Urologia Journal最新文献

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.

Purpose: Compared to other overactive bladder (OAB) symptoms, incontinence has a more negative impact on quality of life and is frequently challenging to treat with antimuscarinic monotherapy. This study's goal was to compare the safety, tolerability, and effectiveness of a combination of solifenacin 5 mg and mirabegron 25 mg or 50 mg versus solifenacin 5 mg in patients with OAB.

Material and methods: In a tertiary care hospital, 258 individuals with overactive bladders participated in a randomised controlled open-label research to examine the safety and efficacy of mirabegron as a supplement to solifenacin. Randomisation was used to assign patients to one of three groups: those receiving solifenacin (5 mg) with mirabegron (25 mg), solifenacin (5 mg) plus mirabegron (50 mg) or solifenacin (5 mg) monotherapy. OABSS was used to examine the patients. A change in the OABSS from baseline to end of treatment (EOT) was the main outcome measure. This research also examined the safety and tolerability of combination treatment in comparison to solifenacin monotherapy.

Results: All combinations with solifenacin five substantially improved the OAB symptoms score as compared to solifenacin 5 mg monotherapy. When compared to solifenacin 5 mg, both combination groups significantly decreased the frequency of micturition. Although there were no dose-related differences between the combination and monotherapy groups in terms of TEAEs, blood pressure, pulse rate, PVR volume, or laboratory or ECG parameters, combination medication did result in a slightly higher frequency of constipation.

Conclusions: When compared to solifenacin 5 mg monotherapy, combination therapy with solifenacin/mirabegron markedly improved OABSS, micturition frequency, and urgency. When compared to monotherapy, all combinations were well tolerated and showed no significant extra safety concerns.

Purpose: To assess and compare the safety and efficacy of supracostal and subcostal access percutaneous nephrolithotomy (PCNL) for isolated upper pole stones, we designed a prospective randomized clinical trial.

Materials and methods: A prospective randomized study of 76 patients (18-65 years old) was conducted from January 2024 to September 2024 on isolated upper calyceal renal stones at a medical teaching hospital. The eligible participants were divided into subcostal and supracostal access for PCNL groups (38 patients per group). The measured variables included age, sex, body mass index, stone size, comorbidities, procedure time, stone-free rate, hospital stay, and complications (modified Clavien Dindo grading).

Results: Of 76 patients, 47 were male and 29 female, with a mean age of 47 and 53 years for the subcostal and supracostal groups, respectively. The mean stone size was 27.38 and 28.89 mm in the two studied groups, respectively. The mean operation and fluoroscopy time, hospital stay, laboratory data, and complications had no significant difference between the two investigated groups.

Conclusion: Unlike the traditional view, supracostal access during PCNL is safe and effective and is not associated with a higher incidence of postoperative complications. However, both procedures were performed by skilled surgeons, so surgeons should have sufficient training and choose the proper method for each patient individually to minimize complications and obtain the best results. Further studies with a large number of cases are recommended.

Objective: The objective of this systematic review is to extract inference from research articles published through evidence-based practice physiotherapy toward resistance training, aerobic exercises, trunk specific exercises, pelvic floor muscle training and manual therapy in managing urinary incontinence and sexual dysfunction along with strategies implemented to improve quality of life in patients undergoing treatment for prostate cancer.

Methods: The databases PubMed, Google Scholar, PEDro, MEDLINE, and Cochrane were systematically searched for this review. Two authors independently evaluated the methodological quality of the included studies using the PEDro scale to ensure reliability and validity.

Results: Total of 22 studies, comprising 1589 participants with a mean age of 62.16 ± 7.24 years were included in the review after meeting the inclusion and exclusion criteria. Physiotherapy interventions, including resistance training, aerobic exercises, trunk-specific exercises, pelvic floor muscle training, and manual therapy, demonstrated significant improvements in managing urinary incontinence among patients undergoing prostate cancer treatment. Pelvic floor muscle training was particularly effective in reducing incontinence, while resistance and aerobic training contributed to enhanced physical function and quality of life. Data extraction and verification were performed independently by two authors, with three authors cross-referencing for additional articles.

