World Journal of Urology最新文献

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by chronic pelvic pain and urinary symptoms that imposes a significant quality-of-life burden, but the pathogenesis of this syndrome is poorly known, preventing effective therapy. Exosomes, small extracellular vesicles, which mediate cellular communication through proteins, cytokines, and miRNAs, are potent immune modulators that promote prostate inflammation and fibrosis. Simultaneously, dysregulated autophagy, a conserved degradation pathway essential for cellular homeostasis, is involved in the chronic inflammation and immune dysfunction characteristic of CP/CPPS. Critically, emerging evidence points to a bidirectional, functional crosstalk between exosome secretion and autophagic flux. This review proposes and critically evaluates the hypothesis that this 'exosome-autophagy axis' is a self-perpetuating process that contributes to immune dysregulation, neuroinflammation and tissue remodelling in CP/CPPS. We synthesize the limited direct data of the CP/CPPS with information extrapolated based on related conditions, establish particular cellular discussions that may operationalize this axis, and discuss its potential implications for future biomarker and therapeutic strategies.

Purpose: Percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment choice for the management of kidney stones larger than 2 cm. However, tract-related complications have always been a concern, especially in standard PCNL where a larger tract > 24Fr is established. The mini-PCNL technique with smaller tract (≤ 18 Fr) has been introduced to decrease tract related complications. Yet, with a smaller mini-PCNL tract, fragments must be fragmented into smaller pieces before extraction, potentially prolonging the operative time. Moreover, if the outflow of irrigation fluid is insufficient via the smaller tract, the intrarenal pressure (IRP) can build up, leading to pyelovenous backflow and infectious complications - an issue theoretically mitigated by the addition of suction techniques. However, high-level evidence comparing suction mini-PCNL outcomes to standard PCNL is still lacking.

Methods: The present multicenter, international, randomized controlled noninferiority trial compares suction mini-PCNL to standard PCNL in the management of 2-4 cm kidney stones. The primary outcomes are the immediate postoperative stone-free rate (SFR) and operative time, while secondary outcomes include the final SFR at 1 month, postoperative pain score, length of hospital stay, postoperative complications, and quality of life.

Results: A total of 960 patients from 20 urological centers will be randomized to receive either suction mini-PCNL or standard PCNL. Intention-to-treat analysis will be performed. For SFR, non-inferiority will be concluded if the lower bound of the 95% confidence interval for the absolute risk difference exceeds - 10%. For operative time, non-inferiority will be concluded if the lower bound of the 95% confidence interval for the mean difference exceeds - 10 min. For all other analyses, a two-sided p-value of < 0.05 will be regarded as statistically significant. Subgroup analyses will be performed to explore potential effect modification by stone location and stone density.

Conclusion: The aim of this trial is to generate high-level evidence regarding the noninferiority of suction mini-PCNL compared to standard PCNL for 2-4 cm renal stones. The trial is registered on ClinicalTrials.gov as NCT05088213.

Purpose: To evaluate the effectiveness and safety of current surgical modalities for nephrolithiasis in ectopic pelvic kidneys, a rare congenital anomaly with limited available evidence.

Methods: A multicenter retrospective study was conducted across 11 high-volume international centers, including 45 patients with congenital pelvic kidneys who underwent flexible ureteroscopy, multimodal-guided percutaneous nephrolithotomy, and laparoscopic pyelolithotomy. Stone-free rate (defined as 0 mm), need for ancillary procedures, and complications (Clavien-Dindo) were assessed.

Results: Stones were classified as GUYS II in 51.1% of patients and GUYS III-IV in 48.9%. flexible ureteroscopy was the most common primary treatment (51.1%), followed by multimodal guided - PCNL (33.3%). Multimodal-guided PCNL achieved the highest stone free rate (86.7%) and the lowest requirement for ancillary procedures (OR 9.7; 95% CI 1.8-51 compared with other modalities). The overall final stone free rate for the cohort was 65.9% after a mean of 1.38 procedures per patient. Complications occurred in 13.3% of cases, with only one major event (Clavien-Dindo IVa).

