Therapeutic Advances in Urology最新文献

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.

Purpose: To evaluate if prostate-specific antigen density (PSAD) predicts incidental prostate cancer (iPCa) in patients undergoing robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH).

Methods: A total of 100 consecutive patients undergoing RASP for BPH were analyzed. Patients were stratified into low-risk and higher-risk groups based on their iPCa risk: 60 patients (PSAD ⩽ 0.1 ng/mL/cc) and 40 patients (PSAD > 0.1 ng/mL/cc), respectively. Outcomes included iPCa detection rates, preoperative imaging/biopsy utilization, and postoperative complications. A multivariable logistic regression and an univariate linear regression analysis were conducted to assess whether PSAD can predict the incidence of PCA.

Results: iPCa was detected in 8% of cases. Five patients had <5% tumor material in their final pathology (pT1a), while three had more than 5% (pT1b). iPCa was detected in eight patients, six with International Society of Urological Pathology (ISUP) 1 and 2 with ISUP > 2. Patients with ISUP 1 were managed with active surveillance; only one chose robot-assisted radical prostatectomy, and the two with ISUP 2 and 3 opted for external radiation. Seven iPCa cases occurred in the low-PSAD group (11.7%), and one in the high-PSAD group (2.5%). In multivariate logistic regression, only a prior negative prostate biopsy was the strongest predictor of iPCa (odds ratio = 5.2, p = 0.01). PSAD > 0.1 ng/mL/cc was not associated (p = 0.09). A univariate linear regression using PSAD as a continuous variable showed no significant association (p = 0.27).

Conclusion: PSAD, whether dichotomized (threshold of >0.1 ng/mL/cc) or continuous, didn't predict iPCa in men with large prostates. To optimize cancer detection, patients with large prostates may profit from prostate MRI before bladder outlet surgery, especially those with a history of prior prostate biopsy. Further research, including larger multicenter studies, is needed to validate our results.

Upper tract urothelial carcinoma (UTUC) is a rare malignancy with a higher incidence in patients with end-stage renal disease (ESRD), particularly in regions with specific environmental risk factors. The diagnosis of UTUC in patients with ESRD remains challenging because of certain limitations inherent to current urine cytology techniques and imaging quality. Herein, we report the case of a 72-year-old woman with a history of bladder urothelial carcinoma and ESRD who was receiving regular hemodialysis and was incidentally diagnosed with high-grade multifocal UTUC following a nephrectomy procedure to treat symptomatic hydronephrosis. Despite routine cystoscopic surveillance and unremarkable cytological findings, progressive hydronephrosis was noted on serial imaging. Surgical intervention was performed as the patient's symptoms worsened progressively, after which pathological examination confirmed the presence of UTUC with renal parenchymal invasion. This case highlights the notion that UTUC should be considered as a differential diagnosis in patients with ESRD exhibiting symptomatic hydronephrosis of an unexplained etiology.