Frontiers in urology最新文献

Background: Erectile dysfunction (ED) is a frequent finding in men living with human immunodeficiency virus (HIV) (MLWH) and this remains a major concern because of its negative impact on the quality of life of those affected. There is limited data about the magnitude of ED and associated factors among MLWH in Tanzania. Thus this study was aimed to determine the prevalence of ED and associated factors among newly diagnosed antiretroviral therapy (ART)-naive MLWH in Mwanza, Northwestern Tanzania.

Methods: A cross-sectional study was conducted among 373 newly diagnosed ART-naïve MLWH attending voluntary counseling and testing centers of four selected hospitals in Mwanza region who were consecutively enrolled and subjected to thorough clinical and general physical examination, including anthropometric measurements. A pre-structured questionnaire was used to collect socio-demographic characteristics and clinical data. ED was assessed using the International Index of Erectile Function-5. Serum total testosterone, follicle-stimulating hormone, luteinizing hormone and estradiol were estimated. Data were entered in Microsoft Excel, cleaned and analyzed using STATA version 15.

Results: Of the 373 analyzed participants with a median age of 40 [IQR: 33-46] years, ED was found in 56.3% (95% CI 51.2%-61.3%), whereas the majority presented with mild (45.2%) to mild-moderate (40.0%) ED. The median testosterone was significantly lower in men with ED as compared with men without (294.5 [135-469] versus 482 [191-602] ng/ml; p<0.001). In a multivariate logistic regression analysis, ED showed significant association with World Health Organization (WHO) clinical stage 4 for HIV infection (AOR 3.2; 95% CI 1.1-9.2; p=0.032), low testosterone level (AOR 1.9; 95% CI 1.2-3.0; p=0.010), and being non-self-employed (AOR 3.7; 95% CI 2.0-7.0; p<0.001).

Conclusion: ED was found in more than half of ART naïve MLWH. The majority had a mild to mild-moderate ED. There was a significant association between ED and WHO clinical stage 4 for HIV infection, low testosterone level, and being non-self-employed. This finding emphasizes the need to routinely screen for early detection and management of ED in care and treatment center (CTC) clinics.

Background: Congenital hydronephrosis involves obstruction of the ureteropelvic junction, which impairs urine passage and elevates renal pelvic pressure. Elevated renal pelvic pressure detrimentally affects renal function. Pyeloplasty is a surgical procedure that aims to prevent deterioration of renal function. The Whitaker test, which is conducted using nephrostomy, is used to measure renal pelvic pressure. However, this method is highly invasive, highlighting the need for alternative testing approaches. Computational fluid dynamics (CFD) provides quantitative predictions of fluid flow phenomena and has recently been applied in medicine.

Objective: The aim of this study was to develop an evaluation method using computational fluid dynamics (CFD) to determine pyeloplasty indications.

Methods: The CFD were analyzed using computed-tomography-extracted images. The urine flow in the extracted geometry was simulated by solving the continuity and Navier-Stokes equations.

Key findings and limitations: CFD analysis revealed that renal pelvic pressure increases when urine output increases because of ureteropelvic junction obstruction during hydronephrosis. Furthermore, hydronephrosis with a renal pelvic pressure of 0.015-0.086 Pa, within the physiological urine output range of 360-1440 mL/day, was associated with poor renal function. The main limitation of this method is that the intrarenal pressure analyzed using CFD is an estimate and not the actual pressure.

Conclusions and clinical implications: Thus, renal-pelvic pressure can be measured through CFD analysis. Furthermore, CFD analysis can be used as a new modality to determine severity of obstruction.

Objectives: Patients with a poorly functioning kidney, defined as less than 20% differential renal function, have historically been considered poor candidates for ipsilateral ureteral reconstruction for stricture. To determine if renal function can be safely preserved in poorly functioning kidneys with ureteral stricture, we evaluated patient outcomes following ureteral reconstruction.

Methods: We conducted a review of 114 adult patients who underwent ureteral reconstructive surgery at our institution between 2013 and 2023. Patients with poorly functioning ipsilateral kidneys were identified by a preoperative renal scan (MAG3 renogram). Variables of interest included patient characteristics, peri/postoperative outcomes, resolution of hydronephrosis, pre/postoperative renal function, and preservation of renal parenchyma.

