BMC Urology最新文献

Introduction: Prostate biopsy is a key diagnostic tool for prostate cancer and is often associated with physical, emotional, and social challenges. To enhance future multicenter trial designs for diagnostic precision, understanding patient-relevant outcomes is essential. Current evidence on patient-reported outcomes (PROMs) and patient-reported experience measures (PREMs) in the context of prostate biopsies remains limited, particularly regarding perioperative biopsychosocial impacts. This study aimed to explore patient-relevant factors, including concerns, side effect tolerance, and preferences, to inform future trials through patient and public involvement (PPI).

Methodology: A prospective monocentric qualitative study was conducted with 12 male patients (mean age: 69.8 years) who underwent prostate biopsy. Preprocedure semistructured telephone-based interviews were conducted from May to August 2024 in Freiburg, Germany, transcribed verbatim, and analyzed via deductive-inductive content analysis. Intercoder reliability reached a kappa of 0.73. A short questionnaire was used to collect background data. The interviews addressed themes such as study motivation, fears, diagnostic precision, side effects, communication preferences, and other outcomes relevant to patients.

Results: The participants expressed fears about physical side effects (e.g., pain, incontinence, and erectile dysfunction) and potential cancer diagnoses. While most patients tolerate temporary side effects for the sake of diagnostic accuracy, potential long-term effects raise concerns. Trust in the medical team's expertise, the reputation of the medical center, and transparent communication were identified as crucial for patient satisfaction. Many participants showed altruistic motivation to contribute to research but emphasized the importance of shorter waiting times and clear communication regarding biopsy risks and benefits. The biopsychosocial model was evident, as patients reported interconnected physical, psychological, and social burdens. Preferences for open, empathetic communication and reduced procedural invasiveness were recurrent themes.

Conclusions: This study highlights the multidimensional nature of patient experiences with prostate biopsy, emphasizing the importance of patient-centered research. Transparent communication, trust, and minimizing invasiveness while ensuring diagnostic accuracy are essential for improving patient satisfaction and reducing anxiety. The findings provide valuable insights for designing future studies and underline the importance of incorporating patient-relevant outcomes in clinical research and decision-making.

Trial registration: This study was registered at the University Medical Center of Freiburg Clinical Trial Register (FRKS005027).

Background: Diabetic urinary incontinence is a multifactorial condition involving neuropathy, oxidative stress, and epithelial dysfunction. Serum biomarkers-cathelicidin (LL-37), elafin, vitamin D receptor (VDR), 4-hydroxynonenal (4-HNE), and amyloid-β1-42 (Aβ1-42) may provide insight into underlying mechanisms.

Methods: We conducted a cross-sectional, single-centre observational study including 120 adults: type II diabetes with urinary incontinence (DI; n = 40), non-diabetic urinary incontinence (Non-DI; n = 40), and healthy controls (n = 40). Serum biomarker levels were measured by ELISA. Group differences were analysed using Kruskal-Wallis, with pairwise Mann-Whitney U tests and Bonferroni adjustment (m = 3) where appropriate.

Results: Among profiled biomarkers, 4-HNE was lower in DI than in both Non-DI and controls, while LL-37, elafin, VDR, and Aβ1-42 showed no Bonferroni-corrected pairwise differences.

Conclusion: In diabetic urinary incontinence, 4-HNE showed the most consistent group-level separation-lower in DI compared with both Non-DI and healthy controls-whereas LL-37, elafin, VDR, and Aβ1-42 did not demonstrate Bonferroni-corrected pairwise differences. These preliminary findings highlight oxidative and neuroimmune alterations in diabetic incontinence and warrant validation in larger longitudinal studies.

Introduction: Testosterone plays a central role in endocrine and metabolic functions. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely prescribed for type 2 diabetes and obesity, have been proposed to modulate testosterone levels. Although this association is not yet covered by clinical guidelines, emerging studies suggest favorable effects, possibly due to weight loss and improved insulin sensitivity. This systematic review and meta-analysis aim to synthesize current evidence on how GLP-1 RAs influence testosterone levels and highlight areas for future investigation.

Materials and methods: A systematic search was conducted using Embase, PubMed, Scopus, Cochrane, and Google Scholar databases through December 2024. Eligible studies included RCTs, cohort studies, and retrospective analyses comparing testosterone levels before and after GLP-1 RA administration. Primary and secondary outcomes included total, free, and bioavailable testosterone, SHBG, and HbA1c. All included studies reported baseline hormone values and used validated measurement techniques. Data analysis was performed using RStudio.

Results: Four studies comprising 219 patients pre-treatment and 216 post-treatment were included. GLP-1 RA use was significantly associated with increased bioavailable testosterone (MD -57.18; 95% CI -87.60 to -26.76; p < 0.001; I² = 86%) and decreased HbA1c (MD 0.79; 95% CI 0.58 to 1.00; p < 0.001; I² = 0%). Free testosterone (MD -1.62; p = 0.051) and SHBG (MD -6.62; p = 0.120) showed no significant changes. Sensitivity and Baujat analyses were used to explore heterogeneity.

