Urology最新文献

Objective: To examine low- and middle-income country (LMIC) representation within urology research and highlight disparities that limit equitable, inclusive, and context-specific investigation.

Methods: A systematic review was performed using Scopus to identify all urology articles published from 2013-2023 across 117 urology journals. Country affiliations were based on abstract, title, or author institution. Publications were categorized by country income level based on World Bank classifications. Trends in first authorship across income settings were analyzed using separate linear regression models and compared using multiple linear regression analysis with interaction terms. Population-adjusted Poisson regression models assessed for associations between income category and first author research output.

Results: A total of 128,949 articles were included. 0.99% were affiliated with low-income (LIC), 7% with middle-income (MIC), 23% with upper-middle-income (UMIC), and 79% with a high-income country (HIC). The top country from each income-category was Niger, India, China and USA, respectively. LICs first-authored 0.4% of all publications. HICs produced 95-times more first-authored articles than LICs, while UMICs and MICs produced 13- and 3-times more, respectively (IRR = 94.8, IRR=12.7, IRR=3.1, all p-values <0.001). Over the 10-years, the proportion of first-authored articles from LIC, MIC and UMICs increased significantly, but variably. On average, HIC publications increased at a rate of 145 more articles/year than LICs and UMICs increased at a rate of 189 more articles/year (both p<0.001).

Conclusions: Major disparities exist in urology research output and authorship across income settings. Addressing these inequities will require deliberate efforts to strengthen research infrastructure, expand international collaborations, and create more inclusive opportunities for publication.

Objective: To characterize risk factors associated with the chronic utilization of narcotics following treatment for penile cancer using a national insurance database.

Methods: The MarketScan Commercial Claims (MCCD) and Medicare supplemental databases (MSD) (2009-2023), were utilized to identify opioid-naive (no narcotic use within 3 months) adults who had undergone treatment for penile cancer. Our primary outcome of chronic opioid use was defined as prescriptions filled 3-6 months after initial treatment. Multivariable regression was utilized to identify independent predictors of chronic opioid use.

Results: 1,286 patients (865 MCCD; 421 MSD) were identified, with 9.6% demonstrating chronic opioid use. In the MCCD cohort, history of mental health diagnosis (OR 2.82), fourth quartile initial prescription dose (OR 2.40), and partial penectomy (OR 2.58) were associated with chronic use (p < 0.05). While in the MSD cohort third quartile initial prescription dose (OR 3.91), and radical penectomy (OR 3.68) were significant predictors (p < 0.05).

Conclusions: Roughly one in ten penile cancer patients will utilize narcotics after the acute/sub-acute procedural period. Initial prescription dose, history of mental health diagnosis and more invasive surgical procedure appear to predict long term use. This study is the first of its kind within this specific cohort, and underscores the importance of ongoing opioid stewardship, and assessment of this vulnerable population.

Objectives: To compare outcomes of patients with localized renal cell carcinoma (RCC) receiving immunosuppressive therapy due to prior organ transplant to a matched cohort of non-transplant patients.

Methods: Patients were identified from a solid organ transplant database with tissue diagnosis of non-metastatic RCC after transplantation between 2000-2020. Transplant patients were matched to non-transplant patients with non-metastatic RCC based on treatment type, age, tumor size, and grade if available. Clinical variables and survival outcomes were compared.

Results: Among 81 transplant patients with non-metastatic RCC (surgery 65%, ablation 23%, surveillance 11%), survival outcomes were comparable to matched non-transplant cohorts. In the surgical cohort, metastasis-free survival and overall survival did not differ between transplant and non-transplant patients, and multivariable analysis confirmed transplant status was not associated with increased risk of metastasis (HR 0.94, P=0.9) or mortality (HR 1.58, P=0.2). In the ablation cohort, transplant patients had better local recurrence-free survival (log-rank P=0.01) compared to non-transplant patients. No difference was identified in metastasis-free or overall survival with regards to transplant status (HR 4.75, P=0.2; HR 0.98, P=0.9). Among patients managed with active surveillance, long-term follow-up demonstrated no differences in probability of treatment, metastatic progression, or survival, and transplantation was not associated with increased risk of death from any cause (HR 0.52, P=0.5).

Conclusions: Across all management strategies, no difference was identified in outcomes for patients with non-metastatic RCC after solid organ transplantation compared to non-transplant patients, despite chronic immunosuppression. Further studies should evaluate the role of active surveillance in this population.

Objective: To evaluate 30-day postoperative UTI rates in children with VUR undergoing ureteral reimplantation, assessing the impact of discharge antibiotics.

Methods: This retrospective cohort study utilized the pediatrics NSQIP VUR specific dataset to analyze patients who underwent ureteral reimplantation for VUR. We compared 30-day UTI rates, readmissions, and ER visits between those discharged with and without antibiotics. Multivariable logistic regression identified independent predictors of UTIs.

Results: Of 3,004 patients included who underwent ureteral reimplant, 2,509 (84%) and 495 (16%) were discharged with or without antibiotics, respectively. On univariable analysis, the proportion of patients who experienced 30-day readmission (3.9% vs 5.3%), emergency room visits (10.5% vs 10.5%), and UTI (2.4% vs 3.2%) did not differ according to discharge antibiotic use (antibiotics vs. no antibiotics, respectively, all p>0.05). On MVA, age (Odds Ratio [OR]: 0.986, 95% CI: 0.978 - 0.994) and female sex (OR: 1.782, 95% CI: 1.005 - 3.162) were found to be significant predictors of UTI occurrence. Conversely, the prescription of antibiotics at discharge (OR: 1.564, 95% CI: 0.886 - 2.763) did not show a significant impact on UTI rates.

Conclusions: Age and sex are predictive of UTI risk within 30 days following ureteral reimplantation for VUR. The absence of significant associations for reflux grade, perioperative stent use, or prophylactic antibiotic administration at discharge suggests that routine prescription of antibiotics post-discharge may not reduce early UTI risk. These findings can guide postoperative care and help tailor antibiotic stewardship efforts in pediatric urology.

Objectives: To evaluate the safety and outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in patients with a history of prior surgical prostate intervention, and to compare these results with the patients without previous prostate intervention.

Methods: A retrospective review of a prospectively maintained database at a tertiary-level center in Texas. From August 2015 to February 2025, 1876 patients underwent HoLEP, 143 had previous prostate surgery. These were matched 1:1 with 143 patients without prior surgery based on prostate weight. Data included IPSS, hemoglobin reduction, resected tissue weight, enucleation and morcellation efficacy, prostate volume, and estimated blood loss (EBL).

Results: A total of 286 patients. Of 143 patients with prior surgery, TURP was the most common procedure (82 cases). No significant differences were found between groups in preoperative IPSS, age, resected weight, enucleation efficacy, hemoglobin reduction, or prostate volume. At three months postoperatively, the IPSS was significantly lower in patients with prior surgery. Morcellation efficacy was reduced, and EBL was higher in the prior surgery group. Both groups demonstrated significant improvements in IPSS overall.

Conclusion: HoLEP is a safe and effective surgical option for BPH in both primary and re-treatment settings. Prior interventions do not significantly affect enucleation efficacy, hemoglobin reduction, or IPSS outcomes; however, they are associated with reduced morcellation efficiency and increased blood loss.