Urologia Journal最新文献

Background: Pediatric urolithiasis is increasingly managed with minimally invasive approaches. Retrograde Intrarenal Surgery (RIRS) offers a promising treatment option, though data on its outcomes in children remain limited.

Objective: To evaluate the safety, efficacy, and predictors of outcomes following Retrograde Intrarenal Surgery (RIRS) in pediatric patients with renal or upper urinary tract stones.

Methods: From September 2022 to August 2024, retrospective observational research was carried out at the Pakistan Kidney and Liver Institute and Research Center in Lahore. Included were pediatric patients (less than 14 years old) who had RIRS for upper tract or renal stones up to 27 mm. Demographics, stone features, surgical parameters, complications, and follow-up imaging results were among the data that were taken from electronic medical records. Statistical analysis was performed using SPSS v27; multivariate logistic regression identified predictors of postoperative complications and stone clearance.

Results: A total of 24 pediatric patients underwent RIRS. Mean age was 9.0 ± 4.27 years; 18 (75.0%) were male. Stones were more often left-sided (14/24, 58.3%) and commonly located at multiple sites (11/24, 45.8%). RIRS was the primary treatment in 17 (70.8%) patients. Complete stone clearance was achieved in 17 (70.8%); access failure occurred in 4 (16.7%). Postoperative complications occurred in 5 (20.8%), including sepsis in 4 (16.7%). Anatomical abnormalities were seen in 5 (20.8%). Multivariate analysis showed anatomical abnormalities were protective against complications (p = 0.037), while stone size >15 mm significantly reduced clearance odds (p = 0.009). The predictive model for clearance was significant (p = 0.013, R² = 0.519).

Conclusion: RIRS is a safe and effective treatment modality for pediatric urolithiasis, achieving high stone-free rate with minimal complications. Anatomical abnormalities may reduce risk of complications, while larger stone size negatively impacts clearance. These findings support the selective use of RIRS in children with careful preoperative evaluation to optimize outcomes.

Introduction: Ureteral strictures are a recognised late complication post ureteroscopy (URS). Most research on the pathology focuses on mechanisms of injury and preventative strategies. There is limited data describing follow up patterns and treatment outcomes. The aim was to evaluate the subsequent management and outcomes of de novo ureteral strictures post URS.

Methods: Retrospective review was conducted of patients diagnosed with a de novo ureteral stricture post URS at a tertiary centre between 2014 and 2024. Eligible cases were identified by manual review of ICD-coded records (N13.0-N13.5), yielding 40 patients for analysis. Baseline and procedural data were summarised descriptively, and group comparisons were performed using the Mann-Whitney U and Fisher's exact tests.

Results: Among 40 patients (median age 69 years), most strictures were detected symptomatically (67.5%) and were located proximally or distally (each 43%). Median time to diagnosis was 3.8 months, and median follow-up was 4.3 years. Overall, 45% achieved successful resolution after a median of two procedures, while 15% underwent nephrectomy. Higher age-adjusted Charlson Comorbidity Index scores and older age were significantly associated with poorer outcomes, although interpretation is limited by the sample size. Stricture length and a history of stone impaction showed no significant associations.

Conclusions: In this cohort, fewer than half of patients with de novo ureteral strictures following URS achieved lasting resolution despite multiple interventions. These findings highlight the potential clinical burden of this complication and support the importance of preventive strategies, timely detection and structured follow-up, while underscoring the need for further studies to better define long-term outcomes.

Introduction: Kidney hemorrhage is one of the most common and significant complications of percutaneous approaches for renal stone removal. This study evaluated the effectiveness and safety of hemostatic completion in minimally invasive percutaneous nephrolithotomy (mini-PCNL) using monopolar electrocautery in patients with intrarenal tract bleeding.

Materials and methods: We prospectively investigated 200 consecutive patients presenting to a single institution and classified them into two groups. The experimental group consisted of 28 patients receiving monopolar coagulation for intrarenal bleeders in the percutaneous tract. The control group included 172 patients in whom fulguration was not done. Perioperative outcomes were compared between the groups.

Results: The two groups had no statistical difference in operative times and transfusion rates. Patients who received electrocauterization demonstrated a significantly shortened duration of double J stent removal (p = 0.011), more rapid recovery of hemoglobin levels, particularly in cases of significant bleeding (p < 0.001), and a lower rate of angiography (p = 0.047). No embolization was needed in the electrocauterization group. No significant complications were observed in either group.

Conclusions: These findings suggest that monopolar electrocautery might effectively reduce the risk of postoperative bleeding and alleviate the burden on patients who may require additional blood transfusions in patients undergoing tubeless mini-PCNL.

Background: Overactive bladder (OAB) is a prevalent condition, and patients increasingly turn to online platforms such as YouTube for information, raising concerns about accuracy and reliability.

Purpose: This study aimed to evaluate the quality and reliability of YouTube videos related to overactive bladder (OAB) using two validated instruments: the DISCERN tool and the Global Quality Scale (GQS).

