Urologia Internationalis最新文献

Introduction: The aim of the study was to explore whether patients with autosomal dominant polycystic kidney disease (ADPKD) require native nephrectomy prior to kidney transplantation.

Methods: A retrospective analysis of 44 ADPKD patients who received deceased donor allogeneic kidney transplantation at Beijing Friendship Hospital (2013-2024) was conducted. Patients were divided into pre-transplantation nephrectomy (PN) group (n = 29) and a non-PN (nPN) group (n = 15). The pre-transplant general status, surgical duration, intraoperative blood loss, postoperative recovery, and survival rates were compared between the two groups. Additionally, total kidney volume (TKV) and adjusted TKV were used to predict ultimate nephrectomy (UN) status via a receiver operating characteristic (ROC) curve analysis. Finally, the nPN group was subdivided to UN group (n = 8) and non-ultimate nephrectomy (nUN) group (n = 7) based on final nephrectomy status, with comparisons made regarding kidney function and survival analysis.

Results: The nPN group had better long-term survival (62 vs. 38 months, p < 0.001). ROC analysis showed BSA-TKV had the highest predictive accuracy (sensitivity: 69.44%, specificity: 87.50%). Subgroup analysis indicated post-transplant nephrectomy did not impact long-term survival or kidney function.

Conclusion: Pre-transplant nephrectomy in ADPKD patients should be limited to essential cases as it may prolong recovery and reduce survival. Post-transplant nephrectomy is a safer alternative, guided by predictive metrics like BSA-TKV.

Introduction: Patient education materials (PEMs) play a vital role in ensuring that patients understand their medical conditions and treatment options. In prostate cancer, complex medical terminology can hamper comprehension and informed decision-making. This study evaluates the readability of prostate cancer PEMs to determine if they meet recommended standards for lay audiences.

Methods: A selection of standardized prostate cancer PEMs, including standard surgical consent forms and patient brochures from major German cancer organizations, was analyzed. Readability was assessed using established metrics, including the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of 70 (at or below a seventh-grade reading level) and the other readability indexes ≤7, following European Union recommendations.

Results: The readability of prostate cancer PEMs of both surgical consent forms and patient brochures did not meet the recommended thresholds set by the European Union for layperson summaries. The median FRES for consent forms was 25.9 (SD: 1.52), ranging from 24.3 (prostate biopsy) to 28.0 (open RPx). Patient brochures showed a median FRES of 23.2 (SD: 2.87), with scores of 23.2 (German Cancer Aid), 22.5 (DKFZ), and 28.9 (S3-Guidelines). Section-specific values varied, with the highest FRES observed in the "Basic Explanation and Screening" section of the S3-Guidelines (39.0, SD: 7.09) and the lowest in the "Follow-Up" section of the German Cancer Aid brochure (15.8, SD: 10.35). All grade-level metrics (FKGL, GFS, SMOG, CLI, ARI) exceeded the recommended level of grade 7.

Conclusion: The readability of prostate cancer PEMs in Germany falls short of recommended thresholds for lay comprehension. To enhance clarity and accessibility, the use of automated readability tools and standardized benchmarks (e.g., FRES ≥70, grade level ≤7) is recommended. Involving multidisciplinary teams may further support the development of patient-centered content. Future research should combine readability metrics with patient feedback to evaluate real-world comprehension and usability.

Introduction: The aim of the study was to determine the interactive effect of pelvic organ prolapse (POP) on voiding dynamics of female patients with urodynamic stress urinary incontinence (USUI). Free urine flow curve pattern (FUFCP) criterion was implemented to bladder outlet obstruction (BOO) and detrusor underactivity definitions.

Methods: Patient file review of 362 female patients with non-neurogenic USUI was conducted, and after exclusion criteria 178 female patients with pure USUI were eligible for the study. Patients with USUI were divided into three groups: group 1 without (w/o) prolapse, group 2 with mild, and group 3 with moderate/severe prolapse. The patient characteristics, pressure flow findings, and FUFCPs were compared between three groups.

