Urology Journal最新文献

Purpose: Urolithiasis is the condition of forming stones inside urinary tract with diverse shape, size, and location. The sooner urolithiasis is diagnosed, the easier it is to treat and prevent complication. This study aims to propose a method for predicting urolithiasis recurrence based on machine learning methods.

Materials and methods: The proposed method uses clinical data, demographics, and CT findings of 4246 patients who were referred to the clinic once or multiple times within three years. The proposed method has three main phases of data engineering and pre-processing, machine learning prediction model development, and performance evaluation. In addition, the performance of six machine learning-based classifiers is evaluated by performance metric calculation, ROC curve analysis, calibration analysis, and decision curve analysis.

Results: The results of 10 independent repeats of the proposed method using a train/test split evaluation strategy reveal that the best-performing classifier is random forest with the area under the ROC curve, sensitivity, and positive predictive value of 0.64, 0.87, and 0.84, respectively. On the other hand, k-fold cross-validation: A comma is needed after "hand" and before "k-fold" evaluation strategy reveals that the best-performing classifier again is RF, with the area under the ROC curve, sensitivity, and positive predictive value of 0.63, 0.90, and 0.83, respectively. Moreover, the brier score of 0.18 shows that this classifier is well-calibrated among other evaluated classifiers.

Conclusion: This study presents a practical application of predictive machine learning methods for predicting urolithiasis recurrence with clinically acceptable accuracy compared to traditional scoring systems. To select the best classifier, six different predictive ML models have been evaluated using different performance metrics and analysis tools.

Purpose: Surgical management is a key component in treating adrenal masses, particularly when they are functional or large. However, the choice between partial adrenalectomy (PA) and total adrenalectomy (TA) remains controversial. Therefore, this systematic review and meta-analysis aimed to evaluate whether surgical outcomes differ between patients undergoing PA versus TA.

Materials and methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies published up to April 2025. Nineteen studies were included, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted to estimate pooled outcomes.

Results: A total of 19 studies comprising 3,165 patients were included, of whom 1,084 underwent partial adrenalectomy (PA) and 2,081 underwent total adrenalectomy (TA). PA was associated with a significantly higher risk of tumor recurrence compared with TA (RR = 2.64, 95% CI 1.55-4.51), while no significant differences were observed for metastasis or mortality. In contrast, PA significantly reduced the risk of postoperative steroid dependence (RR = 0.44, 95% CI 0.34-0.55) and adrenal insufficiency (RR = 0.49, 95% CI 0.34-0.70). Perioperative complications were less frequent following PA (RR = 0.56, 95% CI 0.40-0.78), particularly mild complications, with no differences in severe complications. There were no significant differences in operative time or intraoperative blood loss between the two techniques. Subgroup analyses demonstrated higher recurrence rates in pheochromocytoma among patients undergoing PA, compared with Conn's adenoma. Perioperative complications were less frequent in PA in patients with Conn's adenoma. No significant differences were observed regarding surgical laterality (left vs. right) or the operative approach (transperitoneal vs. retroperitoneal laparoscopic / robotic surgery).

Conclusion: PA offers superior preservation of adrenal function and fewer mild perioperative complications compared with TA, but shows a higher risk of tumor recurrence in pheochromocytoma patients. PA was not associated with higher recurrence in Conn's patients. Other surgical and oncological outcomes were similar, underscoring the need to individualize the choice of procedure based on tumor type and patient factors.

Purpose: To evaluate the effectiveness of contralateral testicular volume measurements in differentiating monorchidism from intra-abdominal viable testes in children with non-palpable testes (NPt).

Materials and methods: The data of 179 patients who underwent surgery for undescended testes between January 2017 and January 2024 were retrospectively reviewed. The study included 33 patients with unilateral non-palpable testes. Testicular volumes were measured by ultrasonography 6-12 months prior to diagnostic laparoscopy, and the surgical findings were recorded.

Results: Diagnostic laparoscopy was performed on 33 children with non-palpable testes. For five patients, staged orchiopexy was planned due to the testes being 2 cm or more away from the internal inguinal ring. In 22 patients, inguinal orchiopexy was performed as the testes were around the internal inguinal ring (AIR). In the remaining six patients, no testes were found; the spermatic cord and vessels terminated at the internal inguinal ring (vanishing) or were atrophic (nubbin). There was a significant difference in the contralateral testicular volumes between patients with vanishing testes and those with intra-abdominal viable testes (p < 0.001). Additionally, there was a statistically significant difference in the contralateral testicular volumes between the AIR group and those with testes remote from the internal inguinal ring (RIR) (p = 0.03).

