Urologia Journal最新文献

Introduction: Robot-assisted radical prostatectomy (RARP) is the treatment option for localized prostate cancer. It can lead to side effects like erectile dysfunction (ED) and post-prostatectomy urinary incontinence (PPUI). This study aimed to evaluate association between dyadic adjustment, PPUI and ED.

Material and methods: Consecutive male patients who underwent RARP from January 2019 to December 2021, with at least 12 months of follow-up and preoperative International Index of Erectile Function (IIEF) 15 erectile domain questionnaire's score ⩾17 were enrolled. Demographic and surgical data were collected at baseline. Validated questionnaires were self-administered at 12-month follow-up: IIEF-15, Dyadic Adjustment scale (DAS), and Los Angeles-Prostate Cancer Index Urinary Function Score (UCLA-PCI-UFS). Univariable and multivariable analyses were performed to examine degree of association between different variables.

Results: Out of 96 enrolled patients, 37 (38.5%) were socially incontinent (>1 pad per day) at 12 months from surgery. Statistically significant association was found between incontinence and lower DAS total score (p < 0.0001), DAS consensus domain (p < 0.0001), and DAS affectional expression domain (p = 0.002). DAS total score (p = 0.002) and DAS consensus domain score (p = 0.012) were lower in impotent group (IIEF-15 erectile domain score <17). On a multivariable analysis, PPUI (beta: -0.25; 95% CI: -4.42, -0.47; p = 0.016) and post-operative ED (beta: 0.19; 95% CI: 0.002, 0.57; p = 0.048) were independent predictors of low DAS score. Pelvic lymphadenectomy (PLND) (beta coefficient: 0.25; 95% CI: 0.1, 1.2; p = 0.022), bladder neck reconstruction (beta: 0.26; 95% CI: 0.19, 1.09; p = 0.006), and ED (beta coefficient: -0.3; 95% CI: -0.07, -0.018; p = 0.001) were independent predictors of continence status.

Conclusion: PPUI following RARP is associated with lower dyadic adjustment, independently from other factors, indicating significant impact of PPUI on marital relationships. Further research should be conducted to understand better the cross-effective relationship between PPUI, potency, dyadic adjustment, and the effect of surgical treatments on incontinence and sexual function.

Introduction: Pseudotumors are benign lesions which may mimic like a malignant tumor on conventional imaging. They are formed in kidneys which are scarred and deformed by chronic pyelonephritis, glomerulonephritis, trauma or infarction. There is a diagnostic dilemma in most of the cases as to differentiate RCC and pseudotumors. Our study shows bp-MRI (T2w, DW MRI) can distinguish pseudotumors from RCCs and offers a non-contrast non-invasive alternative in CKD patients.

Materials and methods: Prospective evaluation of 80 CKD patients (CKD IV/V), having suspicious renal mass <4 cm on Ultrasound, were subjected to bp-MRI. Two groups were defined on the basis of restriction pattern on DWI. ADC values were calculated. Group I (suspected RCC or malignant tumor) underwent surgical management according to the institutional protocol. Group II (suspected pseudotumor) were subjected to biopsy. ROC curves were drawn to find out area under curve for differentiation of groups and cut-off ADC values calculated so as to achieve highest average sensitivity and specificity. A p-value of <0.05 was considered as statistically significant.

Results: Sixty patients (Group I) had restricted pattern on DWI imaging whilst 20 had no restriction (Group II), hence ruling out malignancy. It showed a sensitivity of 81.82%, specificity 96.55% in the correct diagnosis. Mean ADC-value for CKD pseudotumors (Group II) was significantly higher than RCCs and surrounding diseased parenchyma (2.20 vs 1.52 (×10^-3 mm²/s; p < 0.0001) and 1.99 (×10^-3 mm²/s; p = 0.0001) respectively). ROC analysis for differentiating CKD pseudotumors and RCC yielded high sensitivity (85%) and specificity (99%) for cut-off ADC-value of 1.71 (×10^-3 mm²/s).

Conclusion: bp-MRI is a highly reliable imaging modality for the evaluation of renal lesions. Its ability to accurately differentiate pseudotumors from renal cell carcinomas, even in the absence of contrast administration can be a boon in the diagnostic armamentarium.

Introduction: Salvage intermittent ADT has been demonstrated to be a potentially effective treatment option for BCR following RP. Although ADT improves urinary symptoms by reducing prostate volume, no studies have been conducted to investigate its effect on urinary symptoms after RP. We retrospectively examined changes in urinary symptoms in patients who developed BCR after RP and underwent salvage intermittent ADT.

