World Journal of Urology最新文献

Purpose: We aimed to demonstrate and compare the efficacy and safety of HoLEP and ThuFLEP procedures in patients with very large prostates (> 175 ml).

Methods: Patients with prostates larger than 175 ml who underwent HoLEP (Group 1, n = 72) and ThuFLEP (Group 2, n = 85) for benign prostatic obstruction (BPO) were retrospectively analysed. Perioperative, postoperative functional outcomes and complications were analysed and compared.

Results: Significant improvements were observed in functional parameters related to IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at 1, 6 and 12 months postoperatively. Except for IPSS at the first postoperative month (3.22 ± 1.77 vs. 2.07 ± 1.11; p = 0.001), no difference was observed between the groups in terms of quality of life, IPSS, Qave and PVR at the sixth and twelfth months. There was no significant difference between the laser sources in terms of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) at 1 month postoperatively, and no UI was observed in any patient at 6 and 12 months. No significant difference was observed between laser types in terms of postoperative complications.

Conclusion: HoLEP and ThuFLEP are safe and effective minimal invasive surgical methods in very large prostates with improvement in postoperative functional parameters and low perioperative complication rates. Since there are no significant differences in outcomes between these laser sources, they can be employed as alternative surgical techniques for BPO in patients with very large prostates.

Purpose: To compare the intraoperative, postoperative and pathologic results of transperitoneal (TLPN) and retroperitoneal (RLPN) laparoscopic partial nephrectomy for anterior renal tumors.

Methods: Data of the 401 patients in two different centers, who had LPN operations due to anteriorly placed renal tumor with RLPN and TLPN approaches, were analyzed retrospectively. Demographic, tumor characteristics, intraoperative, postoperative and pathologic data of all patients were evaluated. 74 TLPN cases were matched with 74 RLPN cases with respect to age, body mass index, tumor size and PADUA nephrometry score (matched 1:1). The groups were compared according to the parameters above.

Results: The two groups were similar in terms of clinical data and tumor characteristics, including matching parameters. The median operative time was similar between two groups (115 vs. 110 min, p = 0.235; 20 vs. 22.5 min, p = 0.283 in the RLPN group than in the TLPN group, respectively). Intraoperative complication rates were similar between the groups (6.8% in RLPN group vs. 10.8% in TLPN group, p = 0.384). The median amount of bleeding in the TLPN group was statistically higher than in the RLPN group (150 vs. 50 cc, p < 0.001). There were no difference in terms of postoperative complication rates and the rate of residual tumor presence (9.5% in RLPN group vs. 12.2% in TLPN group, p = 0.144; 6.8% in the RLPN group, 5.4% in the TLPN group, p = 0.731,respectively).

Conclusion: In high-volume centers, both transperitoneal and retroperitoneal procedures yield comparably favourable outcomes for anterior kidney tumors. Thus, tumor location should not be regarded as a deterrent to considering RLPN.

Purpose: We aimed to compare the efficacy of three different antiseptic methods to determine the most effective prophylactic approach to prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB). The methods evaluated were transrectal povidone-iodine injection (TRPI), biopsy needle disinfection with chlorhexidine, and biopsy needle disinfection with formalin.

Methods: Between January 2018 and January 2023, 904 patients who underwent TRUS-PB were retrospectively analyzed. All patients had prophylactic antibiotic use and negative urine/rectal culture results. Patients were divided into three groups according to the antiseptic protocol: Group 1 (n = 245) received only TRPI injection into the rectum before biopsy, Group 2 (n = 295) received only chlorhexidine needle disinfection before biopsy, and Group 3 (n = 364) received only formalin needle disinfection before biopsy. The biopsy needles used in our clinic are not single-use and are used on other patients after sterilization. The primary endpoint was the incidence of infectious complications within 30 days post-procedure. Continuous variables were analyzed using the Mann-Whitney U test, while categorical variables were analyzed using the Chi-square test, and post-hoc analysis was applied for pairwise comparisons between groups. Univariate and multivariate logistic regression analysis was performed to evaluate factors associated with postoperative infection.

Results: The overall infection rate was 20.4%. Infection rates were 4.5% in the TRPI group, 16.6% in the chlorhexidine group, and 34.1% in the formalin group (p < 0.001). The TRPI group showed significantly lower rates of all infectious complications compared to other groups. Disinfection of biopsy needles with chlorhexidine was found to be significantly more effective in preventing infectious complications compared to disinfection with formalin (p < 0.001).

Conclusion: TRPI injection before TRUS-PB appears to be more effective in preventing post-biopsy infectious complications compared to needle disinfection with chlorhexidine or formalin. This method may be considered as a preferred antiseptic approach for TRUS-PB procedures.

Objective: Surgical decisions for simple renal cysts (SRCs) depend on symptoms and compression of the renal collecting system. This study investigated the relationship between cyst location and patient clinical characteristics, offering insights into personalized management and surgical intervention.

Methods: This study investigated hospitalized isolated SRCs patients, excluding those with renal cancer or unknown cyst sizes. Isolated SRCs were defined as a single large cyst in either kidney, accompanied by less than three additional cysts < 1 cm. Patients with two or more cysts ≥ 1 cm were excluded. Complete clinical data, including cyst location and compression effects, were required for inclusion. Ethical approval was obtained.

