World Journal of Urology最新文献

Purpose: To compare the risk of incident dementia in patients prescribed either an anticholinergic medication or mirabegron.

Materials and methods: This was a retrospective cohort study of patients treated for OAB with pharmacotherapy between the years 2012 and 2023, using data from the TrinetX Research Collaborative Network. Patients who were diagnosed with OAB who were prescribed Mirabegron, Oxybutynin, Tolterodine, Darifenacin, Trospium, Fesoterodine, or Solifenacin after 1/1/2012 were identified. Anticholinergic medications were stratified into high-risk (Oxybutynin, Tolterodine, and Solifenacin) and low-risk (Darifenacin, Trospium and Fesoterodine) Patients with OAB who were not prescribed medications were included as a control group. The primary outcome was incidence of dementia occurring after initiation of pharmacotherapy or entry into the study (for the control group). Using Cox proportional hazard analyses, and adjusting for age and sex and adjusting for Elixhauser comorbidity index, anticholinergic burden score, and the average treatment effect, the risk of each medication on incident dementia was determined.

Results: A total of 941,402 met inclusion for the final analysis, with 83,550 prescribed any medication. With an average follow-up time of 4.3 years, the only medication not found to be associated with an increased risk of dementia in any group was fesoterodine, while mirabegron was found to have a significant association with dementia across all age groups for both sexes.

Conclusions: Most anticholinergic medications and mirabegron are associated with an increased risk of dementia compared to untreated controls with OAB, while fesoterodine was not found to be associated with an increased risk in any group.

Objective: To assess the long-term urinary continence of patients operated for isolated female epispadias using novel approach of distal urethral lengthening along with the incorporation of deeper periurethral muscles over the native urethra. Occurrence of UTI and stress incontinence too were assessed as secondary outcomes.

Methodology: All girls diagnosed with isolated female epispadias, who underwent epispadias repair, and completed follow-up period of minimum 2 years, were included in this study. Their long-term continence was assessed using a validated questionnaire. The study group patients underwent distal urethroplasty using hairless skin of mons along with incorporation of deep periurethral tissue. Bladder neck reconstruction was added in initial patients with minor variant (type 2 of Davis classification) and in patient with cleft extending till bladder neck (type 3 of Davis classification). Five of the patients with type 2 defects were managed only with urethroplasty.

Results: At a mean follow up of 7.4years all patients with type 2 epispadias (Davis classification) are continent and void on desire. None of them are having UTI or stress incontinence. Patient with type 3 epispadias is incontinent with dry interval of less than 30 min and awaiting augmentation cystoplasty.

Conclusion: Simple urethral reconstruction with inclusion of hairless skin over mons and deeper peri-urethral soft tissue might be sufficient to restore sphincteric function in minor variants of isolated female epispadias. More extensive procedures may be reserved for the most severe cases.

Purpose: To investigate the effectiveness of DISS feature of novel 7.5Fr and 9.2Fr single-use flexible digital ureteroscopes to relocate and evacuate stone fragments (2-5 mm in diameter) without any accessory instruments.

Methods: An ex-vivo experimental study on porcine kidney and ureter was performed. Natural calcium oxalate dihydrate stone fragments sized 2-5 mm placed in the upper, middle and lower calyces were used. For each stone in each location 5 attempts were performed. The attempt was defined as successful if stone evacuation was reported while withdrawing the scope through the 12/14Fr UAS. The time collapsing the collecting system was also reported.

Results: The time needed to collapse the porcine pelvi-calyceal system (PCS) was 4-5 s for 9.2Fr and 5-6 s for 7.5Fr scope. Evacuation of 2 mm stone fragments occurred in all trials both with 9.2Fr and 7.5Fr scopes. In case of 3 mm stone, evacuation of stone fragments was observed in 3 out of 5 and 1 out of 5 attempts in upper calyx, 5 out of 5 and 3 out of 5 in the middle calyx and 2 out of 5 and 0 out 5 in lower calyx using 7.5Fr and 9.2Fr scope, respectively.

Conclusion: The DISS feature of the novel 7.5Fr and 9.2Fr single-use digital flexible ureteroscope can be potentially used not only to aspirate dust but also to relocate and evacuate larger stone fragments up to 4 mm in diameter using only suction. The speed of collapse of the PCS seems to be one of the main predictors of success.

Introduction: Botulinum toxin A detrusor injection (BoNT/A-DI) is used in patients with overactive bladder (OAB) or neurogenic bladder due to multiple sclerosis (MS) or after spinal cord injury. The procedure is generally performed under local anaesthesia. We examined the influence of BoNT/A-DI on blood pressure, the most important autonomic parameter in awake patients, as a potential risk factor for cardiovascular events.

