Therapeutic Advances in Urology最新文献

Retroperitoneal fibroids are a rare condition that is often misdiagnosed preoperatively. It typically occurs in women with a history of hysterectomy or myomectomy for benign uterine smooth muscle tumors. In this case report, we present the case of a 50-year-old woman who presented with discomfort in the right perineal area. Imaging showed a large retroperitoneal tumor. The patient underwent robotic-assisted laparoscopic surgery to remove the mass, which was confirmed by histopathological analysis to be a uterine smooth muscle tumor of undetermined malignant potential (STUMP). The patient had no recurrence during the 2-year follow-up. The overall prognosis of STUMP is favorable, but more rigorous and long-term follow-up is required to monitor potential recurrence. Our case highlights that retroperitoneal masses in women with prior uterine fibroid surgery should raise suspicion for retroperitoneal fibroids. Robot-assisted laparoscopic surgery may be a safe and feasible minimally invasive option.

Background: Enfortumab vedotin (EV), an antibody-drug conjugate targeting Nectin-4, has demonstrated efficacy in advanced urothelial carcinoma (UC) following platinum-based chemotherapy and immune checkpoint inhibitor (ICI) therapy. However, real-world evidence on its effectiveness and safety remains limited.

Methods: We conducted a multicenter retrospective study across Italian oncology centers to evaluate EV in patients with metastatic UC (mUC) who had progressed after prior platinum-based chemotherapy and ICI. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety. We also assessed prognostic factors, including a composite index (HERO score) based on baseline hemoglobin and neutrophil-to-lymphocyte ratio (NLR).

Results: Fifty-three patients were included (median age 72 years; 41.5% ⩾75 years). The ORR was 34.0% (all partial responses), with a DCR of 58.5%. Median PFS and OS were 6.1 and 9.7 months, respectively. Multivariate analysis identified NLR ⩾ 4 and lung metastases as independent predictors of inferior PFS, while NLR ⩾ 4 remained independently associated with worse OS. Dose reductions and peripheral neuropathy were associated with improved outcomes. The HERO score significantly stratified patients by PFS and OS (p = 0.017 and p < 0.001, respectively). EV was generally well tolerated, with most adverse events being low-grade.

Conclusion: In this real-world cohort, EV confirmed its efficacy and manageable safety profile in mUC. The HERO score may provide a simple tool for risk stratification in clinical practice, though prospective validation is needed.

Background: Previous reviews evaluating biofeedback (BF)-assisted pelvic floor muscle (PFM) training (PFMT) with or without electrical stimulation (ES) for women with stress urinary incontinence (SUI) have reported conflicting results, and no consensus has been reached on the optimal parameters for this intervention.

Objectives: To (1) evaluate the effectiveness of non-invasive and invasive BF-assisted PFMT with or without ES for SUI in women and (2) investigate whether study design characteristics and intervention parameters affect treatment effects.

Design: Systematic review with meta-analysis and meta-regression.

Data sources and methods: Seven English and two Chinese databases were searched from inception to May 2025. Outcomes were synthesized as standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals. Meta-regression was employed to investigate the impact of study design characteristics and intervention parameters on outcomes.

Results: This review included 21 studies involving 2373 participants. Meta-analyses revealed significant effects of invasive BF-assisted PFMT on PFM strength (SMD 0.71 (0.29, 1.14), p = 0.001), urinary incontinence (UI) symptom severity (SMD -0.33 (-0.63, -0.03), p = 0.032), quality of life (QoL; SMD -1.10 (-1.78, -0.41), p = 0.002), and improvement/cure rate (OR 2.02 (1.25, 3.26), p = 0.004). Meta-analyses also revealed significant effects of both invasive (SMD -1.23 (-1.93, -0.52), p = 0.001) and non-invasive (SMD -1.23 (-1.77, -0.68), p < 0.001) BF-assisted PFMT on urine loss severity. Meta-regression analysis revealed higher improvement/cure rates when BF-assisted PFMT involved mildly challenging exercises, tailoring to patients' abilities, therapist supervision, sessions of <10 min, durations of >1 h/week for ⩾8 weeks, and ⩾80%-95% adherence.

