BMC Urology最新文献

Background: In recent years, many studies have illustrated that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor of metastatic castration-resistant prostate cancer (mCRPC), but their conclusions are controversial. The aim of this study was to assess the prognostic value of the NLR in patients with mCRPC treated with docetaxel-based chemotherapy.

Methods: Database searches were conducted in PubMed, EMBASE and the Cochrane Library to retrieve relevant published English-language literature up to 20 February 2023. RevMan 5.4.1 was used to summarize the hazard ratio (HR) and its 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) with subgroup analysis. Finally, Stata software was adopted for sensitivity analysis, and Egger's test was used to calculate the results of stability to determine whether there was publication bias.

Results: A total of 1,983 mCRPC patients from 14 retrospective cohort studies were included in this meta-analysis. The combined results showed that elevated NLR was significantly associated with worse OS (HR = 1.86, 95% CI: 1.55-2.23, P < 0.00001) and PFS (HR = 1.96 (95% CI: 1.52-2.53), P < 0.00001) in patients with mCRPC treated with docetaxel-based therapy. For subgroup analysis of high NLR, studies performed in Asia and cutoff value > 3 were associated with poorer OS, while cutoff values > 3 were associated with poorer PFS.

Conclusion: Our results suggest that the neutrophil-to-lymphocyte ratio may be a prognostic factor in patients with mCPRC with docetaxel-based chemotherapy.

Background: To analyze the clinical characteristics, complications and patients satisfaction of MIP hypospadias variant.

Methods: A retrospective analysis was performed for 31 patients with MIP admitted to our hospital from January 2008 to February 2023. All enrolled patients underwent telephone follow-up and a survey was conducted on the satisfaction of patients and their families. Outcome analysis was focused on clinical data includes age, position of the meatus, penile curvature, type of repair, complications and satisfaction survey results. Statistical analyses were performed using R software.

Results: The average age of 31 MIP patients was 92.1 ± 40.7 months, and the median follow-up time was 49.0 [21.0-82.2] months. Twenty one patients (67.7%, 21/31) had ventral curvature and no dorsal curvature was observed. All cases were divided into chordee group and no chordee group. There was a statistical difference in age (80.4 ± 41.6 Vs 117.0 ± 26.0 months) and weight (22.7 [15.8-35.0] Vs 45.0 [32.0-46.0] kg) between the two groups. Six children (19.4%, 6/31) experienced post-operative complications; however, none required reoperation. The only risk factors for complications were the meatus position and whether urethroplasty was performed.Only the occurrence of complications may affect patients satisfaction.

Conclusions: MIP hypospadias variants can exhibit severe ventral curvature. Surgery can achieve good results with a low incidence of complications. A satisfactory skin appearance and adequate curvature correction are key concerns for both patients and parents.

Background: Long-term survival can be achieved in patients with localized prostate cancer (PCa). Therefore, maintenance of postoperative quality of life (QOL) and treatment satisfaction are important. Although longitudinal changes in disease-specific QOL are reported, there are few studies investigating which factors longitudinally affect treatment satisfaction in patients who undergo robot-assisted radical prostatectomy (RARP). Therefore, we examined the factors associated with treatment satisfaction over the first 12 months postoperatively based on an assessment using a patient-reported questionnaire.

Methods: Of the 612 consecutive patients who underwent RARP, 408 patients were enrolled in this study and divided into a satisfied group and a non-satisfied group at every evaluation timepoint. Multivariate logistic regression analysis was conducted to clarify factors affecting the postoperative treatment satisfaction between the two groups.

Results: Multivariate logistic regression analysis revealed that factors relating to treatment satisfaction had longitudinally changed. Urinary bother (UB) (odds ratio (OR) = 1.023; p = 0.008), and sexual function (SF) (OR = 0.941; p = 0.004) were the significant factors associated with treatment satisfaction at 1 month postoperatively; UB (OR = 1.040; p = 0.001) and sexual bother (SB) (OR = 1.019; p < 0.001) at 3 months; urinary function (UF) (OR = 1.027; p = 0.008), UB (OR = 1.035; p = 0.011), SB (OR = 1.013; p = 0.009), and hormonal bother (HB) (OR = 1.065; p = 0.023) at 6 months; UF (OR = 1.026; p = 0.008), UB (OR = 1.030; p = 0.029), and SB (OR = 1.014; p = 0.004) at 9 months; UF (OR = 1.024; p = 0.002) at 12 months.

Conclusions: Treatment satisfaction in patients who underwent RARP changed over time. Our results suggest that giving sufficient information before treatment choice is both important and useful for patients' decision-making, leading to improved patient QOL.

Background: The incidence of prostate cancer is increasing in Asian countries. Although moderately hypofractionated radiotherapy is not inferior to conventional fractionated radiation according to the updated guidelines, data regarding its efficacy and safety in Taiwan are currently lacking. The aim of this study was to investigate the outcomes of prostate cancer patients treated with hypofractionated image-guided radiotherapy at a single institution in Taiwan.