Results: Of 178 patients with a median age of 55 (47-65), 61 (34.3%) did not have any prolapse, 95 (53.4%) had mild, and 22 (12.3%) had moderate/severe POP (p = 0.571). No statistically significant difference was determined between pressure-flow numeric values in USUI patients with or w/o POP (p = 0.104 for Q_max and p = 0.587 for PdetQmax). Ordinal logistic regression analysis results showed that smaller amount of voided volume during free urine flow (p = 0.037), non-bell-shaped FUFCP (p = 0.006), larger amount of post-void residual urine volume (p = 0.001), and more frequent urodynamic diagnosis of BOO (p = 0.046) were the independent significant urodynamic features of the patients in group 3. Bell-shaped pattern was the most frequent pattern in group 1 (62.3%) while this pattern was infrequent in group 3 (18.2%).

Conclusions: Using the new FUFCP criterion in the present study, a marked shift from bell-shaped to prolonged/intermittent patterns with increasing POP severity was evident. Although detrusor pressure metrics changed little, patients with coexistent USUI and moderate/severe POP had more frequent urodynamic BOO, supporting the construct validity of incorporating FUFCP into the evaluation.

Aim: The aim of the study was to evaluate the safety and efficacy of same-day versus next-day urinary catheter removal following ureteroscopic holmium laser lithotripsy (with routine double-J stent placement) in a day-surgery setting.

Methods: In this comparative study, 191 patients undergoing day-care holmium laser lithotripsy were allocated to next-day (n = 94) or same-day (n = 97) extubation groups. Outcomes included catheter retention duration, post-removal complications, voiding function, and recovery parameters.

Results: No catheter-related adverse events occurred in either group. No significant differences were observed in first void volume, catheter reinsertion rates, post-catheter removal urination, lower abdominal distension, or urethral pain (p > 0.05). The same-day group demonstrated significantly shorter catheter retention time (p < 0.001) and earlier postoperative ambulation (p < 0.001). Notably, time to spontaneous voiding was prolonged in the same-day group (p = 0.009), though all values remained within physiological ranges.

Conclusion: Same-day catheter removal after ureteroscopic holmium laser lithotripsy, even with routine double-J stent placement, safely reduces indwelling time and promotes early mobilization without increasing the risk of urinary retention or exacerbating stent-related discomfort. The protocol is feasible for day-surgery populations.

Introduction: The aim of the study was to evaluate the efficacy and safety of percutaneous antegrade flexible ureteroscopic lithotripsy (PAFUL) using a tip-bendable suction ureteral access sheath (UAS) for managing middle and lower ureteral stones after failed retrograde ureteroscopy.

Methods: This retrospective study analyzed 75 patients (43 males, 32 females; mean age 51.7 ± 13.1 years) with middle (n = 54) and lower (n = 21) ureteral stones treated between June 2023 and May 2025. All patients underwent PAFUL with 12/14 Fr tip-bendable suction UAS after failed ureteroscopy. Outcomes included stone-free rate (SFR), operative time, complications, and hydronephrosis improvement.

Results: The immediate and 1-month SFR was 100% (75/75). The mean operative time was 168.2 ± 35.9 min, with a median postoperative hospital stay of 3 days. Four patients (5.3%) required nephrostomy tube placement. Complications (Clavien-Dindo grade I) included fever (n = 2), nausea/vomiting (n = 8), and pain (n = 18). No grade II-V complications occurred. Postoperative hydronephrosis significantly improved (p < 0.001), with complete resolution in 68 patients (90.7%).

Conclusion: PAFUL with tip-bendable suction UAS is a safe and immediately effective alternative for mid-distal ureteral stones after failed retrograde treatment, achieving single-session clearance with minimal morbidity. Future studies should validate cost-effectiveness through reduced re-interventions and resource utilization.

Introduction: To offer valuable insights into potential dietary influences on bladder health, the study investigated the relationship between urinary caffeine metabolites and overactive bladder (OAB) syndrome.