Conclusions: Our findings indicate that multimodal-guided PCNL achieved the highest success rates and required fewer ancillary procedures than other approaches when treating stones in ectopic pelvic kidneys. In contrast, flexible ureterorenoscopy showed lower efficacy and required more ancillary interventions. Complication rates were low and comparable to those observed in anatomically normal kidneys. Although larger cohorts would strengthen these observations, the very low incidence of ectopic pelvic kidneys inherently limits the ability to accumulate large patient numbers.

Objective: To investigate metabolic differences between pure and mixed calcium oxalate (CaOx) stone formers and identify key metabolic signatures for prevention strategies.

Patients and methods: A retrospective analysis was conducted on 101 patients from a metabolic clinic database, identifying 49 (48.5%) as CaOx stone formers based on non-zero CaOx monohydrate or dihydrate percentages. Patients were stratified into 25 (51%) with pure CaOx stones and 24 (49%) with mixed stones (CaOx with secondary components). Metabolic parameters (urine volume, calcium, citrate, oxalate, uric acid, sodium, magnesium, serum calcium, uric acid, vitamin D, PTH, and urine pH) were analyzed and compared.

Results: The 49 CaOx patients had a median age of 46 years (IQR 34.5-63), with 33 males (67.3%) and 16 females (32.7%). Surgical history included a median of 2 prior procedures (IQR 0-20), with 89.7% undergoing ureteroscopy. Pure CaOx patients showed higher hypercalciuria (60% vs. 29.2%, p = 0.04) and hypocitraturia (32% vs. 16.7%, p = 0.3), while mixed CaOx patients exhibited slightly lower hyperuricemia (20.8% vs. 24% in pure) and acidic urine pH < 5.5 (24% vs. 25%), reflecting uric acid stones in their composition. Low urine volume (< 2000 mL) was common (56% pure vs. 33.3% mixed). Other parameters (hyperoxaluria, hypomagnesuria, hypovitaminosis D) showed minimal differences.

Conclusions: Metabolic profiles differ between pure and mixed CaOx stones, with hypercalciuria and hypocitraturia in pure stones and hyperuricemia and low urine pH in mixed stones. Tailored prevention includes indapamide and citrate supplementation for pure CaOx and alkalinization for mixed stones, alongside universal hydration.

Purpose: To compare Rezūm water vapor therapy and transurethral resection of the prostate (TURP) using a newly proposed composite definition of procedural success that integrates symptom improvement, safety, and preservation of sexual function.

Methods: This multicenter retrospective cohort included 192 matched patients (96 Rezūm, 96 TURP) treated between 2020 and 2024. Groups were matched for age, prostate volume, International Prostate Symptom Score (IPSS), Qmax and post-void residual urine. Procedural success required simultaneous achievement of all the following: ≥50% IPSS reduction, ≥ 50% Qmax improvement, ≥ 50% (or ≥ 1-point) QoL improvement, absence of intraoperative or Clavien-Dindo grade ≥ III complications, preservation of erectile and ejaculatory function, and no retreatment.

Results: Baseline characteristics were comparable between groups. Rezūm was mostly performed as an outpatient procedure (89.6%), while all TURP patients required admission (p < 0.001). Catheterization duration was longer after Rezūm (5 vs. 1.5 days, p < 0.001). Both techniques significantly improved IPSS, Qmax, PVR, and PSA with no difference in median changes. Ejaculatory preservation favored Rezūm (87.5% vs. 50.0%, p < 0.001), whereas retreatment was more frequent (46.9% vs. 15.6%, p < 0.001). Overall procedural success was comparable (53.1% vs. 47.9%, p = 0.47). Median follow-up was 46 months.

Conclusions: Rezūm and TURP achieved similar overall procedural success. Rezūm offered superior sexual function preservation and outpatient feasibility, whereas TURP provided greater long-term durability, supporting tailored treatment selection.