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英文中文

Repair of Meatal Stenosis Following Hypospadias Reconstruction. 尿道下裂重建术后椎管狭窄的修复。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-06 DOI: 10.1016/j.urology.2026.02.037

Tomer Bashi, Ilay Rikover, Adi Kidron, Snir Dekalo, Omer Efrat, Asaf Fishelevitz, Noam Bar-Yaakov, Jacob Ben-Chaim, Yuval Bar-Yosef

Objective: To evaluate the success of meatoplasty for isolated meatal stenosis following hypospadias repair and identify factors associated with recurrence.

Methods: We reviewed all patients who underwent meatoplasty for meatal stenosis following hypospadias repair at a tertiary center during 2000-2024. Data were collected from clinical records and telephone interviews. Outcomes included surgical success (symptom resolution without reintervention) and time to recurrence. Associations with variables (age, hypospadias severity) were analyzed.

Results: Among 112 eligible patients, 63 met inclusion criteria (consented with adequate follow up). One meatoplasty was curative in most cases; 45 patients (71.4%) required one meatoplasty, while 18 (28.6%) developed recurrent stenosis and underwent a second meatoplasty. The median age at primary hypospadias repair was 17 months (IQR 9-36), and the median age at first meatoplasty was 3.8 years (IQR 2.5-6.7). Baseline characteristics and age at first meatoplasty did not significantly differ between those with and without recurrence (p>0.05). The median interval from first to second meatoplasty was 3.5 years (range 0.2-13.7). Recurrence timing showed a bimodal pattern: ~28% occurred within 1 year and ~39% at ≥5 years post meatoplasty. All patients were symptom free after reoperation, and none of the patients needed further intervention.

Conclusion: Meatoplasty is an effective treatment for meatal stenosis after hypospadias repair. No clear predictive factors for recurrence were identified. Even late presenting recurrences were successfully managed with repeat meatoplasty, highlighting the need for prompt intervention and extended surveillance into adolescence.

目的：评价尿道下裂修复后孤立性金属狭窄的成形术的成功率，并探讨与复发相关的因素。方法：我们回顾了2000年至2024年间在三级中心接受尿道下裂修复术后金属狭窄的所有患者。数据收集自临床记录和电话访谈。结果包括手术成功（无再次干预的症状缓解）和复发时间。分析与变量（年龄、尿道下裂严重程度）的关系。结果：112例患者中，63例符合纳入标准（同意充分随访）。一种肉成形术在大多数情况下是治愈的；45例（71.4%）患者需要一次肉成形术，而18例（28.6%）复发狭窄并进行了第二次肉成形术。原发性尿道下裂修复的中位年龄为17个月（IQR 9-36），首次成形术的中位年龄为3.8岁（IQR 2.5-6.7）。有复发和无复发患者的基线特征和首次成形术时年龄无显著差异（p < 0.05）。从第一次到第二次成形术的中位间隔为3.5年（范围0.2-13.7）。复发时间呈双峰模式：~28%发生在术后1年内，~39%发生在术后≥5年。所有患者再次手术后症状消失，无需进一步干预。结论：肉成形术是尿道下裂修复后金属狭窄的有效治疗方法。没有明确的复发预测因素。即使是晚期的复发也可以通过重复的肉成形术成功地管理，强调了及时干预和延长监测到青春期的必要性。

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引用次数: 0

Revision Hypospadias Repair in Adolescence: A Scoping Review. 青春期尿道下裂修复：范围综述。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-06 DOI: 10.1016/j.urology.2026.02.032

Colton Bohonos, Roshan Ajeet Singh, Elaine Joanne Redmond

Objective: To assess the outcomes from revision hypospadias surgery in adolescence.

Methods: A comprehensive literature search of PubMed and Embase was performed to identify articles that focused on revision hypospadias surgeries in adolescence. Two authors screened abstracts and identified articles suitable for inclusion. Publication characteristics including authorship, objectives, study design, cohort, surgical methods, and outcomes were recorded.

Results: A total of 36 full length articles were included in the final review. Nineteen articles focused on recurrent hypospadias, fifteen on urethrocutaneous fistula, and a single study each on urethral stricture and glans dehiscence. There was significant heterogeneity of reported surgeries, cohorts, and outcomes throughout.

Conclusion: The wide variability in reported outcomes highlights the knowledge gaps that persist in hypospadias revision surgery. Distal hypospadias recurrence is often managed with tubularized incised plate procedures, while proximal is often performed with two staged buccal mucosal grafting. Growth adaptation of such grafts during puberty remains uncertain. Future well designed studies should aim to clarify the effect of pubertal change on such reconstructive procedures, as well as the psychological implications of revision surgery in childhood.

