Research and Reports in Urology最新文献

Background: Mpox primarily presents with systemic and cutaneous symptoms. However, it can also lead to urological complications, necessitating specialized attention. The aim of this scoping review is to summarize the current evidence regarding the urological manifestations of Mpox, possible complications, and available treatments.

Methods: An electronic systematic search of the current literature was conducted through the Medline and NCBI PubMed and Scopus databases on 18th August 2024. Our study search and inclusion criteria were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 9 The search terms and keywords used were: "monkeypox; Mpox" (MeSH Terms), combined with different terms: "urology", "kidney", "ureter", "bladder", "prostate", "genitals", "penis", "testicles", "urethra", in all different possible combinations.

Results: A total of 32 articles included in the scoping review. A total of 116 patients were included, all males. The genitals were the most interested organs, associated with urethritis, while bladder and kidneys seemed to be not impacted by the disease. Patients were usually young, with a mean age of 36 years [31.5-40 years]. The most prevalent risk factor was sexual intercourse in the days/weeks before the appearance of symptoms. All patients had a molecular confirmatory diagnosis by a polymerase chain reaction (PCR) test. Five articles out of 32 (15.6%) reported the need for surgical debridement of penile and genital lesions due to their clinical worsening. However, in most reports, patients experienced spontaneous resolution of the lesions and symptoms.

Conclusion: Awareness of Mpox and timely diagnosis are crucial for ensuring appropriate treatment and reducing the need for surgical management and the possible risk of long-term sequelae. Collaboration among dermatologists, infectious disease specialists, and urologists is pivotal to effectively managing Mpox patients.

Introduction: This study aimed to evaluate fresh-frozen cadavers (FFC) as a novel model for percutaneous nephrolithotomy (PCNL) training, focusing on ultrasound-guided supine PCNL.

Methods: Sixteen urologists participated in a 2-day course at a tertiary center to assess the utility of an FFC model for ultrasound-guided supine PCNL. After the procedure, the participants completed a 24-question evaluation of the FFC model using a 5-point Likert scale. The questionnaire assessed tissue quality, US imaging, procedural steps, overall experience compared to live patient procedures, and suitability of the model for both basic and advanced supine PCNL training.

Results: The tactile sensation, skin stiffness, and distensibility of the calyces resembled real-life scenarios as the cadavers thawed. Similarly, US quality was worse in frozen cadavers and improved after irrigation with the collection system. Valdivia-Galdakao positioning is considered more difficult than in real life, because of rigor mortis.

Conclusion: FFC demonstrated robust content validity as a training model for PCNL. The model provides a realistic and effective training experience, offering a promising tool for developing critical surgical skills, while minimizing radiation exposure and procedural risks.

Vesicouterine fistula (VUF) is a rare form of urogenital fistula, accounting for approximately 4% of cases. It commonly arises as a complication of uterine interventions, especially previous cesarean sections (C-sections). Intravesical ectopic pregnancy complications are infrequent. We discuss a 39-year-old female with severe lower abdominal pain spreading to the flank, dysuria, hematuria, and urinary hesitancy one week after laparotomy for fetal demise at 17-18 weeks of gestation. A dead fetus in the urinary bladder along with the VUF was revealed in the imaging. The surgical operation identified a fistula between the posterior bladder wall and the lower uterine segment. Fetus evacuation and fistula repair were performed with symptom resolution achieved. A literature review was conducted and nine articles were extracted. These articles discussed the risk factors and complications of VUF. The articles, selected for relevance and quality, highlighted cesarean sections as the most common risk factor, with hematuria being the most frequent complication. Only a small number of cases had fetal migration into the bladder documented, showcasing its rarity. This case represents a rare complication of VUF: intravesical ectopic pregnancy into the bladder. Surgical intervention led to favorable outcomes and is consistent with findings in the reviewed literature. The rare complication of VUF such as intravesical ectopic pregnancy requires proper diagnosis and treatment. This case emphasizes the importance of surgical management in achieving successful outcomes for VUF and its complications.

Bladder foreign bodies (BFBs) are an uncommon clinical occurrence, often resulting from trauma, self-insertion, iatrogenic causes, or organ migration. These objects can act as nidus for stone formation, leading to vesicolithiasis. Here, we present a rare case of a 61-year-old male with hematuria, dysuria, and abdominal pain. Initial evaluation, including imaging and cystoscopy, revealed a bladder stone encapsulating a foreign object identified as a blue cable wire. Despite denying self-insertion, his history suggested potential unreported trauma. Management involved cystoscopic lithotripsy and foreign body extraction. The case underscores how foreign objects act as nidus for stone formation through inflammatory and biochemical pathways, emphasizing the importance of early diagnosis and appropriate surgical management to prevent severe complications.