Results: This study included 1,093 cases of isolated SRCs: extracalyceal cysts (780 patients), parapelvic cysts (158 patients), cysts above renal pelvis (78 patients), and cysts below renal pelvis (77 patients). Patients with parapelvic cysts had a greater incidence of symptoms (77.85% vs. 57.56%, 61.54%, 53.25%). Parapelvic cysts (72.15%) and cysts below the renal pelvis (88.31%) had a higher risk of collecting system compression risk than extracalyceal cysts (47.69%) and cysts above the renal pelvis (60.26%). The combined risk of hydronephrosis was higher in parapelvic cysts (46.03%) and cysts below the renal pelvis (44.44%) than in extracalyceal cysts (8.96%) and cysts above the renal pelvis (0.00%). Cox regression analysis revealed that cyst size at diagnosis (p < 0.001) and the presence of parapelvic cysts (p < 0.001) independently contributed to symptomatic risk. Cyst size at diagnosis (p < 0.001), parapelvic cysts (p < 0.001), and cysts below the renal pelvis (p < 0.001) were independent predictors of hydronephrosis in patients with SRCs.

Conclusion: SRCs in different kidney locations have unique features, necessitating tailored management. Cysts size at diagnosis and the presence of parapelvic cysts independently contribute to the symptoms of patients with SRCs. Parapelvic cysts and cysts below the renal pelvis are independent risk factors for hydronephrosis and should be actively managed.

Purpose: The classification of different phenotypes of interstitial cystitis/ bladder pain syndrome (IC/BPS) provides different pathophysiology and associated treatment strategies. Most clinical studies have focused on bladder symptoms and cystoscopic findings. This study analyzed bladder wall thickness (BWT) and compared bladder conditions, urinary biomarkers, and histopathology among patients of IC/BPS with different BWT.

Methods: A total of 182 patients with cystoscopy-proven IC/BPS underwent abdominal computed tomography (CT) before intervention. The BWT on CT was classified as smooth, focal thickness, and diffuse thickness. Clinical symptoms, urodynamic findings, cystoscopic characteristics, presence of Hunner's lesion, urinary biomarkers, and bladder histopathology were compared among the three subgroups.

Results: Among the patients, 85 had smooth, 64 had focal, and 33 had diffuse BWT. There was a significant trend of patients with focal and diffuse BWT being significantly older with higher symptom scores, smaller bladder capacity, higher grade of glomerulations, and incidence of Hunner's IC. Pathological findings revealed that patients with diffused BWT, followed by those with focal thickness, had the greatest uroepithelial cell denudation and plasma cell infiltration. Patients with diffuse BWT has higher rate of inflammatory cell infiltration, nerve bundle hyperplasia, and granulation tissue. The urinary levels of tumor necrosis factor-alpha and oxidative stress biomarkers in IC/BPS patients with different BWT were significantly higher than those in the controls.

Conclusion: BWT in CT scans can reflect chronic inflammation of the bladder wall in patients with IC/BPS, which is clinically relevant for the diagnosis and treatment of IC subtypes.

Purpose: The aim of the study was to analyze the effect of tidal volume during mechanical ventilation (MV) on pediatric retrograde intrarenal surgery (RIRS) outcomes.

Methods: The data of patients who underwent RIRS between January 2018 and January 2023 were retrospectively analyzed. Patients under the age of 18 who underwent RIRS and whose data were available were included in the study. Patients were divided into two groups, ≤ 7 ml/kg (Group 1) and > 7 ml/kg (Group 2), according to the tidal volume during MV. Demographic data, clinical characteristics, and perioperative and postoperative data of the patients were statistically compared in both groups.

Results: A total of 83 patients were enrolled, with a mean age of 6.9 ± 4.5 (1-17) years and a mean stone size of 11.7 ± 5.4 (5-33) mm. There were 31 patients in Group 1 and 52 patients in Group 2. The demographic data and clinical characteristics of the patients in both groups were comparable. There was no statistically significant difference between the two groups regarding stone-related (side, size, density, number, and location) and surgical (access sheath and basket use, operation time, fluoroscopy time, or postoperative stenting rates, complication rates) parameters. In the first month, the stone-free rate was higher in Group 1 than in Group 2 (90.3% vs. 71.1%, p = 0.03). No high-grade or anesthesia-related complications were observed in any of the patients.

Conclusion: Reducing tidal volume in pediatric RIRS may improve the stone-free rate by facilitating laser targeting and increasing operative field stability and surgical comfort.

Purpose: The therapeutic efficacy of metastatic renal cell carcinoma (mRCC) has been significantly enhanced with the advent of immune checkpoint inhibitors (ICIs). However, there are limited data on the efficacy of Tislelizumab in patients with mRCC. This study aimed to assess the effectiveness and safety of Tislelizumab plus tyrosine kinase inhibitor (TKI) for patients with mRCC.

Methods: Demographic and clinicopathological data of mRCC patients treated with first-line TKI monotherapy or Tislelizumab plus TKI therapy between March 2019 to February 2023 were collected. Outcome measures included the objective response rate (ORR), median progression-free survival (mPFS). Patient baseline characteristics and adverse events (AEs) were documented.

Results: Totally 136 patients were included in the analysis, with a median age of 57 years. Of the patients, 72.1% were male, 78.8% with intermediate/poor-risk disease. For the overall population, the combination group (n = 61) exhibited a longer PFS compared to the TKI monotherapy group (n = 75) (mPFS (95% CI): 15.9 (10.9-20.9) vs. 6.2 (5.4-6.9) months, P < 0.001) and improved ORR (44.3% vs. 18.7%, P = 0.001). In the non-clear cell RCC (nccRCC) subgroup (n = 39), the combination group (n = 20) showed improved PFS (mPFS (95% CI): 11.9 (0.6-23.3) vs. 4.6 (3.4-5.9) months, P < 0.001) and ORR (40.0% vs. 10.5%, P = 0.006) compared to the TKI monotherapy group (n = 19). The incidence of grade three or higher treatment-related AEs are comparable between the groups (47.54% vs. 40.00%).

Conclusion: Our data demonstrated the promising efficacy and safety profile of Tislelizumab plus TKI as first-line treatment for both ccRCC and nccRCC.