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Exploration of the Feasibility of Mini-percutaneous Nephrolithotomy with Gravity-assisted Low-pressure Irrigation in the Treatment of Renal Stones with 'Cat's Paw Sign' Pyonephrosis instead of Multiple Percutaneous Drainage. 重力辅助低压灌洗微创经皮肾镜取石代替多次经皮引流治疗“猫爪征”肾结石的可行性探讨
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-02-11 DOI: 10.1159/000550854
Kai Wang, Rongchang Guo, Xuhong Zhang, Mingxi Xu, Jun Da, Yiwei Wang

: Introduction To investigate the feasibility of mini-percutaneous nephrolithotomy (mPCNL) with gravity-assisted low-pressure irrigation in managing renal pelvic stones complicated by multiple calyceal pyonephrosis (characterized by the "cat's paw sign" on CT scan) as an alternative to multiple percutaneous drainage. Methods A retrospective analysis was conducted on 7 patients (4 males, 3 females; mean age 52.14 years) who underwent one-stage mPCNL between 2019 and 2023. Meticulous preoperative antibiotic prophylaxis was administered, and intraoperative perfusion pressure was maintained below 100 cm H₂O using gravity irrigation. Results All operations were completed successfully without major complications (Clavien-Dindo grade >2). Two patients experienced transient fever, which resolved with targeted treatment. Key outcomes included stable preoperative hemoglobin levels (mean: 107.86 g/L) and manageable postoperative inflammatory markers (CRP: 35.54 mg/L at 12 hours postoperatively). Conclusions mPCNL combined with gravity-assisted low-pressure irrigation is a practical alternative for resource-limited centers, enabling single-tract decompression of all obstructed calyces, immediate stone clearance, and acceptable complications. It is particularly suited for small renal pelves with obstructing stones, providing prompt relief of obstruction and infection while minimizing renal parenchymal damage. However, the small sample size warrants further multicenter studies for validation.

摘要:探讨微型经皮肾镜取石术(mPCNL)联合重力辅助低压冲洗治疗肾盆腔结石合并多发性肾盏肾盂积水(CT扫描表现为“猫爪征”)替代多次经皮引流的可行性。方法回顾性分析2019 - 2023年行一期mPCNL的7例患者(男4例,女3例,平均年龄52.14岁)。术前给予严密的抗生素预防,术中灌流压维持在100 cm H₂O以下。结果所有手术均顺利完成,无重大并发症(Clavien-Dindo分级>2)。2例患者出现短暂发热,经靶向治疗后消退。主要结局包括稳定的术前血红蛋白水平(平均:107.86 g/L)和可控的术后炎症标志物(术后12小时CRP: 35.54 mg/L)。结论mPCNL联合重力辅助低压灌洗是资源有限的中心的实用选择,可以实现所有阻塞肾盏的单束减压,立即清除结石,并发症可接受。它特别适用于有结石阻塞的小肾盂,可迅速缓解阻塞和感染,同时最大限度地减少肾实质损害。然而,小样本量需要进一步的多中心研究来验证。
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引用次数: 0
Absorbable vs. Non-Absorbable Sutures in Plication Surgery for Penile Curvature: A Comparison of Outcomes. 可吸收缝线与不可吸收缝线在阴茎弯曲应用手术中的效果比较。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-02-09 DOI: 10.1159/000550894
Etan Eigner, Nicola Fazaa, Ameer Nsair, Melissa Atallah, Valentin Shabataev, Sergiu Bistritchi, Ariel Zisman

Background: Peyronie's disease is a fibrotic disorder of the tunica albuginea that causes penile curvature and sexual dysfunction. Plication surgery is a standard treatment for men with preserved erectile function; however, non-absorbable sutures may lead to palpable and bothersome nodules.

Objective: To compare surgical and patient-reported outcomes between absorbable and non-absorbable sutures in penile plication surgery.

Methods: This retrospective study included 48 patients who underwent plication surgery between 2013 and 2023 and completed long-term follow-up. Twenty-nine (60.4%) received absorbable sutures and 19 (39.6%) non-absorbable sutures. Mean follow-up was 8.4 ± 2.9 vs 4.0 ± 1.2 years (p < 0.001). Primary outcomes were surgical success (no residual curvature) and bothersome nodularity, both self-reported. Univariate and multivariable logistic regression identified predictors of these outcomes.

Results: Surgical success rates were comparable (62.1% vs 63.2%; p = 0.94). Bothersome nodularity was significantly less frequent with absorbable sutures (6.8% vs 36.8%; p = 0.02). On multivariable analysis, non-absorbable sutures remained the strongest predictor of bothersome nodularity (adjusted OR 18.0; 95% CI 1.36-642; p = 0.057), while no independent predictors of surgical success were identified.

Conclusions: Absorbable sutures reduce bothersome nodularity without compromising surgical outcomes, suggesting improved postoperative comfort with comparable efficacy.

