World Journal of Urology最新文献

Purpose: To report on in-vivo intrarenal pressure (IRP) during flexible ureteroscopy for treatment of kidney stones while using the novel flexible and navigable suction ureteral access sheath (FANS).

Methods: A retrospective observational analysis was performed for 25 patients undergoing routine flexible ureteroscopy for treatment of renal stones between February 2024 and June 2024 from two centres in Canada. The LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) with pressure sensing capability was used together with the Clearpetra^® Ureteral Access Sheath System (Well Lead Medical Co. Ltd., Guangzhou, China) for all cases. Irrigation was via a pressure bag set at 250mmHg where possible and the access sheath was connected to wall suction at 200mmHg. Median and maximum IRP, as well as the distribution of cumulative procedure times according to various IRP ranges were analyzed.

Results: The median age of the patients was 56 years, with a median BMI of 26.7 kg/m². The median (Interquartile range {IQR}) IRP for all the cases was 22.0 (15.0-36.5) mmHg, with a median (IQR) procedure time of 35.9 (16.4-54.8) minutes. The IRP remained below 40mmHg in 76.2% of the total time in all procedures, and was below 60mmHg in 94.1% of the time. Significant variables associated with lower IRP were having a prior endourological procedure, pre-stenting, larger ureteral access sheath size and use of pre-operative alpha blocker. Age, BMI and total stone volume did not significantly affect IRP.

Conclusions: Low intrarenal pressures can be achieved with the use of FANS, even with higher irrigation pressures. Alpha blocker use, larger sheath size, prior endourological procedures and pre-stenting are all associated with lower IRP.

Purpose: To determine the clinical effects of urethral suspension-assisted urethral anastomosis on complex long-segment posterior urethral stricture and describe the technical aspects of this procedure.

Materials and methods: The clinical data for 24 patients who underwent urethral suspension-assisted urethral anastomosis for complex long-segment posterior urethral stricture between March 2021 and March 2024 were retrospectively analyzed. The surgical procedure comprises the following four steps: creation of an inverted Y-shaped incision in the perineum; mobilization of the urethra up to the penile-scrotal junction followed by dissection and separation of the septum of the corpus cavernosum; separation of the inferior pubic symphysis, excising a portion of the inferior pubic symphysis bone tissue and thoroughly clearing the scar tissue surrounding the proximal urethra; and suturing and suspension of the proximal urethra and surrounding tissues at the 2, 5, 7, and 10 o'clock positions, ensuring complete exposure of the proximal urethral mucosa and tension-free anastomosis between the proximal and distal urethra.

Results: The mean patient age was 46.7 years (range 27-64) and the median urethral stricture length was 5.1 cm. The urethral catheter was removed 4 weeks postoperatively. The median follow-up duration was 13.6 months (4-32). Urinary flow remained unobstructed in 22 patients (91.7%), with an average maximum flow rate of 24.5 ml/s (15.3-36.2). Urethral stricture recurred post-surgery in two patients, one of whom underwent successful repair with the same surgical procedure while the other achieved successful voiding after urethrotomy.

Conclusions: Urethral suspension-assisted urethral anastomosis is an effective treatment for complex long-segment posterior urethral stricture. This technique allows for optimal exposure of the proximal urethral mucosa, reduces the distance between the proximal and distal urethra, simplifies surgical procedures, enables tension-free anastomosis between the proximal and distal urethra, and has a high success rate.

Introduction: This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC).

Methods: We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence.

Results: In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously.

Conclusion: HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

Introduction: Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER.

Methods: A retrospective multicenter study of 80 patients, who underwent 82 ureteroenteric reimplantations (17 OUER vs 65 RUER) at 8 institutions between 2009-2021 for benign UESs after radical cystectomy. All the open procedures were performed by the same center in order to compare the robotic approach with a standardized technique. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Complication and stricture recurrence rates were compared between both groups.