Conclusion: The preoperative ultrasonographic measurement of the contralateral testicular volume in children with a unilateral non-palpable testis can provide valuable information about the nature of the intra-abdominal testis. The presence of a hypertrophic contralateral testis can guide surgeons prior to laparoscopy and is valuable for counseling parents about potential diagnoses.

Purpose: Non-obstructive urinary retention (NOUR) is the inability to empty the bladder with no physical obstruction to urine flow. It can occur as a result of neurological disorders or be idiopathic. In younger women, it may be caused by Fowler's syndrome (FS), a rare disorder in which the urethral sphincter fails to relax to allow urine to pass normally. This study covers both idiopathic NOUR and FS. Sacral neuromodulation (SNM) has been introduced as an effective option for patients with NOUR.

Materials and methods: Forty-two patients (aged 17 to 61 years) suffering from refractory NOUR who had a successful first-stage SNM with the Interstim II device, and in whom the second stage was completed, were prospectively studied in the department of neurogenic bladder and neuromodulation in our hospital from February 2016 to August 2019 to evaluate the efficacy and safety of SNM.

Results: The study included forty-two women with NOUR: 20 (47%) with FS and 22 (53%) with idiopathic NOUR. Their mean age was 27.2 ± 12.4 years. Thirty-eight (90%) of them had a successful trial phase (responders) with more than 50% improvement in their voiding parameters. After continued follow-up, a clinical success rate of 79% (30 out of 38 cases) was achieved, with a median follow-up period of 28 ± 8 months. The voiding parameters of these 38 patients showed statistically significant improvement after SNM. Their post-void residual volume dropped significantly from 330 ± 77 mL to 97 ± 55 mL (P < 0.001), average voided volume increased from 60 ± 23 mL to 265 ± 99 mL (P < 0.001), and the number of clean intermittent catheterizations per day fell from 5.6 ± 1 to 1.3 ± 1.6 (P < 0.001). The total number of patients who required surgical revision was 10 (26.4%), for reasons including malfunction due to external trauma in four patients (10.5%), continuous pain in four (10.5%), and device infection in two (5%).

Conclusion: SNM is an effective and safe option for women with refractory idiopathic non-obstructive urinary retention and Fowler's syndrome.

Purpose: This study investigated the impact of synbiotics on blood and urinary concentrations of factors related to kidney stone formation in overweight or obese patients with hyperoxaluria.

Materials and methods: A randomized double-blind clinical trial was conducted involving forty-four patients assigned to either synbiotic or placebo groups. Participants received their respective capsules twice daily for 12 weeks. Blood and 24-hour urine samples were collected at baseline and week 12 for biochemical analyses.

Results: Urinary oxalate significantly decreased in the synbiotic group compared with both baseline (P=.001) and placebo (P=.001). Other biochemical markers showed no significant differences, while urine volume increased in both groups without between-group variance.

Conclusion: Synbiotic supplementation significantly reduced urinary oxalate but did not affect other blood or urinary parameters associated with kidney stone formation.

Purpose: Urolithiasis is the formation of stones within the urinary tract with diverse shapes, sizes, and locations. Earlier diagnosis facilitates treatment and complication prevention. This study aimed to propose a method for predicting urolithiasis recurrence using machine learning.

Materials and methods: We used clinical data, demographics, and CT findings from 4,246 patients who visited a clinic once or multiple times within three years. The method comprises three phases: data engineering and preprocessing, machine learning model development, and performance evaluation. Six machine learning classifiers were evaluated using standard performance metrics, ROC analysis, calibration analysis, and decision curve analysis.

Results: Across 10 independent repeats with a train/test split, the best‑performing classifier was random forest, with area under the ROC curve (AUC), sensitivity, and positive predictive value of 0.64, 0.87, and 0.84, respectively. Using a 10‑fold cross‑validation strategy, random forest again performed best, with AUC, sensitivity, and positive predictive value of 0.63, 0.90, and 0.83, respectively. A Brier score of 0.18 indicated comparatively better calibration.

Conclusion: This study presents a practical machine learning application for predicting urolithiasis recurrence with clinically acceptable accuracy compared with traditional scoring systems. Six predictive models were assessed using multiple metrics to select the optimal classifier.

Purpose: This study was designed to evaluate the effectiveness of dynamic neuromuscular stabilization (DNS) training in children with non neurogenic lower urinary tract dysfunction (LUTD) and compare it with biofeedback (BF) treatment.

Materials and methods: A total of 15 participants aged 6-15 years with non neurogenic LUTD were divided into three groups: Group I, DNS exercise training; Group II, BF training; and Group III, DNS plus BF training. Dysfunctional Voiding and Incontinence Scoring System (DVISS) scores, uroflowmetry parameters, uroflow curve, post void residual (PVR) values, and deep trunk muscle strength were evaluated at baseline and at 4, 8, and 12 weeks after treatment.

