BJUI compass最新文献_第6页

Development of a prediction model for urinary tract infection risk after open reimplantation in children with primary unilateral vesicoureteral reflux: A multicentre study 原发性单侧膀胱输尿管反流患儿开腹再植术后尿路感染风险预测模型的建立：一项多中心研究

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-17 DOI: 10.1002/bco2.70111

Khadija Ismail, Mohamad Moussa, Bilal Aoun, Mohamad Abou Chakra, Anthony Kallas-Chemaly, Priyank Yadav, Christian Kruppa, Katrin Schuchardt, Alexandra Wilke, Pascale Salameh, Amal Al-Hajje

Objectives

To develop a predictive model for symptomatic postoperative febrile urinary tract infections (UTIs) in children undergoing open reimplantation for vesicoureteral reflux (VUR) and evaluate the association with VUR recurrence.

Patients and methods

This multicentre retrospective study included children with unilateral VUR (grades III–V) who underwent open Cohen or Lich-Gregoir reimplantation (2010–2022), had recurrent febrile UTIs, and ≥1 year follow-up. Analyses used 10-pooled multiple imputation, with complete case for sensitivity. Full and Least Absolute Shrinkage and Selection Operator (LASSO) Weibull regression models with centre clustering, bootstrapping, and 10-fold cross-validation identified predictors. Prediction used demographic, clinical, procedural and antibiotic factors. The non-scaled LASSO model informed the nomogram, evaluated using C-indices, calibration and decision curve analysis (DCA). UTI and VUR recurrence were analysed via cumulative incidence.

Results

A total of 404 children (median age 8 (6–9) years; follow-up 2.3 (2.0–3.3) years, 233 complete-case) were analysed. Median preoperative febrile UTIs were four, 74.5% had antibiotic resistance and median postoperative prophylaxis was two days. The 3-year cumulative incidence of postoperative UTI was 27.2% (95% CI: 22.9–31.6). LASSO-significant predictors included operative time (HR 1.10, 95% CI 1.03–1.16); in sensitivity analyses, prior injection (HR 2.08, 95% CI 1.88–2.30) and postoperative antibiotic duration (HR 0.81, 95% CI 0.69–0.97) were also significant. The nomogram included preoperative fever, antibiogram resistance, renal defect, VUR phase, prior injection, surgical indication, catheterization, hospitalization and stenting. The model performed well (C-indices = 0.743; calibration slope = 1), with DCA supporting clinical utility for 10–40% predicted risk. Recurrent VUR grade ≥II after 12 months (3.3%–12.7% at 1–3 years, n = 273) did not increase UTI risk.

Conclusions

Children with unilateral dilating VUR remained at risk of postoperative febrile UTIs. The nomogram can assist in identifying high-risk children for targeted interventions, but requires external validation and refinement.

目的：建立膀胱输尿管反流（VUR）患儿开窗再植术后症状性发热性尿路感染（uti）的预测模型，并评估其与VUR复发的关系。患者和方法：这项多中心回顾性研究纳入了接受开放性Cohen或Lich-Gregoir再植术（2010-2022）的单侧VUR （III-V级）儿童，有复发性发热性尿路感染，随访≥1年。分析使用10池多重输入，具有完全的敏感性。完全和最小绝对收缩和选择算子（LASSO）威布尔回归模型与中心聚类，自助和10倍交叉验证确定的预测因子。预测采用人口统计学、临床、程序和抗生素因素。非比例LASSO模型通知nomogram，使用c指数、校准和决策曲线分析（DCA）进行评估。通过累积发生率分析UTI和VUR复发情况。结果：共404例患儿(中位年龄8（6-9）岁；随访2.3年（2.0 ~ 3.3年），完整病例233例。术前发热性尿路感染中位数为4例，74.5%为抗生素耐药，术后预防中位数为2天。术后3年累计尿路感染发生率为27.2% （95% CI: 22.9-31.6）。lasso显著预测因素包括手术时间（HR 1.10, 95% CI 1.03-1.16）；在敏感性分析中，既往注射（HR 2.08, 95% CI 1.88-2.30）和术后抗生素持续时间（HR 0.81, 95% CI 0.69-0.97）也具有显著性。影像学检查包括术前发热、抗生素耐药性、肾缺损、VUR分期、既往注射、手术指征、置管、住院及支架置入术。该模型表现良好（c指数= 0.743；校准斜率= 1），DCA支持10-40%预测风险的临床效用。12个月后复发VUR分级≥II（1-3年3.3%-12.7%,n = 273）不增加UTI风险。结论：单侧VUR扩张性患儿仍有术后发热性uti的风险。nomogram nomogram nomogram nomogram nomogram nomogram nomogram nomogram

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引用次数: 0

Robotic vs. open ureteral reimplantation: A retrospective comparative single-centre series 机器人与开放输尿管再植：回顾性比较单中心系列。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-16 DOI: 10.1002/bco2.70110

Alice Bourillon, Lucas Freton, Gregory Verhoest, Juliette Hascoet, Claire Richard, Camille Haudebert, Romain Mathieu, Lee C. Zhao, Karim Bensalah, Benoit Peyronnet

Objectives

To compare the outcomes of open versus robotic ureteral reimplantation procedures at a single centre.

