Investigative and Clinical Urology最新文献

Purpose: To investigate the role of combined periprostatic nerve block (PNB) and intrarectal local anesthesia with heated lidocaine gel (ILAHL) in reducing pain during transrectal ultrasound (TRUS)-guided prostate biopsy, compared with PNB alone.

Materials and methods: We performed a prospective randomized trial with 140 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from July 2021 to June 2022. These participants were divided into two groups. Before prostate biopsy, group 1 (n=70) received PNB and group 2 (n=70) received PNB combined intrarectal local anesthesia with 20 mL of heated (40℃) 2% lidocaine gel. The primary outcome was pain score on a 0-10 visual analogue scale (VAS) at four time points (VAS A: during local anesthesia procedure, VAS B: during probe insertion, VAS C: during biopsy procedure, VAS D: 30 minutes after biopsy). The secondary outcome included adverse events during and after the procedure.

Results: Mean pain scores were significantly lower in group 2 than in group 1 at VAS A (2.53 vs. 1.60, p=0.001) and VAS B (2.47 vs. 1.49, p<0.001). The mean VAS C pain score in group 2 was significantly less than in group 1 (3.07 vs. 2.20, p=0.001), while there was no significant difference in the mean VAS D pain score between two groups (1.06 vs. 0.89, p=0.318). There were no significant differences in the occurrence of complications in both groups.

Conclusions: The combination of PNB and ILAHL provides more effective pain control than PNB alone without increase of complication rates in patients undergoing TRUS-guided prostate biopsy.

Purpose: This study aimed to report the results of Korean Antimicrobial Resistance Monitoring System (KARMS) for uncomplicated cystitis (UC) in 2023.

Materials and methods: KARMS was established for the surveillance of antimicrobial resistance in urinary tract infections with the cooperation of Korean nationwide medical centers. Data from patients with UC have been collected in the web-based KARMS database. Demographic data, uropathogen distribution, and antimicrobial susceptibility of representative pathogens were analyzed.

Results: A total of 885 patients' data were collected in KARMS database. The mean patient age was 56.39±18.26 years. The number of postmenopausal and recurrent cystitis were 530 (61.1%) and 102 (11.5%), respectively. Escherichia coli was the most frequently identified uropathogen (654/871, 75.1%). Regarding antimicrobial susceptibility, 94.9% were susceptible to fosfomycin, 90.5% to nitrofurantoin, 58.4% to ciprofloxacin, 83.6% to cefotaxime, and 100.0% to ertapenem. ESBL positivity was 13.7% (96/702), and significantly higher in tertiary hospital (23.1%, p<0.001), postmenopausal (15.9%, p=0.044), and recurrent cystitis (24.7%, p=0.001). Fluoroquinolone resistance was significantly higher in tertiary hospital (47.4%, p=0.001), postmenopausal (44.9%, p<0.001), and recurrent cystitis (59.8%, p<0.001). In addition, postmenopausal (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.38-2.77, p<0.001) and recurrent cystitis (OR 2.37, 95% CI 1.44-3.92, p=0.001) were associated with increased fluoroquinolone resistance.

Conclusions: These data provide information on the distribution of uropathogen and the status of antimicrobial resistance in UC of South Korea. In addition, KARMS will be a useful reference in the future through the continuous surveillance system construction over the years.

Purpose: To compare encrustation resistance between silicon- and polytetrafluoroethylene (PTFE)-covered metallic ureteral stents (MUS) in an in vitro infection model and to determine the most effective material for reducing biofilm formation and encrustation.

Materials and methods: A total of 52 MUS were prepared: 26 silicon-covered and 26 PTFE-covered stents. Each sample was immersed in artificial urine inoculated with Proteus mirabilis in a biofilm reactor for 48 hours. After immersion, the stents were weighed to measure their encrustation level. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to assess the surface morphology and elemental composition of the encrustation deposits.

