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.