World Journal of Urology最新文献

Purpose: Previous studies have reported an increased risk of bladder cancer (BC) in IC/BPS patients. In this study, we re-examined the BC risk in a population based IC/BPS cohort to assess the potential detection bias caused by some IC/BPS patients diagnosed who might already have co-existing BC.

Methods: We performed a retrospective cohort study based on a Research Database by extracting IC/BPS patients diagnosed within years 2002-2013. The patients in the study cohorts were identified based on at least 2 IC/BPS diagnoses and excluded patients with BC occurred before IC/BPS diagnosis. The primary outcome was BC events detected. Propensity scores (PSs) were calculated for matching IC/BPS cohort with non-IC/BPS cohort on a 1:1 basis. Cox proportional hazard regression analysis was then used to compare hazard ratios of BC development between 2 cohorts.

Results: By excluding patients with BC diagnosed within 1 year after IC/BPS diagnosis, the study cohort was insignificantly different from the PS-matched control (Model 1, p = 0.219) but significantly different from the non-PS-matched control (Model 2, p < 0.001). However, when including patients with BC diagnosed within 1 year after IC/BPS diagnosis, the study cohort was significantly different from both PS-matched (Model 3, p = 0.002) and non-PS-matched (Model 4, p < 0.001) controls, indicating that excluding patients with BC diagnosed within 1 year after IC/BPS diagnosis and adopting PS matching method greatly reduce the BC detection bias.

Conclusions: IC/BPS is not associated with BC. The detection bias of previous studies may result from inadequate recruitments of study cohorts or improper matching of control cohorts.

Purpose: Limited data are available on the impact of socioeconomic disparities on the survival of patients with non-muscle invasive urothelial carcinoma (NMIBC).

Methods: We analyzed the Surveillance, Epidemiology, and End Results database to review the effects of sex, race, location, and socioeconomic factors on the survival of patients with NMIBC. We calculated 5-year overall survival (OS) and cancer-specific survival (CSS) using the log-rank test. The impact of socioeconomic factors on OS and CSS was analyzed using the Cox proportional hazards model adjusted for clinical characteristics. Hazard ratios (HR) and survival rates were reported with 95% confidence intervals (CI).

Results: Analysis of 3831 patients showed that older age was associated with worse OS (HR 1.08 [1.08-1.09]) and CSS (HR 1.05 [1.04-1.06]). Women and men had similar OS (HR 0.91 [0.82-1.01]) and CSS (HR 1.12 [0.95-1.32]). Black patients had worse OS (HR 1.33 [1.08-1.62] and CSS [HR 1.54 [1.13-2.05]) than their White counterparts. Patients with an annual household income below $40,000 had worse outcomes compared to those with income above $70,000 for both OS (HR 1.79 [1.37-2.33]) and CSS (HR 1.924 [1.26-2.89]).

Conclusions: There were no gender differences in survival outcomes of NMIBC. Older age, Black, American Indian/Alaskan Native, and patients with a household income below $40,000 appear to have worse survival. However, the area of residence did not seem to affect patient survival.

Introduction: In an effort to address the limitations of current lasers, pulsed-waved Thulium: YAG laser devices were released. The purpose of this systematic review is to present all existing data, arising exclusively from human studies and clinical practice, regarding the endourological applications of the new pulsed-waved Thulium: YAG laser technology in stone disease management.

Patients and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, three databases (PubMed, Scopus and Cochrane) were thoroughly investigated from inception to 30 December 2024. The following search string was utilized: (pulsed OR hybrid) AND (thulium: YAG OR Tm: YAG).

Results: In total eight studies satisfied all inclusion criteria and were finally included in the qualitative analysis. Six studies reported the use of the pulsed-waved Thulium: YAG laser during ureteroscopic lithotripsy (URSL) or retrograde intrarenal surgery (RIRS) and two studies reported its use during percutaneous nephrolithotomy (PCNL). In included studies, the lasing time ranged from 6.7 (2.7-13.9) to 36 (11-52) minutes. Stone-free rates (SFRs) ranged from 82 to 95%, while the Grade I-II and III-IV complications, based on the Clavien-Dindo Classification System, ranged from 3.3 to 30% and from 0 to 2%, respectively.