Methods: The data for this investigation consisted of individuals who were 20 years old or older, obtained from the National Health and Nutrition Examination Survey (NHANES) database. To assess the correlation between urinary caffeine metabolites and OAB, logistic regression analyses were utilized. In addition, quantile g-computation model (Qgcomp) and Bayesian kernel machine regression (BKMR) model were used to determine the combined effect of urine caffeine metabolites on OAB risk.

Results: In the analyses of a dataset comprising 4,354 participants, 815 were diagnosed with OAB. After adjusting for various covariates, logistic regression analyses revealed the highest tertiles of caffeine metabolites and ln-transformed caffeine metabolites were negatively associated with OAB risk. Subsequent analyses using the Qgcomp demonstrated that an increase in the quartiles of caffeine metabolites mixture was associated with a decreased risk of developing OAB. The OR was 0.89 (95% confidence interval: 0.81, 0.99). Moreover, such negative correlation was primarily driven by 1,3-dimethylxanthine (1,3-DMX) and 1-methylxanthine (1-MX). The BKMR model confirmed a strong inverse link between urinary caffeine metabolites and OAB.

Conclusion: Our work demonstrates a strong inverse relationship between urine caffeine metabolites and the occurrence of OAB. Among these metabolites, 1,3-DMX and 1-MX have the most pronounced impact on the combined effect. These findings suggest that the way caffeine is metabolized in the body could play a crucial role in the development of OAB.

Introduction: The aim of the study was to evaluate the efficacy, safety, and recurrence risk of minimally invasive percutaneous nephrolithotomy (PCNL) in Uyghur and Han pediatric patients with upper urinary tract calculi and develop predictive models with nomograms for postoperative recurrence.

Methods: Clinical data from 231 children (159 Uyghur, 72 Han) treated with Mini-PCNL or Microperc between June 2019 and June 2024 were retrospectively reviewed. Recurrence-free survival was analyzed using Kaplan-Meier estimates. Cox regression was applied to construct two models: Model 1 (Outpatient Clinical Predictive Model, OCPM) based on clinical variables, and Model 2 (Comprehensive Inpatient Predictive Model, CIPM) incorporating imaging and urine culture. Nomograms were established, and model performance was assessed using time-dependent ROC curves, calibration curves, and 10-fold cross-validation. Clinical utility was evaluated by decision curve analysis and clinical impact curves.

Results: Stone-free rates (SFRs) and complication rates (CRs) were comparable between groups, but Uyghur children had a higher recurrence rate (25.2% vs. 13.9%, HR = 2.31, 95% CI: 1.30-4.10). Model 1 (OCPM, age, ethnicity, urine pH, serum creatinine) showed good discrimination for outpatient screening (AUC 0.79-0.85), while Model 2 (CIPM, adding stone size, laterality, multiplicity, and hydronephrosis) achieved superior accuracy (AUC >0.90) and calibration at higher risk levels.

Conclusion: PCNL is effective and safe in both ethnic groups, but Uyghur patients have a higher recurrence risk. The predictive models provide valuable tools for optimizing postoperative management and follow-up strategies.

Introduction: The aim of the study was to examine 5-year overall survival (OS) of upper urinary tract urothelial carcinoma (UTUC) patients versus age- and sex-matched population-based controls.

Methods: Within Surveillance, Epidemiology, and End Results database (2004-2020), we identified newly diagnosed (2004-2015) UTUC patients. Relying on Social Security Administration Life Tables (2004-2020), age- and sex- matched population-based controls were simulated (Monte Carlo simulation).

