Advances in Urology最新文献

Background: Bladder reconstruction traditionally involves intestinal segments, which, despite their effectiveness, carry significant risks such as metabolic disturbances and infection. Safer, synthetic alternatives are needed. We evaluated a novel 3D-printed multilayered bladder scaffold combining polylactic acid (PLA), thermoplastic polyurethane (TPU), and polyvinyl alcohol (PVA) in a rabbit model. Methods: Anatomically tailored scaffolds were designed using computer-aided design (CAD) and fabricated under good manufacturing practice (GMP) conditions. Mechanical integrity was assessed after 60 days of incubation in simulated bladder media, including measurements of modulus of elasticity, tensile strength, elongation, and shape recovery. Acid/alkaline resistance was tested for chemical stability. For in vivo analysis, four rabbits underwent bladder augmentation with a 1 × 1 cm scaffold-augmented defect. Postoperative outcomes were monitored for 60 days, followed by histopathological evaluation. Results: After incubation, the scaffolds retained mechanical strength (modulus: 1.2 ± 0.3 GPa; tensile strength: 18.5 ± 2.1 MPa) with minimal elongation reduction (25% vs. 28% unused). Chemical testing confirmed structural stability and full shape recovery. In vivo, all rabbits survived without urinary leakage. Mild intra-abdominal adhesions and universal cystolithiasis were noted. Histology showed complete urothelial reepithelialization and mild-to-moderate submucosal fibrosis with chronic inflammation but no necrosis or acute inflammation. Compared to biological scaffolds, the synthetic construct showed reduced mortality and comparable inflammation, though with increased stone formation. Conclusion: This 3D-printed scaffold demonstrates promising biocompatibility, mechanical durability, and integration in bladder repair. While early results are encouraging, further studies with larger sample sizes and longer follow-up are needed to address limitations such as cystolithiasis risk.

Background: In biochemically recurrent prostate cancer (BRPC), no definitive independent prognostic factors were reported. This study aimed to identify the factors impacting overall survival (OS) in patients with BRPC after radical prostatectomy (RP). Methods: Among 610 consecutive patients who underwent RP between January 2000 and December 2019, with follow-up through December 2024, 152 (25%) patients who developed BRPC were analyzed. The primary endpoint was to identify an independent prognosticator of OS, while the secondary endpoint was to investigate clinical and tumor characteristics in BRPC patients. Results: The median age of the cohort was 67 years. Of the BRPC patients, 37 (24.4%) were managed with observation alone, 80 (52.6%) underwent external beam radiation therapy with or followed by androgen deprivation therapy (ADT), and 35 (23.0%) received ADT alone. During follow-up, two cases of local recurrence and nine cases of distant metastases were observed, with seven patients (1.2%) progressing to castration-resistant prostate cancer. Over a median follow-up of 118 months, 21 all-cause and 5 cancer-specific deaths were recorded. Multivariable analysis identified time to biochemical recurrence (TTBR) as the sole independent significant prognostic factor for OS (hazard ratio: 0.956, 95% confidence interval: 0.916-0.997, p=0.036). Kaplan-Meier survival curves, using a TTBR cutoff of 12 months, revealed significant differences in OS between the shorter and longer TTBR cohorts. Conclusions: This long-term retrospective study demonstrates that TTBR may serve as a unique independent prognostic factor for OS in BRPC patients. A TTBR of ≤ 12 months was significantly associated with worse OS, irrespective of clinicopathological risk features.

