Minerva Urology and Nephrology最新文献

Background: The rising incidence of kidney stones underscores the imperative to devise effective preventive measures. While a robust association between cardiovascular disease (CVD) and kidney stones exists, the current research landscape lacks investigations between cardiovascular health (CVH) and kidney stones. This study aims to explore the association between CVH, assessed by Life's Essential 8 (LE8), and kidney stones, with the role of blood lipids and insulin resistance in this relationship.

Methods: The study included 19,942 adults aged ≥20 from the National Health and Nutrition Examination Survey of the US from 2007 to 2018. LE8, measuring CVH, includes four behavior and four factor metrics. Participants were categorized into high, moderate, and low CVH levels according to LE8 Scores: 80-100, 50-79, and 0-49, respectively. Kidney stones cases were identified through interviews and self-reported records. Weighted multivariate linear regressions, weighted logistic regressions, restricted cubic spline (RCS) analysis, mediation analyses, and sensitivity analyses were conducted.

Results: In the fully adjusted logistic model, 10-point increase in LE8 Score exhibited a significant 19% reduction in kidney stones prevalence (OR=0.81, 95% CI: 0.77-0.85). The RCS confirmed the nonlinear association between LE8 Score and kidney stones (P for non-linearity: 0.004). Mediation analyses showed the mediation proportions of 19.62%, 24.26%, and 27.82% for high-density lipoprotein (HDL), insulin resistance (HOMA-IR), and serum insulin, respectively. The mediation proportions of the HOMA-IR-HDL and serum insulin-HDL pathways were 6.62% and 5.96%, respectively.

Conclusions: This study illuminates a negative association between CVH and kidney stones, providing an effective strategy for kidney stones prevention.

Background: Approximately 70% of bladder cancer is diagnosed as non-muscle invasive (NMIBC) and inflammation is known to impact the oncological outcomes. Adjuvant intravesical BCG in intermediate/high risk can lower recurrence and progression. The efficacy of intravesical BCG can be impacted by smoking effects on systemic inflammation.

Methods: Our retrospective, multicenter study with data from 1.313 NMIBC patients aimed to assess the impact of smoking and the systemic inflammatory status on BCG response in T1G3 bladder cancer, using a machine-learning CART based algorithm.

Results: In a median of 50-month follow-up (IQR 41-75), 344 patients experienced progression to muscle invasive or metastatic disease and 65 died due to bladder cancer. A CART algorithm has been employed to stratify patients in three prognostic clusters using smoking status, LMR (lymphocytes to monocytes ratio), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) as variables. Cox regression models revealed a 1.5-fold (HR 1.66, 95%, CI 1.20-2.29, P=0.002) and three-fold (HR 2.99, 95% CI 2.08-4.30, P<0.001) risk of progression, in intermediate and high risk NMIBC respectively, compared to the low-risk group. The model's concordance index was 0.66.

Conclusions: Our study provides an insight into the influence of smoking on inflammatory markers and BCG response in NMIBC patients. Our machine-learning approach provides clinicians a valuable tool for risk stratification, treatment, and decision-making. Future research in larger prospective cohorts is required for validating these findings.

Background: The aim of this study was to report our technical experience and mid-term outcomes of robot-assisted redo ureteral reimplantation in adults following failed primary ureteral reimplantation.

Methods: Twelve patients underwent robot-assisted redo ureteral reimplantation from December 2020 to May 2022 at double centers. Surgical procedures included anti-reflux dismembered submucosal tunnel reimplantation, anti-reflux dismembered nipple reimplantation, and anti-reflux non-dismembered submucosal tunnel reimplantation. The perioperative variables were prospectively collected, and the outcomes were assessed.

Results: Twelve patients underwent 13 robot-assisted redo ureteral reimplantations. Anastomotic stenosis was the primary cause of redo surgery, accounting for 83.3% of cases. Additionally, 83.3% of patients had received balloon dilation, stent placement, and other urological treatments after primary surgery. All patients successfully underwent robot-assisted redo ureteral reimplantation without conversion to open or laparoscopic surgery. All patients underwent anti-reflux technique, with 9 patients undergoing submucosal tunnel reimplantation (75%) and 3 nipple reimplantation (25%). Psoas hitch was required in eight patients (66.7%). The mean operative time was 129.3±29.0 minutes. The median postoperative hospitalization time was 3.0 (IQR, 3.0, 3.0) days. At a mean follow-up of 15.7±5.9 months, all patients achieved complete success with no severe complication. Two patients (16.7%) still experienced vesicoureteral reflux related symptoms postoperatively, which improved compared to preoperatively.

Conclusions: Robotic redo ureteral reimplantation is safe and effective. The success of redo surgery is attributed to preoperative nephrostomy, clearing the fibrous scar surrounding the ureter, appropriate selection of anti-reflux technique, and psoas hitch when needed.

Background: Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners.

Methods: One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications.

Results: The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups.

Conclusions: Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.

Background: To develop and evaluate a nomogram for predicting impacted ureteral stones using some simple and easily available clinical features.

Methods: From June 2019 to July 2022, 480 patients who underwent ureteroscopic lithotripsy (URSL) for ureteral calculi were enrolled in the study. From the eligible study population between June 2019 and December 2020, a training and validation set was randomly generated in a 7:3 ratio. To further evaluate the generalization performance of the nomogram, we performed an additional validation using the data from January 2021 to July 2022. Lasso regression analysis was used to identify the most useful predictive features. Subsequently, a multivariate logistic regression algorithm was applied to select independent predictive features. The predictive performance of the nomogram was assessed using Receiver Operating Characteristic (ROC) curves, calibration curves and decision Curve Analysis (DCA). The Hosmer-Lemeshow Test was utilized to evaluate the overall goodness of fit of the nomogram.

Results: Multivariate logistic regression analysis showed that flank pain, hydronephrosis, stone length/width, HU below (Hounsfield unit density of the ureter center below the stone), HU above/below (HU above divided by HU below) and UWT (ureteral wall thickness) were ascertained as independent predictors of impacted ureteral stones. The nomogram showed outstanding performance within the training dataset, with the area under the curve (AUC) of 0.907. Moreover, the AUC was 0.874 in the validation dataset. The ROC curve, calibration curve, DCA curve and Hosmer-Lemeshow Test suggested that the nomogram maintains excellent clinical applicability and demonstrates commendable performance. Similar results were achieved in the test dataset as well.

Conclusions: We established a nomogram that can be effectively used for preoperative diagnosis of impacted ureteral stones, which is of great significance for the treatment of this disease.