American journal of clinical and experimental urology最新文献

Time from cancer diagnosis to treatment initiation (TTI) can influence clinical outcomes and is a measure of care quality. This study aimed to evaluate the associations between clinical, sociodemographic, and facility-level factors with treatment delays among patients with prostate cancer during the COVID-19 pandemic. We conducted a retrospective analysis of the National Cancer Database (NCDB) for prostate cancer cases diagnosed in 2020 and 2021. We assessed the associations between clinical factors, sociodemographic variables (age, race, ethnicity, sex, income, education, insurance), facility-related factors (facility type, geographic region), and TTI. Multivariable logistic regression was used to identify factors associated with prolonged TTI, defined as the top decile of days to treatment. We identified 160,863 patients, with a median TTI of 71 days (IQR: 43-107). The 90th percentile for TTI was 154 days. Compared to White race, Black (OR 1.39, 95% CI 1.33-1.45), Asian (OR 1.28, 95% CI 1.08-1.52), and Hispanic (OR 1.31, 95% CI 1.21-1.41) patients had significantly longer TTI. Treatment at academic (OR 1.84, 95% CI 1.70-2.00), network (OR 1.37, 95% CI 1.25-1.49), and comprehensive facilities (OR 1.16, 95% CI 1.07-1.26) was associated with longer TTI compared to community facilities. Lastly, private insurance was associated with shorter delays compared to uninsured individuals (OR 0.75, 95% CI 0.71-0.81). Sociodemographic disparities, including race, insurance status, and treatment facility, were associated with longer TTI among prostate cancer patients during the COVID-19 pandemic. These findings can guide efforts to improve timeliness of cancer care.

Background: Tuberculosis spondylitis, also known as Pott's disease, is a form of osteomyelitis that primarily affects the vertebral bodies and can lead to severe complications such as paravertebral abscesses, kyphosis, and degenerative spinal changes. Although it typically involves the skeletal system, contiguous spread to adjacent organs, such as the genitourinary tract, is rare.

Methods: We report the case of a 64-year-old male with chronic back pain who underwent a renal protocol abdominopelvic CT scan following ultrasound findings of right kidney stasis.

Results: The CT revealed obstructive uropathy with a dilated and tortuous ureter, a 27×30 mm intraluminal lesion, intraluminal gas, and periureteric fibrosis. Fusion of the L3-L5 vertebrae with gibbous deformity and degenerative changes suggested tuberculous spondylodiscitis with extension to the ureter. Urinalysis was positive for acid-fast bacilli, confirming genitourinary tuberculosis. The patient underwent right ureteronephrectomy due to pyonephrosis and extensive adhesions precluding ureteral reconstruction.

Conclusion: This case highlights a rare but serious complication of spinal tuberculosis involving direct spread to the ureter. Timely diagnosis using imaging and microbiological testing, followed by appropriate surgical intervention, is critical to prevent long-term morbidity.

Purpose: Temsirolimus and pazopanib serve as first-line therapies for renal cell carcinoma (RCC). This meta-analysis was performed to assess and compare their efficacy, optimal treatment targets, and associated toxicities.

Methods: We searched the PubMed, CNKI, Wanfang, and VIP databases for relevant literature published from 2003 to 2023. Studies were selected based on specific exclusion criteria, and eligible articles were subjected to data extraction for subsequent subgroup analysis.

Results: Fourteen studies of moderate to high quality were included. In the low-risk group, the mortality rate was significantly lower in the temsirolimus group at 0.23 (95% Cl, 0.15-0.31) compared to 0.44 (95% Cl, 0.40-0.47) in the pazopanib group. In the high-risk group, the mortality rate was 0.73 (95% Cl, 0.69-0.76) for temsirolimus and 0.67 (95% Cl, 0.64-0.71) for pazopanib.

Conclusion: Temsirolimus demonstrated greater efficacy in the low-risk group, while pazopanib was superior in the high-risk group for the treatment of RCC. Consideration of both efficacy and toxicity is crucial to guide drug selection for patients. TRN: CRD42024578497 (Registration date: 2024/08/21).

Objective: To explore the efficacy and safety of continuous nursing based on the Omaha System in patients with double-J stents after upper urinary tract stones surgery.

Patients and methods: A total of 171 patients who underwent upper urinary tract stones surgery in our department from July 2022 to December 2023 were selected. According to the envelope randomization method, patients were divided into a control group (85 cases) and a study group (86 cases). In the control group, we carried out discharge education upon discharge, distributed health education manuals, explained the nursing, diet, daily exercise, and other precautions for indwelling double-J stents outside the hospital. On the basis of the control group, the Omaha System will be used to evaluate nursing issues, including the four aspects with the highest post discharge nursing needs: physiological, psychological, environmental, and health-related behaviors. Then, problem oriented continuous nursing.

Results: After nursing intervention, the cognitive score, behavioral score, and condition score of the two groups were separately higher than pre-nursing, and the scores in the study group were all significantly higher than those in the control group (P < 0.05). With respect to the secondary important variables, the overall incidence of complications in the study group was significantly lower than that in the control group (P < 0.05).