Material and methods

The charts of all patients with ureteral strictures who underwent open ureteral reimplantation between 2005 and 2024, and those who underwent robotic reimplantation between 2013 and 2024, were retrospectively reviewed, and the outcomes of the two approaches were compared.

Results

Eighty patients were included in the final analysis: 45 in the open surgery group and 35 in the robotic group. After a median follow-up duration of 16,5 months for the open group and 10 months for the robotic group, the stricture recurrence rate was similar in both groups (6,8% vs. 8.6%; p = 0.99). In terms of long-term complications, there were similar rates of symptomatic reflux (4.4% vs. 5.7%; p = 0.99) and flank pain (8.9% vs. 8.6%; p = 0.99) between both groups. There were more recurrent urinary tract infections in the open group (17.8% vs. 8.6%) and more de novo lower urinary tract symptoms in the robotic group (11.4% vs. 2.2%), but these differences were not statistically significant (p = 0.33 and p = 0.16, respectively). Overall, 30 patients (38%) had at least one long-term complication (35.6% vs 40%; p = 0.82). The only variable significantly associated with the risk of stricture recurrence was radiotherapy (OR = 11.2; p = 0.01).

Conclusion

The robotic approach appears to be non-inferior to the open approach in terms of stricture recurrence while being associated with a shorter length of hospital stay and lower estimated blood loss. More importantly, the present series raises questions regarding the long-term consequences of ureteral reimplantation and confirms the higher risk of failure in radiated patients.

目的：比较单一中心开放输尿管与机器人输尿管再植术的结果。材料与方法：回顾性分析2005 - 2024年所有输尿管狭窄行开放输尿管再植术患者的病历，以及2013 - 2024年所有行机器人输尿管再植术患者的病历，比较两种方法的结果。结果：最终纳入80例患者：开放手术组45例，机器人组35例。切开组和机器人组的中位随访时间分别为16.5个月和10个月，两组的狭窄复发率相似（6.8% vs 8.6%; p = 0.99）。在长期并发症方面，两组有相似的症状性反流发生率（4.4%对5.7%,p = 0.99）和侧腹疼痛发生率（8.9%对8.6%,p = 0.99）。开放组复发性尿路感染较多（17.8%比8.6%），机器人组新发下尿路症状较多（11.4%比2.2%），但差异无统计学意义（p = 0.33和p = 0.16）。总体而言，30例患者（38%）至少有一种长期并发症（35.6% vs 40%; p = 0.82）。唯一与狭窄复发风险显著相关的变量是放疗（OR = 11.2; p = 0.01）。结论：机器人入路在狭窄复发方面不低于开放入路，同时住院时间更短，估计失血量更少。更重要的是，目前的一系列研究提出了关于输尿管再植的长期后果的问题，并证实放疗患者失败的风险更高。

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引用次数: 0

Assessing EAU criteria for high-risk upper tract urothelial carcinoma 评价EAU对高危上尿路上皮癌的诊断标准。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-11 DOI: 10.1002/bco2.70044

Mahmoud Farzat, Sami-Ramzi Leyh-Bannurah, Mykyta Kachanov, Florian M. Wagenlehner

Background and Objective

Preoperative EAU guideline criteria stratify Upper tract urinary carcinomas (UTUC) into low- and high-risk groups. Depending on this classification, high-risk patients may receive simultaneous lymphadenectomy (LAD) during robot-assisted radical nephroureterectomy (RANU). This study examines the reliability of such stratification, focusing on oncological outcomes.

Methods

In 60 patients with UTUC who underwent RANU, 38 were stratified as low-risk (63%) and 22 as high-risk (37%) based on preoperative EAU guideline criteria. LAD was performed solely in the high-risk group.

Results

In the low-risk group, 19 patients (50%) had non-muscle-invasive (Ta, Tis-T1) disease, 7 (18%) had muscle-invasive, locally confined (T2) disease and 12 (32%) had locally advanced (T3/4) disease. In the high-risk group, results were 11 (50%), 3 (14%) and 8 (36%), with no statistical differences observed. Follow-up (6 to 60 months) showed no significant differences in cancer-specific (p = 0.3) and overall survival (p = 0.8) between groups. Limitations: the small sample size and the retrospective nature. Conclusions and Clinical Implications: The current EAU guideline-based preoperative criteria for UTUC risk stratification demonstrated limited accuracy in identifying high-risk patients undergoing RANU, potentially excluding some patients from receiving LAD.

Patient Summary

We think that improved preoperative staging and risk stratification tools are needed to better manage patients with upper urinary tract urothelial carcinoma undergoing surgical treatment.

