Urology Annals最新文献

Purpose: We evaluated the clinical outcome of high-risk prostate cancer patients receiving radical prostatectomy (RP) or radiotherapy (RT).

Materials and methods: Patients were classified as high-risk prostate cancer and received definitive treatment between 2013 and 2023. Patients with previous pelvic RT and incomplete medical record were excluded. The primary outcomes were progression-free survival (PFS) and distant metastasis-free survival (MFS). The secondary outcomes were factors for progression and metastasis.

Results: Of 244 patients analyzed (89 RP and 155 RT); the estimated 10-year PFS was 49.9% in the RP and 75.5% in the RT (P = 0.013). No significant difference was seen in the distant MFS (P = 0.177) and overall survival (P = 0.052). Univariate and multivariate were analyzed; the factor for progress or metastasis was initial prostate-specific antigen.

Conclusion: Our data demonstrated that RT offers superiority over RP in PFS, whereas distant metastasis was similar.

Introduction: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk nonmuscle-invasive bladder cancer. The impact of minimally invasive surgeries (MIS) such as laparoscopic and robot-assisted RC (RARC) on outcomes and morbidity remains debated, especially in India. This study compares perioperative outcomes and complications of open RC (ORC), laparoscopic RC (LRC), and RARC.

Materials and methods: This prospective cohort study included 186 patients who underwent ORC, LRC, or RARC at our institution between October 2013 and April 2024. Preoperative parameters such as age, body mass index (BMI), comorbidities, and chemotherapy status were recorded. Postoperative parameters including operative time, blood loss, return of bowel function, complications, and survival rates were analyzed. Pathological parameters such as stages, lymph node yield, and positive surgical margins were assessed.

Results: The study included 120 ORC, 56 RARC, and 10 LRC patients. The median age was highest in the laparoscopic group (67.4 ± 6.33 years) with a higher BMI (26.22 ± 5.24). Operative time was longest for RARC (414 ± 115.7 min) versus 357.96 ± 60.08 for ORC (P ≤ 0.0001), but blood loss was lowest (413.39 ± 165.55 ml) versus 518.33 ± 171.49 for ORC (P = 0.0001). Return of bowel function was fastest in the RARC group (4.27 + 2.79 days). Complications were highest in the ORC group (70.83%) compared to RARC (51.78%) (P = 0.03). Mean lymph node yield was highest in RARC (24.35 ± 3.06) versus Lap RC (22 ± 2.87) and ORC (19.47 ± 3.56) (P ≤ 0.0001). Overall survival rate was 78.57% for RARC compared to 74.16% for ORC.

Conclusions: Our findings suggest that while RARC provides advantages in blood loss, complication rates, and mean lymph node yield, its longer operative time necessitates further optimization. The study highlights the importance of considering patient-specific factors and regional contexts in surgical approach decisions, with RARC showing promising results.

Objectives: The objective of the study was to analyze the efficacy and safety of superpulsed thulium fiber laser (TFL) lithotripsy and to identify the ideal laser settings.

Methodology: Patients with ureteric stones were included prospectively. We performed Lithotripsy by superpulsed TFL 400 micron laser fiber, UROLASE SP+ (60W), IPG IRE POLUS Russia. Semirigid ureteroscope 6/7.5 Ch (Scholly, Denzlingen, Germany) was used. Demographic data and stone parameters such as stone size, volume, density, position, and laterality were recorded. The efficacy of lithotripsy was analyzed by measuring total energy, laser time, ablation efficacy, ablation speed, and energy consumption. Stone retropulsion and visibility were assessed using a three-point Likert scale. Complications were assessed using the Clavien-Dindo classification system.

Results: Ninety-one patients underwent URSL for ureteric calculi. The mean stone size was 9.5 mm. The mean stone volume was 268.3 mm³. The mean stone density was 839.5HU. The stone-free rate at 3 months was 92.3% (84/91). The complication rate was 12% (11 patients).

Conclusion: The SuperPulsed thulium-fiber laser provides safe and effective lithotripsy in Ureteric calculi. Ideal laser settings for ureteric stone are 0.9J × 10 Hz for fragmentation and 0.2J × 20 Hz for dusting.