Objectives: The study aims to determine the uroflowmetry parameters of patients undergoing artificial urinary sphincter (AUS) implantation. Hence, uroflowmetry results pre- and post-AUS implantation and differences according to patient background were evaluated. Methods:Thirty-five patients who underwent primary AUS implantation for severe stress urinary incontinence due to radical prostatectomy were enrolled. All patients underwent uroflowmetry tests before and 1, 3, 6, and 12 months after AUS device activation. The patients reported outcomes using validated questionnaires: the King's Health Questionnaire (KHQ), the International Prostate Symptom Score (IPSS), and the quality of life (QOL) score. Results: The mean patient age was 72.8 ± 5.4 years. The mean maximum flow rate (Q _max) value pre-AUS implantation (20.4 ± 11.3 mL/s) was significantly higher at 1-month post-AUS implantation and maintained at 12 months (26.0 ± 14.7 mL/s; p=0.011). KHQ, IPSS, and QOL scores were significantly improved after AUS implantation. Q _max, and voiding volume was significantly higher in patients aged < 73 years compared to those aged ≥ 73 years. Conclusion: Uroflowmetry parameters were improved after AUS implantation and maintained for at least 12 months. Not only subjective outcomes but also objective outcomes of uroflowmetry parameters significantly improved after AUS implantation. This is the first report assessing uroflowmetry outcomes after AUS implantation.

Background and Objective: Benign prostatic hyperplasia (BPH) often necessitates surgical treatment, with open prostatectomy remaining a standard approach. However, this procedure carries a significant risk of intraoperative and postoperative bleeding, often requiring blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown potential in reducing surgical blood loss. This study aims to evaluate the effect of intraoperative local administration of TXA on perioperative blood loss in patients undergoing open prostatectomy for BPH. Methods: In this double-blind randomized controlled trial, 140 patients with BPH were assigned to either a TXA group or control group. In the intervention group, 1 g of TXA was diluted in 100 mL of normal saline and injected into the prostatic fossa during surgery, followed by three additional postoperative doses. The primary outcome was total perioperative blood loss. Secondary outcomes included changes in hemoglobin, hematocrit, platelet count, transfusion requirement, and length of hospital stay. Baseline differences, including a significant age gap between the groups (mean age: TXA group 60.70 ± 7.44 years vs. control group 70.50 ± 6.68 years), were statistically adjusted during analysis. Results: Perioperative blood loss was significantly lower in the TXA group (116.65 ± 43.23 mL) compared to the control group (210.27 ± 87.94 mL, p value = 0.001). The mean hemoglobin drop was also significantly reduced in the TXA group at both 24 and 48 h postoperatively. Fewer patients in the TXA group required blood transfusion (2.85%) compared to the control group (10%, p value = 0.03). No major adverse events directly attributed to TXA were identified, although one patient in the TXA group developed a pulmonary embolism. Conclusion: Intraoperative local administration of TXA significantly reduces perioperative blood loss and the need for blood transfusion in patients undergoing open prostatectomy. TXA appears to be a safe and effective strategy for minimizing surgical bleeding in this setting. Trial Registration: Iranian Registry of Clinical Trials: IRCT20180625040232N8.

Genitourinary tract injuries can occur in the urinary tract or reproductive system as a result of trauma-related pelvic fractures, iatrogenic lacerations or ligations, and radiation therapy for reproductive or digestive malignancies. Although surgical reintervention is possible for large urinary tract injuries, a key component for healing smaller injuries is the ability to divert urine from the injury site to prevent urine-wound contact. This enables the injury to heal prior to reintervention and can eliminate the need for a secondary procedure, reducing the potential for complications. This type of urinary diversion is required by 140,000 patients in the United States annually, leading to the development of several devices to divert urine. The current standard of care includes minimally invasive procedures, such as placement of a catheter, double-J stent, or nephroureteral stent, but such measures often do not maintain sufficient dryness to enable wound healing. Based on a review of the literature, we have determined that successful devices need to prevent 100% of the anterograde urine flow, resist migration down the ureter because of peristalsis, and prevent urothelium growth over the device to promote wound healing without causing complications or necessitating reintervention. We also evaluated these devices according to the robustness of the study populations and designs in which they are reported. Some of the more successful devices include detachable, semicompliant balloons, platinum coils, and ureteral clips. Here, we present a narrative review of temporary and permanent ureteral occlusion devices and evaluate their potential for supporting wound healing. We also explore metrics by which to compare and select appropriate devices for urinary diversion.

