Research and Reports in Urology最新文献

Background: Primary intratesticular rhabdomyosarcoma (PTRMS) is an exceptionally rare malignancy and may be clinically indistinguishable from more common scrotal conditions or germ cell tumors prior to orchiectomy. Evidence to guide management is limited, and treatment is typically extrapolated from pediatric and adolescent/young adult rhabdomyosarcoma protocols.

Case presentation: A 17-year-old male presented with progressive, painless enlargement of the right testis. Cross-sectional imaging demonstrated a large intratesticular mass with extensive retroperitoneal and pelvic lymphadenopathy causing grade II hydronephrosis due to ureteral compression, bilateral pulmonary nodules, and axillary lymphadenopathy. He underwent radical inguinal orchiectomy. Histopathology showed a high-grade malignant neoplasm involving the testis, epididymis, and spermatic cord with focal vascular invasion; immunohistochemistry was strongly positive for SMA, desmin, and MyoD1, supporting rhabdomyosarcoma. A double-J ureteral stent was placed, and systemic therapy with vincristine, actinomycin D, and cyclophosphamide (VAC) was initiated. After three cycles, follow-up imaging demonstrated complete radiologic resolution of pulmonary metastases, marked regression of nodal disease (including axillary involvement), and resolution of hydronephrosis with ongoing clinical improvement.

Literature review: In a PubMed-based review of 87 eligible articles comprising 99 individual cases of primary testicular or paratesticular rhabdomyosarcoma, the mean age at presentation was 19.76 years (SD 14.44). Tumors were predominantly paratesticular (80.8%) rather than intratesticular (19.2%). Among cases reporting staging data, nodal involvement at presentation was observed in 31.5% and distant metastasis in 25.6%. Treatment most commonly included surgery plus chemotherapy (54.5%) or trimodality therapy with surgery, chemotherapy, and radiotherapy (24.2%).

Conclusion: PTRMS can present with advanced nodal and distant metastases yet remain chemosensitive. This case highlights a brisk response of disseminated intratesticular rhabdomyosarcoma to VAC chemotherapy and supports comprehensive staging and response-adapted multidisciplinary management. The complete case-level extraction and full citations are provided in the Supplementary material.

Purpose: Transperineal prostate biopsy is essential for diagnosing prostate cancer; however, infection remains a clinically significant issue. We evaluated the safety and outcome of a single, prophylactic oral dose of cefaclor 500mg during transperineal prostate biopsy.

Patients and methods: This retrospective observational study included 127 patients who underwent transperineal prostate biopsy for suspected prostate cancer at our institution between April 2024 and October 2025. Biopsies were performed transperineally under spinal anesthesia. Cefaclor 500 mg was administered orally 30 minutes pre-operatively as a prophylactic antibiotic. We collected information on laboratory data, medication history, comorbidities, frailty, and infection risk for analysis.

Results: Among 127 patients, 73 (57.8%) were classified as prefrail or frail and 27 (21.2%) were identified as at risk of infection. The median initial prostate-specific antigen level was 9.92 ng/mL (interquartile range, 6.55-17.3 ng/mL). Fifty patients (39.3%) with polypharmacy and seventy-one (55.9%) with multimorbidity were noted. All patients were discharged after a 2-day hospital stay. Complications were observed in 36 patients (28.3%). Grade 1 and grade 2 Clavien-Dindo complications occurred in 33 patients (25.9%) and 3 patients (2.3%; urinary retention in 2 patients, fever in 1), respectively. One patient (0.7%) developed a urinary tract infection and underwent additional oral antibiotic therapy. No cases of rehospitalization or sepsis occurred. Among patients who underwent biopsy, 90 (70.8%) tested positive for cancer.

Conclusion: Single-dose oral cefaclor prophylaxis in TPB appears to be safe, with no serious post-procedural infections observed. Its effectiveness in frail or high-risk patients requires confirmation in future large prospective studies.

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal stones, but the optimal patient positioning remains debated. While the traditional prone position offers excellent access to posterior calyces, it can limit ventilation and increase anesthetic complexity. Supine modifications improve airway management but may reduce access efficacy. We propose the "GENOA" Prone Modified Position, a novel setup combining the advantages of both approaches. In this preliminary study, three patients underwent PCNL using this technique, which involves prone positioning with a ~30-45° rotation obtained by placing gel pads under the thoracic and abdominal regions contralateral to the affected kidney. This alignment brings the renal axis parallel to the floor, facilitating a safer and more ergonomic puncture. All punctures were performed below the costal margin, accessing the lower calyces in four of six renal units. Mean operative time was 72.2 minutes, and two patients achieved complete stone clearance. No complications or opioid use were recorded, and the average hospital stay was 4.3 days. The GENOA Prone Modified Position appears to be a feasible and effective solution that enhances access to posterior calyces while minimizing ventilatory risk. Further studies are needed to validate its reproducibility and long-term benefits in larger cohorts.

