Urology最新文献

Objective: To use DCE-MRU to evaluate the physiological differences between duplex kidneys with and without obstructed moieties.

Methods: Consecutive patients who underwent DCE-MRU studies between January 2019 and March 2021 for evaluation of duplex kidneys were included. The study population consisted exclusively of patients with duplex kidneys (complete ureteral duplication), divided into Group A (duplex kidneys with one obstructed moiety, n=5) and Group B (duplex kidneys without obstruction, n=5). Utilizing prior described techniques, filtration rate (Ft) parameter, which is a measure of renal filtration, was calculated of each renal moiety and compared between the two groups.

Results: 5 patients in Group A were compared to 5 patients in Group B. In group A, the non-obstructed moiety showed relative increased Ft or hyper filtration compared to the normal contralateral side. Those in group B did not show increased Ft.

Conclusion: MRU, with its high spatial and temporal resolution and its ability to calculate Ft, provides a non-invasive assessment of renal physiology, and this is the first report of renal compensation occurring within a kidney where one moiety of the kidney demonstrates hyperfiltration, perhaps as a compensation for the stressed obstructive state of the other pole.

Objective: To evaluate cause-specific mortality among patients diagnosed with kidney cancer before age 40 from 2000 to 2020 using the SEER incidence database.

Methods: Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were calculated for 1,323 patients relative to the general population. Analyses were stratified by time from diagnosis, cancer subtype, and stage. Limitations include the use of registry data and potential coding inaccuracies.

Results: Among all kidney cancer patients, regardless of stage, primary kidney cancer accounted for the majority of deaths (n=882, SMR 1475.7, 95% CI 1379.9-1576.3). Patients with any type of kidney cancer, regardless of stage, had significantly higher risk of non-cancerous death (n = 312, SMR 2.44, 95% CI 2.18-2.73). Non-Wilms tumor/non-renal cell carcinoma tumors and low-stage cancers had the largest SMRs for non-cancer causes of death (n <16, SMR 5.77, 95%CI 1.57-14.77 and n = 155, SMR 2.47, 95%CI 2.10-2.90). Nephritic/nephrotic syndromes, septicemia, and accidents, suicides, and homicides were significant causes of non-cancer deaths.

Conclusions: Cancer survival outcomes are potentially limited by fatal later effects of treatment, psychological impacts, or comorbidities from conditions that may predispose to kidney cancers. Potential survivorship strategies could include expanded genetic screening, increased use of nephron-sparing approaches, adoption of less toxic treatment regimens, enhanced monitoring for low-stage disease, and incorporation of routine psychological support.

Objectives: To examine the validity of the American Urological Association Symptom Index (AUA-SI) to assess varied lower urinary tract symptoms in men and women.

Methods: Internal consistency and test-retest reliability of the AUA-SI were assessed in a community-dwelling cohort representative of the United States population (n=1551) and a national care-seeking cohort (n=1083). We also examined correlations of the AUA-SI subscale and total scores with validated urinary symptom severity measures, the lower urinary tract symptoms tool (LUTS tool) and gender-specific versions of the International Consultation on Incontinence Questionnaire-lower urinary tract symptoms (ICIQ-LUTS).

Results: Men demonstrated more severe voiding phase symptoms, while women exhibited more storage phase symptoms. Internal consistency of the AUA-SI, measured by McDonald's omega, was >0.7 for the assessment of voiding-phase lower urinary tract symptoms, but performed poorly for storage symptoms at 0.61 and 0.56 for men and women, respectively. Spearman's correlation coefficients between the AUA-SI and other survey instruments assessing urinary symptoms were poor, particularly for women and storage lower urinary tract symptoms-related quality of life.

Conclusions: The AUA-SI is a validated symptom score with high internal consistency and reliability for assessing men with benign prostatic hyperplasia but is broadly used to assess women and men with lower urinary tract symptoms. While validated for use in men with benign prostatic hyperplasia, the AUA-SI performs poorly in evaluating storage lower urinary tract symptoms and related quality-of-life, particularly in women. Clinicians should use caution in non-validated uses of the AUA-SI, particularly for female storage voiding dysfunction.

