Minerva Urology and Nephrology最新文献

Introduction: Achieving stone-free status (SFS) is a key goal of endourological treatment, yet definitions of SFS and clinically insignificant residual fragments (CIRF) remain controversial. While CIRF is frequently defined as residual fragments ≤4 mm, there is no consensus on its clinical significance regarding complications and re-intervention needs. We evaluate the risk of complications and the need for re-intervention associated with the presence of CIRF following endourological treatment for urolithiasis.

Evidence acquisition: PubMed/Medline, Scopus, Web Of Science, and Embase databases were searched for articles relating to SFS and CIRF definitions and outcomes, in February 2025, using keyword combinations: "stone-free rate," "residual fragments," "clinically insignificant residual fragments," "urinary calculi," "urolithiasis," "complications," and "outcome". Inclusion criteria were all studies with SFS/CIRF definition and complications associated with residual fragments following treatment (shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy).

Evidence synthesis: Fifty-two studies met inclusion criteria. From the pooled analysis the probability of spontaneous expulsion of CIRF≤4 mm was 33% (95% CI: 12-50%; P<0.001), while regrowth occurred in 32% (95% CI: 23-40%; P<0.001). CIRF-related complications were observed in 27% (95% CI: 21-34%; P<0.001), and the re-intervention rate was 21% (95% CI: 16-26%; P<0.001). Within a variable mean follow-up ranging from 3 to 59 months. The risk of bias was moderate overall, with single-arm studies exhibiting the highest bias risk.

Conclusions: Patients with CIRF≤4 mm should be monitored closely and informed about the non-neglectable likelihood of complications and of re-intervention. On the other hand, they have one probability out of three of spontaneous passage. Endourologist and patients should be aware of these outcomes to better plan the management, follow-up, and the "insignificant" nature of residual fragments. Hence, the aim of surgeries should be achieving the complete SFS, especially in high-risk stone former patients.

Background: The growing use of smartphones offers a key opportunity to monitor BPO/LUTS through well-designed medical apps. The primary objective of the study was to assess the feasibility and acceptability of a mobile app (MyBPHCare) for men with lower urinary tract symptoms (LUTS). Secondary objectives included medical adherence using electronic reminders and compliance of treatment with current guidelines.

Methods: This was an observational cohort pilot study conducted in Greece, Türkiye, and Italy. Patients with LUTS, treatment-naïve or under treatment, older than 40 years were eligible. Patients received standard care according to physician's practice and duration of follow-up was 6 months. Standard questionnaires, diagnostic tools, medication, and follow-up visits were employed. Feasibility, acceptance, and satisfaction were assessed using a standardized, translated and validated app rating user questionnaire (uMARS). Patients' adherence to treatment and physicians' with guidelines were also recorded.

Results: From a total of 157 patients, 68.15% filled in the uMARS questionnaire. All uMARS mean scores ranged between "Acceptable" and "Good": App Quality (3.43), Engagement (3.21), Functionality (3.47), Aesthetics (3.37), and Information (3.68). 96.3% of the participants would recommend using the app. Recorded adherence to medication was 47.85%, while a discrepancy between guidelines and real-life practice was found.

Conclusions: MyBPHCare app is a possibly feasible application for virtually monitoring men with LUTS with good acceptance from the patients.

Background: To determine the utility of creatinine-to-hemoglobin (Cr:Hgb) ratio, as a predictor of survival outcomes in upper tract urothelial carcinoma (UTUC).

Methods: We performed a multi-institutional retrospective analysis of UTUC-patients who underwent robotic radical nephrouretectomy utilizing the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) registry. Patients were divided into elevated Cr:Hgb ratio (>0.15, based on upper-limit of normal for creatinine and lower-limit of normal for hemoglobin) vs. non-elevated Cr:Hgb ratio (≤0.15). Primary outcome was all cause mortality (ACM)/overall survival (OS). Secondary outcomes were cancer-specific mortality (CSM) / survival (CSS) and recurrence-free survival (RFS). Cox proportional hazards (MVA) was used to elucidate predictive factors for ACM, CSM, and RFS. Kaplan-Meier analysis (KMA) was performed to analyze 5-year OS, CSS, and RFS.

