Urologia Journal最新文献

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.

Objective/purpose: This study aims to compare BPT and RC for long-term survival and quality of life outcomes in MIBC patients.

Materials and methods: The study conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, with search strategy across databases (PubMed, Scopus, Cochrane Library, EMBASE, and MEDLINE) used relevant keywords. RCTs, observational studies, and simulation studies were included. Each included study was evaluated with the Newcastle-Ottawa Scale (NOS) for observational studies and the Jadad score for randomized controlled trials (RCTs). Disagreements between reviewers were resolved by consensus, and inter-rater agreement was assessed using Cohen's Kappa statistic. The meta-analysis was performed with Review Manager (RevMan), v5.4.

Results: Seven studies (six retrospective cohorts, one RCT) met the inclusion criteria with a total of 25,212 patients. Analysis of four studies evaluating the comparison of BPT and RC showed no statistically significant differences in overall survival rates between the two therapies (HR = 1.14, 95%CI: 0.99-1.31, p = 0.07, I² = 0%). Subgroup analysis results showed significant differences in overall mortality (HR = 1.16, 95%CI: 0.94-1.42, p = 0.17, I² = 9%) and bladder cancer-specific mortality (HR = 1.11, 95%CI: 0.89-1.39, p = 0.34, I² = 0%) between the two treatment approaches.

Conclusion: Compared to RC, BPT generally demonstrated similar results in terms of survival, local recurrence-free survival, and disease-free survival. Treatment decisions should be individualized, considering patient preferences, tumor characteristics, and available resources.

Objective: To research the best time to provide cardiopulmonary bypass (CPB) and the best way to do it when treating an extensive tumor thrombosis of the inferior vena cava vein (IVC).

Results: The operating times in groups A and B were (376.7 ± 91.2) and (373.1 ± 80.7) minutes, respectively, with no statistically significant difference (t = 0.716, p > 0.05); intraoperative bleeding was (1916.7 ± 925.1) ml and (2600 ± 3756.3) ml, (t = -0.601, p < 0.05), and hospitalization was (32.3 ± 16.0) and (34.0 ± 8.0) days, with statistically significant differences (p < 0.05).

Conclusion: The CPB approach has the advantages of less intraoperative blood loss, faster surgical procedures, and fewer hospitalizations.

Infertility is a disease of the reproductive system which is defined as the inability to conceive after more than 12 months of unprotected intercourse. It affects millions of people and has far-reaching impacts on quality of life, sexual dysfunction, marital impact, and societal implications. Despite advancements in understanding infertility, the cause of infertility in around 28% of cases remains unclear. This review addresses the pivotal relation between Gut microbiota (GM) and infertility. GM is now believed to interplay with the human body at different levels and is essential for our well-being. The abnormal translocation of GM to the systemic circulation, known as dysbiosis triggers an over-stimulated immune response associated with a marked increase in pro-inflammatory cytokines. This inflammatory situation may disrupt the hypothalamic-pituitary-gonadal axis and lead to disseminated inflammation ending in adhesions and obstructive lesions of the reproductive tract. Dysbiosis can also predispose individuals to obesity and insulin resistance, where both are risk factors for diabetes, hypertension, polycystic ovary syndrome (PCOS), impaired spermatogenesis, erectile dysfunction, and infertility. GM has an inevitable role in the pharmacokinetics of many drugs and can regulate the expression of many cytochrome P450 enzymes and several transporters. Further research is needed to validate the possible implication of GM in the pathophysiology of infertility, the efficacy of infertility medications, and the potential of GM-based therapies to treat infertile couples.

Purpose: To evaluate the effect of neoadjuvant chemotherapy (NAC) on short-term complications following robotic radical cystectomy (RRC).

Methods: A retrospective review of 134 bladder cancer patients who underwent RRC. Perioperative outcomes were compared between patients who received NAC (nRRC) and those who underwent upfront RRC (uRRC).

Primary outcome: 30-day Clavien-Dindo classification score of ⩾2 (CDC ⩾ 2).

Secondary outcomes: 30-day infectious complications, readmission rates, postoperative ileus, blood transfusion, and mortality.

Results: Of the 134 patients, 90 (67%) were in the nRRC group and 44 (33%) in the uRRC group. The total 30-day CDC ⩾ 2 complication rates and high-grade complications were comparable between the groups. Among the various outcomes assessed, only postoperative ileus showed a statistically significant difference, with lower rates in the nRRC (20% vs 38.4%, OR = 0.39, p = 0.021). Other outcomes, including 30-day readmission, infectious complications and blood transfusions, were similar. All four cases of 30-day mortality occurred in the nRRC group.

Conclusion: NAC in the era of RRC was not associated with a statistically significant increase in overall perioperative complication rates in our cohort. NAC can likely be administered without a significant increase in perioperative complications, although confirmation in larger studies is warranted.