背景和目的：术前EAU指南标准将上尿路癌（UTUC）分为低危组和高危组。根据这一分类，高危患者可能在机器人辅助根治性肾输尿管切除术（RANU）期间接受同步淋巴结切除术（LAD）。本研究考察了这种分层的可靠性，重点是肿瘤学结果。方法：在60例接受RANU治疗的UTUC患者中，根据术前EAU指南标准将38例分为低危（63%），22例分为高危（37%）。LAD仅在高危组进行。结果：低危组19例（50%）为非肌肉侵袭性（Ta、Tis-T1）疾病，7例（18%）为肌肉侵袭性局部局限（T2）疾病，12例（32%）为局部晚期（T3/4）疾病。高危组11例（50%）、3例（14%）、8例（36%），差异无统计学意义。随访6 ~ 60个月，两组间肿瘤特异性（p = 0.3）和总生存率（p = 0.8）无显著差异。局限性：样本量小，具有回顾性。结论和临床意义：目前基于EAU指南的UTUC风险分层术前标准在识别接受RANU的高危患者方面准确性有限，可能会排除一些接受LAD的患者。患者总结：我们认为需要改进术前分期和风险分层工具来更好地管理手术治疗的上尿路尿路上皮癌患者。

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引用次数: 0

Glans tunnel-based reconstruction with skin flap or lip mucosa graft for distal penile urethral strictures 以龟头隧道为基础的皮瓣或唇黏膜重建阴茎远端尿道狭窄。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-11 DOI: 10.1002/bco2.70097

Fuhao Ji, Lin Wang, Tong Zhao, Yidong Liu, Xiangguo Lyu

Purpose

The aim of this study is to evaluate the clinical efficacy of glans tunnel urethroplasty using a pedicled penile flap or lower lip mucosa for glans penis urethral stricture.

Methods

A retrospective analysis was conducted on 41 patients with urethral stricture at the glans penis who visited our hospital from January 2021 to July 2025. Causes include iatrogenic factors (including prostate hyperplasia surgery, transurethral resection of bladder lesions and catheterisation), a history of hypospadias repair and penile lichen sclerosus (LS), including 14 cases of urethral meatus stricture and 27 cases of navicular fossa stricture. The length of the stricture was 2.0 (1.0, 3.0) cm, the maximum flow rate (Q_max) was (7.24 ± 3.47) ml/s, the International Prostate Symptom Score (IPSS) was (17.49 ± 5.29), and the International Index of Erectile Function - 5 (IIEF-5) was 14.0 (9.00, 21.00) points. Surgery preserved glans integrity, incised the ventral stenotic urethra and reconstructed the defect with a flap or mucosa graft. A F16/18 indwelling catheter was removed after 3 weeks. Pre- and post-operative uroflowmetry, IPSS and IIEF-5 evaluations were conducted.

Results

All post-operative outcomes were assessed at 12–23 months (median 20, IQR 19–21). Postoperative Q_max increased to 23.61 ± 4.54 ml/s, and the IPSS decreased to 9.02 ± 3.57 (both P < 0.001 vs. pre-op). The IIEF-5 score (14.71 ± 6.48) points showed no significant change. No recurrence, glans dehiscence, fistula, infection or ischaemia occurred.

Conclusions

Glans tunnel urethroplasty maintaining glans integrity effectively treats urethral meatal and navicular fossa strictures, balancing function and aesthetics.

目的：探讨带蒂阴茎瓣或下唇黏膜治疗龟头尿道狭窄的临床疗效。方法：回顾性分析我院2021年1月至2025年7月收治的41例阴茎龟头处尿道狭窄患者。病因包括医源性因素（包括前列腺增生手术、经尿道膀胱病变切除和导尿术）、尿道下裂修复史和阴茎硬化地衣（LS），其中尿道道狭窄14例，舟状窝狭窄27例。狭窄长度为2.0 (1.0,3.0)cm，最大流速（Q max）为（7.24±3.47）ml/s，国际前列腺症状评分（IPSS）为（17.49±5.29）分，国际勃起功能指数-5 （IIEF-5）为14.0（9.00,21.00）分。手术保留了龟头的完整性，切开腹侧狭窄尿道，用皮瓣或粘膜移植重建缺损。3周后拔除F16/18留置导管。术前、术后行尿流仪、IPSS及IIEF-5评价。结果：所有术后结果在12-23个月（中位20，IQR 19-21）进行评估。术后qmax为23.61±4.54 ml/s， IPSS为9.02±3.57 ml/s（均P）。结论：维持龟头完整性的龟头隧道尿道成形术能有效治疗尿道金属窝和舟状窝狭窄，兼顾功能和美观。