Material & methods: Patients with OAB or spontaneous voiding with neurogenic detrusor overactivity (NDO) due to MS in whom BoNT/A-DI was planned under local anaesthesia, vital parameters (systolic, diastolic, and mean blood pressure; heart rate; and rate pressure product [RPP]) were recorded before, during, and after the procedure. Participants with and without previously known hypertension were compared, along with those with initial versus repeat injections, with a focus on the high-risk group, which comprised the 20% of patients with the highest baseline blood pressure values.

Results: Seventy patients were included (mean age: 64.0, median age: 66, range: 27-86 years), and two were excluded because their initial blood pressure values were too high. Sixty patients had OAB, and eight had NDO due to MS; twenty-two patients had a history of hypertension. A total of 40 patients received the first injection, and 28 received a repeat injection. Systolic blood pressure increased significantly by an average of 9.8 mmHg. However, in the hypertensive patients, systolic blood pressure rose by an average of 19.4 mmHg; isolated peak systolic values rose by up to 232 mmHg, and peak diastolic values rose by up to 128 mmHg. Cardiac stress (measured by rate pressure product [RPP]) in these patients increased significantly (RPP = 17.6 versus 7.2 in the non-hypertensive group). In the 20% of patients with the highest resting blood pressure values, systolic blood pressure rose to an average of 187.4 mmHg (15.1 mmHg compared with resting blood pressure), and cardiac workload increased by 17. No significant differences were observed between patients who received initial and repeat injections.

Conclusions: Clinicians who administer BoNT/A-DI should monitor blood pressure during the procedure and be aware of the risk of potentially significantly elevated blood pressure values during BoNT/A DI, especially in patients with a medical history of hypertension. Significantly elevated pre-interventional blood pressure values should receive an internal medicine consultation timely before the intervention to prevent cardiovascular risks.

Background: There are limited studies describing the contractile function of the endopelvic fascia in the male pelvis and the role of the endopelvic fascia in the pathophysiology of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We performed ex-vivo functional studies and described the histology of the endopelvic fascia.

Methods: Endopelvic fascia specimens were collected from patients (n = 10) undergoing robotic prostatectomy. Two fascia strips (2 × 1 cm) from each side of the pelvis were excised and immediately used for functional studies. Each strip was cut into one centimeter piece for studying. One strip was suspended in organ baths and contractile response to potassium chloride (100 mM), and carbachol (0.01 µM, 1 µM, 10 µM, 20 µM) assessed. The second strip was used for histology with hematoxylin and eosin (H&E) and Masson-trichrome staining for elastic fibers, collagen and smooth muscle or stress strain testing.

Results: Twenty endopelvic fascia samples from 10 patients were analyzed. Only two specimens showed a contractile response to potassium chloride. The remaining 18 specimens exhibited no contractile response. Histologically, the fascia consisted mainly of fibrous connective tissue with minor adipose tissue and occasional smooth muscle, along with arterioles. Tensile testing revealed nonlinear behavior, with a nominal stiffness estimated at 0.765 MPa after the toe region.

Conclusions: The male endopelvic fascia lacks contractile response to potassium chloride and cholinergic stimulation, resembling other human fasciae histologically. It's improbable that it contributes to male LUTS but may impede prostate expansion mechanically due to its fibrous nature.

Purpose: Upper tract urothelial carcinoma (UTUC) presents distinct clinicopathological, molecular features, and biological behaviors compared to urothelial bladder carcinoma (UBC). Currently, no prognostic model exists for metastatic UTUC (mUTUC). This study aimed to develop a prognostic model for patients with mUTUC receiving first-line systemic therapy.

Patients and methods: A total of 476 patients with mUTUC who received first-line systemic therapy were included and retrospectively analyzed. Patients were randomly assigned to development and validation cohorts in a 3:1 ratio, with potential prognostic factors recorded prospectively. Univariate analyses identified clinical and laboratory factors significantly associated with median overall survival (mOS) in the development cohort, followed by multivariate analyses to determine independent prognostic factors. These factors were utilized to develop a prognostic model. Internal validation was conducted using the validation cohort.

Results: The number of metastatic organs, Eastern Cooperative Oncology Group Performance Status (ECOG PS), time to distant metastasis (TTDM), white blood cell (WBC) count and alkaline phosphatase (ALP) were identified as independent prognostic factors for mUTUC. Patients were stratified into three risk categories: favorable (0 risk factors, mOS 65.0 months, 95% confidence interval [CI] 35.5-94.6]), intermediate (1 risk factor, mOS 32.0 months, 95% CI 25.8-38.2), and poor (2 + risk factors, mOS 16.0 months, 95% CI 12.1-19.9) (P < 0.001). The model's concordance statistic (c-statistic) was 0.71.

Conclusion: We developed and validated a prognostic model to estimate survival of patients with mUTUC receiving first-line systemic therapy. This model is applicable to real-world clinical practice and may inform the design of future clinical trials.

