Urologia Internationalis最新文献

Introduction: Germany's 2025 hospital reform promotes outpatient care, yet ureterorenoscopy (URS) remains predominantly inpatient. This study compares outcomes of outpatient versus inpatient URS.

Methods: This retrospective, dual-center study compared patients who underwent URS in either an inpatient (Regensburg) or outpatient (Landshut) setting. Surgical parameters, stone-free status, and postoperative complications (classified by Clavien-Dindo) were analyzed. Risk factors for complications were evaluated using chi-square testing.

Results: Baseline characteristics were comparable between groups. Complication rates - particularly Clavien-Dindo grade II - were higher in the outpatient cohort. Residual stone rates, surgical time, and postoperative fever did not differ significantly. Residual stones (p < 0.001) and surgical time above the median (p = 0.003) were identified as significant risk factors for postoperative complications.

Conclusion: Outpatient URS is a safe and effective alternative to inpatient treatment, with comparable stone-free rates, operative times, and postoperative fever incidence. The higher rate of minor complications in the outpatient setting likely reflects a more precautionary antibiotic management strategy rather than increased clinical severity. These findings support broader implementation of outpatient URS, while emphasizing the need for antibiotic stewardship and further prospective, multicenter investigations.

Introduction: Routine systematic prostate biopsy still is recommended beside targeted biopsies, since without it, a significant proportion of prostate cancer (PCa) will be missed. Out of the various methods, we investigated two in a head-to-head comparison: the volumetric-optimized software-supported (VOT) and the conventional cognitive freehand (CFT) ultrasound-guided systematic prostate biopsy.

Methods: This is a retrospective analysis within a consecutive cohort of men undergoing prostate biopsy between 2014 and 2023. Baseline characteristics, diagnostic performance in detecting PCa with corresponding relative risks, have been assessed.

Results: A total of 573 patients have been included into analysis: 135 in the CFT and 438 in the VOT group. In the CFT group, 25 (18.5%) showed positive with significant PCa (defined as Gleason Score ≥7), and in the VOT group 125 (28.5%), respectively. The relative risk for the diagnosis of significant cancer was statistically significantly higher in the VOT compared to the CFT group with a relative risk of 1.54 (95% CI from 1.05 to 2.26), whereas the relative risk for insignificant cancer was almost identical.

Conclusion: Our results showed that VOT has better diagnostic performance than CFT in detecting significant PCa (defined as Gleason Score ≥7). Taking the study limitations into consideration, the corroboration of our results in other cohorts would promote their generalizability.

Introduction: Baseline renal function plays a crucial role in influencing postoperative functional decline following minimal invasive partial nephrectomy (PN), yet its impact remains inadequately understood. This study aimed to elucidate the relationship between baseline renal function and postoperative decline in renal function.

Methods: A retrospective study was conducted on patients undergoing PN for renal tumor from 2014 to 2021 in prospectively maintained cohorts. Patients were divided into CKD (eGFR <60 mL/min/1.73 m2) and normal (eGFR ≥60 mL/min/1.73 m2) renal function groups. Restricted cubic spline (RCS) and multivariate Cox proportional hazard regressions were used to explore the relationship between baseline and postoperative renal function decline.

Results: A total of 546 patients were included for analysis. The average eGFR percent decline was found to be -8.0% (-12.1%, -4.3%), with an eGFR absolute decline of -8.2 (-16.5, -3.0) mL/min/1.73 m2. Patients with severe compromised baseline function experienced higher postoperative complications and CKD-upstage compared to those with normal function (34.5% vs. 16.1%; 23.1% vs. 12.2%). Patients with CKD 3a stage were revealed to experiencing lowest functional decline even after adjusting with other well-known covariates. RCS plotted the risk of reaching >25% decline as a "U"-shaped pattern among patients with different baseline renal functions.

Conclusion: Patients with severe compromised baseline renal function have higher risk of perioperative complications and functional decline. The exact relationship between baseline renal function and postoperative functional decline is nonlinear.

