World Journal of Urology最新文献

Introduction: Transient stress urinary incontinence (SUI) after holmium laser enucleation of prostate (HoLEP) is commonly linked to intraoperative injury of the external urethral sphincter (EUS). We assessed the reliability of the post-HoLEP endoscopic appearance of the membranous urethra mucosa (MUM) in predicting post-HoLEP continence.

Methods: Forty HoLEPs were prospectively recorded by an artificial intelligence video platform capable of segmenting clips by surgical steps. The final clip was assessed for postoperative MUM integrity by 2 experts in HoLEP and 2 residents, all blinded to the clinical outcome. Their findings were scored as no injury, anterior injury, and lateral injury, and the results underwent statistical analyses.

Results: The referent rating was 72% for no injury, 23% for anterior injury, and 5% for lateral injury. The overall inter-observer agreement was K = 0.26, the inter-experts' agreement was K = 0.12, and the inter-residents' agreement was K = 0.38, reflecting low inter-observer reliability. The postoperative rate of SUI, defined as any drop on a pad, was 30% at 1 month and 12.5% at 3 months. There was no association between the MUM injury graded and SUI according to any of the evaluators (univariate analysis OR 0.83, 95%CI 0.17-3.89). A multivariate analysis controlling for age, prostate size, resectoscope size (22 vs. 26 FR), surgery time, and use of final fulguration showed no significantly independent predictor of post-HoLEP-related incontinence.

Conclusion: The post-HoLEP endoscopic appearance of the MUM is apparently not a reliable marker of EUS injury. Further studies are needed to better understand the mechanism underlying post-HoLEP SUI.

Purpose: To evaluate MRI and histological concordance in prostate cancer (PCa) identification via mapped transperineal biopsies.

Methodology: Retrospective per-lesion analysis of patients undergoing MRI and transperineal biopsy at the Valencian Institute of Oncology (2016-2024) using CAPROSIVO PCa data. Patients underwent MRI, with or without regions of interest (ROI), followed by transperineal biopsies (3-5 cores/ROI, 20-30 systematic). Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC) were calculated, considering PI-RADS 3 lesions as positive or negative. Gleason Grade Group (GG) > 1 defined clinically significant PCa (csPCa).

Results: 1817 lesions were analyzed from 1325 patients (median age 67, median PSA 6.3 ng/ml). 53% MRI were negative, GG > 1 prevalence was 29.1%. MRI-negative cases showed varying PCa rates: 57.4% negative, 34.3% GG 1, and 8.3% GG > 1. PI-RADS 3 lesions had mixed outcomes: 45.6% benign, 29.5% GG 1, and 24.9% GG > 1. 9.2% PI-RADS 4-5 lesions were negative, 23% GG 1, and 67.8% GG > 1. For PI-RADS 3 lesions considered positive, Se, Sp, NPV, PPV, and AUC were 84.9%, 68.4%, 91.7%, 52.6%, and 0.77 respectively. Considering PI-RADS 3 as negative yielded 70.6% Se, 86.2%, Sp, 87.7% NPV, 67.8% PPV, and 0.78 AUC.

Conclusion: MRI and mapped prostate biopsies exhibited moderate concordance. MRI could miss up to one in ten csPCa foci and misinterpret one in two ROIs. Careful MRI interpretation is crucial for optimizing patient care.

Purpose: There is very limited evidence on the optimal surgical treatment for patients with larger T2 renal tumors. This study aims to evaluate the oncologic outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in T2 renal cell carcinoma (RCC).

Methods: A retrospective data analysis was conducted on T2 RCC patients who underwent PN or RN between 2004 and 2019 using the SEER database, and validated with data from multiple centers in China from 2014 to 2019. Kaplan-Meier survival curves and multivariate Cox regression analysis were performed to assess the treatment effects of PN and RN.

Results: The Kaplan-Meier survival curves showed that both in the SEER database and Chinese multicenter data, PN was associated with a higher overall survival (OS) compared to RN in the all patients, male and age ≤ 60 years groups after propensity score matching. The multivariate Cox regression analysis indicated that PN benefited the OS in the all patients (RN vs. PN, HR = 1.476; 95% CI, 1.113-1.957; P = 0.007), and T2a age ≤ 60 years subgroup (RN vs. PN, HR = 2.147; 95% CI, 1.228-3.754; P = 0.007).

Conclusion: PN is a viable treatment option for patients with T2 RCC, particularly for patients with T2a age ≤ 60 years, where PN is associated with a higher OS rate. However, patients with stage T2 tumors undergoing PN should be referred to high-volume centers for treatment.

