BMC Urology最新文献

Objective: Long-acting triptorelin (LAT) (22.5 mg) is a gonadotropin-releasing hormone (GnRH) agonist used in men with prostate cancer. This study investigated the prescription pattern of LAT in a real-world setting and its efficacy.

Patients & methods: This was a retrospective review of patients in a tertiary center who were prescribed LAT for prostate cancer from January 2018 to March 2023 after the introduction of LAT in the territory. Demographic data were collected, and LAT prescription patterns were reviewed. These patterns included the indication and duration of prescription, testosterone suppression and characteristics of the primary prostate cancer.

Results: A total of 237 prostate cancer patients were prescribed LAT in the study period. The indications for LAT included metastatic prostate cancer (50.6%), neoadjuvant/adjuvant therapy for radiotherapy (28.7%) and neoadjuvant therapy for radical prostatectomy (5.1%). Among the cohort, 41.4% of the patients were receiving short-acting triptorelin (11.25 mg) before LAT initiation, 15.2% were receiving other GnRH agonists, and 15.6% were receiving GnRH antagonists. The median age at the first dose of LAT and the median treatment duration were 72 (53-94) years and 30 (6-72) months, respectively. During the study period, 92.0% of the patients did not receive another form of hormonal treatment other than LAT. A total of 121 (51.1%) patients had their testosterone level checked after LAT initiation. The median time interval of testosterone measurement after LAT initiation was 8 (1-47) months, with 98.3% of the patients having a testosterone level < 1.7 nmol/L and 92.6% having a level < 0.7 nmol/L. Among the cohort, 1 patient stopped LAT due to hot flashes and muscle weakness.

Conclusion: The LAT adherence rate was high in the setting of hormonal treatment for prostate cancer. Testosterone suppression was satisfactory after the initiation of LAT and was generally well tolerated.

Objective: To investigate the clinical efficacy and patient-reported discomfort associated with traditional versus reverse placement of double-J ureteral stents (DJUS) in patients undergoing ureteroscopic stone removal.

Materials and methods: This prospective, randomized, single-center, one blinded, controlled study. In the control group, the double-J stent was placed with its upper end facing laterally (towards the kidney) and its lower end facing medially (towards the bladder trigone), while in the study group, the reverse was done in a mirror manner. Patients in the study group were further subdivided based on the orientation of the upper and lower tips of the stent (B1: upper medial/lower lateral, B2: both medial, B3: both lateral). Patient discomfort was assessed using the Turkish version of the Ureteral Stent Symptom Questionnaire (T-USSQ), and secondary outcomes included postprocedural hydronephrosis, hematuria, and urinary tract infection.

Results: A total of 120 patients were included and 60 patients to each the control and study groups. Forty patients were included in group B1, 8 in B2 and 12 in B3. The reverse placement group (Group B) reported significantly lower USSQ (p < 0.05) and reduced analgesic use compared to the control group. Midline crossing of the stent was significantly less frequent in the study group (11.7% vs. 30%; p = 0.013). Subgroup analysis revealed that the B1 and B3 groups had significantly lower analgesic usage and symptom scores compared to the control group, while the B2 group reported higher hydronephrosis and symptom scores.

Conclusion: Reverse placement of DJUS, particularly when both stent ends are laterally positioned, may reduce stent-related discomfort. There is a need for a new stent design with both ends facing laterally, tentatively named "ipsi-DJUS".

Trial registration: Turning the tip of the stent upside down may ease urinary symptoms" is now listed on the ISRCTN registry with study registration number ISRCTN17937257 (Date of registration: 22/10/2024). Retrospectively registered.

Background: Urinary stone disease is a common urological disorder, particularly among middle-aged individuals. Extracorporeal Shock Wave Lithotripsy (ESWL) is often the first-line treatment for kidney and ureteral stones. Traditionally, fluoroscopy is used for stone targeting in ESWL, but it exposes patients and clinicians to radiation and cannot visualize non-opaque stones. Ultrasonographic targeting eliminates these issues. This study compares the advantages and disadvantages of fluoroscopy and ultrasound-targeted ESWL.

Methods: At Düzce University Hospital, 100 patients with radio-opaque stones indicated for ESWL between February 2023 and February 2024 were divided into two groups. Group A underwent ESWL with fluoroscopic targeting, while Group B used ultrasonographic targeting. Patient demographics, stone size (measured by CT), and stone locations were recorded. The number of shocks per session, energy intensity (kV), and fluoroscopy time were noted for Group A. One week after each ESWL session, patients were evaluated by ultrasound or direct radiography. Success was defined as being stone-free or having ≤ 4 mm asymptomatic residual stones after up to four sessions. Failure was defined as no results after two sessions or the need for additional treatment.

