Urologia Internationalis最新文献

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.

Introduction: The aim of this study was to evaluate the predictive value of the Node Reporting and Data System (Node-RADS) for lymph node involvement (LNI) in prostate cancer (PCa) using preoperative multiparametric MRI (mpMRI) and to assess its utility in risk stratification.

Methods: This retrospective cohort study reviewed 1,263 patients with PCa who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) between 2016 and 2024. Ninety-four patients with a Briganti score ≥7% were selected through 1:1 matching based on age, PSA, clinical T stage, and biopsy Gleason score. All underwent standardized laparoscopic extraperitoneal RP. Node-RADS scores were assigned based on preoperative mpMRI and analyzed using logistic regression and receiver operating characteristic (ROC) analysis to assess diagnostic performance. Statistical significance was set at p < 0.05.

Results: Node-RADS scores were significantly associated with histopathologically confirmed LNI (p < 0.001). Logistic regression confirmed Node-RADS as an independent predictor, with higher scores linked to increased LNI risk. ROC analysis demonstrated strong diagnostic performance (area under the curve = 0.928), with 83.0% sensitivity and 91.5% specificity at a cutoff ≥4. In contrast, PSA levels, Gleason score, and clinical T stage did not significantly predict LNI (p > 0.05).

Conclusion: The Node-RADS system offers a robust and standardized imaging-based approach for preoperative assessment of LNI in PCa. Its integration into clinical workflows may enhance the accuracy of risk stratification, facilitate more appropriate patient selection for ePLND, and ultimately reduce overtreatment.

Introduction: The study aimed to compare pain scores during flexible cystoscopy among male patients in different positions: supine position versus lithotomy position.

Methods: This prospective randomized controlled trial included male patients undergoing flexible cystoscopy at a tertiary care hospital. The pain level was assessed immediately after the procedure using the visual analog pain scale, and the cystoscopic time was recorded.

Results: This randomized study involved 142 male patients undergoing flexible cystoscopy, equally divided into two groups as 71 men in the supine and 71 men in the lithotomy position. Baseline characteristics including age, indication for the procedure, prior cystoscopy experience, and surgeon background showed no significant differences between the groups. Patients in the supine position reported significantly lower pain scores compared to those in the lithotomy position (median pain score: 1 vs. 2; p < 0.001). Moderate to severe pain was significantly more common in the lithotomy group (28.2% vs. 7.0%; p = 0.002). The procedural duration was also significantly shorter in the supine group (138 vs. 180 s; p = 0.001). Multivariate analysis revealed that patient positioning was the only independent factor associated with moderate to severe pain, while other factors such as time taken to complete the procedure, previous cystoscopy history, surgeon experience, and different individual surgeons were not statistically related.

Conclusion: Patients in the supine position reported reduced pain levels with a shorter flexible cystoscopy procedure duration compared to those in the lithotomy position.

Introduction: The aim of the study was to evaluate the predictive value of Mayo Adhesive Probability (MAP) and the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scores for postoperative complications in laparoscopic total adrenalectomy (LTA) and partial adrenalectomy (LPA).

Methods: This study included 140 patients who underwent transperitoneal laparoscopic adrenalectomy at our clinic. Patients were grouped based on the presence (group 1, n = 11) or absence (group 2, n = 129) of complications. Preoperative, perioperative, and postoperative data were collected. A MAP score ≥2 was defined as high.

Results: Group 1 had a higher incidence of chronic pulmonary and coronary artery disease (p < 0.001). Operative time and estimated blood loss (EBL) were also significantly greater (p = 0.036 and p = 0.041). High MAP scores were more common in this group (p = 0.008), and E-PASS scores were significantly elevated. Univariate logistic regression analysis revealed predictive value for both MAP and Comprehensive Risk Score (CRS) (OR: 5.8, 95% CI: 1.6-21.1, p = 0.008; OR: 18.77, 95% CI: 4.75-74.3, p = 0.000, respectively) for complications. However, multivariate analysis identified only CRS and EBL as independent predictors (OR: 13.5, 95% CI: 2.26-80.6, p = 0.001 and OR: 1.007, 95% CI: 1.001-1.010, p = 0.013, respectively).

Conclusion: The MAP and E-PASS scores are both useful for predicting postoperative complications in patients undergoing LTA and LPA. However, the E-PASS score was found to have independent predictive value for postoperative complications.

