Urology Journal最新文献

Purpose: Clear cell renal cell carcinoma (ccRCC), the dominant subtype of renal malignancy, has a rising global incidence and mortality. While surgery is the standard of care for localized cases, adjuvant therapy aims to improve outcomes in high-risk postoperative patients. To quantify the clinical value of adjuvant pharmacotherapy, this systematic review and meta-analysis assesses its effect on overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) in patients with ccRCC.

Materials and methods: A comprehensive search of the Web of Science, Embase, Cochrane Library, and PubMed databases was conducted for articles published up to October 2024. The search used the English keywords "clear cell renal cell carcinoma," "adjuvant drug therapy," and "randomized controlled trials," combined with a free-word search. Randomized controlled trials (RCTs) assessing the effectiveness of at least one adjuvant drug therapy in patients with ccRCC were included.

Results: The meta-analysis showed that adjuvant drug therapy did not result in a statistically significant improvement for OS or PFS compared with the control group. There was also no statistically significant difference in DFS (P > 0.05). This systematic review provides evidence on the impact of adjuvant targeted therapy on OS, DFS, and PFS for patients with clear cell renal cell carcinoma.

Conclusion: This study summarizes the effects of adjuvant drug therapy on OS, PFS, and DFS in ccRCC patients. The evidence from this meta-analysis can inform clinical decision-making, support risk stratification strategies, and encourage the integration of OS-driven endpoints in future trial designs, thereby providing valuable data for the treatment of ccRCC.

Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy (T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients with renal calculi with a maximum diameter of 2-3 cm treated between January 2022 and July 2024. Of these, 146 cases were treated with single-use ureteroscopic lithotripsy through an FV-UAS, while 124 cases were treated by tubeless PCNL (T-PCNL group) through a 16F Amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFRs) were compared.

Results: There was no significant difference in the stone-free rates (SFRs) between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI), 0.56-2.28; odds ratio (OR) = 1.13; P = .724. The SFRs at 1 month postoperatively were: 95% CI, 0.417-2.60; OR = 1.041; P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were: 95% CI, 0.355-1.055; OR = 0.612; P = .076; the SFRs at 1 month postoperatively were: 95% CI, 0.374-1.320; OR = 0.703; P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P = .813 and P = .839, respectively). The surgical duration in the FV-UAS group was significantly longer (P < .001). The decrease in postoperative hemoglobin (Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (both P < .001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

Purpose: Despite its prevalence, the etiology and pathogenesis of cryptorchidism remain poorly understood. This study aimed to identify potential biomarkers associated with cryptorchidism development using bioinformatics methodologies.

Materials and methods: We utilized three microarray datasets from the Gene Expression Omnibus (GEO) database, comparing gene expression profiles between cryptorchidism patients and control individuals. Differentially expressed genes (DEGs) were identified using statistical analysis. Subsequently, we constructed a gene co-expression network using weighted gene co-expression network analysis (WGCNA) to identify modules of genes highly associated with the cryptorchid phenotype. Hub genes within these modules were identified using cross-validation and multiple algorithms.

Results: A total of 1,539 differentially expressed genes were identified between cryptorchidism patients and controls. WGCNA revealed a gene module strongly associated with the cryptorchidism phenotype. Ten genes (CDH1, CS, G6PD, HSPA5, KEAP1, NEDD8, POLR2J, JUN, SOD2, and TXN) with the highest association to cryptorchidism were identified in this module. Single‑gene gene set enrichment analysis (ssGSEA) showed that these hub genes were mainly enriched in metabolism-, translation-, and inflammation‑related processes. Notably, several key genes are involved in oxidative stress responses.

Conclusion: This study identified a credible set of hub genes associated with cryptorchidism. Some of these genes have been shown to affect testicular development or spermatogenesis through mechanisms such as inflammation and oxidative stress, while others have not been fully studied in the context of cryptorchidism. These hub genes may provide new biomarkers for cryptorchidism risk assessment and warrant further investigation to clarify their specific roles.

Introduction: Open nephrectomy surgery in a kidney donor involves pain and many risks after the surgery, which leads to the inability to perform normal activities. For this reason, today the laparoscopic nephrectomy method is preferred in order to avoid complications and to return to normal life sooner. However, it is very critical to assess the impact of modifying the surgical technique on the outcome of kidney donation. Thus, the present study was undertaken with the following specific objective: a comparative study of the renal profile of live kidney donors who have undergone open and laparoscopic nephrectomy.

Materials and methods: The study in the present report was cross-sectional in nature. Participants included 91 kidney donors who had undergone either open nephrectomy (n = 46) or laparoscopic nephrectomy (n = 45). Data on the level of initial basic renal function, the duration of surgery, and the duration of hospitalization, together with the course of renal function in the 6 months after surgery, were collected. The data were analyzed using the Statistical Package for the Social Sciences, version 27 (SPSS version 27).

