World Journal of Urology最新文献

Purpose: To evaluate the appearance of dust and stone fragments in the upper urinary tract after retrograde intrarenal surgery (RIRS) on computed tomography (CT) imaging.

Methods: Human renal stones were implanted into porcine kidneys to assess the characteristics of dust and small fragments on CT imaging. Stone samples were classified as small fragments (2.00-2.36 mm), tiny fragments (1.00-1.40 mm) or dust (≤ 250 μm). Each group was divided into multiple 0.25-g dry weight samples. Twenty-four samples were placed in the upper poles of porcine kidneys with a ureteroscope and characterized using CT. The reconstructed images were evaluated with volume analyzer software to determine stone volume, maximum and mean attenuation values, and standard deviation of the stone attenuation value.

Results: The mean stone volume decreased with increasing stone size (p < 0.001). The mean attenuation value (depicted in Hounsfield units [HU]) significantly increased with increasing stone size: dust (309.9), tiny fragments (401.2), and small fragments (474.5). The maximum attenuation value (HU) of small fragments (1430.0) was significantly greater than those of tiny fragments (1126.3) and dust (1039.8). As the stone size decreased from the small fragment size to the dust size, the standard deviation of the stone attenuation value significantly decreased.

Conclusion: As the stone size approaches the that of dust particles, the mean and maximum attenuation values decrease and become more homogeneous. CT and volume analyzer software can be used to distinguish dust from small fragments and assess small residual stones after RIRS.

Purpose: Although the preventive effect against intravesical recurrence (IVR) has been established for single instillation of chemotherapy during or after radical surgery of upper urinary tract urothelial carcinoma (UTUC), there has been no research on the long-term outcome. This study aims to investigate the IVR and long-term survival outcome of a single intraoperative instillation of pirarubicin during radical nephroureterectomy (RNU).

Methods: In this prospective, multicenter, randomized trial, 97 patients undergoing RNU between August 2012 and January 2019 were randomly assigned either to receive a single intraoperative pirarubicin instillation or to serve as the controls.

Results: A total of 80 patients were analyzed, including 42 in the pirarubicin group and 38 in the control group. The median follow-up period was 58.5 months and 62 months in the pirarubicin and the control groups, respectively. In patients who did not experience IVR, the median follow-up period was 59 months and 61 months in the pirarubicin and the control groups, respectively. There was no significant difference in OS between the two groups, although the IVR rate was significantly lower in pirarubicin group (p = 0.044). Multivariable analyses revealed that the pirarubicin instillation was the only independent factor for IVR.

Conclusions: The present trial demonstrated that a single intraoperative instillation of pirarubicin resulted in a significant and long-term reduction of IVR, although there was no significant difference in OS.

Purpose: Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent surgical treatment for benign prostatic hypertrophy. There is currently a lack of data on peri-operative antibiotic prescribing patterns for HoLEP and, thus, no consensus on optimal practices. This study aims to assess peri-operative antibiotic prescribing practices for HoLEP.

Methods: Members of the Endourological Society (EUS) were invited by e-mail to complete a REDCap survey. The survey inquired about surgeons' practice setting, training, surgical volume, antibiotic prescribing practices and explored different factors that might affect antibiotic choice and duration. A p-value of < 0.05 was determined to be statistically significant.

Results: A total of 70 Urologists (66 male, 4 female) reported that they performed an average of 108 HoLEPs per year with a mean clinical experience of 11 years. In the case of a negative pre-operative urine culture with a patient who is not catheterized/intermittently self-catheterizing (C/ISC), 96% of urologists would only give a single peri-operative dose of antibiotic. If the patient is C/ISC then 49% of Urologists would give more than a single dose of peri-operative antibiotic when the urine culture is negative. If the pre-operative urine culture is negative, 39% of surgeons would prescribe post-operative antibiotics even when the patient is not C/ISC and this increased to 64% if the patient is C/ISC. The most common factors urologists considered when prescribing antibiotic prophylaxis/therapy were positive urine culture, catheterization status, and a history of recurrent UTIs. Non-academic urologists administered post-operative prophylaxis more often (p < 0.05) and urologists with more experience treated a positive urine culture for a shorter period.

Conclusion: There is significant variability for peri-operative antibiotic prescribing practices prior to HoLEP. In general, more antibiotics are prescribed if the patient has a history of C/ISC or infection. Further clinical studies are needed to identify optimal antibiotic prescribing protocols prior to HoLEP.

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.