Buccal mucosa grafts (BMG) have become the standard for complex urethral reconstruction due to unique regenerative properties including rapid re-epithelialization, minimal inflammation, and tightly controlled fibroblast action that results in "scarless healing". These characteristics reflect fetal-like wound healing phenotypes with distinct fibroblast subpopulations and favorable inflammatory profiles. BMG have applications across the genitourinary tract from renal pelvis to external genitalia. Emerging technologies-tissue-engineered oral mucosal substitutes, extracellular vesicles, and organoid systems-offer future possibilities for patients who need large reconstructions. However, clinical translation requires manufacturing standardization and cost reduction. This review outlines BMG biology and highlights future urologic applications.

Objective: To evaluate adolescent satisfaction and decisional regret after hypospadias repair in childhood and to assess associations with anatomical severity, surgical complications, and reoperations.

Patients and methods: Adolescents who underwent hypospadias repair in childhood completed a pre-mailed questionnaire before their final paediatric follow-up visit. Satisfaction was assessed using the validated Penile Perception Score (PPS), evaluating meatal location, glans shape, penile skin, and overall appearance. Additional items addressed satisfaction with penile length and straightness, perceived timing of surgery, and decisional regret. Reference data for age-matched healthy controls were derived from published normative material.

Results: In total, 176 patients (101 distal, 20 midshaft, and 55 proximal hypospadias) responded (response rate 64%); 51% had undergone at least one unplanned reoperation. Median age at primary surgery was 1.4 years and at follow-up 16.3 years. Dissatisfaction with meatal location, glans, skin, and straightness did not differ between patients and controls. Dissatisfaction with penile length (18.6% vs 0%, p < 0.01) and overall appearance (11.8% vs 1.6%, p = 0.03) was more common among patients. PPS scores were generally higher after distal than proximal repair. Dissatisfaction with penile length was more frequent after a Nesbit procedure (26% vs 12%, p = 0.03). Most patients (89.8%) considered the timing of surgery appropriate; 2.9% reported decisional regret.

Conclusions: Most adolescents were satisfied with outcomes following early hypospadias repair. Dissatisfaction with penile length and appearance was more frequent among patients, especially after proximal repair. Decisional regret was rare, supporting early surgery combined with structured long-term follow-up and appropriate counselling.

Objective: To evaluate the impact of catheter type and size on patient-reported pain, anxiety, and adverse events during intravesical therapy.

Methods: A total of 200 patients were screened and 179 were randomized into four groups: Foley 12 Fr (n=31), Foley 8 Fr (n=60), Nelaton 12 Fr (n=46), and Nelaton 8 Fr (n=42). Pain was assessed using the Visual Analog Scale (VAS), anxiety using the Beck Anxiety Inventory (BAI), and complications were recorded for one week following instillation.

Results: Compared with Foley 8 Fr, pain scores were significantly higher with Nelaton 12 Fr (OR 713.4; 95% CI 231.5-2424.7; p<0.001). Male sex was independently associated with increased pain (OR 3.8; 95% CI 1.7-8.5; p=0.001). Anxiety severity was higher only in the Nelaton 12 Fr group (OR 2.6; 95% CI 1.24-5.35; p=0.012). There were no statistically significant differences in overall complication rates among the groups.

Conclusion: Catheter type and size significantly influence pain and anxiety during intravesical therapy, with smaller rubber catheters (Foley 8 Fr) providing the most favorable patient experience.

Objective: To describe the distribution of predefined Index Symptoms and Diagnostic Profiles in a cohort of men undergoing Remote multi-day urinary diagnostics (RMUD) for lower urinary tract symptoms (LUTS).

Methods: We retrospectively analyzed 1,047 RMUD performed with CarePath® in men referred for LUTS across 18 sites. RMUD combined multi-day frequency-volume and uroflowmetry data with the IPSS. Six Index Symptoms were operationalized: (1) low flow with elevated IPSS (device trial criteria), (2) overactivity, (3) primary overactivity (overactivity without obstructive RMUD findings), (4) nocturia, (5) nocturnal polyuria (NP) using the ICS NP index, and 6) no qualifying voids. Combinations of the Index Symptoms were used to define non-overlapping Diagnostic Profiles.

