Urology最新文献

Objectives: To evaluate lifestyle modification achieved through a structured self-check sheet-based behavioral therapy program and its association with changes in nighttime frequency in patients with nocturia.

Methods: We analyzed 218 patients from 14 institutions aged ≥40 years who completed a 4-week behavioral therapy program. Eight lifestyle habits were assessed before the intervention, and behavioral change was defined as executing a behavioral item on ≥14 of 28 days. Outcomes included (i) the association between the number of behavioral items successfully adopted and the change in nighttime frequency, (ii) the association between adoption of each behavioral item and (iii) changes in estimated salt intake.

Results: Greater reductions in nighttime frequency were associated with a higher number of behavioral items adopted, with the greatest reduction observed in those who adopted four to five items (-1.1 episodes), and showed significant differences among groups (p = 0.03). In multivariable regression, positive changes in nighttime frequency (indicating greater improvement) were independently associated with regular mealtimes (β = 0.739, p = 0.030) and evening exercise (β = 0.328, p = 0.028). Salt intake significantly decreased only in patients who newly adopted salt-reduction behavior (9.4 → 8.6 g/day, p = 0.01).

Conclusions: Behavioral therapy using a simple, time-efficient self-check sheet is associated with improvement in nighttime frequency with a minimal burden on patients. Greater adherence is associated with greater improvement, and specific behaviors, particularly regular mealtimes and evening exercise, show independent associations with symptom improvement.

Objective: To elicit preferences for bladder-sparing treatments among patients with non-muscle-invasive bladder cancer (NMIBC) in the United States.

Materials and methods: Patients with self-reported NMIBC completed an online discrete-choice experiment survey evaluating their preferences for efficacy-, safety-, and administration-related treatment attributes. Evidence-based attributes included NMIBC recurrence, progression to MIBC, mode and frequency of administration, fatigue, urinary symptoms or infection, and chance of immune-related side effects requiring steroids. In a series of direct-elicitation questions, respondents chose between fixed profiles of bladder-sparing treatment and radical cystectomy (RC). The 9-item Shared Decision-Making Satisfaction Questionnaire (SDM-Q-9) captured respondents' experiences and perspectives regarding involvement in shared treatment decisions with providers.

Results: A total of 206 respondents completed the survey. Reduced risks of progression to MIBC and NMIBC recurrence were the most important of the attributes evaluated, followed by, in order, chance of immune-related side effects requiring steroids, mode and frequency of administration, treatment-related fatigue, and urinary symptoms or infection. In fixed direct-elicitation questions, most patients (>70%) preferred bladder-sparing treatments over RC except when comparing repeated BCG treatment to RC. Over 25% of respondents disagreed with the statement "My doctor asked me which treatment option I prefer" when reflecting on their shared decision-making experiences.

Conclusions: Reduced risks of progression to MIBC and NMIBC recurrence had the greatest impacts on treatment choice; treatment-related side effects and administration-related attributes were less important. Most respondents preferred nonsurgical treatment options with similar clinical benefits over RC. Continued efforts to incorporate shared decision-making into NMIBC treatment decisions are warranted.

Objective: To investigate whether photodynamic diagnosis (PDD) influences recurrence and progression risk in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG).

Methods: We performed a nationwide cohort study using Danish health registries. Patients with a first-time diagnosis of NMIBC who received BCG between 2009 and 2022 were included. Patients were followed until death, cystectomy, or December 31, 2023. Exposure was PDD at primary transurethral resection of the bladder (TURB). We estimated cumulative incidences and relative risks for recurrence and progression, and calculated crude and adjusted odds ratios for BCG response according to PDD status.

Results: A total of 4,318 patients were included, of whom 2,388 (55%) underwent PDD-assisted diagnosis. At 1 year, the age-adjusted relative risk for recurrence was 0.85 (95% CI, 0.76-0.96) in the PDD group compared with the non-PDD group. At 5 years, the relative risk was 0.94 (95% CI, 0.87-1.03). No significant differences were observed in BCG response among adequately treated patients between the PDD and non-PDD groups.

Conclusions: This large registry-based cohort study found no evidence that the use of PDD was associated with differences in BCG treatment outcomes. While PDD was associated with a modest reduction in recurrence risk at 1 year, no long-term benefit was observed regarding recurrence, progression, or BCG response.

Objective: To evaluate longitudinal trends in Urology In-Service Examination (ISE) from 2016 to 2023 and identify changes in performance patterns over time.

Methods: Retrospective cohort analysis of aggregate ISE scores provided by the American Urological Association. Mean percent-correct scores across postgraduate years (PGY1-5) and subtopics were analyzed from 2016 to 2023. 2020 was used as a temporal marker for the onset of the COVID-19 pandemic in sub-analyses. Two-sample t-tests determined statistical significance (α ≤ 0.05).

Results: A total of 680 scores were analyzed. Mean scores increased with PGY level (43-46% in PGY1 to 68-71% in PGY5) but declined over time. Linear trend analysis showed a statistically significant decline for PGY2-5, with the steepest and strongest correlation seen in PGY3-5. Subtopic declines were most notable in calculous disease (64.2% to 56.1%, p=0.01) and physiology/immunology/adrenal (70.2% to 56.5%, p<0.001), both affecting all PGY levels. Additional decreases were noted in pediatrics (PGY2-4), congenital anomalies/embryology/anatomy (PGY1-2, 4), and imaging (PGY3-4). In contrast, PGY1 scores in fluid & electrolytes/transplant/hypertension/vascular/nephrology improved modestly (50.5% vs. 56.0%, p=0.05). Performance on 217 repeated questions was stable (69.3% vs. 69.7%).