Introduction and importance: Advances in endourology have greatly reduced open stone surgeries (OSS) worldwide. However, in some rural areas of developing countries, PNL for large, complex stones is not feasible due to limited resources and lack of angioembolisation. We share our experience in such cases.

Materials and methods: Using STROCSS 2025 and PROCESS 2023 checklists, we outlined objectives and reported a case series. From January 2012 to June 2023, 2241 patients had surgery for urinary stones at a rural hospital: 286 PNL, 1625 URS, 281 RIRS, and 49 OSS. We retrospectively analysed demographic data, stone burden, surgical techniques, and outcomes.

Outcomes: There were 23 men and 26 women, aged 31 to 66 (average: 52 years). CSB was included in 46 patients (93.8%), and CSB with PUJ obstruction in 3 patients (6.12%). Procedures were pyelolithotomy (26.53%), extended pyelolithotomy (38.77%), and pyelolithotomy with lower calyceal nephrotomy (24.48%). Mandatory intraoperative nephroscopy was used to remove calyceal stones. Complete stone-free status was achieved in 47 cases (95.9%) at discharge and 3-month CT. Two patients (4.08%) had residual fragments needing RIRS at 3 months. The mean operative time was 88.67 min (70-120), and hospital stay averaged 5.87 days (5-8). The follow-up period averaged 24.48 months (24-30). Intraoperative complications occurred in 10.20%, and significant postoperative complications in seven cases (14.28%), including sepsis, urinary leakage, chest effusion, and wound issues.

Conclusion: Single-session OSS with Nephroscopic clearance can achieve a higher stone-free rate. Although the morbidity of OSS is considerably higher than that of PNL, it may be safe and effective for managing complex stone burdens in resource-constrained rural areas of developing countries.

Objective: The objective of the study was to determine the prevalence of elevated PSA levels (> 4.0 ng/mL) and examine sociodemographic and modifiable lifestyle risk factors associated with PSA elevation among asymptomatic Rwandan men aged ≥ 40 years.

Material and methods: A cross-sectional study was conducted at Kabutare District Hospital in Rwanda between March and April 2025, enrolling 136 asymptomatic male participants aged ≥ 40 years. Lifestyle and anthropometric data were collected via structured interviews. Serum total PSA was measured using the enzyme linked immunosorbent assay (Fortress BXE0851A kit). Elevated PSA was defined as > 4.0 ng/mL. Statistical analyses included descriptive statistics and Chi-square/Fisher's exact tests for bivariate associations.

Results: Elevated PSA was observed in 14% of participants. Chi-square analysis revealed significant associations between elevated PSA and BMI category (p < 0.001), smoking status (p < 0.001), alcohol use (p < 0.001), sexual activity frequency (p = 0.018), and occupation (p < 0.001).

Conclusion: Elevated PSA prevalence among asymptomatic Rwandan men mirrors global patterns observed in Black populations. Associations with underweight status, occupational exposure, and alcohol use suggest multifactorial influences. These findings highlight the need for targeted screening strategies and community-level interventions to promote early prostate cancer detection in Rwanda.

Purpose: To evaluate survival outcomes and identify prognostic factors among bladder cancer patients.

Patients and methods: A total of 488 bladder cancer patients admitted between 2007 and 2017 were followed until December 31, 2020, using both active and passive follow-up. The Kaplan-Meier method was used to estimate observed survival (OS), with group comparisons performed using the Log rank test. Variables included sex, age group, number of hospital admissions, TNM stage, and geographic origin.

Results: Of 488 patients, 485 (99.38%) were successfully followed. The majority were male (80.21%) with a mean age of 66.5 years. The average number of hospital admissions was 1.81. Overall 1-, 3-, 5-, and 10-year OS rates were 79.95%, 63.50%, 56.32%, and 45.54% for males, and 69.79%, 58.33%, 56.01%, and 56.01% for females, respectively (P = 0.697). Age significantly affected prognosis (P < 0.01), with 5-year OS declining from 66.67% (age ≤34) to 29.53% (≥80). Patients with ≥3 admissions had worse survival (44.87%) than those with one (61.93%) or two admissions (58.97%) (P < 0.01). TNM stage was strongly with survival: 5-year OS rates were 86.43% (Stage I), 55.48% (Stage II), 38.25% (Stage III), and 13.85% (Stage IV) (P < 0.01). Regional differences were not statistically significant (P > 0.05).

