Translational andrology and urology最新文献

Background: Little is known regarding medical retreatment rates after water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA) for benign prostatic hyperplasia (BPH). We sought to identify incidence and predictors of medical retreatment for symptomatic recurrence among this population.

Methods: We performed a single institution retrospective review of patients who underwent WVTT by a single surgeon from July 2018 to January 2024. We excluded patients with prostate volume >80 cc. Primary outcome was medical retreatment, defined as initiation or resumption of any BPH medication following WVTT.

Results: We identified 155 patients with mean age 67.4±10.3 years and prostate volume 46.4±13.6 cc. Forty-eight (31%) patients underwent medical retreatment within mean follow up of 19.5 months. Mean time to retreatment was 9.8 months. Alpha blockers were the most commonly restarted medication (40.5%), followed by daily tadalafil (25.5%) and 5-alpha reductase inhibitors (10.6%); 23.4% of patients restarted multiple medications. Preoperative use of alpha blockers (95.8% vs. 84.1%; P=0.04), 5-alpha reductase inhibitors (39.6% vs. 23.4%; P=0.04) and daily tadalafil (35.4% vs. 15.0%; P=0.004) significantly predicted medical retreatment. At 3 months, International Prostate Symptom Scores (IPSS) total (15.5±7.9 vs. 9.8±6.1, P=0.002) and quality of life (QoL) (3.2±1.6 vs. 2.4±1.5, P=0.05) were significantly higher in the medical retreatment group. Surgical retreatment within 3 years occurred in 9.7% of the cohort, with nonsignificant higher rates in the medical retreatment group (12.5% vs. 8.4%, P=0.43).

Conclusions: Nearly one-third of patients undergo medical retreatment after WVTT, often within the first year. Early symptom trajectory, preoperative medication use, and close follow-up may help identify patients at risk and improve long-term outcomes.

Background: Spontaneous ureteral rupture is a rare and emergent urological entity, with limited literature guiding its diagnosis and management. Its non-specific presentation can lead to delayed recognition, posing risks of severe complications such as urinoma, sepsis, and renal failure. Currently, there is limited experience regarding the diagnosis and treatment of spontaneous ureteral rupture during pregnancy. Herein, we present a case to illustrate effective diagnostic and therapeutic strategies for managing this rare but potentially life-threatening condition.

Case description: We present a 38-year-old woman at 25 weeks' gestation who presented with acute left flank pain and nausea. Initial ultrasonography revealed bilateral hydronephrosis without evidence of urolithiasis. Non-contrast magnetic resonance urography (MRU) confirmed discontinuity of the left upper ureter wall and perirenal fluid collection. Given the significant urinary extravasation and concerns about retrograde access, percutaneous nephrostomy was performed to prevent infection and preserve renal function. She remained stable throughout pregnancy and underwent an elective cesarean section at 35 weeks. Postpartum antegrade urography at 8 weeks demonstrated a patent ureter, and the nephrostomy tube was subsequently removed without complications.

Conclusions: Clinicians should consider spontaneous ureteral rupture as a differential diagnosis of abdominal pain during pregnancy, even in the absence of calculi. Repeated ultrasonography and MRU are safe and effective imaging modalities for diagnosis of spontaneous ureteral rupture in pregnant patients. Percutaneous nephrostomy can serve as a viable, effective and minimally invasive strategy that protects renal function and ensures maternal-fetal safety.

Background: The coronavirus disease 2019 (COVID-19) pandemic created a paradigm shift in healthcare delivery with rapid utilization of telehealth in urology. Despite cessation of pandemic policies, urologists continue to utilize telehealth at a high rate. While these visits can improve access and convenience for many, the degree to which they translate to in person encounters remains underexplored. This study aimed to evaluate features associated with in-person encounters following a virtual visit within our urology department.

Methods: Telehealth visits in our department with a new or consult billing code between January 2022 and December 2023 were retrospectively identified. The primary outcome was follow-up for an in-person appointment within 90 days. Secondary outcome was the number of surgical procedures. Multivariable logistic regression was used to model associations between patient features and subsequent in-person care, using benign prostatic hyperplasia (BPH) as the referent category for visit diagnosis.

