Cuaj-Canadian Urological Association Journal最新文献

Introduction: Active surveillance (AS) requires regular monitoring to detect disease progression. Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsies are commonly used to identify clinically significant prostate cancer (csPC) in AS patients, yet their diagnostic value remains unclear among this population.

Methods: We conducted a retrospective study of patients who underwent mpMRI followed by combined prostate biopsies between 2017 and 2022. Patients were categorized into AS and non-AS groups. We compared the diagnostic yield of mpMRI suspicious Prostate Imaging-Reporting & Data System (PI-RADS) 3-5 lesions using comparisons of PI-RADS score distribution and detection rates of csPC from targeted biopsies between the groups. Logistic regression was used to assess associations between AS category and outcomes. csPC detection rates of targeted and combined biopsies were assessed as well.

Results: The study consisted of 600 patients, 158 in the AS group and 442 in the non-AS group. PI-RADS scores distribution and the number of suspicious lesions were similar between AS and non-AS groups. csPC detection rates from targeted biopsies were not different between AS and non-AS patients (32% vs. 30%, p=0.68), and AS was also not associated with the rates of csPC for each PI-RADS score. The addition of systematic biopsies did not increase csPC detection in AS patients (36% vs. 32%, p=0.47).

Conclusions: Our findings suggest that mpMRI suspicious PI-RADS 3-5 lesions are reliable for csPC diagnosis during AS, and that targeted biopsies alone may be sufficient for its detection; however, further prospective research is needed to validate these results and optimize biopsy strategies within AS protocols.

Introduction: This study aimed to evaluate the performance of three artificial intelligence (AI) models - ChatGPT, Gemini, and Copilot - in addressing priapism-related inquiries. The accuracy, comprehensiveness, and clinical applicability of AI-generated responses were systematically analyzed.

Methods: Frequently asked questions (FAQs) regarding priapism were collected from medical guidelines, literature, and online health platforms. Each AI model generated responses, which were independently assessed by two experts based on accuracy, fluency, and clinical relevance. The Global Quality Score (GQS) was used for evaluation. Statistical analysis was performed using one-way ANOVA, with a significance threshold of p<0.05.

Results: ChatGPT and Gemini demonstrated comparable performance across all thematic categories, with mean scores ranging from 4.5-4.9, while Copilot showed significantly lower scores (3.2-4.2, p<0.001). Both ChatGPT and Gemini provided clinically relevant and accurate information, whereas Copilot's responses frequently lacked guideline-based recommendations.

Conclusions: ChatGPT and Gemini were statistically comparable in generating reliable, clinically useful responses, making them valuable tools for medical education and patient counseling. Copilot, however, exhibited lower accuracy and applicability. These findings highlight the need for continuous refinement of AI models to enhance their role in clinical decision-making while ensuring human expertise remains central to patient care.

Introduction: High-grade T1 (HGT1) bladder cancer is considered to have high five-year recurrence and progression rates, at 50-70% and 25-50%, respectively; however, contemporary data are lacking. We examined the contemporary outcomes of HGT1 bladder cancer to inform patient counseling, management, and clinical trial design.

Methods: We identified patients aged ≥18 years with a new diagnosis of HGT1 bladder cancer between 2010 and 2022 treated at our institution. Recurrence-free (RFS), progression-free (PFS), and cancer-specific (CSS) survival were estimated using the Kaplan-Meier method. Associations of baseline characteristics with outcomes were evaluated using Cox regression.

Results: A total of 213 patients were included, representing 332 cancer occurrences. Median age at diagnosis was 72 (interquartile range [IQR] 65-80) years. Median followup for RFS, PFS, and CSS was 13, 20, and 36 months, respectively. The one-, three-, and five-year event-free rates were 65%, 51%, and 48% for RFS; 85%, 78%, and 72% for PFS; and 99%, 95%, and 95% for CSS. There was a median of 1 (IQR 1-2) recurrence per patient, with a median time to first recurrence of seven months (IQR 4-14) and a median time between recurrences of seven months (IQR 5-18). Larger tumor size was associated with increased risks of recurrence. Receipt of adjuvant intravesical therapy was associated with reduced risks of recurrence and progression.

Conclusions: Contemporary five-year recurrence and progression rates for HGT1 bladder cancer remain high at 53% and 28%, respectively. The disease burden is substantial, with a median time between recurrences of seven months. These results can inform patient counseling, management, and clinical trial design.

Introduction: Erectile dysfunction (ED) is a significant issue that adversely affects the quality of life in young men. Venous leakage is a common etiologic factors of ED. This study aimed to evaluate the clinical efficacy and safety of venous ligation applied to incidentally detected dorsal penile vein anomalies during penoscrotal surgeries.