Conclusions: GLP-1 RAs appear to elevate bioavailable testosterone and improve glycemic control, while effects on free testosterone and SHBG remain inconclusive. These findings suggest possible endocrine benefits of GLP-1 therapy; however, further well-powered studies are warranted.

Background: Current research indicates that prostate cancer (PCa) is one of the most common cancers in men, and its occurrence may be linked to metabolic unhealth. Therefore, we conducted a study on the correlation between metabolic unhealth and PCa.

Objective: To study the correlation between metabolic unhealth and the incidence of PCa.

Methods: A total of 607 patients underwent prostate biopsy in the urology department of a certain tertiary hospital in Urumqi, Xinjiang from May 2018 to September 2022. Age was used as a matching variable inverse probability weighted to reduce the influence of confounding factors. Logistic regression models were used to analyze the association between metabolic unhealthiness and the risk of prostate cancer.

Results: (1) Logistic regression analysis showed that the risk of prostate cancer in metabolically unhealthy people was 1.684 times higher than that in metabolically healthy people (OR=1.684,95%CI:1.224-2.317,P=0.001); (2) In sensitivity analysis, multifactor Poisson regression showed that metabolically unhealthy people had higher risk of the disease (RR=1.145, 95%CI:1.015-1.292, P =0.028). Subsequently, excluding those with diabetes, sensitivity analysis using inverse probability-weighted logistic regression with age as a matching variable showed that those with unhealthy metabolism had a higher risk of prostate cancer (OR=1.464,95% CI:1.046-2.050, P =0.026).

Conclusion: Metabolic unhealth, obesity, are risk factors for PCa, which have certain diagnostic and therapeutic value for the risk of PCa. Reducing body weight and managing blood pressure, blood sugar, blood lipids, and high-density lipoprotein through reasonable diet can effectively prevent and control PCa.

Purpose: To describe a novel single-position intraperitoneal laparoscopic surgery (SP-ILS) technique for radical nephroureterectomy (RNU) and bladder cuff excision (BCE) in the supine position.

Methods: Between January 2019 and June 2023, 40 patients with UTUC underwent laparoscopic RNU and BCE using the SP-ILS technique. Clinical, perioperative, and pathological data were retrospectively analyzed.

Results: All procedures were performed laparoscopically without patient repositioning. No intraoperative or postoperative complications occurred. The mean operative time was 101.0 ± 24.5 minutes, and mean estimated blood loss was 53 ± 27.0 mL. The median postoperative hospital stay was 4.2 ± 1.1 days. Postoperative pathology revealed Ta in 14 patients, T1 in 21 patients, and T2 in 5 patients. During a mean follow-up of 12.9 months (range, 2-24), one patient developed bladder recurrence.

Conclusions: The SP-ILS technique offers direct visualization, reproducible bladder cuff excision, and efficient single-position workflow during both LRNU and BCE.

Background: Malignancies of the adrenal gland account for a minority of adrenal incidentalomas, with metastases being more common than primary tumors. Cholangiocarcinoma, an aggressive malignancy of the bile ducts, rarely metastasizes to the adrenal gland, and to date, no cases of primary cholangiocarcinoma originating in the adrenal gland have been reported. This case presents a novel and unprecedented tumor origin, offering valuable insights into diagnostic challenges and the utility of molecular profiling in rare adrenal neoplasms.

Case presentation: A 44-year-old female with a history of hypertension, obstructive sleep apnea, and bariatric surgery presented with progressive voiding dysfunction. Imaging revealed a right adrenal mass with radiologic features suspicious of adrenocortical carcinoma. Biochemical evaluation for a functional tumor was unremarkable. She underwent laparoscopic adrenalectomy. Histopathology revealed metastatic adenocarcinoma with an immunoprofile initially suggestive of a pancreatic primary. However, further molecular analysis using AI-driven genomic profiling indicated a 91% probability of cholangiocarcinoma. Despite comprehensive post-operative imaging, including PET-CT and MRCP, no primary hepatic, pancreatic, or biliary tumor was identified, supporting the diagnosis of a primary adrenal cholangiocarcinoma. The patient was treated with six cycles of gemcitabine, cisplatin, and durvalumab, which was later discontinued due to thyroiditis. Follow-up imaging revealed no residual or metastatic disease.

Conclusions: This case represents the first known report of cholangiocarcinoma arising in the adrenal gland, broadening the differential diagnosis for adrenal incidentalomas. It underscores the critical role of advanced histopathologic and genomic profiling in evaluating atypical adrenal lesions, especially in patients without a known primary malignancy. Comprehensive diagnostic workup and a multidisciplinary approach are essential for accurate diagnosis and appropriate management of rare adrenal tumors.