Urologia Internationalis最新文献

: 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.