLR were independent prognosticators of local and contralateral RFS respectively. All markers were correlated to poor postoperative clinical characteristics mainly pathological grade (p<0.05).

Conclusions: Preoperative NLR, MLR, PLR, SII, and SIRI were associated with higher pathologic features and worse oncological outcomes in patients treated with RNU for UTUC.

Purpose: Neural crosstalk in the pelvis involves intrinsic communication networks among pelvic structures that direct afferent inputs to converge on neurons, leading to viscerovisceral and somatovisceral reflexes. We aimed to explore the overlap between intestinal and urinary symptoms and their correlations in patients undergoing colonoscopy.

Materials and methods: Cross-sectional study with 167 participants who underwent colonoscopy and were assessed using three self-administered questionnaires: the International Prostate Symptom Score (IPSS) for lower urinary tract symptoms, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for overactive bladder symptoms, and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal (GI) symptoms.

Results: Among the participants, 55.1% were male, and the median age was 57 years. Most colonoscopies (80.8%) were performed for screening, and the most common finding was diverticular disease (DD) (35.9%). The IPSS and ICIQ-OAB were strongly correlated (rho=0.544, p<0.001), while the IPSS and GSRS scores showed a moderate correlation (rho=0.304, p<0.001). In the DD subgroup, both ICIQ-OAB and IPSS (rho=0.568, p<0.001), and IPSS and GSRS (rho=0.493, p<0.001) showed strong correlations. In contrast, the subgroup without DD showed a strong correlation between the ICIQ-OAB and IPSS (rho=0.510, p<0.001), but only a weak correlation between the IPSS and GSRS (rho=0.188, p=0.057), suggesting that the urinary-GI connection is influenced by the presence of DD.

Conclusions: The findings revealed intrinsic relationships between urinary and GI symptoms, with DD as a significant factor influencing these relationships, suggesting that a more integrated approach to evaluate and manage these patients can potentially improve diagnostic accuracy and treatment outcomes.

Purpose: Coronavirus disease 2019 (COVID-19) infection may affect serum hormones levels and male sexual function. This study aims to provide evidence for the causal relationship between COVID-19 infection, serum testosterone levels and the risk of erectile dysfunction (ED) using a two-sample Mendelian randomization (MR) approach.

Materials and methods: Summary-level data for serum testosterone levels (199,569 samples and 12,321,875 single nucleotide polymorphisms [SNPs]) were obtained from Rebecca's study, while data for ED (6,175 cases and 217,630 controls) were sourced from Bovijn's study. Genetic variations linked to COVID-19 were used as instrumental variables (IVs) in meta-analyses of genome-wide association studies (GWASs) involving 6,406 cases and 902,088 controls from the COVID-19 Host Genetics Initiative. The inverse-variance weighted (IVW) method was primarily employed to evaluate the potential associations between COVID-19 infection, serum testosterone levels, and the risk of ED. The weighted mode, weighted-median and simple-median method were employed to evaluate the sensitivity. Heterogeneity and pleiotropic outlier were assessed using Cochran's Q test and MR-Egger regression.

Results: The MR analysis demonstrated that COVID-19 infection was associated with reduced serum testosterone levels (odds ratio [OR] 0.966, 95% confidence interval [CI] 0.938-0.993, p=0.016) and an increased risk of ED (OR 1.205, 95% CI 1.063-1.367, p=0.004) when using IVW methods. Sensitivity analyses utilizing various IV sets and MR approach remained consistent.

Conclusions: COVID-19 infection is associated with a decrease in serum testosterone levels and an increased risk of ED. Male patients recovering from COVID-19 need to pay special attention to their sex hormone levels and sexual health.