Current Urology最新文献

Urological tumors represent a significant global health challenge, with conventional therapies often proving insufficient to control disease progression. Recent breakthroughs in cellular immunotherapy, particularly in chimeric antigen receptor (CAR)-T cell, CAR-natural killer cell, and CAR-macrophage therapies, have demonstrated remarkable potential for treating these malignancies. Ongoing research is actively refining CAR-based strategies to enhance their precision in targeting tumor-associated antigens. This review comprehensively summarizes the applications of CAR cell therapy in the following 3 major urological tumors: renal cell carcinoma, bladder cancer, and prostate cancer. Furthermore, we analyzed the current advantages and limitations of these approaches and propose potential strategies for optimization focused on CAR-T cells. This review will provide future directions in this field and contribute to the development of more effective treatments for patients with urological cancer.

Background: This study aimed to evaluate the clinical efficacy and safety of combining a programmed cell death protein 1 (PD-1) inhibitor with a poly(ADP-ribose) polymerase inhibitor (PARPi) in patients with metastatic castration-resistant prostate cancer (mCRPC) who progressed after multiple lines of treatment, from a real-world perspective.

Materials and methods: This open-label, single-arm, prospective study enrolled patients with mCRPC who had experienced disease progression after docetaxel and at least 2 lines of next-generation hormonal agents to receive camrelizumab (PD-1 inhibitor) and fluzoparib (PARPi). The primary endpoints were radiographic progression-free survival and overall survival (OS), and the secondary endpoints were prostate-specific antigen progression-free survival and safety.

Results: Eight patients with mCRPC who met the inclusion criteria were enrolled. The results showed that the median radiographic progression-free survival was 5.1 months, the median OS was 8.1 months, and the median prostate-specific antigen progression-free survival was 3.1 months. Safety analysis revealed that 87.5% of the patients experienced one or more treatment-related adverse events (AEs), with 37.5% reporting grade 3 or higher treatment-related AEs. None of the patients discontinued treatment because of treatment-related AEs.

Conclusions: This real-world study demonstrated that the combination of a PD-1 inhibitor and PARPi exhibited sustained antitumor activity with an acceptable safety profile in the fourth-line treatment of patients with mCRPC.

Background: Renal anastomosing hemangiomas (RAHs) are rare. This study aimed to summarize the clinical, pathological, and imaging characteristics of RAH.

Materials and methods: We retrospectively analyzed 14 patients who underwent surgery for RAH at our center between December 2014 and December 2023. In addition, we conducted a literature review of case reports and case series on RAH published between 2009 and 2023.

Results: Renal anastomosing hemangioma predominantly affected men and was typically solitary. More than half of the tumors were localized in the renal parenchyma. Approximately 70.7% (65/92) of patients were asymptomatic. The mean maximum tumor diameter was 20 mm (range, 14-28 mm). A total of 35.2% (37/105) of patients had end-stage renal disease. Patients with end-stage renal disease and RAH are generally younger and have bilateral multifocal tumors. However, these tumors were smaller in size. Continent of origin of patient and tumor location were significant factors influencing tumor size. No tumor recurrence or distant metastases were observed during a median follow-up period of 18 months. Postoperative pathological staining remains the criterion standard for diagnosing RAH; however, preoperative multiparametric magnetic resonance imaging provides valuable diagnostic information. The RAH typically exhibits peripheral, discontinuous, and nodular enhancement during the corticomedullary phase, followed by centripetal fill-in enhancement during the excretory phase. Preoperative ultrasound-guided percutaneous biopsy is recommended when these characteristic magnetic resonance imaging features are observed.

Conclusions: Renal anastomosing hemangioma is a rare benign renal tumor that is often misdiagnosed on imaging, leading to potential overtreatment. Surgeons must be well versed in the differential diagnosis of tumors to provide optimal treatment for patients.

The androgen receptor (AR) plays a critical role in the development and progression of prostate cancer by regulating key cellular processes such as cell proliferation and apoptosis. Although traditional AR-targeted therapies have shown initial success, acquired resistance remains a significant clinical challenge, often driven by AR alterations and somatic gene mutations associated with homologous recombination deficiency (HRD). Approximately 20% of advanced prostate cancer cases exhibit HRD, resulting in substantial genomic instability and complicating treatment. Fortunately, Food and Drug Administration-approved poly(ADP-ribose) polymerase inhibitors, including olaparib and rucaparib, exploit synthetic lethality to target prostate cancer with HRD, and additional drugs targeting DNA damage response (DDR) proteins are under development. Emerging evidence suggests that AR activity enhances DDR gene expression, with multiple DDR proteins localized near androgen-regulated regions, highlighting a close interaction between AR and DDR pathways. Consequently, recent preclinical and clinical studies have investigated combining AR-targeted therapies with treatments that induce DNA damage, such as radiation therapy, or inhibit DNA repair mechanisms. This review discusses AR's role in cellular processes, the interplay between AR and DDR, and recent advances in prostate cancer treatment strategies.

Background: In this study, we aimed to evaluate the efficacy of dorsal plication (DP) in correcting mild-to-moderate ventral penile curvature (VPC) during primary hypospadias repair with urethral plate preservation.

Materials and methods: We retrospectively reviewed medical records of patients who underwent DP during primary hypospadias repair with urethral plate preservation between January 2018 and December 2021. Patients were categorized into 2 groups based on the degree of curvature following degloving: <30° (group 1) and 30° to 40° (group 2). Recurrent VPC, urethral complications, and pediatric penile perception scores were analyzed.

