Urologia Internationalis最新文献

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.

Introduction: 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.

Objective: To conduct a systematic review and meta-analysis comparing ablation therapy (AT) and partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods：This systematic review and meta-analysis were performed in compliance with the PRISMA guidelines. A comprehensive search of the literature published prior to February 1, 2025 was carried out using Pubmed, Embase, Cochran, and Web of Science databases. Stata16 statistical software was utilized for the statistical analysis.

Results: This review has analyzed 32 studies involving a total of 6,030 patients. Patients undergoing AT were found to have shorter operation time (OT), reduced length of stay (LOS), lower complication rates (CR), and decreased estimated blood loss (EBL). The study revealed significant differences between AT and PN in terms of overall survival (OS) and recurrence-free survival (RFS). Nevertheless, no statistically significant differences were observed between the two procedures regarding cancer - specific survival (CSS).

Conclusion: As a minimally invasive treatment for RCC, AT is superior to PN in terms of OT, EBL, LOS, eGFR, and CR. However, it falls short of PN in OS and RFS.

Introduction: Renal cancer is among the ten most common cancers in western societies, with renal cell carcinoma (RCC) accounting for 95% of malignant renal neoplasms. Recent advances in surgical techniques and approaches have expanded treatment options, necessitating an evaluation of optimal approaches.

Methods: A retrospective, propensity-matched cohort with 814 patients (1999-2021) was conducted comparing open and minimally invasive (laparoscopic and robotic-assisted) nephrectomy and partial nephrectomy techniques, focusing on operative time, blood loss, hospital stay, complications, and perioperative complications.

Results: The retroperitoneal (RP) approach demonstrated shorter operation times, reduced blood loss, and quicker recovery compared to the transperitoneal (TP) approach. Minimal invasive techniques, whether laparoscopic or robotic, had shorter hospital stays, fewer complications, and better postoperative renal function. The RP approach showed advantages in operative efficiency and reduced postoperative morbidity.

Conclusion: The findings support that the RP approach is at least as effective as, or superior to, the TP approach in terms of perioperative outcomes. Minimally invasive approaches, including robotic-assisted and laparoscopic techniques, are associated with improved recovery and fewer complications, highlighting their advantages in the surgical treatment of renal tumors. Further studies are needed to assess long-term oncologic and functional outcomes. These findings underline the importance of tailored surgical planning to optimize patient outcomes.

Introduction: The aim of this study was to evaluate the prognostic significance of the Naples Prognostic Score (NPS) in testicular germ cell tumors (TGCT), with a focus on its association with tumor stage, histological subtype, and survival outcomes.

Methods: In this retrospective study, 133 patients with TGCT treated at a single tertiary center between 2015 and 2023 were evaluated. The NPS was calculated for each patient based on pre-treatment albumin, cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Patients were stratified into low (0-2) and high (3-4) NPS groups. Clinicopathological characteristics were compared between NPS groups. Overall survival was analyzed using Kaplan-Meier estimates with log-rank tests, and Cox proportional hazards regression was performed to identify independent prognostic factors.

Results: Patients with high NPS were significantly younger on average and more likely to have non-seminomatous histology, advanced clinical stage, elevated tumor markers, and metastatic disease compared to those with low NPS (all p < 0.01). Overall survival was markedly worse in the high NPS group (p < 0.005). On multivariate analysis, NPS emerged as an independent predictor of poorer overall survival alongside clinical stage (hazard ratio for high NPS ∼ 8.4, p = 0.018).

Conclusion: The NPS is a significant prognostic indicator in TGCT. A high NPS is associated with aggressive disease features and inferior survival outcomes, remaining an independent prognostic factor when controlling for stage. Incorporating NPS into clinical risk stratification may help identify TGCT patients at higher risk of treatment failure, though prospective studies are warranted to validate its utility.

Introduction: Distant metastases and especially single side metastases of non-muscle invasive bladder cancer (NMIBC) without regional progression in lymph nodes are extremely uncommon and rare.

Case presentation: We report a case of a plasmacytoid and sarcomatoid differentiated urothelial NMIIC with a single metastasis to the right ventricle of the heart, which was surgically resected, but the patient died shortly after the resection with progressive metastatic disease. To the best of our knowledge, this is the first case with two different variant histologies in NMIBC with a single heart metastasis. Furthermore, we conducted a rapid review using MEDLINE regarding single heart metastasis of bladder cancer. Four cases have been identified. Interestingly, with 2 cases of variant histology and one with single plasmacytoid differentiation, also being NMIBC.

Conclusion: These findings underline the aggressiveness of the variant histologies in NMIBC, especially plasmacytoid differentiation, and may favor an early and aggressive treatment regimen. Further scientific research concerning the optimal treatment of histologically variant bladder cancer is absolutely needed.

