Minerva Urology and Nephrology最新文献

Introduction: Urolithiasis prevalence and ureteroscopic lithotripsy utilization have increased ureteral strictures' visibility. It is imperative to summarize the global epidemiological trends and investigate risk factors associated with lithotripsy itself.

Evidence acquisition: A systematic review of English literature was conducted to assess the incidence of ureteral strictures following lithotripsy across all age groups. Comprehensive analyses, including meta-regression, network meta-analysis, and Joinpoint regression, were used to investigate subgroup incidence. Machine learning algorithms identified influencing factors related to lithotripsy.

Evidence synthesis: This study included 43 studies, estimating an overall ureteral stricture (US) occurrence rate of 1.7% and 2.9% over the past decade, indicating an upward trend. Subgroup analysis showed the lowest postoperative stenosis incidence of 1.4% for flexible combined with semi-rigid ureteroscopy. Laser lithotripsy had a higher incidence (2.4%) than pneumatic lithotripsy (1.7%), with an odds ratio (OR) of 4.61 (95% CI: 2.0-10.6). Middle and proximal segment strictures had higher ORs compared to the distal segment (2.2, 95% CI: 1.1-4.1; 2.0, 95% CI: 1.1-3.5, respectively). Machine learning models indicated that operation time is a significant predictor of postoperative stenosis. Joinpoint regression identified a change point at 45 minutes of surgical time (MPC=2.18, P<0.05), with increased stenosis incidence thereafter.

Conclusions: The prevalence of US post-lithotripsy is increasing. Different endoscope types, lithotripsy methods, and locations show distinct incidence rates. Patients with urinary lithotripsy lasting longer than 45 minutes should be actively evaluated for potential stenosis.

Background: Teupolioside effectively reduced hirsutism in policystic ovary sindrome by lowering hormonal levels, thus suggesting potential for benign prostatic hyperplasia (BPH) treatment. This study will assess Dihydrotestosterone (DHT) levels and prostate inflammation in BPH patients before and after Xipag^® (Ajuga Reptans extract) administration.

Methods: Formalin-fixed paraffin embedded (FFPE) samples from prostate biopsies (PB) and trans-urethral resection (TURP) specimens of 10 patients with elevated Prostate Specific Antigen (PSA) were analyzed. All had prostate inflammation and BPH at biopsy and received Xipag^® (1 tablet/day, median 50 days) between PB and TURP. DHT tissue levels, CD4+, and CD8+ lymphocyte expression were assessed via 3'-3' diaminobenzidine staining on 5 µm sections. Serum PSA levels were measured before PB and prior to TURP. All antigens were visualized using the same secondary antibody, producing a uniform brown stain. A paired t-test compared conditions.

Results: Total PSA serum levels dropped from 4.21 (3.61-8) ng/mL pre-PB to 2 (1.53-3.03) ng/mL post-Xipag^® and pre-TURP (P=0.016). Xipag^® significantly reduced CD4+ recruitment by 46.1% and increased CD8+ by 19.89%, enhancing CD4+ target cell elimination (P=0.0003; P=0.0006), indicating inflammatory normalization in BPH tissue. DHT expression decreased by 26.67% post-treatment (P=0.0002; CI -36.08, -17.25).

Conclusions: The short period of Xipag^® administration effectively reduced DHT and PSA levels in patients affected by BPH. Additionally, it decreased CD4+ T lymphocyte infiltration while promoting CD8+ T lymphocytes, leading to a normalization of the prostate tissue inflammatory infiltrate.

Introduction: Interstitial cystitis/bladder pain syndrome is a chronic bladder condition with a rising incidence that significantly impacts the lives of millions worldwide. The lack of understanding regarding the pathophysiology of this condition has resulted in a deficiency of effective treatment options. However, the development of regenerative medicine has brought platelet-rich plasma into our field of vision. Platelet-rich plasma may address unresolved inflammation in the interstitial cystitis/bladder pain syndrome bladder and facilitate the restoration of bladder and urethral barrier function through repeated injections, potentially reducing bladder pain. Our aim is to investigate the efficacy and safety of intravesical injection of platelet rich plasma in the treatment of interstitial cystitis/bladder pain syndrome.

Evidence acquisition: A comprehensive search was conducted across PubMed, EMBASE, MEDLINE, Cochrane Library, and Web of Science databases for studies on platelet-rich plasma injection for the treatment of interstitial cystitis/bladder pain syndrome, with a search cutoff date of August 7, 2024.

Evidence synthesis: A total of 11 studies with 391 participants were included. The combined statistics indicated that the baseline interstitial cystitis symptom index score was 11.20±4.60, the interstitial cystitis problem index score was 10.81±3.51, and the pain score was 4.37±3.14. The results showed that compared to pre-treatment, the interstitial cystitis symptom index score decreased by 3.56 (95% CI -4.39 to -2.72, P<0.00001), the interstitial cystitis problem index score decreased by 3.24 (95% CI -3.90 to -2.58, P<0.00001), and the pain score decreased by 1.84 (95% CI -2.19 to -1.48, P<0.00001). Additionally, the average proportion of patients with a global response assessment score of ≥2 after treatment was 48% (95% CI 0.37 to 0.58, P<0.00001). Furthermore, the overall incidence of adverse events among patients was 2.9%.

Conclusions: Evidence-based statistical analysis results suggest that intravesical platelet-rich plasma treatment is effective and safe, potentially serving as a promising approach for managing interstitial cystitis/bladder pain syndrome.