Conclusions: Mean ISE performance declined from 2016 to 2023 across all PGY levels, with the greatest decreases observed in general urology subtopics. Scores after 2020 were lower across most PGY levels and content domains, while performance on repeated questions remained stable. These trends may reflect increased examination difficulty, expanded content, changes in question composition, evolving study strategies, and variability in clinical exposure rather than diminished knowledge.

Objective: To prospectively evaluate the efficacy and predictive factors of a two-phase intravesical injection protocol using apheresis-derived Platelet-Rich Plasma (PRP) in patients with refractory non-ulcerative Primary Bladder Pain Syndrome (PBPS).

Materials and methods: Between June 2023 and August 2025, 102 patients with PBPS were stratified into Groups A, B, and C based on cystoscopic grading of hydrodistention (Grade I-III). All patients underwent video-urodynamic studies and PRP collection, followed by a two-phase intravesical injection protocol comprising an intensive weekly phase for three weeks and a consolidation monthly phase for three months. Follow-up assessments were conducted at baseline, 1 month, and 6 months after the treatment. Outcome measures included Global Response Assessment, questionnaire scores and voiding diary.

Results: Compared with baseline, all groups demonstrated significant improvements in questionnaire scores and voiding diary at 1 month post-treatment, with Groups B and C showing significantly greater improvement than Group A in most of these. At 6 months post-treatment, only Groups B and C maintained significant improvements in all aforementioned parameters. Consistently, the treatment success rate was significantly lower in Group A than in Groups B and C at follow-up. Nine patients (9.4%) experienced self-limiting gross hematuria, and no other adverse events were reported. Maximal bladder capacity and cystoscopic grade were associated with 1 month post-treatment efficacy. However, only cystoscopic grade was independently predictive factor.

Conclusion: Two-phase intravesical injection of autologous apheresis-derived PRP is a safe and effective treatment for refractory non-ulcerative PBPS. Cystoscopic grading of hydrodistention serves as an independent predictor of treatment response.

Objective: To study the emotional responses and family-building decisions made by individuals and couples following unsuccessful microsurgical testicular sperm extraction (micro-TESE), as described in publicly accessible online narratives.

Methods: Public posts describing personal or partner experiences after unsuccessful micro-TESE for nonobstructive azoospermia were systematically identified across online forums. Two independent investigators conducted a qualitative theme analysis using grounded theory of methodology.

Results: Fifty-two posts were analyzed, authored by patients (46%) and partners (54%), with most published in 2025. The most common choice was pursuing sperm donation (46%), followed by additional medical interventions (19.2%) and ongoing decision-making (21%). Others reported embryo donation (3.8%), adoption/fostering (6.7%), or remaining child-free (3.8%). Five major thematic categories emerged: (1) Emotional processing, with many users expressing grief over the loss of biological parenthood; (2) Family planning, highlighting financial limitations and medical decision-making; (3) Therapy and counseling, including reflections on emotional and genetic support; (4) Timeline of decision-making, influenced by partner alignment and emotional readiness; and (5) Role of online communities, which offered validation, peer advice, and emotional support in lieu of formal follow-up care. Three broader concepts were identified: emotional recovery precedes decision-making; partner consensus influences chosen pathways; and online platforms serve as informal support systems.

Conclusion: Online narratives illustrate the complex journey couples face after a failed micro-TESE. Emotional readiness, partner consensus, financial barriers, and peer support influence reproductive decisions. These findings highlight gaps in structured post-procedural guidance and underscore the need for earlier, integrated, patient centered emotional and clinical counseling.

Objective: To assess overactive bladder symptoms and identify risk factors for worsened symptoms after vaginoplasty in transgender women.

Methods: This was a retrospective longitudinal study examining changes in OAB symptoms of transgender women undergoing vaginoplasty. All participants completed the 19 question Overactive Bladder Questionnaire Short-Form (OAB-q SF) to assess urinary symptoms before and after vaginoplasty. Medians of OAB-q SF scores, including Symptom Bother and Health-Related Quality of Life (HRQL) sub-scores, were measured. Changes in scores were compared using Wilcoxon signed-rank tests. Data were further stratified by factors such as age at time of surgery and type of vaginoplasty performed.

Results: 53 transgender women undergoing vaginoplasty were evaluated. Median time from surgery to post-operative questionnaire was 29 weeks. 53% underwent peritoneal flap vaginoplasty (PFV), 21% penile inversion vaginoplasty (PIV), 15% minimal depth vaginoplasty (MDV), and 11% sigmoid vaginoplasty (SV). For all patients, statistically significant HRQL declines were noted post-operatively (96.9/100 vs 93.8/100, p=0.020). When stratified by age, the oldest quartile of patients (44 to 71 years old) experienced the largest worsening of Symptom Bother (6.7/100 vs 20/100, p=0.020) and HRQL (96.9/100 vs 90.8/100, p=0.008). When stratified by vaginoplasty type, PFV had a significant decrease in HRQL (96.9/100 vs 93.8/100, p=0.023).

Conclusions: Patients undergoing vaginoplasty can experience worsening of overactive bladder symptoms affecting their quality of life, which in our series was more pronounced in older individuals and those undergoing PFV. However, the clinical significance of these symptom changes are unclear, suggesting that overall effects of vaginoplasty on OAB symptoms are limited.