Conclusions: The application of continuous nursing based on the Omaha System in patients with double-J stents after upper urinary tract stones surgery can improve nursing outcomes, reduce the incidence of complications, and enhance self-care capabilities.

Objective: This study aimed to evaluate the therapeutic efficacy and safety profile of pelvic floor magnetic stimulation (PFMS) in combination with mirabegron in male patients diagnosed with benign prostatic hyperplasia (BPH) and overactive bladder (OAB).

Patients and methods: Eighty-six patients were prospectively randomized into two cohorts. The control group received oral mirabegron (50 mg daily), whereas the experimental group underwent combined PFMS and mirabegron therapy. Primary endpoints included variations in urinary frequency and urgency intensity, measured through a 3-day voiding diary. Secondary endpoints included changes in the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire (OAB-q) Health-Related Quality of Life (HRQol) index, and symptom burden, assessed at weeks 6 and 12.

Results: Among the participants, 42 received the combination therapy and 44 received mirabegron monotherapy. At both time points, the combination group demonstrated significantly reduced lower urinary tract symptoms (LUTS) - including urgency, frequency, and incontinence - relative to the monotherapy group (P < 0.05). Moreover, OAB-q HRQol scores were consistently higher in the combination group (P < 0.05). Significant improvements were also observed in the IPSS, OAB-q symptom bother index, and Overactive Bladder Symptom Score (OABSS) within the combination cohort (P < 0.05). The incidence of drug-associated adverse events did not differ significantly between groups (P > 0.05).

Conclusion: PFMS combined with mirabegron markedly alleviated BPH and OAB symptoms and improved patient-reported quality of life, without increasing the risk of adverse events compared to mirabegron monotherapy.

Objective: This study aimed to assess the efficacy and safety of tracking extended nursing (TEN) on patients with urinary tract stones after holmium laser lithotripsy (HLL).

Patients and methods: A total of 232 patients with urinary tract stones after HLL were prospectively randomized into 2 groups. One hundred and sixteen patients in the study group accepted TEN mode and 116 patients serving as control accepted only traditional nursing mode. The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores, measured at different time points, were considered the primary outcomes for evaluating patients' psychological state. The secondary end points were Quality of life (QOL) scores and complications between the two groups.

Results: After the TEN mode was applied to the study group, the HAMD and HAMA scores were significantly lower than those in the control group at the second and fourth week (P<0.05). With regard to the secondary variables, the QOL scores in the study group was significantly higher than that in the control group at the second and fourth week (P<0.05). In addition, the overall incidence of complications was significantly lower in the study group than in the control group (P<0.05). No serious complications were reported in either group.

Conclusions: The TEN mode improves psychological well-being and Qol in urinary tract stone patients undergoing HLL, accelerates recovery, reduces complications, and enhances self-care.

Purpose: To evaluate the role of functional bladder dysfunction in failed vesicoureteral reflux (VUR) surgery through conventional urodynamic study.

Materials and methods: This cohort study was conducted at the Labbafinejad Hospital in 2020-2022. Patients <18 years with VUR who were referred with failed surgical intervention (persistence, progression, or recurrence of reflux on the same or opposite side) were included. Demographic information (sex, urinary tract symptoms, type of surgical intervention, and side and grade of VUR) and urodynamic study UDS results were recorded and analyzed statistically.

Results: 53 patients were referred with failed surgery, with an average age of 8.20 ± 3.88 and a male-to-female ratio of 0.76/1.25. Bilateral vesicoureteral reflux (VUR) was present in 47.2%. Detrusor overactivity (DO) and dysfunctional voiding (DV) were found in 41 (77.4%) and 37 (69.8%) patients. The mean maximum amplitude and frequency of DOs were 50.58 ± 43.12 and 9.02 ± 8.15. Patients with bilateral VUR had significantly higher DO (92% vs 64.2%, P = 0.022), DO amplitude (70.60 ± 40.78 vs 32.71 ± 37.43, P = 0.001), and DO frequency (11.52 ± 8.14 vs 6.79 ± 7.63, P = 0.034).

Conclusion: Individuals with failed VUR surgery commonly have UDS abnormalities and it is more severe in bilateral VUR patients. It can be postulated that non-surgical management and medications may be recommended as the first approach.

Objectives: The predictive value of blood and serum markers for spontaneous ureteral stone passage (SSP) has been investigated, with no substantial conclusion about their reliability. Therefore, we aim to evaluate the predictive potential of blood and urine laboratory tests for ureteral stone passage.

Methods: This prospective, single-center observational study included patients with a solitary obstructing ureteral stone <10 mm diagnosed via non-contrast computerized tomography (NCCT). Definition for SSP was strict including physical evidence of stone passage, follow-up NCCT, or ureteroscopy, and patients were followed until stone passage or urologic intervention occurred. Blood and urine markers, including white blood cells count (WBC), neutrophil-to-lymphocyte ratio (NLR), creatinine, calculated glomerular filtration rates, urine leukocyte esterase and nitrates were collected. Univariate analysis, multivariate analysis, and receiver operating characteristic curves were performed to assess the association between markers and SSP.

