BMC Urology最新文献

Purpose: The albumin-globulin ratio (AGR) influences the development of prostate cancer; however, the relationship between AGR and prostate-specific antigen (PSA) has not been reported.

Methods: This cross-sectional investigation used comprehensive AGR versus PSA data from men with 40 years of age and older, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2010, spanning 4 investigation cycles, as only these cycles contained complete PSA data. To evaluate the nonlinear relationship between the ARG and PSA level, a regression utilizing smoothed curve fitting (penalized spline approach) and a generalized additive model (GAM) were employed. A two-segment linear regression model was used to conduct threshold effect evaluations. Lastly, subgroup analyses were carried out along with interaction tests.

Results: This study included 5,376 subjects, whose total serum PSA (mean ± standard deviation) was 1.83 ± 3.34, and its level decreased roughly with increasing quartiles of AGR. In the fully-adjusted model, AGR was negatively correlated with the likelihood of PSA, and this relationship persisted across subgroups (trend > 0.05). The PSA was characterized by an "L"-shaped curve with an inflection point. On the left side of the inflection point (K = 1.32), there was a negative relationship between AGR and PSA.

Conclusion: In the United States, among men over 40 years of age without prostate diseases, AGR demonstrated a nonlinear relationship with PSA, negatively correlating when AGR was below 1.32.

Clinical trial number: Not applicable.

Background: The inelasticity of dartos tissue and the regulation of collagen expression are significant factors in the pathophysiology of chordee associated with hypospadias. While the COL2A1:COL1A1 ratio is recognised as a measure of cell differentiation, there is yet to be a study specifically examining this ratio in hypospadias. The aim of this study was to determine the COL2A1:COL1A1 ratio.

Methods: We collected 55 samples of dartos tissue, comprising 35 from patients with hypospadias procured from urethroplasty procedures and 20 from patients with phimosis collected during circumcision without any lichen cases at our institution. The gene expression levels of COL1A1 and COL2A1 in the dartos tissue were analyzed using reverse-transcriptase polymerase chain reaction (qPCR).

Results: Based on the type of penile abnormality, the expression levels of COL1A1 and COL2A1 measured by qPCR were downregulated in hypospadias, with value of 0.83 (0.38-2.53) and 0.43 (0.10-5.66), respectively, compared to phimosis, which had levels of 1.85 (1.24-4.61) and 0.94 (0.26-2.47) (p < 0.001). The expression levels of COL1A1 and COL2A1 were also significantly downregulated among mild, moderate, severe penile curvature, and control groups (p < 0.001 and p = 0.02). However, the COL2A1:COL1A1 ratio did not show statistically significant differences based on penile abnormalities and curvature (p > 0.05).

Conclusion: The expression levels of COL1A1 and COL2A1 are significantly downregulated in patients with hypospadias and ventral curvature when compared to those in the phimosis group. However, the COL2A1:COL1A1 ratio was not significant.

Background: There is still controversy about the best minimally invasive surgical method for the treatment of calyceal diverticulum calculi. We conducted meta-analysis to evaluate the effectiveness and safety of PCNL and FURL in the treatment of calyceal diverticulum calculi.

Methods: We searched Pubmed, Cochrane Library, Web of Science, Embase, Clinical trial platform, CNKI, VIP until April 2024. We utilized the Newcastle-Ottawa Scale (NOS, 0 to 9 stars) to assess the quality of the included literature.

Results: Totally 15 high-quality studies with 755 patients were included in the meta-analysis. Meta-analysis showed that FURL group was better than PCNL group in blood loss [SMD = 1.713, 95%CI:(0.858, 2.568), Z = 3.928, P = 0.000] and hospital stay [SMD = 2.611, 95%CI: (1.726, 3.496), Z = 5.784, P = 0.000], there was no significant difference in operating time [SMD = 0.079, 95%CI:(-0.43, 0.589), Z = 0.306, P = 0.760], complication rate [OR = 1.793,95%CI: (0.952,2.602), Z = 1.586, P = 0.113], stone-free rate [OR = 1.339, 95%CI: (0.576, 3.112), Z = 0.678, P = 0.497] and symptom-free rate [OR = 3.826,95%CI: (0.561,10.238), Z = 0.966, P = 0.334] as well.