目的：评价青少年尿道下裂修补术的治疗效果。方法：对PubMed和Embase进行全面的文献检索，以确定关注青少年尿道下裂修补手术的文章。两位作者筛选摘要并确定适合纳入的文章。记录发表特征，包括作者、目的、研究设计、队列、手术方法和结果。结果：最终评审共纳入36篇全文文章。19篇文章聚焦于复发性尿道下裂，15篇聚焦于尿道瘘，1篇聚焦于尿道狭窄和龟头开裂。报告的手术、队列和结果存在显著的异质性。结论：报道结果的广泛差异突出了尿道下裂翻修手术中持续存在的知识差距。尿道下裂远端复发通常采用管状切开钢板手术，而近端复发通常采用两期颊粘膜移植。这种移植物在青春期的生长适应性仍不确定。未来精心设计的研究应旨在阐明青春期变化对此类重建手术的影响，以及儿童翻修手术的心理影响。

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引用次数: 0

Editorial Comment on "Are We Exposing Urology Residents to Rural or Non-Metropolitan Practice? A Program Director Survey of Urology Residency Training". 社论评论“我们是让泌尿科住院医生接受农村还是非城市的治疗？”泌尿外科住院医师培训项目主任调查”。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-05 DOI: 10.1016/j.urology.2026.02.034

Casey Kowalik, Danica May, Moben Mirza

引用次数: 0

Reply to Editorial Comment on "In Vitro Fertilization Utilization Rates and Outcomes in States with and without Insurance Coverage Mandates for Male Infertility Care". 回复关于“有和没有男性不育症护理保险规定的州的体外受精利用率和结果”的社论评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-05 DOI: 10.1016/j.urology.2026.02.036

Amelia A Khoei, James M Dupree

引用次数: 0

Editorial Comment on "Longitudinal Trends in Urology In-Service Examination Performance: 2016 - 2023". 对“2016 - 2023年泌尿外科在职检查绩效纵向趋势”的评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-05 DOI: 10.1016/j.urology.2026.02.035

Theodore Dowd, Alp Turgut, Ching Man Carmen Tong

引用次数: 0

Editorial Comment on "Understanding Couples' Perspectives After Negative Microsurgical Testicular Sperm Extraction (micro-TESE): A Qualitative Theme Analysis". “了解阴性显微手术睾丸精子提取（micro-TESE）后夫妇的观点：定性主题分析”的评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-04 DOI: 10.1016/j.urology.2026.02.033

Dr Tom Deklaj, Dr Gerald Brock

引用次数: 0

Evaluation of Multifocal Positive Surgical Margin Predictors and Mapping of Positive Surgical Margin Locations in Robot-assisted Radical Prostatectomy 机器人辅助根治性前列腺切除术中多灶阳性手术切缘预测因子的评估和阳性手术切缘定位。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-12-16 DOI: 10.1016/j.urology.2025.12.022

Ali Kaan Yildiz , Huseyin Gultekin , Turgay Kacan , Demirhan Orsan Demir , Yusuf Gokkurt , Omer Furkan Erbay , Sedat Tastemur , Bugra Bilge Keseroglu , Tolga Karakan

Objective

To identify predictive factors for multifocal positive surgical margins (PSM) in patients undergoing robot-assisted radical prostatectomy (RARP) and the impact of prostate volume (PV) on the locations of PSMs.

Methods

A total of 440 patients who underwent RARP between 2021 and 2024 were retrospectively evaluated. A PSM was defined as ≥3 mm of continuous tumor at the surgical margin. Patients were divided into 3 groups: negative SM (surgical margin) (n = 312), unifocal PSM (n = 61), and multifocal PSM (n = 67). The groups were compared in respect of age, body mass index (BMI), total linear length of PSM, prior pelvic surgery, prior radiotherapy (RT), prior transurethral-resection of prostate (TURP), prostate-specific antigen (PSA), PV, PSA density (PSAD), nerve-sparing status, and tumor stage and grade. Multivariate logistic regression analysis was performed.

Results

The overall PSM rate was 29.0% (128/440 patients). There were no statistically significant differences between the unifocal and multifocal PSM groups in terms of age, BMI, nerve-sparing status, PSAD, or pathological stage (all P >.05). Significant differences were observed for PSA (P = .001), PV (P = .001), biopsy ISUP grade (P = .04), and pathological ISUP grade (P = .04). In multivariate analysis, higher PSA (OR 1.406, P = .03) and larger PV (OR 1.229, P = .04) emerged as independent predictors of multifocal PSM. Posterolateral PSMs were more common in prostates ≤40 mL (37.1%), whereas apical PSMs predominated in prostates >40 mL (57.4%).

Conclusion

Addressing the risk factors associated with multifocal PSMs may contribute to better oncological outcomes. Predicting the likely locations of PSMs based on PV may help enhance the success of the surgical procedure.

