World Journal of Urology最新文献

Introduction: Multiaccess PCNL, typically performed for large complex renal stones, is associated with higher complication rates. Newer techniques like ECIRS and US-guided supine PCNL may reduce the need for multiple tracts and related morbidity. This study aims to identify contemporary preoperative predictors for multiple access tracts during ECIRS and US-guided supine PCNL.

Methods: We analyzed our most recent 250 patients undergoing US-guided supine PCNL (and ECIRS when indicated) with at least one year follow-up using logistic regression models and sensitivity analyses to find preoperative factors associated with the likelihood of requiring multiple access tracts.

Results: Seventeen patients (7%) had a multiaccess procedure, with the lower pole as the most common first access site (59%), followed by upper pole (35%) and interpolar (6%). Fourteen patients had two access sites, two had three, and just one had four. On univariable analysis, multiple stones, higher stone burden, upper pole stones, interpolar stones, and a higher Guy's Stone Score were associated with likelihood of requiring multiple accesses. On multivariable analysis, stone burden remained the only significant predictor (OR = 1.038, 95% CI: 1.010-1.066, p = 0.007). A burden > 34.5 mm was found to be the optimal size cutoff. Among 36 full staghorn cases, 6 (17%) required multiple accesses. In non-staghorn patients, upper pole stones were the strongest predictor (OR = 5.056, 95% CI: 1.272-20.099, p = 0.021).

Conclusion: In the era of ECIRS, US-guidance, and supine position, only 7% of patients require multiaccess PCNL. Total linear stone burden, upper pole stones and number of calyces are key risk factors, highlighting the value of preoperative identification for optimized surgical planning and outcomes.

Purpose: Stress urinary incontinence (SUI) after radical prostatectomy markedly reduces quality of life, yet care gaps remain. This study evaluated patients' knowledge of treatment options and use of continence aids.

Methods: We analysed follow-up data from the multicentre HAROW study (2013-2018) and a cross-sectional study from Dresden (2021). Included were men up to 15 years after prostatectomy using ≥ 2 pads daily. The survey examined awareness of surgical treatments, continence aids, information sources, and barriers to therapy.

Results: Ninety-nine patients participated (HAROW: 62; Dresden: 37). Median age at surgery was 67 years (47-85); median postoperative interval 11 years (0-15). Continuous leakage was reported by 70% (68/97), and 53% (51/96) used > 3 pads/day. Pads were the main aid (97%, 93/96); condom catheters (12%) and penile clamps (2%) were rarely used, with 86% unaware of these options. Knowledge of surgical treatments was absent in 62% (55/89). Better awareness was linked to younger age (p = 0.002) and fewer pads used (p = 0.04). Urologists were the main information source (88%), followed by treating hospital (50%) and partners (44%). Key reasons for not seeking surgery were sufficient coping with pads (69%), doubts about efficacy (55%), and fear of health risks (44%).

Conclusion: Most men with SUI after prostatectomy remain poorly informed about surgical options despite frequent urologist consultations. Fear and misconceptions limit therapy uptake. Structured, targeted education is needed to bridge the gap between clinical need and treatment, potentially improving utilization and quality of life.

Purpose: Multiparametric MRI (mpMRI) is crucial for diagnosing prostate cancer, with PI-RADS 5 lesions indicating a high likelihood of clinically significant prostate cancer (csPCa). However, some patients with PI-RADS 5 lesions have negative biopsies, and optimal management remains unclear. This study aims to identify clinical and imaging factors predicting negative biopsy outcomes in these cases.

Methods: We conducted a retrospective analysis of a prospectively maintained single-center cohort of patients with PI-RADS 5 lesions who underwent transrectal cognitive fusion-guided prostate biopsy between November 2016 and December 2024. All procedures included systematic 12-core sampling plus targeted biopsies of mpMRI-detected lesions. Clinical and imaging variables-including age, PSA, PSA density, DRE, prostate volume, prior negative biopsy, lesion location, and TRUS findings-were evaluated as potential predictors of negative biopsy outcomes using univariate and multivariate logistic regression, and ROC curve analysis.