Results:  The mean age of kidney donors was 29.4 ± 4.8 years, and all patients were male (100%). Body mass index and weight were comparable between the open and laparoscopic nephrectomy groups, with no statistically significant differences (P > 0.05). The mean duration of surgery in the open nephrectomy group (2.37 ± 0.30 hours) was significantly shorter than that in the laparoscopic group (3.37 ± 0.13 hours) (P < 0.001). The mean length of hospital stay was significantly shorter in the laparoscopic group (3.31 ± 0.31 days) compared to the open group (4.06 ± 0.04 days) (P < 0.001). GFR decreased significantly in both groups at discharge and 6 months postoperatively compared to baseline (paired t-test, all P < 0.001), but there was no significant difference in GFR between groups at any time point (P > 0.05).  Both groups experienced a significant postoperative decline in hemoglobin, with a greater reduction in the open group (-1.59 ± 0.79 g/dL)  compared to the laparoscopic group (-1.05 ± 0.95 g/dL)  (P = 0.004). White blood cell counts increased postoperatively in both groups, with no significant difference between them (P = 0.118). Surgical complications included transection of the superior polar artery in 5.5% of cases.

Conclusion: In laparoscopic nephrectomy, the time of surgery is longer, but the days of hospitalization after surgery do not differ and do not negatively affect the return of donor kidney function compared to the open method. Moreover, post-surgical problems have not been very frequent and are manageable in the best way possible.

Purpose: To investigate the safety and efficacy of supine percutaneous nephrolithotomy performed completely under ultrasound guidance without fluoroscopy and ureteral catheterization in kidneys with hydronephrosis.

Materials and methods: This retrospective study analyzed the data of 30 patients (Group 1) with kidney stones larger than 2 cm and Grade 2 or higher hydronephrosis who underwent ultrasound-guided supine percutaneous nephrolithotomy without ureteral catheterization and fluoroscopy between January 2022 and November 2024. The data of these patients were compared using matched-pair analysis (1:1) with patients who underwent supine percutaneous nephrolithotomy under ultrasound and fluoroscopy guidance with ureteral catheterization (Group 2) in the same period. The groups were compared regarding access time, operation time, stone-free rates, blood loss, and complications.

Results: There were no statistically significant differences between the two groups in terms of age, gender, side, stone diameter, stone volume, stone density, hydronephrosis grade and Guy's stone score. Access time was significantly shorter in Group 1  (11.3 ± 3.9 minutes vs. 13.9 ± 4.7 minutes, respectively, 95% CI: 0.3-4.9, p = .026). The mean operation time was 64.4 ± 19.4 in Group 1 and 102.3 ± 31.2 in Group 2, and this difference was statistically significant (95% CI: 24.2-51.6, p = .001). There was no significant difference between the two groups in terms of postoperative 1st month stone-free rates (83.3% vs 86.6%, respectively, p = .723 Conclusion: Compared with standard supine mini percutaneous nephrolithotomy, totally ultrasound guided supine mini percutaneous nephrolithotomy without ureteral catheter is an effective, safe and feasible surgery.

Purpose: Müllerian anomalies are rare, and the obstructed hemivagina and ipsilateral renal anomaly/agenesis (OHVIRA) syndrome is the rarest. Its subtle and nonspecific symptoms cause delays in diagnosis, especially in prepuberty. This study aims to remind this rare anomaly and review its symptoms, clinical and radiological findings, and treatment in pre- and post-pubertal girls.

Materials and methods: We conducted a retrospective chart review of cases of OHVIRA syndrome that were diagnosed and treated between May 2018 and June 2024. We evaluated the results and reviewed relevant literature.

Results: Seven patients were diagnosed with OHVIRA syndrome during the study period. Two patients were diagnosed in the pre-pubertal period, and all post-pubertal cases, except one, underwent surgery. Five (71%) of the seven patients had left-sided obstructed hemivagina with ipsilateral renal agenesis.

Conclusion: OHVIRA syndrome is a rare condition. Its diagnosis and management depend on the patient's age, symptoms, familiarity with the syndrome, and teamwork. Although a renal anomaly is part of the triad of this syndrome, OHVIRA syndrome often remains undiagnosed during infancy, even in cases of prenatally diagnosed renal agenesis. Screening for OHVIRA syndrome and associated urinary anomalies in cases of renal agenesis, particularly in prepubertal cases, is crucial.

