World Journal of Urology最新文献

Objective: To analyze adverse events (AEs) associated with enfortumab vedotin (EV) and pembrolizumab (PB) monotherapy and combination therapy using the FDA Adverse Event Reporting System database (FAERS).

Methods: A retrospective pharmacovigilance study was conducted using FAERS data. Data were classified into EV monotherapy, PB monotherapy, and combination therapy groups. Disproportionality analysis was conducted to identify the overall distribution and specific AEs. The results were compared with drug labels for cross-validation. High-evidence positive signal AEs were obtained by matching the signals from the MHRA integrated method and the MGPS method, and differences between monotherapy and the combination therapy were compared.

Results: The results compared with the package inserts showed that the results well reflected the AEs reported in the package inserts. In addition, 40 new AEs with dual positive signals were identified in the combination therapy, which were not reported or had significantly lower signal intensity in monotherapy, including various infections and inflammations, blood pressure fluctuations, taste loss, and neurological issues. There were 27 AEs with dual positive signals in EV and PB monotherapy, but the signal intensity of these AEs was significantly reduced in combination therapy, like adrenal cortical insufficiency, bone marrow suppression, skin and subcutaneous tissue diseases, and gastrointestinal ulcers and perforations.

Conclusions: The overall safety of the combination therapy may be superior to that of monotherapy, suggesting that the synergistic effect of combination may also operate in the safety dimension. Some newly identified AEs with positive signals reported only in combination therapy required attention and verification through further studies.

Purpose: To examine the association between the preoperative G8 score and urinary continence recovery after robot-assisted radical prostatectomy (RARP).

Methods: This study included 1794 patients enrolled in SUPER-PC-RP prospective cohort who underwent RARP and completed G8 questionnaire preoperatively. Patients were classified into high (G8 score ≤ 14) and low (G8 score > 14) frailty groups. Continence recovery, defined as the use of less than one pad per day, was assessed three months and one year postoperatively. Factors affecting continence recovery were identified using multivariable logistic analysis. Kaplan-Meier analysis evaluated continence recovery over two years according to frailty and nerve-sparing status.

Results: Overall, 649 and 1145 patients were assigned to high- and low-frailty groups, respectively. At three months, continence group was significantly younger and had a lower prevalence of diabetes, lower International Society of Urological Pathology grade, lower pathological T stage, higher nerve-sparing rate, and lower frailty than incontinence group. At one year, patients who recovered continence were younger and had a higher nerve-sparing rate and lower frailty. Multivariable analysis showed age (3-month odds ratio (OR) 0.973, 1-year OR 0.947), nerve-sparing (3-month OR 2.39, 1-year OR 1.77), and low frailty (3-month OR 1.56, 1-year OR 1.75) as significant factors affecting continence recovery (all P < 0.05). In cumulative Kaplan-Meier analysis, low-frailty group showed better continence recovery than high-frailty group, with a greater difference observed in non-nerve-sparing group (P < 0.001).

Conclusion: Frailty assessment using G8 questionnaire is associated with urinary continence recovery after RARP, which provides an advantage for preoperative patient counseling and surgical planning.

Purpose: Holmium laser enucleation of the prostate (HoLEP) is as an effective, size-independent treatment for benign prostatic hyperplasia (BPH) with durable outcomes. However, one of its adverse outcomes is post-operative stress urinary incontinence (SUI). We sought to determine if membranous urethral length (MUL) as measured on preoperative magnetic resonance imaging is a predictor for post-operative SUI in patients undergoing HoLEP for BPH.

Methods: A single-center, retrospective observational study was conducted on 147 consecutive patients who underwent HoLEP for BPH between 2018 and 2024. Preoperative baseline characteristics, perioperative details, and SUI outcomes at 1, 3, and 6 months were collected. Binary logistic regression was used to assess the association between MUL and SUI at each follow-up interval.