Results: We identified 1,079 video visits, of whom 598 (55%) sought in-person care within 90 days. Following multivariable adjustment, patients living over 150 miles away [adjusted odds ratio (adjOR) 0.56, 95% confidence interval (CI): 0.41-0.78] and prostate cancer visits (adjOR 0.40, 95% CI: 0.30-0.65) were less likely to follow-up in-person. Among returning patients, 413 (69%) underwent urological surgery within 90 days. After multivariable adjustment, kidney cancer (adjOR 0.41, 95% CI: 0.23-0.72), elevated prostate-specific antigen (PSA) (adjOR 0.36, 95% CI: 0.23-0.56), and prostate cancer (adjOR 0.32, 95% CI: 0.22-0.47) were significantly less likely to pursue surgery than BPH visits.

Conclusions: Patients with a shorter travel distance and those being seen for a vasectomy were more likely to pursue in-person care within 90 days after a telehealth visit than those seen for oncologic indications. These findings may be useful to other urology departments seeking to efficiently integrate virtual visits in resource-constrained environments.

Background: Adrenocortical carcinoma (ACC) is an exceptionally rare and aggressive endocrine malignancy with limited treatment options and poor prognosis. Accurate preoperative differentiation from benign adrenal tumors remains a significant clinical challenge. Systemic inflammatory markers, particularly the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have emerged as potential diagnostic tools across various malignancies. However, their specific utility in distinguishing ACC from other adrenal tumors, especially in the context of hypercortisolemia, requires further investigation. This study aimed to evaluate the diagnostic accuracy of NLR and PLR for differentiating ACC from non-ACC adrenal tumors in a Chinese cohort.

Methods: A retrospective analysis was conducted on patients diagnosed with ACC at The First Affiliated Hospital of Xi'an Jiaotong University from 1985 to 2020. The non-ACC adrenal tumors group included patients with pheochromocytoma, aldosteronoma, Cushing's syndrome (CS) due to adrenocortical adenoma (ACA), and nonfunctioning ACA diagnosed from 2018 to 2020. Demographic, clinical, laboratory, and pathological data were collected. NLR and PLR were calculated from preoperative routine blood tests.

Results: This study retrospectively analyzed 45 patients (mean age, 49.33±11.30 years) with ACC, and 533 with non-ACC (mean age, 47.99±12.83 years). The NLR [4.28 (2.58-5.71) vs. 2.43 (1.76-3.38), P<0.001] and PLR [182.72 (142.55-211.45) vs. 135.26 (106.77-178.97), P<0.001] of patients with ACC were significantly higher than those of the non-ACC patients. The areas under the curve for differentiating ACC from non-ACC tumors were 0.742 [95% confidence interval (CI): 0.67-0.82] for NLR and 0.696 (95% CI: 0.63-0.77) for PLR. At a cutoff of >3, NLR showed a sensitivity of 71.11% and specificity of 69.04%. At a cutoff of >140, PLR showed a sensitivity of 84.44% and specificity of 52.91%. The independent predictive factors for ACC were NLR (>3) [odds ratio (OR) =2.819, P=0.04], PLR (>140) (OR =3.238, P=0.03), and tumor size (>48 mm) (OR =565.600, P<0.001). Among patients with CS, there were no significant differences in NLR or PLR between patients with ACC and those with ACA.

Conclusions: For patients without hypercortisolemia, NLR >3 and PLR >140 can be used to differentiate ACC from non-ACC adrenal tumors. For patients with CS, NLR and PLR cannot differentiate ACC from ACA.

Prostate procedures, including radical prostatectomies and transurethral outlet surgeries, are commonly performed in the U.S. with complications such as vesicourethral anastomotic stenosis (VUAS) and bladder neck contracture (BNC) affecting 2-12% of patients. Traditionally, patients with VUAS or BNC have been managed through recurrent dilations or resections, though success rates vary. Steroids and mitomycin C have shown some benefit, but refractory cases may require complex abdominoperineal repairs. Robotic surgeries have improved outcomes, with success rates ranging from 75% to 100%, albeit with the associated increased risks and limitations of intra-abdominal surgeries. In 2021, our group introduced the transurethral incision with transverse mucosal realignment (TUITMR) procedure, a technique that offers a similar approach to robotic urethroplasties by incising scar tissue and advancing healthy bladder mucosa. In a study of 19 patients evaluated within 1 year of surgical correction, TUITMR demonstrated an 89% success rate after one treatment and 100% after two, importantly, with no reported de novo incontinence. This paper highlights the preoperative preparation, surgical technique and postoperative considerations involved in TUITMR overall, as well as particulars related to VUAS and BNC patient populations specifically. The surgical technique is described in detail, along with tips and pearls for each group. Ultimately, we describe a minimally invasive surgical technique that utilizes healthy mucosal tissue to offer a long-lasting, and potentially permanent, solution to bladder neck complications following prostate surgery without the need for open or robotic surgical methods.