Introduction: Extended pelvic lymphadenectomy (ePLND) is the gold standard for staging prostate cancer (PCa) in patients at risk of lymph node invasion, though its oncological benefit remains debated. Indocyanine green-guided PLND (ICG-PLND) has emerged as a less morbid alternative, but its long-term oncological efficacy compared to ePLND is unclear.

Methods: This extended follow-up of a randomized clinical trial (N = 108) compared ICG-PLND (n = 54) with ePLND (n = 54) in patients undergoing radical prostatectomy. ICG-PLND involved the selective removal of fluorescent nodes, while ePLND followed a standardized template. Primary outcomes included biochemical recurrence (BCR), metastatic progression, and secondary treatment rates. Median follow-up was 52 months.

Results: No significant differences were observed in 52-month BCR-free survival rates (ICG-PLND: 71% vs. ePLND: 73%, p = NS) or pelvic recurrence (ICG: 4 patients vs. ePLND: 2 patients). Distant metastases occurred in 6 ICG and 2 ePLND patients. ICG-PLND detected more pN1 disease (28%) despite fewer nodes being removed (median 7 vs. 24, p < 0.001). Complication rates remained lower with ICG-PLND (32% vs. 70%, p < 0.001).

Conclusions: ICG-PLND demonstrated comparable midterm oncological outcomes to ePLND while significantly reducing morbidity. These findings support ICG-PLND as a safer, targeted alternative for nodal staging in PCa, though longer follow-up is needed to validate survival outcomes.

Introduction: The aim of this study was to explore the role of systemic immune indices (systemic immune-inflammation index [SII] and systemic inflammatory response index [SIRI]) in the differential diagnosis between chromophobe renal cell carcinoma (chRCC) and oncocytoma.

Methods: The medical records of 162 patients diagnosed with chRCC and 90 patients with oncocytoma, who underwent surgery for renal masses between January 2013 and December 2022, were reviewed. Inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), SII, and SIRI, were calculated for both groups. The results were compared to assess the effects of these markers on renal cell carcinoma (RCC) subtypes.

Results: Median age was significantly higher in the oncocytoma group (65 vs. 61 years, p = 0.01). Tumor size was larger in the chRCC group (p < 0.001). NLR, MLR, PLR, SII, and SIRI values were significantly higher in chRCC (all p < 0.001). ROC analysis showed area under the curve (AUC) values of 0.688 (NLR), 0.673 (MLR), 0.750 (PLR), 0.720 (SII), and 0.679 (SIRI). The optimal SII cut-off was 460 (AUC: 0.692), and for SIRI, 0.7 (AUC: 0.647), offering the best discriminative performance between chRCC and oncocytoma.

Conclusion: Inflammatory indices, particularly PLR, SII, and SIRI, are accessible and cost-effective tools that can aid in the preoperative distinction of chRCC from oncocytoma, potentially guiding treatment planning.

Introduction: Adjuvant or salvage systemic therapy after nephrectomy for intermediate- and high-risk clear cell renal cell carcinoma (ccRCC) improves overall survival. However, severe renal impairment represents a relative contraindication to systemic therapy administration. This study aimed to analyze the impact of overweight and obesity at the time of nephrectomy in determining subsequent renal function impairment and limited accessibility to systemic therapy.

Methods: Within a prospectively maintained database, we identified 795 nonmetastatic ccRCC patients at intermediate or high risk of recurrence. BMI was calculated as weight/height (kg/m2), and chronic kidney disease (CKD) upstage was defined as estimated glomerular filtration rate <30 mL/min/1.73 m2. Multivariable Cox regression models assessed the association between BMI and the risk of CKD upstage. Cumulative incidence curves illustrated the risk of disease relapse across different risk groups.

Results: Overall, 504 (63%) were classified as intermediate and 291 (37%) as high risk of recurrence. The median BMI was 26 kg/m2 (IQR: 24-28), with 407 (51%) patients being overweight and 89 (11%) classified as obese. The 5-year risk of disease recurrence was 20% for intermediate and 70% for high-risk patients (p < 0.001). After accounting for patient, surgical, and tumor characteristics, the adjusted risk of CKD upstage increased from 24%-35% to 42%-61% in normal vs. overweight vs. obese patients. BMI resulted as an independent predictor of CKD upstage (hazard ratio [HR] 1.08, p = 0.04). Specifically, overweight (HR: 2.11) and obese (HR: 3.26) patients were at higher risk of CKD upstage (all p < 0.05).

