Current Urology最新文献

Immunotherapy has become a standard treatment for patients with advanced urothelial carcinoma, and neoadjuvant immunotherapy is currently being extensively explored. This review highlights the initial findings and key clinical therapeutic insights on immune checkpoint inhibitors in the early treatment of muscle-invasive bladder cancer across diverse patient populations. Most available literature consists of clinical investigations involving small sample, single-arm phase II trials, with the primary endpoint being the pathologic complete response rate. Early results of immune checkpoint inhibitors in the neoadjuvant treatment of bladder cancer have demonstrated promising efficacy. However, these findings require confirmation in large phase III clinical trials, with particular emphasis on long-term survival benefits and identifying patients who respond to treatment.

Background: Isolinderalactone (ILL), extracted from the dried tubers of Linderae aggregate, has multiple functions, such as antioxidation, antitumor, and anti-infection effects. However, there have been few studies on ILL's antitumor role and no reports on its role in bladder cancer (BC).

Materials and methods: Human BC cell lines T24 and EJ-1 were treated with different concentrations of ILL (0, 10, 20, 50, 100, 200, 400, 600, 800, and 1000 μmol/L), and the cell proliferation inhibition rate was analyzed using the CCK-8 assay. The effect of ILL on T24 and EJ-1 cell cycle inhibition and apoptosis was examined using flow cytometry. Immunoblotting was used to detect the levels of apoptosis-related proteins, BAX, BAK1, and CYCS, in BC cells of the control and ILL-treated groups, and quantitative PCR experiments were performed to detect the apoptosis-related gene expression of CASP10, CYCS, BAX, BCL-2, CASP8, and BAK1. T24 and EJ-1 tumor-bearing mouse models were established and divided into vehicle control, low-dose (10 mg/kg) and high-dose (20 mg/kg) groups, with 5 mice in each group. Hematoxylin and eosin staining and immunohistochemistry were used to detect changes in apoptosis-related proteins in vivo.

Results: The CCK-8 assay showed that in vitro, ILL significantly inhibited the proliferation of the T24 and EJ-1 BC cell lines. Flow cytometry and immunoblotting results showed that ILL increased mitochondrial permeability by upregulating proapoptotic proteins BAK1 and BAX, promoting CYCS release and significantly inducing cell cycle arrest at G0/G1 phase. In vivo, on day 25 of administration, tumor inhibition rates in T24 and EJ-1 tumor-bearing mice were up to 75.24% and 47.43%, respectively, in the ILL high-dose-treated and 71.58% and 43.89%, respectively, in the ILL low-dose-treated groups.

Conclusions: Isolinderalactone controls BC progression by inducing apoptosis, suggesting that ILL may be an effective drug for the treatment of BC.

Although suprapubic cystotomy for catheter insertion is commonly performed, complications can be associated with serious morbidity. This case describes delayed recognition of a transperitoneal suprapubic catheter (SPC) traversing the small bowel mesentery and causing a closed loop obstruction of the caecum 7 years after SPC insertion. There are very few cases in the literature of SPC causing mesenteric perforation and to the best of our knowledge, this is the first reported case causing subsequent obstruction of the caecum and the longest delay of 7 years between SPC insertion and manifestation of bowel obstruction.

Background: This study aimed to evaluate the impact of the clock drawing test (CDT) on postoperative delirium and compare the abilities of the mini-cognitive (Mini-Cog) test and the CDT for predicting postoperative delirium after major urological cancer surgery.

Materials and methods: In this single-center retrospective observational study, we collected the medical records of patients who underwent major urologic cancer surgery and preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and the 3-word recall task at our department in 2020-2021 (n = 387). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for postoperative delirium. We also compared the ability of the CDT alone and the Mini-Cog test consisting of the CDT and 3-word recall task to predict postoperative delirium.

Results: A total of 117 patients (30%) had abnormal CDT results. Postoperative delirium occurred in 29 patients (7%). On multivariate analysis, American Society of Anesthesiologists physical status ≥3 (odds ratio [OR], 5.0; p = 0.01), abnormal CDT (OR, 4.8; p < 0.001), preoperative benzodiazepine use (OR, 4.9; p < 0.001), and operative time ≥237 minutes (OR, 3.0; p = 0.01) were independent risk factors for postoperative delirium. The area under the curve for predicting postoperative delirium was 0.709 for CDT alone and 0.743 for the Mini-Cog test. No significant intergroup difference was observed (p = 0.43).

Conclusions: The CDT served as a formal but simple tool with adequate predictive power to identify the risk of postoperative delirium among patients undergoing major urological cancer surgery. Effective screening using the CDT might help provide optimal urological care for older patients.

Background: The prevalence of benign prostatic hyperplasia (BPH) in older men increases with age, beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years. Surgical procedures such as holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the preferred treatments for BPH. Nevertheless, there is disagreement regarding the most efficient and safe treatment for BPH. The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.

Materials and methods: This meta-analysis was performed in accordance with the PRISMA guidelines. In February 2023, a literature review was conducted using PubMed, ScienceDirect, and the Cochrane Library, and the meta-analysis was performed using RevMan V.5.4.