背景:佩罗尼氏病是一种白膜纤维化疾病,可导致阴茎弯曲和性功能障碍。应用手术是男性保留勃起功能的标准治疗方法;然而,不可吸收的缝合线可能导致可触及和麻烦的结节。目的:比较可吸收缝线和不可吸收缝线在阴茎扩张手术中的手术结果和患者报告的结果。方法:回顾性研究纳入48例2013 - 2023年间行手术的患者,并完成长期随访。29例(60.4%)采用可吸收缝线,19例(39.6%)采用不可吸收缝线。平均随访时间为8.4±2.9年vs 4.0±1.2年(p < 0.001)。主要结果是手术成功(无残余弯曲)和麻烦的结节,两者都是自我报告的。单变量和多变量逻辑回归确定了这些结果的预测因子。结果:手术成功率相当(62.1% vs 63.2%; p = 0.94)。可吸收缝线明显减少了恼人的结节(6.8% vs 36.8%; p = 0.02)。在多变量分析中,不可吸收缝线仍然是令人讨厌的结节的最强预测因子(调整后的OR为18.0;95% CI为1.36-642;p = 0.057),而没有发现手术成功的独立预测因子。结论:可吸收缝合线在不影响手术结果的情况下减少了令人烦恼的结节,表明术后舒适度得到改善,疗效相当。
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引用次数: 0
Radiomics for the Prediction of Postoperative Chronic Kidney Disease in Renal Tumor Patients undergoing Surgical Resection. 放射组学用于预测手术切除肾肿瘤患者术后慢性肾脏疾病。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-02-09 DOI: 10.1159/000550856
Julius C Holzschuh, Jonas Bohn, Tobias Norajitra, Klaus Maier-Hein, Heinz-Peter Schlemmer, Olivia Johnston, Sophie Bachanek, Johannes Uhlig, Annemarie Uhlig

Objective: Chronic kidney disease (CKD) is a significant concern following renal tumor surgery, impacting long-term renal function and patient outcomes. This study investigates the potential of CT-based radiomics as a quantitative imaging approach to predict postoperative CKD in kidney tumor patients.

Methods: We included adult patients with renal tumor surgery treated at our center between 2012 and 2022. Preoperative retrospective CT-imaging data were analyzed and radiomic features were extracted from tumor lesions and renal parenchyma. Machine learning models were trained to predict postoperative new-onset CKD based on clinical information and radiomics. Model performance was assessed using five-fold cross-validation on training-set (n=65) and on a separate test-set (n=17). Model performance was primarily evaluated using the receiver operating characteristic (ROC) curve, with the area under the curve (AUC) serving as the principal summary metric.

Results: The study cohort comprised n=82 patients of which n=25; 30% developed postoperative new-onset CKD. Best models achieved a mean validation AUC of 0.74 [95% CI 0.60-0.86] for solely radiomics, 0.83 [0.73-0.93] with clinical information only, and 0.80 [0.67-0.91] on radiomics and clinical parameters, respectively (p > 0.05). For the test dataset, AUCs were 0.62 [95% CI 0.29-0.92], 0.77 [0.50-0.98], and 0.80 [0.52-1.00], respectively (p > 0.05).

Conclusion: Preoperative CT-based radiomic features in combination with clinical information can serve as a non-invasive predictor of postoperative CKD in renal tumor patients undergoing surgical resection. While prospective and external validation is needed, this approach facilitated clinical decision-making and enables personalized treatment strategies in patients with renal tumors.

目的:慢性肾脏疾病(CKD)是肾肿瘤手术后的一个重要问题,影响长期肾功能和患者预后。本研究探讨了基于ct的放射组学作为定量成像方法预测肾肿瘤患者术后CKD的潜力。方法:纳入2012年至2022年间在本中心接受肾肿瘤手术治疗的成年患者。分析术前回顾性ct影像资料,提取肿瘤病变和肾实质的放射学特征。训练机器学习模型,根据临床信息和放射组学预测术后新发CKD。在训练集(n=65)和单独的测试集(n=17)上使用五倍交叉验证来评估模型的性能。模型性能主要使用受试者工作特征(ROC)曲线进行评估,曲线下面积(AUC)作为主要的综合指标。结果:研究队列包括n=82例患者,其中n=25例;30%发生术后新发CKD。最佳模型在单独放射组学时的平均验证AUC为0.74 [95% CI 0.60-0.86],仅临床信息时的平均验证AUC为0.83[0.73-0.93],放射组学和临床参数时的平均验证AUC为0.80 [0.67-0.91](p < 0.05)。对于测试数据集,auc分别为0.62 [95% CI 0.29-0.92]、0.77[0.50-0.98]和0.80 [0.52-1.00](p < 0.05)。结论:术前ct放射学特征结合临床信息可作为肾肿瘤手术切除患者术后CKD的无创预测指标。虽然需要前瞻性和外部验证,但这种方法有助于临床决策,并使肾脏肿瘤患者的个性化治疗策略成为可能。
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引用次数: 0
MANAGEMENT OUTCOMES OF SWL IN URETERAL STONES: Evaluation of Radiological and Patient-Related Factors on a Location-Based Manner. 输尿管结石SWL的治疗结果:基于位置的放射学和患者相关因素的评估。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-02-05 DOI: 10.1159/000550893
Rasim Guzel, Salih Yildirim, Mehmet Bilgin, Mahmut Oguz Ozulu, Hikmet Taha Temizkan, Alper Asik, Kemal Sarica