Background: Up to now, the underlying molecular mechanisms of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) remain unclear. This study aimed to identify programmed cell death (PCD) associated genes in BPH and PCa development by integrated bioinformatics analysis and machine learning using publicly available genomic datasets.

Methods: The GSE119195 and GSE55597 datasets were downloaded from the Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEGs) were obtained using the Limma package for differential expression analysis. The intersection of core genes was filtered using four machine learning methods [least absolute shrinkage and selection operator (LASSO) regression, eXtreme gradient boosting (XGBoost), random forest, and Boruta].

Results: We identified 159 key genes from the intersection of two DEGs. Fifteen hub genes were obtained by intersecting 159 DEGs with PCD genes. Two hub genes [bone morphogenetic protein 5 (BMP5) and cytochrome p450 family 1 subfamily b member 1 (CYP1B1)] were ultimately chosen after further reducing the dimension of 15 hub genes using four machine learning techniques. The nomogram's findings showed that BMP5 and CYP1B1 together were a reliable indicator of the risk factors of PCa and BPH. Furthermore, the risk score in the GSE55597 dataset displayed an area under the curve (AUC) value of 0.988. Moreover, the risk score in the GSE119195 dataset displayed an AUC value of 1. In addition, PCa patients' prognosis was significantly correlated with CYP1B1, Gleason score, and tumor (T) in the tumor-node-metastasis (TNM) stage.

Conclusions: We established a prediction model with a high predictive ability in the analyzed datasets. As a bioinformatics analysis, our study indicated that there are possible DEGs in the prostate, such as BMP5 and CYP1B1, which might provide further insight for the pathogenesis of BPH and PCa. However, these findings warrant further validation in prospective, real-world clinical studies.

Background: Acute urinary retention in older patients is a major problem that prolongs hospitalization and requires appropriate management. We investigated whether gait function is associated with the resolution of urinary retention in hospitalized patients treated with catheterization to determine its association with urinary retention.

Methods: Patients with post-void residual (PVR) urine of ≥200 mL were treated with intermittent catheterization, medication, and physical rehabilitation, while their gait function was assessed between January and December 2020. The patients were divided into two groups according to their voiding status after treatment: voluntary voiding with PVR urine of <200 mL or continued catheterization. Variables potentially associated with voiding function, including age, sex, bladder outlet obstruction, neurological disorders, comorbidities, medication use, and gait function (walker or non-walker), were compared between the groups.

Results: We analyzed data from 104 patients (62 men, 42 women; median age 78 years, range, 60-95 years). Voluntary voiding with PVR urine of <200 mL was achieved by 64 (62%) patients. Before treatment, 55 (53%) patients were non-walkers. The patients who became walkers after treatment were 13 of 22 (59%) in the voiding group and 2 of 33 (6%) in the catheterization group. Multivariate analysis showed that gait function, but not age, was significantly associated with post-treatment voiding function. Among pretreatment non-walkers, the number of post-treatment walkers was significantly greater in the voluntary voiding group than in the catheterization group [n=13 (59%), P<0.001].

Conclusions: Gait function is associated with voiding outcomes, suggesting that physical rehabilitation to improve mobility may facilitate recovery from acute urinary retention in hospitalized older adults.

Background: Artificial urinary sphincter (AUS) remains the gold standard of urinary incontinence management for moderate and severe cases. However, risks such as erosion, infection, and mechanical failure are present when using these sphincters. Therefore, it is essential to explore this aspect of AUS in order to deliver more effective patient care. This analysis offers the first investigation into medical malpractice cases pertaining to AUS placement.

Methods: The LexisNexis+ and Westlaw databases were used to access all federal and state cases, jury verdicts, and settlements. The LexisNexis+ and Westlaw databases were queried for the term "artificial urinary sphincter" or "artificial urethral sphincter" between the years 1990 and 2024. Cases selected for patients suing a urologist or medical system after implantation of an AUS. Common reasons for exclusion included the plaintiff suing a urologist who performed prostate surgery requiring eventual placement of AUS.