Results: Median MUL was 8.2 mm (IQR 6.1-11.0), and post-operative SUI incidences were 73 (49.7%), 36 (24.5%), and 16 (10.9%) at 1, 3, and 6 months respectively. Longer MUL was significantly associated with lower odds of SUI at 1 month (OR: 0.86, 95% CI: 0.77-0.96, p = 0.009), 3 months (OR: 0.77, 95% CI: 0.65-0.91, p = 0.002), and 6 months (OR: 0.65, 95% CI: 0.49-0.87, p = 0.004). Internal validation demonstrated good discrimination (areas under the curve of 0.73, 0.75, and 0.83 at 1, 3, and 6 months) with well-calibrated models, and decision curve analysis confirmed clinical utility within prespecified risk thresholds.

Conclusions: Longer MUL is significantly associated with lower rates of SUI following HoLEP at 1, 3, and 6 months. Longer MUL may serve as a valuable predictive factor for continence recovery and should be considered during preoperative counseling and surgical decision planning.

Objective: To describe the demographic profile and risk factors for kidney stone formation in patients with sarcoidosis.

Material and methods: 158 sarcoidosis patients were analyzed, comparing groups with and without kidney stones evaluating clinical and metabolic factors and medication use. Statistical analysis was carried out using R software (p < 0.05).

Results: The sample consisted of 138 patients (87.34%), with a majority of females (67.4%) and a median age of 54. Frequent comorbidities included hypertension (38.4%), diabetes (18.1%), and dyslipidemia (6.5%). Nephrolithiasis was reported by 11.9% of patients. Laboratory tests showed hypercalcemia in 9.4% and hypercalciuria in 17.4%. Kidney stones were found in 15.9% of patients, three of whom were bilateral. The comparative analysis revealed a significant association with a previous history of nephrolithiasis (40% vs. 6.6%). There was no statistical correlation with laboratory tests, except for uric acid, which was lower in the group with stones. Hydroxychloroquine was more frequent in the group with stones but without statistical significance. Logistic regression did not identify any significant associations.

Conclusion: Nephrolithiasis occurred in 16% of sarcoidosis patients and was more prevalent in women and adults. Calcium disturbances persist, requiring continuous monitoring. A history of renal lithiasis should be valued in diagnosis and follow-up.

Purpose: To evaluate the feasibility, and outcomes of partial nephrectomy (PN) for clinical T2b, T3a, and T3b renal mass in a high-volume tertiary care setting.

Methods: We retrospectively analyzed patients who underwent open or robotic-assisted PN between 2017 and 2024 at a single academic center. Patients had imperative indications for PN [solitary kidney, chronic kidney disease CKD, bilateral neoplasm]. Data on perioperative outcomes, renal function, oncologic endpoints, and Trifecta achievement [no major surgical complications according to Clavien-Dindo classification (CD ≥ 3), negative surgical margins, 80% of estimated new baseline estimated glomerular filtration rate (eGFR)] were collected. Multivariable Firth logistic regression (MLRA) assessed predictors of failure to achieve Trifecta.

Results: We analyzed 103 patients with (12 T2b/88 T3a/3 T3b) renal mass (median tumor size 6.0 cm/median R.E.N.A.L. score 10). Median ischemia time was 37.0 min (cold in 45.6%, warm in 44.7% and segmental/clampless in 9.7%). Median blood loss was 200 mL. Major post-operative complications occurred in 20.4% [urine leak (9.7%), fluid collection (6.7%), hematoma (2.9%)]. Intraoperative complication rate was 1.9% (2 enterotomies). Microscopic positive surgical margins were observed in 10.7%; mean ΔeGFR was - 14.6 ml/min/1.73m². At median 38-month follow-up, 3-year overall, cancer-specific and recurrence-free survival rates were 92%, 94% and 75%, respectively. Trifecta was achieved in 43.7% patients. On MLRA, receipt of neoadjuvant therapy was associated with higher odds of failure to achieve Trifecta (OR 3.25, 95%CI 1.15-9.20; p = 0.03).

Conclusion: PN for large and complex locally-advanced renal tumors is feasible with acceptable outcomes in carefully selected patients with imperative indication for nephron preservation. Further investigation is requisite to delineate role of PN in locally-advanced renal mass.