{"title":"Glans tunnel-based reconstruction with skin flap or lip mucosa graft for distal penile urethral strictures","authors":"Fuhao Ji, Lin Wang, Tong Zhao, Yidong Liu, Xiangguo Lyu","doi":"10.1002/bco2.70097","DOIUrl":"10.1002/bco2.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study is to evaluate the clinical efficacy of glans tunnel urethroplasty using a pedicled penile flap or lower lip mucosa for glans penis urethral stricture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 41 patients with urethral stricture at the glans penis who visited our hospital from January 2021 to July 2025. Causes include iatrogenic factors (including prostate hyperplasia surgery, transurethral resection of bladder lesions and catheterisation), a history of hypospadias repair and penile lichen sclerosus (LS), including 14 cases of urethral meatus stricture and 27 cases of navicular fossa stricture. The length of the stricture was 2.0 (1.0, 3.0) cm, the maximum flow rate (<i>Q</i><sub>max</sub>) was (7.24 ± 3.47) ml/s, the International Prostate Symptom Score (IPSS) was (17.49 ± 5.29), and the International Index of Erectile Function - 5 (IIEF-5) was 14.0 (9.00, 21.00) points. Surgery preserved glans integrity, incised the ventral stenotic urethra and reconstructed the defect with a flap or mucosa graft. A F16/18 indwelling catheter was removed after 3 weeks. Pre- and post-operative uroflowmetry, IPSS and IIEF-5 evaluations were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All post-operative outcomes were assessed at 12–23 months (median 20, IQR 19–21). Postoperative <i>Q</i><sub>max</sub> increased to 23.61 ± 4.54 ml/s, and the IPSS decreased to 9.02 ± 3.57 (both <i>P</i> < 0.001 vs. pre-op). The IIEF-5 score (14.71 ± 6.48) points showed no significant change. No recurrence, glans dehiscence, fistula, infection or ischaemia occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Glans tunnel urethroplasty maintaining glans integrity effectively treats urethral meatal and navicular fossa strictures, balancing function and aesthetics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bigger challenges, similar outcomes: Robotic prostatectomy in the obese patient 更大的挑战，类似的结果：肥胖患者的机器人前列腺切除术。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-09 DOI: 10.1002/bco2.70112

Andrew Evans, Ibrahim Ibrahim, Thomas Miller, Assia Djoudi, Katharine Hill, Imran Ahmad

Objectives

The study aims to review the safety of performing robotic-assisted radical prostatectomy (RARP) in patients with a body mass index (BMI) > 35 kg/m² in a high-volume robotic centre.

Materials and methods

A prospective database of all patients who underwent RARP between December 2015 and October 2024 was reviewed. Propensity score matching was done preoperatively on age, prostate-specific antigen, ISUP grade and T stage. Matched cohort analysis was conducted comparing outcomes in 89 patients with BMI ≥ 35 kg/m² and those with BMI 18–25 kg/m². Outcomes included operational time, estimated blood loss (EBL), positive surgical margins (PSM), complications, length of stay, continence and erectile function at 12 months.

Results

Console time was significantly longer in the high-BMI group (146 ± 48 min vs. 129 ± 44 min, p = 0.02). EBL was also greater (median 350 ml vs. 200 ml, p < 0.001). However, there was no significant difference in hospital stay (median 3 days for both groups, p = 0.86), nerve sparing rates or PSM. Patients in the obese cohort experienced more complications although this was not statistically significant. At 12 months post-operatively, continence was comparable between the groups. Median pad use was 1/day (interquartile range [IQR] 0–2) in the obese cohort versus 0/day (IQR 0–1) in the non-obese cohort (p = 0.09). Pad-free status was achieved in 48.3% compared with 61.8% respectively (p = 0.06). Erectile function recovery found 14.8% regaining function in the obese cohort compared with 18.0% in the non-obese cohort (p = 0.82).

Conclusion

This matched cohort analysis demonstrates that obese patients undergoing RARP experience longer operative times and increased EBL. These factors do not adversely impact functional or oncological outcomes. The incidence of post-operative complications remained low and comparable with patients with a normal BMI. With appropriate surgical expertise, high BMI alone should not be considered a contraindication to RARP.

目的：该研究旨在回顾在大容量机器人中心对体重指数（BMI） bb0 - 35 kg/m2的患者进行机器人辅助根治性前列腺切除术（RARP）的安全性。材料和方法：对2015年12月至2024年10月期间接受RARP治疗的所有患者的前瞻性数据库进行回顾。术前对年龄、前列腺特异性抗原、ISUP分级和T分期进行倾向评分匹配。对89例BMI≥35 kg/m2患者与BMI 18-25 kg/m2患者的结局进行配对队列分析。结果包括手术时间、估计失血量（EBL）、阳性手术切界（PSM）、并发症、住院时间、12个月时的尿失禁和勃起功能。结果：高bmi组的安慰时间明显长于对照组（146±48 min vs. 129±44 min, p = 0.02）。EBL也更大（中位350 ml vs 200 ml， p p = 0.86），神经保留率或PSM。肥胖组的患者出现了更多的并发症，尽管这没有统计学意义。术后12个月，两组间尿失禁情况比较。肥胖组中位pad使用量为1/天（四分位数范围[IQR] 0-2），非肥胖组中位pad使用量为0/天（IQR 0-1）（p = 0.09）。无垫状态分别为48.3%和61.8% （p = 0.06）。勃起功能恢复发现，肥胖组14.8%的人恢复了勃起功能，而非肥胖组18.0% （p = 0.82）。结论：该匹配队列分析表明，接受RARP的肥胖患者手术时间更长，EBL增加。这些因素不会对功能或肿瘤结果产生不利影响。术后并发症的发生率仍然很低，与BMI正常的患者相当。在适当的外科专业知识下，高BMI不应被视为RARP的禁忌症。

