Translational andrology and urology最新文献

Background and objective: Managing surgical queues for urinary lithiasis is a persistent challenge in healthcare systems. Despite substantial research in this area, clear criteria for prioritizing patients and determining those who can safely wait longer without complications remain elusive. This review aims to develop a rational framework for optimizing surgical queue management in urinary stone treatment by analyzing primary literature.

Methods: We conducted a review of relevant guidelines, held departmental discussions to identify additional factors, and performed an extensive PubMed search using key terms related to queue management and expectant care in lithiasis.

Key contents and findings: Significant factors identified include stone volume and location, presence of hydronephrosis, patient frailty and comorbidities, recurrent urinary infections, nephrostomy or double-J stent, urinary diversion, high occupational risk, limited healthcare access, and refractory pain impacting quality of life. A detailed analysis of these factors is presented in the article.

Conclusions: Effective management of surgical waitlists for urinary lithiasis requires a comprehensive assessment of factors such as stone characteristics, hydronephrosis, patient frailty, comorbidities, infections, drainage devices, accessibility, and quality of life, as prioritization based solely on waiting time is insufficient and potentially harmful.

Background: Post-operative recurrence for patients with intermediate and high-risk non-muscular invasive bladder cancer (NMIBC) is common. This study aims to evaluate the potential factors of tumor recurrence, and construct a novel nomogram to predict the probability of tumor recurrence.

Methods: We retrospectively enrolled patients with intermediate and high-risk NMIBC who received thulium laser resection of bladder tumors (TmLRBT) or transurethral resection of the bladder tumor (TURBT) followed by intravesical bacille Calmette-Guérin (BCG) immunotherapy. The risk factors were screened by the least absolute shrinkage and selection operator (LASSO) regression method. And multivariate logistic regression was applied to recognize the independent risk factors of bladder cancer recurrence. A nomogram was established, and the recurrence probability was calculated based on the model scores.

Results: A total of 90 patients with intermediate and high-risk NMIBC were included in this study, of whom 53 underwent TURBT and 37 underwent TmLRBT. During the follow-up period, 22 patients (24.4%) experienced bladder cancer recurrence. Three variables were screened out in the LASSO regression. The multivariate logistic analysis suggested that surgery of TURBT [odds ratio (OR) =6.86760; 95% confidence interval (CI): 1.5048-31.34300] and previous bladder tumor (OR =14.73600; 95% CI: 2.81180-77.23000) were independent risk factors of recurrence, while more BCG treatment sessions (OR =0.26504; 95% CI: 0.12455-0.56398) was independent protective factor of recurrence.

Conclusions: Patients with TURBT and previous bladder tumor history were more likely to develop recurrent bladder cancer, while more BCG treatment sessions was independent protective factor of recurrence.

Background: Prostate cancer (PCa) with low levels of prostate-specific antigen (PSA) (0-4 ng/mL) includes PCa detected through biopsy and incidental PCa (IPC) in patients with previous prostate surgeries. The study was conducted to compare these two groups of patients undergoing radical prostatectomy (RP), aiming to assess pathological characteristics and suggest strategies for predicting and managing low PSA PCa.

Methods: A retrospective analysis was performed on two categories of low PSA PCa patients. Baseline characteristics, PSA density (PSAD), preoperative multiparametric magnetic resonance imaging (mpMRI) for RP, preoperative and postoperative pathological data, and biochemical recurrence (BCR) were evaluated.

Results: Fifty patients were analyzed. There were 80% of tumors being clinically significant and in early-stage, indicating a favorable prognosis for most low PSA PCa patients, and the use of preoperative androgen deprivation therapy (ADT) treatment may be beneficial for a small subset of patients with advanced tumors. Patients with low PSA and IPC history had lower PSA levels, PSAD, and prostate volume, however, BCR rates did not significantly differ between low PSA patients with and without IPC history. mpMRI and PSAD demonstrated potential in predicting PCa in low PSA cases.

Conclusions: Predicting low PSA PCa remains challenging, but mpMRI and PSAD could be valuable predictors. Both low PSA groups showed a likelihood of clinical significance, with favorable pathological features. Early diagnosis and treatment are crucial, especially for aggressive IPC PCa tumors. Reevaluating PSA thresholds is vital to avoid missed or misdiagnosed low PSA cases.

Background: The flexible and navigable suction ureteral access sheath (FANS-UAS) is regarded as a complement to flexible ureteroscopy in retrograde intrarenal surgery. Management of lower pole stones (LPS) is challenging due to the difficulty of anatomical access to the inferior renal calyx.

