Urologia Internationalis最新文献

Introduction: Posterior urethral valve (PUV) is a major cause of congenital bladder dysfunction, often persisting despite treatment. Emerging therapies, including anticholinergics and α-1 blockers, offer potential but lack clear guidelines. This study evaluates their effectiveness in improving bladder function after valve fulguration.

Methods: Twenty posterior urethral valve patients, aged ≥3 years, were randomized into Anticholinergic (group A, n=11) and α-1 adrenergic blocker (group B, n=9) groups post-fulguration. Follow-up included clinical, radiological, and urodynamic assessments six months post-treatment initiation.

Results: In group A, the mean maximum detrusor pressure (Pdet) decreased from 30.17 to 23.45 cm H2O (p= 0.033). Two patients normalized from high detrusor pressure (>40 cm H2O). In group B, one patient retained high detrusor pressure post-treatment. Group B improved in Q avg and Q max, with all patients having initially low Q avg (<10 ml/sec). Two group B patients showed improved average flow rates post-treatment (p=0.016); three in group A showed improvement, but were not statistically significant (p=0.197). Q max/flow time ratio was abnormal in all group B patients pre-treatment. Two of the nine improved post-treatment, while only one in group A did.

Conclusions: Anticholinergic medications positively impact cystometric parameters and are effective for detrusor instability and low compliance bladder. α-adrenergic blockers influence uroflow parameters and can help treat bladder outflow obstruction. Consideration for a larger study with extended follow-up is warranted.

Introduction: The workload for BPH surgery is expected to rise with an increase in life expectancy and a growing population. Surgical modalities for BPH have evolved, shifting towards minimally invasive transurethral procedures. This study aims to investigate the trends in BPH surgical procedures across medical centers in Israel.

Methods: Data from seven academic medical centers in Israel from 2010 to 2022 were analyzed. Procedures included open prostatectomy, transurethral prostatectomy (TURP), laser enucleation of the prostate (HoLEP), and photovaporization of the prostate (PVP). Statistical analyses were employed, including t-tests, ANOVA, and ARIMA models.

Results: Over 12 years, 13,478 BPH procedures were performed. TURP was the most common (72%), followed by open surgery (12%), HoLEP (12%), and PVP (3%). Annual procedures increased by approximately 5% each year, with a cumulative surge of 63% cases by 2022. The average patient's age remained stable. TURP and HoLEP showed continual growth, while open surgery declined. HoLEP exhibited a shorter length of hospital stay compared to other modalities. Predictive models suggest open prostatectomy will cease within two years, while TURP and HoLEP will continue to rise.

Conclusion: This study highlights a significant increase in BPH surgical procedures over time, with a notable preference for TURP and HoLEP. The findings emphasize the importance of size-independent techniques like HoLEP for optimal healthcare management in the future.

Introduction: Cisplatin-based standardized therapy has been established for metastatic testicular germ cell tumors (TGCTs). However, the patient prognosis is considerably less favorable if the disease recurs following failure of first-line therapies. There is a need for novel treatment options for patients with recurrent or metastatic TGCTs, notably for those that are not sensitive to first-line chemotherapy. With the development of next-generation sequencing technologies, an increasing number of gene mutations has been identified in TGCTs. Previously published research studies have established a link between KRAS mutations and chemotherapy resistance, and have demonstrated that KRAS mutations are associated with inflammatory tumor microenvironment and tumor immunogenicity, leading to an improved response to inhibition of programmed death (PD-1) protein expression. Previous studies have reported that the tumor immune microenvironment of TGCT influences therapeutic efficacy.

Case presentation: A65-year-old metastatic patient with TGCT and a KRAS-12 valine-for glycine gene mutation was described. This patient initially underwent inguinal orchiectomy and received two prior chemotherapeutic regimens. Following the rapid progression of the disease, the patient was treated with anti-PD-1 therapy and nab paclitaxel chemotherapy, and his condition was successfully controlled by this combination treatment.

Conclusion: To the best of our knowledge, this is the first successful case of KRAS-mutation patient with TGCT who achieved partially and sustained disease remission by combining immune checkpoint inhibitors with chemotherapy. This case provides an excellent example for personalized treatment of metastatic TGCTs.