Results: Cohort consisted of 165 participants who met the inclusion and exclusion criteria with adequate data collection and follow-up. Median age was 54 years with a male to female ratio of 11:5. Most stones were in the mid-distal ureter (56%) and median stone size was 3.5 mm. SSP was observed in 87 patients (53%). None of the blood or urine markers demonstrated a significant association with SSP, and areas under the curves were poor and insignificant. Smaller stone size and distal location significantly predicted SSP.

Conclusions: Routine blood and urine markers are not associated with SSP, and their contribution to SSP nomograms might be negligible. These negative results may redirect providers' focus to other factors when predicting SSP.

Introduction: Neuroinflammation of the central nervous system (CNS) triggers long-lasting neurodegenerative changes associated with the development of neurogenic dysfunction in the pelvic organs. We previously described the symptoms of voiding dysfunction in a mouse model of multiple sclerosis (MS) induced by a coronaviral infection with mouse hepatitis virus (MHV). The aim of the current study was to identify immune, inflammatory and neuronal changes in the lumbosacral (L6-S2) dorsal root ganglia (DRG) innervating the lower urinary tract (LUT) after severe neurodegeneration in the CNS.

Methods: Adult C57BL/6 male (N=18) and female (N=18) mice received either an intracranial injection of MHV (coronavirus-induced encephalomyelitis, CIE group), or sterile saline (control group). Dorsal root ganglia were collected from mice of both sexes at 1 and 4 weeks, followed by isolation of total RNA and bulk RNA sequencing.

Results: Transcriptome analysis of LS DRG identified a sex dependent expression of the genes at baseline with females having an increased expression of the immune system and extracellular matrix (ECM) related differentially expressed genes (DEGs) whereas males showed an upregulation of the genes belonging to protein synthesis, folding, and post-translational phosphorylation. Acute neuroinflammation (1 wk post-infection) triggered extensive immune responses involving the families of interferons (Ifna2, Ifng, Ifnl1), interleukins (Il1a, Il1b, Il6), toll-like receptors (Tlr9, Tlr7), and guanylate-binding proteins (GTPases, Gbp) in both, CIE males and females. However, at a later stage of neurodegeneration (4 wks post-infection), the number of upregulated DEGs was down 6-fold in CIE males, whereas in CIE females the downregulated pathways were predominant, and mostly included genes encoding motor proteins (Myh7, Myl2, Myl3, Tnnt1, TnnI1, Dnah5). Among the pathways upregulated in males but downregulated in females at both time points were phagosome formation pathway, neutrophil extracellular trap signaling, and hepatic fibrosis pathway.

Conclusions: This study confirmed a differential expression of immune, inflammatory, and neural DEGs in sensory ganglia of male and female mice undergoing CNS neurodegeneration and neuroinflammation. The obtained results suggest a functional role of sex-dependent sensory interoception in the development of neurogenic LUTS in a coronavirus-induced murine model of MS.

The synergistic interplay between RB1 deletions and TP53 mutations drives androgen deprivation therapy (ADT) resistance and neuroendocrine transdifferentiation in advanced prostate cancer, culminating in treatment-related neuroendocrine prostate cancer (t-NEPC). This investigation systematically examines the clinicopathological characteristics and immunohistochemical phenotypes of t-NEPC to enhance diagnostic accuracy and prognostic understanding. We conducted a retrospective analysis of 23 t-NEPC cases diagnosed at the First Affiliated Hospital of Zhejiang University School of Medicine (2013-2024). We collected comprehensive clinical data, including patient demographics, treatment history, and serum biomarker profiles. Immunohistochemical evaluation was performed to determine expression patterns of prostate-associated antigens, neuroendocrine markers, and tumor suppressor proteins RB1/p53. The cohort demonstrated a mean age of 70 years at initial prostate cancer diagnosis, with t-NEPC emerging after a median ADT duration of 18 months. Biochemical profiles revealed a characteristic dissociation between suppressed prostate-specific antigen (PSA) levels and elevated neuroendocrine markers alongside other tumor-associated antigens, including carcinoembryonic antigen (CEA). The immunohistochemical signature of lineage transdifferentiation, indicated by the loss of androgen receptor (AR) and the expression of neuroendocrine markers, provides critical diagnostic clues for this aggressive variant. Molecular alterations were prevalent, with RB1 loss detected in 78.26% (18/23) and p53 abnormalities in 82.61% (19/23) cases. Notably, a histologically confirmed t-NEPC case with neuroendocrine marker negativity exhibited RB1/p53 co-alterations, molecularly aligning with most neuroendocrine-positive cases. These findings substantiate that combined RB1/p53 aberrations serve as robust diagnostic indicators for t-NEPC, particularly in tumors exhibiting small cell carcinoma morphology without neuroendocrine marker expression.