Results: Seventy-six patients met the inclusion criteria: 59 in group 1 and 17 in group 2. The incidences of recurrent VPC (1.7% vs. 5.9%; p = 0.928) and urethral complications (32.2% vs. 29.4%; p = 0.827) were comparable between groups. A total of 29 completed pediatric penile perception scores questionnaires were collected. No significant difference was observed in dissatisfaction with penile length (13.6% vs. 14.3%; p = 0.692).

Conclusions: Dorsal plication did not increase the rates of VPC recurrence, urethral complications, or dissatisfaction with penile length in cases with 30° to 40° VPC after degloving. Long-term follow-up with larger sample sizes is warranted to further assess the efficacy of DP.

Background: Rezūm therapy, a minimally invasive surgical procedure for benign prostatic hyperplasia (BPH), was very recently developed. Its characteristics and safety profile render its use in patients with multiple comorbidities attractive. In this study, we evaluated the outcomes of Rezūm therapy in patients with frailty, BPH, and an indwelling catheter.

Methods: This single-center prospective study involved consecutive patients with frailty who underwent Rezūm therapy from June 2022 to December 2023. Patients with a prostate volume of 30-150 cm³, indwelling bladder catheter for ≥6 months, and diagnosis of frailty were included. Frailty was defined as the concomitant presence of a Clinical Frailty Score of ≥4, Charlson Comorbidity Index of ≥3, and Modified Frailty Index of ≥2. The primary end point was successful removal of the catheter and continued catheter independence 12 months after treatment. The International Prostate Symptom Score, maximum urinary flow rate, and post-void residual volume were evaluated 3, 6, and 12 months after the procedure. Adverse events were monitored throughout the study.

Results: Seventy patients were included: catheter removal was successful in 66 of these patients (94%), all of whom completed 1 year of follow-up without recatheterization. Statistically significant (p < 0.05) improvement was observed in the International Prostate Symptom Score, maximum urinary flow rate, and post-void residual volume during follow-up. No intraprocedural complications occurred. At 30 days, 4 of the 66 patients (6%) experienced postprocedural complications of Clavien-Dindo grades II (n = 2) and IIIa (n = 1).

Conclusions: Rezūm therapy was effectively and safely performed in patients with frailty, BPH, and an indwelling catheter. Further large comparative studies are needed.

Background: Kidney renal clear cell carcinoma (KIRC) is a major subtype of renal cell carcinoma. Because of its rapid progression and resistance to targeted therapies, KIRC poses a significant threat to human health. KRBA2, a member of the KRBA family, is recognized as a transcription factor. Nevertheless, limited research has focused on the effect of KRBA2 in KIRC.

Materials and methods: The Cancer Genome Atlas database was utilized to analyze the expression of KRBA2 in KIRC, and quantitative real-time PCR was used to validate KRBA2 mRNA expression in clinical KIRC samples and KIRC cell lines. The correlation between KRBA2 expression and clinicopathological features was determined via the Wilcoxon rank sum test. Next, we assessed the prognostic value of KRBA2 in patients with KIRC using Kaplan-Meier survival analysis. The association between KRBA2 expression and immune infiltration in KIRC was investigated using the Tumor Immune Estimation Resource.

Results: Our research demonstrated that KRBA2 expression was downregulated in KIRC and was correlated with multiple clinicopathological characteristics. Low KRBA2 expression was associated with poorer overall survival, progression-free interval, and disease-specific survival. Enrichment analysis suggested that KRBA2 was related to immune processes and the cell cycle, and Tumor Immune Estimation Resource analysis indicated that KRBA2 expression correlated with immune infiltration levels and immune characteristics of multiple immune cells.

Conclusions: These findings suggest that KRBA2 may serve as a potential prognostic biomarker associated with KIRC immunity and could be a promising target for KIRC diagnosis and treatment.

Benign prostatic hyperplasia (BPH) and benign prostatic obstruction (BPO) remain significant contributors to male lower urinary tract symptoms, often leading to bladder damage and dysfunction. The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions, leading to disease progression and a negative impact on quality of life. This review proposes a paradigm shift to focus on bladder health preservation, as the bladder is an end organ that cannot be transplanted. Therefore, earlier diagnosis and timely surgical treatment within the "window of curability" are required. We introduce the Man vs Prostate "Five Stages of Bladder Health" to provide the needed framework to build the next iterations of BPH/BPO care. This patient-facing decision-making aid categorizes BPH/BPO progression. It integrates clinical observations with underlying pathophysiology and patient experience. This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages, the possible consequences of not taking action, and the goal to prevent late-stage disease: stage I, BPO; stage II, detrusor overactivity; stage III, urgency incontinence; stage IV, acute retention; and stage V, detrusor underactivity. On an individual patient basis, transitions are not distinct, stages can coexist, and stages can be skipped. Although promising, this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy. The concept of the "window of curability" emphasizes the need for therapeutic intervention at the optimal time. By identifying patients in earlier stages and initiating appropriate treatment, disease progression can be potentially stabilized or even reversed while aiming to optimally preserve detrusor function. Along with the Man vs Prostate staging system, this framework provides a structure for future research, shared decision making, and personalized treatment strategies. This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices, focus on earlier intervention within the "window of curability," and prioritize bladder health preservation.