Results: The procedure success rate was 66% for men and 78% for women, with no statistically significant gender difference (p > 0.05). Stone locations were similar in both groups. Success rates were 66% in Group A and 74% in Group B, with no significant difference (p > 0.05). Successful procedures were associated with an average patient weight of 76.6 kg, stone size of 8.9 mm, and total energy of 12.2 kV, with significant differences compared to unsuccessful procedures (p < 0.04, p < 0.04, p < 0.001, respectively). No significant differences were found between Group A and Group B in terms of age, height, BMI, stone density (HU), and number of sessions (p > 0.05).

Conclusion: Ultrasonography is as effective as fluoroscopy for imaging and focusing during ESWL treatment. It enhances the success of ESWL for non-opaque stones and reduces radiation exposure disadvantages.

Ectopic prostate tissue, defined as the aberrant localization of prostate tissue, is often asymptomatic but may occasionally present with various clinical symptoms. A definitive diagnosis is established through surgical excision and subsequent histopathological analysis. This report discussess a case of ectopic prostate tissue identified in the bladder trigone of a 31-year-old patient who presented with lower urinary tract symptoms. Imaging studies revealed a suspicious lesion within the bladder, initially concerning for a potential tumor. Following cystoscopic examination, the lesion was transurethrally completely resected. Pathological analysis confirmed the diagnosis of ectopic prostate tissue, and the patient was subsequently monitored. This case highlights ectopic prostate tissue as a rare pathological condition that can present with clinical features resembling bladder tumors.

Purpose: We aimed to assess the impact of GATA3 binding protein (GATA3) gene copy number alterations on tumor aggressiveness, patient prognosis, and GATA3 protein expression in a large urothelial bladder cancer cohort.

Methods: A tissue microarray containing over 2,700 urothelial bladder cancers (pTa-pT4) was analyzed retrospectively using dual-labeling fluorescence in-situ hybridization (FISH) with probes for GATA3 (10p14) and centromere 10. GATA3 copy number gains were categorized as GATA3 elevation (ratio GATA3/centromere ≥ 2/≤4), low-level amplification (ratio > 4/≤12), and high-level amplification (ratio > 12) and deletions were divided between homozygous and heterozygous.

Results: GATA3 copy number gain was detected in 9.9% of 2,213 interpretable tumors, including 2.0% with GATA3 elevation, 3.2% with low-level amplification, and 4.7% with high-level amplification. The frequency of high-level amplification increased from pTa G2 low (0%) to pTa G3 tumors (12% [CI 0.07;0.21]; p < 0.0001 pTa G2 low vs. pTaG2 high) but decreased in advanced-stage carcinomas pT2-4 with 5.4% [CI 0.07;0.21] (p < 0.0001, pTa vs. pT2-4). In muscle-invasive carcinomas, GATA3 amplification was not linked to tumor aggressiveness or patient survival. Overall, no homozygous GATA3 deletion was detected and heterozygous GATA3 deletion was only observed in 1.1%; of 1,432 pT2-4 tumors without any association to cancer progression. While GATA3 copy number was significantly correlated with GATA3 expression (p < 0.0001), the relationship was not strong. Only 2.3% of GATA3-negative cancers had a deletion, and 42.1% of strong GATA3-expressing cancers exhibited high-level amplification.

Conclusion: High-level GATA3 amplification is common in urothelial bladder cancer and correlates with grade progression in pTa tumors, while GATA3 deletion is rare. Neither amplification nor deletion appears to be the primary driver of GATA3 expression dysregulation.

Clinical trial number: Not applicable.

Background: The purpose of this study is to evaluate the efficacy and safety of holmium laser prostatectomy in patients diagnosed with primary bladder neck obstruction (PBNO), compared with patients with benign prostatic hyperplasia (BPH).

Methods: We analyzed the databases of patients who underwent a holmium laser prostatectomy or enucleation of the prostate for PBNO and BPH between January 2018 and August 2022. PBNO was diagnosed primarily based on cystourethroscopic findings. Patients were followed up according to a regular protocol at 2 weeks, 3 mo, and 6 mo postoperatively.

Results: In total, 28 and 447 patients with PBNO and BPH, respectively, were identified. Preoperative urodynamic studies showed that detrusor underactivity was significantly more prevalent in the PBNO group (78.6%) than in the BPH group (57.5%) (p < 0.01). Both PBNO and BPH groups showed significant improvements in the total International Prostate Symptom Score, Overactive Bladder Symptom Score, and maximum flow rate at 6 mo postoperatively compared with the preoperative values (p < 0.01). Subjective satisfaction 6 mo after operation was not significantly different between the PBNO and BPH groups (p > 0.05). Complications in the PBNO group included recatheterization (n = 1, 3.5%), with no patients requiring blood transfusion or transurethral coagulation.

Conclusions: Holmium laser prostatectomy was effective and safe for patients with PBNO, with elevated subjective patient satisfaction.

Background: Benign prostatic hyperplasia (BPH) is a common male urological disease around the world. This study aimed to evaluate global, regional, and national burden of BPH from 1990 to 2021, and to forecast the incidence and prevalence of BPH to 2035.

