Urologia Internationalis最新文献

Introduction: Bilateral testicular tumours occur in 3-5% of all cases with testicular neoplasms. In the majority of cases, histology of the two new growths is identical. The time interval between the two neoplastic events rarely exceeds 10 years.

Case presentation: A 29-year-old man of Caucasian descent underwent right-sided orchiectomy for a nonseminomatous germ cell tumour (GCT). Postoperatively, he received adjuvant chemotherapy with 2 cycles of a cisplatin based regimen for clinical stage 1 disease. Twenty-seven years later when aged 56 years, he developed a lump in the left testis. Serum tumour markers including microRNA-371a-3p were within normal limits. Orchiectomy was performed. Histology revealed a spermatocytic tumour with positive stainings of SALL4, NUT, and CD117. No germ cell neoplasia in situ (GCNis) was detected in the tumour-surrounding tissue.

Conclusion: Histogenetically, testicular GCTs are thought to derive from the precursor GCNis, while spermatocytic tumours directly derive from adult spermatogonia. This case is exceptional, firstly because of the very long interval of 27 years between the two neoplastic events, and secondly because of the unprecedented occurrence of two testicular neoplasms with different pathogenetic origins in 1 individual patient.

Introduction: We examined the practice and variability of indwelling urinary catheter changes in male nursing home residents.

Methods: Cross-sectional data from a nationwide survey conducted in a representative sample of German nursing homes in 2023 were analyzed. The professions conducting most transurethral/suprapubic catheter changes in men were identified, and proportions for whom respective catheters are changed in nursing homes were determined. Associations between these proportions and nursing home characteristics were investigated via multivariable logistic regressions.

Results: Of 1,369 invited facilities, 330 (24.1%) participated. Urologists changed most catheters in 72.8% (transurethral catheters) and 88.3% (suprapubic catheters) of the facilities. The median proportion of men whose catheters were changed in nursing homes was 8.5% (transurethral catheters; interquartile range 0.6%-100.0%) and 1.0% (suprapubic catheters; interquartile range 0.0-100.0%). Facilities in which urologists changed most catheters were less likely to have a high proportion (≥90%) of in-home catheter changes compared to the reference group (odds ratio 0.44 [transurethral catheters; 95% confidence interval 0.24-0.82] and 0.30 [suprapubic catheters; 0.12-0.76]).

Conclusion: The proportion of men whose catheters were changed in nursing homes varied considerably between facilities and was lower where urologists were involved.

Introduction: Sexually transmitted infections (STIs) are on the rise globally, yet accurate data regarding infection rates remain scarce. There is the assumption that STIs among women with chronic urinary tract infections (UTIs) have been underestimated. This may arise from the reliance on specialised cultivation or nucleic acid amplification techniques for detection, which are more costly than standard urine culture and are typically only conducted by specialists like urologists.

Methods: A retrospective, observational, single-centre study using medical records of patients who received a urethral swab in a German urological practice in the past 5 years has been conducted.

Results: 55% of patients had a STI requiring treatment. People with recurrent UTIs had a STI in 35% of the cases. Younger age is associated with the detection of STIs. The female gender is significantly associated with a positive swab result.

Conclusion: Distinguishing between cystitis and urethritis, particularly in women with recurrent UTIs experiencing dysuria, presents a clinical challenge. The prevalence of asymptomatic infections suggests that the true burden of urethritis, particularly STIs, may be substantially higher in the general population than currently reported. This underscores the urgency of establishing guidelines for referral and diagnostic evaluation as delayed or inadequate treatment may contribute to escalating infection rates and antibiotic resistance.

Introduction: This study presents a systematic approach for en bloc transurethral enucleation of the prostate utilizing a bipolar system (TUEB), evaluating its effectiveness and safety. Furthermore, the research aims to pinpoint risk factors contributing to early stress urinary incontinence (SUI) after undergoing en bloc TUEB.

Methods: The en bloc TUEB procedure is visually demonstrated through images and videos. A retrospective analysis was conducted based on the data of 88 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent en bloc TUEB between January 2018 and April 2023. Detailed perioperative and follow-up clinical data were collected and analyzed. Patients were categorized based on the occurrence of SUI, and their clinical characteristics were analyzed.