Purpose: Testicular torsion is a prevalent scrotal emergency associated with a significant risk of testicular loss, and there is no reliable scoring system available to assess the likelihood of orchiectomy following testicular torsion.

Methods: Clinical characteristics and surgical data of patients with testicular torsion from January 2015 to May 2024 were gathered from National Center for Children's Health (NCCH) and the Children's Hospital of Capital Institute of Pediatrics (CIPCH). Independent risk variables for testicular resection were evaluated by logistic regression analyses, leading to the establishment of a nomogram. The performance of the nomogram was assessed and validated using AUC, C-index, calibration curves, and DCA. Patients were classified based on their risk score obtained from the nomogram for clinical application.

Results: A total of 387 patients were included. Risk factors were identified by multifactorial analysis: symptoms duration, testicular blood flow, degree of torsion, and cryptorchidism. A nomogram exhibits an area under the ROC curve of 0.9305 and a C-index of 0.9310. A scoring system was developed accordingly, categorising patients into four groups; 88.7% of patients in the super-low and low-risk categories preserved their testes, while 78.6% in the super-high and high-risk categories underwent testicular resection.

Conclusion: The strong concordance between predicted and actual outcomes suggests the model's utility in clinical decision-making. The nomogram demonstrates robust calibration and differentiation capabilities.

Purpose: Despite the growing adoption of HIFU treatment for localized prostate cancer (PC), standardized criteria for evaluating success and predicting recurrence remain undefined. Herein, we analyze the predictive value of noninvasive tools such as PSA dynamics and MRI to determine recurrence.

Methods: We identified from our HIFU therapy prospective registry patients who developed biopsy-proven recurrence, between 2016 and 2023. Clinically significant recurrence (CS-R) was defined as the presence of GG 2 or greater on control biopsy. Different modalities of PSA kinetics were analyzed and determinants for recurrence were based on either PSA or MRI criteria (PIRADS > 3). Sensitivity, specificity, PPV, and NPV were estimated based on single or combined criteria.

Results: 92 patients were included in the study. A total of 17(18%) patients had CS-R. Those patients presented higher PSA velocity (p < 0.001) and a higher proportion of PSA above nadir + 1 at 12 months (p = 0.001). Static PSA measurement and % of PSA drop were not associated with recurrence. Follow-up based on a combination of PSA parameters (PSA below nadir + 1) and MRI criteria had higher sensitivity (88%) and negative predictive value (96%) in detecting post-treatment recurrence. Limitation of the study included limited number of patients and a relatively short follow up period.

Conclusions: Post-HIFU recurrence surveillance through dynamic PSA monitoring shows better predictive value. Implementing 'for cause' surveillance biopsies guided by dynamic PSA changes along with mpMRI appears to enhance the detection of recurrences without missing a significant number of cases.

Introduction: The use of lasers has created a major impact in the management of stones. The aim of our study is to evaluate and compare the effectiveness and safety profile of Thulium fiber laser (TFL) and Holmium: YAG (Ho: YAG) laser in ureteric stones.

Methods: It is a prospective randomized single-centre study carried out from December 2022 to December 2023. About 110 patients were subjected to the study with 55 randomized to each group. All underwent ureterorenoscopic lithotripsy either with TFL or Ho: YAG laser. Patient demographic data, stone-related factors, and complications were analyzed in both groups and compared.

Results: Mean stone volume was comparable in the Ho: YAG laser and TFL group (578.62 [SD 296.48] mm³ vs. 556.64 [SD 246.18] mm³; P = 0.67). Mean total operative time was significantly different between the two groups (Ho: YAG - 27.3 (SD 2.77) vs. TFL - 24.8 (SD 2.58) minutes, P = 0.005). Mean lasing time was also found to be significantly different (Ho: YAG - 15.16 (SD 3.97) vs. TFL - 13.13 (SD 3.21) minutes, P = 0.004). Ablation speed was also significantly different (Ho: YAG mean 35.67 (SD 9.13) vs. TFL mean 40.48 (SD 10.60) mm³/min, P = 0.012). Stone-free rates (SFR) at 3 months follow-up were similar in TFL and Ho: YAG laser group.

Conclusions: Shorter lasing time, decreased overall operative time, and higher ablation speed are a few selective advantages of TFL over Ho: YAG laser. The SFR and complication rates remained almost the same in both.

Purpose: To assess differences in efficacy and safety between Thulium:YAG laser enucleation of the prostate (ThuLEP) and enucleation performed with the Holmium:YAG Cyber Ho laser generator (HoLEP) with Magneto technology (Quanta System®).