Purpose: This study aims to compare the safety and efficacy of robot-assisted partial nephrectomy (RAPN) and robot-assisted radical prostatectomy (RARP) using the Chinese surgical systems KangDuo-SR-2000 (KD-SR-2000) and EDGE MP1000 (MP1000) versus the Da Vinci Xi (DV-Xi) system, to explore viable alternative options to DV-Xi.

Methods: This prospective, single-center, non-randomized clinical trial enrolled 261 patients who underwent RAPN or RARP from August 2023 to June 2024. All surgeries were performed by 3 surgeons. For RAPN, the primary outcome included surgical success, positive surgical margin (PSM), warm ischemia time (WIT) and conversion to open or laparoscopic surgery. The secondary outcome was estimated glomerular filtration rate (eGFR). For RARP, the primary outcome was surgical success without conversion to open or laparoscopic surgery, and the secondary outcomes included PSM and urinary continence recovery at 4 weeks post-catheter removal.

Results: Baseline demographics were comparable across the KD-SR-2000 group (n = 88), EDGE MP1000 group (n = 59) and DV-Xi group (n = 114). No significant differences observed in primary and secondary outcomes. However, operation time and suture time per stitch were longer in Chinese surgical systems for both RAPN and RARP compared to DV-Xi, and estimated blood loss (EBL) is higher in RAPN. Subgroup analyses indicated that performance differences were primarily attributed to the KD-SR-2000, with no significant differences observed between the MP1000 and DV-Xi. No severe complications (Clavien-Dindo grade ≥ 3) reported in any group.

Conclusions: Chinese surgical systems provide a viable alternative, demonstrating non-inferiority compared to DV-Xi.

Trial registration number: ChiCTR2300074914; Registration Date: 2023-08-21.

Background: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition affecting 2-10% of men globally. Its symptoms, including pelvic pain, urinary problems, and reduced quality of life, vary widely. Despite extensive research, a definitive treatment remains elusive. Alpha-adrenergic antagonists are frequently used to manage urinary symptoms, while analgesics are employed for pain. However, the long-term efficacy of alpha-adrenergic antagonists for pelvic pain requires further investigation. CP/CPPS places a significant burden on healthcare systems and the economy. This systematic review aims to evaluate the effectiveness of alpha-adrenergic antagonists in reducing pain symptoms in men with CP/CPPS compared to placebo.

Methods: A systematic search of randomized, placebo-controlled trials evaluating the effectiveness of alpha-adrenergic antagonists for the treatment of pain in CP/CPPS was conducted and captured all available studies (n = 680). After application of exclusion criteria, five studies were identified as suitable for inclusion.

Results: Four papers consisting of five studies, containing a total of 578 participants, were evaluated. The combined effects found no difference in pain relief between treated and control subjects for the data from the five studies in the meta-analysis (P = 0.106), with the 95% CI for the random effects model containing a value of 0.00.

Conclusion: In adults with CP/CPPS, alpha-adrenergic antagonists were ineffective as monotherapy to treat pain. Further studies are needed to address possible confounding variables for alpha-adrenergic antagonist efficacy. These findings suggest that alpha-adrenergic antagonists as monotherapy are not effective for pain reduction in CP/CPPS and highlight the need for further research to explore combination therapies or other treatment modalities.

Purpose: Kidney stones have a recurrence risk of 30-50% within five years, with surgical recurrence often being the most clinically significant and burdensome. Stone composition results obtained after surgery are readily available and typically precede metabolic evaluation. However, only few, relatively small studies, correlated stone composition with surgical reccurence. This study aims to determine whether stone composition alone can reliably predict recurrent stone surgery, offering insights into personalized management strategies.

Methods: A retrospective analysis of surgically treated patients with an available stone composition analysis performed between 2013 and 2020 in a large healthcare provider database. Data were analyzed for up to 5 years from the initial surgery.

Results: 8,561 patients underwent surgical procedures for stones and 2,097 (24.5%) had repeat surgery within 5 years. Compared to calcium oxalate stone formers, individuals forming uric acid, calcium phosphate, infection, brushite, and cystine stones were 1.5, 1.5, 1.87, 2.64, and 2.71 times more likely, respectively, to undergo a second stone surgery (p < 0.001). The median time for repeat stone surgery in cystine and infection stone formers was significantly shorter compared to calcium oxalate (p < 0.01).

Conclusions: Stone composition significantly affects the 5-year surgical recurrence rates and the median time to recurrence, with non-calcium oxalate stone formers at a higher risk for recurrence. Sharing this information with patients may improve compliance with preventive strategies, including comprehensive metabolic evaluation and adherence to preventive therapy. Emphasizing this risk may help prioritize proactive management in high-risk patients.