World Journal of Urology最新文献

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.

Background: Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) represent two clinically prevalent pediatric disorders that frequently present as comorbidities. OSA, characterized by recurrent upper airway collapse during sleep, and NE, defined as involuntary voiding during sleep, collectively contribute to psychosocial distress in children. Emerging evidence suggests that OSA in children can cause NE through multiple mechanisms, though the pathophysiological interplay involving altered arousal thresholds and hormonal dysregulation remains incompletely elucidated. Herein, we summarized the relationship between OSA and NE and identified mainstream research directions and recent hotspots in the relationship between OSA and NA in children and informed further research.

Materials and methods: This review searched for original publications on the relationship between OSA and NE in children in the Web of Science Core Collection from 1981 to 2025. Research trends, countries, institutions, journals, authors, highly cited publications, and keywords were analyzed using bibliometrics. Co-citation networks were mapped using VOSviewer, and research hotspots and trends were analyzed using CiteSpace.

Results: A total of 147 publications were included. The number of publications and related research interest in the relationship between OSA and NE in children has increased globally year after year. Sleep monitoring and multidisciplinary collaboration may be the next hotspot in this field. The occurrence of NE shows a positive correlation with the prevalence of OSA, and children with NE frequently exhibit comorbid sleep-disordered breathing. Adenotonsillectomy has been demonstrated to have therapeutic efficacy as a primary intervention for children with concurrent OSA and NE.

Conclusions: The co-morbid association between NE and OSA may have significant adverse effects on the psychophysical health of children. Adenotonsillectomy shows potential for treating children with co-morbid OSA and NE. However, systematic multidisciplinary clinical evaluation remains critical in this patient population. Furthermore, this review will help researchers to identify the mainstream research directions and latest hotspots in the field of the relationship between OSA and NE.

Objective: This research aimed to identify the most effective energy source for en bloc resection of non-muscle-invasive bladder cancer (NMIBC) by a systematic review and network meta-analysis of randomized controlled trials (RCTs) and observational studies. We assessed and contrasted the effectiveness and safety of various energy modalities used in en bloc resection (ERBT) with those employed in conventional transurethral resection of bladder tumor (cTURBT).

Methods: A thorough search was conducted in PubMed, EMBASE, Cochrane, and Web of Science (WOS) to discover relevant articles published till August 29, 2024. Research comparing en bloc resection using various energy sources (such as hybrid knife, holmium laser, thulium laser, green-light laser, monopolar, and bipolar devices) to conventional transurethral resection of bladder tumor (cTURBT) was included. A network meta-analysis was performed using Stata/MP 18.0. Standardized mean differences (SMD) were computed for continuous outcomes, whilst relative risks (RR) were used for dichotomous outcomes. Nine clinical outcomes were assessed: duration of surgery, length of hospital stay, catheterization duration, irrigation duration, volume of intraoperative blood transfusion, 12-month recurrence rate, bladder perforation rate, incidence of obturator nerve reflex, and presence of detrusor muscle in the resected specimen. (PROSPERO ID: CRD42024623881).

Results: The study included 37 research, including 8 randomized controlled trials (RCTs) and 29 high-quality non-randomized controlled trials (NRCTs), with a total of 4973 patients involved. The network meta-analysis revealed that ERBT was much better than cTURBT in the majority of outcomes. Hybrid knife and laser technologies (holmium, thulium, and green-light lasers) shown superior efficacy regarding decreased surgical length, diminished 12-month recurrence rates, and fewer problems. Hybridknife proved to be the most advantageous energy source for various results, while cTURBT consistently exhibited the least effective performance across all metrics.

Conclusion: En bloc resection surpasses traditional TURBT in the management of NMIBC, with various energy modalities exhibiting distinct benefits. Among the assessed energy sources, laser technologies and hybrid knives regularly surpassed monopolar and bipolar devices. These findings provide critical direction for urologists in selecting the most suitable energy source for en bloc resection in NMIBC, emphasizing the need for individualized decision-making based on the patient's distinct variables and tumor attributes.

Introduction: Disitamab Vedotin (DV, RC48, or RC48-ADC) is a novel humanized antibody-drug conjugate (ADC), which is based on human epidermal growth factor receptor 2 antibody (anti-HER2, or hertuzumab) coupled with monomethyl auristatin E (MMAE). This study aims to evaluate the efficacy and safety of RC48-ADC in combination with programmed cell death protein 1 (PD-1) inhibitors for treatment of locally advanced or metastatic urothelial carcinoma (la/mUC) patients.

Patients and methods: This is a retrospective and real-world investigation originated from an enrollment of locally advanced or mUC patients underwent treatments with RC48-ADC in combination with PD-1 inhibitors in two hospitals, between August 2022 and July 2024. The overall objective response rate (ORR), disease control rate (DCR), median overall survival (mOS), median Progression Free Survival (mPFS) and safety were assessed.

Results: Totally 51 locally advanced or mUC patients were included in this study, with the following background: age range (39-86 years old), gender (39 (76.5%) male, 12 (23.5%) female). Treatment outcomes included complete remission (27.5%), partial remission (33.3%), stable disease (13.7%), and disease progression (25.5%), yielding an ORR of 61% (95% CI:47-73%) and DCR of 75% (95% CI:61-84%). Until July 2024, the median overall survival (mOS) for all patients was not reached, the median progression-free survival (mPFS) for all patients was 9 months (95% CI:5.8-12.1).Treatment-related adverse events occurred in all patients and the most common side effects were anorexia, asthenia, rash, and pruritus. These adverse symptoms were readily manageable and could be relieved by symptomatic treatment.

Conclusion: RC48-ADC in combination with PD-1 immunotherapy has promising efficacy and manageable safety for locally advanced or mUC patients in real-world settings.