Conclusion: Invasive BF-assisted PFMT can improve PFM strength, reduce urine loss and UI symptom severity, enhance QoL, and increase the improvement/cure rate. Non-invasive BF-assisted PFMT can reduce urine loss severity. However, these results must be interpreted cautiously due to methodological flaws, risks of bias, and substantial heterogeneity across the included studies. Further high-quality studies are warranted to confirm the effectiveness of invasive or non-invasive BF-assisted PFMT with or without ES for treating SUI in women. The recommended parameters may optimize treatment effects.

Trial registration: PROSPERO (CRD42023473798).

Background: High sodium intake is associated with cardiovascular and kidney disease, as well as the development of lower urinary tract symptoms (LUTS). The amount of salt intake can influence the development of symptoms, but reduction may benefit patients by lowering the presentation of LUTS. However, there is a lack of systematization of evidence between salt intake and LUTS.

Objectives: Determine the relationship between a high salt intake and LUTS, and the impact of salt intake reduction on the development of LUTS.

Design: Systematic review.

Data sources and methods: We included observational studies and clinical trials that assessed any clinical manifestations of LUTS and any method of measuring salt intake to establish a comparison between high and low salt intake. A search was conducted on PubMed, Scopus, Ovid-Medline, WOS, and Embase databases in February 2024, including studies published at any time until the date of the search. Risk of bias was assessed using the Newcastle-Ottawa Scale and risk of bias in non-randomized studies of interventions. A qualitative synthesis of the included studies was performed, and a meta-analysis was not conducted due to the heterogeneity of how LUTS and salt intake were measured.

Results: We obtained 3085 articles, from which 10 were included in this review. In regards to urinary incontinence and general LUTS, patients who had a salty diet had more frequency and severe symptoms according to the Overactive Bladder Symptom score (H: 286, 1% vs N: 356, 0.6% vs N: 225, 0.8%; p < 0.001) and International Prostate Symptom score (H: 688, 2.5% vs N: 670, 1.7% vs B: 419, 2.3%; p < 0.001) respectively, compared to patients who had neutral or bland diets.

Conclusion: Some evidence suggests a possible association between a high salt intake and LUTS, and lowering salt intake might help to improve symptoms. We suggest that future studies improve clinical trial designs to clarify the relationship and methods to assess salt intake and measurement of LUTS.

Background: Artificial intelligence (AI) is increasingly used in patient education, especially with the rise in popularity of large language models (LLMs) such as ChatGPT, Microsoft Copilot, and DeepSeek, offering quick, accessible answers to health-related queries. Yet, in female sexual health, a field historically under-researched and stigmatized, AI's role in patient-facing education has yet to be thoroughly explored.

Objectives: To evaluate the accuracy and relevance of responses from ChatGPT, Copilot, and DeepSeek to common female sexual health questions, comparing them to the Prosayla website and to each other.

Design and methods: Twelve questions were developed based on content from the Prosayla website, covering topics ranging from menopause to sexual dysfunction. Responses were collected from the three LLMs and Prosayla. Two female sexual medicine experts independently rated each response for accuracy and relevance utilizing a six-point Likert scale (0-5) with a double-blind design being used to minimize bias. One-way ANOVA and Bonferroni post hoc analyses were used to assess statistical significance (p < 0.05).

Results: No significant differences in accuracy scores were observed across the four sources for Physician A (p = 0.558) or Physician B (p = 0.052), although ChatGPT was rated significantly more accurate than Prosayla in post hoc analysis by Physician B (p = 0.044). Relevance scores differed by rater: Physician A found no differences across sources (p = 0.771), while Physician B rated all three AI models significantly higher in relevance than Prosayla (p < 0.001).

