Urology最新文献

Objective: To evaluate the clinical and histopathological parameters of sperm retrieval success using micro-TESE in NOA with complete AZFc microdeletion, since there is limited data in the literature on the outcomes of this patient group and controversial results on the parameters affecting the success of micro-TESE in non-obstructive azoospermia (NOA) patients.

Methods: The data of 1,308 patients with NOA who underwent micro-TESE surgery at two centers between 2014 and 2022 were retrospectively analyzed. Clinical and histopathological data were comparatively assessed in men with complete AZFc microdeletion according to sperm retrieval success.

Results: Among the 1,308 men, 54 (4.1%) were diagnosed with complete AZFc microdeletion. Micro-TESE was successful in retrieving sperm from 28 men with AZFc microdeletion (51.8%). The patient age, FSH and total testosterone levels, duration of infertility, and testicular volume did not statistically significantly differ between the sperm-positive and -negative groups (p>0.05). The analysis revealed that parental consanguinity was significantly different between the two groups (p=0.032). According to the testicular biopsy results in terms of sperm retrieval status, no statistically significant difference was observed in the distribution of histopathological patterns.

Conclusion: Parental consanguinity was found to be the only parameter that negatively affected the success of micro-TESE in patients with NOA who presented with AZFc microdeletion. Clinical parameters, including patient age, FSH and total testosterone levels, and testis volume, did not demonstrate predictive value for sperm retrieval success in micro-TESE in this patient population.

Objectives: To evaluate the occurrence and the oncological predictive value of cribriform growth and/or intraductal carcinoma (CR/IDC) in patients with ISUP grade group (GG) 2 prostate cancer (PCa) at radical prostatectomy (RP) with and without synchronous nodal metastases in a multicenter, international cohort.

Methods: We identified 1060 patients who underwent RP with ISUP GG2 PCa at histopathology and a pelvic lymph node dissection from three tertiary referral centers. Of these, 79 (7.4%) had pN1 disease. Case-control matching was performed using the initial prostate-specific antigen (iPSA) value, pT-stage, age, surgical margin status, and referral center as matching variables to compare histopathological characteristics and oncological outcomes between pN1 and pN0 patients. The predictive value of CR/IDC for biochemical recurrence-free survival (BCRFS), defined as the interval between RP and a PSA of ≥0.2 ng/ml, and radiological recurrence-free survival (RRFS), defined as the interval between RP and an RR, was evaluated using Cox regression analysis.

Results: After case-control matching, 106 patients were included (i.e., 53 cases and 53 controls). CR/IDC was significantly more common in pN1 than pN0 RP specimens (100% vs 51%, p<0.001). In pN0 patients, CR/IDC positivity was not associated with BCRFS (hazard ratio [HR]=0.90, 95% CI 0.32-2.55, p=0.842) or RRFS (HR 2.45, 95% CI 0.45-13.34, p=0.299). pN1 CR/IDC-positive PCa was associated with adverse BCRFS (HR=2.93, 95% CI 1.26-6.83, p=0.013) and RRFS (HR=9.19, 95% CI 2.11-40.04, p=0.003) in multivariable Cox regression analysis.

Conclusions: In ISUP GG2 PCa, CR/IDC strongly correlates with synchronous nodal metastases, the latter being associated with adverse outcomes.

Objectives: To introduce a novel technique, dynamic ^99mTc-MAG3 SPECT/CT (DyMAG3 SPECT/CT), which provides detailed anatomical structure, drainage patterns, presence of scarring, and split renal function in a single imaging session. This method seeks to improve the quality of conventional planar scintigraphy and offer comprehensive diagnostic convenience.

Materials and methods: DyMAG3 SPECT/CT was applied to nine index cases diagnosed with conditions such as ureteropelvic junction obstruction, ureterovesical junction obstruction, or hydronephrosis resembling ureteropelvic junction obstruction, with or without renal parenchymal thinning. Imaging was conducted just before planned pyeloplasty or ureteroneocystostomy. After a 0.1 mCi/kg ^99mTc-MAG3 bolus injection, planar perfusion imaging was performed at 2 seconds per frame for 1 minute. Subsequently, 2-minute-per-cycle SPECT acquisitions were undertaken over 20 minutes, followed by a CT acquisition. Time-activity curves (TACs) were generated from the isolated kidney volumes of interest. Split renal functions were calculated by integrating each kidney's TAC between 2 and 4 minutes, emulating conventional ^99mTc-DMSA scintigraphy.

Results: Preliminary findings from the first nine cases revealed that DyMAG3 SPECT/CT could provide both anatomical and functional data obtained equivalent to conventional techniques in a single imaging session. Moreover, DyMAG3 SPECT/CT improved the diagnostic abilities of ^99mTc-MAG3 scintigraphy by clearly distinguishing renal parenchyma from the collecting system. This allowed for voxel-based calculation of split renal function as an alternative to ^99mTc-DMSA scintigraphy.

Conclusion: This preliminary study suggests that DyMAG3 SPECT/CT could emerge as a state-of-the-art tool for the preoperative evaluation of obstructive uropathies.

Objective: To assess the ability of AI chatbots to deliver quality and understandable information on Wilms tumors to patients and their families.

Methods: Google trends were used to evaluate the most asked questions related to Wilms tumor. Four AI chatbots (ChatGPT version 3.5, Perplexity, Chat Sonic, and Bing AI) were then used to assess these questions and their responses reviewed. Validated instruments were used to assess the quality (DISCERN instrument from 1 low to 5 high), understandability and actionability (PEMAT, from 0% to 100%), the reading level of the information and whether there was misinformation compared to guidelines (5-point Likert scale).