Introduction: This study aimed to investigate the relationship between the International Society of Urological Pathology (ISUP) score upgrade and inflammation in transrectal ultrasound-guided prostate biopsy (TRUS-Bx) specimens.

Methods: The data of 340 patients who underwent robot-assisted radical prostatectomy were retrospectively evaluated, and two groups were formed based on the presence (Group 1, n = 168) or absence (Group 2, n = 172) of an ISUP score upgrade. Prostate characteristics, imaging findings, and inflammation on TRUS-Bx were recorded in both groups for statistical analysis. Univariate and multivariate analyses were used to identify factors predicting the development of the upgrade.

Results: Total inflammation was significantly greater in Group 1 compared to Group 2 (p = 0.04). Glandular-located inflammation was significantly higher in Group 2 compared to Group 1 (p = 0.001). When the factors predicting ISUP score upgrade were examined, glandular inflammation was found to be significant in univariate analysis (p = 0.001), while seminal vesicle invasion in multiparametric magnetic resonance imaging and ISUP grade in TRUS-Bx were found to be significant predictors in multivariate analysis (p = 0.022, p = 0.009, respectively).

Conclusion: Prostatitis accompanying prostate cancer is observed more frequently in patients with an ISUP score upgrade. The location of inflammation may offer insights into predicting an upgrade.

Introduction: The "difficult ureter" specifically denotes narrow and tortuous ureters typically requiring two-stage surgery. We first proposed combining a visible ureteral dilation balloon catheter with a holmium laser to treat ureteral calculi in patients with ureteral stenosis.

Methods: A prospective, multicenter, randomized, open-label, and controlled study enrolled 60 ureteral calculi patients with ureteral stricture from July 2021 to July 2023. Patients were randomly assigned to either first-stage ureteroscopic lithotripsy with direct visualization balloon dilation (DVBD + FUS) or dilation using a scope and inner core (DUS + S). The primary outcome was the success of sheath placement at first-stage surgery, assessed by the secondary operation rate. Secondary outcomes included stone clearance rates, postoperative serum creatinine increase, decreased hemoglobin, total hospital stay, operation time, ureteral stent removal time, ureteral injury, and total surgery costs.

Results: Sixty patients aged 24-68 were enrolled, with stone diameters ranging from 0.6 to 2 cm (average 1.4 cm). After first-stage surgeries, 17 (56.67%) in the DUS + S group and 4 (13.3%) in the DVBD + FUS group required secondary surgery (p < 0.001). The DVBD + FUS group had a significantly shorter hospital stay by 3.2 days (6.60 vs. 3.4 days, p < 0.001) and a shorter operation time by 11 min (p = 0.010). After 3 months, ureteral stent removal times were similar (28.1 ± 8.5 vs. 26.1 ± 6.3 days). Total costs were CNY 7,800 lower in the DVBD + FUS group (p < 0.001). Intraoperative and postoperative complications were comparable. Six-month follow-ups showed no hydronephrosis in either group.

Conclusion: Our study firstly indicated that DVBD + FUS could be an efficacious and safe strategy for treating ureteral calculi in patients with ureteral stricture. Moreover, DVBD + FUS treatment largely decreased total hospital stays, total operation time, and costs.

Background: This work had its origins in the 1990s, when women having collagen-creating midurethral slings for stress urinary incontinence (SUI) and uterosacral slings for uterine prolapse began reporting cure or improvement in co-occurring fecal incontinence, obstructive defecation, and chronic pelvic pain.

Summary: We briefly describe anatomical etiopathogenesis to explain how the same collagen-creating ligament repair system using a common ligament-based diagnostic system, can treat pelvic symptoms from 3 disciplines: Urology, Gynecology, Coloproctology. Collagen-induced laxity in ligaments and vagina diminishes contractile forces required by pelvic muscles to close urethra and anus for continence, open them for evacuation, and stretch the bladder base and rectum like a trampoline to prevent stretch receptors prematurely activating micturition and defecation reflexes. These are perceived cortically as bladder or fecal "urge to go." The pictorial algorithm summarizes common ligament pathogeneses for prolapse/bladder/bowel/pain dysfunctions which can be confirmed by mechanical support of PUL for relief of urine loss on coughing, and uterosacral ligaments (USL) for relief of urge and chronic pelvic pain. The same minimally invasive ligament repairs used for SUI, prolapse, pain/bladder dysfunctions were demonstrated by X-ray defecography controlled studies to cure fecal incontinence, obstructive defecation, anterior rectal wall intussusception and descending perineal syndrome (as shown in 16 case managements in 3 disciplines; video: https://youtu.be/a6jJQXDx71U?si=MLdo3Yq9kAZ82RVb).

Key messages: Symptom relief can be achieved using standard operations which repair PUL or USL even with minimal prolapse. Whether the surgery is done laparoscopically or vaginally is of little consequence, as the same structure is repaired.