World Journal of Urology最新文献

Purpose: The objective of this study was to evaluate the perioperative outcomes and complications associated with the use of acetylsalicylic acid (ASA) in deceased donor kidney transplantation (KTX), with a particular focus on bleeding events.

Methods: We retrospectively analyzed 157 kidney transplant recipients (KTRs) who underwent KTX at Charité Berlin, Department for Urology, between February 2014 and December 2017. Patients were divided into two groups: patients with ASA in their preoperative medication (Group A, n = 59) and patients without ASA use (Group B, n = 98). Data on demographic information, medical conditions, surgical details, and postoperative outcomes were analyzed. Complications were classified using the Clavien-Dindo classification. Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression.

Results: Group A had significantly older donors (59.7 ± 12.9 years vs. 52.0 ± 14.1 years, p < 0.001) and a higher incidence of coronary artery disease (42.4% vs. 3.1%, p = 0.001). There were no significant differences in perioperative hemoglobin loss and perioperative bleeding events between the groups, but a tendency towards higher rates of intraoperative bleeding (15.3% vs. 8.2%, p = 0.17) and postoperative transfusions (22% vs. 13.3%, p = 0.15) in Group A. Mortality was higher in Group A (18.6% vs. 4.1%, p = 0.003), with one death attributed to a cardiac event. Kaplan-Meier analysis revealed significantly inferior overall survival for Group A (p = 0.02), but no significant difference in graft survival (p = 0.18).

Conclusion: ASA use is associated with a trend towards increased intraoperative bleeding and postoperative blood transfusion but does not significantly increase major postoperative bleeding complications. Careful perioperative monitoring of patients with ASA is recommended.

Propose: This study aimed to evaluate the efficacy and safety of neoadjuvant treatment of darolutamide, a next-generation androgen receptor inhibitor, plus androgen deprivation therapy (ADT) for patients with locally advanced prostate cancer (LAPC).

Methods: This single-arm, multicenter, open-label phase II trial (ClinicalTrials.gov: NCT05249712, 2022-01-01), recruited 30 localized high-risk/very high-risk prostate cancer (HRPCa/VHRPCa) patients from three centers in China between 2021 and 2023. Following six months of neoadjuvant therapy combining darolutamide with ADT, the patients underwent radical prostatectomy (RP). The primary endpoint is pathologic complete response (pCR) or minimal residual disease (MRD). The secondary endpoints are progression-free survival (PFS), positive surgical margin rate and safety. Exploratory endpoint was the relationship between postoperative ctDNA and primary outcome.

Results: The pCR or MRD rate was 40%(n = 12). Only four patients (13.3%) had positive surgical margins. The 12 months PFS was 90.0% (95% CI, 74.4-96.5%). The detection of circulating tumor DNA (ctDNA) accurately predicts the disease progression. No grade 3 or 4 adverse events were observed. The most frequent adverse events included hot flashes and elevated alanine aminotransferase or aspartate transaminase levels, which were observed in three patients (10%).

Conclusion: Neoadjuvant therapy with darolutamide plus ADT for six months followed by RP is effective and safe for HRPCa and LAPC. The detection of ctDNA can predict disease progression.

Purpose: Postoperative fever (POF)/urinary tract infection (UTI) is one of the most unpleasant and undesirable conditions for surgeons after retrograde intrarenal surgery (RIRS). RIRS is not recommended for any patient with a positive urine culture to avoid POF and UTI, but some patients may develop postoperative UTI even if the urine culture is sterile. This study investigated the predictive factors of fever and UTIs after RIRS.

Methods: In total, 1240 patients who underwent RIRS for proximal ureteral stones and/or kidney stones were analyzed. After case-control matching, 168 patients were included in the study. Demographic data, preoperative/peroperative/postoperative data, and hematological parameters were compared. Patients with sterile urine cultures were included in the study. Postoperative fever was defined as fever ≥ 38 °C within 72 h after RIRS. Patients were divided into two groups: those with and without POF/UTI. Demographic data, preoperative and postoperative findings, and inflammatory parameters of the patients were compared retrospectively.

Results: POF/UTI was observed in 61 (36.3%) of 168 patients who underwent RIRS. After case-control matching, increased body mass index (BMI) and longer operation time were found to be significant predictors of POF/UTI (p = 0.001 and 0.016 respectively). Preoperative systemic immune-inflammation index (SII) (PxN/L), high Platelet/Lymphocyte Ratio (PLR), and urine leukocyte positivity were found to be significant predictors of POF/UTI (p = 0.037, 0.025 and 0.038 respectively).

Conclusion: Hematological parameters are simple and feasible to use to evaluate POF/UTI in patients undergoing RIRS. High SII and PLR may predict POF and early infection after RIRS. In addition, according to demographic data and per-operative status, high BMI and prolonged operation time are risk factors for infection.