Results: Among 82 reimplantations, 44 were left sided (54%) and 12 bilateral (14%). Median time from cystectomy to diagnosis of stricture was 6 months (range 3-18). Baseline characteristics (gender, age, BMI, side, type of urinary diversion and previous abdominal radiotherapy) were comparable between RUER and OUER groups, except for ASA score and rates of prior robotic cystectomy. The 30-day overall postoperative complication rate was 37% in RUER compared to 70.6% in OUER (p = 0.026). Patients who underwent a RUER had statistically significant lower rate of intraoperative blood transfusion (0% vs 12%, p = 0.041), urinary tract infection (12% vs 53%, p < 0.001), bowel injury (0% vs 12%, p = 0.041) and high-grade complications (Clavien III-IV) (4.6% vs 23.5%, p = 0.031). RUER patients had shorter median length of hospital stay (3 days IQR[1-6] vs 6 IQR[3-9], p = 0.018) and lower readmission rate (4.6% vs 29.4%, p = 0.008). After a median follow-up of 23.5 months (8.7-43), 80% of RUER cases were stricture free compared to 90% of OUER (p = 0.42).

Conclusions: RUER achieved a success rate comparable to that of open revisions and may provide some advantages in terms of perioperative outcomes. Prospective and larger studies are warranted to prove its superiority compared to the standard open technique.

The human body harbors a vast array of microorganisms. Changes in the microbial ecosystem can potentially lead to diseases, including cancer. Traditionally, research has focused more on the gut microbiota and its influence on cancer. However, with the advancement of sequencing technologies, scholars have discovered that microorganisms within kidney tissues are significant components of tumor tissues. Intratumoral microorganisms may affect tumor growth and development through certain mechanisms, influence the function of immune cells, or impact the effectiveness of chemotherapy or immunotherapy in patients. This paper reviews the latest progress in the research on intratumoral microorganisms in renal cancer (RCa). It summarizes the types and distribution characteristics of these microorganisms, discusses the close association between specific viral infections (such as HPV and EBV) and RCa, and highlights the role of microorganisms in the pathogenesis of RCa. This review provides new perspectives for understanding the pathogenic mechanisms of RCa, thereby offering potential clinical applications.

Background: Pre-operative kidney disease was shown to impact peri-operative outcomes of endoscopic BPH surgeries. We aim to assess the effect of novel surgical techniques (Laser Enucleation of the Prostate (LEP) and Laser Vaporization of the Prostate (LVP)) compared to Transurethral Resection of Prostate (TURP), on post-operative outcomes stratified based on kidney function.

Methods: The ACS-NSQIP database was reviewed from 2008 to 2021 for 83,020 patients that underwent TURP, LEP, and LVP. Pre-operative variables were compared across kidney function groups: G1(normal/high function); G2-G3(mild/moderate kidney disease); and G4-G5(severe kidney disease). Multivariate logistic regression was performed on 30-day peri-operative complications adjusting for pre-operative variables. Propensity score matching was done between LEP and LVP to TURP.

Results: LEP showed a protective effect against UTIs (p < 0.05) in the G1 and G2-G3 categories but lost that protective effect in the G4-G5 category when compared to TURP. It had longer operative time (p < 0.05) across all kidney function groups, and demonstrated shorter hospital stay (p < 0.05) in the G1 and G2-G3 categories compared to TURP. LVP had a persistent protective effect against bleeding (p < 0.05) across all kidney function groups and shorter hospital stay (p < 0.05) when compared to TURP. LVP had a protective effect against return to OR (p < 0.05) in the G1 and G2-G3 kidney function group but lost that protective effect in the G4-G5 category. LVP had significant protective effect against thromboembolic events (p < 0.05) in the G2-G3 category and against cardiac complications (p < 0.05) in the G4-G5 category.

Conclusion: LEP and LVP are superior to TURP in terms of post-operative complications. The type of endoscopic surgery technique should be tailored according to patient's pre-operative kidney status and risk.

Purposes: This study aimed to clarify the clinical outcomes of Bacillus Calmette-Guérin (BCG) treatment in patients with urothelial carcinoma (UC) of the prostatic urethra.

Methods: Between August 2003 and January 2023, 428 patients with non-muscle-invasive UC received BCG treatment (Tokyo strain, 80 mg, ≥ 5 times) in our hospital; 39 had UC of the prostatic urethra. We evaluated the cumulative incidence of intravesical recurrence, progression (muscle-invasive bladder cancer [MIBC] or metastasis), and subsequent radical cystectomy after BCG treatment in patients with UC of the prostatic urethra.

