Therapeutic Advances in Urology最新文献

Gender-affirming genital reconstruction surgeries (GAGRS) are essential procedures aimed at aligning transgender individuals' physical characteristics with their gender identity. While these surgeries have been shown to improve psychological well-being and overall mental health, they often come with challenges, particularly in preserving sexual sensation and function. Despite advancements in surgical strategies, postoperative sexual rehabilitation remains an underexplored aspect of gender-affirming care. Emerging evidence suggests that transcutaneous electrical nerve stimulation (TENS) may offer a promising noninvasive approach to enhancing sexual function. This paper explores the role of TENS in sexual rehabilitation following GAGRS, emphasizing the need for a more comprehensive approach that goes beyond anatomical reconstruction.

Background: Men with chronic scrotal content pain (CSCP) commonly present to various providers within the healthcare system. Despite its prevalence, little research has been done to understand risk factors for the development of CSCP. In many cases, the cause of pain is unknown, and there are no widely accepted protocols for evaluation or management.

Objective: To characterize associated symptoms and concomitant concerns of those presenting with CSCP.

Design and methods: Retrospective review of validated questionnaires including the Chronic Orchialgia Symptom Index (COSI), the internal index of erectile function, the NIH-chronic prostatitis symptom index, the American Urological Association symptom index/international prostate symptom score, the hip dysfunction and osteoarthritis outcome score, the Oswestry low back pain questionnaire, the patient health questionnaire-9, the general anxiety disorder-7, and a comprehensive intake form on men presenting to a single urologist's office with CSCP was performed. The analysis included constructing linear best-fit lines between subjective chronic testicular pain rating and other numerical rating scales.

Results: Questionnaires from 94 male patients were reviewed. The average pain subscore on the COSI was 8.00 out of 17. When assessing the association between pain and other domains, more severe chronic scrotal pain was associated with worse pain in and around the genitourinary system (p < 0.001), worse urinary symptoms (p = 0.001), worse hip (p = 0.001) and back (p < 0.001) symptoms, worse sexual function (p = 0.025), and worse anxiety (p = 0.019) and depression (p = 0.003) symptoms. Patients in our study were found to have a wide variety of presentations with differing aggravating and relieving factors, urological and surgical histories, and interventions.

Conclusion: Men presenting with CSCP may present with many co-occurring symptoms. More severe scrotal content pain may be associated with worse symptoms in multiple other domains. In order to create a personalized treatment plan, a more comprehensive understanding of these men is critical. Future studies should focus on further developing a standardized approach for assessing these patients and how directed interventions on associated symptoms may impact outcomes.

Background: The evidence supporting personalized surveillance strategies for upper-tract urothelial carcinoma (UTUC) remains limited. This study seeks to explore how smoking habits influence the oncological outcomes of UTUC.

Methods: Data on disease characteristics from UTUC patients were gathered prospectively. Recurrence-free survival was the primary outcome measured. Patients were stratified based on smoking status for Kaplan-Meier and multivariable Cox regression analyses.

Results: A total of 1952 patients were involved, including 684 (35%) patients who never smoked, 572 (29%) that were ex-smokers, and 696 (36%) that were current smokers. For female patients, most of them were nonsmokers (n = 328). Current smokers were significantly younger and had higher American Society of Anesthesiologist (ASA) scores and Charlson Comorbidity Index. A total of 19.9% (n = 236) of patients developed tumor recurrence. Kaplan-Meier analyses showed that smoking status was associated with a greater likelihood of urothelial carcinoma recurrence (p = 0.011) and intravesical recurrence (p = 0.021). The multivariable Cox regression analysis identified the smoking status as an independent risk factor for urothelial carcinoma recurrence (p = 0.046). When compared with former smokers, current smokers showed a higher urothelial carcinoma recurrence (p = 0.016) and intravesical recurrence (p = 0.006).

Conclusion: Smoking at the time of diagnosis was significantly associated with an increased risk of tumor recurrence in the bladder but not significantly in the upper urinary tract. This study confirms that cumulative smoking exposure accelerates the risk of tumor recurrence and underlines the importance of smoking cessation.