Methods: OABSS, IPSS, and ICIQ-SF scores were compared before ADT, 3 months after the start of ADT, 12 months after the start of ADT, at the end of ADT, and 1 year after the end of ADT in patients who received intermittent ADT following RARP. In addition, changes in urinary symptoms were compared between the group with pre-ADT testosterone levels <400 ng/dL (low testosterone group) and the group with levels ⩾400 ng/dL (high testosterone group).

Results: Three months after the initiation of ADT, the IPSS total score, IPSS urine storage score, and ICIQ-SF score were significantly higher compared to their pre-treatment levels. In the low testosterone group, the ICIQ-SF score was significantly worse only at 12 months after the start of ADT compared to before the start of ADT. In the high testosterone group, the IPSS total score, storage IPSS score, and ICIQ-SF score were significantly higher at both 3 and 12 months after initiating ADT compared to their pre-treatment levels.

Conclusions: ADT for BCR after RARP has been shown to significantly worsen urinary storage symptoms while not improving voiding symptoms, particularly in patients with high testosterone levels pre-ADT.

Aim: To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture.

Materials: Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography.

Results: Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis.

Conclusion: Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.

Introduction: Under staging and over staging are not uncommon with traditional MRI while staging bladder cancer. Current improvements in MRI technology due to addition of functional MR sequences that is, dynamic contrast-enhanced (DCE) imaging and diffusion-weighted imaging (DWI) have enhanced its clinical utility. The current study was designed to look for staging accuracy of multiparametric MRI (mp-MRI) that is, T2W + DCE + DWI, over conventional MRI.

Material and methods: Forty patients with bladder cancer were included were subjected to mp-MRI on a 3T scanner with a phased array body coil. Four MR image sets that is, T2W, T2W + DCE, T2W + DWI, and T2W + DCE + DWI were interpreted. Accuracy of each image set was determined separately and was compared with the gold standard histopathological staging.

Result: Staging accuracy of different image set increased from T2W (55%) to DCE (72.5%) to DWI (80%). Maximum accuracy was seen in mp-MRI (T2W + DWI + DCE) (87.5%). While differentiating non muscle invasive from muscle invasive disease (⩽T1 vs ⩾T2 stage) staging accuracy increased from T2W (65%) to DCE (80%) to DWI (85%) with maximum in mp-MRI (90%).

Conclusion: mp-MRI offers high staging accuracy for bladder cancer.

This Umbrella Review aims to gather high-quality evidence on urolithiasis outcomes and complications, comparing extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), and retrograde intrarenal surgery (RIRS). We incorporated systematic reviews, some containing meta-analyses, into two separate reports, focusing on quantitative and qualitative results. Additionally, when data permitted, a secondary meta-analysis was conducted using final effect estimates from multiple meta-analyses. Stone-free rate (SFR) served as the primary outcome, with complications, retreatment, and hospital stay as secondary outcomes. Adhering to Joanna Briggs Institute (JBI) guidelines, we initially screened 282 titles, narrowed down to 166 titles and abstracts, ultimately selecting 55 full-text articles for review. Of these, 22 met our inclusion criteria for the umbrella review. We evaluated study quality using JBI criteria, excluding five low-quality studies. Analysis showed ESWL had lower SFR compared to RIRS (RR: 0.577, 95% CI: 0.482-0.692) and URSL (RR: 0.570, 95% CI: 0.450-0.722); lower overall risk compared to ureteroscopy (RR: 0.58, 95% CI: 0.51-0.66). ESWL had fewer complications than RIRS (p < 0.001), but lower SFR than ureteroscopy. However, the need for retreatment and auxiliary procedures in RIRS and URSL were lower than that in ESWL. In contrast, individuals undergoing ureteroscopy experienced a greater frequency of complications and longer duration of operation compared to those undergoing ESWL.

Introduction: Prostate-specific antigen (PSA) is a key marker for prostate cancer screening, but its utility is debated, prompting exploration of PSA derivatives for improved accuracy. While racial variations in serum PSA levels are documented, limited data exists for the Indian population. Given increasing life expectancy and heightened awareness of prostate cancer, this study aims to establish age-specific PSA ranges in an Indian cohort, contributing vital insights for population-specific screening and diagnosis.

Methods: A cross-sectional study was conducted on 4860 men with lower urinary tract symptoms (LUTS). Data, collected from April 2016 to March 2023, included age, PSA levels, digital rectal examination (DRE), and biopsy results. Statistical analysis involved Spearman's correlation, descriptive statistics, and confidence intervals.

