World Journal of Urology最新文献

Purpose: Penile surgeries, such as circumcision and hypospadias repair, somewhat raise concerns about long-term effects on genital sensation and sexual function. This study was conducted to support a hypothesis that preserving the dorsal preputial subcutaneous tissue and adding it as a tissue onlay to the ventral hypospadias penis could provide a potential benefit in the future on penile sensation and sexual function.

Methods: The study groups consisted of 22 children who underwent tubularized incised plate urethroplasty (TIPU) distal hypospadias repair, and 24 standard circumcision cases for religious purpose between June 2022-November 2023. Dorsal subcutaneous preputial flap was used to cover the neourethra to reduce the risk of fistula formation in all TIPU repairs as described. Dorsal hood preputium specimens as full layer (after circumcision) and after dissecting its subcutaneous layer (after TIPU) were compared histopathologically for vascular and neural components, focusing on peripheral nerve endings, Meissner and Pacinian corpuscles.

Results: There was no statistically significant difference between full dorsal skin and dissected TIPU skin in terms of the number of arteries, the number of peripheral nerves, and the number of Meissner and Pacini corpuscles.

Conclusion: The structure of skin devoid of subcutaneous layer still contained the same number of neural structures as the normal skin, so the subcutaneous tissue laid ventrally probably will add no benefit for future penile sensation.

Purpose: Repeat transurethral resection (re-TURBT) is recommended for all patients with high-risk bladder cancer to improve staging and oncologic outcomes. However, contemporary evidence on the role of re-TURBT is lacking. We therefore examined the contemporary rates of upstaging at re-TURBT and the association of re-TURBT with disease recurrence and progression.

Materials and methods: We identified patients with an incident diagnosis of high-grade Ta, low-grade T1 and high-grade T1 urothelial carcinoma of the bladder between 2010 and 2022. The association of re-TURBT with disease recurrence and progression was evaluated using Cox regression. Rates and predictors of residual tumor and upstaging at re-TURBT were evaluated using univariable logistic regression.

Results: A total of 328 patients were included, of whom 88 (27%) underwent re-TURBT. Among those who underwent re-TURBT, 9 (10%) were upstaged to ≥ T2, while 39 (44%) were found to have residual non-muscle invasive disease. Median follow-up time was 13 and 24 months for RFS and PFS, respectively. In a multivariable analysis, re-TURBT was not associated with a significant difference in disease recurrence or progression compared with no re-TURBT. In unadjusted analysis, a higher Charlson index was associated with an increased risk of upstaging and residual tumors. A greater number of tumors was associated with increased risks of residual tumor at re-TURBT.

Conclusions: In a contemporary cohort of patients with bladder cancer, the rate of upstaging at re-TURBT was 10%, lower than historical studies. The rate of residual non-muscle invasive disease remains high at 44%. Re-TURBT was not associated with a statistically significant difference in disease recurrence or progression.

Purpose: Neoadjuvant chemo-immunotherapy is emerging as promising strategy in muscle-invasive bladder cancer (MIBC), yet its perioperative safety remains understudied. This post-hoc analysis of the AURA phase-II trial assesses surgical outcomes following neoadjuvant avelumab with or without chemotherapy.

Methods: We analyzed 88 patients with localized MIBC from the phase 2 multicenter AURA trial (NCT03674424) who underwent radical cystectomy after receiving either avelumab monotherapy (n = 22) or chemo-immunotherapy (n = 66). Surgical complications were classified using Clavien-Dindo criteria. A LASSO regression was used to identify predictors of overall complications, followed by multivariable and mixed-effects models.

Results: No increased intra-operative surgical complexity was noted. The overall complication rate was 52%. Major complications occurred significantly more often in the chemo-immunotherapy group compared to monotherapy (21.2% vs. 15.4%, p = 0.03), despite more favorable patient profiles. Neobladder diversion and open surgery were both associated with higher complication rates (81% vs. ileal conduit 40%, p = 0.001; 61% vs. robotic surgery 53%, p = 0.04, respectively). Uretero-enteric stricture occurred in 7.6% of patients, with no significant difference between groups. The predictive model demonstrated high accuracy (AUC 0.851) and identified key risk factors for major complications: neobladder reconstruction (OR 10.9[2.4-48.4], p = 0.002), older age, longer operative time, and low preoperative hemoglobin. Limitations include the non-randomized treatment allocation and small sample size in the monotherapy group, which may limit generalizability.

