Research and Reports in Urology最新文献

Bladder cancer management, particularly non-muscle-invasive bladder cancer (NMIBC), has evolved significantly due to advancements in imaging techniques and surgical methodologies. Enhanced tumor visualization methods, including Photodynamic Diagnosis (PDD) and Narrow-Band Imaging (NBI), offer improved detection rates for both papillary tumors and carcinoma in situ (CIS), compared to traditional white-light cystoscopy (WLC). Recent studies suggest that these technologies enhance diagnostic accuracy, reduce recurrence rates, and improve oncological outcomes. Additionally, transurethral resection of bladder tumors (TURBT), performed with advanced imaging, has demonstrated better resection quality, particularly in terms of detrusor muscle presence. Despite these innovations, challenges remain in the long-term impact on recurrence-free and progression-free survival. Artificial intelligence (AI) integration into cystoscopic imaging further promises enhanced diagnostic precision and cost-effective bladder cancer management. As personalized treatment paradigms emerge, predictive biomarkers, including genomic and pathological markers, may help stratify patients for aggressive treatment, sparing those at lower risk from unnecessary interventions. Future research should focus on validating these AI models and combining them with enhanced imaging modalities to refine treatment protocols further. These advancements collectively represent a significant leap toward precision medicine in bladder cancer care.

Background: Retroperitoneal lymph node dissection (RPLND) plays an integral role in the curative management of metastatic testicular cancer. As a major surgery, RPLND poses a risk of significant complications, particularly in the post-chemotherapy (PC-RPLND) setting. We assessed the safety of introducing RPLND as a new service at an Australian tertiary hospital.

Methods: A strict protocol prioritising appropriate case selection, multidisciplinary surgical expertise and ready access to intensive care facilities was implemented to introduce RPLND. Prospective data was collected on patients who underwent PC-RPLND between October 2020 and October 2022 at the Northern Hospital in Melbourne. Primary and secondary endpoints were 30-day postoperative Clavien-Dindo (CD) classification complication rate and perioperative quality measures, respectively.

Results: Six patients (mean age 28.7 ± 4.3 years) underwent bilateral template open PC-RPLND. Median node count was 17 (IQR = 16) with metastatic germ cell tumour identified in all patients on histopathology. Median length of stay was 6 days (IQR = 3) with 1 day in intensive care. No blood transfusions were required, and no 30-day CD complications were encountered. Median follow-up was 22 months (IQR = 21) with no recurrences or significant delayed complications.

Conclusion: Following a strict protocol, RPLND has been safely introduced as a new service at our tertiary institution. Perioperative quality endpoints match those of high-volume international centres.

Introduction: Magnetic resonance imaging (MRI) is an essential tool in Prostate Cancer (PCa) diagnosis. PI-RADS v2.1 score correlates with clinically significant prostate cancer (CSPCa) and according to the most recent guidelines, prevalence of CSPCa with PI-RADS 4 is 33-41%, while PI-RADS 5 is 62-79%. These groups are separated only by a size of 15 mm yet the difference in risk is significant. This study aims to find a size threshold associated with CSPCa within the PI-RADS 4 group, which may be used in combination with other prostatic parameters, such as PSA density in order to help with risk stratification and patient counselling in the pre-biopsy setting. This may also aid with surveillance of smaller PI-RADS 4 lesions in the setting of a negative biopsy and avoid unnecessary repeat biopsies unless triggered by a size threshold.

Methods: A retrospective study was performed with data from 407 patients undergoing transperineal prostate biopsy (TPPB) between April 2022 and November 2023. A subgroup of patients with PI-RADS 4 was included for analysis. A ROC-AUC was obtained.

Results: Median age was 67 (interquartile range: 61-71) and PSA density 0.20 (interquartile range 0.13-0.28). PI-RADS score correlated with CSPCa: for PI-RADS 1 and 2, the frequency of CSPCa was 10%; for PI-RADS 3, it was 20%; for PI-RADS 4, it was 60%; and for PI-RADS 5, it was 80%, Pearson correlation = 0.51, p < 0.001. The Receiver Operating Characteristic Area Under the Curve (ROC-AUC) was determined to be 0.664 [0.579-0.7499]. The optimal cut-off point was 8.5 mm. Patients with lesions larger than 8.5 mm had 2.31 times higher risk CSPCa.

Conclusion: PI-RADS 4 size does matter and is a useful predictor of CSPCa. In our study, a cut-off of 8.5 mm was identified. The combination of PI-RADS 4 with PSA density provides a specificity higher than 80% for CSPCa detection.

Introduction: Severe chronic testicular pain that has failed medical therapy and physiotherapy poses a treatment dilemma. This study presents a proof of concept for the use of genitofemoral neuromodulation (GFM) as a potential pain management solution for patients with persistent testicular pain unresponsive to conservative and surgical management.

