Frontiers in urology最新文献

Background: Renal medullary carcinoma (RMC) is an aggressive tumor representing less than 0.5% of renal cell carcinomas (RCC), and it is considered rare. When it occurs, patients typically have sickle cell trait, sickle cell disease, or an associated hemoglobinopathy, which is a necessary characteristic for diagnosis. Additionally, RMC is characterized by the inactivation of alterations in the SMARCB1 (INI1) tumor suppressor gene, resulting in the loss of INI1 immunohistochemical expression. However, there are tumors reported in the literature with the same morphological and phenotypic characteristics as RMC but without hemoglobinopathy, referred to as "unclassified RCC with medullary phenotype."

Case report: We present the 13th case of unclassified renal cell carcinoma with a medullary phenotype in a 20-year-old woman. The patient was admitted with complaints of macroscopic hematuria, with no significant findings on physical examination. Diagnostic investigation included a computed tomography urogram, which revealed a hypovascular oval image with central cystic/necrotic areas in the middle third of the right kidney, measuring 32 mm, suggesting a possible diagnosis of an infected renal cyst. Subsequent magnetic resonance imaging showed findings consistent with an atypical presentation of primary neoplasia in the differential diagnosis, prompting a renal biopsy for case definition. Histopathological analysis revealed a high-grade infiltrative epithelioid neoplasm. Immunohistochemistry showed positivity for PAX8 and loss of INI-1 expression. No hemoglobinopathies were identified in the patient, in this context, the neoplasm is appropriately classified as unclassified renal cell carcinoma (RCC) with medullary phenotype and SMARCB1 deficiency. The instituted therapy consisted of right radical nephrectomy with retroperitoneal lymphadenectomy, with nodal metastases detected.

Conclusion: Given the rarity of unclassified RCC with a medullary phenotype, continuous documentation and analysis of individual cases not associated with sickle cell trait are crucial to understanding its behavior, prognosis, and potential therapeutic approaches, considering its aggressiveness and high metastatic potential.

Introduction: This study evaluates our initial experience with miniaturized percutaneous nephrolithotomy (mini-PCNL) in Vietnamese patients with staghorn calculi, using an 18F metal access sheath. This technique addresses the challenges of complex kidney stone management in resource-limited settings.

Methods: A multi-center retrospective review of 236 patients with staghorn calculi who underwent mini-PCNL with high-power Ho laser lithotripsy (Lumenis 100 W) was conducted at four provincial hospitals in northern Vietnam from January 2020 to December 2023.

Results: Among the 236 patients (mean age 54.88 years), 13.56% had prior open surgery, and 3.81% had previous PCNL. Presenting symptoms included flank/back pain (97.88%), acute renal colic (11.44%), and dysuria (5.93%). Right-sided stones were present in 55.93%, left-sided in 32.63%, and bilateral in 11.44%. The mean stone size was 28.05 mm, with 53.81% having stones of 20-30 mm, 38.56% over 30 mm, and 7.63% under 20 mm. Single stones were noted in 69.07%, while 30.93% had multiple stones. The mean stone surface area was 318.17 mm². Hydronephrosis was observed in 53.81% (grade-1: 32.64%; grade-2: 17.37%; grade-3: 3.81%). Postoperative complications included bleeding (13.14%), fever (9.75%), and reoperation or JJ stent placement (1.69%). Stone clearance rates were 67.37% at three days and 80.91% after one month. The mean durations for ureteral catheterization, postoperative hospitalization, and total hospital stay were 3.29, 6.94, and 12.90 days, respectively.

Conclusions: Mini-PCNL with high-power Ho laser lithotripsy demonstrates safety and efficacy in managing staghorn calculi, achieving favorable stone clearance and recovery outcomes. This approach offers a viable, cost-effective solution for enhancing access to advanced urological care in resource-constrained environments.

Introduction: Disparities in pregnancy care exist in the United States, with limited data on access to specialized postpartum care for patients with complicated perineal lacerations. Our objective was to assess for disparities in access to a postpartum pelvic floor healing clinic following vaginal delivery. We hypothesized an underrepresentation of patients from more resource-deprived neighborhoods and those with longer travel times to the specialized clinic.