Results: A total of 656 patients underwent HoLEP, and 653 patients underwent TURP. There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3, 6, 18, 24, and 36 months; the HoLEP group showed a significant difference at 12 months. The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings, but the TURP group showed significant results at 24 months. Meanwhile, the HoLEP group showed significant postvoid residual results. There was no significant difference in the quality of life between the groups. Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop. The operating time was shorter in the TURP group. The difference in specimen weight between the 2 groups was not statistically significant. The overall complications were similar in both groups, but the HoLEP group received significantly fewer blood transfusions.

Conclusions: Holmium laser enucleation of the prostate demonstrated excellent efficacy and safety, with fewer hematological changes and complications; however, TURP had a shorter operating time.

Benign prostatic hyperplasia (BPH) is one of the most frequently diagnosed benign disorders that cause dysuria in middle-aged and elderly men. Some patients with BPH have relatively small prostates (referred to as small-volume BPH) but still experience the lower urinary tract infection. Medication treatment is typically not successful in these patients. In addition, their pathophysiologic pathways deviate from those previously observed. Furthermore, as there is no accepted protocol for the diagnosis and treatment of small-volume BPH, patients can experience great difficulties in managing surgical complications such as bladder neck contracture. Thus, we reviewed the features of small-volume prostates, preoperative assessment, surgical technique, and management of complications.

Background: Flexible ureterorenoscopy (fURS) and mini-percutaneous nephrolithotomy (mPCNL) have been increasingly used for the treatment of renal stones. However, current guidelines do not recommend one modality over the other. The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.

Materials and methods: A prospective, randomized, comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers. Inclusion criteria were adult patients with renal stone(s) ≤ 2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy. Subjects were assigned to 1 of 2 treatment groups, either mPCNL or fURS. Two primary outcomes were assessed: (1) initial success rate, defined as the absence of clinically significant residual fragments (>2 mm) on kidney ureter bladder X-ray and ultrasound on the first postoperative day; and (2) complications, which were reported according to the Modified Clavien-Dindo classification system. Secondary outcomes included final success rate, defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day; operative time; auxiliary procedures and blood transfusion rates; hemoglobin drop; and length of hospital stay.

Results: One hundred and eighteen procedures were analyzed (59 in each group). The initial success rate of the mPCNL group (93%) was significantly higher than that of the fURS group (70%). Complications occurred more frequently with mPCNL than fURS (44.1% vs. 18.6%, respectively). Final success rate, operative time, and length of hospital stay were comparable between the 2 groups.

Conclusions: Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones <2 cm because of its higher initial success rate and lower auxiliary procedure rate. However, mPCNL results in significantly higher complication rates than fURS.

Objectives: To evaluate the urinary kidney injury molecule-1 (KIM-1) as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis.

Materials and methods: Three models of obstruction were induced in 90 male rats: unilateral partial ureteral obstruction with a normal contra-lateral kidney, with nephrectomy of a contralateral kidney (solitary kidney), and bilateral partial ureteral obstruction. Each group was further divided into 2 subgroups; the sham-group (10 rats) and the disease group (20 rats). Serum creatinine, blood urea nitrogen, and urinary KIM-1 were collected on days 0, 7, and 14. Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney.

Results: By the end of first week, there was a significant rise of all biomarker levels in all groups when compared with basal levels. Similarly, biomarker levels at the 14th day were significantly higher than those obtained at the 7th day. The urinary KIM-1 level was not detected in the baseline condition. Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day. Histopathological examination confirmed the presence of different forms of tubular injury.

Conclusions: Urinary KIM-1 is significantly elevated in obstructive uropathy. Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.

Background: This study is aimed to determine the impact of living donor (LD) versus deceased donor (DD) kidney transplantation on renal graft survival and patient overall survival rates within Johannesburg, South Africa.

Materials and methods: A retrospective assessment was conducted of all 1685 adult first kidney-alone kidney transplant recipients transplanted between the years 1966 and 2013 in a single center. The patients were divided according to the source of the transplant: LD versus DD. Demographics and post-transplantation follow-up data were determined and tabulated. Graft and overall survival plots were generated.

Results: Of the recipients enrolled, 84.1% were DD recipients and 15.9% were LD recipients. Living donor recipient status was significantly associated with younger age (p ≤ 0.0001), a higher proportion of white, Asian, or mixed race compared to black race (p ≤ 000.1), a higher proportion of urologic etiology of disease (p = 0.015), and a lower proportion with hypertension (p ≤ 0.0001) as the cause of end stage kidney disease. Results showed a decreased risk of graft failure (hazard ratio, 0.55; 95% confidence interval, 0.45-0.66) and a decreased risk of death (hazard ratio, 0.47; 95% confidence interval, 0.36-0.61) among LD graft recipients as compared to DD graft recipients.

Conclusions: In keeping with internationally reported trends, LD recipients continue to have enhanced patient and graft survival outcomes as compared to DD recipients within our local experience. This Johannesburg experience will serve as a foundation for future related studies in this region of the world.

With advancements in laser technology and urological techniques, flexible ureterorenoscopy has emerged as a vital surgical approach for managing stone disease. Various techniques can be employed to customize endourological stone treatments. Despite the continuous evolution of equipment, it remains crucial to comprehend the fundamental steps of the procedure. This paper offers a comprehensive step-by-step guide that integrates the latest advancements in both scopes and lasers. Additionally, it outlines potential pitfalls and strategies to circumvent them, aiming to achieve optimal stone clearance and deliver individualized patient care safely and efficiently.