Research and Reports in Urology最新文献

Background: Prostate cancer is currently the second commonest male cancer both globally and in Uganda. Men are often tested after presenting with obstructive lower urinary tract symptoms (LUTS). We evaluated total prostate-specific antigen patterns (tPSA), digital rectal examination (DRE) findings, histological findings and prostate cancer rates among patients presenting to Mbarara regional referral hospital with obstructive LUTS.

Methods: This was a cross-sectional study of 140 patients aged ≥50 with obstructive LUTS. Data on demographics and severity of LUTS was collected, plus the results of tPSA testing and DRE. Later, digitally guided transrectal tru-cut prostate biopsy was performed, if necessary. Analysis was done using SPSS (Statistical Package for Social Scientists), version 14. Confidence interval (CI) was set at 95% and P at 0.005.

Results: The majority of patients had severe LUTS (n=103, 73.57%), with a median tPSA of 14.4 ng/mL. Ninety-nine patients experienced digitally guided transrectal tru-cut prostate biopsy (70.71%; Fisher's exact test = 0.001). DRE abnormalities were found in 57.14% (n=80) of participants and these carried a higher risk for prostate cancer diagnosis (risk ratio = 5.895; Fisher's exact test = 0.04; CI 95%: 1.59-21.822). The tru-cut biopsy positivity rate was high, at 46% (45/99; 95% CI: 30.1-46.3); all had prostate adenocarcinoma and the majority (77.78%, n=35) had a total Gleason score of 8 and above. Of those who had a malignancy, more than a quarter were between 60-80 years of age (37.8%, n = 17). There was no statistically significant relationship between LUTs and prostate cancer diagnosis (Fisher's exact test 2-sided = 0.84).

Conclusion: Although severity of LUTS was not predictive of cancer, there was a high rate of advanced prostate cancer among study participants. DRE remains a valuable tool for identifying potential prostate cancer cases, especially in settings where PSA testing may be limited. Further research is needed to explore effective screening strategies and improve outcomes for men with prostate cancer in Uganda.

Purpose: Urinary tract infections (UTI) are a common complication in patients with bladder cancer (BLCA). This study investigated the role of stearoyl-CoA desaturase-1 (SCD1) in BLCA progression and assessed its potential as a biomarker for predicting UTI risk in BLCA patients.

Patients and methods: SCD1 expression profiles were evaluated in BLCA patients with concurrent UTI. Receiver operating characteristic curve analysis was used to assess the diagnostic value of SCD1 for predicting UTI risk. In vitro assays were conducted to explore the functional role of SCD1 in lipopolysaccharide (LPS)-associated BLCA progression.

Results: SCD1 expression was significantly higher in the UTI group compared with the non-UTI group (p = 0.000 and 0.011, respectively). The combination of SCD1, immune-inflammation index, and C-reactive protein demonstrated strong predictive value for UTI risk in BLCA patients (non-muscle invasive BLCA patients: area under the curve (AUC) = 0.887; 95% CI: 0.821-0.935; muscle-invasive BLCA patients: AUC = 0.861; 95% CI: 0.767-0.927). Functional experiments revealed that lipopolysaccharide (LPS)-induced SCD1 expression promoted autophagy and enhanced malignant phenotypes, whereas SCD1 inhibition or treatment with an autophagosome inhibitor reversed these effects.

Conclusion: SCD1 promotes LPS-associated BLCA progression by regulating autophagy and may serve as a valuable biomarker for predicting UTI risk in BLCA patients.

Introduction: β2 microglobulin is a non-glycosylated protein synthesized by all nucleated cells. It has been utilized as a tumor marker in several different malignancies, however, studies examining its role in renal cell carcinoma (RCC) are limited.

Methods: Using the Emory kidney cancer database, patients with any stage or histology RCC who underwent partial or radical nephrectomy from 2014 to 2022 and had an available β2 microglobulin within 90 days before surgery were included. Following manufacturer's recommendation, β2 microglobulin ≥ 2.34 mg/L was considered elevated. Patient and surgical characteristics were recorded. Kaplan Meier curves and multivariable Cox Hazards models were used to assess the association between an elevated β2 microglobulin and overall and cancer-specific survival. Subgroup analysis was performed between patients with and without renal dysfunction (defined as an estimated glomerular filtration rate (eGFR) of ≤ or > 60 mL/min/1.73m²) and with and without metastatic disease.

Results: Of 429 patients who met inclusion criteria, 178 (41.5%) had an elevated preoperative β2 microglobulin. After adjusting for confounders, an elevated β2 microglobulin was independently associated with worse CSS (HR 2.08 [95% CI 1.20-3.60]; p = 0.009) and OS (HR 1.58 [95% CI 1.03-2.41]; p = 0.035) compared to a normal β2 microglobulin. On subgroup analysis, elevations in β2 microglobulin levels remained significantly associated with OS and CSS in patients with normal renal function and non-metastatic disease.