Methods: Patients with chronic testicular pain refractory to conventional treatments were selected for GFM. A total of three patients were included in this proof-of-concept study. Demographic information, prior medical and surgical interventions, and pre- and post-operative pain scores using the Numerical Rating Pain Scale were collected. All patients must have had temporary relief from pain with a spermatic cord block.

Results: Patient 1 (75 years old) had a history of opioid medication use, physiotherapy, radiofrequency ablation, and nerve block. His pain score reduced from 10/10 to 4/10 six months post-operatively. Patient 2 (59 years old) had a history of opioid, nortriptyline, baclofen medication use, and physiotherapy. His pain score reduced from 9/10 to 2/10 six months post-operatively. Patient 3 (36 years old) had a history of opioid medication use and physiotherapy, and bilateral orchidectomy for pain relief. His pain score reduced from 8/10 to 6/10 six months post-operatively.

Conclusion: This study suggests that GFM is effective in reduce pain scores and could be a viable option for patients with chronic testicular pain refractory to traditional interventions. Further research is essential to establish the long-term efficacy and safety of GFM in this cohort.

Purpose: Anterior urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates of and postoperative complications. However, the long-term outcome of surgical management of urethra stricture and the associated risk factors of stricture recurrence remain limited. We conducted a 23-year single-center retrospective study to evaluate the long-term surgical outcomes of anterior urethral strictures with different clinical characteristics and to study factors that contribute to stricture recurrence.

Methods: A retrospective study was conducted on 145 male patients diagnosed with anterior urethral stricture, who underwent meatotomy, anastomotic urethroplasty (AU), penile skin flap urethroplasty (PFU), single-stage buccal mucosa grafting (SSU), or multistage buccal mucosa grafting (MSU) between April 2000 and August 2023. We defined 100 months as the cut-off time point to distinguish short-term and long-term follow-up. Early surgical complications were scored using the Clavien-Dindo classification at 3 months. Patient-Reported Outcome Measure (PROM) was applied to evaluate surgical success. Risk factors for wound complications were evaluated using univariable and multivariable analysis.

Results: The overall mean stricture length was 2.3 ± 1.8 cm (a range of 0.3-7.0). Stricture locations were at the meatus, fossa navicularis, penile, bulbar, and multifocal in 15, 36, 79, 9, and 6. The short-term and long-term success rate for meatotomy, AU, PFU, SSU, and MSU were 70.0%/80%, 70.4%/62.5%, 77.8%/69.2%, 100%/75%, and 81.8%/66.7%, respectively. The early complications classified as Clavien grades I, II, III, IV, and V were 39, 5, 5, 0, and 0. The late complication rate in the short-term and long-term groups were 20.3% and 30.3% (p > 0.05). The satisfaction survey showed that 74.5% (108 of 145) patients were satisfied or very satisfied with the surgical result. There was no statistically significant difference in stricture-free survival among the five surgical groups (Log rank test: χ² = 3.83, p > 0.05). The binary univariate logistic regression analysis showed that stricture symptom duration (p < 0.05) and previous urethroplasty (p < 0.05) were independent predictors of surgery failure.

Conclusion: This long-term retrospective study on male anterior urethral stricture disease demonstrates that surgical management is an effective and functional treatment. However, the success rate of urethroplasty shows a declining trend with longer follow-up. Stricture symptom duration and previous urethroplasty carry a high risk of surgical failure.

3D models have been introduced as tools to improve surgeon's precision during Robotic-Assisted Partial Nephrectomy (RAPN). They showed to provide accurate anatomical details, improve operative time and patient safety by reducing complications. Over the last years, several useful models have been developed and proposed. However, literature is still scant regarding if and how the experience of the operator, and the learning curve, may impact the accuracy and precision of the model. In this light, the aim of the study is to evaluate the accuracy, the interpersonal variability of the precision and the learning curve for the segmentation of RAPN 3D preoperative models starting from CT images. This study will identify the influence of operator experience and learning curves on the accuracy of 3D preoperative models in RAPN, optimizing workflows for broader clinical adoption.

Purpose: Targeted and precise application of thermal energy stored in sterile water vapor is a novel approach to treat cancerous prostate tissue. We report safety and oncological results of transurethral hemigland vapor ablation in a prospective, single-arm study in men with unilateral, intermediate-risk localized prostate cancer.

Patients and methods: Men with biopsy confirmed Gleason Grade Group 2 (GG2) adenocarcinoma of the prostate, mean age 64.6 years, PSA 5.2 ng/mL, and prostate volume 46.8 cc on TRUS were enrolled. Using cystoscopy and transrectal ultrasound (TRUS) guidance, water vapor (~103°C) was delivered to prostate zones for hemigland ablation inclusive of cancers identified by multiparamertric MRI (mpMRI) and biopsy. At 6-months, combined 12-core systematic and mpMRI fusion biopsy was performed. Subjects with no remaining GG2 disease were followed for 12 months. Those with residual or newly identified GG2 disease were eligible for a second vapor ablation and subsequent 6-month mpMRI fusion biopsy and were followed for at least 18 months after index treatment.