Conclusion: Whether FURL is indeed superior to PCNL in safety, whether FURL's efficacy is really close to PCNL, and whether FURL can surpass PCNL as the first choice for the treatment of renal diverticulum stones in the future need to be further verified by multi-center, large-sample and high-quality studies.

Background: Immune checkpoint inhibitors (ICIs) alone or in combination with standard chemotherapy for advanced urothelial carcinoma (UC) have been tested as first-line treatment in clinical trials. This study aimed to evaluate the clinical outcomes of programmed cell death 1 (PD-1) inhibitor alone or combined with chemotherapy for patients with locally advanced or metastatic UC in a real world clinical care setting, and sought to identify prognostic factors for overall survival (OS).

Methods: A retrospective, real-world study involving 35 locally advanced or metastatic UC patients treated with PD-1 inhibitor alone or in combination with chemotherapy was conducted. Kaplan-Meier curves were used to assess progression-free survival (PFS) and OS. A Cox regression analysis was conducted to explore the association of baseline variables with OS.

Results: In our cohort of 35 patients, 7 patients were treated with PD-1 inhibitor alone and 28 with PD-1 inhibitor plus platinum-based chemotherapy. The median OS was 16.0 months (95% CI: 11.9-20.1), and median PFS was 12.0 months (95% CI: 8.6-15.4) for all patients. PD-1 inhibitor combined with chemotherapy was associated with better PFS than PD-1 inhibitor monotherapy (HR: 0.19, p = 0.018). Treatment-related adverse events (AEs) of any grade occurred in 5 (71.4%) patients who received PD-1 inhibitor and 24 (85.7%) patients who received PD-1 inhibitor plus chemotherapy. Eastern Cooperative Oncology Group (ECOG) performance status (PS) and neutrophil-lymphocyte ratio (NLR) were identified as prognostic factors.

Conclusion: This study suggested that patients with locally advanced or metastatic UC could benefit from PD-1 inhibitor alone or combined with chemotherapy in daily clinical practice. ECOG PS and NLR can be used for prognostication of survival.

Background: Managing lower pole renal stones presents clinical challenges influenced by various factors such as stone size, location, and density. This study aims to assess the efficacy, safety, and stone-free rates of Flexible Ureteroscopy (FURS), Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini Percutaneous Nephrolithotomy (Mini PCNL) for treating lower pole renal hard stones (< 2 cm).

Methods: A prospective single-centre comparative study was conducted on 414 adult patients with primary lower pole renal hard stones. Patients were evenly distributed into three groups: Flexible Ureteroscopy (FURS) utilizing holmium laser lithotripsy, Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini PCNL employing holmium laser lithotripsy.

Results: Statistically significant differences with P value < 0.001 were observed among groups in stone-free rates, hospital stay, radiation exposure, operative duration, auxiliary treatments, and overall cost. No statistically significant differences were found in demographic data with P value = 0.245 or complication rates with P value = 0.611 among the groups. At the 2-week follow-up, stone-free rates were 90.2% for Flexible Ureteroscopy which was comparable with mini PCNL and both were significantly higher than ESWL 61.5%.

Conclusions: Mini PCNL and Flexible URS demonstrated comparable stone-free rates for moderate-sized, hard lower pole renal stones, surpassing ESWL. However, Mini PCNL showed longer operative times, increased radiation exposure, and elevated risks of complications and morbidity compared to Flexible URS. Considering these factors, Flexible URS might be recommended in those types of stones.

Trial registration: Our study has been approved by local ethical committee Kafrelsheikh university (KFSIRB20069) on 30/10/2023 and by clinical trials (NCT06120257) on 15/12/2023.

Introduction: Concealed penis is a congenital anomaly that affects not only the appearance but also the function of the external genitalia in the male sex. Different surgical methods have been proposed to correct this disorder, including removal of the previous scar, penile shaft, penile trunk skin reconstruction with flap, penile skin fixation in penopubic and penoscrotal angles, and removal of extra pubic fat. In this study, we will discuss the results of definitive surgery in one stage using autogenous skin grafts and examine the details of this technique.