Case description: The novel FANS-UAS (11/13.5 Fr; 40/50 cm length; 7 cm navigable tip length; 180° angulation) from Well Lead Medical (Guangzhou, China) has been commercially-available in July 2024 and first-used in The University of Hong Kong-Shenzhen Hospital. This case series included five candidates (three males; mean age 37.8±15.1 years) with LPS (max. diameter 7-10.5 mm) undergoing FANS-UAS with flexible ureteroscopic lithotripsy. Success rate of FANS-UAS catheterization was 80% as a male patient displayed poor ureter elasticity intraoperatively and the operation had to be completed with a 10/12 Fr tip-flexible UAS and stone basket. LPS, including those with an infundibulopelvic angle <30°, could be easily navigated and removed with insignificant to no residual stones remaining. No stone basket was used. Grade I and II ureteric injuries occurred in two separate patients that were resolved upon four weeks of ureteral stenting. No significant intra- and post-operative complication was observed. The mean total operative duration was 66.5±22.6 minutes. Computed tomography scans were conducted at day one post-operation. Among the cases with successful FANS-UAS insertion, the absolute and relative stone free rate, defined as complete absence and absence of residual fragments <2 mm, was 75% and 100%, respectively. All patients remained stone-free at one-month follow-up with no adverse events.

Conclusions: Early outcomes of the novel 11/13.5 Fr FANS-UAS applied successfully on four patients demonstrate its feasibility, safety, and efficiency in removing LPS. However, improvements in design may be necessitated in the future. For the meantime, prolonged follow-up and larger patient samples are necessitated to further elucidate its outcomes and prognosis.

Background: Internationally, there is a trend towards early urethroplasty for treatment of urethral stricture, as opposed to endoscopic management, which is associated with short-lived patency and frequent retreatments. The objective of this study was to compare the outcomes of urethral stricture management before and after gaining urethral reconstruction expertise through a fellowship programme.

Methods: This was a retrospective case-control study that compared the characteristics, management, and outcomes of urethral stricture disease managed over two consecutive periods of time-pre-fellowship period (September 2016 to September 2019) and the post-fellowship period (October 2019 to September 2022).

Results: There were 37 patients in the pre-fellowship group and 30 patients in the post-fellowship group. Regarding treatment choice, the proportion of patients undergoing index urethroplasty significantly increased from 2.7% to 36.7% [odds ratio (OR) 18.9, 95% confidence interval (CI): 2.7 to 209.8, P<0.008], due to early recognition of strictures not amenable endoscopic treatment. Retreatment became less frequent post-fellowship (37.8% vs. 16.7%, OR 2.99, 95% CI: 1.6 to 5.9, P=0.001). Average number of procedures per patient also reduced (1.65±0.98 vs. 1.23±0.63, P=0.04). Also, there was a trend towards improved overall patency rate at 6-month in the post-fellowship period compared to the pre-fellowship group.

Conclusions: This study has demonstrated that urethral reconstruction expertise was correlated to the increased exposure of urethral stricture patients to urethroplasty as a more efficacious procedure, and was associated with reduced retreatment rates. The expertise can bring cost benefits for patients and regional institutions.

Despite the widespread use of circumcision, several complications can arise, including cosmetic ones. Obesity is a risk factor that can lead to postoperative buried penis after circumcision due to cicatricial scarring. While there are conservative techniques requiring patient commitment to penile manipulation postoperatively to diminish the risk, it remains an ineffective maneuver. Often, surgeons may remove more penile skin than necessary to prevent this complication, or even avoid offering the procedure in these patients. We propose a new technique that prevents buried penis and recurrent phimosis after circumcision in obese patients. There were 4 obese patients, aged 27-63 years old from a single surgeon that underwent circumcision with placement of dartocavernous stitch using 2-0 polydioxanone (PDS). The technique involves placing 2 sutures at 3 and 9 o'clock attaching the proximal and distal Dartos layers to the tunica albuginea. The average body mass index (BMI) was 41.45 kg/m². Two patients had phimosis preoperatively, one had difficulties with hygiene and painful intercourse, and one had a tight foreskin and pain with intercourse. One patient had a standard circumcision performed first complicated by re-phimosis requiring dorsal slit with dartos fixation. All patients had excellent postoperative outcomes both functionally and cosmetically at a minimum of 1-month follow-up. There was no recurrence of buried penis or re-phimosis, while maintaining adequate penile shaft skin. The dartocavernous stitch is a safe and effective surgical technique, with satisfactory functional and cosmetic outcomes in patients undergoing circumcision that are at high risk of developing postoperative re-phimosis. This stitch can be performed in standard circumcision or dorsal slit.

Background: Non-obstructive azoospermia (NOA) is a prevalent cause of male infertility, characterized by the lack of sperm in the ejaculate due to impaired spermatogenesis. Accurate prediction of testicular sperm extraction (TESE) outcomes is pivotal for counseling and managing patients, yet remains challenging due to variability in clinical presentations. This study aimed to establish a predictive model for TESE outcomes in patients with NOA.

Methods: We retrospectively analyzed 425 patients who visited the Andrology Outpatient Clinic of the First Affiliated Hospital of Soochow University between January 2010 and January 2024. Of these, 216 had positive sperm retrieval, and 209 had negative outcomes. We compared testicular volume, reproductive hormone levels, and other clinical parameters between two groups. Multivariate logistic regression was used to identify independent risk factors that were used to establish a predictive nomogram. A calibration curve was used to evaluate the model's fit, whereas receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to assess diagnostic effectiveness and net benefit.