Methods: The study included 32 young male patients who presented with ED and underwent surgery for penoscrotal pathology (e.g., varicocele, hydrocele, spermatocele), during which an isolated dorsal penile vein anomaly was concurrently ligated. Patients were assessed preoperatively and at three and six months postoperatively using the International Index of Erectile Function (IIEF-5). Postoperative erectile response, patient satisfaction, and the presence of complications were also evaluated.

Results: The mean age was 33.1±5.4 years. The median operative time was 20 minutes (18-25), and the median followup duration was six months (6-9). The median IIEF-5 score increased from 18 (17-19) preoperatively to 21 (20-22) at three months and 22 (22-24) at six months (p1<0.001, p2<0.001, p3<0.001). Patient satisfaction improved significantly, with median satisfaction scores of 8 (8-9) at three months and 9 (8-10) at six months (p3<0.001). The need for PDE5i therapy decreased markedly, from 100% preoperatively to 56.2% at three months and 31.3% at six months (p1<0.001, p2<0.001, p3<0.001). No perioperative or postoperative complications were recorded.

Conclusions: Venous ligation applied to incidentally detected dorsal penile vein anomalies during penoscrotal surgeries represents an effective and reliable therapeutic option for young patients with ED.

Introduction: Our aim was to assess how monoplanar fluoroscopy-guided access affects the outcomes of percutaneous nephrolithotomy (PCNL).

Methods: This retrospective study included all patients who had renal stones and underwent prone PCNL using monoplanar fluoroscopy-guided access in a single tertiary care center between January 2015 and January 2024. Preoperative and postoperative patient- and procedure-related variables, such as operative time, intraoperative blood loss, number of tracts, complications, stone-free rate (SFR), and hospital stay, were assessed. Multivariable analysis was performed to detect predictors of residual stones and complications.

Results: A total of 662 patients with an average age of 47±12 years were included. Comorbidities were reported in 26.1%. American Society of Anesthesiologists (ASA) score was I in 64.8%. The mean stone diameter was 2.8±0.9 cm. Only 6% had positive preoperative urine culture. The mean stone Hounsfield unit (HU) was 1054±304 with a mean operative time of 94±31 minutes. Most cases (74.9%) required only one tract. Postoperative fever was reported in 22.4%. The median estimated blood loss (EBL) was 160 mL. The complications included urine leak (4.1%), blood transfusion (1.5%), sepsis (1.5%), renal pelvic perforation (0.8%), superselective angio-embolization (0.6%), pleural injury (0.6%), and colonic injury (0.2%). The median hospital stay was three days. Approximately 73% were stone-free. The only predictor of residual stone was higher stone diameter (odds ratio [OR] 1.536, p=0.001). Predictors of complications were three tracts (OR 4.501, p=0.033) and higher EBL (OR 1.003, p<0.001).

Conclusions: The monoplanar fluoroscopy-guided approach has demonstrated a noteworthy success rate, rendering it a safe modality for prone conventional PCNL.

Introduction: We sought to evaluate multiparametric magnetic resonance imaging (mpMRI) findings and biopsy results in men with an indwelling catheter undergoing prostate cancer screening. mpMRI is central to the evaluation of prostate cancer. Little is known about the effect of an indwelling urinary catheter on prostate mpMRI findings and the results of subsequent biopsies.

Methods: We retrospectively reviewed 5820 mpMRI exams performed from 2017-2023. Forty-eight patients underwent mpMRI with an indwelling urinary catheter. Using propensity score matching, patients were matched 1:1 for age, pre-biopsy prostate-specific antigen (PSA), and prostate volume. Clinical characteristics, mpMRI findings, and targeted biopsy results were compared between the groups.

Results: After propensity score matching, clinical characteristics of the study groups did not differ significantly. Prostate Imaging-Reporting & Data System (PI-RADS) distribution did not show a significant difference (p=0.51); PI-RADS ≥3 lesions were identified in 20/48 (42%) patients with indwelling catheters and in 18/50 (36%) patients without catheters. Among patients with a PI-RADS score ≥3, clinically significant prostate cancer (csPCa) was identified in 5/20 patients carrying catheters and 6/18 patients without catheters (p=0.152). A higher rate of any cancer was identified in patients without a catheter (67% vs. 35%, p=0.049). PSA >9.79 ng/ml predicted the finding of csPCa in patients carrying urinary catheters with PI-RADS ≥3 lesions.

Conclusions: Our findings suggest no significant difference in mpMRI findings and csPCa rates for patients with and without indwelling urinary catheters. Patients carrying urinary catheters suspected to harbor csPCa based on an elevated PSA level should undergo further evaluation, including mpMRI and biopsies when necessary before benign prostatic hyperplasia treatment.