Conclusion: Preoperatively elevated β2 microglobulin levels are independently associated with worse OS and CSS in patients with RCC undergoing nephrectomy. The utility of β2 microglobulin as a prognostic indicator is most relevant for patients with normal renal function and non-metastatic disease.

Background: Avelumab maintenance therapy is a standard of care for patients with advanced urothelial carcinoma (UC) who achieve disease control following platinum-based chemotherapy. However, the influence of induction chemotherapy intensity on avelumab outcomes remains unclear.

Materials and methods: This retrospective study included 26 patients with advanced UC who received avelumab maintenance after first-line platinum-based chemotherapy between March 2021 and June 2025. Patients were grouped by induction regimen: full-dose gemcitabine/cisplatin (GC), reduced-dose GC, or gemcitabine/carboplatin (GCarbo). Survival outcomes from the start of avelumab treatment and from chemotherapy initiation were analyzed using the Kaplan-Meier method and compared using the Log rank test.

Results: The median patient age was 72 years, with a significant difference among groups (P < 0.01). The objective response rates to induction chemotherapy were 60.0% (full-dose GC), 80.0% (reduced-dose GC), and 45.5% (GCarbo) (P=0.458), with respective disease control rates during avelumab maintenance of 50.0%, 100.0%, and 54.5% (P=0.188). The median progression-free survival (PFS) values from avelumab initiation were 4.0, 12.1, and 5.7 months, respectively (P=0.636). The median overall survival (OS) values from avelumab initiation were 21.7, 18.6, and 18.4 months (P=0.587), while those from chemotherapy initiation were 28.8, 28.7, and 29.0 months (P=0.496), in the respective groups. No significant differences in PFS or OS were observed among the three groups or between the GC-based and GCarbo regimens.

Conclusion: Avelumab maintenance showed comparable efficacy across the full-dose GC, reduced-dose GC, and GCarbo groups, highlighting the potential feasibility of personalized induction chemotherapy strategies. These findings may provide reassurance in clinical situations where full-dose cisplatin is not feasible due to patient frailty or renal dysfunction.

Introduction and objectives: To investigate outcomes of patients with biochemical or local recurrence, without distant metastasis, who received radiation therapy targeting the prostate bed at our hospital following radical prostatectomy for prostate cancer.

Methods: Patients suspected of recurrence after radical prostatectomy, indicated by an increase in PSA levels or other factors, were evaluated through imaging tests for local recurrence and distant metastasis. Those who showed no local recurrence received salvage radiotherapy to the prostate bed at a dose of 64.8 Gy. Patients with local recurrence received radiotherapy of 70.8 Gy to the site of local recurrence and 64.8 Gy to the prostate bed.

Results: Among 19 cases of local recurrence following radical prostatectomy, three out of nine patients who did not receive ADT experienced recurrence after local radiation therapy. In contrast, none of the ten patients who received ADT during radiation therapy experienced recurrence following treatment. No significant difference was observed in clinical recurrence-free survival between patients receiving radiation therapy alone and those receiving ADT during radiation therapy. (p = 0.302) Fifty-six of the 57 patients without local recurrence were evaluated regarding their PSA doubling time (PSADT). Those with a PSADT of 6 months or more at the time of recurrence following radical prostatectomy tended to show longer clinical recurrence-free survival after local radiation therapy compared with showing PSADT of less than 6 months. (p=0.06) Patients with local recurrence who were treated with escalated radiation doses did not show any difference in the incidence of radiotherapy-related gastrointestinal toxicity compared with patients without local recurrence.

Conclusion: Although this study was conducted at a single institution with a small sample size and a limited number of patients, ADT may be beneficial in preventing recurrence following radiation therapy for local recurrence after radical prostatectomy. When considering salvage radiation therapy for patients with biochemical recurrence following radical prostatectomy, PSADT may be useful.

Background: Non-epithelial bladder neoplasms are rare, and there are only approximately 250 cases of bladder leiomyoma reported in the English literature. We present a case of bladder leiomyoma in a patient with recurrent acute cystitis.

Case presentation: A 53-year-old woman presented to a local clinic with frequent urination and dysuria and was diagnosed with acute cystitis. Her symptoms temporarily improved after taking oral antibiotics, but then flared up repeatedly. Contrast-enhanced computed tomography showed a bladder neck leiomyoma and multiple uterine fibroids. Her body mass index was 27.0 kg/m². The patient successfully underwent transurethral resection of the tumor. The histopathological diagnosis was bladder leiomyoma.

Conclusion: There have been few cases of bladder leiomyoma coexisting with urinary tract infection and uterine fibroids. Our findings suggest that female hormones, which might increase body weight and cause fatty liver, are associated with the growth of bladder leiomyomas. If a patient has recurrent urinary tract infection, a bladder leiomyoma should be included in the differential diagnoses.