Conclusion: BMI emerges as an important marker of vulnerability to clinically meaningful postoperative renal function decline. Patients with intermediate- or high-risk ccRCC who are overweight or obese may benefit from structured multidisciplinary evaluation, including nutritional assessment, to preserve renal reserve and maintain eligibility for adjuvant or salvage systematic treatments when indicated.

Introduction: The aim of the study was to evaluate the efficacy of Ningmitai capsule (NMT), a traditional Chinese medicine, alone or combined with tamsulosin, in promoting residual stone fragment clearance after ureteroscopic holmium laser lithotripsy (Ho:YAG-URS).

Methods: In this multicenter, prospective, randomized controlled trial, 222 patients with distal ureteral residual fragments (3.18 ± 1.14 mm) post-Ho:YAG-URS were randomly assigned to three groups: control (no medication), NMT (0.38 g × 4 capsules, 3 times/day), or NMT + tamsulosin (0.4 mg/day). Primary outcome was the stone-free rate (SFR) at 4 weeks. Secondary outcomes included stone expulsion rate, stone-free time, and expulsion time.

Results: At 4 weeks, SFRs were 76.19% (control), 92.21% (NMT; p = 0.023 vs. control), and 98.91% (combination; p < 0.001 vs. control). The combination group achieved significantly shorter stone-free time (6.37 ± 2.25 vs. 15.82 ± 21.62 days, p < 0.0001) and expulsion time (2.27 ± 1.17 vs. 6.64 ± 10.56 days, p < 0.0001) compared to the control group. No drug-related adverse events were reported.

Conclusions: NMT significantly accelerates residual fragment expulsion post-Ho:YAG-URS, with synergistic effects observed when combined with tamsulosin. This study demonstrates that patients can benefit from NMTs alone or combined with tamsulosin, particularly for small fragments where alpha-blockers show limited efficacy.

Introduction: Arteriosclerosis is common in candidates for kidney transplantation (KT) due to cardiovascular comorbidities and chronic dialysis. Previous studies have demonstrated the prognostic relevance of pelvic calcification on the surgical outcome after KT. The aim of this study was to evaluate the potential of the computed tomography (CT)-based pelvic calcification score (PCS) as a predictive marker of outcome and survival in KT in a comprehensive analysis.

Methods: A prospectively maintained medical database of patients who received KT was used for the present analysis. Calcification in the common and external iliac arteries was analyzed in the CT scan, resulting in a PCS ranking from 0 to 44 points. Receiver operator characteristic curves were generated to determine the optimal diagnostic criterion threshold for predicting postoperative outcomes and survival. Predictive value and association of the PCS with clinicopathological parameters of the donors, recipients, and transplant procedure were analyzed retrospectively.

Results: A total of 87 KTs (31 female, 35.6%) were included in the study with an average PCS of 19.8 ± 13.2 (range: 0-40), whereby 18.4% showed no calcification of the pelvic arteries. Recipient age and BMI showed a significant correlation with PCS (recipient age: r = 0.622; p < 0.001; recipient BMI: r = 0.276; p = 0.010). Using a PCS cut-off value of 14, there was an association of PCS with delayed graft function (DGF), graft survival and patient survival in univariate analysis; however, PCS failed to be an independent predictor of DGF, graft survival and patient survival after adjusting for other relevant donor, recipient, and transplant characteristics (DGF: OR 1.95, CI: 0.29-12.24, p = 0.493; graft survival: HR: 1.75, CI: 0.70-14.40; p = 0.133; patient survival: HR: 5.72, CI: 0.73-45.18, p = 0.098).

Conclusion: Pelvic calcifications are frequent in patients with KT and found in 81.6% of cases. The PCS is associated with age and BMI and was associated with decreased graft and patient survival. However, PCS fails to be an independent predictor in the multivariable analysis. Larger studies are needed to confirm our preliminary results of the prognostic role of PCS.

