Minerva Urology and Nephrology最新文献

Background: Minimally invasive surgical treatments (MISTs) for benign prostatic hyperplasia (BPH) are increasingly adopted due to fewer complications and better preservation of ejaculatory function. However, real-world data on patient selection and clinical application in Italy remain scarce.

Methods: Patients undergoing Aquablation, Rezum, iTIND, TPLA, or PUL from October 2022 to December 2024 were prospectively enrolled by 15 Italian centers in the SIU Research Network. Baseline clinical, anatomical, and functional data were collected via a secure digital platform. Data were recorded using standardized electronic case report forms, and patient-reported outcomes were gathered through validated questionnaires administered at baseline and during follow-up.

Results: A total of 312 patients were enrolled: 30 (9.6%) Aquablation, 97 (31.1%) Rezum, 49 (15.7%) iTIND, 108 (34.6%) TPLA, and 28 (9.0%) PUL. iTIND patients were the youngest (median age 47, IQR 42-57), had the lowest prostate volume (30 mL, IQR 27.5-40), lowest comorbidity scores, and poorest Qmax (6.2 mL/s, IQR 5-8). Aquablation and TPLA were adopted for larger prostates (70 mL, IQR 50-80 and 67 mL, IQR 45-85, respectively). Median lobe was most frequent in Rezum (56.7%) patients. PUL patients had the lowest post-void residual (20 mL, IQR 5-60). Rezum and TPLA patients reported better ejaculatory function (P<0.02), while iTIND patients showed the highest dysfunction (P<0.05). Baseline QoL scores were comparable across groups.

Conclusions: This interim analysis shows that MIST adoption in Italy is influenced by prostate size, age, comorbidities, and functional profiles. The findings describe baseline selection patterns only, with postoperative outcomes to be reported in future analyses.

Introduction: Gradient-boosting (GB) algorithm is considered as the state-of-the-art algorithm for prediction of survival. The aim of the current study was consolidating the evidence on GB machine-learning (ML) model to predict graft survival (GS) after kidney transplant (KT).

Evidence acquisition: A systematic search (PROSPERO: CRD42025645353) with a qualitative analysis was performed according to PRISMA statement. Study quality and risk of bias were evaluated using the Prediction-model Risk of Bias ASsessment Tool (PROBAST).

Evidence synthesis: Overall, 15 studies involving 889,657 patients were included in the final analysis. Of those, 14,334 included GS information. According to ML algorithm, 12 (80.3%) studies relied on eXtremeGB, two (13.3%) on StochasticGB and one (6.4%) on lightGB. The model performance was evaluated with Area Under Curve (AUC) methodology in 12 (80%) of papers and ranged from 0.715 to 0.989. The Brier-score was evaluated in five (33.3%) papers and ranged from 0.020 to 0.14. The C-index and/or Accuracy were evaluated in three (20%) papers and ranged, in respectively, from 0.635 to 0.837, and from 0.81 to 0.979.

Conclusions: The current systematic review showed a promising potential role of GB in the GS prediction after KT. However, ML models should be carefully interpreted before being used in clinical practice.

Background: Retrograde intrarenal surgery (RIRS) is being increasingly used to treat 2-4 cm renal stones, which can be attributed to advances in flexible ureteroscopes and ureteral access sheaths (UASs). Despite the improvement and application of flexible vacuum-assisted (FV) and intelligent pressure-controlled (IPC) UASs, no studies have compared their therapeutic efficacy and safety. Therefore, this study aimed to compare the therapeutic efficacy and safety of IPC-UAS and FV-UAS in RIRS 2-4 cm renal stones.

Methods: We included 96 and 103 patients who underwent IPC-UAS and FV-UAS RIRS, respectively, for 2-4 cm renal stones. Stone-free rate (SFR), operative time, and complications were compared between the two groups.

Results: The immediate SFR was 69.8% and 82.5% in the IPC-UAS and FV-UAS groups, respectively (P<0.05). There were no significant between-group differences in the 1-month SFR (84.4% vs. 84.5%, P>0.05). The IPC-UAS group had a shorter hospital stay (5.2±2.4 vs. 6.2±3.2 days, P=0.018) and lower cost (CNY13014.7±3240.7 vs. CNY14022.5±2301.6, P=0.012) than the FV-UAS group. There were no significant between-group differences in operative time or complications.

Conclusions: Regarding RIRS for 2-4 cm renal stones, the IPC-UAS group can achieve a 1-month SFR similar to that of the FV-UAS group, with shorter hospitalization and lower cost. Additionally, the IPC-UAS is a promising device for efficient and safe RIRS, considering its intelligent pressure regulation. Our findings could inform optimal UAS selection for managing large renal calculi and demonstrate the utility of the novel IPC-UAS in improving outcomes of RIRS for 2-4 cm renal stones.

