BMC Urology最新文献

Background: According to the guidelines of the European Association of Urology, open simple prostatectomy should be offered to men with a prostate size exceeding 80 mL suffering from moderate to severe LUTS in the absence of a transurethral enucleation technique. However, open simple prostatectomy is associated with complications such as bleeding, blood transfusions and increased length of stay compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first cases of robotic assisted simple prostatectomy (RASP) to that of patients subjected to open simple prostatectomy (OSP) at our department.

Methods: The patients were identified by a search for the respective procedure codes. In the OSP group enucleation of the adenoma was performed through the prostatic capsule (Millin procedure), while access to the adenoma was gained through the bladder in the RASP group. Complications were scored according to the Clavien-Dindo classification system.

Results: 27 patients who underwent OSP were retrospectively identified and compared to the first 26 patients who were subjected to RASP. The groups were similar with respect to age, body mass index and ASA score. Operative time was significantly shorter in the OSP group compared to the RASP group. Bleeding volume, drop in postoperative hemoglobin and the number of blood transfusions were all significantly higher in the OSP group compared to the RASP group. Average length of stay was 5.5 (2-18) days in the OSP group compared to 1.6 (1-5) days in the RASP group (p < 0.001). The number of postoperative complications, Clavien-Dindo ≥ 2, were significantly higher in the OSP group (11) compared to the RASP group (none, p < 0.001).

Conclusions: The introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.

Background: The dysregulation of sialylation plays a pivotal role in cancer progression and metastasis, impacting various aspects of tumor behavior. This study aimed to investigate the prognostic significance of long non-coding RNAs (lncRNAs) in relation to sialylation. Additionally, we aimed to develop a signature of sialylation-related lncRNAs in the context of bladder cancer.

Methods: This study used transcriptomic data and clinical information from the TCGA (the Cancer Genome Atlas) database to screen for sialylation-related lncRNAs and constructed a prognostic model. The relationships between these lncRNAs and biological pathways, immune cell infiltration, drug sensitivity, etc., were analyzed, and the expression of some lncRNAs was validated at the cellular level.

Results: This study identified 6 prognostic lncRNAs related to sialylation and constructed a risk score model with high predictive accuracy and reliability. The survival period of patients in the high-risk group was significantly lower than that of the low-risk group, and it was related to various biological pathways and immune functions. In addition, this study found differences in the sensitivity of patients in different risk groups to chemotherapy drugs, providing a reference for personalized treatment.

Conclusion: In this study, we examined the relationship between sialylation-related lncRNA and the prognosis of bladder cancer, providing new molecular markers and potential targets for diagnosis and treatment. Our research revealed correlations between sialylation-related lncRNA characteristics and clinicopathological features, potential mechanisms, somatic mutations, immune microenvironment, chemotherapy response, and predicted drug sensitivity in bladder cancer. Additionally, in vitro cellular studies were conducted to validate these findings and lay the groundwork for future clinical applications.

Objective: The Ureteral Access Sheath (UAS) has notable benefits but may fail to traverse the ureter in some cases. Our objective was to develop and validate a dynamic online nomogram for patients with ureteral stones who experienced UAS placement failure during retrograde intrarenal surgery (RIRS).

Methods: This study is a retrospective cohort analysis using medical records from the Second Hospital of Tianjin Medical University. We reviewed the records of patients with ureteral stones who underwent RIRS in 2022 to identify risk factors associated with UAS placement failure. Lasso combined logistic regression was utilized to identify independent risk factors associated with unsuccessful UAS placement in individuals with ureteral stones. Subsequently, a nomogram model was developed to predict the likelihood of failed UAS placement in this patient cohort. The model's performance was assessed through Receiver Operating Characteristic Curve (ROC) analysis, calibration curve assessment, and Decision Curve Analysis (DCA).

Results: Significant independent risk factors for unsuccessful UAS placement in patients with ureteral stones included age (OR = 0.95, P < 0.001), male gender (OR = 2.15, P = 0.017), body mass index (BMI) (OR = 1.12, P < 0.001), history of stone evacuation (OR = 0.35, P = 0.014), and ureteral stone diameter (OR = 0.23, P < 0.001). A nomogram was constructed based on these variables. Model validation demonstrated an area under the ROC curve of 0.789, indicating good discrimination. The calibration curve exhibited strong agreement, and the decision curve analysis revealed a favorable net clinical benefit for the model.

Conclusions: Young age, male sex, high BMI, no history of stone evacuation, and small diameter of ureteral stones were independent risk factors for failure of UAS placement in patients with ureteral stones, and the dynamic nomogram established with these 5 factors was clinically effective in predicting the outcome of UAS placement.

Background: A systematic review of the evidence was conducted to assess the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with Peyronie`s Disease (PD).

Methods: A comprehensive search of the Cochrane Registry, PubMed and Embase databases was conducted to identify all controlled trials, including randomised controlled trials (RCTs), cohort studies and case-control studies, focusing on the efficacy of LI-ESWT in treating PD, and published before February 2023. The size of plaques, curvature deviation, visual analog scale [VAS] and International Index of Erectile Function (IIEF) were the most commonly used tool to evaluate the treatment effectiveness of LI-ESWT.