Results: The mean surgical duration was 113.1 ± 50.0 min, resulting in an excised prostate gland weighing 58.0 ± 34.3 g and a hemoglobin drop of 14.3 ± 11.2 g/L. The average enucleation rate was 79.00 ± 11.01%, enucleation efficiency was 0.54 ± 0.26 g/min and prostate-specific antigen reduction rate was 42.08 ± 22.85%. There were no major complications during operation. Twenty-three patients (26.13%) developed early SUI after catheter removal, and 74% of them were in remission within 1 month. Importantly, no cases of persistent SUI were observed. Lower urinary tract symptoms (LUTSs) duration was significantly different between patients with and without postoperative SUI. Residual urine volume, International Prostate Symptom Score (IPSS), and Quality of Life (QoL) score were significantly improved in BPH patients after surgery (p < 0.05). Twelve months after surgery, only 2 patients (2.27%) had urethral stricture, although it recovered after transurethral dilation.

Conclusions: En bloc TUEB is proven to be effective, practical, efficient, and safe with minimal complications. This procedure could be standardized and widely adopted. LUTS duration can predict the risk of early SUI.

Introduction: To assess gender-specific differences in recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) among patients with intermediate or high-risk non-muscle-invasive bladder cancer (NMIBC) receiving BCG was the primary aim of this systematic review and meta-analysis.

Methods: In July 2023, we performed a literature search using MEDLINE, Embase, and the Cochrane Library. This study was prospectively registered at PROSPERO (CRD 2023443269). The detailed review protocol is accessible via CRD.

Results: The systematic literature search identified 6,723 studies, of which 38 fulfilled the inclusion criteria. Random-effect meta-analysis for RFS, based on data from 24 studies, revealed no statistically significant gender-specific difference (HR comparing males to females = 0.9618, 95% CI: 0.8408-1.1003, p = 0.5707). Similarly, for PFS, incorporating data from 14 studies, no statistically significant difference (HR = 0.9540, 95% CI: 0.7709-1.1805, p = 0.6648), for CSS, analysis of data from three studies yielded no statistically significant difference (HR = 0.9228, 95% CI: 0.6196-1.3743, p = 0.6925), and for OS, based on data from two studies, no statistically significant difference was observed (HR = 1.1436, 95% CI: 0.5092-2.5684, p = 0.7452). The risk of bias assessment indicated an overall moderate to high risk of bias.

Conclusion: The findings indicate no association between gender and oncologic outcomes following BCG.

Introduction: The aim of this study was to evaluate the modification of the subserous extramural tunnel for non-refluxing ureteroileal anastomosis in U-shaped pouches using the Wallace technique with a single trough.

Methods: This prospective study was conducted from 2017 to 2022 in a single tertiary center after approval from the Research Ethics Committee of our institution (approval number: FWA 000017585). 45 patients' candidates for radical cystectomy and orthotopic urinary diversion were included in this study. The patients were diverted using a U-shaped pouch with ureteroileal anastomosis, combining the extramural serous-lined tunnel and Wallace techniques in a single trough. Operative time and complications, including ureteric obstruction, reflux, and renal function, were recorded within 1 year.

Results: The modified ureteroileal anastomosis combined with the extramural serous-lined tunnel and Wallace techniques had a relatively short operative time (mean 132.2 ± 18.3 min) and short bowel segment incorporation (30 cm). In 43 patients, vesicoureteral reflux occurred in only 2 patients (4.7%). One case of anastomotic stricture was diagnosed (2.3%), which increased to 2 cases (4.7%) after 1 year. Three patients (7%) developed pyelonephritis during the year. The mean serum creatinine level of the patients before the operation was 1.2 mg/dL, which increased to 1.4 mg/dL 6 months postoperatively.

Conclusion: A modification of the subserous extramural tunnel for non-refluxing ureteroileal anastomosis in U-shaped pouch appears to be a good simple alternative that is less time consuming and using a shorter segment of bowel for orthotopic diversion with a comparable complication rate.

Introduction: We report a progressive treatment of a 31-year-old patient with end-stage renal disease secondary to congenital posterior urethral valve and valve bladder syndrome. He underwent a laser ablation of the urethral valve at the age of six, but on continuance of renal function deterioration ultimately a bilateral ureterocutaneostomy (UC) in the left lower abdomen had to be fashioned as a supravesical urinary diversion.