Methods: This is a retrospective cohort study comparing sociodemographic variables from a historical cohort of patients with third- and fourth-degree lacerations following vaginal delivery to a cohort of patients evaluated in a postpartum pelvic floor healing clinic. The primary outcome involved the comparison of the neighborhood area deprivation index between groups. The secondary outcomes included median household income, driving time, and distance to the hospital.

Results: Patients seen in the postpartum pelvic floor healing clinic were older (31.3 vs. 29.9 years, p < 0.01) and more likely to be multiparous (20.3% vs. 13.1%, p = 0.04). Race, ethnicity, and operative vaginal delivery were similar between groups. Patients from the postpartum pelvic floor healing clinic had more postpartum visits [3 (IQR 2-4) vs. 2 (IQR 1-2) visits, p < 0.01]. There was no significant difference in median neighborhood area deprivation indices [4 (IQR 2-7) vs. 5 (IQR 3-7), p = 0.06]. Fewer patients from the most resource-deprived neighborhoods were seen in the postpartum pelvic floor healing clinic, though this was not statistically significant (4.5% vs. 8.9%, p = 0.06). There were no significant differences in median household income or driving distance to the hospital between groups.

Conclusions: Access to a specialized postpartum pelvic floor healing clinic at our institution appears equitable across several sociodemographic factors.

Background: Pediatric lower urinary tract symptoms (LUTS) impact a significant number of children and families worldwide. Estimated prevalences rely on small cross-sectional studies, leading to inconsistent estimates. This study aims to characterize demographic and temporal trends in LUTS prevalence within a national claims database of privately insured individuals in the United States.

Methods: We conducted a retrospective cohort study by reviewing the Merative™ MarketScan^® Outpatient Research Database v2.0 between 2007-2016. Patients with neurogenic bladder, renal transplant, structural urologic disease, and concurrent urinary tract infection were excluded. Yearly trends were reviewed across age, sex, geographic region, and clinical comorbidities such as attention-deficit/hyperactivity disorder (ADHD) and constipation. Yearly frequency of diagnostic codes was calculated to characterize LUTS diagnostic coding practices.

Results: We identified 1,625,538 patients aged 5-18 years with LUTS, representing 6% of the total population at risk, with a median age of 8.0 years. More patients in the cohort were female (66.1%), between 5-10 years old (57.9%), and resided in the Southern US (38.5%). The yearly prevalence of LUTS significantly increased from 1.8% to 2.1% yearly, and saw significant increases in females, 15-18 year old patients, and across several geographic regions. Comorbid constipation and ADHD within LUTS patients also significantly increased. Diagnostic coding practices remained stable.

Conclusions: Families of patients with LUTS are increasingly seeking medical care for their condition. These results exceed similar estimates from previous longitudinal studies and can inform population-level intervention strategies. Further studies should investigate the impact of LUTS on healthcare resource utilization, including in non-privately insured populations.

Objective: This research seeks to assess the prevalence of sarcopenia in patients diagnosed with localized prostate cancer and to investigate the influence of sarcopenia on the incidence of urinary incontinence following laparoscopic radical prostatectomy.

Methods: A cohort of 350 patients, diagnosed with prostate cancer and having undergone laparoscopic radical prostatectomy at our hospital's urology department between January 2022 and December 2023, was selected for this study. The cohort comprised 215 patients classified as low to intermediate risk and 135 patients classified as high risk. Participants were categorized into two groups: the sarcopenia group (n = 143) and the non-sarcopenia group (n = 207). The study aimed to summarize the prevalence of sarcopenia among patients with localized prostate cancer and to compare the incidence of urinary incontinence immediately post-surgery, as well as at three and six months postoperatively, between the sarcopenia and non-sarcopenia groups.