Results: Of 10,140 UTUC patients, 3,984 (39%) exhibited localized, 4,904 (49%) locally advanced, and 1,252 (12%) metastatic stages. At 5 years of follow-up, the OS rate was 41 versus 78% (Δ 37%) in UTUC patients versus controls. According to stage, OS difference was greatest in metastatic stage (4 vs. 75%; Δ 71%), followed by locally advanced (36 vs. 78%; Δ 42%) and localized stages (58 vs. 78%; Δ 20%). At 5 years of follow-up, the CSM rate was 44%, and the OCM rate was 16%. According to stage, CSM and OCM rates were 88 and 7% in metastatic, 49 and 15% in locally advanced, and 22 and 19% in localized stage UTUC patients.

Conclusion: UTUC patients may experience worse OS compared to population-based controls. The most pronounced differences in the 5-year OS were recorded in metastatic and locally advanced stages, suggesting a potentially substantial impact of UTUC on patients' life expectancy.

Introduction: Aminoglycosides, valued for their lower antimicrobial resistance, are used for perioperative antibiotic prophylaxis (PAP) in urological procedures such as robot-assisted radical prostatectomy (RARP). However, data regarding the safety of gentamicin in robot-assisted surgery remain limited. This study assessed the incidence of acute kidney injury (AKI) associated with PAP with single-dose gentamicin during the transition from open prostatectomy to RARP.

Methods: This single-center, retrospective, matched case-control study included 77 RARP patients receiving gentamicin and 72 matched controls receiving cefuroxime. AKI was assessed using the Kidney Disease: Improving Global Outcome (KDIGO) criteria, considering age, comorbidities, and prostate weight.

Results: AKI occurred in 33.8% of the gentamicin group versus 9.7% of the cefuroxime group, resulting in an odd's ratio (OR) of 6.25. In the gentamicin group, grade 1 AKI was most frequent (19.5%), followed by grade 2 (7.8%) and grade 3 (6.5%). In the cefuroxime group, grades 1 (5.6%) and 2 (4.2%) were observed. Prostate volume and gentamicin use emerged as independent cofactors. Limitations include missing long-term data, variable gland measurements, and inclusion of patients with pre-existing kidney disease.

Conclusion: The risk of AKI was significantly higher after PAP with gentamicin compared to PAP with cefuroxime (OR: 6.25, 95% CI: 2.095-18.664, p = 0.001), suggesting that PAP with gentamicin should be avoided in RARP.

Introduction: This comprehensive review and meta-analysis investigates the effectiveness of neoadjuvant hormone therapy (NHT) in conjunction with radical prostatectomy (RP) for patients diagnosed with clinical stage T3 (cT3) prostate cancer (PCa) patients. Our objective is to evaluate its influence on cancer-related outcomes.

Methods: In accordance with PRISMA standards, we conducted an analysis of 10 randomized controlled trials (RCTs) sourced from PubMed, Embase, Web of Science, and Cochrane databases, with a cutoff date of May 17, 2025. The main outcomes assessed included rates of positive surgical margins (PSMs) rates and prostate-specific antigen progression-free survival (PSA-PFS). Additional outcomes evaluated were pathologic complete response (pCR), minimal residual disease (MRD), and metastasis-free survival (MFS). We aggregated risk ratios (RRs), hazard ratios (HRs), and mean differences along with 95% confidence intervals (CI) utilizing either fixed or random-effects models.

Results: The combination of NHT and RP led to a notable decrease in PSM rates when compared to RP alone (RR = 0.75, 95% CI: 0.60-0.94, p = 0.01), particularly evident in Asian demographics (RR = 0.47, p = 0.001) and for NHT durations of 6 months or more (RR = 0.75, p = 0.01). Additionally, PSA-PFS showed significant enhancement (HR = 0.25, 95% CI: 0.22-0.28). While there was no overall advantage in achieving pCR or MRD, certain subgroups in North America and those undergoing extended NHT experienced benefits. MFS did not show any significant changes (RR = 0.99, 95% CI: 0.89-1.10).

Conclusion: The combination of NHT and RP enhances immediate surgical and biochemical results in patients with cT3 PCa, especially among those of Asian descent, and leads to a longer duration of NHT. However, the long-term survival advantages are still not established, highlighting the need for standardized RCTs to refine treatment protocols.