Methods: We retrospectively included patients with prostate cancer across all risk groups who were treated with hypofractionated image-guided radiotherapy 70 Gy (Gy) in 28 fractions (at 2.5 Gy/fraction) between 2007 and 2022. We analyzed treatment efficacy by assessing overall survival, prostate cancer-specific survival, event-free survival, biochemical failure, locoregional recurrence, and distant metastasis. The safety of the treatment was evaluated through acute and late gastrointestinal (GI) and genitourinary (GU) toxicity grading based on the Radiation Therapy Oncology Group criteria. Event-free survival, overall survival, prostate cancer-specific survival, biochemical failure, locoregional recurrence, and distant metastasis were evaluated using the Kaplan-Meier method.

Results: We identified 150 consecutive men with prostate cancer: 12.7% were at low risk, 32.7% were at intermediate risk, 44.6% were at high risk, and 10% had N1 disease. The median follow-up time was 68.9 months (range: 2.3-172 months). The 5-year overall survival rate was 91.7% for the entire cohort, with rates of 100%, 94.3%, 93.3% and 71.1% for the low-risk, intermediate-risk, high-risk, and N1-disease groups, respectively (p < 0.001). The 5-year event-free survival rate for all patients was 75.8%. Among the risk groups, the 5-year event-free survival rates were 100%, 86.3%, 68.3% and 52.5% for the low-risk, intermediate-risk, high-risk, and N1 disease groups, respectively (p < 0.001). Grade ≥ 2 late GI toxicity was rare (0.7%), and grade ≥ 2 late GU toxicity was observed in 9.3% of the patients.

Conclusions: Hypofractionated image-guided radiotherapy, delivering 70 Gy at 2.5 Gy per fraction, is both effective and safe for Taiwanese patients with prostate cancer across all risk groups, consistent with findings from existing large randomized trials. Therefore, as a solution to enhance patient convenience, hypofractionated radiotherapy is a reasonable option for the definitive treatment of prostate cancer.

Trial registration: Not applicable.

Background: Benign prostatic hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) are commonly observed among aging males and have a substantial effect on quality of life. Metabolic syndrome, with a specific focus on obesity, is believed to play a role in the development of BPH. This study intends to explore the relationship between several obesity-related metrics, including the Chinese Visceral Adiposity Index (CVAI), and LUTS/BPH within a national cohort of Chinese men.

Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed, encompassing a sample of 5,735 male participants aged 45 and older. Eight obesity-related indices-namely Body mass index (BMI), Waist-height ratio (WHtR), Triglyceride-glucose.BMI (TyG.BMI), TyG. Waist circumference (TyG.WC), TyG.WHtR, CVAI, Visceral adiposity index (VAI), and A body shape index (ABSI)-were examined. Logistic regression models, adjusted for potential confounders, were utilized to evaluate the associations between these indices and LUTS or BPH. The predictive capabilities of these indices were further assessed using receiver operating curves (ROC).

Results: Among the participants, 718 (12.5%) were diagnosed with LUTS/BPH. All obesity-related indices were significantly higher in the LUTS/BPH group compared to the healthy group. CVAI demonstrated the highest predictive ability for LUTS/BPH, with an area under the curve (AUC) of 0.58. The study highlighted a nonlinear relationship between LUTS/BPH and several obesity-related indices, including CVAI.

Conclusions: This study underscores the significant association between visceral fat, as measured by CVAI, and the risk of LUTS/BPH in Chinese men. CVAI emerged as the most effective predictor among the indices evaluated, suggesting its potential utility in identifying individuals at risk for LUTS/BPH. Further prospective studies are needed to confirm these findings and elucidate the underlying mechanisms.

Objective: This study aimed to evaluate the effects of two absorbable hemostatic agents, oxidized regenerated cellulose (ORC) and gelatin sponge, on wound healing in a rat model of penile fracture.

Materials and methods: A total of 32 Wistar albino rats were divided into four groups: Control (C), Primary Suturing (PS), ORC, and Gelatin Sponge (GS). A penile fracture model was created in all rats, and wound healing was assessed histopathologically after two weeks. Key parameters assessed included primary healing, fibrosis, inflammation, and cavernous tissue healing.

Results: The ORC group showed significantly higher primary healing rates (100%) compared to the other groups (p < 0.01). Fibrosis was more common in the GS group (87.5%), whereas no fibrosis was observed in the ORC group (p < 0.01). In terms of cavernous tissue healing, the group treated with the ORC absorbable hemostatic agent demonstrated significantly higher healing rates compared to the control group (p = 0.000). No significant differences were observed between groups regarding inflammation.

Conclusion: ORC absorbable hemostatic agents significantly promote primary wound healing and reduce fibrosis in an experimental penile fracture model, whereas the gelatin sponge was associated with increased fibrosis and did not improve healing. These findings suggest that ORC may have potential clinical applications in penile fracture repair. Further clinical studies are necessary to validate these results.