Penile incarceration with a foreign body is a rare urological emergency necessitating prompt intervention. We present a 59-year-old patient who entrapped his penis and right testicle with a metal thread reducer for sexual arousal four days prior to admission to the Emergency Room. Ultrasound revealed a significantly reduced Color Doppler signal in the right testicle and a completely absent signal in the penile artery. After admission, the metal reducer was removed using a hacksaw under analgosedation. Magnetic resonance imaging showed penile ischemic changes. The patient experienced a reduction in penile swelling, and parts of the skin highly suspected of necrosis recovered fully with preserved sensation. Despite penile ischemia on magnetic resonance imaging, the patient had a full recovery, obtaining normal erections. He was discharged six days after admission, presenting with a normal International Index of Erectile Function score on the follow-up exam.

Objective: This study aimed to investigate the potential role of systemic inflammatory markers in the management of Prostate Cancer (PCA) with variant pathology.

Materials and methods: A retrospective analysis was conducted on 302 patients who underwent radical prostatectomy between 2014 and 2023. After applying exclusion criteria, 279 patients were included: 207 with adenocarcinoma and 72 with variant pathologies. Systemic inflammatory markers such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) were compared between the groups.

Results: Patients in the variant group were significantly older (p = 0.005). The frequencies of lymphovascular invasion (LVI), perineural invasion (PNI), and positive surgical margins (SM) were significantly higher in the variant histology group (p < 0.001, p = 0.014, and p < 0.001, respectively), as were ISUP grades (p < 0.001). Pretreatment PSA values were also significantly higher in the variant group (p < 0.001), as was the rate of subsequent radiotherapy (p < 0.001). However, no significant differences were found in NLR, PLR, SIRI, or SII values between the groups. Recurrence rates were significantly higher in the variant group (p < 0.05), but overall mortality did not differ.

Conclusion: Systemic inflammation markers have limited value in predicting prognosis among patients with variant PCA. This highlights the complex role of inflammation in cancer progression and underscores the need for further research to identify more specific biomarkers for different PCA variants.

Purpose: This study aims to investigate the therapeutic efficacy and complications of low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept in central neurogenic bladder (CNB).

Materials and methods: This study was a prospective, randomized controlled trial. Sixty patients diagnosed with CNB without prior treatment were randomly divided into two groups: the control group (n = 30) was treated with basic rehabilitation training, and the treatment group (n = 30) was treated with basic rehabilitation training plus low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept for 4 weeks. The fixed acupuncture points selected were: Sanyinjiao (bilateral), Zhongji (unilateral), and Diji (unilateral). The study compared pre- and post-treatment clinical curative effects, urodynamic indicators, urination status, the Neurogenic Bladder Symptom Score (NBSS), the Urinary Symptom Distress Scale (USDS), the World Health Organization Quality of Life Brief Inventory (WHOQOL-BREF), and the occurrence of adverse reactions and complications between the two groups.

Results: The overall efficacy rate of 96.67% in the treatment group was significantly higher than that in the control group (86.67%) (P < 0.05). After treatment, the MBC, MFR, Pdet, DASUV, and WHOQOL-BREF scores significantly increased, while the RUV, DUF, DAUL, NBSS and USDS scores all decreased in both groups, with the treatment group showing significantly better results than the control group (P < 0.05). There was no statistically significant difference in adverse reactions and complication rates between the two groups (P > 0.05).

Conclusion: Low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept significantly improves bladder function and alleviates urinary difficulties in CNB, demonstrating good safety and considerable clinical applicability.

Purpose: Working during non-traditional hours is becoming more prevalent in modern societies and presents a significant hurdle to an individual's circadian rhythm. We examined the bladder health of shift workers in the United States by analyzing information obtained from the National Health and Nutrition Examination Survey.

Materials and methods: National Health and Nutrition Examination Survey (NHANES) datasets from 2005 to 2010 were utilized. Regression analyses were used to assess the association between shift work and bladder health (stress incontinence, urge incontinence, and nocturia) by adjusting for age, race, education, smoking, and other factors.

Results: The percentage of non-Hispanic Black individuals was notably higher among shift workers (25.8% vs. 17.8%). Among shift workers, there was a lower percentage of individuals with a college degree or higher compared to day workers. Shift work was found to be associated with nocturia in men in the unadjusted model (OR=1.2, 95%CI=1.0-1.5, p = 0.038). However, the adjusted results indicate that the connection is not statistically significant (Adjusted Model II: OR=1.2, 95%CI=1.0-1.5, p = 0.105). Similarly, no statistically significant association was observed between shift work and nocturia in women. There was also no significant relationship between shift work and Stress Urinary Incontinence (SUI) in men or women. The results from the fully adjusted model (Adjusted Model II) indicate a significant association between shift work and the prevalence of Urgency Urinary Incontinence (UUI) in women (OR=1.2, 95%CI=1.0-1.5, p = 0.041).

Conclusion: Results of this cross-sectional study indicated that shift work was associated with a higher risk of UUI in women. Further research is needed to explore this relationship.