BMC Urology最新文献

Background: This study aimed to develop and validate a novel preoperative nomogram to predict stone-free status (SFS) in patients undergoing retrograde intrarenal surgery (RIRS) for kidney stones.

Methods: A total of 220 patients who underwent RIRS were retrospectively analyzed. Feature selection was performed using Boruta and LASSO algorithms, identifying six key preoperative predictors: inferior pole stone (classified by RIPA), calyx pelvic height (CPH), number of stones, maximum stone diameter, stone volume, and mean stone density. A nomogram was constructed using multivariable logistic regression and evaluated by receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC). Internal validation was performed with 1,000 bootstrap resamples.

Results: The nomogram demonstrated strong discriminative ability with an AUC of 0.873 in the training cohort and 0.862 in the validation cohort. Calibration plots showed good agreement between predicted and observed outcomes. DCA and CIC confirmed its superior clinical utility across a range of threshold probabilities. Notably, inferior pole stones with RIPA ≤ 30° and higher CPH were strongly associated with SFS failure. Compared to existing scoring systems, the new model achieved better predictive performance. Including both stone volume and maximum diameter offered a more accurate assessment of stone burden than using either metric alone.

Conclusion: We developed and internally validated a nomogram that outperformed existing tools in predicting SFS after RIRS. It may assist clinicians in individualized risk assessment and preoperative planning. As this predictive model was developed based on a single-centre study, it will be necessary to conduct further multicentre or prospective studies in the future.

Background: Primary renal neuroendocrine tumors (PRNETs) are exceptionally rare neoplasms, with only limited cases documented in the literature. Their occurrence in association with horseshoe kidney represents an even rarer clinical scenario. This report presents a case of well-differentiated neuroendocrine tumor arising in a horseshoe kidney and discusses its clinical management and prognostic implications.

Case presentation: A 58-year-old female was admitted after an incidental discovery of a left renal mass during a routine health examination. Imaging studies, including enhanced CT and MRI, revealed a horseshoe kidney with a 5.5 × 4.7 cm cystic-solid mass in the mid-lower portion of the left kidney, classified as Bosniak IV. The patient underwent laparoscopic partial nephrectomy via a retroperitoneal approach. Histopathological and immunohistochemical analyses confirmed a well-differentiated neuroendocrine tumor, with positive staining for Syn, CD56, SSTR2, and focal CgA, and a low Ki67 index (3%). The postoperative course was uneventful, and no recurrence or metastasis was observed during the 12-month follow-up.

Conclusion: PRNETs, though rare, should be considered in the differential diagnosis of renal masses, particularly in patients with congenital renal abnormalities such as horseshoe kidney. Nephron-sparing surgery may be a feasible option in selected cases, with favorable short-term outcomes. Long-term follow-up is essential due to the potential for delayed metastasis. Immunohistochemical profiling plays a critical role in diagnosis and therapeutic planning, especially regarding the potential use of somatostatin analogs.

Background: The red blood cell distribution width-to-albumin ratio (RAR) is a novel hematological biomarker that integrates information on inflammation and nutritional status. While RAR has been applied in assessing risks for various chronic diseases, its association with diabetic kidney disease (DKD) remains unclear. This study aims to evaluate the relationship between RAR and the risk of DKD in diabetic patients, exploring its potential value in early risk identification.

Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2020, we included 7,191 eligible adult participants diagnosed with diabetes. RAR was categorized into quartiles, and weighted multivariable logistic regression along with restricted cubic spline (RCS) models were employed to assess the association between RAR levels and the prevalence of DKD. Subgroup and sensitivity analyses were conducted to validate the robustness of the findings.

Results: The RAR level was significantly higher in the DKD group compared to the non-DKD group (p < 0.001), and the prevalence of DKD increased progressively across RAR quartiles (25.20%, 30.17%, 39.34%, and 43.33%, p < 0.001). In the unadjusted model, each one-unit increase in RAR was associated with a 76.4% higher risk of DKD (OR = 1.764, 95% CI: 1.541-2.017, p < 0.001). Participants in the highest RAR quartile (Q4) had a 2.269-fold increased risk of DKD compared to those in the lowest quartile (Q1) (95% CI: 1.809-2.846, p < 0.001). RCS analysis suggested a potentially linear association between RAR and DKD risk, with no significant non-linear trend observed after adjusting for covariates (p > 0.05). Subgroup analysis revealed that the association remained consistent across most strata, although significant interactions were found for sex and BMI (P for interaction < 0.05), with stronger associations observed in males and in participants with higher BMI. Sensitivity analyses confirmed the robustness of these findings.

Conclusion: Elevated RAR levels are significantly associated with increased risk of diabetic kidney disease among individuals with diabetes, suggesting its strong predictive potential. As a simple and cost-effective biomarker, RAR may serve as a useful tool for early DKD risk screening and stratification. However, prospective studies are warranted to further validate its clinical utility.

Introduction: Retrograde intrarenal surgery (RIRS) is a primary treatment for urolithiasis, with successful ureteral access sheath (UAS) placement being a critical step. Preliminary studies suggest preoperative electroacupuncture (EA) may enhance UAS placement success, reduce ureteral injury, and improve stone clearance rates. This trial evaluates the efficacy and safety of EA as an adjunct to first-stage RIRS.

Methods and analysis: This multicenter, randomized, single-blind, sham-controlled trial will enroll 120 adult patients with upper ureteral or renal stones (≥ 10 mm) scheduled for first-stage RIRS. Participants will be randomized (1:1) to receive either preoperative EA plus general anesthesia or sham EA plus general anesthesia across multiple sessions. The primary outcome is the proportion of patients with successful UAS placement during first-stage RIRS. Secondary outcomes include surgical duration, UAS insertion resistance, ureteral injury (Post-Ureteroscopic Lesion Scale [PULS]), stone clearance rate at 2 weeks post-surgery, and adverse events (AEs) up to 2 weeks post-surgery. Data will be analyzed using intention-to-treat principles.