Results: Investigation of the LexisNexis+ database yielded 103 cases. The Westlaw database offered 41 cases. After exclusion criteria, 24 cases were included from the LexisNexis+ database and 3 cases from Westlaw; 14 cases were ruled in favor of the defendant; 4 cases were ruled in favor of the plaintiff with awards ranging from $46,400-$980,000; 4 cases were settled with payouts ranging from $70,000-$4,500,000. The most common cause for litigation included damage to a device, which was a precipitating issue in 46% of cases. Failure of technique of AUS placement was alleged in 33% of cases. The region of the United States with the most cases was the South with 58% of cases. Precipitating issues that resulted in outcomes in favor of the plaintiff were diverse and included failure of informed consent, failure of technique, infection, pain, and damage to the device.

Conclusions: Urologic surgeons placing artificial urethral sphincters face the risk of medical malpractice litigation.

Prostate cancer (PCa) is the second most frequently diagnosed malignancy in men worldwide and a leading cause of cancer-related mortality. The clinical course of PCa is constantly improving, with a trend toward ever greater precision diagnostics and less invasive methods. Magnetic resonance elastography (MRE), a novel modality for quantifying tissue stiffness, significantly enhances detection as a complement to conventional multiparametric magnetic resonance imaging (mpMRI). Providing information about the mechanical properties of prostate tissue, MRE enhances the detection, localization, and characterization of malignant tumors, particularly those that are not optimally visualized with conventional methods. This review covers the underlying principles of MRE, its technological developments, such as tomoelastography, and its application in differentiating PCa from benign prostatic hyperplasia and normal parenchyma. Clinical studies have indicated that increased stiffness of the prostate gland may be associated with cancer aggressiveness, and MRE can be used to improve diagnostic performance when it is combined with mpMRI. Emerging technologies, such as radiomics, artificial intelligence-driven segmentation, and high-frequency driver systems, have created new possibilities for applying MRE in the diagnosis and follow-up of PCa and treatment. In conclusion, MRE can be a great complement to mpMRI, and could potentially improve diagnosis, risk stratification, and treatment monitoring of PCa in future clinical practice.

Background: Prostate cancer (PCa) is the second most common cancer worldwide and a major cause of cancer-related mortality. Although obesity is an established modifiable risk factor for multiple cancer types, conventional anthropometric measures such as body mass index (BMI) fail to capture body fat distribution, particularly visceral adiposity, which is thought to be strongly associated with carcinogenesis. The body roundness index (BRI) is a novel anthropometric metric that provides a more accurate estimation of percent body fat and visceral adipose tissue (VAT) than traditional indices. However, the association between BRI and PCa risk remains unclear in general population-based studies. Therefore, this study aimed to explore the relationship between BRI and PCa.

Methods: Data from 18,732 male participants (aged ≥20 years) in the 1999-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Participants with missing data on PCa status, BRI, or the covariates were excluded. PCa was defined based on self-reported physician diagnosis. BRI was calculated using validated anthropometric formulas. Multivariable logistic regression models assessed the BRI-PCa relationship, adjusting for age, race, education level, marital status, poverty income ratio (PIR), BMI, alcohol use, smoke, hypertension, diabetes, coronary heart disease, stroke, total cholesterol, high-density lipoprotein cholesterol. Restricted cubic spline (RCS) and subgroup analyses evaluated nonlinearity and interaction effects. Receiver operating characteristic (ROC) curves compared BRI's predictive performance against BMI, waist circumference, and weight.

Results: A higher BRI was significantly associated with increased PCa risk. In fully adjusted models, each 1-unit increase in BRI raised PCa odds by 17% [odds ratio (OR) =1.17, 95% confidence interval (95% CI): 1.06-1.28, P<0.001]. Individuals in the highest BRI quartile exhibited a PCa risk that was four-fold higher than those in the lowest quartile (OR =4.00, 95% CI: 2.32-6.90, P<0.001). RCS analysis revealed a nonlinear positive correlation. Subgroup analyses confirmed consistent associations in all subgroups. Compared with BMI [area under the curve (AUC) =0.509, 95% CI: 0.486-0.533], waist circumference (AUC =0.594, 95% CI: 0.572-0.615) and body weight (AUC =0.488, 95% CI: 0.465-0.512), BRI showed a moderate and significant improvement in the discriminative ability of PCa (AUC =0.608, 95% CI: 0.587-0.630) (P<0.001).

Conclusions: Among the general population in the United States, BRI is independently and positively correlated with the risk of PCa. BRI showed modest but significant improvement in PCa risk discrimination compared to traditional obesity indicators, suggesting its potential as a complementary anthropometric tool that merits validation in prospective studies with clinical endpoints.