Cuaj-Canadian Urological Association Journal最新文献

Introduction: Water vapor thermal therapy (WVTT), Rezūm, is a minimally invasive therapy that uses water vapor to ablate benign prostatic tissue. This study aimed to present the prospective, multicenter outcomes of the largest cohort of prostates ≥80 mL treated with Rezūm.

Methods: This study involved a prospective, WVTT registry that collated information from two high-volume centers between April 2019 and August 2024. Baseline medical histories, uroflowmetry (peak flow rate [Qmax], postvoid residual [PVR], and validated questionnaires (International Prostate Symptom Score [IPSS], IPSS quality of life (QoL), Benign Prostatic Hyperplasia Impact Index [BPHII], International Index of Erectile Function [IIEF-15], Male Sexual Health Questionnaire for Ejaculatory Dysfunction [MSHQ-EjD]) were recorded. The main outcomes assessed included symptom scores, functional improvement, and safety at baseline, six, 12, and 24 months.

Results: A total of 259 patients with a prostate volume ≥80 mL were treated with Rezūm. The median prostate volume was 105 mL, with 207 patients (81.2%) exhibiting a median lobe. The IPSS improved from 21.8 at baseline to 5.7 at 24 months. The IPSS QoL score improved from 4.5 at baseline to 1.1 at 24 months. At baseline, the Qmax rate was 8.2 mL/s, increasing to 14.9 mL/s at 24 months. PVR volume decreased from 132.5 mL at baseline to 90 mL at 24 months. The BPHII decreased from 7.5 at baseline to 2.3 at 24 months. There was no significant change in sexual function as measured by IIEF and MSHQ.

Conclusions: Rezūm therapy is a safe, effective, and minimally invasive option for managing large prostates (≥80 mL), providing significant and sustained improvements in urinary symptoms with minimal impact on sexual function.

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.