Results: A study of 990 patients with PI-RADS 5 lesions found that 113 (11.4%) had negative biopsies. Among the 863 diagnosed with prostate cancer, 92.8% (801) had csPCa. Independent predictors of negative biopsy included prostate volume > 60 cc (22.3%), normal DRE (20.0%), prior negative biopsy (27.9%), transition zone (TZ) lesion location (25.8%), and absence of a suspicious hypoechoic lesion on TRUS (19.9%). The likelihood of a negative biopsy increased with the combination of these factors-rising to 64.3% when all were present. Multivariate analysis confirmed these as independent predictors, with their combination enhancing predictive accuracy (AUC ≥ 0.84).

Conclusion: Despite the high probability of clinically significant prostate cancer in PI-RADS 5 lesions, approximately 10-12% of cases result in negative biopsy findings. Our results indicate that combining prostate volume, lesion location, DRE findings, and TRUS characteristics allows for improved risk stratification. These predictive factors can improve both pre- and post-biopsy decision-making by helping tailor follow-up strategies such as repeat biopsy, mpMRI monitoring, or PSA testing to each individual patient.

Purpose: To assess oncological outcomes and prognostic factors for recurrence and survival after robot-assisted radical cystectomy (RARC) according to the type of urinary diversion.

Methods: We conducted a retrospective single-center study including 109 patients who underwent RARC between 2008 and 2022. Clinical, pathological, and follow-up data were analyzed and compared between patients with ileal conduit (Bricker) and those with orthotopic neobladder. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier curves. Prognostic factors were evaluated using logistic regression and Cox proportional hazards models.

Results: Among the 109 patients, 74 (67.9%) underwent ileal conduit diversion and 35 (32.1%) received an orthotopic neobladder. Patients in the neobladder group were younger, in better general health (ASA score), and more frequently treated with neoadjuvant chemotherapy (59.6% vs. 21.4%, p = 0.002). Complete pathological response (pT0) was significantly more common after neobladder reconstruction (42.9% vs. 14.9%, p = 0.006). At 5 years, RFS (83.9% vs. 64.7%, p = 0.03) and OS (64.9% vs. 41.8%, p = 0.02) were higher in the neobladder group. On multivariate analysis, impaired health status (ASA 3-4), ileal conduit diversion, lymph node involvement, muscle-invasive disease at cystectomy, and positive surgical margins were identified as independent predictors of worse RFS and OS at both 2 and 5 years.

Conclusion: Patients undergoing orthotopic neobladder reconstruction demonstrated better oncological outcomes, primarily reflecting their more favorable baseline characteristics. Nonetheless, lymph node involvement, pathological tumor stage, and patient general health remain the strongest determinants of recurrence and mortality following RARC.

Purpose: Urolithiasis is a common, recurrent condition that poses significant health and economic challenges. This study aims to assess the global, regional, and national trends in urolithiasis burden and explore its association with socio-demographic disparities from 1992 to 2021.

Methods: We utilized data from the Global Burden of Disease (GBD) 2021 to analyze the burden of urolithiasis across 204 countries and territories from 1992 to 2021. Age-standardized incidence rates (ASIR), DALY rates (AS-DALYR), and years of life lost rates (ASYR) were assessed. Inequality analysis was performed to evaluate socio-demographic disparities. Age-period-cohort (APC) analysis examined trends by age, period, and cohort.

Results: In 2021, urolithiasis was responsible for 693,444 DALYs globally, with an AS-DALYR of 8.146 per 100,000 and 105,984,000 cases (ASIR: 1242.840). Despite a moderate global decline (AAPC: -0.159), males exhibited a higher burden, with 412,237 DALYs (AS-DALYR: 10.092) and an ASIR of 1685.100. Asia and Europe accounted for the highest burdens, while Oceania had the lowest. Regional disparities persisted, particularly in Europe and Oceania. APC analysis showed increasing age-specific risks in older populations, particularly in Americas and Europe. Limitations include data accuracy, bias of statistical models and limited consideration of risk factors.

Conclusion: This study highlights persistent global inequalities in the urolithiasis burden, with marked regional and gender disparities. The burden remains particularly high in Asia and Europe, with increasing trends observed in Americas. Targeted interventions are urgently required, focusing on high-risk groups such as males, older adults, and specific birth cohorts.

Trial registration: Not applicable.