Conclusion: AI models demonstrated comparable accuracy to Prosayla (a trusted patient education source), with the models being more relevant for one of the raters. These findings suggest that AI tools may complement traditional educational materials and support patient learning. However, expert oversight remains essential to ensure content quality and appropriateness. Future efforts should develop structured strategies and implementation frameworks to responsibly integrate AI into patient education, particularly in sensitive areas like women's sexual health.

Background: Urethroplasty may influence ejaculatory function due to the potential for nerve injury during perineal dissection. It is essential to understand postoperative ejaculatory outcomes for effective patient counseling and surgical planning.

Objectives: To compare ejaculatory function and satisfaction following excision and primary anastomosis (EPA) versus substitution urethroplasty (SU), and to identify independent predictors of these outcomes.

Design: Retrospective cohort study.

Methods: A total of 63 sexually active men who underwent anterior urethroplasty between July 2017 and July 2022 at two tertiary centers were evaluated. Group I (EPA, n = 33) underwent transecting end-to-end urethroplasty, while Group II (SU, n = 30) underwent substitution urethroplasty utilizing buccal mucosa grafts. Ejaculatory function and satisfaction were assessed using the Male Sexual Health Questionnaire (MSHQ).

Results: The mean stricture length was 3.3 ± 7 cm, and the overall urethroplasty success rate was 87% after a mean follow-up of 45.6 ± 21 months. The mean score on the MSHQ Erection Scale differed significantly between groups (EPA = 10.13 ± 4.66 vs SU = 12.69 ± 3.12, p = 0.008). Conversely, scores on the Ejaculation Scale (EPA = 27.24 ± 7.63 vs SU = 27.57 ± 6.84, p = 0.443) and Satisfaction Scale (EPA = 24.17 ± 6.73 vs SU = 25.79 ± 5.64, p = 0.790) were comparable. Multivariate analysis identified age as the sole independent predictor of Ejaculation Scale scores (β = -0.219, 95% CI: -0.351 to -0.087, p = 0.001).

Conclusion: Postoperative ejaculatory function showed no significant difference between EPA and SU urethroplasty. Younger age was associated with improved ejaculatory outcomes, whereas no surgical or stricture-related factors predicted patient satisfaction. These findings underscore the importance of considering patient age during postoperative counseling and expectation management.

This study aimed to offer important diagnostic insights and a sensible treatment plan for such challenging situations by presenting an incredibly unusual example of Skene's gland cyst. We described a 39-year-old woman who suffered dysuria for 20 years with an acute exacerbation. Her sexual life was normal, and she did not exhibit any other significant clinical symptoms. However, positron emission tomography/computed tomography (PET/CT) and imaging tests gave contradictory results, with the former creating a high suspicion of malignancy, while the latter indicated a benign tumor. After a multidisciplinary discussion, a cautious treatment approach was adopted. Finally, the patient underwent a diagnostic puncture, and bacteriology detection, along with histological analysis, ultimately confirmed the diagnosis of a Skene's gland cyst. Following needle puncture biopsy and subsequent antibiotic therapy, follow-up assessments revealed that the mass disappeared. Importantly, the patient's clinical symptoms completely resolved, and no complications were observed. This case highlighted that puncture biopsy coupled with drainage was a safe and efficacious method, especially when faced with the challenge of diagnosing and treating paraurethral cystic masses.

Background: The clinical utility of preoperative mid-stream urine culture (MSUC) in predicting fever and urinary tract infections (UTIs) after suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) remains debated.

Objectives: This study aims to evaluate the correlation of postoperative fever and UTIs following SM-PCNL in patients with a positive preoperative MSUC versus those with a negative culture.

Design: This was a retrospective analysis of a prospectively collected registry including 693 patients from the international STUMPS registry (30 centers and 21 countries).

Methods: Patients were stratified by preoperative MSUC results. All positive cultures were treated with targeted antibiotics for ⩾5 days as per the antibiogram; repeated negative cultures before surgery were not mandatory. Intraoperative parameters, 30-day postoperative complications, and stone-free rates (SFR) were evaluated. Multivariable logistic regression was performed to assess independent predictors of infectious complications.

