Urologia Journal最新文献

Purpose: This study aimed to develop and validate an AI-assisted framework for the automated evaluation of uroflowmetry data in patients presenting with lower urinary tract symptoms. The primary goal was to overcome the limitations of traditional manual interpretations by leveraging advanced machine learning techniques to achieve higher diagnostic accuracy, objectivity, and clinical applicability in urological assessments.

Materials and methods: A retrospective analysis was conducted using a large, de-identified dataset comprising uroflowmetry recordings, patient-reported symptom scores, and comprehensive demographic data. The data underwent rigorous preprocessing-including noise reduction, baseline correction, normalization, and feature extraction-with key parameters such as peak flow rate, voided volume, average flow rate, and voiding time being analyzed. Multiple machine learning models-including a deep neural network, support vector machine, and random forest classifier-were developed and validated through cross-validation and extensive statistical testing. Performance metrics such as accuracy, sensitivity, specificity, and area under the ROC curve (AUC-ROC) were calculated, while multivariate regression analyses were performed to explore the relationships between uroflowmetry parameters and symptom severity.

Results: The AI framework, particularly the deep neural network model, exhibited outstanding diagnostic performance with an accuracy of 92.5%, sensitivity of 90.0%, specificity of 94.0%, and an AUC-ROC of 0.96. Statistical analyses demonstrated significant correlations between key uroflowmetry parameters and clinical symptoms, with lower peak flow rates showing a strong association with increased symptom severity (p < 0.001). These findings confirm that the integration of multi-dimensional data through AI significantly enhances the objectivity and precision of urinary function evaluation compared to conventional methods.

Conclusion: The study successfully established an AI-assisted diagnostic framework that markedly improves the automated evaluation of uroflowmetry data and lower urinary tract symptoms. This innovative approach offers a robust alternative to traditional diagnostic practices by reducing subjectivity and enhancing diagnostic accuracy, thereby paving the way for more personalized and effective management of urinary disorders.

Robotic-Assisted Partial Nephrectomy (RAPN) can be performed via a transperitoneal (t-RAPN) or retroperitoneal (r-RAPN) approach. Despite the retroperitoneal route being potentially more suitable for posterior renal tumors, most surgeons prefer the transperitoneal access due to greater familiarity. This study evaluated perioperative and functional outcomes of r-RAPN versus t-RAPN for posterior renal masses performed by a surgeon without prior retroperitoneal experience. We retrospectively analyzed patients undergoing RAPN for posterior renal tumors between September 2023 and April 2025. Patient and tumor characteristics, operative time (OT), warm ischemia time (WIT), ΔeGFR, length of stay (LOS), complications, and Trifecta rate were compared. Trifecta was defined as WIT < 25 min, negative margins, and absence of Clavien-Dindo ⩾ III complications. Twenty patients were included: eight underwent t-RAPN and 12 r-RAPN. Baseline features were comparable. r-RAPN showed significantly shorter OT (125 ± 29 min vs 168 ± 37 min, p = 0.01), time on console (72 min vs 110 min, p = 0.01), and WIT (12 min vs 18 min, p = 0.048). Trifecta was achieved in all cases. Multivariate analysis identified surgical approach as the only independent predictor of console time (p = 0.024), with r-RAPN reducing it by 39 min. In conclusion, r-RAPN is feasible and safe even without prior retroperitoneal experience, offering comparable outcomes to t-RAPN with shorter operative times.

Background: In recent years, there has been a growing trend toward minimally-invasive techniques (MISTs) in men presenting symptomatic lower urinary tract symptoms (LUTS). However, direct comparisons between techniques are rare. This work compares 2-year functional outcomes and failure rates after implantable nitinol device (iTIND) and prostatic Urethral lift (Urolift).

Methods: Data of patients presenting with LUTS with an International Prostatic Symptom Score (IPSS) ⩾10, Qmax < 12 mL/s, and prostate volume < 70 mL were obtained retrospectively from two different referral centers' databases. Patients with neurogenic bladder, sphincter abnormalities, urethral strictures, post-void residual (PVR) volume > 250 mL, urinary bladder stones, and active urinary tract infections were excluded from the study. Treatment failure was defined as the need for surgical retreatment for LUTS or ejaculatory dysfunction. Postoperative uroflowmetry, PVR, IPSS, ejaculatory function, and retreatment rate were collected at 24 months follow-up.

Results: A total of 134 cases were collected. iTIND was used in 92 (68.7%) patients and Urolift in 42 (31.3%). Baseline characteristics were similar in both groups; however, Urolift patients were younger, with more significant prostate volumes and median lobe enlargement. No patients developed ejaculatory dysfunctions after the treatment, and the retreatment rate was similar in the two groups (13% vs 11.9% p = 0.8). Urolift demonstrated a shorter length of stay. Uroflowmetry, PVR volume, and symptom scores improved in both groups; iTIND cases showed significantly better symptom score reduction.

