Urologia Internationalis最新文献

Introduction: LEAN is a prospective, multicenter, noninterventional, German cohort study in patients with locally advanced and metastatic hormone-sensitive prostate cancer (PC). This analysis explores the efficacy and safety of leuprorelin in patients with PC and an indication for androgen deprivation therapy (ADT) in routine practice.

Methods: Safety assessment focused on the incidence of major adverse cardiovascular (CV) events (MACEs; a composite of all-cause death, myocardial infarction, or stroke) over the 12-month study period. Patients initiating ADT before enrollment were excluded from the analysis.

Results: Of the 1,372 patients included, MACEs occurred in 57 (4.2%) patients, and in 18/532 (3.4%) versus 39/840 (4.6%) patients without and with a pre-existing CV comorbidity, respectively (p=0.264). Of the 57 MACEs, 17 were CV events and 20 were considered PC related events; in 20 patients, events were classed as 'other' or the context remained unknown. Only one MACE, nonserious arrhythmia, was considered drug related by the urologist. Of the 51 deaths reported in patients with MACEs, 12 were related to a CV event and 20 were related to disease progression.

Conclusion: In a large European patient cohort, leuprorelin-based ADT demonstrated an acceptable safety profile, with a low incidence of CV events.

Introduction and objective Robotic-assisted surgery (RAS) is widely adopted across surgical fields, notably urology, but patient knowledge remains limited, often shaped by misconceptions. Previous research indicates factors like age, profession, and technology use influence RAS perceptions. This study investigates public knowledge, preferences, and misconceptions about RAS within a German cohort. Methods A cross-sectional survey at a university hospital's open house gathered responses from 339 participants prior to an RAS exhibition. The questionnaire assessed demographics, surgical preferences, and RAS knowledge. Statistical analyses, including t-tests, chi-squared tests, ANOVA, and multivariate logistic regression, identified key associations. Results Results showed 71% (234) of participants favored RAS over conventional surgery, yet misconceptions persisted in 38% (122), particularly among pensioners (48% (46) , p < 0.01). Misconceptions were linked to a preference for conventional surgery (43% (52) vs. 19% (36), p < 0.01). Surgical preference emerged as a significant predictor of misconception. Concerns included surgeon skill (41%, 141) and machine malfunction (39%, 132), with younger participants fearing human error and older individuals fearing technical failure (p < 0.01). Conclusion This local study reveals strong public support for RAS but underscores prevalent misconceptions, especially among older adults, suggesting that addressing misconceptions could foster acceptance and informed decision-making.

Introduction: Renal cysts are a common clinical finding necessitating a nuanced approach to management. This study explores outcomes and patient characteristics associated with two interventions for renal cysts: aspiration of renal cyst povidone-iodine sclerotherapy and laparoscopic renal cyst deroofing.

Methods: A study was conducted on patients admitted to urology and nephrology hospital at Assiut University between February 2022 and December 2022. The study population included adult patients diagnosed with renal cysts. Data included demographic information, operative times, post-operative complications, and follow-up assessments.

Results: Our findings revealed the effectiveness of single session povidone-iodine sclerotherapy with a high success rate of 95% and comparable to laparoscopic deroofing (98.3%); however, the patients who underwent laparoscopic deroofing had significantly longer operative times compared to those who underwent aspiration (p < 0.001). Gender did not significantly influence operative time (p = 0.583), but age exhibited a marginal association (p = 0.0667). The overall complications rate (over a period of 6 months) has no significant difference between the two groups. Re-do procedures were infrequent in both groups.

Conclusion: This study showed the outcomes of two common interventions for renal cyst management. The effectiveness of a single session povidone-iodine sclerotherapy in management of symptomatic simple renal cyst in comparison to the gold standard technique of laparoscopic deroofing which is associated with longer operative times and more invasiveness. These insights can guide clinicians in selecting appropriate interventions and managing patient expectations.