Case presentation: For the management of dialysis dependent end-stage renal disease, an allogenic renal transplantation was planned. When a postmortal organ was available, the patient wished for a complete internalisation of the incontinent diversion if possible. To better delineate the current status of the lower urinary tract, an intraoperative cystoscopy was performed. Besides an elevated bladder neck and a low bladder capacity, there were no distinct pathologies. Therefore, a right iliac allogeneic renal transplantation with simultaneous dissolution of the bilateral UC and an anastomosis of all three ureters to the bladder was performed. Placement of a suprapubic catheter enabled safe urine drainage and a prospective evaluation of the voiding function. Because of obstructive voiding, we performed a transurethral resection of the prostate. This resulted in sufficient spontaneous voiding.

Conclusion: After a 19-month observation period, the patient now exhibits good renal function with normal excretion and consistent retention parameters with satisfactory transurethral voiding and quality of life (QoL). This is an encouraging case where it was possible to convert an incontinent urinary diversion to a continent urinary diversion after renal transplantation to improve the patient's QoL.

Introduction: This article focused on probing the correlation of magnetic resonance imaging (MRI) and computed tomography (CT) manifestations with biological factor expression and lymph node metastasis (LNM) in aggressive prostate cancer (PCa).

Methods: A total of 136 PCa patients underwent surgical treatment and received CT and MRI examinations before surgery, whereby the apparent diffusion coefficient (ADC) values of quantitative MRI (qMRI) parameters were obtained. Patients were categorized into the non-aggressive PCa group and the aggressive PCa group according to the postoperative pathological results and Gleason scores. The expression of biological factors (prostate-specific antigen [PSA], proliferating cell nuclear antigen [PCNA], p27, and Ki-67) in both groups was tested. CT and MRI manifestations of aggressive PCa patients were analyzed. The qMRI parameters, biological factors levels, and LNM were compared in two groups; the relationships between CT and MRI manifestations, qMRI parameters, and positive expression of biological factors and LNM were probed in two groups.

Results: In the aggressive PCa group, MRI and CT presented different degrees of abnormal prostate changes. In the aggressive PCa group, PSA and p27 expression and ADC values were lower, and PCNA and Ki-67, and LNM rates were higher. Patients' LNM rate was higher than that of ≤2 cm when the tumor diameter was >2 cm. ADC values were positively correlated with PSA and p27 positive expression and negatively correlated with PCNA, Ki-67, and LNM in the aggressive PCa group.

Conclusion: MRI and CT manifestations of aggressive PCa had certain characteristics; MRI manifestations and qMRI possessed a correlation with biological factors and LNM; ADC could be employed to assess the aggressiveness of PCa.

Introduction: Darolutamide is a structurally unique second-generation androgen receptor antagonist that has been approved for indications in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). The aim was to assess the efficacy and safety of Darolutamide for mCRPC.

Methods: In this single-center, open-label study, patients with previously untreated mCRPC were enrolled and received androgen deprivation therapy (goserelin acetate 3.6 mg every 28 days) and docetaxel (75 mg per square meter of body surface area every 21 days) with Denosumab (120 mg every 28 days) for bone metastases, Darolutamide (300 mg orally twice daily) in the experimental group, and the control group received the corresponding of placebo. Serum PSA changes were detected and recorded, and imaging changes and adverse events (AEs) were evaluated. The primary endpoints were safety, tolerability, and antitumor efficacy, and the second endpoint was radiographic progression-free survival (rPFS).

Results: Thirty-seven patients with mCRPC were enrolled. The median time to PSA50 in the Darolutamide group was 1.5 months (95% CI: 0.2619-0.9545), significantly lower than that in the placebo group (3.0 months [95% CI: 1.048-3.818], p = 0.0259). The median time to PSA90 in the experimental group was 4 months (95% CI: 0.3094-1.437), 2 months shorter than that in the placebo group (6.0 months [95% CI: 0.6961-3.232]). With the median follow-up of 6 months, the median decrease in serum PSA was -81.8% (range -60.4 to -99.9%) in the Darolutamide group and -69.4% (range -50.3 to -89.6%) in the placebo group. Tumor-related pain and AEs were not increased, and the median rPFS was not reached.

Conclusions: The combination of Darolutamide and docetaxel was well tolerated with more clinically beneficial than docetaxel alone in previously untreated mCRPC. Darolutamide rapidly reduced PSA levels and prolonged rPFS and did not increase the incidence of AEs.