Results: Of the 8 patients meeting inclusion criteria, 5 underwent bladder elongation psoas hitch (BEPH), 1 ileal ureter, 1 ileal ureter with BEPH, and 1 ureteroureterostomy. Median preoperative differential renal function was 16.0% with a median preoperative serum creatinine (sCr) of 1.70 mg/dL before decompression and 1.35mg/dL after percutaneous nephrostomy tube (PCN) placement. Preoperative median average renal parenchyma thickness (RPT) was 14.5mm. At 6-month follow-up, median sCr and RPT were preserved at 1.25mg/dL (p= 0.084) and 14.3 mm (p=0.41), respectively. At median follow-up of 49.2 months, all patients had a successful repair, defined as no reinsertion of stent/PCN, resolution of hydronephrosis, and no return to the operating room for revision or nephrectomy. Median sCr at last follow-up showed sustained improvement at 1.22 (p=0.0097).

Conclusions: Reconstruction can be successful for obstructed kidneys with less than 20% differential function and may be considered prior to nephrectomy.

Objective: To analyze the related literature of self-reported outcomes of prostate cancer patients using bibliometric methods, and explore the research status and development trend in this field.

Methods: The literature related to self-reported outcomes of prostate cancer was searched in Web of Science core database. The literature on prostate cancer self-reported outcomes was visualized using VOSviewer, CiteSpace and R software packages.

Results: A total of 1119 relevant literatures were retrieved. Annual output consistently exceeded 100 articles since 2018, peaking at 161 in 2022. The U.S. (47.2%) and U.K. (21.5%) contributed 68.7% of publications. The University of Michigan emerged as the most productive institution. Collaborative networks showed strong U.S.-European ties, while Asian engagement intensified post-2020.The journal International Journal of Radiation Oncology Biology Physics (n=69) published most papers, whereas Journal of Clinical Oncology (n=48, citations=1,412) was most influential. Dual-map analysis revealed frequent citations from molecular/biology journals to clinical medicine literature. Barocas D.A., Cooperberg M.R., Koyama T., and Chen R.C. (21 publications each) were top producers. Ethan Basch (259 co-citations) was the most cited scholar. The EPIC scale development study (Wei et al., 2000) was the most co-cited reference. Key citation bursts included Taneja's long-term outcomes study (2013-2018) and the CHHiP radiotherapy trial (2018-2021). "Quality of life" (181 occurrences) dominated keyword analysis, followed by "radiation therapy" and "prostatectomy." Five thematic clusters emerged: radiotherapy with a blue cluster, prostatectomy with a green cluster, daily management with a red cluster, research methods with a yellow cluster and scale development with a purple cluster. Qualitative methods gained prominence after 2020, while exercise and radiotherapy remained sustained intervention focuses.

Conclusions: The reported outcomes of patients with prostate cancer have continued to receive attention in the past 10 years. In this study, three recognized bibliometric software were used for the first time to analyze the related studies on the reported outcomes of patients with prostate cancer, so as to provide reference and direction for future research.

Background: Radical cystectomy accompanied by urinary diversion remains the standard surgical intervention for individuals diagnosed with muscle-invasive bladder cancer. Notably, around 30% of these patients opt for a ureterocutaneous stoma. However, this technique is frequently associated with complications such as anastomotic stenosis, obstruction, and infection, which can lead to the deterioration of renal function and significantly impair the patient's quality of life. Consequently, this study investigates the safety of robot-assisted laparoscopic conversion from a ureterocutaneous stoma to an ileal conduit stoma, thereby offering a novel surgical alternative for patients undergoing total cystectomy with ureterocutaneous stoma.

Methods: A retrospective analysis was carried out on two patients who underwent total cystectomy and ureterocutaneous stoma and were admitted to our hospital in January 2025. We performed robot-assisted laparoscopic conversion of the ureterocutaneous stoma to an ileal conduit for these patients and subsequently evaluated the clinical benefits and surgical safety associated with the procedure.

Result: Both patients successfully underwent surgery, with operation durations of 293 minutes and 281 minutes, respectively. Intraoperative blood loss was recorded at 100 ml and 50 ml, respectively. Abdominal drainage tubes were removed five days postoperatively, and both patients were discharged seven days following the procedure. No surgery-related complications were observed during the perioperative period. Ureteral stents were removed two months post-surgery. Post-extubation CT scans indicated a resolution of the initial mild hydronephrosis in the kidneys. Renal function assessments, including creatinine levels and glomerular filtration rate, demonstrated improvement compared to preoperative values. Additionally, patients reported lower pain scores and higher quality of life scores postoperatively compared to preoperative assessments.

Conclusion: Robot-assisted laparoscopic ureterocutaneostomy to ileal channel surgery is both feasible and safe, offering potential improvements in renal function and quality of life for patients. Additionally, it presents an alternative surgical option for those requiring ureterocutaneostomy.

