Urology Annals最新文献

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.].

Background: It was estimated that 3%-8% of women presented with bladder obstruction, and 4%-13% of these women had female urethral stricture (FUS), which is an uncommon disorder.

Aims: The study has been conducted to analyze the outcome of Dorsal onlay urethroplasty using buccal mucosal graft (BMG) and vaginal wall graft (VWG) for FUS.

Settings and design: It was a retrospective, single-centric cohort study. The study has been conducted for 2 years and 2 months, i.e., from July 2021 to September 2023.

Subjects and methods: The study included 20 female patients with urethral stricture who had urethroplasty. The participants were further classified into two groups respectively. One of the groups included 10 participants with cases of BMG urethroplasty and another 10 were cases of VWG urethroplasty.

Statistical analysis: The Statistical Package for the Social Sciences (SPSS) version 24 program was used to analyze the data. Both continuous and categorical variables were present in the data. Descriptive Statistics were expressed as mean ± standard deviation or n (%) or n.

Results: The BMG group had a substantially lower postvoid residual (PVR) of 10 ± 4.2 mL than the VWG group, which had a PVR of 15 ± 6.4 mL with a P = 0.04. The operating time was 110 ± 10.8 in the BMG urethroplasty group and 90 ± 8.2 in the VWG group with a P < 0.001. VWG urethroplasty group. No statistically significant differences were observed in terms of AUA symptom score and Q_max.

Conclusion: The study concluded that FUS reconstruction can offer a good, long-lasting response. Moreover, between both the preferred techniques of BMG and VWG urethroplasty, which is safe and effective, patients with postmenopausal atrophy or vaginal pathology may benefit more from BMG.

Purpose: The novel Quanta Litho 150 W (Samarate, Italy) was recently introduced and incorporates new pulsed modulation settings. We sought to analyze ablation rate and efficiency in short pulse (SP), virtual basket (VB), and vapor tunnel (VT) pulsed modulations, in an in vitro pop-dusting simulation across different settings at a fixed power of 30 Watts (W) and fixed periods of time.

Materials and methods: Seven millimeter BegoStone phantoms were subjected to lithotripsy in a simulated calyx using Holmium: yttrium:aluminum garnet Quanta System 150 W. 30 W was applied at different settings across three pulse modulation modes: SP, VB, and VT. Ablation rate and efficiency were and compared between the three groups.

Results: Maximum ablation efficiency for the VB and VT groups was achieved at VB 2J x 15 Hz and VT at 2.5 J x 12 Hz. Ablation efficiency decreased with higher Joules. VB at 1.5 J x 20 Hz and SP at 2.5 J x 12 Hz were the only settings to obtain 85% ablation at 5 min.

Conclusions: In vitro laser lithotripsy using a BegoStone phantom, VB at 2J x15 Hz and VT at 2.5 J x 12 Hz were the most efficient setting for pop-dusting with the Quanta Litho 150. The highest efficiency (mg/min) was achieved with VB at 2 J x 15 Hz and VT at 2.5 J x 12 Hz at 1:15 min.

Introduction: In pediatric patients, the preferred intervention following a failed pyeloplasty is a surgical challenge. Balloon dilatation is a minimally invasive option with low complication rates. However, redo-pyeloplasty provides workable and effective outcomes but is more technically demanding. The study demonstrates our experience with redo-pyeloplasty for previously failed pyeloplasty compared to balloon dilatation.

Methodology: A total of 298 patients underwent pyeloplasty between 2013 and 2022. Out of these 19 patients (6%), aged 11 months to 12 years (median age 7 years) had failed pyeloplasty; 11 patients underwent redo-pyeloplasty (robotic in 63.6%[7] and laparoscopic in 36.4% [4]), and eight patients were treated with balloon dilatation. Ultrasound and renogram were performed to evaluate the patient's outcomes. Success was defined as improving hydronephrosis in 6 weeks, 3 months, 6 months, and 1-year follow-up without an obstructed curve in renogram. The aim is to evaluate and assess the success rate and outcomes of redo-pyeloplasty compared to antegrade/retrograde balloon dilatation in pediatric patients with a previously failed pyeloplasty.

Results: All patients who underwent redo pyeloplasty had successful outcomes (100%). However, of patients who underwent balloon dilatation, only 1 (12.5%) patient had a successful outcome, and seven patients (87%) did not show improvement. Patients' age, gender, and laterality of ureteropelvic junction obstruction were insignificant among both groups.

Conclusion: We demonstrated that balloon dilatation has a meager success rate in managing failed pyeloplasty cases. Redo-pyeloplasty procedures, either robotic or laparoscopic, have the potential to offer superior results.

Purpose: To evaluate the effect of preoperative training in an experimental setting on the preparation and docking of the avatera robotic system.

Materials and methods: Two different surgical groups (consisting of two nurses, one assistant, and one operating surgeon) attended an initial training on robot draping and docking procedures. Group 1 was involved in 10 robotic-assisted operations while Group 2 was trained in the dry lab using an artificial insufflated abdominal model (10 sessions). The decrease in time needed for docking and draping was evaluated. After the completion of the initial training, each group performed docking and draping procedures in five surgeries (including robotic-assisted radical prostatectomy and pyeloplasty) and the recorded times were compared.

Results: In Group 1, the docking and draping time were diminished during the initial training program from 17 to 7 min and from 12 to 5 min, respectively. In Group 2, the docking time was decreased from 9 to 6 min and the draping time from 8 to 5 min. Both types of training (during real-life OR program vs. dry laboratory setting inclusive an insufflated abdominal model) resulted in nearly the same positive training effect for Group 1 and Group 2, respectively.

