World Journal of Urology最新文献

Purpose: Endoscopic enucleation of the prostate (EEP) is a preferred treatment for benign prostatic hyperplasia (BPH). This bibliometric analysis aims to analyze the application trends and research hotspots of EEP.

Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science Core Collection from 1989 to 2023. The techniques examined include holmium laser enucleation (HoLEP), thulium laser enucleation (ThuLEP/ThuFLEP), bipolar/monopolar transurethral enucleation (b-TUEP/m-TUEP), GreenLight laser enucleation (GreenLEP), and diode laser enucleation (DiLEP). We utilized VOSviewer, CiteSpace, and the R package 'bibliometrix' for the analysis.

Results: A total of 739 English-language studies were analyzed, revealing a steady increase in EEP-related publications. HoLEP was the most extensively studied technique, followed by ThuLEP and b-TUEP, while ThuFLEP gaining emerging interest. There has been a notable lack of high-quality randomized controlled trials (RCTs) for GreenLEP, DiLEP and m-TUEP. China, the United States, and Germany led in publication volume and collaboration networks. Key contributors in the field were identified, with recent research focusing on topics like postoperative transient urinary incontinence (TUI) and the role of robot-assisted simple prostatectomy (RASP) in comparison to EEP.

Conclusions: EEP is gaining widespread clinical acceptance for BPH treatment. Future research should focus on addressing the gap in high-quality RCTs, especially for underexplored techniques like GreenLEP, DiLEP and m-TUEP, and explore strategies to reduce postoperative TUI. Prospective comparisons between RASP and EEP will be crucial for optimizing surgical approaches in BPH management.

Aim: This study aims to evaluate the success rate of Shock Wave Lithotripsy (SWL) in treating kidney stones using the Modulith SLK Inline lithotripter, with a focus on the importance of device efficacy as emphasized in EAU guidelines.

Patients and methods: This retrospective single-center study was conducted between June 2023 and June 2024. Inclusion criteria were adult patients (> 18 years) with radiologically confirmed renal stones smaller than 15 mm in diameter. Exclusion criteria included patients with solitary kidneys, significant renal functional deterioration, skeletal deformities, active urinary tract infections, pregnancy, or coagulopathies. Treatment outcomes were collected and analyzed in detail, considering patients' demographic characteristics (age, gender) and stone parameters (size, location, and hardness [Hounsfield Unit, HU]). The SWL procedures were performed using the Modulith SLK Inline lithotripter (Storz Medical, Switzerland). The success of SWL was defined as achieving complete stone clearance or the presence of clinically insignificant residual fragments (CIRF) (< 4 mm). This study seeks to provide detailed insights into the optimal use cases of SWL as a non-invasive yet effective treatment option for smaller, more manageable stones.

Results: The mean age of the 208 patients included in the study was 42.2 ± 12.7 years (18-75), with a male-to-female ratio of 1.9:1. The mean stone size across all patients was 10.3 mm, and the average HU value was 874.0 ± 283.2. Patients who achieved a completely stone-free status had significantly lower HU values (p = 0.049). The overall success rate of SWL was 78.8%, with 164 patients achieving complete stone clearance. When cases with clinically insignificant residual fragments (CIRF, < 4 mm) were included as successful outcomes, the overall success rate increased to 92.3%. This distinction highlights the inclusion of patients with small residual fragments that are deemed clinically irrelevant in the adjusted success rate. In cases with successful outcomes, the mean stone size was 10.3 mm, whereas it was 12.5 mm in patients with residual fragments or treatment failure. A statistically significant relationship was identified between stone size and treatment success rates (p < 0.001). In contrast, stone localization did not have a significant impact on SWL success rates (p = 0.377).

Conclusions: SWL has demonstrated its effectiveness in kidney stone treatment with a 78.8% complete stone-free rate using the Modulith SLK Inline lithotripter. Higher success rates were achieved with smaller stones (< 15 mm) and lower HU values. These findings support the significance of advanced lithotripter technology in establishing SWL as a valuable non-invasive option for stones under 15 mm.

Objectives: To evaluate the occurrence, risk factors, and outcomes of post PCNL (Percutaneous Nephrolithotomy) Acute Kidney Injury (AKI), with a secondary goal of developing a nomogram for post-PCNL AKI prediction.