Objective: Digital Rectal Examination (DRE) remains an important preventive measure in primary care settings, but a single screening may produce false positives. We sought to explore the trend of abnormal DRE (suspicious and non-suspicious) findings in men with and without prostate cancer.

Methods: We utilized data on 34,756 men (1,713 Black and 33,043 White) from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Serial DRE measurements were collected over a 10-year follow-up prior to prostate cancer diagnosis. DRE results were categorized as: normal, abnormal non-suspicious, and suspicious DRE. Generalized estimating equation (GEE) model was used to evaluate the trend in suspicious DRE findings over time.

Results: After adjusting for potential confounders, the interaction term of time to diagnosis and prostate cancer status was statistically significant indicating a 23.0% increase in the odds of suspicious DRE (OR=1.230, 95% CI: 1.193-1.268) and a 5.2% increase in the odds of non-suspicious DRE (OR=1.052, 95% CI: 1.033-1.072) per year closer to diagnosis. The positive predictive value of abnormal suspicious DRE was 4.74% at 10 years prior to diagnosis, 36.82% at 5 years prior to diagnosis, 60.63% at 2 years prior to diagnosis, and 90.48% at diagnosis. Older age and benign prostatic hyperplasia (BPH) were more likely to have increased suspicious DRE findings.

Conclusion: Our results suggest that incorporating serial DRE findings into screening strategies may reduce false positives and improve early detection of clinically significant prostate cancer. This study demonstrates a rising probability of abnormal DRE findings in men with prostate cancer, whereas no temporal change was observed in men without prostate cancer.

Artificial intelligence (AI) is increasingly influencing the field of urologic oncology, offering novel tools to support for clinical decision-making, enhance diagnostic precision, and assist in surgical and pathological workflows. Machine learning (ML) and deep learning (DL) approaches-artificial neural networks, particularly convutional ones-have demonstrated potential across various urologic malignancies, with applications ranging from imaging interpretation and tumor grading to risk stratification and operative planning. While prostate cancer remains the most explored domain, growing interest surrounds AI's use in bladder and renal tumors, and more recently in testicular and penile cancers. Moreover, the integration of AI into robotic surgery and medical writing is opening new frontiers in performance evaluation and patient communication. Despite these advances, critical limitations persist. Issues such as data heterogeneity, lack of external validation, ethical and legal ambiguity, and algorithmic bias continue to hinder widespread adoption. This narrative review examines current developments in AI across major genitourinary cancers, highlighting both clinical opportunities and unresolved challenges in translating these technologies into practice.

Bladder calculi occur predominantly in men, and their incidence is very low in females. Female urethral calculi are even rarer and are usually associated with anatomical or pathological abnormalities. This case report describes a female patient with a giant calculus extending from the urinary bladder into the urethra, crossing the bladder neck. The patient had a three-year history of lower urinary tract symptoms before diagnosis. She was presented with acute pyelonephritis on the left side, bilateral hydronephrosis due to reflux, and recurrent urinary tract infections. An emergency cystostomy was performed at our medical center for urinary drainage, followed by open cystolithotomy. Urethroscopy revealed a urethral diverticulum near the bladder neck; however, the patient declined diverticulum resection. A five-year follow-up was conducted. This case report provides valuable insights into diagnosing and treating rare lower urinary tract calculi in females, accompanied by a literature review.

Background: Incorporating the modified Seoul National University Renal Stone Complexity (S-ReSC-R) scoring system into the preoperative evaluation of both retrograde intrarenal surgery and percutaneous nephrolithotomy has proven to be highly effective in predicting stone-free status after each procedure.

Objective: This study aimed to validate the S-ReSC-R scoring system in extracorporeal shock wave lithotripsy (ESWL) and compare it with the Triple D score under the same protocol.

Materials and methods: Data on consecutive patients undergoing ESWL at a tertiary referral center between 2019 and 2021 were retrospectively analyzed. A total of 297 patients who were evaluated with non-contrast CT prior to the procedure and had adequate follow-up data were included in the analysis. The S-ReSC-R score was calculated based on the number of sites affected. Stone-free status was defined as no evidence of residual stones. Receiver operator characteristic (ROC) curves were generated to determine cutoff values for both scoring systems.

Results: The overall stone-free rate (SFRs) after a single session was 60.5%. The average S-ReSC-R score was significantly lower in patients who had successful ESWL than in those with failed ESWL (1.50 vs 2.63, p < 0.001). The SFRs were significantly lower with higher S-ReSC-R scores: 72.4% in the low score (1-2) group, 36.0% in the intermediate score (3-4) group, and 10.5% in the high score (5-12) group (p < 0.001). Multivariate analyses revealed that both the S-ReSC-R score and the Triple D score independently influenced ESWL success (both p < 0.001). The area under the ROC curve for the S-ReSC-R score was 0.767, whereas that for the Triple D score was 0.694.

Conclusion: This study confirms that the S-ReSC-R is a reliable tool for predicting stone-free status after ESWL. Thus, its use in evaluating patients for ESWL is recommended.