Introduction: The aim of this study was to compare the efficacy and safety of two surgical procedures, namely, retroperitoneal laparoscopic simple renal pedicle lymphatic ligation and retroperitoneal laparoscopic perirenal lymphatic ligation, by evaluating the effectiveness and safety of the former.

Methods: A retrospective analysis was conducted on the clinical data of 330 patients with chyluria who underwent laparoscopic simple renal pedicle lymphatic ligation (group A, 92 cases) and laparoscopic perirenal lymphatic ligation (group B, 238 cases) at the First Affiliated Hospital of Nanchang University from January 2011 to September 2023. The surgical duration, intraoperative blood loss, postoperative hospital stay, postoperative drainage tube placement time, perioperative complications, long-term postoperative complications, and recurrence were compared between the two groups, the follow-up period ranged from 12 to 164 months.

Results: All 330 surgeries were completed without any cases requiring conversion to open surgery. Compared to group B, group A was associated with a significant reduction in both postoperative hospitalization duration (6.00 days vs. 7.00 days, p < 0.05) and surgical duration (112.50 min vs. 140.00 min, p < 0.001). Furthermore, group A demonstrated a markedly lower incidence of perioperative complications (5.43% vs. 13.45%, p < 0.05) and reported no cases of late complications (0% vs. 4.62%, p < 0.05). No significant intergroup differences were observed in intraoperative blood loss, time to drainage tube removal, or recurrence rates, indicating that patients in group A recovered faster and had fewer complications were achieved without compromising other safety and efficacy metrics. Multivariate logistic regression analyses revealed that the surgical approach demonstrated a consistent protective effect by significantly reducing both perioperative and long-term complications. Furthermore, a specific laterality (right) were associated with a significantly reduced risk of perioperative complications. Disease duration was identified as an independent risk factor for perioperative complications. In terms of recurrence, albumin level served as the only significant protective factor.

Conclusion: Retroperitoneal laparoscopic simple renal pedicle lymphatic ligation can shorten the operation time and postoperative hospitalization time, and reduce the occurrence of postoperative complications. Compared with retroperitoneal laparoscopic perirenal lymphatic ligation, this method has less trauma, faster recovery, and fewer complications. It is an improved surgical approach that benefits both doctors and patients.

Introduction: Bladder cancer (BC), the most prevalent type of cancer in the urinary system globally, presents a substantial health challenge worldwide. Although the global burden of disease (GBD) study provides valuable insights, thorough analyses of BC are still scarce. This study utilizes the latest GBD dataset to examine the impact of BC, combining current statistics with projections for 2036.

Methods: We analyzed data from the 2021 GBD Study, concentrating on BC-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries and territories, categorized into 21 GBD regions and 5 sociodemographic index (SDI) regions based on the SDI. The data analysis encompassed calculations of relative change, annual percentage change (APC), and estimated APC (EAPC). This research utilized the Spearman algorithm to assess the correlation between disease burden and SDI, conducted age-period-cohort analysis, and performed decomposition analysis. An autoregressive integrated moving average model was employed to forecast trends for the subsequent 15 years.

Results: From 1990 to 2021, the global prevalence of BC cases surged by 127.65%, exceeding 3.02 million, even though age-standardized rates declined. A comparable trend was observed in mortality and DALYs, with absolute numbers increasing while age-standardized rates declined. Gender data from 1990 to 2021 revealed a consistent male predominance in BC prevalence, despite decreasing rates for both sexes. A notable association exists between the disease burden of SDI and BC, and the age-period-cohort model has revealed additional insights. Decomposition analysis suggests that population growth is the primary factor influencing the burden of BC disease, yet predictive analysis projects a decrease in age-standardized disease burden over the next 15 years.

Conclusions: Our analysis reveals a complex interplay between sociodemographic factors and BC trends, underscoring the need for targeted healthcare interventions. Despite progress, vigilance and continued research are crucial for effective BC management globally.