Therapeutic Advances in Urology最新文献

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.

Renal cell carcinoma (RCC) represents 2.2% of all malignancies worldwide; however, its mortality rate is not negligible. Surgery is the primary treatment for most nonadvanced cases, with its indications and techniques evolving over the years. To provide an update on RCC management in Brazil, focusing on surgery. The Latin American Cooperative Oncology Group-Genitourinary Section and the Latin American Renal Cancer Group gathered a panel of Brazilian urologists and clinical oncologists to vote on and discuss the best management of surgically resectable RCC. The experts compared the results with the literature and graded them according to the level of evidence. For small renal masses (SRMs; less than 4 cm), biopsy is indicated for specific/select cases, and when intervention is needed, partial nephrectomy should be prioritized. Radical nephrectomy and ablative techniques are exceptions for managing SRMs. Patients with small tumors (less than 3 cm), slow tumor growth, or a risk for surgery may benefit from active surveillance. Localized carcinoma up to 7 cm in diameter should be treated preferably with partial nephrectomy. Lymphadenectomy and adrenalectomy should be performed in locally advanced cases if involvement is suspected by imaging exams. Patients with venous tumor thrombi usually require surgical intervention depending on the extent of the thrombus. Neoadjuvant therapy should be considered for unresectable cases. Even in the era of targeted therapy, cytoreductive nephrectomy still has a role in metastatic disease. Metastasectomy is indicated for most patients with resectable disease. This consensus presents recommendations for surgical treatment of RCC based on expert opinions and evidence from the medical literature. Surgery remains the best curative option for nonadvanced cases, and it still has a role for select patients with metastatic disease.

The field of reconstructive urology has seen a paradigm shift in the surgical approach for intra-abdominal cases, resulting in an increased preference for minimally invasive techniques. The introduction of the surgical robot has led to exponential growth in innovative approaches, reflecting the ongoing efforts to improve patient outcomes and address the limitations of open and laparoscopic surgery. This review article summarizes the knowledge gained in the last 10 years about adult robotic ureteral reconstruction. A non-systematic literature review was conducted on February 18, 2024 using Medline, PubMed, Web of Science, and Embase libraries. Studies published in English since 2014 reporting at least five robotic ureteral reconstructive cases for the management of benign ureteral obstruction in adults were included. A narrative review focusing on robotic ureteral reconstructive techniques, their associated success and complication rates, and how the robotic approach compares to open and laparoscopic reconstruction was performed. The current literature demonstrates increased utilization of the robotic platform in reconstructive urological procedures. Robotic surgery has been shown to be associated with shorter learning curves, lower surgeon fatigue, better visualization and equivalent results to those seen with laparoscopic surgery. While the literature is limited by a lack of comparative data, well-designed randomized controlled trials, and standardized criteria for defining and measuring success, this review demonstrates the safety, feasibility, and efficacy of robotic ureteral reconstruction for managing benign ureteral strictures, confirming it as a viable alternative to open and laparoscopic surgery.

Germ cell tumors (GCTs) represent about 5% of urological cancers affecting mostly younger males with increasing incidence in the last decades. GCTs are very sensitive to cisplatin-based therapy and are highly curable regardless of metastatic stage, likely based on having inherited unique mechanisms of sensitivity to DNA damage and other stressors to prevent germline mutations. Here, we present the first case of a 60-year Caucasian male with a heavily pretreated, cisplatin-refractory extragonadal non-seminomatous GCT (choriocarcinoma) treated with pembrolizumab and olaparib based on high programmed death-ligand 1 expression (tumor proportion score 50% and a combined positive score 55%) high tumor mutational burden, borderline genomic loss of heterozygosity, and a heterozygous variant of uncertain significance in the DNA repair gene ATM, as confirmed by next-generation sequencing (NGS) analysis. Despite a notable decrease in b-hCG within 4 weeks after starting pembrolizumab and olaparib, b-hCG increased steadily again afterward. In addition, the patient developed an immune-related pneumonitis with a fatal outcome 3 months later. NGS with subsequent targeted treatment possibilities might present a helpful step toward precision medicine in GCT patients who have exhausted all other conventional treatment options, and genetic testing should therefore be offered to patients prior to progression.

Background: Next-generation imaging (NGI) technologies such as multiparametric magnetic resonance imaging (mpMRI) and total-body NGI (tbNGI) methodologies including choline, fluciclovine or PSMA positron emission tomography/computed tomography (PET/CT), whole-body MRI (wbMRI), and PET/MRI are becoming increasingly available, but their use in different prostate cancer (PCa) settings is under debate. The Gruppo Uro-Oncologico del Nord-Est (GUONE) designed a survey to explore the current clinical practice of NGI utilization in a specific macro-region in North-Eastern Italy.

Methods: A cross-sectional survey was conducted by administering an anonymous online multiple-choice questionnaire to uro-oncologists practicing in North-Eastern Italy, using the Google Forms^® platform. The use of NGI was investigated in the following settings: primary staging of PCa; management of biochemical (BCR) and local recurrence (LR); re-staging in metastatic hormone-sensitive PCa (mHSPC), metastatic castration-resistant PCa (mCRPC), non-metastatic CRPC (nmCRPC), and oligometastatic PCa (OMPC).

Results: In all, 100 uro-oncologists accessed and completed the survey. In primary N/M staging, the use of tbNGI increases in accordance with NCCN risk groups. Re-staging with choline and PSMA PET/CT is the prevalent choice in the case of BCR after radical prostatectomy. Moreover, when the PSA value rises, there is a parallel increased use of tbNGI. When an LR is suspected, PSMA PET/CT plus mpMRI is the most selected option. Re-staging with tbNGI (PSMA PET/CT) is preferred in mHSPC, mCRPC, and nmCRPC patients in case of progression of disease. Overall, there is a limited use of wbMRI and PET/MRI in all the settings investigated.

Conclusion: Our survey describes the expanding role of NGI modalities in the management of PCa patients, from primary staging and re-staging to management of advanced PCa and assessment of treatment response. Several controversial issues have emerged, which need to be addressed in prospective studies to develop a standardized and cost-effective NGI utilization.