Frontiers in urology最新文献

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.

Objectives: To characterize the estimated prevalence and treatment patterns of erectile dysfunction and hypogonadism in men with spina bifida through a large claims database.

Methods: This retrospective claims study used the MarketScan^® databases from 2008 to 2017 to compare prevalence estimates for erectile dysfunction and hypogonadism in men with spina bifida to those in men without spina bifida and to describe treatment patterns in this cohort.

Results: The estimated prevalence of erectile dysfunction and hypogonadism in men with spina bifida was 7.83% and 7.71%, respectively. Men with spina bifida exhibit high rates of smoking and metabolic comorbidities but are diagnosed less frequently with erectile dysfunction when controlling for age and metabolic comorbidities than men without spina bifida. Most men with spina bifida and erectile dysfunction (66.6%) or hypogonadism (77.4%) do not receive treatment. However, a diagnosis of spina bifida did not appear to affect the likelihood of treatment for either condition on multivariate analysis.

Conclusions: Men with spina bifida are known to be at high risk for erectile dysfunction but may be diagnosed or treated less frequently than age and disease-matched men without spina bifida. Hypogonadism is diagnosed more frequently in men with spina bifida, which is a new finding that warrants further investigation. Most men with SB and either ED or HG do not receive treatment. The results suggest there is potential for improving care delivery for sexual health issues in men with spina bifida.

Background: National guidelines recommend obtaining prostate gland volume (PGV) prior to benign prostate hyperplasia (BPH) surgery. Measurement of PGV with handheld ultrasound (HUS) probes shows promise.

Objective: To compare the reliability of two HUS probes (Butterfly iQ and Clarius C3) to the BPH guideline-recommended imaging (GIm) for both prostate and bladder volumetrics.

Methods: Male patients with GIm were randomized to undergo transabdominal HUS PGV with one of the two probes. A subset underwent voided volume measurements with one of the two HUS and a conventional bladder scanner (BS). The reliability of the volume measurements was assessed for each probe via intraclass correlation coefficients (ICCs). We utilized the following standard criteria: ICC < 0.5: poor reliability; 0.5 ≤ ICC < 0.75: moderate reliability; and ICC ≥ 0.75: good reliability.

Results: A total of 78 men in the prostate arm (38 Butterfly, 40 Clarius) and 45 in the bladder arm (24 Butterfly, 21 Clarius) were randomized and included in this study. The mean prostate volume based on GIm was larger in the Clarius group (p = 0.044). Other baseline characteristics were similar between groups (p > 0.05). The ICCs were 0.78 (95% CI: 0.62, 0.88) and 0.71 (95% CI: 0.51, 0.83) for the Butterfly and Clarius probes, respectively. Regarding bladder volumetrics, the ICCs were 0.82 (95% CI: 0.19, 0.95), 0.72 (95% CI: 0.44, 0.88), and 0.69 (95% CI: 0.13, 0.87) for the Butterfly, Clarius, and bladder scanner, respectively.

Conclusions: The Butterfly iQ demonstrated good reliability for PGV and voided volume measurements, in comparison to moderate reliability for Clarius C3.

Background: Primary neuroendocrine carcinoma of the urethra is a very uncommon malignant tumor, and no reports have been made about large cell neuroendocrine carcinoma (LCNEC) in the past.

Case description: A 43-year-old non-smoking female patient presented with symptoms of dysuria and urination-related pain at TangDu Hospital in April 2022. A biopsy subsequently confirmed the diagnosis of primary urethral LCNEC. Following radical resection, the patient exhibited abnormal lymph node enlargement in the first month and pelvic metastases in the fourth month. Ultimately, the patient succumbed to the disease 486 days after the radical resection, attributed to widespread tumor metastases and concurrent multi-organ failure. The final pathological examination confirmed the presence of a high-grade LCNEC.

Conclusion: The occurrence of primary LCNEC in the urethra is exceptionally uncommon. This particular instance was notable for its aggressive progression and unfavorable prognosis. Historically, there have been no prior documented instances of primary pure LCNEC in the urethra. It is imperative to emphasize that early identification and intervention for LCNEC could potentially offer patients a more favorable survival outcome.