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引用次数: 0

Exploring patient and clinician opinions, perspectives and acceptance of the use of artificial intelligence in the histological diagnosis of prostate cancer 探讨患者和临床医生的意见，观点和接受使用人工智能在前列腺癌的组织学诊断。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-09 DOI: 10.1002/bco2.70108

Lisa Browning, Abhisek Ghosh, Monica Dolton, Kate Hutton, Jacqueline Birks, Richard Scheffer, Ewart Stanislaus, James Crofts, Richard Colling, Richard Bryant, Clare Verrill

Objectives

This study aims to explore the opinions and attitudes of patients and clinicians regarding the use of artificial intelligence (AI) in the diagnosis of prostate biopsies, with a focus on acceptance and trust in the use of AI, and factors that may impact this.

Subjects and methods

Surveys were sent to patient members of UK-based prostate cancer support groups and to a group of clinicians managing patients with prostate cancer (or suspected prostate cancer).

Results

Of 130 patient respondents, 94% expressed acceptance of AI assistance in the diagnosis of prostate biopsies when a pathologist retains responsibility for the final diagnosis, but regard it as the responsibility of the pathologist to decide whether AI is used in this setting. Similar responses were noted among the nine clinician respondents. Regarding factors with potential impact on acceptance of AI, an understanding of how the AI was tested and its performance in comparison with a pathologist was considered to be more important than how the technology was developed, and half (51%) of patients suggested that access to additional information might impact their acceptance of AI.

Conclusion

Understanding the perspectives of stakeholders is key to the successful clinical implementation of AI in the histological diagnosis of prostate biopsies. Our study shows a high level of acceptance of AI for the diagnosis of prostate biopsies among patients if a pathologist retains oversight of the diagnosis and the decision as to when AI is used. Furthermore, it suggests similar levels of acceptance among clinicians. Our study provides insight into areas for educational focus to enhance understanding of AI in this setting.

目的：本研究旨在探讨患者和临床医生对人工智能（AI）在前列腺活检诊断中的使用的意见和态度，重点是对人工智能使用的接受度和信任度，以及可能影响这一点的因素。研究对象和方法：调查被发送给英国前列腺癌支持小组的患者成员和一组治疗前列腺癌（或疑似前列腺癌）患者的临床医生。结果：在130名接受调查的患者中，94%的人表示，在病理学家保留最终诊断责任的情况下，接受人工智能协助前列腺活检的诊断，但认为在这种情况下是否使用人工智能是病理学家的责任。在9名临床医生的回应中也发现了类似的反应。对于可能影响人工智能接受度的因素，了解人工智能的测试方式及其与病理学家相比的表现被认为比技术的开发方式更重要，一半（51%）的患者表示，获取额外信息可能会影响他们对人工智能的接受程度。结论：了解利益相关者的观点是人工智能在前列腺活检组织学诊断中的临床成功实施的关键。我们的研究表明，如果病理学家对诊断进行监督，并决定何时使用人工智能，那么患者对人工智能在前列腺活检诊断中的接受程度就会很高。此外，它表明临床医生的接受程度相似。我们的研究为教育重点领域提供了见解，以增强对这种情况下人工智能的理解。

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引用次数: 0

Contemporary assessment of diagnostic performance and histologic concordance of renal mass biopsy with surgical pathology 当代肾肿块活检与外科病理的诊断表现和组织学一致性评估

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-06 DOI: 10.1002/bco2.70104

Mitchell M. Huang, Cristina B. Arruza-Frau, Austin P. Drysch, Nicole Handa, Ridwan Alam, Behtash G. Nezami, Ashley E. Ross, Niraj K. Shenoy, Kent T. Perry, Hiten D. Patel

Background

Improvements in imaging and technique have led to a greater role for renal mass biopsy (RMB) to risk-stratify localized renal masses. We sought to assess the contemporary diagnostic accuracy of RMB for identifying renal cell carcinoma (RCC) based on concordance with final surgical pathology.

Materials and Methods

Consecutive patients undergoing RMB between 2013 and 2023 across an 11-hospital health system were identified. Concordance between RMB and final pathology for patients receiving partial or radical nephrectomy was compared. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RMB for identifying RCC among patients who underwent surgery.

