Urologia Internationalis最新文献

Introduction: The aim of this study was to assess parameters predicting acute kidney injury (AKI) and chronic kidney disease progression (CKDP) after partial nephrectomy (PN).

Methods: The data of 785 patients were retrospectively reviewed. Follow-up eGFR was assessed in 542 patients. Patient characteristics, comorbidities, medication, and type of surgery were analyzed using group comparison and logistic regression.

Results: Age (OR: 1.027 95% CI: 1.008-1.047; p = 0.006), male sex (OR: 2.128 95% CI: 1.506-3.007; p < 0.001), anemia (OR: 2.423 95% CI: 1.521-3.858; p < 0.001), CKD (OR: 1.742 95% CI: 1.084-2.800; p = 0.022), open PN (OR: 3.190 95% CI: 1.958-5.198; p < 0.001), ischemia (WIT) (OR: 1.049 95% CI: 1.027-1.072; p < 0.001), and surgery time (OR: 1.005 95% CI: 1.001-1.008; p = 0.008) were independent predictors of AKI. CKDP occurred in 224 (41.3%) patients, of whom 137 (61.2%) had experienced AKI (p < 0.001). Incidence increased with each AKI stage, which was the only independent predictor of CKDP (OR: 2.391 95% CI: 1.603-3.567; p < 0.001). Patient characteristics, approach, and WIT had no significant impact on CKDP.

Conclusion: AKI determines CKDP. Renal function loss increased at each AKI stage. We identified patients at risk for AKI, who could benefit from minimally invasive surgery and perioperative assessment in a team with nephrologists. As WIT did not influence CKDP, surgeons might consider prioritizing oncological outcomes, without compromising renal function through unnecessarily strict WIT limitations.

Introduction: Osseous metastasis is the most common site of distant spread in prostate cancer. Several factors contribute to predicting bone metastasis, including elevated PSA levels, short PSA doubling time, advanced ISUP grading, local tumor progression, and novel biomarkers. However, no clinical scoring system currently exists to assess bone metastasis risk at the time of prostate cancer diagnosis. Furthermore, no study has investigated the correlation between predictive factors and bone sialoprotein (BSP) expression in the primary tumor.

Methods: Immunohistochemistry was used to evaluate BSP expression in transrectal ultrasound-guided biopsies from prostate cancer patients. Data from 673 patients were analyzed over a 7-9 year follow-up period to assess the development of bone metastases. BSP expression was also evaluated in patients with benign prostatic hyperplasia (BPH). Additionally, BSP expression was analyzed alongside established risk factors using multivariate logistic regression to determine their combined predictive value for bone metastasis.

Results: Bone metastases developed in 12.5% (84/673) of patients. BSP expression was negative (0-5%) in 23.8% of cases, while 22.2% exhibited high expression (>40%). Patients with bone metastases had significantly higher BSP expression than those without (55.5 ± 19.7% vs. 25.7 ± 24.9%; p < 0.001). In contrast, 97% of patients without prostate carcinoma had BSP values below 5%. Among metastatic patients: 82.9% had BSP expression of at least 40%, and none had values below 20%. As a single predictive parameter, BSP showed a sensitivity of 50% and a specificity of 81.6%. However, using multivariate analysis, a three-parameter scoring model integrating BSP expression, ISUP grading, and the number of affected core needle biopsies achieved 88.6% sensitivity and 81.1% specificity for predicting bone metastases.

Conclusion: BSP expression serves as a potential indicator for bone metastasis development but lacks sufficient sensitivity as a standalone clinical marker. Similarly, local tumor progression and histopathologic grading (ISUP) fail as single predictors. However, integrating BSP expression with established risk factors significantly enhances predictive accuracy. Given that all three parameters are derived from routine histopathological analysis, BSP immunohistochemistry should be considered for integration into clinical practice for early risk stratification in prostate cancer patients.

Introduction: Although intermittent catheterization is the gold standard for bladder evacuation in patients with neurogenic lower urinary tract dysfunction (NLUTD), an increasing number of patients are not able to perform this procedure and require indwelling catheters. Insertion of a suprapubic catheter (SPC) is usually done percutaneously. Due to comorbidities, this minimally invasive approach is not possible in all patients. We describe the results of a case series of patients in which the SPC was inserted by laparotomy.

Methods: In a retrospective chart analysis, we evaluated the complication rates, clinical course, and urodynamic results in patients with NLUTD undergoing autologous SPC insertion by laparotomy at our institution.

Results: The data of 24 patients who underwent this procedure could be analyzed. In 1 patient, SPC placement was not possible with this technique. After a median follow-up of 37 months, all patients were still equipped with an SPC. In 3 patients, surgical re-insertion was required. One patient used an additional transurethral catheter due to incontinence despite SPC. Postoperative complications occurred in 5 patients (20.8%), which required surgical interventions in 3 patients (12.5%) (wound revision and transurethral coagulation).