Introduction Double J stent is a common medical device, and it may become encrusted causing significant concern. Understanding the composition and associated risk factors for encrusted stents is crucial for appropriate management. Objective: to evaluate the types of DJ encrustation by infrared spectroscopy and correlate them with patient characteristics and computerized tomographic findings. Methods All encrusted stents surgically removed over a one-year period underwent infrared spectroscopy analysis and types of encrustations were compared with the patient's demographic, clinical, and imaging features. For categorical variables, frequency tables were generated and for comparing continuous measurements across multiple groups, the Kruskal-Wallis test was used, considering p<0.05 as statically significant. Results 33 patients were included, the mean age was 46 years, mean BMI was 32.9 ± 8.98 kg/m2. The average DJ indwelling time was 8.3 ± 7.78 months. Spectroscopic analysis: 34.3% struvite, uric acid 22.8%, 17.1% calcium oxalate, 11.4% ammonium urate, 5.7% Brushite, 5.7% calcium oxalate dihydrate, and 2.9% Protein. Lower urine pH was associated with Uric Acid encrustations (p=0.017). Uric Acid and urate encrustations presented significantly lower densities on CT readings (p=0.043). Brushite prevalence was surprisingly high in our series and therefore it has to be considered for early double J encrustation. Conclusion The types of mineral deposits depicted in our study differed from the literature where calcium oxalate is the most common, therefore other compositions such as struvite and uric acid/ ammonium urate should be considered. Urine pH demonstrated an association with uric acid and urate calcifications, which can be predicted by lower densities in CT readings.

Objectives: Outpatient transurethral resection of bladder tumours (TURBT) is not widespread, involving only 5% of patients. Our aim was to assess the feasibility of TURBT in an outpatient setting and to evaluate factors possibly associated with conversion to inpatient care as well as unscheduled care.

Subjects and methods: All consecutive outpatient TURBT performed between January 2016 and December 2022 in one academic center were retrospectively analyzed. Outpatient success was defined as the absence of conversion to conventional hospitalization (CH) as well as the absence of unscheduled care within 30 postoperative days. The quality of the resection was assessed by the presence of detrusor muscle in the surgical specimen.

Results: A total of 500 consecutive outpatient TURBT were included in 376 patients. Outpatient-TURBT was performed for primary tumour diagnosis in 187 (37%) cases, second look in 66 (13%) cases and tumour relapse in 216 (43%) cases. Muscle was present in 86% of cases. Perioperative inpatient conversions occurred in 40 cases (8%). Once converted, patients stayed a median of 2 days IQR[1;3]. Seventy-seven post-TURBT unscheduled care were observed (15%) with 40 emergency room visits (8%) and/or 22 rehospitalizations (4%), occurring on a median post-operative day 3 IQR[1 ; 4]. Overall complication rate was 11% (51 cases of grade 1 and 2 complications (10%) and 6 cases of grade 3 complications (1%)). Multivariate predictors of outpatient-TURBT failure were specimen weight ≥1g (OR=4.35, 95%CI: 1.60 - 13.3, p=0.007), surgery duration (OR=1.03, 95%CI: 1.06 - 1.71), p=0.002) and antiplatelet treatment (OR=2.86, 95%CI: 0.864 - 9.17, p=0.077) Conclusion : Outpatient TURBT appears to be acceptable with an 8% conversion rate, as well as safe, with an 11% complication rate. Quality of the resection was not affected by the outpatient setting. Tumour weight ≥1g, surgery duration and absence of antiplatelet treatment were significant multivariate predictors of outpatient surgery failure.

Introduction: Bladder urothelial carcinoma is highly heterogeneous and is prone to recurrence. There are many types of drugs for intravesical instillation, and there is an urgent need for reliable tumor models for individualized treatment strategies. Patient-derived organoids (PDOs) are efficient and accurate neotype tumor models that can compensate for the deficiencies of traditional tumor models.

Methods: From September 2023 to February 2024, bladder cancer tissues were collected from surgical resections in the Department of Urology, Beijing Tiantan Hospital, Capital Medical University. We explored suitable culture systems and cultured primary tumor cells in Matrigel matrix gels. Hematoxylin and eosin (HE) staining and immunohistochemistry were performed for comparison with the original tumor tissue at the histological level for validation. Drug sensitivity tests were also conducted.

Results: In this study, a culture system for PDOs was successfully established. Hematoxylin and eosin (HE) staining and immunohistochemistry were used to morphologically verify the organ model. Drug sensitivity tests have clarified the value of PDOs as preclinical models of precision medicine. Conclusion A bladder tumor PDOs culture platform was initially established, which laid a foundation for the subsequent construction of the organoid bank, the study of bladder tumor progression mechanism, and research in precision medicine.