Percutaneous nephrolithotomy (PCNL) is the gold standard for large and complex renal stone despite other available modalities. PCNL techniques have been evolved with many modifications and innovation in the recent decade. It can be safely performed in elderly patient and children with highest stone-free rate (SFR) among all other modalities. However, as PCNL is a blind procedure, chance of bleeding is very high than other surgical modalities. If patient already had, hematological problem, then perioperative risk of bleeding increased significantly. We are presenting few cases of PCNL in thrombocytosis child and young adult. This is a retrospective analysis of four renal stone patients from 2017 to 2024. Surgical outcomes such as SFR and complications were analyzed and discussed. There were no major perioperative bleeding problems in our study. Mild-to-moderate thrombocytosis does not pose extra risk to bleeding. However, hematology opinion and informed decision are needed for risk stratification before performing PCNL.

Antenatal hydronephrosis (ANH) is detected in up to 5% of pregnancies and is most commonly caused by pelviureteric junction obstruction (PUJO). While many cases resolve spontaneously, subset of patients require surgical intervention. Differentiating between these groups remains a clinical challenge, often leading to unnecessary investigations or delayed treatment. Numerous scoring systems and predictive tools have been developed to support risk stratification, yet none have achieved universal adoption. A comprehensive literature search of MEDLINE and Google Scholar was performed to identify scoring systems, predictive models, and tools designed to predict the need for surgical intervention in patients with ANH or confirmed PUJO. Search terms included variations of "PUJO," "prognosis," "predictor," and "surgery." Included studies described original tools or external validation of models using radiological parameters to stratify risk. Each tool was appraised for input parameters, derivation methodology, outcome definitions, external validation, and clinical applicability. Nine predictive tools were identified, all based on imaging data, with one incorporating machine learning (ML). Eight of nine tools aimed to predict the need for pyeloplasty. Four tools have undergone some form of external validation. Most tools used numerical scores, one applied a visual grading system, and another used a nonpercentage-based ML approach. While several demonstrated high predictive accuracy, limitations included retrospective design, small sample sizes, subjective imaging interpretation, and lack of consistent surgical outcome definitions. Despite growing interest and several promising models, no tool has yet been externally validated in large, diverse prospective cohorts. Further research is needed to develop clinically robust, generalizable tools for early risk stratification in ANH.

Introduction: Urology is a part of healthcare known as surgical specialty that deals with different diseases of male and female urinary system and male reproductive organs.

Aim: The study aimed to evaluate the urological education in Saudi Arabia medical schools and assess medical students' knowledge and preference.

Methodology: A cross-sectional study in Saudi Arabia targeted clinical years' medical students from all regions, using a validated questionnaire to collect demographic, academic, and urology specialty knowledge, attitudes, and reasons for not choosing a specialty. The questionnaire was distributed through social media until no more answers were obtained.

Results: A study of 216 students in Saudi Arabia found that 58.8% were male, with 107 in their 5^th year, 78 in their 6^th year, and 31 in medical interns. The majority were in public universities, with 59.7% believing urology rotation should be the part of the medical school curriculum. The most preferred specialties were family medicine (18.1%), anesthesia (7.9%), and urology (7.4%).

Conclusion and recommendations: The study revealed that medical students lack knowledge and interest in the urology specialty, leading to low career preference. The frequency of rotations is insufficient, and more exposure is needed. Most students believe urology rotation should be the part of medical school curriculum.

Aims: The plaque excision and grating technique is indicated for correcting penile curvature in Peyronie's disease. We assessed our experience of the modified split graft technique using bovine pericardium after plaque excision.

Materials and methods: Between March 2020 and September 2024, we operated on 12 patients by the excision of plaque and split grafting technique. Here, we discuss our experience customizing a bovine pericardium graft on a table according to the size of the defect and joining pieces of graft and tunica albuginea with a Polydioxanone (PDS) suture to cover the cavernosal defect.