Results: The differences were significant in serum follicle-stimulating hormone (FSH) (P<0.001), body mass index (P=0.04), elastase levels (P=0.005), and testicular microlithiasis levels (P=0.005) between the groups. Multivariate regression identified FSH (P<0.001), testicular volume (P<0.001), and testosterone levels (P=0.003) as independent risk factors for TESE outcomes. FSH levels were negatively correlated [odds ratio (OR) =0.905, 95% confidence interval (CI): 0.876-0.935, P<0.001], while testicular volume (OR =1.453, 95% CI: 1.328-1.591, P<0.001) and testosterone (OR =1.326, 95% CI: 1.098-1.601, P=0.003) were positively correlated. Nomogram based on these factors showed a good fit with an area under the ROC curve of 0.879. The DCA plot demonstrated substantial clinical benefits.

Conclusions: In patients with NOA, low testicular volume, low testosterone levels, and high FSH levels were independent risk factors for unsuccessful TESE. The predictive nomogram provided excellent predictive power for positive TESE outcomes.

Background: Ureteral stents, including internal stents and stentless techniques, are commonly employed in urological procedures such as urinary stone management and deformity correction. However, their use in radical cystectomy for bladder cancer remains relatively limited. This study aimed to compare the efficacy of internal stent, external stent, and no-stent treatments for ureteroileal anastomosis in laparoscopic radical cystectomy (LRC) combined with ileal orthotopic neobladder (IONB). The goal was to compare postoperative outcomes and complications to identify the optimal stent choice.

Methods: A retrospective analysis was conducted on 51 patients who underwent LRC with IONB between April 2013 and December 2023. Patients were divided into three groups: internal stent (Group A), external stent (Group B), and no stent (Group C). Baseline characteristics, perioperative data, and postoperative complications were compared across three groups.

Results: Among the 51 patients (42 males, 9 females; median age: 62 years), internal stents were used in 18 (35.3%, Group A), external stents in 20 (39.2%, Group B), and no stents in 13 (25.5%, Group C) patients. Group A demonstrated significantly shorter hospital stays compared to Groups B and C (P=0.02). Abnormal renal function occurred less frequently in Group A (16.7%) and Group B (15.0%) than in Group C (53.8%, P=0.04). Early postoperative hydronephrosis was significantly different among the three groups (Group A: 5.6%, Group B: 5.0%, Group C: 38.5%; P=0.02). Ureteroileal anastomotic stricture (UIAS) was observed less frequently in Group A (0%) than in Group B (12.5%) and Group C (20.0%, P=0.01). No significant differences were found in other perioperative characteristics or complications.

Conclusions: Internal stents reduce early postoperative complications, including hydronephrosis and renal dysfunction, while lowering the risk of late UIAS. Internal stent use is a safe and effective option that promotes faster recovery and better postoperative outcomes.

Background: Post-biopsy acute urinary retention (AUR) is still a common complication, often leading to extended hospital stays and greater patient discomfort. This study aimed to develop and validate a nomogram for the early identification of AUR after transrectal prostate biopsy (TRPB).

Methods: We collected data on patients who underwent TRPB at The Third Affiliated Hospital of Sun Yat-sen University between January 2019 and November 2023, including all characteristics and prostate morphological parameters. A total of 403 patients were screened for eligibility, and after strict screening, 333 patients were included in the study. These patients were randomly divided into a development cohort (n=233) and a validation cohort (n=100) in a 7:3 ratio. Moreover, the International Prostate Symptom Score (IPSS) and quality of life (QoL) before and after biopsy were collected for 66 patients with AUR with varying post-void residual urine volumes (PVR). Additionally, the voiding situation after catheter removal was also documented. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for AUR. The performance of the nomogram was assessed via calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.

Results: The PVR (200-300 mL) group showed significantly lower IPSS and QoL on post-biopsy day 7 compared to the 301-500 mL and >500 mL groups (P<0.05 and P<0.001, respectively). Additionally, the PVR (200-300 mL) group had the highest urinary catheter removal success rate. Univariate and multivariate logistic regression analyses identified 3 clinical factors-hypercholesteremia, prostatic urethral length (PUL), and the prostatic urethral angle (PUA)-that are significantly correlated with the AUR. This nomogram exhibited strong discriminative ability in both the development and validation cohorts, with an area under the curve (AUC) of 0.834 [95% confidence interval (CI): 0.772-0.896] in the development cohort and an AUC of 0.895 (95% CI: 0.831-0.958) in the validation cohort. The Hosmer-Lemeshow test indicated a well-fitted calibration curve (P=0.69). Furthermore, DCA and the CIC suggested favorable clinical utility for the nomogram.

Conclusions: Here, we first determined that patients unable to void with a PVR >200 mL should be considered as having AUR and developed a nomogram to predict its occurrence, facilitating individualized medical treatment after TRPB.