Urologia Journal最新文献

Purpose: A retrospective study was performed to identify potential metabolic abnormalities and inflammatory abnormalities associated with benign prostatic hyperplasia (BPH) secondary to bladder calculi.

Materials and methods: This study enrolled 646 patients with bladder calculi between 2008 and 2022, including 314 patients with benign prostatic hyperplasia (BPH) and 332 without BPH. Demographic characteristics, serum biochemical parameters, prostate volume, maximum bladder calculus diameter, and randomized urinary metabolic profiles were compared between the two groups.

Results: BPH was associated with increased aspartate aminotransferase/alanine aminotransferase (mean 1.2 vs 1.1, P < 0.05), lower cholinesterase (mean 7240.5 vs 7778.4, P < 0.01), increased systolic pressure (mean 137.2 vs 133.4, P < 0.01). Patients with BPH were significantly older and had higher systolic blood pressure compared to non-BPH patients. BPH group exhibited significantly lower levels of albumin/globulin ratio, cholinesterase, phosphorus, triglycerides, platelet count, neutrophil count, and white blood cell count, while demonstrating higher aspartate aminotransferase/alanine aminotransferase ratio, mean corpuscular volume, monocyte ratio, and urinary red blood cell count. Prostate volume was proportional to body weight and crystal count. Lower phosphorus (OR = 0.207; 95%CI = 0.068, 0.635; P < 0.01) and higher age (OR = 1.065; 95%CI = 1.041, 1.090; P < 0.001) were associated with BPH.

Conclusions: Advanced age was identified as a significant risk factor for prostate hyperplasia in patients with bladder calculi, whereas elevated phosphorus levels emerged as a protective factor. The pathogenesis of BPH secondary to bladder calculi appears to be multifactorial, primarily influenced by metabolic abnormalities and inflammatory processes. These findings provide valuable insights for the clinical assessment and management of BPH secondary to bladder calculi.

Background: In percutaneous nephrolithotomy, when tract dilatation fails due to short advancement, endoscopic tract dilatation can be used as a salvage technique for renal access. We aimed to report complications of this technique and compare it with uneventful dilatation cases.

Methods and materials: The study enrolled patients who underwent sonography-guided PCNL for six consecutive months in 2023. After renal puncture under the sonography guide, an Amplatz dilator was used for one-shot tract dilation. In the case of short-advancement, a bi-prong forceps was used under direct endoscopic vision for tract dilatation. The study compared the operation time, postoperative complications, and stone-free rate between successful one-shot Amplatz dilatation (SA) and those with salvage endoscopic tract dilatation (SE).

Results: The study included 108 patients with a mean age of 47.9 ± 11.6 (50.9% male). Short-advancement occurred in 63 patients (58.3%). The salvage technique was successful in 95.2% of occasions of short advancement. Pre-operative demographic and clinical data were not different in this group compared to the (SA) group. The operative time was 21.1 ± 14.5 min in the (SE) group, which was not longer than the (SA) group with 22.7 ± 12.6 min (p = 0.2). The stone-free rate was 81.0% in the (SE) group, which was not inferior to 73% in the (SA) group (p = 0.3). The transfusion rate and complications were not different as well.

Conclusion: Salvage bi-prong forceps tract dilation in the event of short advancement after one-shot Amplatz tract dilation during percutaneous nephrolithotomy is not linked to a higher complication rate or inferior clinical outcomes compared to successful one-shot dilation.

Objective: To evaluate the therapeutic effect of acupuncture combined with cross-moxibustion in patients with severe overactive bladder (OAB).

Methods: OAB patients from August 2018 to July 2023 were collected, and 101 severe OAB patients were selected based on the Overactive Bladder Symptom Scale (OABSS) score. The patients were divided into three groups according to their treatment methods, including 33 cases of behavioral therapy group, 32 cases were in the acupoint acupuncture group, and 36 cases were in the acupuncture combined with cross-moxibustion group. The treatment outcomes of the three groups were evaluated through the OABSS score, and the quality of life (QOL) was assessed.