Results: Patients' mean age and follow-up were 48 years and 30 months, respectively. The average size of the plaque and penile curvature was 4.6 cm (range 1.5-8 cm) and 45°, respectively. No residual penile curvature was observed in 83.5% of patients while (16.5%) had curvature of <20°. All patients experienced an improvement in stretched penile length with an average increase of 1.6 cm. Seventy-five percent of patients were able to perform sexual activity without assistance after 3 months. One patient, who had a sizeable cavernosal defect of 8 cm × 2 cm, experienced severe postoperative erectile dysfunction (ED) along with residual penile curvature of 15° and required semi-rigid penile prosthesis. Two patients having mild ED was managed by Tadalafil 10 mg. Another patient with residual chordee of <20° was managed on conservative therapy.

Conclusions: In our limited experience, this modified split graft technique using bovine pericardium after plaque excision seems feasible, cost-effective, and safe. It has comparable outcomes to the standard methods reported in the literature and reduces graft material wastage. Further, long-term randomized trials are needed to validate its long-term efficacy and safety compared to conventional grafting approaches.

Background: Prostate cancer is among the most commonly diagnosed cancers in males worldwide. While Prostate-specific antigen (PSA) remains the front-line screening marker, it lacks sufficient diagnostic accuracy.

Aims and objectives: So, in the quest for improved biomarkers, the expression profiles of circulating miRNAs have become increasingly significant. Hence, this study was undertaken to identify the miRNA profile unique to prostate cancer.

Materials and methods: Using NanoString Human MicroRNA Arrays, we analyzed serum samples from three groups: patients with localized prostate cancer, metastatic prostate cancer, and benign prostatic hyperplasia.

Results: Our analysis revealed distinct circulating miRNA expression patterns in prostate cancer patients compared to those with benign conditions. Specifically, miR-1272 and miR-1247-5p were significantly up-regulated (log2FC > 1, p < 0.05), whereas miR-337-3p, miR-191-5p, and let-7a-5p were significantly down-regulated (log2FC < -1, p < 0.05) in prostate cancer versus BPH. Additionally, when comparing localized and metastatic prostate cancer, hsa-miR-302d-3p and hsa-miR-1246 were notably up-regulated (log2FC > 3, P < 0.05). These specific miRNAs show potential for facilitating early diagnosis, enhancing risk stratification, and serving as non-invasive biomarkers for monitoring disease progression, thereby helping to reduce the need for unnecessary biopsies.

Conclusions: Our findings suggest that circulating miRNAs could serve as minimally invasive biomarkers in prostatic cancer with a higher specificity and sensitivity, making them more effective at distinguishing between cancerous and benign conditions. However, despite their promise, miRNA testing remains costly, technically complex, and not yet standardized for routine clinical use. Therefore, further validation in larger, independent cohorts is essential to confirm the diagnostic and prognostic utility of the miRNAs identified in this study.

Objectives: To evaluate a novel, simplified technique for TRUE supine percutaneous nephrolithotomy (PCNL) that omits the use of bolsters or stirrups, utilizing a novel anatomical landmark ("Dixit line") for initial puncture. The outcomes of this technique are compared with those of the traditional supine PCNL approach.

Materials and methods: A retrospective observational study was conducted on 400 patients who underwent supine PCNL for renal or upper ureteric stones between January 2020 and January 2024. All procedures were performed by a single urologist at a tertiary care center. Patients were divided into two groups: One treated with the novel technique and the other with the traditional technique. Data on demographics, stone characteristics, intraoperative variables, and postoperative outcomes were collected and analyzed.

Results: The novel technique group demonstrated significantly shorter operative times (53 ± 10 min vs. 70 ± 15 min, P < 0.01), demonstrating enhanced procedural efficiency. Demographic and stone characteristics, as well as most intraoperative and postoperative outcomes, showed no significant differences between the two groups. However, the novel technique group exhibited a trend toward quicker discharge times (1.8 ± 0.5 days vs. 2.1 ± 0.7 days, P = 0.05).

Conclusions: The novel TRUE supine PCNL technique, which excludes bolsters or stirrups and uses the "Dixit line" for initial puncture may serve as an effective alternative to traditional methods, improving efficiency while maintaining safety.

[This corrects the article on p. 92 in vol. 17, PMID: 40352087.].