Results: Silicon-covered stents showed a statistically significant reduction in weight gain due to encrustation compared to PTFE-covered stents (9.50±5.77 mg vs. 16.75±10.61 mg; p=0.004). Additionally, encrustation per unit length was lower in silicon-covered stents (0.76±0.45 mg/mm vs. 1.30±0.81 mg/mm; p=0.004). SEM and EDS analyses demonstrated lower calcium salt deposition on the silicon-covered stents, indicating greater resistance to encrustation.

Conclusions: Silicon-covered MUS demonstrated superior resistance to encrustation compared to PTFE-covered stents, supporting silicon as a more suitable covering material for long-term MUS applications. This finding may lead to extended stent lifespans and a reduced frequency of stent replacements, benefiting both patients and healthcare systems.

Climate change and its effects on society represent an increasingly critical concern. The healthcare industry contributes substantially to carbon emissions and bears responsibility for managing its environmental impact. This review examines recent progress, challenges, and future prospects in reducing the carbon footprint of diagnostic urology without compromising patient care, with particular emphasis on imaging. We analyze the environmental effects of urological procedures and devices, along with practices that can minimize greenhouse gas emissions. Promoting sustainability in healthcare requires a comprehensive approach from manufacturing to disposal, including examination of sterilization-related carbon footprints. This work aims to analyze existing literature on urological carbon footprints, focusing on processes and practices within the field.

Purpose: Scheduled administration of intravenous acetaminophen improves catheter-related bladder discomfort (CRBD) after urological surgery. However its efficacy for patients undergoing transurethral resection of bladder tumors (TURBT) remains unclear. This study aimed to investigate the efficacy of scheduled administration of intravenous acetaminophen after TURBT.

Materials and methods: At the end of surgery, patients in both the control (n=39) and the scheduled administration (n=45) groups received analgesics at the discretion of the anesthesiologists. In the scheduled administration group, intravenous acetaminophen was administered every 4 hours for 12 hours after the surgery. Both groups were administered on-demand analgesics as needed. The primary outcome was CRBD scores, and the secondary outcomes were the face rating scale for lower abdominal pain, administration rates of additional analgesics, durations of bladder catheterization, lengths of postoperative hospital stay, and postoperative complication rate.

Results: The scheduled administration group had significantly lower CRBD scores than those of the control group at 8 hours postoperatively (p=0.014), and lower administration rates of additional analgesics 4-8 hours (p=0.029) and 8-12 hours (p=0.027) postoperatively compared to those of the control group. Other secondary outcomes were not significantly different between the groups (all p>0.05). The scheduled administration group did not have postoperative complications related to the scheduled administration of intravenous acetaminophen.

Conclusions: Scheduled intravenous acetaminophen administration alleviated postoperative CRBD and reduced the need for additional analgesics in patients who underwent TURBT. These findings can be utilized to improve the quality of postoperative care.

Purpose: To assess the effectiveness of the prostate health index (PHI) in patients with no index lesions on multiparametric magnetic resonance imaging (mpMRI) or with negative findings on past prostate biopsy if there was an index lesion on mpMRI.

Materials and methods: Patients without an index lesion on MRI or with a negative result on combined biopsy for index lesions were assessed. Patients who underwent transperineal mapping biopsy among those suspected of having prostate cancer (PCa) due to persistently elevated prostate-specific antigen (PSA) levels were analyzed.

Results: Of the 291 patients, 82 (28.2%) were diagnosed with PCa. Sixty-five of 291 patients had negative finding in previous combined biopsy. In total, 226 patients did not have any index lesions. The mean age of the PCa group was 64.33±8.88 years and that of the non-cancer group was 59.88±10.26 years (p<0.001). The PHI was 46.75±28.22 in the PCa group and 37.74±17.37 in the non-cancer group (p=0.001), and the prostate volume was 41.52±15.77 mL in the PCa group and 50.78±23.97 mL in the non-cancer group (p=0.001). In multivariate analysis, age (odds ratio [OR] 1.096, p<0.001), PHI (OR 1.021, p=0.005), and prostate volume (OR 0.954, p<0.001) were identified as significant factors for PCa detection. The optimal cutoff value of the PHI for PCa detection was 44.6 and the PHI density (PHID) was 0.88.

