Urologia Journal最新文献

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.

Objectives: To evaluate the efficacy, safety, and patient-reported outcomes, including satisfaction and pain level, of electroconductive (EC) and electrohydraulic (EH) extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureter and kidney stones in a randomized controlled trial.

Materials and methods: A total of 56 patients were randomly allocated to the EC or EH groups. Patient and stone characteristics and treatment outcomes were compared.

Results: The stone-free rates were not different between the groups. The EH group achieved the same stone-free rates as the EC group with less energy use. Pain scores were higher in the EH group (mean 4.76 ± 3.53) than in the EC group (mean 3.04 ± 2.84), with borderline significance (p = 0.063). Satisfaction scores and radiation exposure were significantly lower in the EH group than in the EC group, regardless of the stone location. Univariate and multivariate analyses identified the total number of shocks and stone location as significant predictors of stone-free status.

Conclusions: EC and EH lithotripters demonstrated comparable efficacy and complication rates across different stone locations. While the EC group showed lower pain scores and higher satisfaction, these outcomes required greater energy use and resulted in higher radiation exposure. Patient satisfaction and pain level, as patient-reported outcomes, may be considered as additional measures alongside safety and efficacy in the evaluation of ESWL modalities.

Background: Anterior urethral strictures significantly impact urinary function and quality of life, often requiring surgical intervention. This study evaluates the histopathological characteristics of strictures and their correlation with urethroplasty outcomes.

Methods: A prospective study was conducted on 65 male patients (aged 20-60) diagnosed with anterior urethral strictures at SMS Medical College. Exclusion criteria included posterior urethral distraction defects and prior surgical interventions. Biopsies from stricture sites were analyzed for lichen sclerosus (LS) and inflammation. Urethroplasty techniques included dorsal augmentation, ventral onlay buccal mucosal graft, Asopa's dorsal inlay, and staged urethroplasty. Statistical analysis was performed using the chi-square test, independent t-test, and ANOVA, with a significance threshold of p < 0.05.

Results: The majority of strictures were idiopathic (46.1%), followed by LS (26.1%) and iatrogenic causes (21.5%). LS was significantly associated with poorer surgical outcomes (p = 0.032). Severe inflammation within the stricture segment correlated with unsuccessful urethroplasty outcomes (p = 0.027), whereas inflammation in proximal or distal segments showed no impact. Stricture length > 8 cm also exhibited higher failure rates. The most common postoperative complication was wound infection (13.8%).

Conclusion: LS and severe inflammation are key predictors of unsuccessful urethroplasty outcomes. Histopathological evaluation should be integrated into preoperative assessment to optimize surgical planning and reduce recurrence rates. Future studies with larger cohorts and extended follow-ups are warranted to validate these findings.

Introduction: Intravesical therapy following transurethral resection of bladder tumor (TURBT) remains the standard of care for non-muscle invasive bladder cancer (NMIBC). However, the global shortage of Bacillus Calmette-Guérin (BCG) and its notable side effect profile have driven interest in alternative agents such as gemcitabine and hyperthermic intravesical chemotherapy (HIVEC), both of which have shown promising results.

Materials and methods: A total of 100 consenting patients with intermediate- and high-risk NMIBC, as per EAU 2020 risk stratification, were enrolled at a single institution between January 2021 and July 2022. Patients were electronically randomized in a 2:1:1 ratio into three groups: gemcitabine (n = 50), HIVEC (n = 25), and BCG (n = 25). Follow-up included cystoscopy and urine cytology every 3 months. Adverse events were assessed and graded using the Modified Clavien-Dindo Classification System.

Results: At 12 months, recurrence-free survival (RFS) was 94% in the gemcitabine group, 84% in the HIVEC group, and 92% in the BCG group (p = 0.675, intention-to-treat analysis). No cases of grade or stage progression were observed. Most recurrences (88.9%) occurred in the high-risk subgroup. Treatment-related side effects were significantly more frequent in the BCG group, while gemcitabine was the most well-tolerated during both induction and maintenance phases. The most common adverse events included lower urinary tract symptoms (LUTS), dysuria, and urinary tract infections (UTIs).

Conclusion: Preliminary findings indicate that intravesical gemcitabine is non-inferior to BCG and HIVEC in terms of short-term efficacy, with a significantly better safety and tolerability profile. These results position gemcitabine as a viable alternative in the management of NMIBC. However, the study's limited sample size and short follow-up period necessitate larger, long-term studies to validate these outcomes.

Introduction: Elastography, introduced in the early 1990s, is a high-performing diagnostic tool that enhances conventional B-mode ultrasonography. This study assessed the diagnostic potential of ultrasound (US) elastography for early prostate cancer, using histopathology as the reference. It aimed to evaluate elastography's ability to differentiate benign from malignant prostate lesions and measure its sensitivity and specificity.