目的：探讨机器人辅助根治性前列腺切除术（RARP）患者多灶性阳性手术切缘（PSM）的预测因素，以及前列腺体积（PV）对PSM位置的影响。方法：对440例2021年至2024年间接受RARP的患者进行回顾性评估。PSM定义为手术边缘连续肿瘤≥3mm。患者分为3组：阴性SM （n=312）、单焦点PSM （n=61）和多焦点PSM （n=67）。比较两组患者的年龄、体重指数（BMI）、PSM总线性长度、既往盆腔手术、既往放疗（RT）、既往经尿道前列腺切除术（TURP）、前列腺特异性抗原（PSA）、PV、PSA密度、神经保留状态、肿瘤分期和分级。进行多因素logistic回归分析。结果：总PSM率为29.0%（128/440例）。单灶性PSM组与多灶性PSM组在年龄、BMI、神经保留状态、PSA密度、病理分期等方面无统计学差异（均p < 0.05）。PSA （p=0.001）、前列腺体积（p=0.001）、活检ISUP分级（p=0.04）和病理ISUP分级（p=0.04）的差异均有统计学意义。在多因素分析中，较高的PSA （OR 1.406, p=0.03）和较大的PV （OR 1.229, p=0.04）成为多灶性PSM的独立预测因子。后外侧psm多见于≤40mL的前列腺（37.1%），根尖psm多见于≤40mL的前列腺（57.4%）。结论：解决与多灶性psm相关的危险因素可能有助于更好的肿瘤预后。根据前列腺体积预测psm的可能位置可能有助于提高手术的成功率。

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引用次数: 0

Delay of Secondary Diversion After Failed Ablation May Commit Patients With Posterior Urethral Valves to Worse Renal Short-term Outcomes 消融失败后的二次分流延迟可能使后尿道瓣膜患者的肾脏短期预后更差。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.urology.2025.12.037

Juliane Richter , Joana Dos Santos , Jin Kyu Kim , Michael E. Chua , Rodrigo Romao , Joao Pippi Salle , Priyank Yadav , Armando J. Lorenzo , Mandy Rickard

Objective

To compare the effects of secondary versus primary diversion on kidney and bladder function in infants with posterior urethral valves (PUV). Although primary valve ablation is considered the gold standard, it is controversial and typically reserved for severe cases with valve ablation being the gold standard. In cases that fail to improve, secondary diversion may be offered—after a delay that likely had a detrimental impact on renal reserve.

Methods

A retrospective review of our institutional database between 2000 and 2024 identified 81 patients with diversion. After exclusion of patients ≥1 year at initial presentation (n = 8), other LUTO diagnoses (n = 11), and deceased patients (n = 1), 61 patients were included. Data were summarized as mean ± standard deviation (SD) for continuous variables.

Results

A total of 45 patients underwent primary and 16 secondary diversions. Mean follow-up was 4.9 ± 4.7 years for primary and 8.9 ± 5.9 years for secondary diversion, respectively. There was no difference in creatinine levels at presentation (P = .7609), at 30 days (P = .3748), 1 year postoperatively (P = .4487), at 1 year of age (P = .6158), time to nadir (P = .2109), and nadir creatinine levels (P = .8708). Secondary diversion was associated with higher likelihood of persistent high-grade hydronephrosis (P = .0146) and transplantation (P = .0252). While secondary diversion had an impact on CIC rates (P = .0028) and creatinine levels at last follow-up (P = .0064), risk of progression to ESKD (P = .1159) and UTI rates (P = .3207) were not impacted.

Conclusion

There was no impairment in short-term renal function; however, children with marginal baseline function deteriorated early (elevated creatinine levels, progression to transplantation). In carefully selected patients, primary diversion appears advantageous over salvage diversion after failed ablation and should be favored to protect long-term kidney function.

目的：比较继发性和原发性分流对婴儿后尿道瓣膜（PUV）患者肾脏和膀胱功能的影响。虽然初级瓣膜消融被认为是金标准，但它是有争议的，通常保留在严重的情况下，瓣膜消融是金标准。在病情没有改善的情况下，可能会在可能对肾储备产生不利影响的延迟后进行二次转移。方法：对我院2000-2024年间的数据库进行回顾性分析，确定了81例分流患者。在排除首次就诊时bb0 1年的患者（n=8）、其他LUTO诊断（n=11）和死亡患者（n=1）后，共纳入61例患者。连续变量的数据汇总为平均值+标准差（SD）。结果：45例患者接受了原发性转移，16例患者接受了继发性转移。原发性分流的平均随访时间为4.9 + 4.7年，继发性分流的平均随访时间为8.9 + 5.9年。发病时（p=0.7609）、术后30天（p=0.3748）、术后1年（p=0.4487）、1岁（p=0.6158）、至最低点时间（p=0.2109）和最低点肌酐水平（p=0.8708）均无差异。继发性分流与持续高级别肾积水（p=0.0146）和移植（p=0.0252）的可能性较高相关。虽然继发性分流对CIC率（p=0.0028）和最后随访时肌酐水平（p=0.0064）有影响，但对ESKD进展风险（p=0.1159）和UTI率（p=0.3207）没有影响。结论：无短期肾功能损害；然而，边际基线功能恶化的儿童早期（肌酐水平升高，进展到移植）。在精心挑选的患者中，消融失败后，初次分流比补救性分流更有利，更有利于保护长期肾功能。

