Frontiers in urology最新文献

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.

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.