Methods: This study was conducted as a clinical trial in Hospitals related to the Isfahan University of Medical Sciences. Children over the age of 7 years old. A full-thickness graft with a length of 1.5 times the defect and a width of 1 cm was taken from the non-dominant thigh and defatted. The inguinal skin was chosen because it is hairless and next to the penis, and the resulting scar is easily hidden under clothing. Then, the graft was transferred to the operation site and fixed.

Results and conclusion: We proposed a method of treatment for concealed penis, using a full-thickness inguinal graft. Our technique showed promising results with minimal and negligible complications. To fully highlight each process's benefits and limitations and evaluate them against one another, these procedures should, however, be tested on larger populations and compared comprehensively.

Trial registration: The study was conducted in accordance with the ethical standards of the Isfahan University of Medical Sciences Research Ethics Committee (ethical code: IR.MUI.MED.REC.1402.073) And was registered on 27/05/2023 as a clinical trial in Iranian registry of clinical trials. (IRCT code: IRCT20230513058160N1).

Background: Prostate cancer is the most frequently diagnosed cancer among men in the world. Uganda and Zimbabwe have been reported to have highest incidence rates of prostate cancer in sub-Saharan Africa. There are no urologists and no prostate cancer diagnostic facilities in rural communities in south western Uganda. Men with lower urinary tract symptoms are treated with prostatectomy by midlevel healthcare workers and general surgeons without prior prostate cancer screening. Histological diagnosis relies on the prostate tissue retrieved during surgery and the results may take several months. Prostate cancer care in southwestern Uganda remains uncoordinated and has not been documented before. This study aimed to establish and document the burden of prostate cancer in rural southwestern Uganda as a basis for further research.

Methods: This was a retrospective study conducted in hospitals in rural southwestern Uganda. We used hospital records as primary source of data. Histology results of patients treated with prostatectomy during the five-year period (2019-2023) were retrieved and data extracted for analysis. 1013 patients were included in the study. Univariate data analysis was done with STATA version 17.0. The study received ethics clearance for Kabale university REC and Uganda National council of Science and Technology.

Results: The average age of patients in this study was 70.6 year (range 54-102 years). Prostate cancer was present in 232 (22.9%) patients. Seventeen (7.3%) patients with prostate cancer were below sixty years. Most (75.4%) of the patients with prostate cancer in this study had low to intermediate risk disease. Perineural tumor infiltration was present in 28.9% of prostate cancer patients.

Conclusion: More than 1 in 5 men (22.9%) with lower urinary tract symptoms treated with prostatectomy in the study period in southwestern Uganda had prostate cancer. Majority of patients (75.4%) had low to intermediate risk disease. These findings highlight the urgent need for systematic improvements in prostate cancer care, including sensitization of both health workers and the general population, establishment of early screening and regional diagnostic and treatment facilities to enhance patient outcomes in resource -limited rural communities in Uganda.

Clinical trial number: Not applicable.

Objective: A ureteric stone is a type of urinary tract stone that is found within the ureter. While most cases can be managed with conservative treatment or minimally invasive surgery, these methods often cause significant pain for the patient. Interestingly, a new type of ureteroscope has shown considerable promise in treating patients with ureteric stones, and this study aims to explore its clinical application.

Methods: A total of 120 patients with ureteric stones were recruited from our hospitals between January 1, 2023, and December 31, 2023. These patients were randomly assigned to either the control group, which received the traditional straight ureteroscope, or the experimental group, which was treated with the new type of ureteroscope. Both groups provided general data and blood samples for further analysis. A logistic regression analysis was conducted to examine the factors influencing infection following surgery in patients with ureteric stones, including preoperative CRP greater than 8 mg/L, postoperative CRP greater than 8 mg/L, preoperative white blood cell count (> 10⁹/L), postoperative white blood cell count (> 10⁹/L), preoperative urinalysis count greater than 28 (/ul), postoperative urinalysis count greater than 28 (/ul), and urine routine leukocyte count.