Aim: To determine the possible predictive value of certain radiological and stone related factors on the stone free (SF) rates following shock wave lithotripsy (SWL) in patients with upper ureteral calculi on a stone location-based manner Material and methods: The success rates of SWL applications in a total of 190 patients (146 males, 44 females M/F :3,32) presenting with ureteral stones were evaluated in detail. The impact of certain radiological and patient related factors on the success rates particularly with an emphasis on the stone location were evaluated. Variables analyzed were the diameter of ureteric portion proximal to the stone, grade of hydronephrosis, stone size, stone density and ureteral wall thickness at the impacted stone site. Success rates in terms of final SF status was evaluated after 4 weeks with non-contrast computer tomography (NCCT) examination.

Results: All patients had a single ureteral stone. A total of 141 stones were located in the upper ureter and 49 in the middle ureter. The mean age was 41.59±11.66 years (range 17-72), and the mean stone size was 8.47 mm (4.1-23.7 mm). After SWL, 108 patients (76.6%) with upper ureteral stones were SF at the 4-week follow-up, whereas this rate was 25 (51.0%) in patients with middle ureteral stones. Although stone diameter was similar between groups, stone length and density were significantly higher in upper ureteral stones (p=0.002 and p=0.007, respectively). Proximal ureteral stones showed higher disintegration and SF rates than mid-ureteral stones (p=0.001).

Conclusions: Prediction of the final outcome of SWL in patients with upper ureteral stones is a challenging issue and our data did clearly indicate a meaningful relationship between UWT and the success rates of SWL particularly in cases requiring additional procedures. Of all the evaluated stone and related factors, only UWT was found to be higher in proximal ureteral calculi at the stone site which could help us to predict the likelihood of stone disintegration in these parts of the involved ureter.

目的:探讨基于结石位置的某些放射学及结石相关因素对输尿管上段结石患者冲击波碎石术(SWL)后无结石(SF)率的可能预测价值。材料和方法:详细评价190例输尿管结石患者(男146例,女44例,男/女:3,32)冲击波碎石术的成功率。评估了某些放射学和患者相关因素对成功率的影响,特别是对结石位置的强调。分析的变量包括结石近端输尿管直径、肾积水程度、结石大小、结石密度和结石影响部位输尿管壁厚度。4周后通过非对比计算机断层扫描(NCCT)检查评估最终SF状态的成功率。结果:所有患者均为单一输尿管结石。141例结石位于输尿管上部,49例位于输尿管中部。平均年龄41.59±11.66岁(17 ~ 72岁),平均结石大小为8.47 mm (4.1 ~ 23.7 mm)。SWL术后4周随访时,上输尿管结石患者有108例(76.6%)发生SF,而中输尿管结石患者有25例(51.0%)发生SF。虽然各组间结石直径相似,但输尿管上部结石的结石长度和密度显著高于对照组(p=0.002和p=0.007)。输尿管近端结石崩解率和SF率高于输尿管中端结石(p=0.001)。结论:预测输尿管上段结石患者SWL的最终结果是一个具有挑战性的问题,我们的数据确实清楚地表明UWT与SWL成功率之间存在有意义的关系,特别是在需要额外手术的情况下。在所有评估的结石及相关因素中,只有输尿管近端结石结石处的UWT较高,这有助于我们预测受灾区输尿管这些部位结石崩解的可能性。
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引用次数: 0
Pelvic lymph node dissection during radical prostatectomy for prostate cancer: harms versus benefits. 前列腺癌根治性前列腺切除术期间盆腔淋巴结清扫:危害与益处。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-02-02 DOI: 10.1159/000550027
Eva Donck, Claudia Fede Spicchiale, Tong Yang, George Bou Kheir, Sofie Verbeke, Pieter De Visschere, Geert Villeirs, Sigi Hendricks, Valerie Fonteyne, Ben Vanneste, Charles Van Praet, Camille Berquin, Robbe Waterschoot, Kathia De Man, Nicolaas Lumen

Introduction: This study aimed to evaluate the harms and oncological benefits of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in prostate cancer patients at risk for regional lymph node invasion (LNI).

Methods: Patients with cN0M0 prostate cancer who underwent RP between January 2013 and February 2023 were included. Patients were categorized into two groups: 334 patients who underwent RP with PLND (group A) and 161 without PLND (group B). Perioperative and oncologic outcomes were assessed, and multivariate analysis identified independent prognostic factors. Inverse Probability of Treatment Weighting (IPTW) was applied to account for baseline differences.

