BMC Urology最新文献

Objective: To report our single-center experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in infants managed with the Enhanced Recovery After Surgery (ERAS) approach.

Methods: The clinical data of infants aged ≤ 12 months with UPJO who underwent laparoscopic pyeloplasty at our center from October 2018 to October 2023 and who were eligible for inclusion according to the inclusion and exclusion criteria were collected. General clinical, perioperative, and postoperative data were collected. All infants were managed with the ERAS approach. ERAS is a multidisciplinary perioperative approach designed to improve perioperative management and facilitate patient early recovery.

Results: Overall, 37 patients were included. All surgeries were successfully completed without conversion to open surgery. The median age of the patients was 2 (1, 4.5) months. The median weight was 6.5 (5.25, 7.25) kg. The mean surgical duration was 251.3 ± 65.4 min, and the mean hemorrhage volume was 7.4 ± 5.3 mL. There were no intraoperative complications. The mean postoperative pain score was 0.24 ± 0.86, and the median urinary catheter removal time was 1 (1, 1) day. The mean postoperative hospital length of stay was 2.7 ± 2.3 days, and the mean overall hospital stay was 6.5 ± 3.5 days. The mean hospital cost was 31,515.2 ± 5,550.9 yuan. Postoperative complications were observed in 9 patients (24.3%), including one patient (2.7%) with intestinal obstruction (Clavien-Dindo classification grade I), four (10.8%) with febrile urinary tract infection (Clavien-Dindo classification grade II), and four (10.8%) with distal ureteral stricture. The median time to double J-tube extraction was 35 (32,66) days, the mean follow-up time was 33.6 (± 20.7) months, and the success rate was 100% (37 of 37 patients).

Conclusions: ERAS-managed laparoscopic pyeloplasty is safe and effective in infants with UPJO.

Background: Prostate cancer incidence increases markedly after midlife, coinciding with age-related hormonal decline and alterations in antioxidant defense mechanisms. This study investigated age-specific associations between endogenous antioxidant markers (total bilirubin, albumin, and uric acid) and prostate cancer risk.

Methods: Data were derived from the Korean Cancer Prevention Study-II (KCPS-II), and a total of 83,371 men were included after excluding individuals with a history of cancer or missing key variables at baseline. Participants were categorized into four age groups: < 45, 45-55, > 55, and > 65 years. During a mean follow-up of 13.5 years, 705 incident cases of prostate cancer (ICD-10: C61) were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer per 1-standard deviation (SD) increase in each antioxidant marker were estimated using Cox proportional hazards models. Quartile and trend analyses were also performed.

Results: Total bilirubin showed a statistically significant negative association with prostate cancer risk in men aged 45-55 years (HR: 0.86, 95% CI: 0.75-0.98, p = 0.0208), while a significant positive association was observed in men over 65 years (HR: 1.21, 95% CI: 1.02-1.43, p = 0.0285). Albumin was not significantly associated with prostate cancer risk in most age groups, but a significant positive association was found in men under 45 years (HR: 1.41, 95% CI: 1.07-1.86, p = 0.0152). Uric acid showed a consistent positive association with prostate cancer risk in the overall population (HR: 1.13, 95% CI: 1.06-1.21, p = 0.0003), and in men aged < 45 years (HR: 1.15, 95% CI: 1.02-1.30, p = 0.0241), > 55 years (HR: 1.20, 95% CI: 1.08-1.32, p = 0.0005), and > 65 years (HR: 1.20, 95% CI: 1.04-1.38, p = 0.0121).

Conclusions: Total bilirubin was negatively associated with prostate cancer risk during the andropause period (ages 45-55), but this association reversed with increasing age. Uric acid consistently showed a positive association with prostate cancer risk across all age groups.

Objective: To systematically evaluate the effectiveness and safety of suction-assisted sheaths (SAS) compared to traditional access sheaths (TAS) in minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi-addressing key limitations of MPCNL such as compromised irrigation outflow, intraoperative elevation of intrarenal pressure (IRP), and the associated risk of infectious complications.

Methods: This PRISMA-compliant meta-analysis (PROSPERO-registered) included 10 randomized controlled trials (RCTs; n = 1,540) identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library from database inception to May 2025. Pooled outcomes were calculated using random- or fixed-effects models, with subgroup analyses based on lithotripsy modality (laser vs. non-laser) and stone type (staghorn vs. non-staghorn). Study quality was assessed using the Cochrane Risk of Bias Tool, and evidence certainty was graded via GRADE.