Conclusion: The purely pulsed Thulio^® and hybrid RevoLix^® Thulium: YAG lasers demonstrate promising safety and efficacy for RIRS and PCNL, with high peak power enabling efficient stone disintegration and effective dusting. However, the evidence is limited by small sample sizes, heterogeneity, and a lack of high-quality comparative trials. Further robust studies are needed to confirm these findings and draw reliable conclusions.

Purpose: To compare the visual quality amongst the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S flexible ureteroscopes (FUS) and determine whether urologists can distinguish which FUS is in use.

Methods: In this prospective survey, 6 patients were prospectively randomized to the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS for retrograde intrarenal surgery (RIRS) for nephrolithiasis. Each RIRS was performed by a single-surgeon and recorded. 9 fellowship-trained endourologists were blinded to which FUS was used. They were asked to view the recordings, answer which FUS was used, and fill out a 7-question survey grading parameters from 0 to 5. Statistical analysis was performed with SPSS. ANOVA with Tukey's posthoc analysis confirmed significance defined as p < 0.05.

Results: 78%, 89%, and 78% of endourologists correctly identified which FUS was used between the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS's respectively. The digital FUS outperformed the others in overall score (p < 0.001). The only visual parameter that was not statistically different amongst FUS's was Laser Activation Interference (p = 0.97). After Tukey's posthoc analysis, the digital FUS outperformed the fiberoptic scope in all parameters except LAI. The disposable FUS outperformed the fiberoptic scope in all parameters except for LAI, tissue interference (TI), and overall impression. The digital FUS was superior to the disposable FUS only in Visual quality (Color) and TI.

Conclusions: The majority of fellowship-trained endourologists can distinguish which type of KARL STORZ FUS is in use. The KARL STORZ digital and disposable FUS's outperform the KARL STORZ fiberoptic FUS in nearly all visual parameters. The KARL STORZ disposable FUS is comparable to the KARL STORZ digital FUS except for Visual Quality (Color) and Tissue Interference.

Clinical trial registration: This study was approved by the Northwestern Institutional Review Board and was assigned study ID STU00217933. It is also registered under NCT05646069, titled "Evaluation of Novel Disposable Flexible Ureteroscope for the Treatment of Renal Calculi."

Introduction: The European Board of Urology (EBU) In-Service Assessment (ISA) test evaluates urologists' knowledge and interpretation. Artificial Intelligence (AI) chatbots are being used widely by physicians for theoretical information. This research compares five existing chatbots' test performances and questions' knowledge and interpretation.

Materials and methods: GPT-4o, Copilot Pro, Gemini Advanced, Claude 3.5, and Sonar Huge chatbots solved 596 questions in 6 exams between 2017 and 2022. The questions were divided into two categories: questions that measure knowledge and require data interpretation. The chatbots' exam performances were compared.

Results: Overall, all chatbots except Claude 3.5 passed the examinations with a percentage of 60% overall score. Copilot Pro scored best, and Claude 3.5's score difference was significant (71.6% vs. 56.2%, p = 0.001). When a total of 444 knowledge and 152 analysis questions were compared, Copilot Pro offered the greatest percentage of information, whereas Claude 3.5 provided the least (72.1% vs. 57.4%, p = 0.001). This was also true for analytical skills (70.4% vs. 52.6%, p = 0.019).

Conclusions: Four out of five chatbots passed the exams, achieving scores exceeding 60%, while only one did not pass the EBU examination. Copilot Pro performed best in EBU ISA examinations, whereas Claude 3.5 performed worst. Chatbots scored worse on analysis than knowledge questions. Thus, although existing chatbots are successful in terms of theoretical knowledge, their competence in analyzing the questions is questionable.

Purpose: To evaluate the feasibility and clinical efficacy of transvesical robotic assisted radical prostatectomy (TvRARP) for the treatment of recurrent recalcitrant bladder neck contracture (rBNC) after holmium laser enucleation of prostate (HoLEP).