Results: All AI chat bots provided a high level of patient health information with a median DISCERN score of 4 (IQR 3-5). Additionally, there was little to no misinformation in outputs with a median of 1 (IQR 1-1). The median word count per output from the AIs was 275 (IQR 156-322), with an advanced ease of reading level comparable to a high school or college student, median Flesch-Kincaid Readability level of 46.7 (IQR 41.1-52.2). The overall PEMAT actionability was poor with a median of 40% (40-65), while the PEMAT understandability of the AI chatbot outputs was high, 83% (IQR 75-91.2).

Conclusion: AI chatbots provide generalized, understandable and accurate information regarding Wilms tumor. They can be reliably used as a source for patients and families when seeking further information. However, much of the information is reliant of medical professionals and not easily actionable by consumers but may act as a guide to help with discussions and understanding treatments.

Objective: To evaluate the noise levels of Holmium:YAG (Ho:YAG), Thulium Fiber (TFL), and pulsed Thulium:YAG (p-Tm:YAG) lasers across various settings, focusing on compliance with safety thresholds and potential impact on communication in the operating room (OR).

Materials and methods: Noise measurements were taken in an empty OR using sound meters placed 1 m from the laser source. Ambient noise, standby, ready, and lasering modes at three settings (0.2 J-50 Hz, 0.5 J-20 Hz, and 1 J-10 Hz) were measured. Background noise was adjusted logarithmically, and sound emissions were weighted on dBA. Eleven laser models across Ho:YAG, TFL, and p-Tm:YAG systems were analyzed using descriptive and inferential statistics.

Results: Noise levels varied significantly by system and setting. All lasers produced <55dBA during standby/ready modes. During lasering, the Rocamed MH01 (Ho:YAG), RevoLix (Tm:YAG), and IPG Urolase PRO (TFL) were the quietest. The Quanta Cyber Magneto (Ho:YAG), Dornier Thulio (Tm:YAG), and EMS Laserclast (TFL) reached the highest noise levels, up to 66.06dBA. All lasers complied with NIOSH (85dBA) and OSHA (90dBA) limits, though several exceeded the 55dBA threshold for high-concentration tasks.

Conclusion: Endourological lasers produce <55dBA in standby/ready modes but may exceed this during lasering, potentially impacting communication and focus in the OR. While occupational noise risks are minimal, attention to noise emissions is crucial for optimizing surgical team performance. Future studies should explore noise impact on surgical outcomes.

Objective: To provide a comprehensive overview of the American Urological Association (AUA) Medical Student Surveys and includes data 2022, 2023 and 2024.

Methods: Data collected through surveys distributed prior to match day and were distributed to all medical students who submitted a rank list for urology residency. Questions consisted of various topics including applicant demographics, application metrics, and experiences with preference signals and virtual interviews.

Results: 440 (79%), 428 (84%), and 387 (77%) applicants participated in surveys for the years 2022, 2023, and 2024, respectively. Applicants continue to participate in research at a high level. Additionally, USMLE Step 2 Clinical Knowledge scores gained prominence following the transition of USMLE Step 1 to pass/fail. Preference signals were well-received, and large volume signaling may have prompted applicants to apply to fewer programs. Virtual interviews were favored for cost-effectiveness and perceived equity benefits, however, applicants expressed a preference for in-person interactions.

Conclusions: There have been dynamic shifts in urology residency applications from the applicant perspective from 2022 to 2024. This may be influenced by changing evaluation metrics as well as the adoption of preference signals and virtual interviews. The findings highlight the need for ongoing feedback and transparency to ensure equitable practices for both applicants and residency programs during this evolution.

Objectives: To test if our artificial intelligence (AI)-postoperative GFR prediction is as accurate as a validated clinical model. The American Urologic Association recommends estimating postoperative glomerular filtration rate (GFR) in patients with renal masses and prioritizing partial nephrectomy (PN) when GFR would be< 45 ml/min/1.73m² if radical nephrectomy (RN) was performed. Previously validated models have limited clinical uptake.

Methods: We included 300 patients undergoing nephrectomy for renal tumors from KiTS19 challenge. Preoperative GFR was collected just before surgery, and new baseline GFR 3-12 months postoperatively. Split-renal function (SRF) was determined in a fully automated way from preoperative computed tomography, combining our deep learning segmentation model, then using those segmentation masks to estimate postoperative GFR=1.24×GFR_Pre-RN×SRF_{Contralateral} for RN and 89% of GFR_preoperative for PN. A clinical model estimated postoperative GFR=35+GFR_preoperativex0.65-18 (if RN)-agex0.25+3 (if tumor>7cm)-2 (if diabetes). We compared the AI and clinical model GFR estimations to the measured postoperative GFR using correlation coefficients and their ability to predict GFR<45 using logistic regression.

Results: Median age was 60 years, 41% were female, and 62% had PN. Median tumor size was 4.2 cm, and 92% were malignant. Compared to the measured postoperative GFR, correlation coefficients were 0.75 and 0.77 for the AI and clinical models, respectively. The AI and clinical models performed similarly for predicting GFR<45 (areas under the curve 0.89 and 0.9, respectively).

Conclusions: Our fully automated prediction of new baseline renal function is as accurate as a validated clinical model without needing clinical details, clinician time, or measurements.