Conclusion: Advanced age and late-stage diagnosis were associated with poorer survival, while early-stage detection correlated with better outcomes. These findings underscore the importance of early screening, timely treatment, and comprehensive care strategies to improve bladder cancer survival, especially in resource-limited settings. Limitations include single-center design and absence of multivariate adjustment.

Purpose: Varicocele, present in 15-20% of males and linked to 35-40% of primary infertility, is commonly treated with microsurgical ligation. This review compares venous shunting techniques such as spermatic-inferior epigastric vein anastomosis with ligation in terms of efficacy, safety, and clinical outcomes, especially in complex cases like recurrence or Nutcracker Syndrome.

Methods: We included randomized, prospective, retrospective, and cohort studies comparing venous shunting (eg, spermatic-inferior epigastric vein anastomosis) with ligation or without control group. We searched PubMed, EBSCO, ProQuest, EMBASE, and Scopus on 31 April 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale and JBI (Joanna Briggs Institute) for case series. Outcomes assessed included operative time, semen parameters, hormonal levels, recurrence, and complications. This study was registered in PROSPERO (CRD420251060842).

Results: Twelve studies (n = 420 patients) were included. Shunting demonstrated improvements in semen quality (eg, sperm motility: 59.4% vs 41.6% post-ligation) and lower recurrence rates (0-5% vs 5-15%). However, operative times were longer (99-146 vs 48-92 minutes). Shunting also showed benefits in vascular parameters and testicular volume, particularly in NCS-associated cases. Complications were rare, with minor issues like scrotal edema reported.

Conclusion: Venous shunting shows promise as an alternative in selected varicocele patients, with potential benefits in semen motility, pain relief, and recurrence reduction. However, the current evidence is limited, heterogeneous, and largely non-randomized. Shunting should therefore be considered experimental, requiring advanced microsurgical expertise, and further high-quality trials are needed before incorporation into standard guidelines.

Purpose: This study aimed to compare lower urinary tract symptoms (LUTS) in women with pelvic organ prolapse (POP) undergoing robot-assisted sacrocolpopexy (RSC) or transvaginal mesh surgery (TVM).

Methods: A retrospective analysis was conducted on patients who underwent RSC or TVM at our institution between August 2017 and December 2024. Patient demographics, surgical records, and questionnaire responses were collected. LUTS were evaluated using the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score (IPSS), and Quality of Life (QOL) score. Preoperative and 1-month postoperative questionnaire responses were compared within each group using the Mann-Whitney U-test. Intergroup comparisons were performed after adjusting for baseline differences through propensity score matching, and their significance was analyzed using the Wilcoxon rank-sum test.

Results: A total of 51 patients underwent RSC and 21 underwent TVM. No significant differences were observed in age, body mass index, or Pelvic Organ Prolapse Quantification stage between the groups. The RSC group had a longer operative time (273 vs 127 minutes, p < 0.01) and less blood loss (10.0 vs 150 mL, p < 0.01). Both groups showed significant improvements in IPSS and QOL scores, whereas the OABSS did not change significantly. The RSC group had a significantly lower postoperative QOL score compared with the TVM group, but no significant differences were found after propensity score matching. No significant differences were observed between the groups in either the absolute changes or relative reductions of LUTS questionnaire scores. The incidence of de novo stress urinary incontinence was similar between the groups.

Conclusion: Both RSC and TVM effectively improved LUTS in women with POP. After adjusting for baseline differences, no significant differences in postoperative voiding symptoms were observed between the two procedures. These findings support flexible surgical decision-making based on patient characteristics, perioperative risks, surgeon experience, and shared decision-making.

Nephrolithiasis is a common global urological disorder, with incidence rates being as high as 13% in some regions of North America, contributing to substantial healthcare burdens. In 2021, 106 million new cases were reported worldwide, predominantly in men, reflecting a 27% rise since 2000. Regional disparities are notable, with Eastern Europe showing the highest rates (3,560 per 100,000). Management has evolved from open surgery to minimally invasive, precision endourological techniques, driven by innovations such as advanced lasers, digital ureteroscopes, artificial intelligence, virtual reality training, and robotic-assisted procedures, these advances have enhanced stone-free rates and reduced complications This review provides a comprehensive analysis of the epidemiology and contemporary management of kidney stone disease especially analysing variables affecting the disease including gender, age, geography and climate, occupational exposure, dietary lifestyle, and systemic diseases. Understanding the multifactorial epidemiology of nephrolithiasis is essential for effective prevention, while modern technological interventions are reshaping treatment standards and improving patient outcomes by offering individualized treatment options.

Purpose: The purpose of this study is to evaluate a novel surgical method for idiopathic chyluria.

Methods: Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed.

Results: DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029).

Conclusion: Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.