Methods: Patients with surgical indication for benign prostatic hyperplasia underwent ThuLEP using Cyber TM generator (Group A) versus HoLEP using Cyber Ho generator with Magneto technology (Group B). In Group A settings were 100W for enucleation and 35W for coagulation. In Group B early apical detachment and coagulation were performed with energy 1 J and frequency 30 Hz by applying Magneto technology. Enucleation was performed with energy 2 J and frequency 40 Hz by applying Virtual Basket pulse modulation.

Results: 200 patients were enrolled (100 patients per group). Preoperative features were comparable. Mean prostate size was 78.9 vs. 80.5 ml in Group A vs. B (p = 0.09). Mean operative time was 70.6 vs. 64.3 min (p = 0.13) with mean enucleation time 48.8 vs. 43.7 min (p = 0.21) and morcellation time 21.2 vs. 14.6 min (p = 0.03) in ThuLEP vs. HoLEP group. Micturition improvements were comparable. Postoperative gross haematuria was significantly more frequent after ThuLEP and clots-induced urinary retention occurred in 5.0% of cases, compared to no cases after HoLEP (p = 0.02).

Conclusions: HoLEP using the Cyber Ho generator with the application of Magneto technology for coagulation seems to provide an haemostatic advantage compared to ThuLEP, suggested by the significantly shorter morcellation time, higher morcellation efficiency and lower rate of postoperative gross haematuria and clots-induced urinary retention. Functional outcomes are comparable.

Purpose: To compare the perioperative, functional, and oncological outcomes of the intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) technique following robot-assisted radical cystectomy (RARC).

Methods: We reviewed our single-institutional, prospectively collected database for consecutive patients who underwent RARC with an ileum neobladder from July 2016 to February 2023. Patients were divided into 2 groups according to the approach of reconstruction (ICNB or ECNB). The chi-squared test and Wilcoxon test were used to summarize categorical and continuous variables, respectively. survival and complication outcomes were analyzed using Kaplan-Meier curves, multivariate logistic regression and Cox hazards models.

Result: Among 304 patients, 190 ICNB patients and 114 ECNB patients were identified. A shorter median operative time (320 vs. 354 min; p = 0.001) and less median EBL (300 vs. 500 ml; p < 0.001) were recorded in the ICNB group. A significant difference in 90-d overall complications was detected between the 2 groups (49.5% vs. 61.4%; p = 0.043). Multivariate logistic regression analysis demonstrated that age, relapsed tumor and surgical approach (ECNB/ICNB) were individual predictive factors for 90-d overall complications. The functional outcomes and survival rates were comparable between the ICNB and ECNB groups. A Cox proportional hazards model indicated that higher pathological stage and pN status are predictors of both recurrence-free survival (RFS) and overall survival (OS).

Conclusion: Compared with ECNB, ICNB significantly improves perioperative outcomes without compromising functional or oncological outcomes.

Purpose: To evaluate the histopathological characteristics of bladder cancer in patients presenting to Johannesburg hospitals over a 13-year period (2010-2023).

Methods: Following ethical clearance, a retrospective observational, descriptive review of histopathological reports over 13 years was conducted in Johannesburg. Inclusion criteria was bladder biopsies, TURBT specimens, and radical cystectomy (RC) specimens positive for bladder cancer. Exclusion criteria was non-primary bladder cancers (prostate, cervical, colon) and urothelial carcinoma of upper tract origin (N = 970). Of the initial specimens (N = 2450), 1480 met the inclusion criteria, representing 858 patients, owing to multiple transurethral resections of bladder tumours (TURBT). Categorical variables were summarised as counts and percentages, while numerical variables were reported as means with standard deviations or medians with interquartile ranges, depending on data distribution and tested via the Shapiro‒Wilk test. Statistical comparisons were performed using Fisher's exact test (sex), one-way ANOVA, or the Kruskal‒Wallis test (age). Statistical significance was set at p < 0.05.

Results: Urothelial carcinoma accounted for 88.8% of bladder cancer, squamous cell carcinoma (7.7%), adenocarcinoma (1.5%), and other malignancies (2%). High-grade urothelial carcinoma was predominant at 75%. Non-muscle invasive disease accounted for 72% of these cases, while 28% were muscle invasive. Data from radical cystectomies showed a high proportion of aggressive and advanced disease.

Conclusions: The study highlights the predominance of high-grade non-muscle invasive bladder cancer in Johannesburg, consistent with global trends. The findings suggest a shift in bladder cancer trends in Johannesburg away from assumed squamous cell carcinoma towards urothelial carcinoma.