Frontiers in urology最新文献

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.

Giant prostatic hyperplasia (GPH) is defined as benign prostate hyperplasia (BPH) of more than 200 ml. It is a challenging condition because transurethral resection is classically indicated for prostate volume less than 80 ml and open adenectomy remains the gold standard therapy for GPH. Herein, we present the case of a 54-years old male with giant prostatic hyperplasia (total prostate volume of 265 ml) causing lower urinary tract symptoms (LUTS) and recurrent episodes of acute urinary retention. The patient refused the surgical adenomectomy and underwent bilateral prostate arteries embolization (PAE). Post embolization period was uneventful. Total prostate volume decreased progressively and LUTS disappeared. At more than 5 years follow-up the patient remains still asymptomatic, despite the discrete regrowth of the prostate detected on imaging. This case report suggests that PEA may be a good alternative to open surgery for patients with symptomatic GPH.

Introduction: We previously presented promising results with a Burch-type colposuspension (BC) in a heterogeneous group of girls with therapy-resistant daytime incontinence (DUI). In view of our clinical observations, we expect that a small group of girls with refractory DUI based on stress-urinary incontinence (SUI) might also benefit from a BC in order to achieve continence.

Objective: To assess the (long-term) effect of BC on refractory DUI in girls with SUI, and to identify predictive factors for success.

Study design: A retrospective chart study including all girls with refractory DUI who underwent an open or laparoscopic BC at our tertiary referral center between 2003-2017 (n=34) was performed. Patients were considered refractory after having failed all non-invasive treatment methods. The main outcome measurement was continence, expressed as the percentage of children with decreased incontinence at post-surgical follow-up without any additional treatment (complete response 4-6 months after surgery). Additionally, a cross-sectional follow-up was carried out, assessing the long-term effect of BC on DUI and patient satisfaction by means of standardized questionnaires.

Results: Complete continence after surgery was achieved in 12% (4/34) and 12% (4/34) showed a decrease in frequency of incontinence episodes. Patients with an abnormal flow pattern more often failed complete continence or improved incontinence. After a mean duration of 8 years, 84% (16/19) still experienced DUI. 68% (13/19) of those patients would opt for the BC again.

Conclusion: Although 84% of children still experienced any degree DUI after a mean duration of 8 years after BC, most patients do not regret the decision of surgical treatment. Given the limited benefit and invasiveness of the procedure, however, we discourage to routinely perform BC in children with refractory DUI and SUI. Our results should be taken into account when discussing expectations and chances of success.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans, particularly affecting women, with significant clinical and socioeconomic impacts. Despite advances in medical research, the diagnostic criteria for UTI have remained practically unchanged since Kass's seminal work, emphasizing the need for a reevaluation in light of new scientific insights. Recent studies have highlighted the importance of the urobiome, a previously underappreciated community of microorganisms within the urinary tract (UT), and its role in maintaining urogenital health. The gut-bladder axis has emerged as a critical pathway in understanding UTI as a dysbiosis, where imbalances in the microbial community and its relation with the host contribute to infection susceptibility. This review explores the evolving definitions and diagnostic challenges of UTI, particularly in women, and examines the implications of recent discoveries on the urobiome and the gut-bladder axis. Additionally, we discuss the potential of novel therapeutic strategies to restore microbial balance, offering a promising avenue for the therapeutic management of UTIs.