Conclusion: In our case series, SPC insertion by laparotomy is a safe and well-tolerated procedure with satisfying long-term results in patients with NLUTD who otherwise would have been dependent on transurethral catheters. This technique should, thus, be considered in carefully selected patients.

Introduction: Abiraterone acetate is an inhibitor of androgen biosynthesis and is approved as a treatment for metastatic castration-resistant and metastatic castration-sensitive prostate cancer. Neither relugolix nor abiraterone is known to cause acute kidney injury (AKI).

Case presentation: A 72-year-old Caucasian man with metastatic prostate cancer presented with non-oliguric severe AKI 1 week after receiving simultaneous therapy with relugolix and abiraterone. The patient had been on abiraterone for 3 weeks. His physical examination was unremarkable. Blood work on admission revealed hypocalcemia, and elevated creatinine at 3.6 mg/dL. A kidney biopsy confirmed the diagnosis of a high-grade subacute tubular damage, most likely due to nephrotoxicity. The patient did not respond to intravenous isotonic fluids, the discontinuation of relugolix, abiraterone, and rosuvastatin, as well as to hemodialysis. He died 22 days after hospital admission.

Conclusion: We report the first case of biopsy-proven drug-induced AKI in a cancer patient acutely exposed to relugolix and abiraterone. Whether one of these drugs individually, or their combination, was the cause of the AKI is unknown. Nonetheless, our report is hypothesis-generating for further investigations on the effect of these drugs.

Introduction: Premature ejaculation is a common problem in men and filler injection into the glans penis has become a prevalent practice in treatment. Since the glans penis augmentation is an invasive treatment method, it also carries the risk of complications. Herein, we aimed to present a case of glans penis ischemia due to hyaluronic acid filler injection.

Case presentation: The patient was a 29-year-old male with premature ejaculation. The physical examination was normal, and sensory testing with a biothesiometer revealed vibration perception threshold values of 5.3V for the glans, 4.1V for the frenulum, and 3.9V for the penile shaft. Under local anesthesia, hyaluronic acid filler was applied with the multiple puncture technique, 2 mL in total, 0.2 mL per injection. One day after the procedure, the patient referred with complaints of discoloration of the glans penis. The physical examination revealed blackening at the distal tip of the glans with a visible demarcation line. Hyaluronidase was applied for the treatment of glanular glans penis ischemia secondary to hyaluronic acid filler injection. A significant improvement in the glans penis color was observed after hyaluronidase injection. The patient was prescribed 100 mg of aspirin, a warm saline dressing, and a nitroglycerin-containing cream and was discharged for daily follow-up.

Conclusion: Although vascular complications are rare after hyaluronic acid filling into the glans penis, early diagnosis and treatment are crucial. Patients should be informed about possible adverse events. The main treatment method for vascular complications is urgent hyaluronidase injection. In addition, prevention of clot propagation with oral aspirin and vasodilatation treatments should be applied. In the glans penis ischemia after hyaluronic acid injection, early diagnosis and immediate hyaluronidase administration can reverse ischemia without necrosis or surgical intervention.

Introduction: Fumarate hydratase-deficient renal cell carcinoma is a rare and aggressive subtype associated with hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome, characterized by germline mutations in the fumarate hydratase (FH) gene. Here, we report a case of HLRCC with early recurrence during adjuvant therapy following radical nephrectomy.

Case presentation: A 34-year-old woman with FH-deficient RCC presented with fever, right flank pain, and a large renal mass with a tumor thrombus. Open radical nephrectomy and IVC tumor thrombectomy were performed. Pathological findings and genetic analyses confirmed the diagnosis of HLRCC. Despite adjuvant pembrolizumab therapy after nephrectomy, bone metastases were detected within 9 weeks. The patient was treated with stereotactic body radiotherapy (SBRT), followed by systemic therapy with nivolumab and cabozantinib. After 16 months since the recurrence, no further disease progression was observed. Genetic counseling revealed the same FH mutation in her daughter, prompting annual surveillance.

Conclusion: This case highlights the potential efficacy of combining tyrosine kinase inhibitor therapy with SBRT in managing aggressively progressive HLRCC.

Introduction: This study aims to evaluate the effectiveness of prostatic artery embolization (PAE) in treating benign prostatic hyperplasia (BPH), focusing on identifying the predictors of treatment failure and assessing patient satisfaction and second-line therapies for patients who undergo reoperation.

Methods: We conducted a monocentric, retrospective study involving 344 patients who underwent PAE from 2017 to 2022. The minimum follow-up time was 12 months. Baseline data were retrospectively collected. A single follow-up questionnaire was administered at the time of the study. Included patients were ≥50 years, with a prostate volume ≥40 mL, an International Prostate Symptom Score (IPSS) ≥8 and were unresponsive to medical therapy.