Conclusion: The clinical presentation in patients undergoing treatment for prostate cancer was found to be positively influenced by physiotherapy interventions, decreasing the symptoms of urinary incontinence and thus, improving the quality of life.

Objective: To evaluate the relationship between cumulative smoking exposure, measured in pack-years, and pathologic progression in patients with transitional cell carcinoma (TCC) of the bladder staged as high-grade T1 (HG-T1).

Patient and methods: We conducted a retrospective cohort study of patients diagnosed with HG-T1 urothelial carcinoma between 2020 and 2024. Clinical and pathological data were extracted, including age, gender, BMI, comorbidities, tumor size/location, completeness of resection, and presence of variant histology. Pathologic progression was defined based on worsening histology or stage on follow-up restaging transurethral resection of bladder tumor (TURBT). A pearson correlation and multivariate logistic regression were used to assess associations.

Results: Among the 80 patients analyzed, increasing cumulative smoking exposure, measured in pack-years, demonstrated a weak negative correlation with favorable pathology outcomes (r = -0.13). Neither tumor size nor completeness of resection showed a significant association with pathology change. Pathologic worsening was observed in 29.0% of smokers compared to 5.6% of non-smokers, with this difference approaching statistical significance (p = 0.057; OR = 7.0). When comparing non-smokers specifically to heavy smokers (⩾30 pack-years), the difference was statistically significant, with 34.4% of heavy smokers experiencing pathologic progression versus 5.6% of non-smokers (p = 0.036; OR = 8.9), indicating a strong association between heavy smoking exposure and adverse pathology.

Conclusion: Cumulative smoking exposure is an independent predictor of pathologic progression in patients with HG-T1 bladder cancer. These findings support the incorporation of smoking history into risk stratification models and underscore the importance of smoking cessation counseling in this population.

Objective: This study investigates the diagnostic potential of nicotinamide N-methyltransferase (NNMT) and NM23A as biomarkers for renal cell carcinoma (RCC), focusing on their ability to facilitate early detection and improve diagnostic precision.

Methods: A prospective observational study was conducted over 24 months, enrolling patients with RCC, benign renal tumors, and healthy controls. Biomarker levels were measured using enzyme-linked immunosorbent assays (ELISA). Diagnostic performance was evaluated through statistical analyses, including ROC curve analysis and Mann-Whitney U tests. Additionally, machine learning models such as Random Forest and Gradient Boosting were employed to identify key predictors of RCC.

Results: NNMT and NM23A demonstrated significant diagnostic accuracy, with area under the curve (AUC) values of 0.933 and 0.915, respectively. Both biomarkers showed substantial differences across RCC, benign, and control groups (p < 0.001). Machine learning analyses highlighted NNMT as the most influential predictor for RCC diagnosis, further supporting its clinical relevance.

Conclusions: NNMT and NM23A emerge as promising non-invasive biomarkers for RCC, offering substantial diagnostic accuracy and reducing reliance on invasive procedures. Their integration into clinical workflows, supported by advanced machine learning methodologies, could transform RCC diagnostics. Further research with diverse populations is recommended to validate these findings and expand their clinical applicability.

Objectives: This study examines the current state of robotics for bladder cancer in recent years, thereby enabling researchers to gain a comprehensive understanding of the field and anticipate future advancements.

Methods: A thorough search was performed on the Web of Science Core Collection (WoSCC) to identify literature about bladder cancer robotics published from 2004 to 2023. Bibliometric methods, such CiteSpace and VOSviewer, were used to examine publications, nations, institutions, journals, authors, and keywords.

Results: The 1678 papers from 2004 to 2023 showed an increasing trend in yearly publications related to robotic surgery for bladder cancer. Regarding publishing volumes and citations in this field, the United States, Roswell Park Comprehensive Cancer Center, European Urology, and Guru Khurshid A were the top nation, organization, journal, and author. Interestingly, eight of the top 10 publications in terms of citations were published in JCR1 designated scientific journals. Terms like "complications," "outcomes," "trial," "enhanced recovery," and "minimally invasive diversion" are emphasized in the study, suggesting that they are important and current research issues.

Conclusions: Recent hotspots include clinical studies evaluating outcomes and problems across various procedures, nevertheless, more work is required in the areas of minimally invasive surgery and improved recovery.