Human papillomavirus (HPV) is a prevalent sexually transmitted disease worldwide. Very little is known about the effect of HPV on men's health. It is estimated that it is one of the most critical causes of penile cancer worldwide, representing a considerable percentage of the cases. We aimed to review the information on HPV vaccination strategy plans worldwide and the effect on male genital health. Studies on the outcomes of countries that include males in HPV vaccination programs and what the result will be in those that do not indicate favorable data in terms of preventing disease and thus the cost-effectiveness of gender-neutral HPV vaccination in most high-income countries (HIC) as well as in low-to-middle income countries (LMIC), considering HPV universal vaccination as a public health strategy. Vaccination of men against HPV is an effective strategy to prevent the development of genital cancers in this population.

Background: This study assessed the safety and efficacy of management strategies for residual upper calyceal stones (1-2 cm) following percutaneous nephrolithotomy for staghorn calculi, comparing conservative management to interventional approaches.

Methods: A randomized trial included 105 patients with residual stones, assigned to flexible ureterorenoscopic laser lithotripsy (Group A), extracorporeal shock wave lithotripsy (ESWL, Group B), or conservative management (Group C). Outcomes included the need for additional interventions, stone-free rates, complications, and cost-effectiveness. Patients were followed for 1 year to assess pain, hematuria, hospital readmission, and stone clearance.

Results: Conservative management led to a 20% intervention rate within a year, primarily due to pain, obstruction, or patient preference. A stone size ⩽ 1.4 cm predicted the likelihood of intervention. Flexible ureterorenoscopy had the highest stone-free rate (94.29%), followed by ESWL (71.43%, p = 0.023). ESWL was the most cost-effective option (10.17 × 10³ vs 39.47 × 10³ Egyptian pounds, p < 0.001) but was less effective for high-density stones.

Conclusions: While conservative management avoids immediate intervention, it carries a higher risk of future complications and delayed interventions. Early intervention with flexible ureterorenoscopy or ESWL offers better long-term outcomes, with ESWL being the most cost-effective option.

Introduction: Various nephrolithometry scoring systems have been introduced to assess the outcomes of percutaneous nephrolithotomy (PCNL) and postoperative complications. Previous studies have incorporated various variables to determine factors influencing postoperative acute kidney injury (AKI). Using separate scoring systems or nomograms to predict postoperative outcomes and AKI is cumbersome. Our study aims to find if stone scoring systems can be used to predict AKI following a PCNL procedure.

Materials and methods: A prospective observational study was conducted at Kasturba Hospital and Medical College from December 2023 to June 2024. All patients undergoing PCNL were included in the study. Scores were calculated for all patients pre-operatively using various nephrolithometry scoring systems. Patients were divided into two groups based on the presence or absence of AKI following PCNL. The various stone scoring systems were assessed for their ability to predict AKI following PCNL.

Results: Out of the 90 patients in the study, 15 (16.66%) developed AKI, and 75 (83.33%) had no AKI following PCNL. Statistical significance was found in stone size (p < 0.001), stone location (p = 0.011), Staghorn (p < 0.001), Guy's Score (p = 0.001), STONE score (0.002), CROES Score (p = 0.001), Amplatz size (p = 0.012) and energy source (p = 0.01). No statistical significance was found when comparing sex, comorbidities, number of stones, the severity of HN, puncture location and number, intraoperative hypotension, operative time, and duration of hospital stay.

Conclusion: Nephrolithometry scoring systems, in addition to assessing postoperative outcomes such as stone-free rate and complications, can also be used to predict the occurrence of AKI. The use of a limited number of scoring systems to assess all the postoperative outcomes will help simplify and facilitate their use in routine clinical practice.

Background and objective: This study aims to map the prevalence and treatment of urachal cancer (UrC) in Norway, establish survival rates, identify prognostic factors, and evaluate whether any of the three commonly used staging systems for UrC provide superior prognostic value.

Methods: In this retrospective cohort study, data from the National Cancer Register was collected to identify patients diagnosed with UrC between1997 and2022. Eligible cases (n = 43) underwent retrospective review of their individual hospital records. All patients were staged using the Sheldon, Mayo, and Limonnik-revised TNM systems. This was performed locally and then checked by the coordinating center.Key findings and limitations:The median age at surgery was 59.5 years (IQR 49-73), with 57% of patients being male. The median follow-up time for survivors was 98 months (IQR 81-153). Macroscopic hematuria was the most common presentation (67%, n = 28). Recurrence-free survival (RFS) rates at 1, 3, and 5 years were 71%, 57%, and 53%, respectively. Cancer specific survival (CSS) was 95%, 62%, 55%, and overall survival (OS) rates were 93%, 61%, 46% at the same time points. Smaller tumor size was an independent predictor of improved CSS (HR 1.3, CI: 1.01-1.6, p = 0.045). Of the three staging systems, only the Mayo system showed statistically significant differences between stages for OS, while none of the systems, including Mayo, showed significant differences for CSS. Study limitations include a small sample size and a prolonged study period of 25 years, which may affect the generalizability of the findings and introduce bias due to changes in clinical practice over time, such as advancements in surgical techniques, and oncological therapies.

Conclusions and clinical implications: Urachal cancer is frequently diagnosed at an advanced stage. Our findings suggest that the Mayo system more effectively distinguishes between localized, locally advanced, and advanced disease compared to the Sheldon and Limonnik-revised TNM systems.