Results: Group A had more advanced disease, longer operation times, and higher complication rates, with 58.3% of complications related to PLND. After a median follow-up of 56 months, there were no significant differences in 4-year biochemical recurrence-free survival (BRFS)(68.9% vs. 75.4%), metastasis-free survival, or overall survival between the groups. Positive surgical margins and tumor grade were independent risk factors for biochemical recurrence, while PLND was not. Cox regression in the IPTW-adjusted cohort confirmed no significant impact of PLND on BRFS (HR 0.70, p=0.09) Conclusion: PLND during RP increases postoperative complications without improving short-term oncologic outcomes, serving mainly as a staging procedure to inform management.

本研究旨在评估有区域淋巴结浸润(LNI)风险的前列腺癌患者在根治性前列腺切除术(RP)中盆腔淋巴结清扫(PLND)的危害和肿瘤学益处。方法:纳入2013年1月至2023年2月期间接受RP治疗的cN0M0前列腺癌患者。患者分为两组:334例RP合并PLND患者(A组)和161例无PLND患者(B组)。评估围手术期和肿瘤预后,并通过多变量分析确定独立预后因素。应用治疗加权逆概率(IPTW)来解释基线差异。结果:A组病情进展较晚,手术时间较长,并发症发生率较高,与PLND相关的并发症占58.3%。中位随访56个月后,两组患者的4年生化无复发生存率(BRFS)(68.9% vs. 75.4%)、无转移生存率或总生存率均无显著差异。手术切缘阳性和肿瘤分级是生化复发的独立危险因素,而PLND不是。经iptw校正的队列Cox回归证实,PLND对BRFS无显著影响(HR 0.70, p=0.09)。结论:RP期间PLND增加术后并发症,但不改善短期肿瘤预后,主要作为分期程序告知管理。
{"title":"Pelvic lymph node dissection during radical prostatectomy for prostate cancer: harms versus benefits.","authors":"Eva Donck, Claudia Fede Spicchiale, Tong Yang, George Bou Kheir, Sofie Verbeke, Pieter De Visschere, Geert Villeirs, Sigi Hendricks, Valerie Fonteyne, Ben Vanneste, Charles Van Praet, Camille Berquin, Robbe Waterschoot, Kathia De Man, Nicolaas Lumen","doi":"10.1159/000550027","DOIUrl":"https://doi.org/10.1159/000550027","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the harms and oncological benefits of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in prostate cancer patients at risk for regional lymph node invasion (LNI).</p><p><strong>Methods: </strong>Patients with cN0M0 prostate cancer who underwent RP between January 2013 and February 2023 were included. Patients were categorized into two groups: 334 patients who underwent RP with PLND (group A) and 161 without PLND (group B). Perioperative and oncologic outcomes were assessed, and multivariate analysis identified independent prognostic factors. Inverse Probability of Treatment Weighting (IPTW) was applied to account for baseline differences.</p><p><strong>Results: </strong>Group A had more advanced disease, longer operation times, and higher complication rates, with 58.3% of complications related to PLND. After a median follow-up of 56 months, there were no significant differences in 4-year biochemical recurrence-free survival (BRFS)(68.9% vs. 75.4%), metastasis-free survival, or overall survival between the groups. Positive surgical margins and tumor grade were independent risk factors for biochemical recurrence, while PLND was not. Cox regression in the IPTW-adjusted cohort confirmed no significant impact of PLND on BRFS (HR 0.70, p=0.09) Conclusion: PLND during RP increases postoperative complications without improving short-term oncologic outcomes, serving mainly as a staging procedure to inform management.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-21"},"PeriodicalIF":1.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomechanics-Driven Rehabilitation for Pelvic Floor Dysfunction: Efficacy and Predictors of Combined Biofeedback Electrical Stimulation and Hip Muscle Training in Postpartum Stress Urinary Incontinence. 生物力学驱动的盆底功能障碍康复:联合生物反馈电刺激和臀部肌肉训练治疗产后应激性尿失禁的疗效和预测因素。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-31 DOI: 10.1159/000550581
Jing Zhang, Ping Li, Xiaoyu Wu, Xiaoyun Wang, Xiaoyan Su, Xiaodan Yang

Objective: This study aims to evaluate the therapeutic efficacy of hip muscle training combined with pelvic floor biofeedback electrical stimulation (BES) in postpartum patients with stress urinary incontinence (SUI) and identify predictors of treatment outcomes.

Methods: A total of 142 SUI patients were randomly allocated to a control group [n = 71, pelvic floor muscle training (PFMT) + BES] or an observation group (n = 71, PFMT + BES + hip muscle training). Outcomes included therapeutic efficacy, pelvic floor muscle strength (GRRUG criteria), and incontinence symptoms (International Consultation on Incontinence Questionnaire-Short Form, ICI-Q-SF). Univariate and multivariate logistic regression analyses were performed to identify predictors of treatment success.