Results: Fifteen subjects were successfully treated. At 6 months 4/15 subjects were identified for further management, two with residual GG2 cancer on the treated side, and two with newly identified GG2 cancer on the untreated contralateral side; one of two subjects with residual GG2 was ineligible for retreatment (unrelated myocardial infarction). Follow up at 12 to 18 months after initial or retreatment provided a final ≥GG2 negative biopsy in 14/15 (93.3%) subjects. Device or procedure-related adverse events (AEs) were mild/moderate and transient; none were serious AEs.

Conclusion: Water vapor ablation has low morbidity. It is possible to successfully retreat residual disease or new lesions identified on surveillance with only transient mild to moderate adverse events and acceptable oncologic outcomes offering a new management strategy for localized prostate cancer.

Teratoma is neoplasia originating from a germ cell, which usually contains identifiable tissue derived from all three germ cell layers. The presence of teratoma is due to an organ being affected by a tumor, which generally occurs in ovary. Teratoma is also seen occasionally in some extragonadal organs. However, a primary teratoma in the bladder is a rare entity. We hereby present a case of bladder teratoma. A 53-year-old woman whose chief complaints were urinary interruption, pilimiction, and a stone in her urine was diagnosed by cystoscopy and received rehabilitation after tumor resection surgery. She was then symptom-free and further follow-up observation was in progress. We also include a literature review concerning primary bladder teratoma.

Introduction: Prostate cancer (CaP) is the most common malignancy and the second leading cause of cancer-related deaths among men in Botswana. Currently, diagnosing CaP relies on examining prostate biopsy samples, which can be challenging due to benign mimics. This study aims to evaluate the potential of Alpha-methyl acyl-CoA racemase (AMACR/p504s) and p63, as diagnostic markers for CaP. This may potentially validate the use of immunohistochemistry for detecting CaP in Botswana, where it is not routinely utilized.

Methods: The study included 69 samples, comprising 5 prostatic chip specimens, 50 core biopsies, and 14 radical prostatectomy specimens. These cases were reviewed and categorized into CaP (49 cases) and benign prostatic hyperplasia (BPH) (20 cases). Immunohistochemistry was performed using AMACR/p504s and p63 immunohistochemical stains.

Results: The study found that AMACR/p504s had a sensitivity of 96% and a specificity of 95%, while p63 had a sensitivity and specificity of 100%. PSA levels showed significant positive correlation with AMACR/p504s expression (P < 0.00001).

Discussion: In this study, we have demonstrated the diagnostic utility of AMACR/p504s and p63 due to their high sensitivity and specificity in detecting CaP in Botswana, where these biomarkers are not yet widely used. Furthermore, utilizing these markers in conjunction with other diagnostic tools, such as PSA levels and morphological evaluation, could improve the diagnostic accuracy, especially in challenging cases where histopathological examination alone may be inconclusive.

Purpose: The objective of our study was to examine the knowledge of male infertility and the acceptance of assisted reproductive technology (ART) methods.

Patients and methods: We conducted a descriptive, comparative, cross-sectional study from April 2023 to August 2023 in a center in Dakar. Included in the study were male patients aged 18 and older followed for male infertility (group 1) and fertile patients of the same age as those in group 1 (group 2). We designed a questionnaire assessing the sociodemographic characteristics of the respondents, their knowledge of male infertility, knowledge of ART, its acceptability, and the source of information about male infertility.

Results: Our sample size consisted of 119 respondents for each group. The average age of respondents in both groups was 41.24 ± 8.42 years. Fifty-eight percent of respondents in group 1 were referred by their wife's gynecologist. Fifty-four percent of respondents in group 1 had a good knowledge of male infertility, and 42.86% had average knowledge of male infertility. The majority of respondents in group 1 (42.9%) and group 2 (40.3%) did not know the duration that defines infertility. Fifty-seven percent of respondents in Group 1 and 81.5% of respondents in Group 2 did not know what assisted reproductive technology meant. Eighty-six percent of respondents in Group 1 agreed to use ART for procreation. The majority of respondents in Group 1 (54.6%) and Group 2 (58.8%) attributed a success rate of between 35% and 75% to ART.

Conclusion: Infertile men had better knowledge of male fertility than fertile men. Respondents in both groups, as well as the advanced age of men did not know the duration defining infertility. Poor knowledge of ART was also observed among respondents in both groups, and a better acceptance of ART methods was noted among infertile men.