Purpose: In patients with prostate cancer (PCa), focal therapy with High-Intensity Focused Ultrasound (HIFU) combined with benign prostatic hyperplasia (BPH) surgery has been used to improve immediate post-operative voiding symptoms. Our study aimed to evaluate the functional outcomes of patients undergoing simultaneous holmium laser enucleation of the prostate (HoLEP) + HIFU and compare them to those who underwent HoLEP for bladder outlet obstruction secondary to BPH.

Methods: We performed retrospective review of patients who underwent HoLEP + HIFU or HoLEP between June 2017 and May 2024. The nearest neighbor method with age and prostate volume were used to propensity match HoLEP + HIFU patients with HoLEP only patients in a 1:2 ratio. Demographics, functional characteristics, and complications of patients who underwent HoLEP + HIFU were compared with patients undergoing only HoLEP for BPH.

Results: A total of 99 patients were analyzed, of which 33 patients underwent combined HIFU with HoLEP. Patients undergoing HIFU + HoLEP experienced higher rates of acute urinary retention (p = 0.016) and transient urinary incontinence, along with a delayed recovery of full continence, compared to those who underwent HoLEP alone. Postoperative urinary tract infection (UTI), urethral stricture, bladder neck stenosis (BNS), and continence rate were similar between the groups.

Conclusion: Patients undergoing HoLEP + HIFU seems to have a higher risk of post-operative acute urine retention and delayed recovery from transient urinary incontinence, compared to HoLEP alone. The addition of HIFU to HoLEP does not influence the rate of UTI, urethral stricture, BNS, or improvement of voiding parameters up to one year follow up.

Objective: The intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) prognostic group is heterogeneous. Growing evidence supports the role of active surveillance (AS) for patients with low-risk NMIBC, however, no clear data exists considering IR-NMIBC. The aim of the study was to assess the risk of recurrence of patients eligible for AS based on the International Bladder Cancer Group (IBCG) stratification.

Methods: We retrospectively evaluated 174 LG IR-NMIBC patients who underwent transurethral resection of bladder tumor (index TURBT) from 2012 to 2023 at a tertiary referral center and fulfilled the inclusion criteria for enrollment in AS protocols at the index TURBT (≤ 5 suspicious lesions, no macrohematuria, negative urine cytology, lesions ≤ 1 cm). Patients were then stratified according to the International Bladder Cancer Group (IBCG) risk factors: frequent recurrence, early recurrence, previous instillation, and multifocality. Kaplan Meier plots and multivariable Cox regression analysis (MVA) were used to assess the risk of any and high-grade (HG) recurrence according to the number of risk factors.

Results: Overall, 168 (97%) patients had a Ta low grade bladder tumor. After a median follow-up of 36 months [Interquartile range (IQR) 20-54], 75 (43%) and 32 (18%) patients experienced any- and HG recurrence, respectively. The 3-year recurrence free-survival (RFS) was 86% [95% Confidence Interval (CI) 76-98%] for patients with 0, 76% (95% CI 68-84%) for those with 1-2, and 54% (95% CI 34-84%) for those with ≥ 3 risk factors. The 3-year HG-RFS was > 90% for patients with 0 and 1-2 risk factors, compared to 76% (95% CI 58-99%) for those with ≥ 3 risk factors. At MVA, the presence of ≥ 3 risk factors was associated with a higher risk of recurrence [hazard ratio: 4.74, 95% CI 1.75-12.8, p = 0.002].

Conclusion: Among patients with LG IR-NMIBC eligible for AS, those with more than 2 IBCG risk factors may not be suitable candidates due to a higher risk of developing HG recurrence. Randomized controlled trials with standardized AS protocols are necessary to validate these findings and optimize patient selection for AS in LG IR-NMIBC.

Purpose: No currently available phase III trial compared docetaxel vs. androgen receptor pathway inhibitors (ARPI) regarding cancer-control outcomes in metastatic hormone-sensitive prostate cancer (mHSPC). Moreover, few is known about the effect of sequential therapies in mHSPC and subsequent metastatic castration resistant prostate cancer (mCRPC).

Methods: We relied on the FRAMCAP database and compared docetaxel vs. ARPI in mHSPC patients regarding time to mCRPC (ttCRPC) and overall survival (OS). Sensitivity analyses addressed high volume mHSPC patients. Finally, sequential therapies were compared regarding progression-free survival (PFS) and OS in first-line mCRPC.