Results: Of the studied participants, 809 underwent prostatic biopsy, revealing malignancy in 500 cases. Age-specific PSA values were studied in 4170 subjects and showed positive correlation with increasing age and prostate size. Most cancers were metastatic (66%), emphasizing the need for early detection. Age-specific PSA ranges were lower in the Indian population compared to the West. This study's Indian cohort exhibited higher PSA values than some previous Indian studies but lower than Western populations, aligning with global trends. The rising incidence of prostate cancer in India underscores the importance of understanding the disease burden.

Conclusion: PSA levels exhibit race-specific variations, cautioning against direct extrapolation of Western data to the Indian population. This study contributes age-specific PSA ranges for an Indian cohort, facilitating nuanced prostate cancer screening strategies.

Purpose: Patients with ureteral stones and acute renal colic significantly impaired their quality of life (QOL). However, the factors that affect quality of life during conservative management, particularly medical expulsive therapy (MET), are not well understood. This study aimed to assess the determinant of QOL.

Materials and methods: We conducted a prospective study to longitudinally assess QOL using the EuroQol-5 Dimension (EQ-5D) in patients undergoing medical expulsive therapy.

Results: Ninety-three patients were enrolled between April 2020 and December 2022, and 187 questionnaires were completed at each visit before spontaneous passage or intervention. The study found that a higher pain intensity was significantly associated with worse QOL during the primary visit (p = 0.03). At the second visit, younger age (p < 0.01), increased frequency of renal colic attacks (p < 0.01), maximum pain intensity since the last visit (p < 0.01), and shorter time from disease onset (p = 0.03) were associated with a worse QOL. Multivariate analysis showed that only the total number of renal colic attacks was associated with EQ-5D score (p = 0.047). The stone location significantly affected the cumulative incidence of renal colic attacks (p = 0.02). The mean total number of renal colic until stone passage was 3.58 in individuals with proximal stones versus 0.86 in with distal stones (p < 0.01).

Conclusions: This study identified pain intensity and colic frequency as key factors contributing to the decline in QOL in patients with ureteral stones. Patients with proximal stones may be good candidates for early intervention to reduce colic events.

Background and objective: Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) is the most common and preferred imaging modality for evaluating urethral strictures, despite its well-known limitations and disadvantages. In this study, we assessed the clinical relevance of RUG + VCUG, along with intraoperative assessment in measuring male urethral strictures.

Method: This study was a single-center retrospective study involving 134 male patients diagnosed with urethral stricture disease. All participants underwent RUG + VCUG before the intervention, and the results were interpreted by a single radiologist. The location and length of urethral strictures were assessed. The accuracy of urethral stricture measurements obtained from combined VCUG and RUG imaging was compared to intraoperative measurements, which served as the reference standard. Urethral strictures were classified into three types: membranous and bulbomembranous, bulbar, and penile.

Results: A total of 130 patients were included (38.14 ± 12.05 years) in the study. For patients with membranous and bulbar strictures, there were statistically significant differences in stricture length measurements between VCUG + RUG and surgical evaluation (p < 0.05). However, for patients with penile strictures, the differences in stricture length measurements between VCUG + RUG and surgical evaluation were not statistically significant (p = 0.448).

Conclusion: This study suggests that RUG + VCUG may underestimate urethral stricture, particularly in the membranous and bulbar regions.

Kidney cancer is one of the most dangerous cancer mainly targeting men. In 2020, around 430, 000 people were diagnosed with this disease worldwide. It can be divided into three prime subgroups such as kidney renal cell carcinoma (KIRC), kidney renal papilliary cell carcinoma (KIRP) and kidney chromophobe (KICH). Correct identification of these subgroups on time is crucial for the initiation and determination of proper treatment. On-time identification of this disease and its subgroup can help both the clinicians and patients to improve the situation. Hence, this study checks the possibility of using multi-omics data in the kidney cancer subgrouping, whether integrating multiple omics data will increase the subgrouping accuracy or not. Four different molecular data such as genomics, proteomics, epigenomics and miRNA from The Cancer Genome Atlas (TCGA) are used in this study. As the data is in a very high dimension world, this study starts with selecting the relevant features of the study using Pearson's correlation coefficient. Those selected features are used with three different classification algorithms such as k-nearest neighbor (KNN), supporting vector machines (SVMs) and random forest. Performances are compared to see whether the integration of multi-omics data can improve the accuracy of kidney cancer subgrouping. This study shows that integration of multi-omics data can improve the performance of the kidney cancer subgrouping. The highest performance (accuracy value of 0.98±0.03) is gained by top 400 features selected from integrated multi-omics data, with support vector machines.