Introduction The aim of this study was to prove if the SARS-CoV-2-pandemic resulted in a delay in diagnosis and treatment of prostate cancer (PC). Methods A monocentric, retrospective analysis was conducted at a university cancer center. Included were all patients with untreated PC diagnosed between January 2019 and December 2021. The observation covered 22 months of the SARS-CoV-2-pandemic and 14 months preceding it. Results 969 men prior (T0) and 1343 during pandemic (T1) where included. Mean age was 68.0 (SD 8.2). Median initial PSA was 8.1 ng/ml (T0) and 7.9 ng/ml (T1, p= 0.288). Time from biopsy to tumor board (T0: 1.3 months vs. T1: 0.9 months, p=0.001), to staging (T0: 1,1 months vs. T1: 0.75 months, p=0.707) and to therapy (T0: 3.0 months vs. T1: 2.0 months, p<0.001) were shortened during pandemic. Classified by d'Amico, a significant shift towards higher risk groups was seen (p=0.024). Local staging showed an insignificant increase in locally advanced PCs. Metastatic diseases decreased from 10.3 % to 8.9% (p=0.433). Pathological staging showed pT3+ in 44.4% vs. 44.7% (p=0.565) and pN+ in 9.9 % vs 9.6% (p=0.899). Conclusion Regarding the diagnosis and treatment of PC, we could not demonstrate any delays due to the SARS-CoV-2-pandemic.

Introduction According to guidelines, transrectal random biopsy of the prostate (TRBP) is performed under antibiotic prophylaxis (AP). Fosfomycin-trometamol (FOS) is not approved in Germany, but TRBP as indication was listed in the product information falsely. Aim was to investigate infectious complications of TRBP under FOS as a single dose. Methods All TRBPs under FOS 3000 mg as a single dose between 1st of July 2020 and 30th of June 2021 at a university institution were recorded. 357 patients (41-85 years old, median 66) were included. 243 received first TRBP, 321 TRBP were MRI-fusionated. 10 to 22 cores were taken (median 14). PSA was 0.1 to 1224ng/ml (median 7.7ng/ml), prostate volume 5 to 263ml (median 50ml). Analysis was performed using Chi square test or Fisher's exact test, Mann-Whitney-U test, and t-test. Results Four patients suffered an infection (1.1%), without significant difference according to age (p=0.849), PSA (p=0.957), number of cores (p=0.905) and increase in volume (p=0.456). Limiting is the retrospective character. Conclusion The complication rate was 1.1%, FOS single dose therefore represents sufficient antibiotic prophylaxis for TRBP in this collective. FOS as a single dose should be re-evaluated in a prospective study to obtain approval in Germany for this indication.

Introduction Lutetium-177 (Lu-177) prostate specific membrane antigen (PSMA) therapy is a radionuclide treatment that prolongs overall survival in metastatic castration-resistant prostate cancer (MCRPC). We aimed to predict lesion-based treatment response after Lu-177 PSMA treatment using machine learning with texture analysis data obtained from pretreatment Gallium-68 (Ga-68) PSMA PET/CT. Methods Eighty-three progressed, and 91 nonprogressed malignant foci on pretreatment Ga-68 PSMA PET/CT of 9 patients were used for analysis. Malignant foci with at least a 30% increase in Ga-68 PSMA uptake after two cycles of treatment were considered progressed lesions. All other changes in Ga-68 PSMA uptake of the lesions were considered nonprogressed lesions. The classifiers tried to predict progressed lesions. Results Logistic regression, Naive Bayes, and k-nearest neighbors' AUC values in detecting progressed lesions in the training group were 0.956, 0.942, and 0.950, respectively, and their accuracy was 87%, 85%, and 89%, respectively. The AUC values of the classifiers in the testing group were 0.937, 0.954, and 0.867, respectively, and their accuracy was 85%, 88%, and 79%, respectively. Conclusion Using machine learning with texture analysis data obtained from pretreatment Ga-68 PSMA PET/CT in MCRPC predicted lesion-based treatment response after two cycles of Lu-177 PSMA treatment.

Introduction: Although albumin-globulin ratio (AGR) has been used in the prognostic assessment of multiple solid malignancies, so far no research has confirmed the prognostic significance of AGR as a biomarker for urachal carcinoma. We analyzed the relationship between AGR and prognosis in urachal carcinoma, aiming to identify a promising prognostic biomarker for urachal carcinoma.

Methods: We reviewed the clinical data of 25 patients diagnosed with urachal carcinoma in the Xiangya Hospital, Central South University, from January 2008 to October 2021. The best cut-off value of preoperative AGR was determined according to the receiver operator characteristic curve. The Kaplan-Meier curve was used to analyze the effect of preoperative AGR on the overall survival (OS) and relapse-free survival (RFS) of patients. Cox proportional hazards model was used to analyze prognostic factors including preoperative AGR.

