Journal of Urology最新文献

Purpose: Pulse-modulated holmium:YAG (Ho:YAG) and SuperPulse thulium fiber laser are high-power laser systems used for retrograde intrarenal surgery. We conducted a prospective randomized trial to compare lithotripsy efficiency, complications, and stone-free rates.

Materials and methods: Patients with CT-confirmed intrarenal stones between 5 and 20 mm were randomly assigned to pulse-modulated Ho:YAG (Moses 2.0, 120 W) or SuperPulse thulium fiber laser (60 W). The primary outcome was absolute (0 fragment) stone-free rate 6 weeks postoperatively evaluated by CT. Secondary outcomes included residual fragment size, laser efficiency, and postoperative complications. Categorical variables were compared using χ² or Fisher exact tests. Continuous variables were analyzed with Mann-Whitney U tests.

Results: Sixty-six patients were randomized to pulse-modulated Ho:YAG (n = 33) or SuperPulse thulium fiber laser (n = 33). Absolute stone-free rates were 79% and 82%, respectively (P = .8). Less than 3 mm residual fragments were observed in 18% and 6.1% (P = .3) and ≥ 3 mm residual fragments in 3% and 12% (P = .4), respectively. Total energy used (3.4 vs 3.1 kJ, P = .8) and lasing time (9.4 vs 12.8 minutes, P = .3) were similar. Laser ablation efficiency (0.038 vs 0.055 mm³/J, P = .16), laser activity (46% vs 56%, P = .07), and laser ablation speed (0.40 vs 0.42 mm³/s, P > .9) did not differ. Emergency department visits (3.0% vs 6.1%, P > .9) and complications (6.1% vs 9.1%, P > .9) were similar.

Conclusions: We found no discernible differences between the high-power pulse-modulated Ho:YAG and SuperPulse thulium fiber laser for treatment of renal stones between 5 and 20 mm in terms of stone-free rates by CT scan, laser efficiency, and complications in our single-center study.

Purpose: Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida.

Materials and methods: Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We used a control population of patients (younger than 18 years) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed-effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit.

Results: In total, we included 22,672 emergency visits by patients with spina bifida. Of these, 20.7% of emergency visits were low value vs 17.7% in controls (P < .001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age (odds ratio [OR], 1.05 [1.04-1.06] per year younger), Hispanic/Latino ethnicity (OR, 1.21 [1.06-1.39] compared with non-Hispanics), Black race (OR, 1.35 [1.16-1.58] compared with White), public insurance (OR, 1.14 [1.01-1.29] compared with private insurance), and genitourinary encounter diagnosis (OR, 1.16 [1.04-1.30]). Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36.

Conclusions: Younger age, Hispanic/Latino ethnicity, Black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds of low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals, which warrants further investigation to elucidate best practices.

Purpose: Alternative, noninvasive, cost-effective methods to complement or serve as substitutes to current standard-of-care (SOC) procedures in nonmuscle-invasive bladder cancer (NMIBC) follow-up are needed. Uromonitor is a urine biomarker test detecting bladder cancer recurrence through the screening of TERT, FGFR3, and KRAS hotspot mutations. The aim of this study was to assess Uromonitor performance by comparing it with the current SOC methods.

Materials and methods: Four hundred thirty-nine patients with 528 NMIBC surveillances were enrolled in this study. All patients underwent SOC methods and provided a urine sample for Uromonitor analysis before undergoing cystoscopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for recurrence and compared with the gold standard cystoscopy plus transurethral resection of bladder tumor histopathology.

Results: Uromonitor displayed a sensitivity of 87% (95% CI, 74-95), with only 6 of 47 recurrences failing to be detected; specificity of 99% (98-100); PPV of 93% (82-98); and an NPV of 99% (97-99). Cystoscopy showed a total of 22 false positives (32%) not confirmed by transurethral resection of bladder tumor, whereas Uromonitor presented only 3 positive tests where no lesions were found. Overall recurrence rate was 8.9% (n = 47) among 528 total screenings. Sensitivity, specificity, PPV, and NPV values for Uromonitor remained high across all NMIBC grades and stages.

Conclusions: Uromonitor represents a reliable tool in the detection of NMIBC recurrence in patients undergoing routine surveillance, regardless of stage and grade. To our knowledge, this is the largest single-center study assessing Uromonitor's performance, thus validating its usefulness in clinical practice.

Purpose: The aim of this study was to assess the diagnostic prevalence, incidence, diagnostic age, and surgical volume of hypospadias in Denmark.

Materials and methods: Males with a hypospadias diagnosis in the Danish National Patient Registry (n = 10,276) were identified (1977-2019). A diagnostic algorithm, validated by medical file review (n = 1710), confirmed diagnoses and severity (distal/proximal). The yearly prevalence (live-born hypospadias boys/100,000 newborn boys) and incidence (first hypospadias registration in the Danish National Patient Registry/100,000 boys in background population) were calculated. Age at diagnosis and number of health care contacts were calculated. Poisson regression was used to analyze temporal trends.

Results: Hypospadias was verified in 9189 males (89.4%; distal 8404 [91.5%]; proximal 785 [8.5%]). From 1977 to 2006, the prevalence rose significantly to a mean of 503 (95% CI: 440-565) and peaked at 847 (distal 768, proximal 79) in 2007. From 2008 to 2018, the prevalence stabilized (mean 774, 95% CI: 738-810). A significant rise in incidence was observed. Age at diagnosis decreased from 1977 to 2019. Proximal hypospadias was diagnosed earlier (median 0 years, IQR, 0-0.5) than distal (median 0.2 years, IQR, 0-1.9) and had more (P < 10^-4) nonsurgical hospital contacts (median = 5, IQR, 3-7 vs median = 2, IQR, 1-3). At least 1 surgical admission was recorded for 4550 (58.4%). Boys without surgical admissions (n = 3244, 41.6%) were primarily distal cases (97.7%).

Conclusions: Since 1977, the prevalence of diagnosed hypospadias cases significantly increased and peaked around 800 per 100,000 live boys in 2007. The diagnostic age decreased, proximal cases were diagnosed earlier, and there were more surgical admissions than distal cases. A significant proportion were never operated.