Introduction: Ureteropelvic junction obstruction (UPJO) is a common disease of the urinary system. Laparoscopic pyeloplasty, especially robot-assisted laparoscopic pyeloplasty, has become the primary surgical method for the treatment of UPJO. As YouTube gradually becomes a platform for young doctors to learn surgical techniques, we intend to assess these surgical videos of traditional laparoscopic pyeloplasty and robot-assisted pyeloplasty on YouTube in terms of their educational quality.

Methods: Two authors searched for "laparoscopic pyeloplasty," "robot-assisted pyeloplasty," and "robotic pyeloplasty" on YouTube (https://www.youtube.com/) individually on March 16, 2023. We developed the LAP-VEGaS Video Assessment Tool/LAP-VEGaS-LP scale based on the LAP-VEGaS guidelines to quantify the quality of the videos. And we used JAMA (Journal of the American Medical Association) Benchmark Criteria to assess the reliability of the videos. SPSS 26.0 software was applied to the description of the statistics and correlation analysis.

Results: Finally, 55 videos were included. The average length of the videos was 9.30 min (interquartile range [IQR]: 22.56 min). The mean number of subscribers was 4,745 (range: 3-28,700, IQR: 16,684). The mean number of views per like (VPI) was defined as the percentage of the like ratio, and the ratio of the views was 2.48% (IQR: 6.79). The median JAMA score of the videos was 6 (IQR: 2). The mean LAP-VEGaS-LP score was 17.72 (SD: 0.76). The video definition had a positive correlation with the number of subscribers (r = 0.410, p = 0.003), the views-to-subscribers ratio (r = 0.431, p = 0.002), and VPI (r = 0.443, p = 0.001). The LAP-VEGaS-LP score had a positive correlation with the number of subscribers (r = 0.398, p = 0.004), definition (r = 0.314, p = 0.026), views ratio (r = 0.459, p = 0.001), VPI (r = 0.496, p < 0.001), and the score of reliability (r = 6.53, p < 0.001).

Conclusion: The educational quality of laparoscopic pyeloplasty surgical videos is concerning. A more authoritative standard is needed to guide the uploaders and improve the educational value of the videos.

Introduction: Sexually transmitted infections (STIs) continue to rise globally, posing a significant health challenge. This study investigated gender-specific differences in symptom reporting of urethritis, healthcare-seeking behavior, and diagnostic pathways among patients in a German urological practice.

Methods: This prospective, observational study included 91 patients undergoing urethral swab testing due to specific symptoms in a urological practice. Participants completed a questionnaire covering symptom duration, pain intensity, quality of life, libido, and prior healthcare encounters. Microbiological analyses of urethral swabs and demographic data were collected. Statistical analyses compared gender-specific variables.

Results: The cohort was predominantly male (74.7%). Pathogenic bacteria were found in 60.4% of cases, with STIs in 61.8% of positive results. Females reported significantly higher pain levels (p = 0.001), longer symptoms (p < 0.001), and greater impacts on quality of life and libido (p < 0.001). Women more frequently sought prior medical consultation, often primarily from a gynecologist, which may be a factor in the delay of STI specific diagnostics and, therefore, diagnosis.

Discussion: This study highlights significant gender differences in urethritis symptoms and care pathways, emphasizing the need for higher awareness of STIs in primary care and gynecology to reduce delays and possible mistreatment.

Introduction: The College of American Pathologists (CAP) provides synoptic reporting (SR) histopathological protocols for various malignancies, e.g., for bladder cancer. We investigated whether SR can enhance the quality of histopathological reporting at our institution. Specifically, we examined whether SR supports pathologists in report preparation and whether urologists of varying training levels fully understand the histopathological information in narrative reports (NR).

Methods: We investigated the transcription of semantic reports into synoptic CAP protocols by pathologists and clinicians. Through retrospective evaluation, 187 NR were re-evaluated using a CAP protocol by a senior pathologist to assess reporting quality and completeness. Additionally, 50 NR were independently transcribed into synoptic protocols by a resident trainee and board-certified urologists to evaluate clinical adoption.

Results: SR demonstrated advantages in detailing specific pathological features, especially rare variants and tumor characteristics, despite high overall concordance between formats. Diagnostic accuracy improved with clinical experience, with uro-oncologist and department head outperforming the urology resident.

Conclusions: SR has the potential to improve the communication between pathologists and urologists and enhance the quality of care. It also increased standardization and minimized omissions, highlighting its potential to reduce or eliminate information loss.