{"title":"Delay of Secondary Diversion After Failed Ablation May Commit Patients With Posterior Urethral Valves to Worse Renal Short-term Outcomes","authors":"Juliane Richter , Joana Dos Santos , Jin Kyu Kim , Michael E. Chua , Rodrigo Romao , Joao Pippi Salle , Priyank Yadav , Armando J. Lorenzo , Mandy Rickard","doi":"10.1016/j.urology.2025.12.037","DOIUrl":"10.1016/j.urology.2025.12.037","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the effects of secondary versus primary diversion on kidney and bladder function in infants with posterior urethral valves (PUV). Although primary valve ablation is considered the gold standard, it is controversial and typically reserved for severe cases with valve ablation being the gold standard. In cases that fail to improve, secondary diversion may be offered—after a delay that likely had a detrimental impact on renal reserve.</div></div><div><h3>Methods</h3><div>A retrospective review of our institutional database between 2000 and 2024 identified 81 patients with diversion. After exclusion of patients ≥1 year at initial presentation (n = 8), other LUTO diagnoses (n = 11), and deceased patients (n = 1), 61 patients were included. Data were summarized as mean ± standard deviation (SD) for continuous variables.</div></div><div><h3>Results</h3><div>A total of 45 patients underwent primary and 16 secondary diversions. Mean follow-up was 4.9 ± 4.7 years for primary and 8.9 ± 5.9 years for secondary diversion, respectively. There was no difference in creatinine levels at presentation (<em>P</em> = .7609), at 30 days (<em>P</em> = .3748), 1 year postoperatively (<em>P</em> = .4487), at 1 year of age (<em>P</em> = .6158), time to nadir (<em>P</em> = .2109), and nadir creatinine levels (<em>P</em> = .8708). Secondary diversion was associated with higher likelihood of persistent high-grade hydronephrosis (<em>P</em> = .0146) and transplantation (<em>P</em> = .0252). While secondary diversion had an impact on CIC rates (<em>P</em> = .0028) and creatinine levels at last follow-up (<em>P</em> = .0064), risk of progression to ESKD (<em>P</em> = .1159) and UTI rates (<em>P</em> = .3207) were not impacted.</div></div><div><h3>Conclusion</h3><div>There was no impairment in short-term renal function; however, children with marginal baseline function deteriorated early (elevated creatinine levels, progression to transplantation). In carefully selected patients, primary diversion appears advantageous over salvage diversion after failed ablation and should be favored to protect long-term kidney function.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 102-106"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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And Then There Was One: Elective Induction and Contralateral Septopexy for Management of Prenatal Testicular Torsion 然后有一个：选择性诱导和对侧鼻中隔阻断治疗产前睾丸扭转（PTT）。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.urology.2025.12.036

Jonathan T. Xu , Michael P. Kurtz , Stephanie H. Guseh , Mélise A. Keays

Prenatal testicular torsion (PTT) is very rare and poses a unique challenge as the contralateral testis cannot be easily monitored in utero. Delays to induction or delivery could increase the risk of testicular loss and anorchia due to contralateral torsion. We present a case of unilateral PTT in a near-term fetus managed with elective induction who underwent orchiectomy of the ipsilateral testis and septopexy of the contralateral testis, with a specific focus on multispecialty discussion weighing the maternal-fetal risk of early delivery with the risk of contralateral torsion.

产前睾丸扭转（PTT）是非常罕见的，并提出了一个独特的挑战，因为对侧睾丸不容易在子宫内监测。延迟诱导或分娩可增加因对侧扭转导致睾丸丢失和缺氧的风险。我们报告了一例单侧PTT近期胎儿择期诱导的病例，该胎儿接受了同侧睾丸切除术和对侧睾丸中隔切除术，并特别关注多专业讨论，权衡母体胎儿早期分娩的风险和对侧扭转的风险。

引用次数: 0

Aims and Scope 目标及范围

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-03-12 DOI: 10.1016/S0090-4295(26)00131-7

引用次数: 0

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