Results: The best cut-off value of preoperative AGR in urachal carcinoma patients is 1.45. Low preoperative AGR is significantly associated with worse OS and RFS. Univariate analysis and multivariate analysis indicated that low preoperative AGR is an independent and reliable factor to predict poor prognosis, OS, and RFS in urachal carcinoma patients.

Conclusion: Urachal carcinoma patients with low preoperative AGR have worse prognosis, and preoperative AGR is a valuable prognostic indicator for urachal carcinoma research.

BACKGROUNDː To investigate the presence of dysbiosis in patients with naive bladder cancer. METHODSː Twelve male patients with non-invasive bladder cancer and twelve age-matched healthy males had midstream urine and tissue samples taken. A history of endourological interventions was determined as an exclusion criterion, ensuring that the study was designed solely with naïve participants. The bacterial 16s ribosomal RNA V3-V4 regions were used to examine urine and tissue samples. We compared the microbiota composition of the bladder cancer and control groups. RESULTSː Escherichia Shigella (p<0.001), Staphylococcus (p<0.001), Delftia (p<0.001), Acinetobacter (p<0.001), Corynebacterium (p<0.001), and Enhydrobacter (p<0.001) were abundant in bladder cancer tissue samples. Escherichia Shigella (p<0.001), Ureaplasma (p<0.001), Lactobacillus (p=0.005), Stenotrophomonas (p<0.001), Streptococcus (p<0.001), Corynebacterium (p<0.001), and Prevotella (p=0.039) were abundant in bladder cancer urine samples. Midstream urine has a sensitivity of 83% for detecting dysbiotic bacteria in cancer tissue. CONCLUSIONSː Our research is the first microbiota study of bladder cancer done with naive patients who have never had an endourological intervention. Escherichia Shigella, Staphylococcus, Acinetobacter, Enhydrobacter, Delftia, Corynebacterium, and Pseudomonas were detected as dysbiotic bacteria in bladder cancer. The sensitivity of the midstream urine sample in detecting dysbiosis in tissue is %83.

Introduction: In order to examine the susceptibility profile of Escherichia coli in urinary tract infections among elderly diabetic patients to support judicious and evidence-based antibiotic use.

Methods: From January 2021 to December 2022, urine culture results were analyzed to determine the distribution of pathogens, especially Escherichia coli, and their drug susceptibility.

Results: Escherichia coli infection was the most prevalent infection in elderly diabetic patients with urinary tract infections, accounting for 32.6% of cases. Moreover, this bacterium's multiple resistance rate (38.3%) was significantly higher than other bacteria's multiple resistance rate (χ2=81.644, P<0.05). Compared to older diabetic patients with optimal glucose control (HbA1c≤7.0%), patients with poor glycemic control (HbA1c>7.0%) had lower resistance rates to lactams and urine pH values were higher (P <0.05).

Conclusion: The most common cause of urinary tract infections (UTIs) is Escherichia coli, with advanced age and diabetes being the main risk factors. To optimize UTI treatment safety and efficacy, antibiotics should be administered based on the patient's age and blood glucose control.

Introduction: The safety and effectiveness of percutaneous nephroscopic surgery without artificial hydronephrosis remain controversial, and there are few relevant studies. This retrospective study aimed to compare the efficacy of two different methods of eliminating and creating artificial hydronephrosis in percutaneous nephrolithotomy(PCNL) in the oblique supine position.

Methods: This is a retrospective study. A total of 162 patients who underwent PCNL in an oblique supine position at our hospital were divided into two groups according to the surgical method: the free artificial hydronephrosis group (Group A) and the artificial hydronephrosis group (Group B). Group A was directly treated with PCNL under ultrasound guidance and group B was treated with artificial hydronephrosis before PCNL. Several outcomes were measured, including operation time, stone clearance rate, and incidence of complications.

Results: The operation time in Group A lower than that in Group B, and the incidence of sepsis was significantly lower in group A than in Group B (P<0.05). There was no statistical difference in stone clearance rate, success rate of primary establishment of puncture channel, unilateral change in perioperative red blood cell count, change in perioperative renal function, and perioperative complications (except sepsis) between the two groups (P>0.05).

Conclusion: For experienced physicians, percutaneous nephrolithotomy without artificial hydronephrosis in an oblique supine position can be attempted to reduce the number of surgical steps without affecting the stone clearance rate and increasing the occurrence of complications.