Conclusions: Conducing a training of patient preparation and docking in the dry laboratory using an insufflated abdominal model facilitates experience acquisition in a safe and calm environment. The training method of Group 2 might help to avoid the potentially longer anesthesia times for patients during the early learning curve of Group 1.

Context: Ureteral stents are crucial in urological surgery, promoting urine passage and preventing obstruction. They have undergone design, material, and covering changes to minimize pain and enhance efficiency. Researchers are exploring the use of magnetic stents, which use magnets attached to the stent's end.

Aims: This research aims to evaluate and analyze the expulsion of magnetic double J (DJ) stents as compared to conventional methods DJ stents, using qualitative and quantitative data from the literature about morbidity, discomfort, cost, duration, safety, and efficiency.

Settings and design: This research is a systematic review and meta-analysis of randomized controlled trials (RCTs).

Subjects and methods: RCTs comparing the removal of magnetic DJ stents to conventional stents were identified through an extensive search Scopus, Web of Science, PubMed, and Cochrane from January 2014 to January 2024. The search methodology and criteria for eligibility were developed using a modified PICO framework, and the risk of bias in the RCTs was evaluated with the RoB-2 tool. The removal duration, ureteral stent symptom questionnaire (USSQ), and pain (measured by visual analog scale) were pooled for meta-analysis.

Statistical analysis used: The Cochrane Collaboration tool called Review Manager 5.4 will be used to collect quantitative data. The main outcome was evaluated using continuous data, with the mean difference (MD) and a 95% confidence interval (CI) applied. A P < 0.05 was deemed statistically significant. Heterogeneity between studies will be evaluated in this meta-analysis using I² (I²; Inconsistency).

Results: There were six RCT studies involving 570 participants that were finally eligible for the quantitative analysis. Magnetic DJ stent was found to significantly shorten the duration of removal (MD -30.51; 95% CI, -51.82--9.21; P = 0.005) and less pain during removal (MD -2.71; 95% CI, -3.74--1.68; P < 0.00001) than conventional DJ stent. USSQ scores for urinary symptoms (MD 1.88; 95% CI, 0.56-3.19; P = 0.005) and sexual matters (MD 1.18; 95% CI, 0.54-1.82; P = 0.0003) were significantly higher for magnetic than for conventional stents.

Conclusions: Magnetic DJ stent removal offers enhanced safety, efficiency, less pain, a shorter time of removal, and lower costs compared to conventional methods. However, it has a higher UUSQ score for urinary symptoms and sexual matters.

Background: Numerous therapeutic strategies have been developed as a result of the rise in the prevalence of renal stones. Extracorporeal shock wave lithotripsy (ESWL) retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are currently available treatments for lower-pole renal stones (LPRSs). This systematic review and meta-main analysis's primary objective were to assess the requisite studies that examined the effectiveness of ESWL, RIRS, and PCNL for treating LPRS.

Materials and methods: This study adhered to PRISMA guidelines' guiding principles. In two stages, the desired studies were extracted. In the initial screening, we identified 850 related articles from the years 2004 to 2022 using the keywords. Unfortunately, 350 studies were disqualified because they failed to meet our inclusion requirements; the remaining studies underwent additional screening. In the second stage, two authors went through the entire text of the articles and found duplicates and missing data. Ten articles were eventually selected for the research's conclusion.

Results: PCNL and RIRS had higher stone-free rates than ESWL and needed fewer treatment sessions out of the total of 10 clinical trials that were considered to be eligible. While ESWL required more ESWL sessions, operative time and complications seemed to benefit ESWL over PCNL. RIRS looked to be the most efficient technique for treating stones in the lower pole that were up to 1 cm in diameter.

Conclusion: To achieve stone-free status over a brief period of time and with the fewest number of sessions, the management of LPRS should probably be PCNL or RIRS, according to the pooled meta-analysis of the eligible trials in our systematic review. RIRS was more effective than ESWL for stones <10 mm in size. The choice between the two methods (PCNL or RIRS) should be made specifically for each patient depending on their anatomical characteristics, comorbidities, and preferences as deemed appropriate by the attending clinician.

Low-intensity shockwave therapy (SWT) is a promising non-invasive treatment for vasculogenic erectile dysfunction (ED). Two primary modalities, focused linear shockwave therapy (fSWT) and radial shockwave therapy (rSWT), differ in energy delivery and tissue penetration. While fSWT is well-studied, rSWT remains less explored for ED despite its growing use. This study compares the effectiveness of fSWT and rSWT in improving erectile function. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Relevant studies published between 2009 and 2024 were identified through searches in PubMed, ScienceDirect, and Cochrane Library. Studies assessing erectile function using the International Index of Erectile Function (IIEF-5), Sexual Health Inventory for Men (SHIM), or Erection Hardness Score (EHS) were included. A random-effects model was applied to analyze standardized mean differences (SMD) and address heterogeneity. Fifteen studies met the inclusion criteria. Meta-analysis revealed that fSWT demonstrated superior efficacy compared to rSWT, with an SMD of 0.45 (95% CI: 0.04-0.86; P < 0.005). High heterogeneity was observed (I² = 80% for rSWT; I² = 99% for fSWT). fSWT and rSWT improved erectile function, but fSWT consistently produces better outcomes across IIEF-5, SHIM, and EHS scores.