Methods: Using the data and methods of the Global Burden of Disease 2021, we presented the incidence, prevalence, and disability-adjusted life-years (DALYs) of BPH from 1990 to 2021. The trends of burden over time were assessed using estimated annual percentage changes. We applied Bayesian age-period-cohort model to forecast the incidence and prevalence of BPH to 2035.

Results: In 2021, the global number of incident cases, prevalent cases, and DALYs of BPH were 137.88, 1125.02, and 22.36 per 100,000 populations, respectively. From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) of BPH remained stable. The highest ASIR, ASPR, and ASDR were recorded in Eastern Europe in 2021. Nationally, China had the highest number of incident cases, prevalent cases, and DALYs of BPH. With the increase of socio-demographic index, the trends of ASIR, ASPR, and ASDR all exhibit an initial rise followed by a gradual decline. The global incidence and prevalence are expected to increase from 962.42 to 7878.68 per 100,000 populations in 2022 to 998.55 and 8620.60 per 100,000 populations in 2035, respectively.

Conclusions: The persistent burden of BPH continues to pose a critical public health challenge. The escalating prevalence among middle-aged and elderly populations underscores the imperative to tackle this widespread condition.

Prostate cancer (PCa) is one of the most common malignancies in men worldwide. Despite advances in treatment, many patients develop resistance to conventional therapies. Solute carrier (SLC) proteins, as transmembrane transporters, have recently emerged as potential therapeutic targets due to their role in tumor metabolism and progression. This review summarizes the key roles of six SLC proteins in PCa, including their involvement in metabolic reprogramming, regulation of signaling pathways, and effects on the tumor microenvironment. Although targeting of SLC family members in prostate cancer remains an underexplored area, the growing body of evidence suggests that it holds potential for future development.

Background: Radical cystectomy is a cornerstone treatment for muscle-invasive bladder cancer, but its implementation in resource-limited settings is challenged by limited access to trained professionals and inadequate healthcare infrastructure. This pilot study aims to analyze perioperative complications and mortality associated with radical cystectomy and urinary diversion at Gezira Hospital for Renal Diseases and Surgery (GHRDS) in Sudan. These findings reflect the outcomes of an in-country training program established by the Society of International Urology (SIU) to address surgical capacity gaps in resource-limited settings.

Methods: We conducted a retrospective analysis of patient who underwent radical cystectomy with ileal conduit urinary diversion between January 2015 and December 2019. Data were collected from medical records, including demographic details, perioperative complications classified by the modified Clavien-Dindo system, and histopathological findings.

Results: A total of 30 patients were included in the study. The median age was 65 years, and 77% were male. The majority of patients (76%) had transitional cell carcinoma, followed by squamous cell carcinoma (17%) and adenocarcinoma (7%). The clinical stage at presentation were T1 N0 M0 (23%) and T2 N0 M0 (77%). A total of 32 complications were observed, with 91% classified as low-grade. Infectious complications were the most common (50%), followed by gastrointestinal and respiratory issues. Severe complications occurred in 13% of cases, and in-hospital mortality was 3%.

Conclusion: This study demonstrates the feasibility of performing radical cystectomy in a resource-constrained environment, supported by a collaborative training program involving international expertise and local participants. While outcomes were encouraging, key areas for improvement include infection control, critical care capacity, and early detection of bladder cancer. These findings underscore the importance of sustainable in-service training programs in building surgical capacity in resource-limited settings. Future research should focus on long-term outcomes and strategies to reduce complications.

Introduction: Renal oncocytoma (RO) is an uncommon benign neoplasm of the kidney, while eosinophilic vacuolated tumor (EVT) represents a distinct subtype of renal oncocytoma characterized by specific morphological features. EVT is a rare eosinophilic renal neoplasm distinguished by its unique morphological, immunophenotypic, and molecular genetic attributes. Its biological behavior is generally indolent, and it is associated with a favorable prognosis.

Case report: This case report provides a comprehensive account of a 52-year-old female patient who presented to the hospital for a medical evaluation, revealing that her left kidney had been occupying space for over one month. Following an abdominal enhanced CT scan, a diagnosis of renal clear cell carcinoma was suspected, leading to the decision to perform a "robot-assisted laparoscopic partial left nephrectomy." During the surgical procedure, a mass measuring approximately 3.8 × 3.5 cm was identified adjacent to the renal hilum in the midsection of the left kidney. Subsequent pathological analysis classified the excised tumor as an eosinophilic vacuolar tumor of the kidney.

Conclusion: This case illustrates that EVT represents a novel solid neoplasm of the kidney, with occurrences being exceedingly uncommon. It is imperative for clinicians and pathologists to enhance their comprehension of these tumors and distinguish them effectively, thereby facilitating more precise classification of renal tumors and informing clinical management and prognostic assessment.