Results

A total of 733 patients underwent RMB with an overall non-diagnostic rate of 11% and most biopsies (67%) identified RCC. A total of 243 patients with surgical pathology were analysed, and 229 (94%) had RCC on surgical pathology. Excluding non-diagnostic cases, RMB had a 98% concordance with surgical pathology for RCC; RMB had 94% sensitivity, 71% specificity, 98% PPV and 42% NPV for identifying RCC with non-diagnostic cases considered as benign biopsies. For the nine RMB oncocytic cases receiving surgery, six (66%) were RCC and only two (22%) were confirmed oncocytomas. For patients with biopsy grade reported, 100% of high-grade RCC were confirmed while 26% of low-grade RCC were upgraded at nephrectomy (overall 80% concordance).

Conclusions

In a large, contemporary cohort of patients, RMB had high PPV and sensitivity for identifying RCC and high concordance for specific histology at nephrectomy. However, upgrading was common, and oncocytic lesions selected for surgery due to clinical suspicion often harboured RCC.

背景影像学和技术的进步使得肾肿块活检（RMB）在局部肾肿块风险分层中的作用越来越大。我们试图评估基于最终手术病理一致性的RMB在鉴别肾细胞癌（RCC）的诊断准确性。材料和方法对2013年至2023年间11家医院卫生系统中连续接受人民币手术的患者进行了识别。比较部分或全部肾切除术患者的RMB与最终病理的一致性。我们计算了在手术患者中识别RCC的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果733例患者接受了RMB检查，总体未诊断率为11%，大部分活检（67%）确诊为RCC。共分析了243例手术病理患者，229例（94%）手术病理为RCC。排除非诊断性病例，RMB与RCC的手术病理符合率为98%；对于未确诊为良性活检的RCC， RMB的敏感性为94%，特异性为71%，PPV为98%，NPV为42%。在接受手术的9例RMB嗜癌病例中，6例（66%）为肾细胞癌，只有2例（22%）确诊为嗜瘤细胞瘤。对于报告活检分级的患者，100%的高级别RCC被确诊，而26%的低级别RCC在肾切除术时被升级（总体一致性为80%）。结论：在一个大型的当代患者队列中，RMB在鉴别肾细胞癌方面具有较高的PPV和敏感性，在肾切除术时具有较高的特异性组织学一致性。然而，升级是常见的，因临床怀疑而选择手术的癌性病变通常含有RCC。

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引用次数: 0

Effect of prior HoLEP procedure on multiparametric MRI accuracy in detection of prostate cancer 先前HoLEP手术对多参数MRI检测前列腺癌准确性的影响。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-04 DOI: 10.1002/bco2.70105

Austin Drysch, Kathryn E. Fink, Nicole Handa, Mitchell M. Huang, Sai Kumar, Yutai Li, Ridwan Alam, Amy E. Krambeck, Hiten D. Patel, Ashley E. Ross

Objectives

The objective of this study is to evaluate whether prior Holmium laser enucleation of the prostate (HoLEP) affects the diagnostic accuracy of multiparametric prostate MRI (mpMRI) with PI-RADS scoring for detecting clinically significant prostate cancer (csPCa) on biopsy.

Patients and Methods

We queried the Northwestern Electronic Data Warehouse for all patients who underwent mpMRI followed by prostate biopsy. Demographic information, mpMRI data including PI-RADS score and biopsy data including Gleason grade (GG) were collected. Patients were stratified based on prior HoLEP and highest PI-RADS score of index lesion on MRI. The outcome of interest was detection of csPCa (GG ≥ 2) on biopsy. Logistic regression was performed to assess the impact of prior HoLEP on the detection of csPCa at time of biopsy.

Results

A total of 8937 patients met inclusion criteria, of which 97 patients (1.1%) had prior HoLEP. HoLEP specimen revealed benign pathology in 38 patients (39.2%), GG1 in 32 patients (33.0%), GG2 in 25 patients (25.8%) and GG3 in 2 patients (2.1%). Average time from HoLEP to mpMRI was 11.5 months. The post-HoLEP group had lower prostate volumes (median 25.0 vs. 47.0 cc; p < 0.001) and PSA density (median 0.06 vs. 0.12 ng/ml²; p < 0.001). Rates of csPCa detection based on highest PI-RADS score were comparable between control and HoLEP groups. Prior HoLEP did not significantly affect the detection of csPCa on multivariable analysis adjusting for age, race, PI-RADS, family history of PCa, and PSA density (OR = 0.97; 95% CI: 0.60–1.57).

Conclusion

PI-RADS remains a reliable predictor of csPCa after HoLEP despite anatomic alterations. mpMRI should continue to guide biopsy and risk stratification in this population, though larger validation is warranted.