Results: The observation group exhibited a significantly higher total efficacy rate (94.4% vs. 74.6%, P = 0.001) and a greater proportion of grade III or higher pelvic floor muscle strength (88.7% vs. 70.4%, P = 0.007). Post-intervention, the observation group demonstrated superior improvements in leakage frequency, urine volume, and quality of life impact (all P < 0.001). Univariate analysis identified parity, delivery mode, gestational weight gain, fetal weight, episiotomy, bladder neck mobility, SUI severity, and intervention type as significant predictors (P < 0.05). Multivariate analysis confirmed gestational weight gain < 17.5 kg, absence of episiotomy, reduced bladder neck mobility, mild SUI, and combined therapy as independent protective factors (all P < 0.05).

Conclusion: The integration of hip muscle training with pelvic floor BES significantly improves SUI symptoms and pelvic floor function. This biomechanically synergistic approach provides a novel framework for personalized postpartum rehabilitation.

目的:本研究旨在评价臀肌训练联合盆底生物反馈电刺激(BES)治疗产后应激性尿失禁(SUI)患者的疗效,并确定治疗结果的预测因素。方法:142例SUI患者随机分为对照组[n = 71,盆底肌训练(PFMT) + BES]和观察组(n = 71, PFMT + BES +髋关节肌训练)。结果包括治疗效果、盆底肌力(GRRUG标准)和尿失禁症状(国际失禁咨询问卷-短格式,ICI-Q-SF)。进行单因素和多因素逻辑回归分析,以确定治疗成功的预测因素。结果:观察组总有效率明显高于对照组(94.4%比74.6%,P = 0.001), III级及以上盆底肌力比例明显高于对照组(88.7%比70.4%,P = 0.007)。干预后,观察组在漏尿频率、尿量和生活质量方面均有显著改善(均P < 0.001)。单因素分析发现胎次、分娩方式、妊娠体重增加、胎儿体重、会阴切开术、膀胱颈活动度、SUI严重程度和干预类型是显著的预测因素(P < 0.05)。多因素分析证实妊娠体重增加< 17.5 kg、未行会阴切开术、膀胱颈部活动能力降低、轻度SUI和联合治疗是独立的保护因素(均P < 0.05)。结论:髋部肌肉训练与盆底BES相结合可显著改善SUI症状和盆底功能。这种生物力学协同方法为个性化产后康复提供了一种新的框架。
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引用次数: 0
Penile Shear Wave Elastography Can Demonstrate and Classify the Development of Erectile Dysfunction in Patients with Type 1 Diabetes Mellitus: A Prospective Observational Study. 阴茎横波弹性成像可以显示和分类1型糖尿病患者勃起功能障碍的发展:一项前瞻性观察研究。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-22 DOI: 10.1159/000550072
Deniz Noyan Ozlu, Yusuf Arikan, Salih Karaca, Aysegul Oz Ozcan, Zeynep Altin, Busra Emir, Hakan Polat, Mehmet Zeynel Keskin

Introduction: This study aims to evaluate the utility of Penile Shear Wave Elastography (PSWE) in demonstrating erectile dysfunction (ED) in patients with type 1 diabetes mellitus (DM) and to determine an optimal cut-off value.

Methods: Patients aged 18 to 40 who were diagnosed with type 1 DM were included. Erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5). Arterial, venous, and non-vascular etiologies of ED were classified based on peak systolic velocity and end-diastolic velocity data obtained from the penile corpus cavernosum via Penile Doppler Ultrasonography. Five separate PSWE measurements were performed for each patient, and the final kilopascal (kPa) value was calculated as the mean of these five measurements. Patients with IEFF-5 scores ≥17 (no or mild ED) were assigned to Group A, while those with scores <17 (moderate and severe ED) were assigned to Group B.

Results: Among the 132 patients enrolled in the study, 81 had no or mild ED (Group A) and 51 had moderate and severe ED (Group B). PSWE measurements were significantly lower in Group A (p < 0.001). The overall cut-off value for cavernous corporal pressure (CCP) was determined to be 15 kPa. When categorized by the underlying pathology, the cut-off values were 16 kPa for ED due to arterial insufficiency, 13 kPa for venous insufficiency, and 11 kPa for non-vascular causes.

Conclusion: This study categorizes the vascular etiologies of ED with type 1 DM and identifies specific PSWE cut-off values for each category. Implementing closer follow-up protocols for patients exceeding these thresholds may positively impact the treatment of ED patients. However, further research is warranted to validate these findings.