Results: The findings indicated no significant differences between the observation group and the control group regarding preoperative demographic, participants general data (P > 0.05). Postoperative CRP > 8 mg/L, white blood cell count > 10 × 10⁹/L, urinalysis count > 28/µL, and urine leukocyte count significantly decreased in the experimental group compared to the control group (P < 0.05). Binary logistic regression showed that postoperative CRP > 8 mg/L (OR = 7.03), white blood cell count > 109/L (OR = 3.86), urinalysis count > 28/µL (OR = 2.83), and urine leukocyte count (OR = 1.004) were predictive factors for ureteric stones. Preoperative values showed no significant difference (P > 0.05).

Conclusions: The binary logistic regression analysis identified Postoperative CRP > 8 mg/L, white blood cell count > 10 × 10⁹/L, urinalysis count > 28/µL, and urine leukocyte count as significant predictors of postoperative infections. Our research findings indicate that the new ureteroscope has significant advantages over traditional ureteroscopes in terms of ease of entry into the ureteral lumen, stone fragmentation angle during surgery, surgical field of view, surgical operability, and reducing the risk of postoperative potential infections. These characteristics demonstrate that the new ureteroscope has significant potential in clinical applications, warranting further promotion and use.

Objective: This study aims to identify the risk factors for systemic inflammatory response syndrome (SIRS) after minimally invasive percutaneous nephrolithotomy (PCNL) with a controlled irrigation pressure and to find which patients undergoing PCNL are likely to develop SIRS under the pressure-controlled condition.

Methods: A total of 303 consecutive patients who underwent first-stage PCNL in our institute between July 2016 and June 2018 were retrospectively reviewed. All the procedures were performed with an 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. SIRS and sepsis were recorded after PCNL. The demographic data, clinical features, and test results were analyzed.

Results: 52 patients (17.2%) developed SIRS and only 3 patients (0.99%) further progressed to severe sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, the value of glycosylated hemoglobin, history of ipsilateral surgery, preoperative urine culture, Staghorn calculi, pelvic urine culture, stone culture, number of tracts, blood transfusion, and residual stones were found to have a significant correlation with post-PCNL SIRS (p < 0.05). In multivariate analysis, the stone size (OR = 3.743, p = 0.012), preoperative urine culture (OR = 2.526, p = 0.042), pelvic urine culture (OR = 13.523, p < 0.001), the number of access tracts (OR = 8.945, p = 0.002), blood transfusion (OR = 26.308, p < 0.001) were identified as the independent risk factors for post-PCNL SIRS.

Conclusion: The stone size (>4cm²), positive preoperative urine culture, positive pelvic urine culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for SIRS under the pressure-controlled condition. More attention should be paid when the PCNL patients have these risk factors.

Background: Vaginal pessaries are a common method of managing pelvic organ prolapse (POP), as well as different types of urinary incontinence, allowing patients to successfully improve overall quality of life. Yet despite their positive attributes, there are several reasons why patients may choose to discontinue using pessaries and proceed with surgery to treat their condition instead. This study aimed to explore patients' experiences of pessary use in treating POP.

Methods: Participants completed an online survey regarding pessary use and ideal characteristics of a pessary. Participants were recruited from social media advertisements, online support groups for women's health-related conditions, and pelvic floor clinics.

Results: A total of 100 participants were recruited, of which 77 fully completed the survey. The biggest age group of participants was above 65 years, with 48.1% of participants falling into this category, followed by 35-44 years accounting for 20.8% of respondents. Respondents cited pelvic pain (35.2%), excess vaginal discharge and odor (32.4%), as well as difficulty with pessary placement as the most common issues related to pessary use (41.9%). Easy insertion, removal (81.8%), and relief from side effects (81.8%) were the most commonly reported ideal characteristics for pessary use.

Conclusion: Patients had important concerns with pessary use and a high number either stopped or were considering stopping even when it improved their POP. Whilst pessaries can help in the management of POP, further improvement is warranted to increase pessary use, such as through the development of user-friendly designs, or applicators to aid with fitting.