Results: Total DVISS scores significantly decreased after 12 weeks in Groups I and III, while Group II showed significant decreases at 4 and 8 weeks (P < .05). Improvements in deep trunk muscle strength at 4 and 8 weeks were significantly greater in Groups I and III than in Group II (P < .05). In Group I, average flow rate increased at 4 weeks and flow time decreased at 12 weeks (P < .05). PVR decreased significantly at 12 weeks in Group I and at 8 weeks in Group III (P < .05).

Conclusion: DNS and BF training are effective in improving symptoms in patients with non neurogenic LUTD; however, groups receiving DNS exercises were superior for several parameters.

Purpose: To describe our integrated pelvic fascial structure-sparing (IPFSS) technique for robotic-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction and to evaluate its impact on urinary continence and sexual function in male patients.

Methods: This retrospective observational study was conducted at a single high-volume center. Male bladder cancer patients who underwent IPFSS RARC with ONB were included. Demographic, clinical, and pathological data were collected. Functional outcomes were evaluated and compared with a cohort of patients who underwent conventional non-nerve-sparing RARC.

Results: Thirty-six patients were included in the IPFSS group and 42 in the conventional group. RARC with intracorporeal urinary diversion was successfully completed in all patients without open conversion. The mean total operative time was 387.9 minutes in the IPFSS group and 392.0 minutes in the conventional group (p = 0.465). At 3 months post-surgery, 30 patients (83%) in the IPFSS group achieved daytime continence (0-1 pads), compared to 14 patients (33%) in the conventional group. By 6 months, daytime continence increased to 35 patients (97%) in the IPFSS group, while 28 patients (67%) in the conventional group achieved similar results. At 6 months, 30 patients (83%) in the IPFSS group reported full potency with or without phosphodiesterase type 5 (PDE5) inhibitors, compared to only 3 patients (7%) in the conventional group.

Conclusion: We present a feasible surgical technique for RARC that involves holistic preservation of the pelvic fascial architecture. This approach is associated with a rapid recovery of daytime continence and sexual function in male patients.

Purpose: To compare general anesthesia (GA) with spinal anesthesia (SA) regarding postoperative pain and satisfaction after ureteroscopic lithotripsy (URSL).

Materials and methods: Two hundred twenty-nine patients were analyzed in the study. Patients were assigned to two groups-SA and GA. Demographic data, stone characteristics, operation time, and frequency of opioid analgesic use during the admission period were collected from hospital medical records. Visual analogue scale (VAS) scores at 6 hours and 24 hours after URSL were recorded. Complications according to the Clavien-Dindo classification and the experience of headaches after surgery (Yes/No) were documented after one month. Participants and surgeons were asked to rate their satisfaction on a scale of 1 to 10.

Results: Of 237 eligible patients, 229 completed the study. The incidence of headaches and VAS scores (at 6 h and 24 h) were significantly higher in the SA group (P < 0.001). Patient and surgeon satisfaction in the GA group were significantly higher (P < 0.001). Multivariate analysis showed that female sex was associated with lower opioid analgesic use during the admission period (odds ratio [OR] = 0.47), and surgery time correlated with frequency of opioid use and headache (OR = 1.12 and OR = 1.11, respectively).

Conclusion: GA was associated with better postoperative pain control after URSL and higher satisfaction levels for both surgeons and patients.

Purpose: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) often experience erectile dysfunction (ED). While transurethral resection of the prostate (TURP) can improve ED, new onset ED remains a concern. This study compares monopolar (M TURP) and bipolar (B TURP) techniques, with a subgroup analysis based on phosphodiesterase 5 inhibitor (PDE5i) use.

Materials and methods: This randomized clinical trial included candidates for TURP aged over 50 years. Patients were divided into M TURP and B TURP groups. Erectile function was assessed using the International Index of Erectile Function 15 (IIEF 15) at baseline, six weeks, and six months post surgery.

Results: A total of 205 patients were analyzed (102 M TURP, 103 B TURP). Baseline characteristics, perioperative findings, and surgical complications were similar. IIEF 15 scores were comparable between groups at all time points. In the PDE5i user subgroup, M TURP showed a slight short term decline in erectile function and total scores at 6 weeks, but both groups demonstrated no significant long term changes at 6 months.

Conclusion: No significant difference was observed between M TURP and B TURP on erectile function during medium term follow up. Patients with prior PDE5i use may experience fewer short term adverse effects on erectile function from B TURP.