Results: Clavien-Dindo grade 1 postoperative fever occurred in 10.6% of patients with positive MSUC versus 4.6% in those with negative cultures. Clavien-Dindo grade 2 infections were more frequent in MSUC-positive patients (4.9% vs 1.2%). Sepsis requiring intensive care occurred in one patient per group. There was no difference in stone compositions and equivalent distribution of infectious stones in both. Intraoperative pelvic urine cultures were more frequently positive in patients with positive MSUC (5.7% vs 0.9%, p < 0.001). No differences were observed in major complications or SFR at 30 days. A positive preoperative MSUC was the only independent predictor of postoperative infection (OR 3.04; 95% CI 1.48-6.12; p = 0.01).

Conclusion: Positive preoperative MSUC is independently associated with a higher risk of postoperative fever and UTIs, particularly Clavien-Dindo grade 1 and 2 events, following SM-PCNL. Furthermore, these patients are more likely to have a positive intraoperative urine culture. Therefore, a preoperative MSUC should always be obtained, and a targeted antibiotic therapy should be administered irrespective of stone composition to reduce postoperative infectious risk.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a congenital abnormality of sexual development characterized by agenesis of the uterus and vagina. It may be confined to the genital tract (MRKH type I) or be accompanied by abnormalities of the urinary or skeletal systems (MRKH type II). We report a case of an 8-year-old girl who was admitted to the hospital because of a "reducible mass in the left groin." Upon examination, a mass of about 3 × 2 × 2 cm³ in size was found in the left inguinal region on increasing abdominal pressure, and a left inguinal oblique hernia was diagnosed. The vulva developed normally, and the vaginal vestibule had only a urethral opening but no vaginal opening; abdominal ultrasound revealed that the right kidney was absent, and the left kidney seemed to be fused by two renal cavities; ultrasound of the uterine appendages showed no uterus, and the left and right ovaries were normal; thus, the patient was diagnosed with MRKH type II syndrome. Laparoscopic examination verified the above findings, and it was also found that no obvious fallopian tubes were found around both ovaries. High ligation of the left inguinal hernia was performed to treat the inguinal oblique hernia. When a patient with MRKH syndrome presents with an unexplained inguinal mass, an ovarian or uterine inguinal hernia should be suspected. Early detection of this anomaly will aid in reproductive outcome management and appropriate surgical management.

Objective: This study aimed to further investigate the relationship between the ratio of red cell distribution width to serum albumin (RAR) index and the risk of kidney stones in the US population, focusing on the mediating effect of body mass index (BMI), and to provide new insights into the prevention and management of kidney stone disease.

Methods: This was a cross-sectional study derived from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The total sample size of the study was 20,755, and the association between RAR and kidney stones was studied using multiple logistic regression, subgroup analysis and mediation analysis.

Results: The findings of this study demonstrate a substantial positive correlation between the prevalence of kidney stones and the RAR index (OR: 1.37, 95% CI: 1.27, 1.49). This association remains consistent even after adjusting for relevant covariates (OR: 1.23, 95% CI: 1.12, 1.36). Utilising curve fitting, threshold effect analysis and restrictive cubic spline methods, an 'S'-shaped non-linear dose-response relationship between the RAR index and the prevalence of kidney stones was identified (p for overall < 0.001, p for non-linear = 0.002). In subgroup analyses, the association between RAR index and the risk of kidney stones was more significant in the obese population (OR: 1.33, 95% CI: 1.18, 1.51, p for interaction = 0.021). The results of the mediation analysis found that BMI played a 24.5% mediating role between the RAR index and kidney stones. Sensitivity analysis also confirmed the stability of this result.

Conclusion: A non-linear association has been identified between the RAR index and the prevalence of kidney stones. The study found that BMI is a mediating variable in this association. In obese individuals of Other Race - Including Multi-Racial, the RAR index has been shown to have a more marked effect on the prevalence of kidney stones.