Results: Overall, 829 patients were analyzed (744 non-elevated / 85 elevated Cr:Hgb). Elevated Cr:Hgb patients had more frequently advanced-stage (P=0.016) and high-grade tumors (P<0.001) at time of surgery. MVA demonstrated increasing-age (HR=1.04, P=0.002), elevated Cr:Hgb (HR=2.49, P=0.003), lympho-vascular invasion (HR=4.61, P<0.001), and higher-stage (HR=3.82, P<0.001) to be associated with worsened ACM. Increasing-age (HR=1.04, P=0.030), elevated Cr:Hgb (HR=3.64, P<0.001), and lympho-vascular invasion (HR=4.52, P<0.001) were independently associated with worsened CSM. Elevated Cr:Hgb (HR=1.27, P=0.001) was independently associated with worsened recurrence. For elevated vs. non-elevated Cr:Hgb patients, KMA revealed significantly worse 5-year OS (78% vs. 65%, P=0.002), CSS (86% vs. 74%, P<0.001), and RFS (53% vs. 22%, P=0.004).

Conclusions: Baseline elevated Cr:Hgb predicted worsened survival outcomes in UTUC patients and may serve a pre-operative marker to stratify oncologic risk and guide counseling and management.

Background: Intravesical Bacillus Calmette-Guérin (BCG) is an established adjuvant therapy for high-risk superficial bladder cancer, though its efficacy varies among patients. Recent interest in the urinary microbiome comprising microorganisms inhabiting the urinary tract stems from its potential impact on various urological conditions, including bladder cancer. Our study investigates the possible relationship between the bladder microbiome and BCG therapy outcomes in a preliminary and explorative analysis.

Methods: We conducted a retrospective, descriptive study involving 31 high-risk bladder cancer (BC) patients treated with BCG. BC tissues were collected pre-treatment, and formalin-fixed paraffin-embedded (FFPE) samples were analyzed. DNA extracted from these samples underwent high-throughput 16S rRNA amplicon sequencing targeting the V1-V3 regions.

Results: Our cohort consisted of 15 BCG-resistant patients and 16 responders. Median instillation numbers were six (IQR: 6-9) for resistant patients and twelve (IQR: 14-15) for responders, with a median follow-up length of six months (IQR: 3.3-9.5) and 43 months (IQR: 24-55), respectively. Significant differences were observed in the microbiome: BCG responders showed higher median percentages of Firmicutes (1.1 vs. 0.3, P=0.0293) and Verrucomicrobiota (0.9 vs. 0.1, P=0.0285). Additionally, Fusobacteriota was more prevalent among responders (75% vs. 33.3%, P=0.0198), while Cyanobacteria were more common in resistant patients (73.3% vs. 31.3%, P=0.0191).

Conclusions: Our preliminary findings illuminate the bladder microbiome's role in influencing BCG therapy outcomes, underscoring the complex microbial interplay affecting treatment efficacy in urological diseases. This explorative study sets the groundwork for ongoing data collection and future research pathways aimed at further delineating these relationships.

Background: Robotic-assisted surgery, particularly with the da Vinci Single-Port system, enables precise operations in confined anatomical spaces like the retroperitoneum. However, the complexity of retroperitoneal anatomy challenges spatial orientation, especially for novice surgeons. This study aimed to develop and validate an Artificial Intelligence (AI)-based framework for real-time segmentation and feature tracking in Single-Port retroperitoneal robotic-assisted nephrectomies.

Methods: A convolutional neural network based on YOLACT++ was used for instance segmentation. The model was trained on annotated video frames from 15 patients who underwent SP nephrectomies. Key anatomical landmarks and surgical instruments were segmented and detected in real-time. Model performance was evaluated using the Area Under the Precision-Recall Curve.

Results: The model achieved Area Under the Precision-Recall Curve values ranging from 0.759 to 0.901 for anatomical landmarks and up to 0.887 for surgical instruments. Limitations include a small dataset (150 annotated frames), which may lead to overfitting, and lower segmentation precision for some features, such as the ureter. Further validation in live surgical settings and diverse procedures is needed.

Conclusions: This study demonstrates the potential of AI for real-time surgical guidance in Single-Port retroperitoneal procedures. The proposed framework could enhance spatial orientation, improve training for novice surgeons, and streamline complex retroperitoneal surgeries. Future research will focus on expanding the dataset, improving segmentation accuracy, and integrating the model into live surgeries for broader applicability.