Minerva Urology and Nephrology最新文献

Background: Predicting whether recurrence will occur during follow-up in bladder cancer cases confined to the mucosa (Ta-stage) is one of the crucial aspects of management. In this study, we aimed to compare the models obtained by conventional statistical methods and machine learning (ML) methods in order to predict the development of recurrence in the 2-year postoperative period in Ta stage Non-Muscle Invasive Bladder Cancers.

Methods: The data of patients who underwent complete transurethral resection of the bladder and were found to have Ta pathologies due to primary bladder cancer between 2018-2021 was retrospectively screened. Patients with no recurrence during the two-year follow-up were classified as Group 1 (N.=107, 58.2%), and those with recurrence were classified as Group 2 (N.=77, 41.8%). The demographic, clinical, imaging and pathological data were recorded. These parameters were analyzed using a conventional statistical method and ML methods to construct prediction models.

Results: Body Mass Index, American Society of Anesthesiologists (ASA) score, and the presence of macroscopic hematuria were found to be significant variables to predict early recurrence (P<0.05). The prediction model created by Cox-regression analysis was determined to have a sensitivity of 65%, specificity of 63.6%, and an area under the curve (AUC) value of 66%, while the AUC values achieved by the ML methods, namely random forest, logistic regression, and k-nearest neighbors, were calculated to be 0.75, 0.87 and 0.74, respectively.

Conclusions: Models developed using ML can provide more accurate predictions than conventional statistical methods in predicting the recurrence of Ta bladder cancer.

Background: Peyronie's disease (PD) is a progressive fibrotic disorder of the tunica albuginea that impairs penile anatomy, sexual function, and quality of life. With no approved pharmacological treatments in Europe after the withdrawal of collagenase Clostridium histolyticum (CCH), intralesional hyaluronic acid (HA) has emerged as a potential option. This study aims to assess the clinical effectiveness of HA in PD, focusing on patient-reported outcomes via the Peyronie's Disease Questionnaire (PDQ).

Methods: This prospective observational study included patients treated with weekly intralesional HA injections for 8 weeks, combined with penile modeling and daily tadalafil. Inclusion required a penile curvature >30° and at least one episode of penetrative intercourse within the past 3 months. Penile curvature, IIEF-5, and PDQ scores were assessed at baseline and after 3 months.

Results: Sixty-six patients were included. Total PDQ scores improved from 61.5 (50.0-67.0) to 40.0 (26.8-49.0; P<0.001), with a mean reduction of -19.9±9.7. Specifically, all three domains of the PDQ questionnaire (Penile Pain, Penile Deformity, and Symptom Bother) showed a significant improvement (P<0.001). No adverse events were recorded.

Conclusions: Intralesional HA injections are safe and effective in improving patient's reported symptoms and subsequently quality of life in PD patients. This therapy may represent a valuable alternative in real-world clinical practice, especially in Europe where other pharmacological options are lacking.

Prostate biopsy is often perceived as an invasive and painful procedure, frequently associated with significant emotional distress. Despite the use of local anesthesia, a considerable proportion of patients still report pain and anxiety. Hypnosis has been demonstrated to reduce procedural discomfort; however, its clinical use is limited by the requirement of trained professionals and time constraints. This preliminary study evaluates the feasibility and potential benefits of digital sedation using immersive virtual reality (VR) with the HypnoVR system in five patients undergoing prostate biopsy. Patients selected their preferred virtual environment and started wearing the device four minutes before the procedure. Anxiety and pain were assessed using Visual Analog Scales (VAS), and vital signs were monitored as physiological surrogates. Results revealed low pre-procedural anxiety (median 1/10 ±1) and moderate pain during (median 5.6/10 ±1.1) and immediately after biopsy (median 3/10 ±2.2), with no pain reported at 24 hours. All patients reported high satisfaction and no complications occurred. Transrectal biopsies were performed without anesthesia, while the transperineal ones were carried out using subcutaneous anesthesia only, with no significant differences in tolerability. Although limited by its small sample size, this initial experience supports the potential role of VR-based hypnosis as a non-pharmacological, patient-centered approach to enhance comfort and reduce invasiveness during prostate biopsy.

Minimally invasive surgery like robotic surgery is known to yield better outcomes in terms of blood loss, blood transfusion, and length of stay, and robot-assisted radical prostatectomy provides a clear example compared to open surgery. It is still constrained by issues related to platform availability and cost-effectiveness. Introducing new robotic platforms, such as the HUGO^™ Robot-Assisted Surgery (RAS) System, could lead to longer operating times caused by the surgeon's learning curve, system configuration, adjustment of robotic devices, and robotic docking. Several studies have assessed the influence of resident physicians on outcomes in urological surgeries. Our main objective was to evaluate the learning curve of the docking time for 195 radical prostatectomies performed in our hospital. The results of our research indicate that the setup and docking process with the HUGO RAS system can be accomplished with ease, and the learning curve for robotic docking is consistent with the available data for other robotic platforms. Our training facilitated a rapid docking process and seamless completion of the surgery.