Conclusions: In patients with elevated PSA levels but no index lesions on mpMRI or negative biopsy findings, PHI and PHID demonstrated significant potential for improving PCa detection.

To assess the efficacy and safety of using energy devices as treatment for radiation-induced hemorrhagic cystitis (RHC) and to determine the most suitable energy source, settings and techniques based on laser-tissue interaction. A search of Google Scholar, PubMed, and Web of Science databases was conducted uptil February 2024 to identify studies on use of energy devices for RHC. Additionally, ClinicalTrials.gov and the World Health Organization's ICTRP (International Clinical Trials Registry Platform) were searched for ongoing studies. We identified 10 studies fulfilling the search criteria using modalities including Nd:YAG laser, argon plasma coagulation, 980-nm diode laser, and potassium-titanyl-phosphate (KTP) laser. Across studies (n=137), majority (n=116, 84.7%) of RHC patients achieved hematuria resolution after one treatment session, with mean/median hematuria-free intervals of 11 to 16 months. Six patients (4.4%) were unresponsive and underwent cystectomy/urinary diversion. Total adverse events occurred in patients (30/139, 21.6%), including storage symptoms, recurrent hematuria, bladder stones and urinary retention, among others. Typical laser settings involved low power (<40 W), with either a pulse duration of 2-3 seconds or 10-40 milliseconds; some used continuous wave mode. Other standard practises include selective coagulation employed in a "painting" fashion and non-contact mode (3-5 mm). The treatment endpoints were hemostasis, involution of telangiectatic vessels and formation of pale well-circumscribed mucosal ulcer. Energy devices have considerable efficacy and safety to treat RHC patients and can be considered for refractory RHC and as an adjunct after initial management. The various properties of KTP laser confers an advantage over other energy devices.

Purpose: This study aimed to explore the trends in research keywords and topics in the field of urology based on text mining over the recent decades. The investigation looked into changes in frequent subject keywords and the trends in prevailing research topics, as reflected in representative urology journals over recent decades.

Materials and methods: A total of 27,129 bibliographic documents were collected from four urology journals, including European Urology, Journal of Urology, BJU International, and World Journal of Urology. The study then examined the changes in the most frequent author keywords over the decades. Moreover, structured topic modeling was employed to identify twenty prevailing research topics in urology and to examine their trends across different periods.

Results: The study observed consistently increasing patterns in author keywords and topics related to the prostate and oncology. Conversely, research fields such as pediatrics, male infertility, voiding dysfunction, and cancer biology exhibited a downward trend in urology. Potential factors or reasons underlying these trends were further discussed in this study.

Conclusions: This exploratory study uncovered major research topics in the discipline of urology. The findings of this study depict the domain of urology research in recent decades, providing insights for both researchers and clinicians seeking to better understand the research trends in the discipline.

Purpose: Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC.

Materials and methods: We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group.

Results: Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma in situ, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model.

Conclusions: The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.

Purpose: Mirabegron, the first-in-class beta-3 agonist, is the mainstay medication for overactive bladder (OAB). The aim of this study was to investigate the efficacy and safety of generic drugs of mirabegron (Mirabek^®) in adults diagnosed with OAB through a multicenter, prospective, non-interventional observational study.

Materials and methods: Adult patients with OAB prescribed Mirabek^® SR Tab. 50 mg for the first time were recruited from hospitals between September 2021 and September 2022. Participants underwent baseline registration followed by two follow-ups at 4- and 8-week intervals. Data on demographics, medical history, OAB symptoms, vital signs, medication administration, and adverse events were collected.

Results: Among 1,714 patients, Mirabek^® SR Tab. 50 mg effectively improved OAB symptoms over an 8-week treatment period, with significant differences in symptom improvement between baseline and both 4- and 8-week time points as well as between 4 weeks and 8 weeks. The incidence rate of adverse events was 0.70%; most cases were mild with no severe reactions.

Conclusions: This study demonstrated that Mirabek^®, a generic drug of betmiga, is an effective and safe treatment option for adults with OAB. Furthermore, the introduction of generic drug reduced the costs of prescription drugs and expanded the opportunity for many patients to access mirabegron.