BMC Urology最新文献

Background: Varicocele is one of the most common causes of male infertility. Although multiple surgical and interventional methods are available, their cost-effectiveness remains insufficiently studied. This study aimed to compare short-term clinical outcomes and cost-effectiveness of microsurgical and laparoscopic varicocelectomy, reporting embolization outcomes as exploratory data owing to the limited number of cases.

Methods: A retrospective analysis was conducted on 113 patients with varicocele who were admitted to our hospital between June 2022 and May 2025. Based on the surgical approach, patients were categorized into three groups: microsurgical (n = 42), embolization (n = 8), and laparoscopic (n = 63). Owing to the small size of the embolization cohort, primary comparative and cost-effectiveness analyses were performed for the microsurgical and laparoscopic groups, while embolization outcomes were reported descriptively. Preoperative and postoperative measures, including sperm concentration, percentage of forward-moving spermatozoa (PR%), maximum diameter of the spermatic vein, surgical cost, and postoperative complications, were compared and analyzed. All procedures were performed by senior urologists experienced in varicocele repair, and postoperative complications were recorded. A cost-effectiveness analysis was performed by calculating the cost-effectiveness ratio (CER) and incremental CER based on hospitalization costs and improvements in semen parameters.

Results: All 113 patients successfully completed surgical treatment. Intra-group comparisons showed that all three surgical approaches led to significant postoperative improvements compared with the preoperative period (P < 0.05). Inter-group comparisons indicated that the improvement in PR% was significantly greater in the microsurgical group than in the laparoscopy group (P < 0.05). Cost-effectiveness analysis revealed that microsurgery yielded the lowest CERs for sperm concentration improvement (CER: 410.13) and PR% improvement (CER: 220.78), with incremental analysis demonstrating that microsurgery was superior to laparoscopic surgery.

Conclusions: In this single-center retrospective cohort, microsurgical varicocelectomy was associated with superior short-term improvement in PR% and more favorable cost-effectiveness compared with laparoscopic varicocelectomy. Embolization outcomes were exploratory because of the limited sample size and should be interpreted with caution. Further multicenter studies with larger embolization cohorts and longer follow-up are warranted.

Background: This study aims to evaluate the efficacy and safety of modified water vapor thermal therapy for large-volume benign prostatic hyperplasia (BPH).

Methods: This prospective study enrolled 196 consecutive patients with prostate volume ≥ 80 mL who underwent modified water vapor thermal therapy at our institution between October 2023 and September 2024. All procedures were performed using the Rezum system.

Results: The procedures were successfully completed in all 196 patients with a median prostate volume of 96 mL. The IPSS decreased from a preoperative mean of 21.2 ± 3.9 to 11.7 ± 3.4 at 3 months, and further improving to 10.8 ± 3.8 at 1 year. Median prostate volume reduced from 96 mL to 60 mL. The QoL score improved from 4.3 ± 0.9 to 1.7 ± 1.1, and Qmax increased from 8.3 ± 2.3 mL/s to 15.7 ± 3.5 mL/s at 3 months. All observed improvements were statistically significant compared to baseline (P < 0.01). The IIEF-5 score increased from 11.0 ± 3.6 to 14.1 ± 5.4 at 1 year, indicating a statistically significant improvement in erectile function (P < 0.05). The incidence of retrograde ejaculation was 3.1%. Only one patient (0.5%) required surgical retreatment during the follow-up period.

Conclusions: Modified water vapor thermal therapy demonstrates favorable efficacy and safety in the treatment of large-volume BPH. It is associated with significant symptom relief, functional improvement, and minimal complications.

Background: Robot-assisted laparoscopic radical prostatectomy (RALRP) and intensity-modulated radiotherapy (IMRT) are the main curative options for localized prostate cancer (PCA). However, both may significantly affect patients' quality of life (QoL).

Objective: To retrospectively compare post-treatment QoL after at least 24 months of follow-up between bladder-neck- and nerve-sparing RALRP and IMRT in patients with intermediate-risk localized PCA.

Methods: A total of 164 patients treated between October 2016 and May 2023 were analyzed (104 RALRP; 60 IMRT). QoL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-2002). Urinary, bowel, sexual, and hormonal domains were compared using appropriate statistical tests .

Results: Baseline demographics were similar between groups. The mean age was 68.82 ± 6.72 years in the RALRP group and 68.89 ± 7.81 years in the IMRT group. IMRT patients reported better sexual function (p < 0.05), but this advantage was counteracted by hormonal side effects due to androgen deprivation therapy (ADT). Urinary continence was comparable (p > 0.05), whereas irritative urinary symptoms were more common in IMRT (p < 0.001). Bowel function and overall satisfaction were significantly better in RALRP (both p < 0.001).