Background: Urinary tract infection (UTI) is one of the most common infections worldwide, particularly in developing countries. It also is among the most prevalent nosocomial infections, largely due to the widespread use of urinary catheters in hospitalized patients. These catheters often act as reservoirs for multidrug-resistant bacteria, including extended-spectrum beta-lactamase- and carbapenemase-producing pathogens, which significantly limit treatment options and delay appropriate care. This systematic review and meta-analysis, therefore, aimed to assess the pooled prevalence of ESBL- and carbapenemase-producing Gram-negative bacteria associated with UTIs in Ethiopia.

Methods: A systematic literature search of all available electronic databases such as PubMed, Hinari, Google Scholar and EMBASE, Scopus, and African journal online was performed. The quality of the included studies was assessed via the Joanna Briggs Institute critical appraisal tool. The data were extracted from the eligible studies via Microsoft Excel 2019 and analysed via STATA version 17. The presence of between-study heterogeneity was checked via the Cochrane Q statistic, and the magnitude was quantitatively measured via I² statistics. To determine the possible sources of heterogeneity, a subgroup analysis was performed. Additionally, a sensitivity analysis was conducted to determine the influence of single studies on the pooled estimates. Publication bias was checked via funnel plots and Egger's regression tests. A p value of less than 0.05 was evidence of heterogeneity and small study effects according to the Cochrane Q statistic and Egger's test, respectively. The protocol was registered (PROSPERO ID: CRD42024564656).

Results: A total of 20 studies with 1010 and 557 Gram-negative bacterial isolates from 6263 and 2199 study participants for extended-spectrum beta-lactamase and carbapenemase, respectively, were included. The overall pooled prevalence rates of extended-spectrum beta-lactamase-producing and carbapenemase-producing Gram-negative bacteria in Ethiopia were 30.92% (95% CI: 21.23-40.61, P < 0.001) and 15.12% (95% CI: -0.28-30.52, P < 0.001), respectively. The most common extended-spectrum beta-lactamase producers were Klebsiella spp., 43.91% (95% CI: 30.63-57.18, P < 0.001), followed by E. coli, 31.14% (95% CI: 21.27-41.01, P < 0.001). Similarly, the predominant carbapenemase producer was Klebsiella spp., 17.78% and E. coli, 11.42%.

Conclusion: and recommendations. In this meta-analysis, the pooled prevalence of extended-spectrum beta-lactamase- and carbapenemase-producing Gram-negative bacteria was significantly high. During the development of empiric treatment protocols for urinary tract infections, extended-spectrum beta-lactamase- and carbapenemase-producing uro-pathogens should not be underestimated.

Background: Clear cell renal cell carcinoma (ccRCC) is the most common malignant urological tumor, and regrettably, and is insensitive to chemotherapy and radiotherapy, resulting in poor patient outcomes. DBF4 plays a critical role in DNA replication and participates in various biological functions, making it an attractive target for cancer treatment. However, its significance in ccRCC has not yet been explored.

Methods: We utilized external datasets and bioinformatics analyses to investigate the significance of DBF4 in ccRCC. We analysed its expression patterns, prognostic and diagnostic value, and potential mechanisms. We subsequently validated our findings through an immunohistochemistry (IHC) assay of ccRCC clinical samples. We further investigated the impact of DBF4 on the progression of ccRCC cells. Various assays, including assessments of cell proliferation, apoptosis, the cell cycle, cell migration and invasion, and colony formation, and xenograft tumor models were subsequently performed following to the knockdown of DBF4 expression via shRNA.

Results: Bioinformatics analyses revealed that DBF4 is significantly overexpressed in ccRCC tissues compared with adjacent normal tissues. This overexpression was confirmed by IHC analysis of 75 pairs of clinical ccRCC tumor and adjacent tissues. Kaplan-Meier analysis revealed that high DBF4 expression was associated with a significantly lower five-year overall survival rate. Moreover, DBF4 expression was identified as an independent risk factor in multivariate Cox regression analysis. GO and KEGG pathway enrichment analyses revealed a substantial enrichment of terms associated with cell division, whereas gene set enrichment analysis (GSEA) revealed correlations between increased DBF4 expression and the activation of cell cycle-related pathways. Subsequent in vitro and in vivo experiments demonstrated that DBF4 knockdown in ccRCC cells not only suppressed proliferation and migration in vitro but also significantly inhibited tumor growth in xenograft mice by arresting the cell cycle at the G1/G0 phase, which was mediated by the inhibition of MCM2 phosphorylation and cyclin D1 and CDK4 expression.

Conclusion: The current study revealed that DBF4 overexpression is a significant factor associated with malignant features and poor prognosis in patients with ccRCC. Therefore, it was proposed that DBF4 could serve as a novel potential prognostic biomarker and molecular target for ccRCC.

Clinical trial number: Not applicable.

Background: Type-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of "prostate-pelvic syndrome (PPS)" and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear.

Objective: The aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males.

Methods: The clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis.

Results: Of the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old.

Conclusions: Type-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.