Results: Of 419 included mHSPC patients, 25% received docetaxel vs. 75% ARPI. ARPI patients were significantly older (71 vs. 66 years), and harbored lower baseline PSA (38 vs. 183 ng/ml, both p ≤ 0.002). Median ttCRPC was significantly longer for ARPI than for docetaxel-treated patients (30 vs. 17 months, hazard ratio [HR]: 0.49, p < 0.001). In OS analyses, ARPI patients also exhibited significantly longer OS, relative to docetaxel patients (96 vs. 50 months, HR: 0.67, p = 0.03). After multivariable adjustment in Cox regression models, no difference between both treatments remained in both analyses (all p > 0.05). In sensitivity analyses of high volume mHSPC patients only, also no ttCRPC or OS differences were observed for ARPI vs. docetaxel (all p > 0.05). Regarding sequential therapies, no PFS and OS differences were observed for all and specifically high volume mHSPC patients, when ARPI-ARPI vs. ARPI-docetaxel vs. docetaxel-ARPI treatments were compared (all p > 0.05).

Conclusion: In real-world setting, ARPI treatment performs comparable to docetaxel chemotherapy in mHSPC. Therefore, docetaxel should only be used in triplet therapy. Moreover, no differences for sequential therapies of ARPI/docetaxel combinations in first-line mCRPC were observed.

Purpose: To evaluate stone free rate (SFR) predictivity of three different scoring systems in patients with kidney stones larger than 20 millimeters undergoing retrograde intrarenal surgery(RİRS).

Methods: Digital records of a total of 166 patients were reviewed retrospectively. Epidemiological characteristics (age, gender, medical history) of the patients, stone and affected kidney characteristics (size, volume, location, density, opaque, presence of urinary system anomaly, presence of stones in different calyx, number of stones, lower pole stone, renal infundibulopelvic angle (IPA), renal infundibulopelvic length (RIL), hydronephrosis), and operative characteristics (preoperative ureteral stent, operation duration, postoperative residual fragments, hospitalization time and complications were recorded. Each patient was scored separately according to the Resorlu-Unsal Scoring System (RUSS), the modified Seoul National University Renal Stone Complexity (S-ReSC) and R.I.R.S scoring systems based on the stone characteristics seen on CT.

Results: All three methods had statistically acceptable sensitivity and specificity values. Sensitivity for R.I.R.S nomogram is 62.3%, specificity is 77.1% (cut-off: 7.5 points, area under the curve (AUC):0.735, p < 0.001), sensitivity for RUSS nomogram is 60.7%, specificity is 77.9% (cut off: 2.5, AUC = 0.749, p < 0.001), sensitivity for the Modified S-ReSC nomogram was determined as 65.6% and specificity as 71.2% (cut off: 2.5, AUC = 0.743, p < 0.001). The residual stone ratio was found to be higher in the presence of lower pole stone. While the cut-off value for IPA was 44.5°, this value was calculated as 24.5 mm for RIL.

Conclusion: Three scoring systems demonstrate accceptable sensitivity and specificity in predicting stone free rate(SFR) with stones ≥ 20 mm. Multivariate analysis highlighted the superiority of the R.I.R.S. scoring system for SFR predictivity. In the presence of lower pole stones, IPA and RIL are important factors in predicting surgical success.

Purpose: To evaluate the accuracy, comprehensiveness, empathetic tone, and patient preference for AI and urologist responses to patient messages concerning common BPH questions across phases of care.

Methods: Cross-sectional study evaluating responses to 20 BPH-related questions generated by 2 AI chatbots and 4 urologists in a simulated clinical messaging environment without direct patient interaction. Accuracy, completeness, and empathetic tone of responses assessed by experts using Likert scales, and preferences and perceptions of authorship (chatbot vs. human) rated by non-medical evaluators.

Results: Five non-medical volunteers independently evaluated, ranked, and inferred the source for 120 responses (n = 600 total). For volunteer evaluations, the mean (SD) score of chatbots, 3.0 (1.4) (moderately empathetic) was significantly higher than urologists, 2.1 (1.1) (slightly empathetic) (p < 0.001); mean (SD) and preference ranking for chatbots, 2.6 (1.6), was significantly higher than urologist ranking, 3.9 (1.6) (p < 0.001). Two subject matter experts (SMEs) independently evaluated 120 responses each (answers to 20 questions from 4 urologist and 2 chatbots, n = 240 total). For SME evaluations, mean (SD) accuracy score for chatbots was 4.5 (1.1) (nearly all correct) and not significantly different than urologists, 4.6 (1.2). The mean (SD) completeness score for chatbots was 2.4 (0.8) (comprehensive), significantly higher than urologists, 1.6 (0.6) (adequate) (p < 0.001).

Conclusion: Answers to patient BPH messages generated by chatbots were evaluated by experts as equally accurate and more complete than urologist answers. Non-medical volunteers preferred chatbot-generated messages and considered them more empathetic compared to answers generated by urologists.