目的：本研究的目的是评估先前的钬激光前列腺摘除（HoLEP）是否影响多参数前列腺MRI （mpMRI）在活检中检测临床显著性前列腺癌（csPCa）时的PI-RADS评分的诊断准确性。患者和方法：我们查询了西北大学电子数据仓库中所有接受mpMRI和前列腺活检的患者。收集人口统计学信息、mpMRI数据（包括PI-RADS评分）和活检数据（包括Gleason分级（GG））。根据先前HoLEP和MRI指数病变最高PI-RADS评分对患者进行分层。关注的结果是活检中csPCa （GG≥2）的检测。采用Logistic回归评估先前HoLEP对活检时csPCa检测的影响。结果：8937例患者符合纳入标准，其中97例（1.1%）既往有HoLEP。HoLEP标本病理显示为良性38例（39.2%），GG1 32例（33.0%），GG2 25例（25.8%），GG3 2例（2.1%）。从HoLEP到mpMRI的平均时间为11.5个月。HoLEP后组前列腺体积较低（中位25.0比47.0 cc; p 2; p）结论：尽管HoLEP后解剖改变，PI-RADS仍然是csPCa的可靠预测因子。mpMRI应继续指导该人群的活检和风险分层，尽管需要更大的验证。

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引用次数: 0

Multi-modality imaging problem-solving for pelvic splenosis on PSMA PET in a patient with recurrent prostate cancer 多模态显像解决盆腔脾肿大的PSMA PET患者复发性前列腺癌。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-03 DOI: 10.1002/bco2.70090

James Morgan, Anurag Anugu, Jorge D. Oldan, Michael C. Repka, Steven P. Rowe

<p>We present the case of a 73-year-old man with a history of remote splenectomy after trauma, Gleason 3 + 4 prostate adenocarcinoma treated with external beam radiation and 6 months of androgen deprivation therapy 11 years prior to presentation, and T3N0M0 colonic adenocarcinoma treated with hemicolectomy 5 years prior to presentation. He was found to have an increasing PSA on multiple surveillance labs up to 0.94 ng/mL prior to presentation. <sup>18</sup>F-DCFPyL prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) was performed to evaluate for recurrent disease or sites of metastasis. That scan showed mild uptake in the peripheral zone of the prostate as well as a 2.3 cm focus of moderate uptake in the sigmoid colon that was considered concerning for a malignant implant (Figure 1A). However, as splenic tissue is also known to normally express PSMA, splenosis was also included on the differential.<span><sup>1-4</sup></span></p><p>MRI was performed with a nondiagnostic evaluation of the prostate and further characterization of the colonic lesion, which appeared to arise from the distal sigmoid colon (Figure 1B). Comparison to prior imaging showed stable size over multiple prior scans, raising the possibility of a small gastrointestinal stromal tumour (GIST), an entity that is also known to express PSMA.<span><sup>5</sup></span> Particularly considering the history of colon cancer, a 2-deoxy-2-[<sup>18</sup>F]-fluoro-D-glucose (FDG) PET was performed, showing a grossly stable lesion of the sigmoid colon with similar uptake to the surrounding bowel (Figure 1C). A surveillance colonoscopy was not able to identify the lesion of interest and also did not show any other evidence of colon cancer recurrence.</p><p>After discussion at the tumour board, the decision was made to perform <sup>99m</sup>Tc-sulphur colloid liver-spleen scan with single-photon emission computed tomography (SPECT)/CT to rule out splenosis prior to attempting tissue sampling. Although there have been cases that have indicated that heat-damaged tagged red blood cells can have improved sensitivity for splenic tissue,<span><sup>6</sup></span> that agent is not readily available at our institution, whereas <sup>99m</sup>Tc-sulphur colloid can be conveniently obtained. Ultimately, the <sup>99m</sup>Tc-sulphur colloid liver-spleen scan showed increased uptake within the lesion, consistent with implanted splenic tissue (Figure 1D).</p><p>With widespread usage of PSMA-targeted radiotracers, it is important to remain cognizant of the potential pitfalls that can be encountered. Similarly, a thorough review of the patient history, prior images and utilization of other imaging modalities are frequently essential to effectively troubleshoot abnormal presentations of disease and arrive at the correct diagnosis without subjecting the patient to unnecessary invasive procedures. In this case, splenosis and colonic malignancy were included on the initial differenti

