Urologia Journal最新文献

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.

This systematic and bibliometric review synthesizes current knowledge of the relationship between cycling, renal and urological health. A comprehensive search of databases from 2000 to 2023 yielded 38 relevant studies. Bibliometric analysis revealed research trends, key institutions, authors, and countries that contributed to this field. This review discusses the benefits and risks associated with cycling. Benefits included improved cardiovascular health and metabolic function. However, cycling was also associated with urological symptoms, particularly in women, and with risks of erectile dysfunction and genital numbness in both genders. Mountain biking demonstrated higher rates of scrotal pathologies. Saddle design, riding position, and cycling intensity significantly influenced perineal pressure and potential urological issues. Renal biomarkers indicated dehydration, muscle damage, and potential renal insufficiencies in cyclists, especially after prolonged and intense activity. Elevated inflammatory markers and reduced glomerular filtration rates were observed post-cycling. Sodium intake and L-tryptophan supplementation demonstrated positive effects on fatigue reduction and recovery. The review identified research gaps, including limited long-term studies and inconsistent methodologies. Future research should focus on the relationship between high-volume cycling and prostate cancer risk, optimizing bicycle design to reduce urological issues, and developing reliable methods to measure saddle pressure effects on renal health. This review provided valuable insights for cyclists, health professionals, and researchers, emphasizing the need for awareness of potential health impacts and the importance of proper equipment and techniques to minimize risks while maximizing cycling benefits.

Introduction: Laparoscopic adrenalectomy technique has the advantage of reduction in morbidity and peri-operative mortality. This technique has been established in the management of benign small masses (<5-6 cm). A dilemma exists in the management of bigger lesions or potentially malignant tumours. This study aimed to assess the procedure in terms of preoperative requirements, technique itself, the outcome and complications.

Material and methods: This mixed design (retrospective and prospective) cohort study was conducted in the Department of Urology and Renal Transplant, at one of the largest tertiary care centre of north-western India. A total of 27 patients who underwent laparoscopic adrenalectomy from January 2022 to December 2023 were included in the study. Data was collected regarding patient's demographic profile, characteristics of adrenal lesions, surgical procedures, postoperative results, and histological diagnosis.

Results: Age of patients ranged from 9 to 65 years, 15 (55.6%) were male. Common indication for laparoscopic adrenalectomy was Pheochromocytoma (40.7%), Non-Functioning Adrenal Tumour (29.6%), and Conn's syndrome (18.5%). Histopathology confirmed pheochromocytoma in 10 (37%) patients. Adenoma was found in eight (29.6%) patients. The average intra op blood loss was 174.63 ± 90.98 ml, and nine (33.3%) required post operative blood transfusion. The mean duration of surgery was 140.19 ± 26.51 min. Conversion to open surgery was required in two (7.4%) patients. Post op complications included deranged LFT (3.7%), fever (3.7%), and ileus (7.4%). The duration of the hospital stay ranged from 3 to 5 days.

Conclusion: Laparoscopic adrenalectomy can be considered a safe and effective procedure with relatively low rate of morbidity.

To evaluate the role of intralesional steroid and hyaluronidase injection after direct visual internal urethrotomy in short segment (⩽2 cm) anterior urethral strictures.

Materials and methods: A prospective, interventional, randomized study involved 100 patients who underwent direct visual internal urethrotomy for short anterior urethral stricture (⩽2 cm). Patients were randomized into two groups: Group A where all patients had received intralesional triamcinolone and hyaluronidase and Group B where no intralesional injection was given after doing direct visual internal urethrotomy. Postoperatively, all patients were trained for clean intermittent self-dilatation (CISD) using a 14 Fr Foley catheter. Follow-up uroflowmetry was conducted on postoperative day 7 and at 1, 3, 6 and 12 months or when had symptoms such as poor stream of urine, acute urinary retention. Success was defined as Qmax > 12 mL/s for a minimum voided volume of 150 mL and absence of voiding symptoms.

Results: The recurrence rate was 24% in Group A compared to 46% in Group B, with a 22% absolute risk reduction (p = 0.021). The mean time to recurrence was 9.4 ± 2.5 months in Group A versus 7.5 ± 2.2 months in Group B (p = 0.039). The mean Qmax at 6 and 12 months post-DVIU were significantly higher in Group A (15.5 and 14.6 mL/s) than in Group B (14.6 and 13.6 mL/s), with p-values of 0.006 and 0.002 respectively.

Conclusion: Intralesional injection of triamcinolone and hyaluronidase following DVIU significantly reduces the recurrence rate, delays the time to recurrence and improves peak urinary flow rate in patients with short-segment (⩽2 cm) anterior urethral strictures compared to DVIU alone.