Discussion: This study is the first randomized controlled trial to investigate the efficacy of EA in improving the success rate and safety of UAS placement during first-stage RIRS. The findings will provide high-quality evidence to support the use of EA as an adjunctive therapy in clinical practice. Through a comprehensive multidimensional assessment, this study demonstrates the potential of EA for broader application in the treatment of urolithiasis. Further rigorously designed clinical trials are essential to validate and refine this promising therapeutic approach.

Registration number: International Traditional Medicine Clinical Trial Registry. Identifier: ITMCTR2025001039.

Background: Benign prostatic hyperplasia (BPH) prevalence varies by ethnicity, with risk increasing in aging men. The visual prostate symptom score (VPSS) offers a practical alternative to the International Prostate Symptom Score (IPSS), especially for elderly patients, but its validation in Tanzania and correlation with IPSS remain underexplored.

Objectives: This study conducted a comparative analysis of IPSS and VPSS in Tanzanian patients, assessing lower urinary tract symptoms (LUTS) and BPH severity before and after treatment at Muhimbili National Hospital's Urology Department.

Methodology: This longitudinal observational study included both inpatients and outpatients at MNH in Dar es Salaam, examining the correlation between VPSS and IPSS for grading LUTS in BPH patients aged 40 years and above. Prostate volume was measured using transabdominal ultrasound. Participants completed Swahili versions of the 7-item IPSS and 4-item VPSS. Data were collected before treatment and at the six-month follow-up, with surgical patients and deceased patients excluded from follow-up analysis. Statistical analysis was performed using SPSS version 27.

Results: In a study of 137 BPH patients with LUTS, aged 62-76 years (median 70), prostate volume significantly decreased from 49.0 mL before treatment to 35.0 mL after treatment. Most patients (94.2%) were literate in Swahili, with significant differences in completing IPSS on the basis of literacy (p = 0.042) but no difference in completing VPSS (p = 0.999). Both the IPSS and VPSS improved significantly after treatment, with strong correlations before (r = 0.648) and after treatment (r = 0.732), confirming their reliability in assessing LUTS severity.

Conclusion: This study showed that VPSS effectively evaluates LUTS severity in BPH patients, correlating well with IPSS, even in illiterate patients. VPSS's reliability suggests its utility in routine practice, enhancing symptom monitoring and treatment outcomes in BPH management.

Background: Intrauterine device (IUD) migration is a rare but serious complication of IUD use, most often resulting from unnoticed uterine perforation. However, intravesical migration complicated by multifocal sepsis from ruptured tubo-ovarian abscess (TOA) and acute appendicitis is an exceedingly rare and complex clinical scenario.

Case presentation: A 39-year-old multiparous Asian female with history of IUD placement presented with features of sepsis. Laboratory and radiological investigations, and quick sequential organ failure assessment (qSOFA) score were promptly done. The assessment was intravesical IUD migration complicated by multifocal sepsis and septic shock due to ruptured TOA and acute appendicitis. She had resuscitation and an urgent combined minimal access surgical intervention. Her postoperative recovery was rapid, and she was discharged four days after surgery.

Conclusion: This rare case demonstrates the importance of early recognition of sepsis, the relevant diagnostic and therapeutic challenges of managing a critically ill gynecology patient with a migrated IUD complicated by multifocal sepsis and the significance of patient education and appropriate follow-up after IUD insertion.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent and durable treatment, traditionally performed using 26-28 Fr resectoscopes. While larger scopes offer improved visualization and irrigation, they may increase the risk of urethral trauma and strictures. A 22 Fr HoLEP system has recently been introduced, aiming to minimize morbidity without compromising surgical efficiency. This study evaluates perioperative outcomes, safety, and early functional results using the 22 Fr HoLEP system for Minimally Invasive Laser Enucleation of the Prostate (MiLEP).

Methods: We conducted a retrospective review of a database of patients who underwent MiLEP between January 2022 and September 2024. Inclusion criteria were age ≥ 40, prostate volume ≥ 35 cm³, and moderate-to-severe lower urinary tract symptoms (LUTS). Preoperative, intraoperative, and postoperative data were analyzed, including IPSS, PSA, uroflowmetry (Qmax), post-void residual (PVR), complications, and need for urethral or meatal dilation. All procedures utilized the 22 Fr resectoscope with a 100 W holmium laser using an en bloc technique.

Results: All cases were successfully completed using the MiLEP system without scope upsizing or conversion. Mean prostate volume was 84.5 ± 36.3 cm³, operative time was 76.1 ± 21.6 min, and morcellation time was 20.7 ± 6.8 min. Meatal dilation was required in 4% of cases; no patients required urethral dilation. Capsular perforation occurred in 7%, and 1% experienced non-perforating bladder injury during morcellation. No blood transfusions or intraoperative conversions were required. At 3 months, IPSS improved from 24.4 ± 3.7 to 6.7 ± 1.4 (p < 0.001), Qmax increased from 9.0 ± 2.8 to 21.1 ± 6.3 mL/s (p < 0.001), and PSA decreased from 5.7 ± 3.7 to 0.48 ± 0.3 ng/mL (p < 0.001). De novo stress urinary incontinence was reported in 3% of patients. No urethral strictures or bladder neck contractures were observed.

Conclusions: MiLEP using the 22 Fr system is a feasible and effective technique for BPH treatment, offering significant improvements in LUTS and urinary flow with minimal morbidity. This approach may reduce the risk of urethral trauma and postoperative complications while maintaining surgical efficiency.