Results: Among the 101 patients with severe OAB, no statistical differences in age and gender were observed among the three groups of treatments. The treatment effects were evaluated using the OABSS score and it was found that behavioral treatment was basically ineffective. In contrast, both acupuncture and acupuncture combined with cross-moxibustion had significant differences via comparing at pre-post treatment periods, which the OABSS score decreased by 3.25 ± 1.83 and 7.83 ± 1.34 respectively, suggesting that acupuncture combined with cross-moxibustion is more effective than acupuncture group alone. The patient's quality of life was further evaluated through QOL scores, and the results showed that while the acupuncture group was effective, acupuncture combined with cross-moxibustion improved more significantly.

Conclusion: The combination of acupuncture and moxibustion is the most effective treatment for patients with severe overactive bladder.

Background: Onabotulinum toxin A injection is recommended for overactive bladder (OAB) resistant to medical treatments. However, success is not universal, and factors influencing outcomes remain unclear. This study evaluates the factors affecting the success of onabotulinum toxin A injection in refractory idiopathic OAB.

Methods: Data from patients with resistant idiopathic OAB treated with 100 IU onabotulinum toxin A (BOTOX^®, Allergan, Dublin, Ireland) between January 2019 and August 2023 were analyzed. Demographic data and symptom duration were recorded. Patients were evaluated pre- and post-procedure using the overactive bladder symptom score (OABSS) and 3-day bladder diaries. A ⩾50% improvement in OABSS was considered treatment success. Botox was injected at 20 sites (5 IU per site) via 22 Fr rigid cystoscope under sedoanalgesia.

Results: A total of 210 patients (80.5% female, n = 169) with a mean age of 53.76 ± 14.90 years were included. Symptom duration averaged 39.82 ± 22.28 months. Wet OAB was diagnosed in 83.3% (n = 175), while 16.7% (n = 35) had dry OAB. Pre-procedure mean OABSS was 9.18 ± 1.31, daily micturition 8.67 ± 1.52, urge incontinence 2.57 ± 1.28, nocturia 1.87 ± 0.75, and pad use 2.44 ± 1.24/day. Treatment success was achieved in 82.4% (n = 173).

Conclusion: The degree of patient complaints, particularly daily micturition frequency, significantly affects treatment success. Patients with higher daily micturition may require advanced interventions beyond Botox.

Objective: To determine the association between thyroid disorders and the Risk of developing prostate cancer.

Methods: We conducted this review following the recommendations of the Cochrane Collaboration and the PRISMA Statement. From the moment to the present, we have conducted a search strategy using MEDLINE, WEB OF SCIENCE, and GOOGLE SCHOLAR. We included cohort and case-control studies that examined the relationship between thyroid disorders and the Risk of developing prostate cancer. We assessed the Risk of bias using the Newcastle Ottawa Quality Assessment scale. Meta-analysis was conducted in Review Manager 5.4.1 (Revman^®).

Results: We included nine studies in the analysis. The studies included were classified into two groups: those that studied hypothyroidism and those that studied hyperthyroidism. The results showed no association between thyroid abnormalities and prostate cancer risk, with an HR of 1.05 (95% CI: 0.90-1.22). Hyperthyroidism also showed no association with an HR 1.64 (95% CI: 1.00-2.69), characterized by increased serum T4 and decreased TSH. There was also no significant association with hypothyroidism, with an HR of 0.85 (95% CI: 0.67-1.10).

Conclusion: Thyroid disorders were not associated with the Risk of developing prostate cancer.

In the realm of medical procedures for urinary obstructions, a distinct division of roles is evident: the vast majority of percutaneous nephrostomies (PCNs) are the domain of Interventional Radiology (IR), while the placement of double J stents (JJ stents) falls squarely under Urology. This division, however, is not without its complexities. When confronted with a patient suffering from a urinary obstruction, the decision-making process can become intricate. The underlying cause often fuels the debate: should IR intervene with a PCN, or should Urology place a JJ stent? Such decisions have profound implications for the individual patient.In this comprehensive review, we aim to compare the utilization of PCN to that of JJS in a variety of clinical settings and evaluate their indications, relative efficacies, and potential complications to ascertain whether one procedure outperforms the other.

Introduction: The profession of a locomotive engineer involves stress, lack of adequate sleep and rest, and a sedentary lifestyle, all of which can contribute to the development of erectile dysfunction (ErD) as well as arterial hypertension.

