Journal of Urology最新文献

Purpose: Vesicoureteral reflux is one of the common abnormalities in pediatric urology. We previously demonstrated that the ureteral jet angle is a useful noninvasive screening tool for detecting high-grade vesicoureteral reflux. To further explore its clinical application, we evaluated the association of ureteral jet angle with urinary tract infection development and vesicoureteral reflux improvement.

Materials and methods: We assessed the reliability of the ureteral jet angle measurement in 19 healthy adult volunteers in a prospective interrater reliability study. A retrospective study was conducted in 209 pediatric patients who presented with febrile urinary tract infection and underwent both voiding cystourethrography and ureteral jet angle measurement.

Results: The ureteral jet angle was unaffected by sex or laterality, showed a very weak positive correlation with bladder volume, and interrater reliability was high (intraclass correlation coefficient(2,1): 0.90). The ureteral jet angle was significantly higher in patients with multiple urinary tract infections (73.8° ± 2.1°) than in those with a single episode (67.8° ± 1.9°, p = 0.036). It was also higher in patients with breakthrough urinary tract infection (p = 0.013). In contrast, it was significantly lower in the group with vesicoureteral reflux downgrading (p < 0.001) and resolution (p < 0.001). Patients who underwent surgical intervention had a significantly higher ureteral jet angle than nonsurgical patients did (p < 0.001).

Conclusions: Measuring the ureteral jet angle using color Doppler ultrasonography appears to be associated not only with vesicoureteral reflux grade but also with urinary tract infection development and vesicoureteral reflux improvement, supporting its role in vesicoureteral reflux management.

Purpose: To evaluate the efficacy and safety of Toripalimab combined with gemcitabine and cisplatin (GC) as the neoadjuvant treatment (NAT) before radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC).

Materials and methods: This phase II trial enrolled 30 patients with T2-3N0M0 MIBC scheduled for RC. Patients received a treatment regimen of toripalimab 240 mg, gemcitabine 1000 mg/m², and cisplatin 70 mg/m² on day 1, followed by gemcitabine 1000 mg/m² on day 8, in 21-day cycles for a total of 4 cycles. RC was scheduled 4 to 6 weeks after the last treatment cycle. The primary end point is the pathological complete response (pCR), and the secondary end points are safety, overall survival (OS), and progression-free survival (PFS). The FISHER test was performed to analyze the relationship between genomic changes, tumor mutation burden (TMB), and pCR rate.

Results: From January 2020 to December 2021, 27 patients underwent RC after NAT, and 3 withdrew from the study. The pCR rate reached 40.7% (11/27). The 1-year and 3-year PFS rates were 85.2% and 77.6%, respectively; the 1-year and 3-year OS rates were 96.2% and 84.6%, respectively. Among the 18 patients who retained the target lesions during NAT, the pCR rate was 27.8% (5/18), and the pathological response rate was 50.0% (9/18). The rate of adverse events of grade 3 or higher was 13.3%. Biomarker analysis indicated that patients with dual-mutation in KMT2D, ERBB2, or EPHA2 genes had a lower pCR rate following NAT. In the patients with PD-L1 expression ≥ 5% (n = 16), the pCR and pathological response rate were 43.8% (7/16) and 68.8% (11/16), respectively. In patients with PD-L1 expression < 5% (n = 11), the pCR rate was 36.4% (4/11) and the pathological response rate was 63.6% (7/11).

Conclusions: Toripalimab combined with GC chemotherapy demonstrates a good efficacy and safety, making it a promising therapeutic strategy for NAT of MIBC.

Trial registration: The clinical trial number for this study is ChiCTR2100051298.