Methods: A prospective observational study was conducted enrolling 333 patients who underwent PCNL between February 2022 and February 2023. Patient demographics, comorbidities, perioperative lab parameters, stone characteristics, intraoperative details, and postoperative AKI were assessed. Logistic regression analyses were employed to construct a nomogram for predicting post-PCNL AKI.

Results: 40 patients (12.4%) experienced postoperative AKI, with recovery observed in all cases during the 3-month follow-up. Female gender (p = 0.002), hypertension(p = 0.022), higher serum uric acid levels(p = 0.003), staghorn calculi(p = 0.001), higher Hounsfield Units(p = 0.013), bilateral PCNL(p < 0.001), larger tract size(p = 0.017), longer operative time(p < 0.001), greater stone volume(p = 0.025), higher baseline serum creatinine levels(p < 0.001), higher postoperative total leukocyte count(p = 0.005), and postoperative fever(p < 0.001) were significantly associated with the AKI group. Regression analysis identified female gender (OR = 0.26, p = 0.035), higher serum uric acid levels(OR = 1.62, p = 0.013), bilateral PCNL(OR = 12.55, p < 0.001), longer operation time(OR = 1.02, p = 0.047), and larger stone volume(OR = 1.12, p = 0.015) as independent risk factors for postoperative AKI. The internally validated nomogram(n = 70) for predicting AKI demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.984(95% CI, p < 0.001).

Conclusion: AKI occurs in approximately 12% of patients undergoing PCNL. We identified several significant predictors of post-PCNL AKI, including female gender, hypertension, hyperuricemia, higher Hounsfield units, larger stone volume, bilateral PCNL, larger access tract size, and longer operative time. Awareness of these factors is crucial for optimizing management and improving patient outcomes.

Purpose: The purpose of this study is to determine the utility of the CANLPH score as a predictive biomarker for patients with advanced and metastatic renal cell carcinoma (a/mRCC). By validating its prognostic value, this study aims to contribute to more personalized treatment strategies for a/mRCC.

Methods: In a multicenter retrospective study by the JK-FOOT consortium, we analyzed data from 309 a/mRCC patients undergoing ICI-based therapy. The CANLPH score-a composite marker of C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to hemoglobin ratio (PHR)-for its prognostic accuracy in predicting cancer-specific survival (CSS). Advanced statistical methods, including receiver operating characteristic (ROC) curve analysis, Cox proportional-hazard regression, and Harrell's concordance index (C-index), were employed to assess its predictive capacity against established factors.

Results: The median follow-up period was 17 months, revealing two-year and five-year overall survival rates of 76.8% and 62.4%, respectively, with CSS rates at 78.3% and 66.2%. The CANLPH score well stratified survival outcomes of ICI-based treatment for RCC patients (HR 5.71; P < 0.0001). C-index analysis demonstrated that the CANLPH score had the highest predictive potency for CSS among models, including IMDC score. Multivariate analysis confirmed the CANLPH score (HR, 5.59; P = 0.0007) and Karnofsky performance status (HR, 2.59; P = 0.0032) as independent prognostic factors for CSS.

Conclusions: The CANLPH score emerges as a critical tool in the a/mRCC therapeutic landscape, enabling precise prediction of patient outcomes with ICI-based therapies. Limitations include the retrospective design and the single national cohort. Prospective validation studies are warranted.

Objectives: To compare the histological features, biomechanical properties, water permeability, and osmotic stress responses of human buccal mucosa and penile skin flaps to evaluate their suitability as urethral graft substitutes.

Methods: Buccal mucosa (n = 53) and penile skin flap (n = 59) were prepared for histological assessment of tissue structural characteristics and vascular patterns using H&E staining and immunofluorescence. Biomechanical properties were evaluated through mechanical testing, water permeability through deuterium oxide diffusion assays, and osmotic stress responses under hypo-, iso-, and hypertonic conditions.