Results: There were 7 studies including  475 patients from 1999 to 2023. The meta-analysis of the data revealed that LI-ESWT could considerably enhance the proportion of men experiencing a reduction in penile plaques (RD 0.27, 95% CI: 0.04-0.50, P = 0.02), improvement in penile curvature (RD: 0.13; 95% CI, 0-0.26; p = 0.05), alleviation of pain (RD 0.22, 95% CI: 0.01-0.42, P = 0.04), and complete remission (RD 0.38, 95% CI 0.23-0.52, P < 0.00001). However, there were no significant differences in improvement of sexual function (MD: 1.44; 95% CI, -3.10-5.97; p = 0.53) between LI-ESWT and the placebo group.

Conclusions: According to these studies, LI-ESWT has the potential to decrease plaque size and improve penile curvature or pain in men with PD. The publication of robust evidence from additional well-designed long-term multicenter randomized controlled trials would provide more confidence regarding use of these devices in patients with PD.

Background: Benign prostatic hyperplasia (BPH) is common and presents as lower urinary tract symptoms (LUTS). Understanding patient concerns and treatment preferences is essential for effective management. This study aimed to investigate the attitudes, preferences, and expectations of Iranian patients with BPH, and compare them with those of urologists in addressing this condition.

Methods: A cohort of patients diagnosed with BPH underwent assessment during their initial visit. Before any counseling, their attitudes, concerns, and expectations regarding benign prostate enlargement were evaluated using semi-structured interviews. Patient responses were analyzed based on educational levels and age. Additionally, correspondence was initiated with thirty urologists who graduated within the past twelve years to assess their attitudes toward BPH, concerns, and treatment approaches. Interview questions were constructed using the Delphi method, and their validity was confirmed. Responses from both groups were analyzed and compared. Descriptive statistics, independent t-test, Chi-squared test, Mann-Whitney U, and principal component analysis (PCA) with varimax rotation were used for statistical analysis.

Results: The study comprised 261 patients and 30 urologists. Findings revealed that 86.2% of patients and 86.7% of urologists perceived a lack of sufficient patient knowledge about BPH. Patients across all educational levels and age groups expressed a desire for more information about their condition. Primary concerns among patients included exacerbation of urinary symptoms, potential malignancy, and sexual dysfunction. While patients generally preferred pharmacological treatments, those older than 75 years showed a significantly higher preference for surgical options. Conversely, urologists exhibited greater concern for long-term clinical complications associated with BPH. Results indicated significant parallels between the attitudes of urologists and patients in assessing the multifaceted impact of BPH on patient well-being.

Conclusion: This study enhances our understanding of patient attitudes and concerns regarding BPH, thereby facilitating more effective treatment strategies. Our findings encourage urologists to enhance patient perspectives by delivering comprehensive information. Furthermore, the comparison between patient and urologist attitudes towards BPH underscores the importance of tailored care and patient-centered approaches in optimizing outcomes for individuals with BPH.

Aim: To compare and analyze the clinical efficacy of modified Koyanagi and staged Duckett for proximal hypospadias.

Method: The clinical and prognostic data of children were treated and underwent surgery (modified Koyanagi or stage Duckett) in the Department of Urology, Kunming Children's Hospital from January 2020 to January 2023 were retrospectively analyzed. According to different surgical methods, the subjects were divided into the modified Koyanagi group and the staged Duckett group. Patients in both groups were followed up for more than 6 months after surgery. The success rate and complications of postoperative surgery in both groups were analyzed.

Result: A total of 63 patients were included in this study, 34 in the modified Koyanagi group and 29 in the staged Duckett group. A total of 14 patients in the modified Koyanagi group experienced postoperative complications, the success rate of the surgery was 58.82%, and 5 among them experienced more than two kinds of complications. A total of 5 children in the staging Duckett group experienced postoperative complications, and the success rate of the operation was 82.75%. There were significant differences in the incidence of overall complications and fistula between the two surgical methods (P = 0.028).

Conclusion: Compare with modified Koyanagi, staged Duckett can significantly reduce the incidence of overall complications and urethral fistula in patients, and have obvious advantages in the treatment of proximal hypospadias.

Background: Radical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.

Methods: The data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.

Results: A procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.

Discussion: The use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.

Background: It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones.

Methods: In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups.

Results: Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25 min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91 day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively).

Conclusion: Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Background: The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors.

Methods: In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed.

Results: The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76 cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant.

Conclusion: Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors.

Background: Organophosphate-Induced Delayed Neuropathy (OPIDN) is a rare neurological disorder triggered by exposure to organophosphorus compounds. These compounds exert their neurotoxic effects by impacting the nervous system, leading to systemic manifestations. Urinary system symptoms are infrequently observed in clinical settings. Currently, effective therapeutic interventions for OPIDN-related urinary symptoms are lacking. Sacral nerve modulation therapy, an FDA-approved approach for managing lower urinary tract symptoms, presents as a promising option. Herein, we present a case of OPIDN-induced lower urinary tract obstruction successfully treated with sacral nerve modulation therapy, resulting in substantial symptom relief.

Case report: A 27-year-old male patient presented with severe bilateral hydronephrosis, attributed to low bladder compliance and accompanied by a fever persisting for 6 days. The patient's medical history revealed accidental ingestion of organophosphate pesticide (Dimethoate) with no concomitant underlying diseases. In consideration of the potential for OPIDN, surgical intervention in the form of sacral neuromodulation (phase I) was undertaken. Subsequent evaluation one month post-surgery revealed notable improvements in both bladder compliance and bilateral hydronephrosis, necessitating sacral neuromodulation (phase II). Presently, following a 5-month follow-up period, the patient remains asymptomatic and in favorable health.

Conclusion: This patient achieved long-term relief using sacral neuromodulation.