Conclusions: The 24-month failure rate was similar for iTIND and Urolift. Urolift reported a shorter hospitalization. Uroflowmetry and PVR results were comparable in both groups. iTIND cases showed slightly superior improvements in symptom scores; however, the clinical significance of this finding must be confirmed by further studies in correlation with prostate volume and median lobe shape.

Purpose: This study presents a 1-year follow-up for fragile patients with catheter-dependent urinary retention related to benign prostatic hyperplasia (BPH) treated with Rezum therapy.

Materials and methods: All patients participating in this study exhibited catheter-dependent urine retention attributable to benign prostatic hyperplasia, with a mean prostate volume of 65 ± 13.1 ml. The study only included fragile patients with a PRISMA-7 questionnaire score of ⩾3. The study excluded patients with bladder or prostate cancer, ongoing urinary tract inflammation, a history of pelvic irradiation or prostate surgery, neurogenic bladder or urethral stricture. The treatment was carried out under local anesthesia, with the possibility of sedation. Patients were asked to follow up after 1, 2, 9, and 12 months of surgery. Clinical assessments included the IPSS score, bladder scans to determine pre- and post-voiding bladder volume, and an evaluation of the requirement for re-catheterization.

Results: Eighty fragile patients with PRISMA-7 score ⩾3 underwent Rezum treatment for urinary retention due to BPH. Patients were monitored for 1 year after the procedure. Patients' IPSS improved from 14 to 9.5 (p = 0.02), while post-void residual urine decreased from 50 mL to 12 mL (p < 0.001). Prostate volume reduced from 60.5 mL to 40.9 mL (p = 0.0003) and PSA levels also dropped, from 3.5 mg/dl to 2.3 ng/ml (p = 0.03).

Conclusion: This study demonstrates that Rezum therapy is a feasible treatment option for frail patients with PRISMA-7 questionnaire score of ⩾3, presented with catheter dependent urinary retention. There were reported positive post-operative outcomes and an improvement in IPSS scores up to one year after surgery.

Introduction: Urethral stricture is common in men with anterior being more common. Number of surgical techniques are there for anterior urethral stricture depending upon location and extent of stricture. To compare one technique with another in terms of complexity, intra-op difficulty and recurrence, no standard scoring system is there. In order to quantify anterior urethral stricture disease, Weigand developed USS (UREThRAL Stricture Score) in 2012. This scoring system was based on preoperative imaging and intraoperative findings. This scoring system has not been accepted worldwide. The aim of this study is to evaluate the USS in predicting intraoperative complexity and postoperative outcome in anterior urethral stricture disease.

Methods: This ambidirectional study included patients operated for anterior urethral stricture in our institute. USS score for each patient was calculated preoperatively. Patients underwent optical internal urethrotomy (OIU), anastomotic urethroplasty or buccal mucosal graft urethroplasty (BMG). Complexity of surgery (in terms of duration of surgery and need of blood transfusion) and postoperative outcome (post op complications and recurrence) was evaluated for association with USS score.

Results: The study included 100 patients. Mean duration of surgery for overall study population was 99.39 ± 55.78 min with strong positive correlation of 0.76 (p-value < 0.001) with USS. Subgroup analysis revealed significant association between USS and postoperative complications (p-value 0.032) and recurrence of stricture (p-value 0.003) in OIU patients. There was also showed that there was significant association between USS and time to recurrence in patients who underwent OIU (p-value 0.007).

Conclusion: Our study validates the USS in predicting complexity of surgery, postoperative complications and recurrence in anterior urethral stricture disease. Higher the USS, more complex is the surgery needed for anterior urethral stricture, more chances of postoperative complications and recurrence of stricture.

Purpose: To evaluate the safety and efficacy of single-session supine bilateral percutaneous nephrolithotomy (BPCNL) in patients with bilateral renal stones.

Methods: We retrospectively identified patients from February 2019 to July 2023 with bilateral renal stones measuring >2 cm and <5 cm in their maximum dimension for each side mainly located in the renal pelvis that had been treated with single-session supine BPCNL. The stone-free rate was accepted when remaining fragments of ⩽ 2 mm were discovered by a computed tomography scan.