Results: H&E staining revealed that the buccal mucosa epithelium was significantly thicker (628.8 ± 213.3 μm) than that of the penile skin flap (148.2 ± 62.1 μm; p < 0.05). Mechanical testing demonstrated that the buccal mucosa had significantly higher elastic modulus and tensile strength and lower tensile strain compared with penile skin flap (p < 0.05). Water permeability testing revealed that the cumulative diffusion of deuterium oxide (D₂O) through the buccal mucosa was consistently higher at all time points compared to the penile skin flap (p < 0.05). In the Hypo group, the ratio of variation in epithelial thickness was significantly higher in the penile skin flap compared to the buccal mucosa. No statistical differences in the ratio of epithelial thickness variation were observed under Iso (p = 0.43) and Hyper (p = 0.07) conditions. The primary limitation of this study is the relatively small sample size. Additionally, the in vitro model lacks the ability to fully replicate the urethral microenvironment, where multiple interacting factors influence graft survival.

Conclusion: This study presents the first comprehensive comparison of the tissue properties of buccal mucosa and penile skin flaps. Our findings provide valuable insights for surgical decision-making, postoperative management, personalized treatment strategies, and the advancement of bioengineered urethral substitutes.

Background: Few prospective studies in literature with long postoperative follow-up compared between cavernous tissue sparing and conventional penile prosthesis implantation techniques.

Aim: To compare between cavernous tissue sparing and conventional penile prosthesis implantation techniques in terms of patient and partner satisfaction and perioperative outcomes.

Methods: In All, 60 Patients with severe erectile dysfunction were randomized into 2 equal groups; patients undergoing conventional malleable penile prosthesis implantation, and patients undergoing the cavernous tissue-sparing technique. Postoperatively, prosthesis function and patient satisfaction were assessed at 6 weeks after surgery and then 3-6 and 12 months using EDITS and QoLSPP questionnaires. Patients were asked about residual penile tumescence. Perioperative data were recorded.

Results: Modified EDITS questionnaire after 3,6, and 12 months was 76.9 ± 18, 79 ± 17 and 82.3 ± 16 respectively. As QOLSPP questionnaire, 46 (73.8%) subjects were highly satisfied, 25 patients (83.3%) in cavernous tissue sparing and 21 patients (70.00%) in Conventional group. While 14 (26.2%) were less satisfied, 5 patients (16.7%) Cavernous tissue sparing and 9 patients (30.00%) in Conventional group. In the cavernous tissue-sparing group, 26 of 30 patients (86.6%) reported having a significantly higher incidence of residual penile tumescence versus 2 of 30 patients (6.6%) in the conventional surgery group (P < .001). The age of highly satisfied subjects was significantly lower than those less satisfied (p = 0.025), while the BMI of highly satisfied subjects was significantly lower than those less satisfied (p = 0.001).

Conclusion: There is a significantly higher incidence of residual penile tumescence in Cavernous tissue sparing group. Many factors affect male satisfaction rates after PPI as age, and BMI.

Objective: To perform a network meta-analysis comparing the impact of different positive surgical margin locations (Comparisons and intervention) on biochemical recurrence (Outcome) in patients undergoing radical prostatectomy (Population).

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a protocol was registered (PROSPERO: CRD42022119025) and a search across four databases was conducted (the MEDLINE, Scopus, Embase and Cochrane). The primary outcome was biochemical recurrence (BCR). A network meta-analysis was conducted. Further subgroup analysis was performed to evaluate studies exploring robot-assisted radical prostatectomy (RALP).

Results: Our search yielded 1249 unique results; 22 studies were analysed. Anterior margins had the highest risk of BCR (HR 2.46, 95%CI 1.67-3.61, I² = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I² = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I² = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I² = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I² = 60%). Given significant heterogeneity, subgroup analysis was performed. In the RALP subgroup, anterior margins also demonstrated the highest recurrence risk (HR 3.74, 95%CI 2.47-5.66, I² = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I² = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I² = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).

Conclusions: The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.

Background: Proton pump inhibitors (PPIs) are widely prescribed drugs that have been associated with increased prostate cancer (PCa) cell proliferation in vitro and worse oncological outcomes in vivo. However, data on their influence on PSA levels in the general population are lacking.

Methods: We extracted individual participant data from the 2001-2010 cycles of the National Health and Nutrition Examination Survey (NHANES), in which PSA levels were measured in all male participants aged 40 years or older. The association of PPI use with total PSA levels and free/total PSA ratio was evaluated through multivariable linear regression analyses, adjusted for potential confounders.