Objective: To report the preliminary experience of a case in which a thermo-expandable nickel-titanium shape memory alloy metal stent was utilized for the management of urethral stricture following phalloplasty.

Methods: A 51-year-old male patient underwent lower abdominal island flap phalloplasty due to penile trauma. Postoperative recurrent dysuria occurred, and urethrography revealed stricture at the urethral anastomosis site near the penile root. A thermo-expandable nickel-titanium shape memory alloy metal stent was implanted.

Results: The patient underwent a successful surgical procedure. One day after the surgery, the urethral catheter was removed, and the patient resumed normal urination. After achieving satisfactory outcomes, the patient recovered and was discharged. During regular follow-up visits after discharge, the patient maintained unobstructed urination without weak urine stream or other discomforts.

Conclusions: The placement of a thermo-expandable nickel-titanium shape memory alloy metal stent offers a novel treatment option for patients with urethral stricture following phalloplasty.

Objective: To determine whether delays in care during the coronavirus pandemic 2019 (COVID-19) were associated with pathological stage progression in urological malignancies by comparing surgical outcomes between pre-pandemic era (PREP) and pandemic-era (POSTP) cohorts.

Methods: We conducted a retrospective before-and-after cohort study at a tertiary academic center. A total of 368 patients underwent radical surgeries for prostate (n=176), bladder (n=78), kidney (n=78), or testicular (n=36) cancers between April 2019 and March 2022. Patients were grouped into PREP (April 2019-March 2020) and POSTP (April 2020-March 2022) cohorts. Clinical, laboratory, and pathological data were compared using Student's t-test, Mann-Whitney U test, Chi-square test, or Fisher's exact test, with p<0.05 considered statistically significant.

Results: POSTP prostatectomy patients had significantly higher preoperative PSA levels (13.2 ± 16.2 vs. 7.7 ± 4.5 ng/mL, p<0.001), greater tumor involvement (17.0% vs. 11.5%, p=0.019), and increased extraprostatic extension (33.7% vs. 11.9%, p=0.006) compared to PREP patients. Renal tumors were significantly larger during the pandemic (7.4 cm vs. 6.0 cm, p=0.01), and preoperative hemoglobin levels were lower (11.7 vs. 12.9 g/dL, p<0.001), suggesting more advanced disease. No statistically significant differences were observed in pathological staging for bladder or testicular cancers between the two periods (all p>0.05).

Conclusion: COVID-19-related care disruptions were associated with adverse pathological features in prostate and renal cancers. In contrast, bladder and testicular cancers showed no significant stage migration. These findings emphasize the need for resilient cancer care pathways to prevent progression during future healthcare crises.

Objective: There are many treatment options for localized prostate cancer, including external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT), and prostate brachytherapy (BT). This study aimed to compare the travel burdens of high-dose-rate brachytherapy (HDR-BT) at our BT center and EBRT or SBRT if administered close to home.

Materials and methods: This single-institution retrospective cohort study included 69 patients who had HDR-BT monotherapy for their prostate cancer from August 2017 to December 2022. The travel burden for HDR-BT monotherapy was estimated using Google Maps by measuring the distance from each patient's home address to our BT center. The total travel burden was calculated by multiplying the number of treatment fractions required for each modality by the roundtrip travel distance between the home and the treatment facility. Treatment toxicity was evaluated using the Expanded Prostate Index Composite for Clinical Practice (EPIC-CP) questionnaire.

Results: The median age of the 69 patients was 67 years. The mean distance from home to the BT center was 37.4 mi, while the mean distance to the nearest radiation facility was 8.3 mi. The mean total travel distance for HDR-BT was 150 mi, while those for EBRT and SBRT were 463 and 83 mi, respectively. HDR-BT resulted in a mean travel burden reduction of 313 mi compared with EBRT. The EPIC-CP scores indicated minimal posttreatment toxicity, with most patients reporting stable or improved symptoms.

Conclusion: HDR-BT monotherapy significantly reduces the travel burden compared with EBRT for localized prostate cancer, with minimal treatment-associated toxicity. Increasing the availability of BT centers could further alleviate the travel burden. Alternatively, providing transportation support could improve access to care.

Malignant tumours have become one of the diseases that seriously threaten human health, and their incidence is increasing year by year. Worldwide, malignant tumours have become one of the most common causes of death in men. With the continuous progress of comprehensive oncological treatment, the cure rate and the survival rate of malignant tumours have been increasing, and the survival cycle has been prolonged, so the issue of fertility preservation in male malignant tumour patients has received widespread attention. In this review, researchers will discuss the real-world research progress related to fertility preservation in male malignant tumour patients, with a view to provide some reference basis for clinical decision-making.