Results: The median follow-up period was 57 months (interquartile range, 30-85 months). The exact T stage of the patients with UC of the prostatic urethra was carcinoma in situ (CIS) in 29 (27 in the prostatic urethral mucosa and two in the ductal spread), Ta in 7, Ta + CIS in 2, and T1 in 1. All 39 patients had previous or concurrent bladder cancer. Patients with UC of the prostatic urethra experienced significantly higher rates of intravesical recurrence, progression (MIBC or metastasis), and subsequent radical cystectomy than those without UC of the prostatic urethra. In the multivariate analysis, UC of the prostatic urethra was a significant risk factor for progression (hazard ratio 4.06, 95% confidence interval 1.86-8.86, p < 0.001).

Conclusions: This study reported the largest number of clinical outcomes after BCG treatment in patients with UC of the prostatic urethra. Concomitant UC of the prostatic urethra is a strong predictor of subsequent progression; therefore, early timing of radical cystectomy should be discussed.

Introduction: Water vapor thermal therapy (WVTT; REZUM™; Boston, USA) offers symptom relief with reduced risks of complications in patients with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). WVTT therapy has been validated in the pivotal study in men with smaller prostates (< 80 cc). Yet, its feasibility for larger prostates (≥ 80 cc) remains underexplored.

Methods: This retrospective study assessed WVTT efficacy and safety in 131 patients with symptomatic BPH treated between January 2022 and March 2024. Patients were categorized based on prostate size: smaller prostates (SP) (< 80 cc) and larger prostates (LP) (≥ 80 cc). Baseline characteristics, treatment specifics, and post-procedure outcomes-including retreatment rates, symptom scores, and adverse events (AEs)-were recorded. All patients who required surgical retreatment underwent Holmium laser enucleation of the prostate (HoLEP). Statistical analyses compared results between groups over 6- and 12-month follow-up periods.

Results: Among the 131 patients, 48 (37%) had LP, with a median volume of 93 cc (Interquartile range (IQR) 88-110). Patients with LP experienced more non-serious AEs, primarily hematuria (p = 0.001), although serious AEs were similar across groups and limited to urinary retention (p = 0.35). At 6 months postoperatively, LP patients had a higher PVR (42 mL(IQR 21-75) vs. 21 mL (IQR2-40); p = 0.032), though this resolved by 12 months. No significant differences were observed between the groups in IPSS, maximum flow rate (Qmax), or erectile function (IIEF-5) scores at either follow-up point. Medical retreatment rates at 12 months were similar (LP: 4% vs. SP: 7%; p = 0.39), as were surgical retreatment rates (LP: 2% vs. SP: 2%; p = 0.51). Ejaculatory function was largely preserved in both groups (LP: 96%, SP: 95%).

Conclusion: WVTT therapy in LP is associated with a higher risk of minor post-operative AEs, with similar functional outcomes at one year compared to SP. Longer follow-up studies are needed to compare the durability of treatment in LP.

Background: Multidisciplinary teams (MDTs) are essential for cancer care but are resource-intensive. Decision-making processes within MDTs, while critical, contribute to increased healthcare costs due to the need for specialist time and coordination. The recent emergence of large language models (LLMs) offers the potential to improve the efficiency and accuracy of clinical decision-making processes, potentially reducing costs associated with traditional MDT models.

Methods: We conducted a retrospective study of 171 consecutively treated patients with newly diagnosed prostate cancer. Relevant structured clinical data and the European Association of Urology (EAU) pocket guidelines were provided to two LLMs (chatGPT-4, Claude-3-Opus). LLM treatment recommendations were compared to actual treatment recommendations of the MDT meeting (MDM).

Results: Both LLMs demonstrated an overall adherence of 93% with the MDT treatment recommendations. Discrepancies between LLM and MDT recommendations were observed in 15 cases (9%), primarily due to lack of clinical information that could be provided to the LLMs. In 5 cases (3%), the LLM recommendations were not in line with EAU guidelines despite having access to all relevant information.

Conclusions: Our findings provide evidence that LLMs can provide accurate treatment recommendations for newly diagnosed prostate cancer patients. LLMs have the potential to streamline MDT workflows, enabling specialists to focus on complex cases and patient-centered discussions. In this study, we explored the potential of artificial intelligence models called large language models (LLMs) to assist in treatment decision-making for prostate cancer patients. We found that LLMs, when provided with patient information and clinical guidelines, can recommend treatments that closely match those made by a team of cancer specialists, suggesting that LLMs could help streamline the decision-making process and potentially reduce healthcare costs.