Results: Fifty-two patients with bilateral renal stones measuring 2:5 cm in their maximum dimension for each side who had been treated with single-session supine BPCNL were included in the study; a statistically significant difference in serum creatinine level was detected on day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.403 and 0.471 respectively). Also, statistically significant difference in glomerular filtration rate was detected at day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.95 and 0.07 respectively implicating early renal affection that shortly returned to normal values. The mean operative time for both sides was 126.5 ± 22.9 min, and the mean hemoglobin drop after the procedure was 1.9 ± 0.99 g/dl. The primary stone-free rate was 75%, with 11.6% of the remaining patients had a residual insignificant stones >2 mm but still less than 6 mm. Finally, 13.4% of the patients needed ancillary procedures.

Conclusion: Single-session supine bilateral PCNL is both safe and effective for patients with bilateral renal stones. However, this is a complex procedure that should only be performed by expert surgeons in a tertiary centers.

Trial registration number: (167) SPS/URS_008 retrospectively registered.

The optimal timing of perioperative chemotherapy in upper tract urothelial carcinoma (UTUC) remains debated. We conducted a meta-analysis to compare neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) in terms of pathological and survival outcomes. A systematic search identified eligible studies directly comparing NAC and AC in UTUC patients. Five studies with 1938 patients were included. Compared with AC, NAC achieved higher rates of pathological downstaging (OR: 2.13; 95% CI: 1.21-3.76) and a lower risk of positive surgical margins (OR: 0.59; 95% CI: 0.37-0.95). In contrast, lymph node metastasis rates and overall survival were similar between the two groups. Importantly, although renal function outcomes were not directly reported, prior evidence highlights the risk of post-nephrectomy renal decline, which may limit cisplatin eligibility-underscoring the rationale for NAC. Overall, NAC provides superior pathological benefits while maintaining comparable survival outcomes, supporting its consideration in eligible patients. Given the risk of post-surgical renal function decline, NAC should be considered in eligible patients to ensure timely delivery of cisplatin-based regimens. Future studies should incorporate renal functional outcomes to guide treatment selection.

Background: Concerns over infection have driven a shift from transrectal to transperineal prostate biopsy, while pre-biopsy MRI has promoted a move from systematic to targeted sampling. These changes may impact patient selection, treatment planning, and risk stratification in active surveillance.

Objective: To compare active surveillance outcomes of patients diagnosed primarily by targeted transperineal (tTP) biopsy versus standard transrectal (sTR) biopsy.

Design, setting and participants: Prospectively collected data of men who underwent prostate biopsy between January 2018 and May 2022 who were included into active surveillance in our institution.

Outcome measurements and statistical analysis: Comparison of patient characteristics, clinical and radiological features, positive and total number of biopsies, biopsy Gleason grade group (GG) at inclusion using simple descriptive statistics, groups compared using Wilcoxon rank sum test; Fisher's exact test; Pearson's Chi-squared test. Time to transition to curative treatment was calculated using the Kaplan-Meier plot.

Results: There were 112 and 167 patients in the tTP and sTR groups, respectively. No significant differences in age, BMI, ECOG, Charlson Comorbidity Index, PSA, radiological T-stage or GG at inclusion was seen. Number of positive biopsy cores were unchanged between tTP and sTR at 2 (1-3) (median (IQR); p = 0.2), while total cores were reduced significantly to 3 (3-5) from 12 (8-12) (p < 0.001), respectively. Overall, there was no difference in progression from surveillance to active treatment (p = 0.084), but when separated by biopsy type and GG, there was a significantly higher rate of transitioning to curative treatment after 1 year in the sTR group with GG2+ at inclusion (p < 0.0001), compared to the other three.

Conclusion: Using targeted transperineal biopsy of the index lesion(s) alone does not lead to increased treatment of patients included in active surveillance.

Infertility has become a major concern over the past decades. While semen analysis is the standard initial test performed to assess male infertility, it offers limited insight due to its variability. Recently, new diagnostic tools, such as sperm DNA fragmentation (SDF), have been identified as key factors in reproductive failure. Although semen parameters are well-studied, the link between these parameters and SDF remains unclear. In addition, lifestyle factors like age, obesity, and tobacco use, known to affect fertility, have yet to be definitively linked to SDF. This study aims to explore the relationship between semen parameters and demographic factors with SDF rates in a population of Lebanese males. A total of 86 men were included in our study. Neither abnormal semen analysis-defined as the presence of at least one of the following: oligospermia, asthenospermia, and teratospermia-or each of the following semen analysis parameters: pH, vitality, leucocytospermia, oligospermia, asthenospermia, and teratospermia have been associated with high rates of SDF. Additionally, no statistically significant association was found with factors of demographic data. Our study highlights the importance of considering sperm DNA fragmentation (SDF) as an independent factor when semen analysis alone does not fully explain infertility.