我们报告一例73岁男性，创伤后有脾切除术史，Gleason 3 + 4前列腺癌在发病前11年接受外束放疗和6个月的雄激素剥夺治疗，T3N0M0结肠腺癌在发病前5年接受半结肠切除术。在就诊前，他在多个监测实验室中发现PSA升高至0.94 ng/mL。采用18F-DCFPyL前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描（PET）评估复发性疾病或转移部位。该扫描显示前列腺外周区有轻度摄取，乙状结肠有2.3厘米的中度摄取灶，这被认为是恶性植入物（图1A）。然而，由于脾脏组织也被认为正常表达PSMA，脾脾症也被包括在鉴别图中。1-4MRI对前列腺进行了非诊断性评估，并进一步确定了结肠病变的特征，该病变似乎起源于远端乙状结肠（图1B）。与先前的影像相比，多次扫描显示尺寸稳定，增加了小胃肠道间质瘤（GIST）的可能性，这也是已知的表达psma的实体。5特别是考虑到结肠癌的病史，进行了2-脱氧-2-[18F]-氟-d -葡萄糖（FDG） PET检查，显示乙状结肠病变非常稳定，与周围肠道摄取相似（图1C）。监测结肠镜检查不能识别病变，也没有显示任何其他结肠癌复发的证据。在肿瘤委员会讨论后，决定在尝试组织取样之前，用单光子发射计算机断层扫描(SPECT)/CT进行99mtc硫胶体肝脾扫描，以排除脾萎缩。虽然有案例表明热损伤标记红细胞可以提高脾组织的敏感性，但我们的机构并不容易获得这种药物，而99mtc -硫胶体可以方便地获得。最终，99mtc -硫胶体肝脾扫描显示病变内摄取增加，与植入的脾组织一致（图1D）。随着psma靶向放射性示踪剂的广泛使用，重要的是要保持对可能遇到的潜在陷阱的认识。同样，彻底回顾患者病史、既往影像和利用其他成像方式，对于有效诊断疾病的异常表现和在不使患者接受不必要的侵入性手术的情况下得出正确诊断，往往是必不可少的。在此病例中，回顾患者的病史，发现创伤后脾切除术和结肠腺癌的病史后，在最初的鉴别中包括了脾肿大和结肠恶性肿瘤。建议MRI进一步表征前列腺摄取区域和结肠肿块；然而，图像的人为限制阻碍了完整的评估。可以与先前的MRI进行比较，MRI显示结肠病变多年来相对稳定。这一认识在引导对更惰性疾病过程或解剖变异的检查中发挥了关键作用，最终导致决定采用99mtc硫胶体肝脾扫描而不是侵入性组织取样。该病例也强调了在诊断影像学发现时，保持对不常用的影像学方式（如肝脾扫描）的熟悉的价值。虽然更先进的PET放射性示踪剂（如psma靶向剂）在肿瘤成像中发挥着越来越重要的作用，但当初始成像产生不确定的结果时，传统的核医学研究可以提供明确的答案。在这种情况下，使用“旧”诊断工具可以完全避免侵入性活检或手术干预。JM和SPR构思了该文章。JM， AA和SPR对手稿进行了初步的撰写。JDO和MCR提供了对手稿的重要修订。SPR获得了Progenics Pharmaceuticals， Inc.的研究经费，Progenics Pharmaceuticals, Inc.是Lantheus Pharmaceuticals， Inc.的全资子公司，是18F-DCFPyL的被许可方。SPR担任Progenics Pharmaceuticals， Inc.的顾问。

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引用次数: 0

Multidisciplinary meetings for lower urinary tract symptoms and benign prostate hyperplasia 下尿路症状和良性前列腺增生的多学科会议。

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2025-11-03 DOI: 10.1002/bco2.70089

Emilien Seizilles de Mazancourt, Nadia Abid, Gaele Pagnoux, Olivier Rouvière, Ricardo Codas Duarte, Alain Ruffion, Hakim Fassi Fehri

Objectives

To describe a single academic centre experience in the establishment of Multidisciplinary Meetings (MDM) for the management of male non-neurogenic Lower Urinary Tract Symptoms (LUTS) and Benign Prostate Hyperplasia (BPH).

Materials and methods

Retrospective analysis of all the cases discussed in MDM for LUTS/BPH in our academic centre over a year, and analysis of the implementation rates, reasons for failure of implementation and discrepancies between the proposal and the final decision.

Results

Over one year, 108 cases were discussed. The implementation rate of the recommendation was 71% (77/108). The reasons for the failure of implementation of the recommendation were patient preference in 6 (5%), lost to follow-up in 13 (12%), consultant decision in 4 (4%), patient deterioration or new comorbidities in 2 (2%), improvement of LUTS symptoms in 4 (4%) and the suggested technique was not available for technical reasons in 1 (1%). The consultant's proposal was validated in 98 cases (90.7%) and a different decision was made in 9 cases (8.3%).

Conclusion

The establishment of a MDM for male LUTS/BPH is feasible and could contribute to the improvement of the management of patients. Further studies are needed to evaluate all its aspects.

目的：描述一个单一的学术中心在建立多学科会议（MDM）管理男性非神经源性下尿路症状（LUTS）和良性前列腺增生（BPH）的经验。材料和方法：回顾性分析我们学术中心一年来在MDM for LUTS/BPH中讨论的所有案例，分析执行率、执行失败的原因以及提案与最终决定之间的差异。结果：1年多来共讨论108例病例。建议的执行率为71%（77/108）。未能执行建议的原因有6例（5%）是患者偏好，13例（12%）是随访失败，4例（4%）是咨询师的决定，2例（2%）是患者恶化或出现新的合并症，4例（4%）是LUTS症状的改善，1例（1%）是由于技术原因无法获得建议的技术。98例（90.7%）患者的建议被证实，9例（8.3%）患者做出了不同的决定。结论：建立男性LUTS/BPH的MDM是可行的，有助于改善患者的管理。需要进一步的研究来评价其所有方面。

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引用次数: 0