Background and Objective: The optimal definitive treatment for localized prostate cancer (PCa)-radical prostatectomy (RP) or intensity-modulated radiation therapy with image guidance (IMRTG) remains controversial. This study compares the long-term clinical outcomes of RP and IMRTG in patients with PCa. Methods: We retrospectively analyzed 884 consecutive PCa patients over 25 years. Among them, 610 (69%) underwent RP, while 274 (31%) received IMRTG starting in 2011. The primary objective was to comprehensively assess both treatment modalities. Results: The median age was 68 years in the RP cohort and 73 years in the IMRTG cohort. The median operation time for RP was 4.11 h, with nerve-sparing procedures performed in 45% of cases. Median blood loss was 310 mL, the urinary incontinence rate was 13%, and the median hospital stay was 14 days. In the RP cohort, 46 complications (28%) occurred, including a Grade 4 rectal injury and a Grade 4 wound insufficiency. In the IMRTG cohort, over 80% of patients experienced radiation-induced urological complications, with 11% reporting Grade 2 adverse effects. During a median follow-up of 98 months, there were 79 all-cause deaths and 7 PCa-specific deaths. The 15-year overall survival (OS) rates were 80.9% for RP and 58.3% for IMRTG; however, this difference was not significant in the multivariate analysis, likely due to a higher proportion of high-risk disease in the IMRTG cohort. Approximately 45% of all deaths were attributed to malignant tumors. Conclusions: This long-term retrospective study provides valuable insights into the comparative effects of RP and IMRTG on OS in PCa patients. Both treatments are associated with distinct adverse events, complications, and impacts on urinary continence and sexual function, highlighting the importance of individualized clinical decision-making.

Aim: We investigated the role of transperineal template saturation biopsy (TTSB) in detecting clinically significant prostate cancer (csPCa). We compared the TTSB findings with multiparametric magnetic resonance imaging (mpMRI) findings in suspected prostate cancer patients. Methods: This retrospective study included 124 patients who underwent TTSB following mpMRI at our institute. We examined factors contributing to csPCa detection in these patients. We examined the association between the Prostate Imaging-Reporting and Data System (PI-RADS) Version 2.1 category and csPCa detection. Results: The median age at TTSB was 68 (interquartile range: 62-73) years, and the median prostate-specific antigen level was 9.9 (6.1-15.5) ng/mL. Herein, 61.3% (76/124) of the patients who underwent TTSB had cancer and 35.5% (44/124) had csPCa. Abnormal digital rectal examination findings (p=0.006) and PI-RADS category ≥ 4 (p < 0.001) were independent factors for csPCa detection. Among patients categorized as PI-RADS ≥ 4, 64.8% (35/54) had csPCa; csPCa frequency increased with increasing PI-RADS categories (p < 0.001). Cancer was detected in 38.3% (23/60) of the patients categorized as PI-RADS ≤ 2; among them, 10% (6) had csPCa. Only 3.2% (4/124) of the patients had TTSB-related adverse events ≥ grade 2, 0.8% (1/124) suffered from hematuria, and 2.4% (3/124) had acute urinary retention. All patients were treated conservatively. Conclusions: Patients with a higher PI-RADS category tended to have csPCa. However, the PI-RADS category alone may not be sufficient for csPCa detection. TTSB detected csPCa in 10% of the patients with negative mpMRI findings. TTSB is a safe and crucial technique for accurately diagnosing prostate cancer.