Method: From June 2020 to November 2022, 22 men with prostate lesions were enrolled in a prospective study. These patients, referred from the urology outpatient clinic, had a median prostate-specific antigen of 30.6 ng/mL and a median prostate volume of 65 mL. Strain stiffness was calculated for each lesion and subsequently compared with the corresponding histopathological diagnoses.

Results: A stiffness threshold between 35 and 37 kPa demonstrated the optimal discriminatory capacity between benign and malignant lesions, yielding a sensitivity of 83.3%, a specificity of 70%, a positive predictive value of 76.9%, a negative predictive value of 77.7%, and an overall accuracy of 77.2%.

Conclusion: Elastography is an effective diagnostic tool that enhances B-mode ultrasound specificity for prostate cancer detection. It improves differentiation between benign and malignant lesions and increases the accuracy of prostate biopsy outcomes.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is widely recognized as a safe, non-invasive treatment with minimal side effects. This procedure does not require anesthesia, making it an effective option for lower ureteral stones. This study aimed to assess the effectiveness of ESWL in treating distal ureteral stones ranging from 5 to 15 mm in size and to identify factors influencing the treatment outcomes.

Methodology: This was a prospective hospital-based analytical cross-sectional study conducted in the Department of Urology, tertiary care facility, Jaipur. Data collection for the study was started in September 2023 and completed in November 2024. A total of sixty one patients diagnosed with distal ureteral stones and undergoing ESWL treatments were enrolled in this study. The data was analyzed using SPSS 25.0 version.

Results: The average age of the participants was 49.52 ± 10.99 years, with approximately two-thirds being male. The mean stone size was 9.93 ± 2.95 mm, and the average stone density was 765.10 ± 205.88 HU. The overall success rate of the procedure was 85.2% (n = 52/61). Treatment success was significantly associated with age, stone size, and BMI (p < 0.05), but not with the patient's sex or stone laterality (p > 0.05). In the multivariate analysis, the patient's BMI was identified as the only significant predictor of treatment success.

Conclusion: ESWL is a successful, non-invasive, and practical therapeutic option for lower ureteric calculi with no significant side effects. It is an effective procedure for small size ureteric calculi up to 15 mm size, ESWL could therefore be used as the main form of treatment.

Ureteropelvic junction obstruction (UPJO) is a major cause of obstructive uropathy in pediatric patients. However, the optimal management remains controversial. We aimed to summarize the evidence comparing surgical versus conservative treatment. We searched MEDLINE/PubMed (2016 to 31 October 2024) and the Cochrane Central Register of Controlled Trials (CENTRAL) on 31 October 2024. The primary outcome was split renal function (SRF). Results were summarized in a structured table. Study quality was assessed using the ROBINS-I tool and the level of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. Our search resulted in 2.251 reports. We included two non-randomized interventional studies with 136 patients. One study reported no statistically significant difference in SRF between the study groups after 1 year of follow up, while the second study reported higher SRF in surgical group 6 months postoperatively. The studies were judged to have a serious risk of bias, and the quality of evidence was rated as very low. The paucity of eligible data precluded the performance of a meta-analysis. Our findings could not support clinical recommendations. This study highlights the lack of high-quality evidence that will come from large, prospective, well-designed trials comparing surgical intervention to updated conservative treatment options.

Background: Percutaneous nephrolithotomy (PCNL) is a crucial treatment for large renal stones and has a high success rate. Patients require comprehensive information about the procedure to make informed decisions. Effective communication between patients and physicians is essential for treatment adherence and postoperative recovery. Utilizing three-dimensional (3D) models has been shown to improve comprehension of complication and increasing confidence in both treatments and surgeons.

Method: This study involved 40 individuals planned for PCNL surgery, aged 18 to 80, confirmed through computed tomography (CT) scans. They were divided randomly into 2D and 3D groups. The 3D group received detailed information using patient-specific 3D printed kidney models, while the 2D group received education based on conventional 2D CT scan. After the educational session, participants completed a survey to assess their comprehension. Following surgery, participants rated their satisfaction on scale of 1-10. This study aimed to compare the effectiveness of 3D models in patient comprehension and satisfaction in PCNL surgery.

Result: The analysis was performed on 40 individuals (23 males, 17 females). Each group comprises 20 participants, with similar demographic and stone feature characteristics. Participant ages ranged from 32 to 66 years with a mean (SD) of 50.0 (8.52) and no significant age or gender differences were seen between the groups. Patients in the 3D group showed significantly higher comprehension in various aspects and satisfaction levels (p-values<0.05).

Conclusion: Incorporating personalized 3D printed models in PCNL surgery has been shown to enhance the patients' comprehension of renal stone features and PCNL procedure. It also increases postoperative satisfaction.