Conclusions: After ≥ 24 months of follow-up, RALRP provided superior bowel and hormonal outcomes, while IMRT yielded slightly better sexual function scores. Overall satisfaction favored RALRP.

Background: A positive surgical margin (PSM) following radical prostatectomy is a significant prognostic factor that increases the risk of biochemical recurrence (BCR). However, the clinical relevance of the relationship between PSM localization, its extent, and the histopathological characteristics of the tumor and BCR remains unclear. This study aimed to evaluate the association between PSM features, tumor grade, and BCR.

Methods: Patients with pathological stage pT3 who had not received adjuvant therapy were included in the study. Surgical margin status was classified according to localization, length, and the presence of an accompanying tertiary pattern. Patients were compared in terms of clinical and pathological characteristics. The development of BCR was analyzed in relation to PSA dynamics and histopathological parameters.

Results: The presence of PSM significantly increased BCR rates and demonstrated a strong association with tertiary pattern positivity. The tertiary pattern was observed nearly three times more frequently, particularly in patients with PSM. Cases with PSM length > 1 mm exhibited substantially higher BCR, and this parameter emerged as the strongest independent predictor of BCR. Although localization was not generally significant, apical involvement was identified as the only anatomical site associated with BCR. Differences in ISUP distributions according to PSM localization were considered notable in terms of regional tumor biology.

Conclusions: PSM localization alone is not a determinant of BCR; however, PSM length, the presence of a tertiary pattern, and apical involvement provide clinically meaningful prognostic information. Therefore, detailed reporting of margin characteristics in pathology reports is critically important for accurately guiding postoperative treatment strategies.

Purpose: To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Allium stents.

Methods: From June 2020 to July 2022, a total of eight patients underwent IUR for complex ureteral strictures after treatment failure of Allium stents across three tertiary centers. Surgical approaches included open (n = 3), laparoscopic (n = 2), and robot-assisted (n = 3). The clinical data and follow-up results were prospectively collected.

Results: A total of eight patients were enrolled, including seven women and one man, with a mean age of 47.8 years. The median dwelling time of Allium stents was 12.5 months. Reasons for Allium stent failure included recurrent urinary tract infection (UTI), stent migration, unrelieved hydronephrosis and stent calculus. The median stricture length was 15 cm. Four patients underwent unilateral IUR and four underwent bilateral IUR, with a median harvested ileal segment length of 25 cm. The median operation time was 261 min and the median estimated blood loss was 75mL. During a median follow-up of 24 months, ureteral patency was achieved in all patients. The mean eGFR was 71.2 ± 34.5 preoperatively and 65.9 ± 23.9 mL/min/1.73m² at the last follow-up (p = 0.394). Two patients in the open surgery group experienced major complications, specifically ileus and incisional hernia. Long-term minor complications included UTI (n = 5) and metabolic acidosis (n = 2).

Conclusion: Allium stents should be applied with caution and strict indications. For patients experiencing stent failure, IUR serves as a viable salvage option for managing long and complex ureteral strictures.

Objective: To explore the potential mechanisms of interstitial cystitis (IC), we employed a cyclophosphamide (CYP)-induced cystitis rat model, a well-established tool for studying IC-like bladder inflammation and dysfunction. This study aimed to investigate the role of rhythmic genes and immune microenvironment remodeling in this model, focusing on TOP2A and its impact on T-cell infiltration.

Methods: CYP-induced cystitis rat models were established using cyclophosphamide. Single-cell RNA sequencing was performed on bladder tissues to analyze cellular heterogeneity. Differentially expressed genes (DEGs) and weighted gene co-expression network analysis (WGCNA) identified rhythmic and immune-related gene clusters. TOP2A was validated via RT-PCR, Western blot, and immunohistochemistry (IHC). Statistical analyses assessed correlations between TOP2A, CD4 + T cells, and CD8 + T cells.

Results: Single-cell sequencing revealed elevated T-cell infiltration in a CYP-induced cystitis rat model. TOP2A was the sole overlapping gene between rhythmic and immune clusters and showed significant upregulation in IC tissues (P < 0.05). IHC confirmed increased TOP2A, CD4 + T, and CD8 + T cell levels, with strong positive correlations (r = 0.89 and 0.64, respectively). Functional enrichment linked TOP2A to oxidative phosphorylation and ribosomal pathways.

Conclusions: Our findings demonstrate that TOP2A drives immune dysregulation in CYP-induced cystitis by modulating T-cell infiltration. As T-cell infiltration is a hallmark of human IC, our findings in this CYP-induced model suggest that TOP2A may represent a novel therapeutic target worthy of further investigation in human IC tissues.