Results: Compared to TAS, the use of SAS was associated with a significantly higher immediate stone-free rate (SFR; OR 2.29, 95% CI 1.76-3.00) and 3-month SFR (OR 2.72, 95% CI 1.42-5.22), with a greater benefit observed in non-staghorn stones. SAS was also associated with a mean reduction in intrarenal pressure (IRP) of 8.25 mmHg (95% CI - 9.44 to - 7.06), with a more pronounced effect in non-laser procedures. A significant reduction in operative time was observed (MD -13.86 min, 95% CI - 26.43 to - 1.30), although this finding should be interpreted with caution due to substantial heterogeneity (I² = 98%). Regarding safety, SAS was associated with lower rates of postoperative fever (OR 0.40), transfusion (OR 0.43), second surgeries (OR 0.63), and auxiliary procedures (OR 0.38). No significant differences were found for UTI, hospitalization duration, or hemoglobin loss.

Conclusions: This meta-analysis suggests that the use of a suction-assisted sheath in MPCNL is associated with higher stone-free rates, shorter operative times, reduced intrarenal pressure, and a lower incidence of certain postoperative complications, including fever and transfusion requirements. The findings indicate a favorable safety and efficacy profile, suggesting that SAS is a valuable modification for optimizing procedural outcomes.

Background: The management of metastatic castration-resistant prostate cancer (mCRPC) following progression on androgen deprivation therapy (ADT) combined with androgen receptor pathway inhibitors (ARPI) in the castration-sensitive (CS) setting remains unclear. Limited data exist comparing the efficacy of ARPI versus docetaxel as first-line treatment in this context.

Methods: We conducted a retrospective multicentre study across three tertiary cancer centres in Saudi Arabia, including 60 patients with pathologically confirmed mCRPC who progressed after doublet therapy (ADT + ARPI) in the CS setting between January 2018 and September 2022. Patients received either ARPI (abiraterone acetate or enzalutamide) or docetaxel as first-line therapy for mCRPC. Primary endpoints were prostate-specific antigen (PSA) response rate and biochemical progression-free survival (PFS). Secondary endpoints included overall survival (OS) and treatment patterns. PSA response was defined as ≥ 30% decline at 12 weeks from baseline. Survival analyses were performed using Kaplan-Meier and log-rank tests.

Results: Among 60 eligible patients (median age 65 years), 28 received ARPI and 32 received docetaxel. PSA response rates were 39.3% for ARPI and 37.5% for docetaxel. Median PFS was 2.9 months (95% CI 0.37-5.5) for ARPI and 4.5 months (95% CI 2.6-6.3) for docetaxel (p = 0.137). Median OS was 13 months (95% CI 4.0-23.9) for ARPI and 16 months (95% CI 6.1-25.9) for docetaxel (p = 0.236). In patients with visceral metastases, docetaxel conferred significantly longer OS compared to ARPI (14.4 vs. 5.9 months, p = 0.025). Multivariate analysis identified nadir PSA in the CS setting as a predictor of PFS and first-line therapy in the CR setting, visceral metastasis and duration of therapy in CS setting as predictors of OS.

Conclusions: In patients progressing to mCRPC after doublet therapy in the CS setting, docetaxel demonstrated a trend toward longer PFS and OS compared to ARPI, with a significant survival advantage in those with visceral metastases. These findings highlight the need for prospective randomized trials and biomarker-driven treatment strategies to optimize therapy sequencing in this evolving treatment landscape.

Objective: Systematic biopsy (SBx) underdetects clinically significant prostate cancer and overdiagnoses indolent disease. This study compared the transperineal cognitive fusion targeted biopsy (COG-TBx)-which uses multiparametric MRI for precision-against SBx, evaluating their cancer detection rates and safety profiles in a clinical cohort.

Methods: A total of 360 patients undergoing transperineal prostate biopsy were included, with 161 assigned to the COG-TBx group and 199 to the SBx group. Primary outcomes included PCa detection, csPCa (defined as Gleason score ≥ 3 + 4 or ISUP Level ≥ 2), and 30-day complication rates. Secondary outcomes comprised cancer detection rate per core and pathological characteristics. Statistical analyses involved χ² tests, t-tests, and multivariable logistic regression.