Trial registration: NCT02281188.

Background: Urinary tract infections (UTI) are common and costly, but standard urine culture (SUC) diagnostic tests have significant limitations. Emerging molecular techniques like multiplex polymerase chain reaction (PCR) offer rapid simultaneous detection of uropathogens and antimicrobial resistance (AMR) genes allowing timely targeted therapy.

Objectives: To compare the performance of Urine-ID™ test, an expanded multiplex PCR panel designed to detect 26 uropathogens and 49 AMR markers against SUC for pathogen detection in individuals with suspected complicated UTI.

Design and methods: A total of 56 urine specimens from individuals aged 50 and older, who exhibited UTI symptoms and failed previous therapy based on SUC results, were retrospectively analyzed using Urine-ID^™ using the TaqMan^® OpenArray plates on the QuantStudio 12K Flex Real-Time PCR System. Results of simultaneously collected PCR and SUC were compared at patient follow-ups.

Results: Of the 56 suspected UTI cases, SUC failed to detect pathogens in 19.64% (N = 11/56) of the specimens while PCR yielded negative results in 7.14% (N = 4/56) of cases. SUC identified a specific organism in 50% (N = 28/56) while PCR detected at least one uropathogen in 92.86% (N = 52/56) of specimens. Data also revealed that a nonspecific result, "Mixed urogenital flora" (MUG), was the most frequent outcome (N = 18/45) obtained with SUC among positive samples. While SUC identified a single pathogen in 92.80% (N = 26/28) of positive specimens, PCR detected additional co-infecting uropathogens in 71.20% (N = 37/52) of positive samples. Of the 18 MUG and 11 negative samples using SUC, PCR identified treatable pathogens in 13 and 7 samples, respectively.

Conclusion: These results highlight the effectiveness of expanded real-time PCR panels for quickly and accurately identifying uropathogens, surpassing traditional SUC sensitivity. Adopting these advanced molecular techniques, particularly in suspected complicated UTI cases, improves diagnosis efficiency, leading to faster pathogen identification and treatment, ultimately reducing patient morbidity.

Introduction: In recent years, several preliminary reports have suggested that the robot-assisted approach may decrease the surgical morbidity of artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI). However, for now, only short-term outcomes have been reported. The present study aimed to report the 5-year outcomes of robot-assisted AUS implantation in female patients.

Patients and methods: All female patients who underwent a robot-assisted AUS implantation between January 2014 and September 2019 at a single academic center were included in a retrospective study. All robot-assisted female AUS implantations performed after September 2019 were excluded to ensure a 5-year minimum follow-up duration. The indication for AUS implantation was SUI due to intrinsic sphincter deficiency. The primary endpoint was the explantation-free survival and revision-free survival.

Results: Forty-two patients were included. The median age was 66 years (28-84), and 83.8% of the patients had a history of previous anti-incontinence procedure. After a median follow-up of 64 months (16-110), 8 patients were lost to follow-up before the 5-year time point. The 5-year estimated revision-free survival was 89.2 and the 5-year estimated explantation-free survival was 88%. Five AUS explantations were needed (11.9%), and six revisions were required (14.3%). The median time to explantation was 14 months. Four explantations (80%) occurred within the first 18 months, and all of them within the first 27 months. Thirty patients (71.42%) had a complete or improved continence with a complete continence rate of 59.52% and an improved continence rate of 11.9%. There were 10 intraoperative complications (23.8%): 5 bladder injuries and 5 vaginal injuries. Thirteen patients had postoperative complications (30.9%), but only two were Clavien grade ⩾3.

Conclusion: The 5-year outcomes of robot-assisted AUS implantation seem to confirm the promising short-term outcomes that have been reported so far, although revision rates increased with time, which warrants further investigation.

Background: Prostatitis can be challenging to treat. In refractory cases, prostatitis can be treated surgically with transurethral resection.

Objectives: To examine the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) as treatment in patients with prostatitis.