Background: The aim of this study is to compare the long-term clinical outcomes of minimally invasive partial adrenalectomy (MIPA) and minimally invasive total adrenalectomy (MITA) in patients with benign functional adrenal disease, using a standardized clinical outcome metric.

Methods: We conducted a retrospective, multicenter cohort study across six Italian institutions involved in the surgical management of adrenal disease. A total of 212 patients underwent MIPA (N.=41) or MITA (N.=171) for primary aldosteronism (PA, N.=111) or pheochromocytoma (PC, N.=101) between 2010 and 2022. Clinical outcomes were evaluated using the clinical cure classification proposed by Vorselaars et al., stratified by surgical approach and adrenal pathology. Perioperative parameters and postoperative steroidal replacement were also assessed.

Results: Median follow-up was 53.9 months (IQR 31.4-103.1). Rates of clinical cure, clear improvement, and failure were 61.0%, 17.1%, and 21.9% in the MIPA group, and 70.1%, 15.3%, and 14.6% in the MITA group, respectively (all P>0.54). Postoperative steroidal replacement was more common after MITA (19.5% vs. 9.9%, P=0.80). When stratified by pathology, clinical cure was significantly more frequent in PC compared to PA (86.1% vs. 52.3%, P<0.001). Complication rates were low and comparable between groups (P=0.82).

Conclusions: In selected cases, MIPA offers long-term clinical outcomes comparable to MITA, with a lower trend in steroidal replacement. Stratification by pathology confirmed the greater clinical reversibility of PC compared to PA. The clinical cure system proved applicable across disease types and surgical strategies, supporting its broader use as a pragmatic evaluative tool in adrenal surgery.

Background: Three-dimensional virtual models (3DVMs) have emerged as a promising tool to enhance both surgical precision and functional outcomes in complex robot-assisted partial nephrectomies (RAPN). This study aimed to compare perioperative and functional outcomes between two cohorts of patients undergoing RAPN for totally endophytic renal tumors, with and without the use of 3DVMs.

Methods: A retrospective analysis on a prospectively maintained dataset was conducted on 277 patients treated between 2019 and 2022, including 43 who underwent surgery with 3DVM assistance and 234 who relied on conventional two-dimensional (2D) imaging. Propensity-score matching (PSM) analysis using a 2:1 ratio was conducted to reduce selection bias. The primary outcome was achieving the "trifecta". Predictors of trifecta achievement were analyzed using multivariate logistic regression.

Results: After PSM, 43 patients in the 3DVM group were compared with 86 patients in the control group. Baseline patient- and tumor-related characteristics were similar between groups. Selective clamping was exclusively performed in the 3DVM group (16.3% vs. 0%, P=0.01). Global ischemia time was found significantly shorter in the 3D-guided group (median 10 vs. 14 min; P=0.01). Positive surgical margins (6.9% vs. 7.3%) did not differ significantly. Trifecta was achieved more frequently in the 3DVM group (76.7% vs. 68.2%, P=0.04). Multivariate analysis confirmed 3DVMs as an independent predictor of trifecta success (OR 1.58; 95% CI 1.12-1.99).

Conclusions: For totally endophytic renal tumors, 3DVM integration facilitated selective clamping and improved trifecta attainment, reinforcing its role in optimizing outcomes in complex nephron-sparing surgery.

Background: Simple nephrectomy (SN), a procedure performed for benign kidney conditions, can be more challenging and complicated than radical nephrectomy (RN). With the widespread adoption of minimally invasive surgery, robotic platforms have also been introduced for SN. In this study, we aim to compare perioperative outcomes and complications between single-port (SP) robotic-assisted (RA) SN and RN in a tertiary referral center.

Methods: Data from 63 consecutive patients who underwent SP-RASN and SP-RARN between December 2018 and December 2024 at a single center, performed by a single surgeon, were evaluated. We compared baseline patient characteristics, intraoperative and postoperative outcomes.

Results: A total of 33 SP-RARN and 30 SP-RASN were included. There were no differences between the two groups in terms of operation time and estimated blood loss (P=0.741, P=0.587, respectively). None of the patients in the SP-RASN group required conversion to open surgery, and no intraoperative complications were observed. In the SP-RASN group, the median length of hospital stay (LOS) was 0.5 (0-1.25) days, and the same-day discharge (SDD) rate was 50%. The numbers of patients with Clavien grade 1 and grade 2 complications for SP-RASN was 3 (10%) and 4 (13.3%), respectively. There was a 0% incidence of major postoperative complications (≥Clavien-Dindo grade 3). LOS, SDD, postoperative complications and readmission rates were similar between groups (P=0.120, P=0.064, P=0.854, P=0.498, respectively).

Conclusions: SP-RASN is a feasible option for the management of benign renal conditions/diseases, offering a low postoperative complication rate and the possibility of SDD.