Background: The lack of reliable predictive tools for outcomes following ureteral lithotripsy (ULT) presents significant challenges in clinical decision-making. This study evaluates the efficacy of the S.T.O.N.E. score-an assessment incorporating Size, Topography, Obstruction, Number, and Hounsfield units (HU)-in predicting the likelihood of achieving a stone-free rate (SFR) in patients undergoing semirigid pneumatic ULT.

Methods: This retrospective analysis involved 266 patients with ureteral stones who underwent ULT at IBB University Hospitals from April 2021 to September 2023. The S.T.O.N.E. score was derived from preoperative CT scans, and a nomogram was created to predict SFR failure. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and calibration curve, while decision curve analysis (DCA) evaluated clinical utility.

Results: The cohort's mean age was 47.7 ± 15 years, with a predominance of males (72.2%). The mean S.T.O.N.E. score was 7.8 ± 1.8. The overall SFR of 85.3% and residual stones were detected in 39 patients (14.7%). Multivariate analysis identified higher HU (AOR: 1.01; 95% CI: 1.00-1.01; P < 0.001), proximal stone location (AOR: 15.13; 95% CI: 1.52-51.13; P = 0.020), moderate (AOR: 34.23; 95% CI: 8.28-141.45; P < 0.001) and severe hydronephrosis (AOR: 33.75; 95% CI: 4.55-250.36; P = 0.0006), and larger stone size (AOR: 1.51; 95% CI: 1.30-1.75; P < 0.0001) as significant predictors of SFR failure. The S.T.O.N.E. score effectively predicts SFR failure, with an optimal threshold of > 8 achieving 85.0% accuracy. The model demonstrated 72.0% sensitivity, 81.0% specificity, and strong calibration. DCA indicated clinical utility, differentiating between low- and high-risk patients based on their S.T.O.N.E. scores.

Conclusion: The S.T.O.N.E. score is a valuable tool for predicting post-ULT SFR, aiding preoperative decision-making and potentially improving surgical outcomes by identifying high-risk patients. Further validation in diverse populations is needed to confirm its clinical utility.

Purpose: We evaluated the hospitalization rate, length of stay, and management of patients with ureteric lithiasis admitted under emergency conditions at a single institution during the COVID-19 pandemic.

Patients and methods: A retrospective study was conducted on 219 patients with ureteral lithiasis, divided into pre-COVID-19 (1.10.2019-29.02.2020) and COVID-19 groups (1.10.2020-29.02.2021). The study examined patient and stone characteristics, hospitalization duration, surgical interventions, creatinine levels, and associated urinary tract infections. It also evaluated the complications related to delayed treatment during the pandemic.

Results: The study found a 73.41% reduction in admissions for obstructive ureteral lithiasis during the COVID-19 pandemic compared to the pre-pandemic period. Notable differences were observed in age (61.5 vs 46 years, p=0.000), gender (p=0.046), stone laterality (p=0.024), location (p=0.002), serum creatinine levels (1.59 vs 1.09 mg/dL, p=0.000), and urine cultures (45.65% vs 23.12%, p=0.002). During the pandemic period, the rate of primary stone extraction procedures decreased (32.6% vs 59%, p<0.001), while operative time (52.89 vs 39.84 minutes, p<0.001) and hospital stay significantly increased (13.09 vs 3.76 days, p<0.001).

Conclusion: The pandemic resulted in fewer hospitalizations for ureteral lithiasis and an increase in complications, likely due to reduced access to medical care and a greater tendency for upper urinary tract drainage.

A standard prostate biopsy can be performed via a transrectal or transperineal approach using a transrectal ultrasound probe, but not in patients without a rectum. These patients pose a diagnostic challenge to urologists in terms of prostate cancer detection. We report use of a novel technique for cognitive magnetic resonance imaging (MRI)-transperineal ultrasound fusion prostate biopsy with a urinary catheter in two patients without a rectum after abdominoperineal resection. In both cases, a urinary catheter was inserted and clamped after injection of 250 mL of sterile saline into the bladder to improve visualization of the prostate. The inflated catheter balloon was placed to the level of the bladder neck to identify the base of the prostate. Cognitive MRI-transperineal ultrasound fusion biopsy was performed on the MRI-defined lesions after confirmation of anatomic landmarks, including the urethra and base of the prostate. Systemic 8-core biopsies were also obtained. In both patients, the targeted lesion was diagnosed as prostate cancer.

Background: Urolithiasis is a significant global health burden with varying prevalence rates across different regions. In Somalia, data on the prevalence and risk factors associated with urinary stone disease are limited. This study aimed to investigate the prevalence and associated factors of urolithiasis among patients undergoing CT scans at selected centers in Mogadishu.