Background: Although clinical trials should be accessible to all patients, persistent racial and ethnic disparities in clinical trial enrollment exist. Herein, we examine racial disparities in clinical trial enrollment among prostate cancer patients from a large population-based cohort of oncology practices in the United States. Methods: Using CancerLinQ Discovery, we identified men with regional (N1+) and/or metastatic (M1) prostate cancer diagnosed from 2011 to 2023. Enrollment into a clinical trial for prostate cancer was the primary outcome. Multivariable logistic regression and Cox proportional hazard regression were used for analysis. Results: Within our dataset, we identified 17,028 patients with advanced prostate cancer, of which only 2.6% of patients were enrolled in a clinical trial (n = 450). There was variance in the proportion of patients accrued over time with a low of 0.30% in 2011 to a high of 3.94% in 2018 and decreasing to 2.37% in 2023. On multivariable analysis, older age was associated with lower odds of clinical trial enrollment (p < 0.001). Compared to White patients, Hispanics/Latino (OR: 0.35; CI: 0.161-0.744, p=0.04) and patients with self-identified other race or ethnicity (OR: 0.23; CI: 0.295-0.931, p < 0.01) had lower odds of clinical trial enrollment on multivariable analysis. Black men with prostate cancer did not have a statistically significant difference compared to White men for clinical trial enrollment. (OR: 1.033; CI: 0.771-1.384, p=0.828). Conclusion: While clinical trial enrollment remains low for men with advanced prostate cancer in this contemporary population-based cohort, rates of participation for Hispanic/Latino men, but not Black men, are significantly lower. Increased attention is needed to better understand the reasons behind these racial disparities and to develop effective interventions to promote access.

Introduction: Since contact laser vaporization of the prostate (CVP) was approved by the Japanese insurance system in 2016, the use of a 980 nm diode laser system for CVP has become widespread for treating benign prostate hyperplasia (BPH) patients. Our institute has been implementing CVP for BPH since 2018, treating a total of 93 patients, including 28 with a risk of hemorrhage. This study examines the safety and efficacy of CVP treatment for BPH patients with a hemorrhagic risk. Patient and Methods: A total of 93 BPH patients with lower urinary tract symptoms (LUTS) underwent CVP between February 2018 and September 2022. All patients were on medications for BPH and were refractory to these medications. The median (mean ± SD) age was 72 (72.9±6.27), and the prostate volume was 64 (68.9±32.5). IPSS, QOL index, and OABSS scores for patients not requiring catheterization were 22 (22.1±6.38), 5 (5.24±0.74), and 6 (7±3.29), respectively. The CVP treatment was performed using a 980 nm diode laser. Of the 93 patients, 28 (30.1%) had a hemorrhage risk. This group included 13 (14.0%) who were continuously receiving anticoagulant and/or antiplatelet agents, 13 (14.0%) who temporarily stopped these medications, and 2 (2.1%) who had a hemorrhage risk due to low platelet counts (< 5.0 × 10⁴/μL). Results: Postoperatively, 15 (16.1%) patients, including 11 who were catheterized preoperatively, needed temporary catheterization after CVP treatment. Of these, 14 had their catheters successfully removed. The IPSS score significantly decreased from 22 (22.1±6.38) to 8 (9.02±6.07) (p < 0.0001). In patients with hemorrhagic risk on anticoagulant and/or antiplatelet agents, the change in hemoglobin level before and after surgery was 0.6 g/dL, a difference that was not significant. Two of the 15 patients with hemorrhagic risk experienced hemorrhage 23 and 26 days postoperatively and underwent transurethral coagulation. Other perioperative complications classified as Clavien-Dindo Grade 2 or higher occurred in 4 (4.3%) patients. Conclusion: CVP treatment appears to be acceptable for BPH patients with hemorrhagic risk. In this study, late-onset hemorrhage occurred approximately 1 month postoperatively. Close postoperative follow-up is required.

Acute kidney injury (AKI) is characterized by impaired renal function that can result in irreversible severe renal impairment or lifelong dependence on renal replacement therapy in some cases. Early intervention can significantly slow down the progression of AKI and reduce mortality. In recent years, electronic early warning systems for patients with AKI have been gaining attention as a potential clinical decision-support option. This paper presents a review of the application of electronic early warning systems for AKI from four aspects: development process, types of output, influencing factors, and system evaluation.