本研究旨在评估阴茎剪切波弹性成像(PSWE)在1型糖尿病(DM)患者勃起功能障碍(ED)诊断中的应用价值,并确定最佳临界值。方法:纳入18 ~ 40岁诊断为1型糖尿病的患者。使用国际勃起功能指数(IIEF-5)对勃起功能进行评估。根据阴茎海绵体的峰值收缩速度和舒张末期速度数据,通过阴茎多普勒超声对ED的动脉、静脉和非血管病因进行分类。对每位患者进行5次单独的PSWE测量,并计算最终的千帕(kPa)值作为这5次测量的平均值。结果:纳入研究的132例患者中,81例患者无ED或轻度ED (A组),51例患者有中度和重度ED (B组)。A组PSWE测量值显著降低(p < 0.001)。海绵体压(CCP)的总体临界值确定为15 kPa。根据基础病理分类,动脉功能不全ED的临界值为16 kPa,静脉功能不全ED的临界值为13 kPa,非血管原因ED的临界值为11 kPa。结论:本研究对ED合并1型DM的血管病因进行了分类,并确定了每种类型的特定PSWE临界值。对超过这些阈值的患者实施更密切的随访方案可能会对ED患者的治疗产生积极影响。然而,需要进一步的研究来验证这些发现。
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引用次数: 0
Perioperative and Periinterventional Antibiotic Prophylaxis in Urology: Key Recommendations from the German Interdisciplinary AWMF S3 Clinical Practice Guideline. 泌尿外科围手术期和介入期抗生素预防:来自德国跨学科AWMF S3临床实践指南的关键建议。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-21 DOI: 10.1159/000550029
Katharina Hauner, Jennifer Kranz, Florian M E Wagenlehner, Sonja Hansen, Gernot Bonkat, Giuseppe Magistro, Matthias May

Perioperative and periinterventional antibiotic prophylaxis remains fundamental to infection prevention in surgical and interventional urology, yet its overuse and unjustified prolongation continue to drive antimicrobial resistance and expose patients to avoidable harm. The newly finalized German interdisciplinary AWMF S3 Clinical Practice Guideline establishes an evidence-based, risk-adapted, and stewardship-oriented framework that redefines antibiotic prophylaxis as a rigorously justified and time-limited intervention. This manuscript distills the urology-specific recommendations and contrasts them with the 2025 EAU Guidelines on Urological Infections, emphasizing alignment, procedural nuance, and practical relevance. The AWMF S3 framework mandates strict indication, intravenous administration 30 to 60 minutes before incision, single-dose prophylaxis for most clean and clean-contaminated procedures, and redosing only when pharmacokinetically warranted, with discontinuation at wound closure as a universal standard. Within urology, resistance-adapted prophylaxis with rectal antisepsis is recommended for transrectal prostate biopsy, whereas transperineal biopsy may be safely performed without antibiotics in low-risk patients with sterile urine and proper antisepsis. Prophylaxis confers no consistent benefit for ureterorenoscopy or cystoscopy in sterile urine, but remains indicated for percutaneous nephrolithotomy, transurethral resection of the prostate, and major open or laparoscopic procedures such as radical prostatectomy and cystectomy, where broad-spectrum single-dose coverage with intraoperative redosing may be required in prolonged surgery. Across all procedures, the AWMF S3 and EAU 2025 recommendations show high concordance, differing primarily in granularity and evidence grading. A risk-adapted, single-dose strategy unites patient safety with antimicrobial stewardship and positions urology as a model discipline for rational, quality-assured infection prevention in modern surgery.

围手术期和围介入期抗生素预防仍然是外科和介入泌尿外科感染预防的基础,但其过度使用和不合理的延长继续推动抗菌素耐药性,并使患者暴露于可避免的伤害。新完成的德国跨学科AWMF S3临床实践指南建立了一个以证据为基础,适应风险和管理为导向的框架,将抗生素预防重新定义为严格合理和有时间限制的干预措施。这篇文章提炼了泌尿科的特定建议,并将其与2025年EAU泌尿科感染指南进行了对比,强调一致性、程序上的细微差别和实际相关性。AWMF S3框架规定了严格的适应症,切口前30至60分钟静脉给药,大多数清洁和清洁污染程序的单剂量预防,只有在药代动力学需要时才重新给药,伤口关闭时停药是普遍标准。在泌尿外科,经直肠前列腺活检推荐采用适应耐药性的直肠消毒预防,而经会阴活检则可以在低风险患者使用无菌尿液和适当消毒的情况下安全进行。对于输尿管镜或膀胱镜检查无菌尿液,预防性治疗没有一致的益处,但仍适用于经皮肾镜取石术、经尿道前列腺切除术和主要的开放或腹腔镜手术,如根治性前列腺切除术和膀胱切除术,在这些手术中,可能需要广谱单剂量覆盖术中再给药。在所有程序中,AWMF S3和EAU 2025的建议显示出高度的一致性,主要在粒度和证据分级方面存在差异。适应风险的单剂量策略将患者安全与抗菌药物管理结合起来,并将泌尿外科定位为现代外科中合理、有质量保证的感染预防的典范学科。
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引用次数: 0
Extended versus Standard Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer: A Real-World Cohort Study. 扩展与标准多西他赛治疗转移性激素敏感前列腺癌:一项真实世界队列研究
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-19 DOI: 10.1159/000550580
Can Aydogdu, Florian Urban, Elena Berg, Melanie Götz, Severin Rodler, Isabel Brinkmann, Benazir Enzinger, Marie Semmler, Frederik Kolligs, Marina Hoffmann, Leo F Stadelmeier, Thilo Westhofen, Lena M Unterrainer, Volker Heinemann, Christian G Stief, Alexander Tamalunas, Jozefina Casuscelli

Background: Androgen deprivation therapy (ADT) plus six cycles of docetaxel was the global first-line standard for metastatic hormone-sensitive prostate cancer (mHSPC) before triplet regimens emerged. In many regions, this approach remains the only accessible option. Whether extending docetaxel beyond six cycles provides additional benefit remains uncertain. This study evaluated the efficacy and safety of extended docetaxel in newly diagnosed mHSPC.