Materials and methods: Consecutive patients of the railway hospital in Barnaul with arterial hypertension aged 30-60 who work as machinists or assistant locomotive drivers were enrolled. Those who have symptoms of ErD were randomized into three groups: group 1 received an endogenous nitric oxide-synthase (NOS) activator, group 2 received a combination of endogenous NOS activator and phosphodiesterase type 5 inhibitor (PDE-5i), and group 3 received no additional treatment for ErD. 20 individuals belonged to the control group without ErD. A follow-up was conducted after 2 and 4 months.

Results: A total of 85 individuals were examined (65 with symptoms of ErD). After 2 months of treatment, no significant changes in biomarkers and LDF (laser Doppler flowmetry) values were observed in groups 1 and 3. In group 2, ET-1 (endothelin-1) and hs-CRP (high-sensitivity C-reactive protein) returned to reference levels, and ischemic manifestations decreased. After 4 months, group 1 had increased mean blood flow and hs-CRP returned to reference levels. Group 2 showed improved microhemodynamics and biomarkers values. Group 2 patients had a higher IIEF and ICF total scores.

Conclusion: The combination of hypotensive drugs, PDE-5i, and NOS activator was the most effective method of treatment, improving hemodynamics and reparative properties of the endothelium by removing the substrate for thrombus formation. Treatment with an NO-synthase activator was shown to partially eliminate pathological processes in the endothelium.

Objective: FLRT3 is a member of the fibronectin leucine-rich transmembrane protein family, which regulates cell-cell adhesion and epithelial-mesenchymal transition (EMT). However, the role of FLRT3 in clear cell renal cell carcinoma (ccRCC) remains unknown; therefore, we explored the potential role of FLRT3 in ccRCC.

Methods: We analyzed FLRT3 expression levels in ccRCC tissues across multiple databases. We examined the relationship between FLRT3 expression and EMT through single-cell data and transcriptional regulatory network analyses. Additionally, we investigated the association between FLRT3 expression levels and various clinicopathological indicators, compared the impact of FLRT3 expression on patient prognosis, and constructed a nomogram prognostic model. Furthermore, we performed enrichment analyses on differentially expressed genes to reveal potential biological functions and mechanisms.

Results: FLRT3 expression levels were significantly lower in ccRCC tissues compared to normal kidney tissues and progressively decreased with advancing pathological stages and grades. FLRT3 mediated the promotion of EMT by transcription factor ATF4; survival analysis indicated that patients with high FLRT3 expression had significantly better overall survival compared to those with low FLRT3 expression. Enrichment analysis revealed that FLRT3 was associated with epithelial cell differentiation, retinol metabolic processes, and collagen-containing extracellular matrix.

Conclusion: FLRT3 expression is downregulated in ccRCC and may promote EMT through transcription factor ATF4. Downregulation of FLRT3 is associated with poor prognosis.

Introduction: Kidney cancer (KC) with vena cava thrombus (VCT) is a rare but challenging disease. Surgery is associated with significant morbidity and mortality. The aim of our study is to report outcomes of patients with KC and VCT treated at our institution.

Materials and methods: We retrospectively analyzed data from 15 patients who underwent surgical treatment for KC with VCT at our institution between January 2004 and December 2022.

Results: Median age of patients was 70 years (range: 66-77 years) and 13 (86%) were males. The level of thrombus was infrahepatic in 11 patients (73%), retrohepatic in 1 case (6%), and atrial in 3 patients (20%). Radical nephrectomy with vena cava thrombectomy was performed in all patients. Cardiopulmonary bypass was required in three patients (20%). The median operative time was 4.2 h (range: 4.0-4.6 h) and median estimated blood loss was 675 ml (range: 300-1500 ml). Postoperatively, eight patients (53%) experienced complications, and 5 (62%) were Clavien-Dindo >3. After a median follow-up of 15 months (range: 10-49 months), seven patients (46.5%) were alive without evidence of disease, one was alive with disease, among the remainder 7 (46.5%), 5/7 (72%) patients died of other causes, only 2/7 (28%) died because of cancer.

Conclusions: Surgical resection of KC involving VCT represents a challenge for its high rate of complications. Multidisciplinary approach is often needed to achieve radicality safely. Oncological outcomes confirm the aggressiveness of the disease, with only roughly half (46.5%) of patients alive without disease at a median follow-up of 15 months.