Methods: A systematic and structured YouTube search strategy, adapted from systematic review methodology but tailored for digital platforms, was conducted using the keyword overactive bladder. The first 100 videos retrieved were screened, and 60 met the inclusion criteria: English language, duration of at least 60 s, and relevant educational content. Exclusion criteria included non-English language, duplicates, advertisements, and purely promotional material. Two independent urologists evaluated each video using the DISCERN tool (range: 16-80) and GQS (range: 1-5). Additional data collected included video length, view count, uploader type, and thematic content. Descriptive statistics and correlation analyses were performed.

Results: The median video duration was 5.6 min (IQR: 3.4-8.2), with a median view count of 34,200 (IQR: 12,500-89,000). The mean DISCERN and GQS scores were 45.2 ± 10.1 and 2.9 ± 0.8, respectively, indicating moderate overall quality. Videos uploaded by healthcare professionals or institutions had significantly higher DISCERN and GQS scores compared to those uploaded by individuals or commercial entities (p < 0.001). Only 28% of videos addressed neurogenic causes of OAB, and 41% did not mention behavioral therapy. A weak but statistically significant positive correlation was observed between GQS score and view count (ρ = 0.34, p = 0.01).

Conclusions: YouTube contains a wide array of OAB-related videos, but their quality and reliability vary considerably. While some content is accurate and informative, significant gaps remain, particularly regarding neurogenic etiologies and behavioral management. Healthcare professionals should guide patients toward trustworthy resources and consider producing evidence-based content to improve digital health literacy.

Background: Uro-oncology, a multidisciplinary field at the intersection of urology and oncology, holds a pivotal role in the diagnosis, treatment, and prevention of genitourinary cancers. Quantitative and qualitative evaluation of scientific publications, particularly review articles, in the field of uro-oncology provides comprehensive insights into the research landscape. This study provides a scientometric and bibliographic analysis of systematic reviews and meta-analyses in this field based on publications indexed in Scopus between 2020 and 2025.

Methods: Employing a descriptive-analytical design, we analyzed publication trends, citation patterns, core journals, key authors, and collaboration networks using bibliometric tools like R (Bibliometrix, Biblioshiny) and VOSviewer.

Results: Our findings reveal a notable decline in the annual growth rate of publications (-63.18%) and a significant reduction in average citations per article. While core journals such as Cancers, Frontiers in Oncology, and International Journal of Molecular Sciences dominate the field, inconsistencies in Scopus metadata, particularly missing citation counts and science categories, limit the accuracy of bibliometric analysis. Despite these challenges, key researchers and consistent focus on areas like immunotherapy and biomarker development are evident.

Conclusion: The study highlights the need for better data curation, targeted funding, and stronger international collaboration to revitalize uro-oncology research.

Introduction: To study the impact of rectal swab culture based targeted antimicrobial prophylaxis on infectious complications in patients undergoing transrectal ultrasound guided prostate biopsy.

Methods: A prospective observational study was conducted in a tertiary care hospital at Kolkata, we compared the incidence of infectious complications in men who received rectal swab cultured based targeted prophylaxis versus empirical antibiotics prophylaxis who underwent transrectal ultrasound guided prostate biopsy. The targeted prophylactic antibiotics were selected from rectal culture swab plated on selected media containing ciprofloxacin to identify fluoroquinolone resistance, patients with infectious complications within 30 days of prostate biopsy were taken into consideration.

Results: Twenty-four out of the 50 patients (48%) harbored FQ resistant organisms. Only three patients (6%) in the targeted prophylaxis group had infectious complications of UTI and Low-grade fever. In contrast, 6 (12%) of the 50 men undergoing the procedure without culture had infectious complications, two of these (4%) had sepsis.

Conclusion: Frequently used fluoroquinolone prophylaxis fails to give adequate cover because of high rate of fluoroquinolone resistance of the rectal organism. Rectal swab derived antibiotics prophylaxis can reduce post biopsy infectious complications significantly.

Background and objective: Bladder cancer (BC) is the sixth most common cancer in the U.S., with risk factors such as smoking, older age, and male sex. The primary symptom is painless hematuria. Diagnosis is made through cystoscopy, though this method is invasive and expensive. The study investigates the potential of epigenetic modifications, such as DNA methylation, histone modification, and microRNAs (miRNAs), in diagnosing and treating BC.

Methods: A literature review was conducted on epigenetic changes, specifically DNA methylation in genes such as CDH1 and RASSF1A, and their impact on bladder cancer development. Gene mutations (e.g. FGFR3, TP53) and their influence on cancer progression were also investigated. In addition, epigenetic therapies, such as DNA methylation inhibitors, were discussed as potential treatments for advanced BC.Key findings and limitations:Epigenetic changes, such as DNA methylation, contribute to the development of BC, and histone modifications affect gene expression. MiRNAs regulate cancer cell proliferation. Additionally, mutations in genes such as FGFR3 and TP53 are crucial for specific BC subtypes. Despite promising results, challenges such as treatment resistance and difficulties in patient selection for epigenetic therapies remain.

Conclusions and clinical implications: Epigenetic changes could serve as biomarkers for BC and as therapeutic targets. Epigenetic therapies offer an alternative to traditional treatments, especially for advanced BC. Clinical trials are underway to address challenges such as treatment resistance and to refine patient selection for these therapies.

Patient summary: Bladder cancer is common and is related to lifestyle and genetic factors. Advances in epigenetics could lead to more personalized and less invasive treatments, improving outcomes for patients with advanced BC.