Results: A total of 7366 subjects were included (median age: 53 years; median serum PSA: 0.9 ng/mL), of whom 746 were receiving PPI treatment at the time of the study. After adjustment for potential confounders, ongoing PPI use was associated with lower total PSA levels (-0.24 ng/mL, 95%CI: [-0.37,-0.11], p < 0.001), while no significant association with free/total PSA ratio was found (p = 0.881). A significant effect modification was observed according to age, with the association being limited to older participants (≥ 60 years) at stratified analyses.

Conclusions: Contrary to the available data in the context of PCa, we found no evidence of increased PSA levels in PPI users with no prostate malignancy. Instead, PPI use was associated with a decrease of total PSA in older adults. This adds knowledge on how PPIs may influence PSA in population-based screening programs.

Purpose: We aimed to evaluate the ability of the advanced lung cancer inflammation index (ALI) to predict the prognosis of patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We also aimed to compare the ALI with other inflammatory or nutritional indices as prognostic indicators.

Methods: We retrospectively evaluated patients who underwent RNU for UTUC at multiple centers between January 2010 and April 2024. We calculated the ALI before RNU and divided the patients into the low ALI and high ALI groups. We used 1:1 propensity score matching (PSM) to adjust the clinicopathological differences between two groups. We compared the overall survival (OS) and recurrence-free survival (RFS) of the low and high ALI groups using the Kaplan-Meier method. Furthermore, we assessed the ALI as a predictor of OS and RFS using a multivariate Cox proportional hazards regression analysis.

Results: Of 488 patients (48.3% low ALI group), 160 patients from each group were matched. The Kaplan-Meier analysis revealed that the OS (p = 0.009) and RFS (p = 0.006) of the low ALI group were significantly shorter than those of the high ALI group. According to a multivariate analysis that included clinicopathological prognostic indicators, a low ALI was an independent predictor of poor OS (p = 0.014) and RFS (p = 0.038). Furthermore, according to the multivariate analysis including other inflammatory or nutritional indices, the ALI was an independent predictor of poor OS (p = 0.024) and RFS (p = 0.044).

Conclusions: The ALI was a significantly useful prognostic predictors of patients with UTUC who underwent RNU.

Objective: There is ongoing debate regarding whether patients with a positive urine culture (UC) need to wait for the culture to turn negative following antimicrobial treatment before undergoing percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the necessity of achieving a negative UC before PCNL and its association with postoperative systemic inflammatory response syndrome (SIRS) and sepsis.

Methods: This prospective study included 147 patients with positive UCs who underwent PCNL at The First Affiliated Hospital of Guangzhou Medical University from March 2021 to April 2024. Patients were treated with sensitive antibiotics for 5-7 days based on the susceptibility results of their initial UC. Follow-up UCs were performed on day 3 after starting antibiotics and immediately before surgery. The relationship between UC results and postoperative infectious complications, including SIRS and sepsis, was analyzed. Multivariable analysis was conducted to identify independent risk factors.occurrence of postoperative infectious complications, including SIRS and sepsis, was analyzed. Multivariable analysis was used to identify independent risk factors.

Results: Among the 147 patients, 133 (90·5%) had a negative urine culture on day 3 of treatment, while 14 remained positive. Preoperatively, 136 patients (92·5%) had negative UCs. Univariate analysis showed no significant differences in the incidence of postoperative systemic inflammatory response syndrome (SIRS) and sepsis between the UC-negative and UC-positive groups on day 3 and preoperatively (p > 0·05). Multivariable analysis identified stone burden (OR 1·01, 95% CI 1·01-1·01, p = 0·009), multiple access tracts (OR 2·64, 95% CI 1·08 - 6·45, p = 0·034), and positive stone cultures (OR 5·03, 95% CI 1·84 - 13·74, p = 0·002) as independent risk factors for postoperative SIRS. Bacterial variations were observed in follow-up UCs from 8 patients, but these did not impact postoperative complications.

Conclusion: Achieving a negative UC before PCNL is not a necessary condition. Patients with positive UCs can safely undergo surgery after 5 days or more of sensitive antibiotic treatment without the need for a negative UC result. Positive stone cultures are valuable predictors of postoperative SIRS, supporting the routine collection of stone culture specimens.