Conclusion: Radical cystectomy after neoadjuvant immunotherapy+/-chemotherapy is feasible, safe, and is not associated with increased intra-operative surgical complexity. Neoadjuvant chemo-immunotherapy prior to cystectomy was associated with increased risk of major surgical complications compared to immunotherapy alone.

Purpose: To evaluate the risk of thermal injury and the treatment efficiency during thulium fiber laser (TFL) lithotripsy of renal and ureteral stone phantoms in an in vivo porcine model.

Methods: BegoStone phantoms were sequentially implanted and treated in the kidneys and ureters of five live anesthetized pigs using ureteroscopy and a 200-µm TFL fiber. Room-temperature saline irrigation (20 mL/min) was used. Intraluminal temperatures were monitored using thermocouples. Nine kidney stone treatments were performed at 0.8 J/12 Hz, 0.2 J/100 Hz, and 1 J/20 Hz. Twelve ureteral stone treatments were performed at 0.8 J/12 Hz, 2 J/5 Hz, 0.2 J/100 Hz, and 1 J/20 Hz. Treatment efficiency was assessed by measuring residual stone mass. Histopathological examinations assessed for thermal injury.

Results: In kidney treatments, maximum temperatures were lower at 10 W settings (median 33.2˚C) than at 20 W (45.7˚C, p = 0.020). Histology revealed major thermal injury in 1/3 treatments at 10 W and 4/6 at 20 W (p = 0.524). In ureter treatments, temperatures did not differ significantly between 10 W (median 36.3˚C) and 20 W (44.6˚C, p = 0.109) settings. However, major histologic thermal injury occurred in 1/6 treatments at 10 W and 6/6 at 20 W (p = 0.015). Median treatment efficiency was 0.57 mg/sec (kidney) and 0.35 mg/sec (ureter), with no significant differences among settings.

Conclusion: TFL lithotripsy at 20 W can exceed thermal safety thresholds, especially in the ureter. Treatment at 10 W appears safer without significantly compromising efficiency, supporting its use for minimizing thermal injury risk.

Background: Nocturia is a common and burdensome symptom that may reflect underlying cardiovascular dysfunction. While previous studies have linked nocturia to heart failure and fluid overload, direct hemodynamic evidence supporting this association remains limited.

Objective: To evaluate the relationship between left- and right-sided filling pressures, particularly pulmonary artery wedge pressure (PAWP) and right atrial (RA) pressure, and nocturia severity in a cohort of patients undergoing right heart catheterization.

Methods: We conducted a prospective observational study of 74 adult patients undergoing right heart catheterization with documented PAWP. Nocturia frequency was assessed via structured interview and modeled as an ordinal outcome. Spearman's correlation and ordinal logistic regression were used to examine associations between PAWP and nocturia severity. Additional analyses explored relationships with right-sided filling pressures (right atrial, right ventricular end-diastolic (RVEDP), and pulmonary artery (PA) pressures). Because of multicollinearity, we fit separate adjusted ordinal logistic models including one pressure variable at a time (PAWP, RA, PA and RVEDP), each adjusted for left ventricular ejection fraction (LVEF), diuretic use, and peripheral edema (where available).

Results: PAWP was significantly associated with nocturia severity (ρ = 0.35, p = 0.003). In adjusted ordinal logistic regression, each 1 mmHg increase in PAWP was associated with a 7-10% higher odds of more frequent nighttime voiding. In separate multivariable models adjusted for LVEF, diuretic use, and peripheral edema both RA pressure (OR 1.15 per mmHg, p = 0.021) and RVEDP (OR 1.17 per mmHg, p = 0.002) were independently associated with greater nocturia severity, wereas PA pressure showed a trend (OR = 1.06 per mmHg, p = 0.078).

Conclusions: Both left- and right-sided ventricular filling pressures, particularly PAWP and RA pressure, are independently associated with nocturia severity in adjusted analyses. These findings support nocturia as a clinical marker of hemodynamic congestion, highlighting the importance of nocturia as a symptom of fluid overload and potential cardiac dysfunction.