Methods: We conducted a retrospective cohort study of 98 mHSPC patients treated with ADT plus docetaxel (75 mg/m²) at a German tertiary center (2014-2022). Patients were grouped by treatment duration: 4-6 cycles (n=60) vs. 7-10 cycles (n=38). Progression-free survival (PFS1), time to progression after subsequent therapy (PFS2), and overall survival (OS) were analyzed using Kaplan-Meier and Cox models. Adverse events were graded per CTCAE v5.0.

Results: Median PFS1 was similar between groups (12.6 vs. 12.2 months; HR 1.13; p=0.713), as was OS (38.5 vs. 52.9 months; HR 0.99; p=0.958). Extended treatment led to higher overall toxicity (68.4% vs. 38.3%; p=0.004), mainly peripheral neuropathy and dermatologic events, while severe events (grade ≥ 3) were comparable (7.9% vs. 8.3%).

Conclusions: Extending docetaxel beyond six cycles in first-line mHSPC offers no survival advantage and increases toxicity. Six cycles remain an effective, pragmatic standard where triplet therapy is unavailable.

背景:在三联方案出现之前,雄激素剥夺疗法(ADT)加6个周期的多西紫杉醇是转移性激素敏感性前列腺癌(mHSPC)的全球一线治疗标准。在许多区域,这种方法仍然是唯一可行的选择。是否延长多西他赛超过6个周期提供额外的好处仍不确定。本研究评估了延长多西他赛治疗新诊断mHSPC的疗效和安全性。方法:我们对德国三级中心(2014-2022年)接受ADT +多西他赛(75 mg/m²)治疗的98例mHSPC患者进行了回顾性队列研究。患者按治疗时间分组:4-6个周期(n=60) vs. 7-10个周期(n=38)。采用Kaplan-Meier和Cox模型分析无进展生存期(PFS1)、后续治疗后进展时间(PFS2)和总生存期(OS)。不良事件按CTCAE v5.0分级。结果:两组间的中位PFS1相似(12.6 vs 12.2个月;HR 1.13; p=0.713), OS相似(38.5 vs 52.9个月;HR 0.99; p=0.958)。延长治疗导致更高的总毒性(68.4% vs. 38.3%; p=0.004),主要是周围神经病变和皮肤事件,而严重事件(≥3级)相当(7.9% vs. 8.3%)。结论:将多西他赛延长至一线mHSPC治疗6个周期以上不会带来生存优势,反而会增加毒性。在没有三联疗法的情况下,六个周期仍然是有效的、实用的标准。
{"title":"Extended versus Standard Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer: A Real-World Cohort Study.","authors":"Can Aydogdu, Florian Urban, Elena Berg, Melanie Götz, Severin Rodler, Isabel Brinkmann, Benazir Enzinger, Marie Semmler, Frederik Kolligs, Marina Hoffmann, Leo F Stadelmeier, Thilo Westhofen, Lena M Unterrainer, Volker Heinemann, Christian G Stief, Alexander Tamalunas, Jozefina Casuscelli","doi":"10.1159/000550580","DOIUrl":"https://doi.org/10.1159/000550580","url":null,"abstract":"<p><strong>Background: </strong>Androgen deprivation therapy (ADT) plus six cycles of docetaxel was the global first-line standard for metastatic hormone-sensitive prostate cancer (mHSPC) before triplet regimens emerged. In many regions, this approach remains the only accessible option. Whether extending docetaxel beyond six cycles provides additional benefit remains uncertain. This study evaluated the efficacy and safety of extended docetaxel in newly diagnosed mHSPC.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 98 mHSPC patients treated with ADT plus docetaxel (75 mg/m²) at a German tertiary center (2014-2022). Patients were grouped by treatment duration: 4-6 cycles (n=60) vs. 7-10 cycles (n=38). Progression-free survival (PFS1), time to progression after subsequent therapy (PFS2), and overall survival (OS) were analyzed using Kaplan-Meier and Cox models. Adverse events were graded per CTCAE v5.0.</p><p><strong>Results: </strong>Median PFS1 was similar between groups (12.6 vs. 12.2 months; HR 1.13; p=0.713), as was OS (38.5 vs. 52.9 months; HR 0.99; p=0.958). Extended treatment led to higher overall toxicity (68.4% vs. 38.3%; p=0.004), mainly peripheral neuropathy and dermatologic events, while severe events (grade ≥ 3) were comparable (7.9% vs. 8.3%).</p><p><strong>Conclusions: </strong>Extending docetaxel beyond six cycles in first-line mHSPC offers no survival advantage and increases toxicity. Six cycles remain an effective, pragmatic standard where triplet therapy is unavailable.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-20"},"PeriodicalIF":1.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of Oncologic and Functional Outcomes of Orifice Resection via Monopolar and Bipolar System in Bladder Tumors with Orifice Involvement. 经单极系统和双极系统行膀胱肿瘤口切除术累及膀胱口的肿瘤预后和功能比较。
IF 1.3 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-13 DOI: 10.1159/000550478
Yusuf Kadir Topcu, Serkan Yarimoglu, Ertugrul Sefik, Serdar Celik, Deniz Bolat, Ibrahim Halil Bozkurt, Bulent Gunlusoy, Tansu Degirmenci