Methods: This cross-sectional study was conducted between January and May 2024 at three medical facilities in Mogadishu, Somalia. This study included 211 patients who underwent non-contrast abdominopelvic CT scans. Data were collected using a structured questionnaire that covered sociodemographic characteristics, lifestyle habits, dietary patterns, and clinical data. Statistical analysis was performed using R statistical software version 4.4.0, employing descriptive statistics, bivariate analyses, and logistic regression.

Results: The study revealed a prevalence of 26.07% (95% CI: 20.28-32.54%) for urolithiasis. Significant associations were found with marital status (married individuals showing higher risk, AOR 30.42, 95% CI 3.32-278.58) and education level (higher education showing a protective effect). Dietary factors played a crucial role, with irregular dairy consumption (AOR 37.05, 95% CI 3.44-398.62) and occasional meat consumption (AOR 3.58, 95% CI 1.41-9.08) showing increased risk. Previous diagnosis of urolithiasis (AOR 5.2, 95% CI 1.19-22.81) and history of UTIs (AOR 3.43, 95% CI 1.7-6.95) were significant risk factors.

Conclusion: This study identified a substantial prevalence of urolithiasis in Mogadishu, with significant associations between sociodemographic factors, dietary habits, and medical history. These findings emphasize the need for comprehensive screening programs and targeted interventions, particularly for high-risk individuals.

Background: Prostate cancer (PCa) remains a significant health concern due to its high incidence and associated mortality. Conventional screening approaches, like PSA testing, often lack specificity, resulting in unnecessary biopsies and overtreatment. This study seeks to overcome these limitations by assessing the integration of novel urinary biomarkers into established risk prediction models.

Objective: This study aimed to evaluate the performance of incorporating urinary biomarkers - prostate cancer antigen 3 (PCA3) and transmembrane serine protease 2 (TMPRSS2) gene and ETS-related gene (ERG) fusion genes (T:E) - into the Prostate Cancer Prevention Trial Risk Calculator version 2 (PCPTRC2) in a Lithuanian cohort to enhance the detection of clinically significant prostate cancer (csPCa).

Materials and methods: A single-centre prospective study included 246 men scheduled for initial prostate biopsy between January 2021 and August 2024 due to elevated total PSA levels or abnormal digital rectal examination (DRE). Following ethical approval and informed consent, urinary samples were collected post-DRE and analysed for PCA3 and T:E. Each patient's risk was calculated using the basic PCPTRC2 and updated versions incorporating biomarkers. Biopsies were performed based on multiparametric magnetic resonance imaging (mpMRI) findings.

Results: Of 209 biopsy samples analysed, 111 (53.1%) were diagnosed with csPCa. The AUC for PCa detection was 59.6% for the original PCPTRC2, improving to 76.2% with PCA3 and further to 79.5% when both PCA3 and T:E were included. Both updated versions demonstrated significantly higher sensitivity compared to the original (p<0.001). However, no significant differences were noted in distinguishing csPCa from non-csPCa.

Conclusion: Incorporating PCA3 and T:E into PCPTRC2 substantially enhances diagnostic accuracy for detecting PCa in biopsy-naïve patients. Despite limitations, these findings underscore the potential for optimizing risk calculators in clinical practice, advocating for larger cohorts to validate these results.

Objective: Bladder cancer is the 10^th most common cancer worldwide. The investigation and surveillance commonly involve a combination of upper tract imaging along with visual assessment of the bladder via cystoscopy. This study determined the validity of using Cxbladder^® Triage (CxbT) and Cxbladder^® Monitor (CxbM) as a suitable adjunct in ruling out urothelial carcinoma (UC) when investigating haematuria or monitoring for recurrence.

Materials and methods: A single centre prospective study where the patients have been referred for investigation of UC or those on routine surveillance of known UC. All patients were counselled with consent obtained prior to midstream urine collection pre-cystoscopy in line with local protocol for urine-analysis to screen for infection with the residual specimen collected for the CxbT or CxbM test. De-identified patient demographic data along with smoking status, risk of environmental exposures, family history, type of hematuria or last date of last recurrence were collected, and the planned cystoscopy would then proceed. The data pertaining to exposure to smoking and type of haematuria are the symptoms and risk factors that are taken into account with CxbT or CxbM to calculate a score, which can then be correlated with the outcome at the end with cystoscopic and imaging investigations.

Results: A combined 236 patients were recruited (CxbT = 134, CxbM = 102) with results showing excellent negative predictive value of 96.43% and 95.16%, respectively. A key result showed that CxbT in combination with upper tract imaging done as routine was able to rule out UC completely in low-risk patients.

Conclusion: We have validated the use of Cxbladder as an adjunct in the investigation and surveillance of UC. It is a non-invasive, accurate and reproducible test that can aid in ruling out UC, specifically for low-risk patients.