Introduction The primary objective of the study was to assess the impact of EF in women with rUTI on quality of life and sexual health. Methods This prospective observational clinical study included 152 patients women who underwent EF because of rUTI and were followed for a minimum of 18 months. The SF-12 questionnaire and the Female Sexual Function Index (FSFI) are used to evaluate quality of life and sexual dysfunction. The Patient Global Impression of Improvement (PGI-I) scale was assessed to evaluate subjective cure. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during cystoscopy Clinical success was defined as no urinary tract infections at the last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year. Chi-square test, Wilcoxon, and Student's paired t-test were used. Results Seventy patients (52.6%) were defined as cured at least a 1-year follow-up. The subjective cure rate was 71.4% (N = 95) according to PGI-I scores. Women had significantly higher average FSFI scores (P=0.001) in the one-year postoperative assessment. Overall, pathological mental health and physical health scores were significantly higher after the intervention (P=0.00). Thirty-one (23.3%) patients improved clinically with <3 infections per year, and 32 (24.1%) patients failed with >3 infections per year. A total of 97 (74.4%) patients had endoscopic resolution postoperative evaluation. Conclusion EF resulted in clinical cure and improvement in the large majority of the patients. A significant proportion of the patients demonstrated enhanced sexual function and quality of life.

Introduction: This research investigates the influence of the medical personnel shortage on the treatment of urolithiasis by comparing the complication rates in patients with urinary stones who undergo ureterorenoscopy with laser lithotripsy before and after the emergence of this unprecedented situation.

Methods: A total of 160 patients undergoing ureterorenoscopy with laser lithotripsy for urolithiasis were retrospectively evaluated, segmented into pre- and post-pandemic cohorts. Complications that occurred preoperatively (during the waiting period for operation), intraoperatively, and postoperatively were documented to compare the complication rates between the two cohorts.

Results: The investigation demonstrated a significant elevation of complications during the preoperative waiting period in the post-pandemic cohort (p < 0.001), concurrent with a substantial increase in the median waiting time from 20 days to 94 days (p < 0.001). No significant differences were present in intra- and postoperative complications between the two cohorts.

Conclusion: In the new era of personnel shortage, increased complication rates during the preoperative waiting time were observed, concomitant with a significant increase in the waiting times for surgery. This novel challenge of increased preoperative morbidity also led to additional resource consumption. It is imperative to adapt the therapeutic landscape of urolithiasis to the new circumstances.

Introduction: The aim of this study was to determine the impact of diabetes and antidiabetic medications on referral and pathological outcomes in uro-oncology cases. We report preliminary results from a single-center study.

Methods: We retrospectively collected data from 781 patients treated between 2018 and 2023 for radical prostatectomy (RP) for prostate cancer (PCa), radical cystectomy (RC) for bladder cancer, radical nephroureterectomy for upper tract urothelial carcinoma, partial nephrectomy and radical nephrectomy (RN) for renal cell carcinoma (RCC). A total of 617 (79%) patients were nondiabetics, and 164 (21%) were diabetics. Patient data were assessed for differences between diabetics and nondiabetics.

Results: All diabetic patients had a significantly higher BMI than nondiabetic patients (p < 0.05 for PCa and p = 0.006 for RC, respectively). In diabetic patients with PCa, a lower proportion of ISUP grade 3 and 5 PCa was seen (p = 0.047). In diabetic RCC patients on antidiabetic medication, there was a significantly higher incidence of recurrence rates after RN (p = 0.015). Penile cancer was diagnosed in diabetic patients at an older age (p = 0.019).

Conclusion: Significantly, higher BMI was observed for RP and RC in diabetic patients, as well as for RCC after RN. Diabetics showed a significantly higher occurrence of recurrence for RCC after RN.

Introduction: The aim of this study was to assess the prognostic value of the preoperative serum ferritin-to-transferrin ratio (FTR) in renal cell carcinoma (RCC).

Methods: We retrospectively reviewed data from 226 patients who underwent surgery for nonmetastatic RCC at our institution between January 1, 2012, and June 30, 2021. Time-dependent receiver operating characteristic (timeROC) analysis identified the optimal FTR cut-off, dividing patients into high and low FTR groups. Propensity score matching (PSM) adjusted for baseline differences. Recurrence-free survival (RFS) and overall survival (OS) were analysed using the Kaplan-Meier method and Cox regression, with a nomogram validating the results.

Results: The timeROC analysis showed a 5-year area under the curve of 0.786 for FTR, with 68.4% sensitivity and 86.7% specificity at a cut-off of 177.1. High FTR and clinical stage were independent risk factors for OS and RFS. The hazard ratios for OS and RFS in the high and low FTR groups were 2.598 (1.087-6.213), p = 0.032 and 2.591 (1.105-6.074), p = 0.029, respectively. Kaplan-Meier curves showed significant differences post-PSM (log rank p < 0.05). The nomogram validation indicated high predictive accuracy with a C-index of 0.867 (95% CI: 0.836-0.899) for OS and 0.808 (95% CI: 0.764-0.852) for RFS.

Conclusion: Our findings suggest that FTR may serve as an independent prognostic risk factor in patients with locally and localized advanced RCC.