Background: While monopolar and bipolar energy modalities are commonly used, their comparative impact on oncologic and functional outcomes remains uncertain regarding transurethral resection (TUR) of bladder tumors involving the ureteral orifice.

Methods: A total of 112 patients undergoing TUR for orifice-involved bladder tumors were retrospectively analyzed, with 46 treated with monopolar (Group 1) and 66 with bipolar energy (Group 2). Primary outcomes included upper tract urothelial carcinoma (UTUC) development and functional complications such as new-onset hydronephrosis (HN).

Results: The mean tumor size was significantly larger in group 2 (67.8 mm vs. 45 mm, p = 0.014). UTUC developed in 5 patients in group 1 and 1 patient in group 2 (p = 0.066). Although the mean UTUC-free survival time was longer in group 1 than in group 2 (39.4 ± 23.3 months vs. 5 months), there was no significant difference between the groups (p = 0.578). Postoperative HN occurred in 11 patients in group 1 and 17 patients in group 2 (p = 0.603), and the bipolar group exhibited more spontaneous resolution.

Conclusion: Fewer HN and a trend toward lower UTUC incidence suggest a potential advantage of bipolar systems in preserving ureteral integrity. Prospective randomized trials are warranted to validate these findings and establish evidence-based strategies.

背景:虽然单极和双极能量模式通常被使用,但在经尿道切除(TUR)累及输尿管口的膀胱肿瘤时,它们对肿瘤和功能结果的比较影响仍不确定。方法:回顾性分析112例膀胱累及开口肿瘤行TUR的患者,其中单极能量组46例(1组),双极能量组66例(2组)。主要结局包括上尿路上皮癌(UTUC)的发展和功能并发症,如新发肾积水(HN)。结果:2组平均肿瘤大小明显大于对照组(67.8 mm vs. 45 mm, p = 0.014)。1组5例发生UTUC, 2组1例发生UTUC (p = 0.066)。虽然1组患者平均无utuc生存时间较2组(39.4±23.3个月vs. 5个月)长,但两组间差异无统计学意义(p = 0.578)。组1术后HN发生率为11例,组2术后HN发生率为17例(p = 0.603),双相组术后HN发生率更高。结论:更少的HN和更低的UTUC发生率表明双极系统在保持输尿管完整性方面的潜在优势。有必要进行前瞻性随机试验来验证这些发现并建立基于证据的策略。
{"title":"Comparison of Oncologic and Functional Outcomes of Orifice Resection via Monopolar and Bipolar System in Bladder Tumors with Orifice Involvement.","authors":"Yusuf Kadir Topcu, Serkan Yarimoglu, Ertugrul Sefik, Serdar Celik, Deniz Bolat, Ibrahim Halil Bozkurt, Bulent Gunlusoy, Tansu Degirmenci","doi":"10.1159/000550478","DOIUrl":"https://doi.org/10.1159/000550478","url":null,"abstract":"<p><strong>Background: </strong>While monopolar and bipolar energy modalities are commonly used, their comparative impact on oncologic and functional outcomes remains uncertain regarding transurethral resection (TUR) of bladder tumors involving the ureteral orifice.</p><p><strong>Methods: </strong>A total of 112 patients undergoing TUR for orifice-involved bladder tumors were retrospectively analyzed, with 46 treated with monopolar (Group 1) and 66 with bipolar energy (Group 2). Primary outcomes included upper tract urothelial carcinoma (UTUC) development and functional complications such as new-onset hydronephrosis (HN).</p><p><strong>Results: </strong>The mean tumor size was significantly larger in group 2 (67.8 mm vs. 45 mm, p = 0.014). UTUC developed in 5 patients in group 1 and 1 patient in group 2 (p = 0.066). Although the mean UTUC-free survival time was longer in group 1 than in group 2 (39.4 ± 23.3 months vs. 5 months), there was no significant difference between the groups (p = 0.578). Postoperative HN occurred in 11 patients in group 1 and 17 patients in group 2 (p = 0.603), and the bipolar group exhibited more spontaneous resolution.</p><p><strong>Conclusion: </strong>Fewer HN and a trend toward lower UTUC incidence suggest a potential advantage of bipolar systems in preserving ureteral integrity. Prospective randomized trials are warranted to validate these findings and establish evidence-based strategies.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Urologia Internationalis
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