Results: Among 156 participants, the reoperation rate at 5 years was 28.2%. Baseline IPSS and post-void residual volumes (PVR) were significant predictors of therapy failure. Higher satisfaction was associated with younger age (p = 0.01), larger prostate volume (p = 0.02), and lower PVR (p = 0.03). Patients with higher satisfaction had better reoperation-free rates at 60 months (p = 0.002).

Conclusions: PAE is effective in reducing symptoms in patients with BPH; however, the reoperation rate emphasizes the importance of careful patient selection. Study limitations include potential selection bias, missing data, the single-center setting, and the use of a single follow-up questionnaire.

Introduction: This study aimed to compare the urinary microbiota of healthy women, women with a predisposition to UTIs, and patients with chronic recurrent cystitis using real-time PCR, as well as identify diagnostic markers for urinary diseases.

Methods: The study enrolled 3 groups of patients: a healthy control group, patients with chronic recurrent cystitis, and patients with a risk of developing UTIs. Urine samples were analyzed by multiplex real-time PCR reagent kits Femoflor®16 and BacScreen OM.

Results: Chronic recurrent cystitis is associated with an increase in total bacterial mass (TBM), genomic DNA, and relative predominance of facultative anaerobic microorganisms. The most prevalent bacterial species found in chronic cystitis was Escherichia coli in conjunction with other Enterobacteriaceae, most commonly Serratia marcescens. An increased amount of genomic DNA and both facultative and obligate anaerobic microorganisms was observed in patients with a risk of developing UTIs. A relative decrease in Lactobacillus spp. was noted in both groups, with the chronic cystitis group showing a more pronounced reduction.

Conclusion: In summary, the levels of genomic DNA, TBM, and relative values of Lactobacillus spp. can be used as molecular diagnostic markers for chronic cystitis and a variety of other conditions, including micronephrolithiasis and bacterial vaginosis.

Background: Historically, opening the bladder neck and urethra for evacuation has been solely by detrusor contraction with "urethral relaxation."

Summary: We present a change in thinking based on experimental research and clinical practice, human and animal: the urethra is opened externally immediately prior to detrusor contraction by posterior pelvic floor muscles contracting against competent uterosacral ligaments (USLs). A binary feedback control system (EITHER open OR closed) with neurological and peripheral musculo-ligamentous components is presented. Three oppositely acting muscle vectors contract against suspensory ligaments to close urethra distally and at bladder neck; relaxation of the forward closure vector allows the two posterior muscles to contract against USLs to open the posterior urethral wall prior to micturition. Whatever the anatomical cause of bladder emptying difficulties, neurological, muscle damage, ligament damage, urethral obstruction, inability of the pelvic muscles to externally open the urethra means the detrusor must contract against an unopened urethra which presents a high resistance to flow. This resistance is perceived by the patients as "bladder outlet obstruction." Collagen damage during birthing, or breakdown after the menopause, makes ligament damage the most vulnerable part of the female micturition system. Treatment depends on reinforcing USLs as the contractile point for the posterior opening muscles: in premenopausal women by squatting-based exercises; in older women by mechanical support of USLs by pessary, or surgical USL repair.

Key message: A change in thinking: posterior pelvic muscles contract against a firm USL to open posterior urethral wall prior to micturition (video https://www.youtube.com/watch?v=nK0CQmaS-5E&t=7s).

Introduction: Chronic inflammation and infections have been implicated in prostate cancer (PCa) pathogenesis. The association between sexually transmitted infections (STIs) and PCa remains inconclusive. The objective was to evaluate the presence of STI-related pathogens in patients with PCa compared to a control group.

Methods: A prospective multicenter study involving 239 male patients with a clinical suspicion of PCa was conducted. Among the participants, 176 had histologically confirmed PCa, while 63 served as controls with benign histology. Urine, glans swabs, and prostate biopsy specimens were collected from each participant and analyzed using polymerase chain reaction (PCR) to detect a broad panel of STI-causing pathogens, including Candida spp., Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus types 1 and 2, and human papillomavirus.

Results: A total of 717 samples were processed. The detection frequency of STI-related pathogens was relatively low across all sample types. M. genitalium was the most frequently detected pathogen, particularly in prostate biopsy samples. No statistically significant association was found between the presence of these pathogens and the incidence of PCa. N. gonorrhoeae and C. spp. were not detected in any of the samples.

Conclusion: This study did not find a statistically significant association between the presence of STIs and PCa. The low prevalence of STI pathogens despite the use of highly sensitive PCR methods suggests that these infections may play a limited role in prostate carcinogenesis. Future research should consider focusing on the role of the urinary and prostatic microbiome in chronic prostatic inflammation.