Results: Baseline characteristics were comparable between groups, though prostate volume was larger in the COG-TBx group (52.0 ml vs. 46.0 ml, P = 0.024). The COG-TBx group demonstrated significantly higher PCa (52.2% vs. 41.2%, P = 0.034) and csPCa detection rates (44.7% vs. 25.6%, P < 0.05), as well as a higher cancer detection rate per needle (28.5% vs. 19.3%, P = 0.003). The overall 30-day complication rate was slightly higher in the COG-TBx group (13.0% vs. 7.0%, P > 0.05), without statistical significance. Multivariate analysis identified COG-TBx (OR = 1.98, 95% CI: 1.15-3.41, P = 0.013) and PSA level (OR = 1.12 per ng/mL, 95% CI: 1.03-1.22, P = 0.008) as independent predictors of csPCa detection.

Conclusion: Transperineal COG-TBx is associated with higher detection rates for prostate cancer and clinically significant cancer compared to SBx. Although associated with a slightly higher complication rate, the difference was not significant. The overall benefit supports the clinical adoption of COG-TBx.

Introduction: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for managing renal and upper ureteral stones. Ureteral access sheaths (UAS) facilitate instrument access and reduce intrarenal pressure, but their impact on stone-free rates (SFR) remains debated. Suction ureteral access sheaths (S-UAS) offer improved flexibility and can be connected to suction devices, enhancing stone fragment removal. This study aims to compare the outcomes of traditional UAS and S-UAS in RIRS.

Methods: A retrospective cohort study was conducted at Chimei Medical Center from January 2022 to December 2024, including 104 patients who underwent RIRS with either traditional UAS (n = 53) or S-UAS (n = 51). Baseline characteristics, operative time, stone-free rates (SFR), postoperative complications, and the need for auxiliary procedures were analyzed. Stone-free was defined as absence of residual fragments > 4 mm (and > 2 mm for stricter assessment) on KUB. Subgroup analyses assessed the impact of stone size, location, and number on outcomes.

Results: Immediate clinically acceptable SFR was significantly higher in the S-UAS group (82.0%) compared to the traditional UAS group (60.4%) (p = 0.016). At one month, no significant difference was observed between the groups. The S-UAS group required fewer auxiliary procedures (5.9% vs. 22.6%, p = 0.015) and demonstrated a higher SFR for lower calyx stones (81.8% vs. 55.2%, p = 0.046). Operative time, hospital stay, and complication rates were similar between groups.

Conclusion: The S-UAS facilitates efficient stone dust evacuation, improves immediate clinically acceptable SFRs, and reduces auxiliary procedure rates without increasing complications. These findings support its use in RIRS, particularly in select stone characteristics. Prospective studies with larger cohorts and standardized imaging follow-up are warranted to validate these results.

Clinical trial number: not applicable.

Background: PCa (Prostate cancer) is the most prevalent urogenital malignancy among men. The genes APOC1(Apolipoprotein C1) and NOP16 (Nucleolar protein 16) have been associated with various types of cancer. This article aims to investigate the potential of APOC1 and NOP16 as preliminary proactive diagnostic markers for PCa.

Methods: Search for APOC1 and NOP16 using the TCGA (The Cancer Genome Atlas) and GEPIA (Gene Expression Profiling Interactive Analysis) databases. Immunohistochemical staining was employed to detect the expression of APOC1 and NOP16 in prostate tissue. The enzyme-linked immunosorbent assay (ELISA) was utilized to quantify the levels of APOC1 and NOP16 proteins. Spearman correlation coefficient and Pearson correlation coefficient were calculated to validate the association between APOC1 and NOP16. A binary logistic regression model was developed to analyze the factors that influence PCa. Predictive models for APOC1 and NOP16 and PSA, and their role in detecting PCa, were established through the construction of receiver operating characteristic (ROC) curves.

Results: APOC1 and NOP16 are up-regulated in PCa tissues, and their expressions are related with the clinical stage of PCa(n = 51). Furthermore, compared with individuals affected by benign prostatic hyperplasia (BPH), the expression levels of APOC1 and NOP16 in the serum of individuals affected by PCa are higher(n = 61). Moreover, in the tissues and serum of the same PCa patient, APOC1 and NOP16 are positively correlated(n = 32). APOC1 and NOP16 are independent influencing factors for PCa(n = 50). APOC1 and NOP16 showed predictive potential for PCa (n = 50, APOC1 AUC = 0.729, NOP16 AUC = 0.777).

Conclusions: APOC1 and NOP16 are anticipated to function as biomarkers for the early proactive diagnosis of PCa.