Results: Median age was 70 years and median IPSS was 14. Patients produced a median of 15 voids across a 2-day study and 92.8% produced at least one qualifying void ≥150 mL. Obstructive criteria were met in 37.6% of men, while 33.5% demonstrated overactivity and 13.9% had primary/idiopathic overactivity without RMUD evidence of obstruction. Nocturia >2 per night occurred in 67.3%, and NP in 46.8% of patients. Across the cohort, the 6 Index Symptoms combined into 21 discrete, non-overlapping Diagnostic Profiles, most of which reflected mixed storage-voiding-NP phenotypes rather than isolated obstruction.

Conclusions: RMUD-enabled phenotyping with Index Symptoms reveals substantial heterogeneity among men with LUTS and identifies patterns of obstruction, overactivity and NP. This LUTS phenotyping framework supports more precise counseling, treatment selection, and identification of patients who warrant further evaluation.

Objective: To evaluate the concordance between the postoperative priorities of urologists who perform enucleation surgery and patients who are candidates for surgery.

Methods: This cross-sectional study utilized a structured face-to-face survey research design between June and August 2025 in a total of four urology clinics. We included men ≥50 years with lower urinary tract symptoms, excluding those with prior prostate surgery. The study involved administering questionnaires to both urologists who perform enucleation surgery and patients who are candidates for the procedure. The collected data were subsequently analyzed to compare the priorities of surgeons and patients.

Results: A total of 82 urologists and 622 patients were included in the study. Mean IPSS of patients was 17.8 ± 5.5, and mean IIEF-5 score was 15.9 ± 6.3. Surgeons identified continence as the highest priority (45.7% ranked it first, 44.4% second). Patients also ranked continence as the top priority (34.7% first, 27.2% second), although their responses were more widely distributed across lower ranks. Surgeons prioritized continence more strongly than patients (p=0.001). Ejaculation was ranked lowest by surgeons (51.9% ranked it fifth), with none ranking it first. In contrast, patients assigned greater importance to ejaculation (4.7% first, 14.5% second, 16.7% third) (p=0.005). Before enucleation surgery, 14.8% of urologists omitted information on ejaculation, 30.9% on erectile function, and 6.2% on continence.

Conclusion: Both patients and surgeons prioritized effective urination and continence following enucleation surgery. Ejaculation, however, was assigned low priority by surgeons, whereas certain groups of patients regarded it as an important outcome.

Objective: To develop a diagnostic model using preoperative abdominal CT scans that identifies pathologic T3 (pT3) stage renal cell carcinoma among patients with tumors >7cm. Neoadjuvant clinical trials often use tumor size >7cm for enrollment to enrich the study population with higher-risk patients. However, T stage is also an important prognostic factor, and stage pT3 tumors are associated with a significantly higher risk of metastatic progression.

Methods: Data were analyzed for consecutive patients with non-metastatic renal tumors >7cm treated with radical nephrectomy from 2000 to 2024. Univariable and multivariable analyses were used to evaluate radiographic features for associations with pT3. A predictive model was developed, and its accuracy and clinical utility were assessed.

Results: A total of 326 patients with preoperative contrasted CT scans were identified. The median radiographic tumor diameter was 9.1cm, and 59% had a pT3 stage. Four radiographic tumor characteristics were independently predictive and included in the model: 1) irregular tumor-fat interface, 2) attenuation difference of ≥15HU between the peritumor fat and contralateral side, 3) peritumor neovascularity, and 4) venous tumor thrombus. ROC curves demonstrated predictive accuracy with an AUC of 0.84. Decision curve analysis indicated clinical utility across a wide range of threshold probabilities.

Conclusions: The SHARP model improves the ability to identify stage pT3 in renal tumors >7cm using preoperative imaging compared to size alone. This model may be used to improve neoadjuvant clinical trial design.