Design and methods: Patients who underwent HoLEP at a single center between January 2021 and August 2023 were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were collected and analyzed. Patients with an ICD-10 diagnosis of prostatitis were identified and contacted postoperatively to evaluate for recurrent symptoms. Statistical significance was defined as p < 0.05.

Results: We identified 918 patients, of whom 26 (2.8%) had a diagnosis of prostatitis. There were no differences in baseline characteristics between patients with and without prostatitis. Patients with prostatitis were less likely to have a history of a neurologic disorder (p = 0.035), less likely to be catheter-dependent (p = 0.005), and less likely to have a preoperative positive urine culture (p = 0.040). There were no significant differences in intraoperative and postoperative parameters between the two groups. There were 23/26 (88.5%) patients with follow-up. There were no episodes of recurrent prostatitis and one episode of UTI after surgery, with a mean follow-up of 19.39 months (range: 7.45-30.19, SD: 7.38).

Conclusion: Prostatitis patients undergoing HoLEP had comparable safety and efficacy profiles to those who did not have prostatitis. On follow-up, 100% of patients with prostatitis did not experience recurrent prostatitis, suggesting that HoLEP may have a role in the management of prostatitis in the presence of benign prostatic enlargement.

Background: Gender-affirming surgery is a growing field to address gender dysphoria, which is an increasingly recognized condition. The surgical robot is an excellent tool for performing some gender-affirming procedures and has been utilized extensively in both feminizing and masculinizing surgery.

Objectives: To provide an overview for the use of the surgical robot in gender-affirming surgeries.

Design: This is a scoping review.

Methods: A literature search was conducted by the authors via PubMed and Google Scholar.

Results: The ability of the robot to operate within the pelvis makes it an excellent platform for performing colpectomy with colpocleisis, hysterectomy, and vaginoplasty. A variety of grafts and flaps are amenable to robotic employment in the setting of gender-affirming surgeries. Finally, many revisions can be performed via the robotic approach, regardless of the approach of a patient's primary surgery.

Conclusion: The surgical robot is a useful tool for performing gender-affirming surgeries, including primary surgeries and revisions. Future research will continue to define roles for the robot in the setting of gender-affirming surgery, improve outcomes, and develop novel techniques.

Background: Traditional pathological diagnosis methods have limitations in terms of interobserver variability and the time consumption of evaluations. In this study, we explored the feasibility of using whole-slide images (WSIs) to establish a deep learning model for the diagnosis of clear cell renal cell carcinoma (ccRCC).

Methods: We retrospectively collected pathological data from 95 patients with ccRCC from January 2023 to December 2023. All pathological slices conforming to the standards of the model were manually annotated first. The WSIs were preprocessed to extract the region of interest. The WSIs were divided into a training set and a test set, and the ratio of tumor slices to normal tissue slices in the training set to the test set was 3:1. Positive and negative samples were randomly extracted. Model training was based on a convolutional neural network (CNN) and a random forest model. The accuracy of the model was evaluated by generating a receiver operating characteristic (ROC) curve.

Results: A total of 663 pathological slices from 95 patients with ccRCC were collected. The mean number of slices per patient was 7.6 ± 2.7 (range: 3-17), with 506 tumor slices and 157 normal tissue slices. There were 200 tumor slices and 74 normal slices in the training set, and a total of 200,870 small images were extracted. There were 250 tumor slices and 63 normal slices in the test set, and a total of 39,211 small images were extracted. According to the CNN model and random forest model trained with the training set, 11 pathological slices in the test set were identified as false normal slices, and six pathological slices were identified as false tumor slices. The total accuracy was 94.6% (296/313), the precision rate was 97.6% (239/245), and the recall rate was 95.6% (239/250). The generated probabilistic heatmaps were consistent with the manually annotated pathological images. The ROC curve results revealed that the area under curve (AUC) reached 0.9658 (95% confidence interval: 0.9603-0.9713), the specificity was 90.5%, and the sensitivity was 95.6%.

Conclusion: The use of a deep learning method for the diagnosis of ccRCC is feasible. The ccRCC model established in this study achieved high accuracy. AI-based diagnostic methods for ccRCC may improve diagnostic efficiency.