Results: The study assessed the prevalence of sarcopenia in a cohort of 350 patients with localized prostate cancer, revealing an overall prevalence rate of 40.86%. Specifically, the prevalence was 34.2% among patients classified as low to intermediate risk and 51.11% among those classified as high risk (P<0.01). The incidence rates of urinary incontinence were documented at various postoperative intervals: immediately after surgery, at 3 months, and at 6 months, with rates of 72%, 47.81%, and 28%, respectively. Notably, patients with sarcopenia exhibited significantly higher urinary incontinence rates compared to those without sarcopenia, at 82.52%, 65.03%, and 37.06% versus 64.73%, 35.75%, and 21.74% (P<0.01). Among low to intermediate-risk patients, the urinary incontinence rates immediately post-surgery, at 3 months, and at 6 months were 59.53%, 32.56%, and 16.28%, respectively, which were significantly lower than the rates observed in high-risk patients, recorded at 91.85%, 71.85%, and 46.67% (P<0.01). In the subgroup of low to intermediate-risk patients with sarcopenia, the postoperative urinary incontinence rates were 68.92% immediately, 54.05% at 3 months, and 18.92% at 6 months, compared to 54.61%, 21.28%, and 14.89% in patients without sarcopenia. However, the differences in incontinence rates immediately post-surgery and at 6 months were not statistically significant (P>0.05)In patients at high risk with sarcopenia, the incidence rates were 97.10%, 76.81%, and 56.52%, which were higher compared to those without sarcopenia, who exhibited rates of 86.36%, 66.67%, and 36.36%. There was no significant difference observed at three months post-surgery (P > 0.05). Regression analysis indicates that sarcopenia is significantly associated with an increased risk of urinary incontinence following radical prostatectomy at three months post-operation (OR = 0.448, 95% CI: 0.290-0.691, P < 0.001) and s

Introduction: The use of laser in urology is increasing, especially in renal stones and benign prostatic hypertrophy. Despite the interest in this technology on improving surgical management, several adverse events may result. This work collates French reports of care-associated adverse events (CAEs) resulting from lasers used in urological interventions.

Materials and methods: This is a collection of CAEs between May 2016 and December 2023 declared by urologists involved in accreditation throughout France. These CAEs were classified according to five levels of severity. They have been described and classified according to the ALARM protocol. The statistics were mainly descriptive. Fisher's exact test and Student's t-test were used via the software R.

Results: Between May 2016 and December 2023, between the 1,376 declared events, 149 laser-related CAEs were reported in urological interventions. Five CAEs (3.4%) were classified as grade 3, and six CAEs (4%) were classified as grade 4. All the other CAEs were between grades 1 and 2 with negligible consequences. The immediate reported causes of laser AEs were the clinical complexity of the case (7.38%), the technical gesture (14.1%), patient information (24.83%), material (38.25%), and medications (15.43%). Incidents caused by problems in material seem to be more frequent in younger patients (p < 0.001), healthier patients (ASA 1) (p = 0.003), risky situations (p < 0.001), and laser procedures (p < 0.001).

Conclusion: In France, 7.4% of CAEs related to the use of laser in urological surgery are of major to critical severity. Training teams on the use of laser generators and providing feedback on functional results and related specific morbidity seem necessary to guarantee the proper use of these technologies and the safety of staff and patients.

Introduction: In Africa, prostate cancer poses significant diagnostic and treatment challenges due to limited access to diagnostic tools and healthcare resources. This survey aimed to assess current prostate biopsy practices, patient classification methods, and available therapeutic means among African urologists to propose strategies for improved screening, diagnosis, and management.

Methods: A web-based self-administered questionnaire was distributed to urologists in 58 African centres, focusing on biopsy practices, cancer diagnosis, management, and treatment protocols. After pretesting and validation, data collection spanned six weeks, followed by duplicate elimination and arithmetical analysis, with results expressed in absolute, mean, or percentage values.

Results: Feedback was received from 58 centres across diverse African regions, including Central, Southern, West, East Africa, and Madagascar, comprising general, private, and university hospitals. Prostate cancer emerged as the most frequent urological cancer in all regions studied. The assay for prostate-specific antigen (PSA) was available in nearly all centres. Biopsy techniques varied, with ultrasound-guided biopsies being the most common (30 centres), followed by digital-guided (20 centres) and MRI-guided biopsies (5 centres). One centre lacked the expertise to perform biopsies. Radiological workup availability was high, with CT available in 56 centres, MRI in 54, PET scans in 14, and scintigraphy in 29. Treatment capabilities varied, with 53.4% of centres able to perform radical prostatectomies, 86.2% offering radiotherapy, and 94.8% providing medical castration. Among the centres, 56 performed fewer than 5 radical prostatectomies per month, while only 2 centres performed between 5 and 10 per month.

Conclusion: It is important to standardise prostate cancer diagnosis and treatment protocols across Africa while improving access to advanced diagnostic technologies and treatment facilities. Implementing these changes could enhance early detection, improve treatment outcomes, and reduce the burden of prostate cancer in Africa.