Methods: In this retrospective study, 8 patients diagnosed with rBNC were enrolled for TvRARP. The patients' preoperative data median age: 73 years (Interquartile range (IQR) 72-74), median body mass index (BMI): 29.8 kg/m² (IQR 20.5-31.5), median prostate volume: 29 ml (IQR 25-45.3), median peak urinary flow (Qmax): 4.15 ml/s (IQR 3.65-4.35), median post-void residual urine (PVR): 190 ml (IQR 145-220), median International Prostate Symptom Score (IPSS): 31 (IQR 29.8-32.5), and median quality of life (QoL): 5 (IQR 5-6) were collected. All patients were excluded from prostate tumors through PSA testing or magnetic resonance imaging (MRI). The surgical outcomes and perioperative complications were evaluated. All patients received follow-up for a minimum of 6 months postoperatively, and their post-operative data were subsequently collected and analyzed.

Results: The median surgical time was 123 min (IQR 119-130), and the median intraoperative blood loss was 50 ml (IQR 50-62.5). The median hospital stay was 7.5 days (IQR 7-8). No severe intraoperative complications occurred, nor did any major postoperative complications arise. All patients achieved continence at postoperative 3 months. All patients achieved treatment success, as evidenced by the successful passage of a 17Fr cystoscope into the bladder or a postoperative uroflow rate exceeding 15 ml/sec. At the 6-month postoperative assessment, the Qmax significantly improved from 4.15 ml/s (IQR 3.65-4.35) to 17.7 ml/s (IQR 17.5-18.6) (p < 0.05). The PVR notably reduced from 190 ml (IQR 145-220) to 17.5 ml (IQR 13.8-36.3) (p < 0.05). The IPSS improved significantly postoperatively, decreasing from 31 (IQR 29.8-32.5) to 10.5 (IQR 9.8-12) (p < 0.05), while the QoL score improved dramatically from 5 (IQR 5-6) to 1 (IQR 1-1) (p < 0.001). Additionally, the OAB-V8 score demonstrated significant improvement after the surgery, decreasing from 17 (IQR 11.8-23.5) to 7.5 (IQR 6.8-9.5) (p < 0.05).

Conclusion: TvRARP is a valid and safe alternative for the treatment of rBNC with an acceptable risk of intraoperative and postoperative complications. It also is a reasonable approach providing promising success rates and continence outcomes. Long-term functional results require further investigation.

Aim of the study: To investigate the time points at which different major complications occur and their temporal distribution over the postoperative intervals.

Patients and methods: Patients who underwent RC between January 2003 and March 2024 at the university hospital Essen and had complete records regarding postoperative complications and their timing were included. All major complications with Clavian-Dindo (CD) grading III-V were identified and recorded according to a predefined morbidity catalog. The time to occurrence of complications, readmission and mortality, was plotted against the postoperative day over a 90-day period to illustrate the distribution of events in the postoperative period. For each complication group, the median timing and the interquartile range (IQR) as well as the incidence during the postoperative weeks were calculated.

Results: Out of 757 patients, 282 (37.2%) suffered at least one major complication (CDC grade III-IV) with a total of 452 major complications. Most common complications were gastrointestinal, genitourinary and wound complications. Median (IQR) time to first major complication was 7 (4-17) days. Hospital readmission due to major complications was required in 68 (9%) patients at a median of 47 days. Most of cardiac, pulmonary, bleeding and gastrointestinal complications occurred very early in the first week, at a median of 3, 4, 4 and 5 days, respectively. Wound complications were more likely to occur within the second and third week, with a median time of 13 days. Thromboembolism developed at similar rates throughout the first 3 weeks. The other groups of complications including infectious, genitourinary and miscellaneous (mostly lymphocele) complications showed no specific pattern and occurred in a wide range over the 90 days and were considered intermediate and late events. Further analysis of the time to all complications (first major and secondary), showed an increase in median time to occurance for all complications except genitouranry and lymphocele, which occurred earlier. Deaths related to major complications were observed in 50 (6.6%) patients at a median time of 17 days.

Conclusion: The current study shows the temporal patterns of the major complications within the RC morbidity catalog. Physicians should be aware of these patterns to facilitate anticipation and prevent fatal outcomes.