International Urology and Nephrology最新文献

{"title":"Intravesical gemcitabine versus anthracyclines for primary and first recurrent non-muscle-invasive bladder cancer: a single-center retrospective study over 10 years.","authors":"Haobo Fan, Weiwu Chen, Wenhao Guo, Jiayu Han, Haoze Xie, Yanlan Yu, Guoqing Ding, Yicheng Chen","doi":"10.1007/s11255-025-04413-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04413-5","url":null,"abstract":"<p><strong>Purpose: </strong>To compare intravesical instillation of gemcitabine and anthracyclines in the treatment of primary non-muscle-invasive bladder cancer (NMIBC), and to evaluate the effect of changing intravesical chemotherapy drugs on the the second recurrence of NMIBC.</p><p><strong>Method: </strong>Patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) for the first time in our center from January 2014 to December 2023 were enrolled. Kaplan-Meier method was used to analyze the recurrence-free survival (RFS) and progression-free survival (PFS), and COX regression was used to analyze the risk factors for recurrence.</p><p><strong>Result: </strong>464 patients were included in the study (212 in the gemcitabine group and 252 in the anthracyclines group). Anthracyclines-treated patients had superior RFS compared to gemcitabine-treated patients (p = 0.006), but PFS did not differ significantly between the two groups (p = 0.654). After the first recurrence of NMIBC, patients who changed intravesical chemotherapy drugs had better RFS than those who kept the original chemotherapy drugs (p = 0.037). In terms of safety, the incidence of adverse events of pirarubicin was significantly higher than that of gemcitabine and epirubicin (55.2% vs 26.4% vs 36.2%, p < 0.001).</p><p><strong>Conclusion: </strong>Anthracyclines are more effective than gemcitabine in preventing recurrence of primary NMIBC but with more adverse events. After the first recurrence of NMIBC, changing the drugs of intravesical chemotherapy can reduce the second recurrence of NMIBC.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventative effect of montelukast in mild to moderate contrast-induced acute kidney injury in rats via NADPH oxidase 4, p22phox and nuclear factor kappa-B expressions.","authors":"Oguzhan Simsek, Elif Baris, Cemre Ural, Canet Incir, Selma Aydemir, Mukaddes Gumustekin, Zahide Cavdar, Osman Yilmaz, Seda Ozbal, Mualla Aylin Arici","doi":"10.1007/s11255-025-04378-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04378-5","url":null,"abstract":"<p><p>Reactive oxygen species (ROS) generation, inflammation and apoptosis are observed in contrast-induced acute kidney injury (CI-AKI). NOX4, isoform of NADPH oxidase main regulatory enzyme for ROS generation, is mostly expressed in the kidney and co-localized with p22phox. It is investigated the effect of antioxidant, anti-inflammatory and anti-apoptotic montelukast pre-treatment on expression of NOX4, p22phox and NF-κB in preventing CI-AKI in rats in this study. Wistar male rats randomized into four groups: 1. Control (C), 2. CI-AKI (iohexol; 3 g iodine/kg), 3. Montelukast (10 mg/kg) (M), 4. M + CI-AKI. Rats sacrificed on the 7th day. Urine and serum creatinine and serum Kidney injury molecule-1 (KIM-1) levels measured. NF-κB, NOX-4, p22phox mRNA and protein expressions, TNF-α, KIM-1 mRNA expressions, ROS and caspase-3 evaluated from kidney tissue. Histological injury scored. ANOVA and Kruskal-Wallis tests were used for analysis parametric and nonparametric data, respectively. p < 0.05 considered statistically significant. Tubular injury score, KIM-1 and caspase-3 levels increased in CI-AKI group compared to C group (p < 0.05). TNF-α, NF-κB, NOX-4, p22phox, KIM-1 mRNA expressions and ROS levels increased in CI-AKI group compared to C group (p < 0.001 and p < 0.05). NF-κB, NOX-4, p22phox protein expressions increased in CI-AKI group compared to C group (p < 0.05) and decreased in the M + CI-AKI group compared to CI-AKI group (p < 0.01, p < 0.05, p < 0.05). TNF-α, NF-κB, NOX-4, p22phox, KIM-1 mRNA expressions and ROS levels decreased with montelukast pre-treatment (p < 0.001). One of the mechanism of increased ROS level in the CI-AKI model is related the increase the expression of NOX4 and p22phox and montelukast pre-treatment has a protective effect by decreasing NOX4 and p22phox mRNA and protein expressions.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenine phosphoribosyltransferase (APRT) deficiency: an increasingly recognized disease.","authors":"Esther Huimin Leow, Indra Ganesan, Siew Le Chong, Celeste Jia Ying Yap, Sing Ming Chao, Fan Wang, Yong Hong Ng","doi":"10.1007/s11255-025-04420-6","DOIUrl":"https://doi.org/10.1007/s11255-025-04420-6","url":null,"abstract":"<p><p>Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder which causes high urinary 2,8-dihydroxyadenine (2,8-DHA) excretion, resulting in urolithiasis and crystal nephropathy. It is caused by mutations in the APRT gene. Even though it is an inherited kidney stone disease, the varied clinical presentations, even within a family with the same underlying genetic variants, can lead to delayed diagnosis with some only being recognized in adulthood and even, following a kidney transplant. First presentations include symptoms of reddish-brown diaper stains, urinary tract infections, urolithiasis, acute kidney injury from obstructive uropathy and/or intratubular 2,8-DHA crystallization or kidney failure. Siblings of index cases should be screened for APRT deficiency. An early diagnosis and treatment with xanthine oxidoreductase inhibitors (XORi) can preserve kidney function and/or prevent progressive kidney injury and kidney failure. In this review, we will discuss the pathophysiology, clinical presentations, investigations, and management of APRT deficiency.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of ovarian reserve on pregnancy outcomes in patients undergoing IVF treatment due to azoospermia.","authors":"Aycan S Arabacı, Can Köse, Esin Kasap, Ebru Sahin Güleç, Ahmet Demir","doi":"10.1007/s11255-025-04412-6","DOIUrl":"https://doi.org/10.1007/s11255-025-04412-6","url":null,"abstract":"<p><strong>Purpose: </strong>Infertility is an increasingly common condition that has demographic, psychological, economic, and medical consequences for society. Although many studies have examined azoospermia (AZO) and diminished ovarian reserve (DOR), few have investigated these two groups together. In this study, we aimed to contribute to the literature by comparing these conditions, which can be challenging for physicians and patients.</p><p><strong>Methods: </strong>The study included couples with AZO and/or DOR who underwent intracytoplasmic sperm injection (ICSI) at Tepecik Training and Research Hospital Gynecology and Obstetrics Clinic In Vitro Fertilization (IVF) Center between 01 January 2017 and 30 June 2023. A total of 100 couples meeting the inclusion criteria were divided into 3 groups according to treatment indication: AZO (n = 34), DOR (n = 34), and AZO + DOR (n = 32). The women's ages, basal hormone levels (follicle-stimulating hormone, estradiol, progesterone, anti-Müllerian hormone), treatment indications, day of embryo transfer, and clinical pregnancy outcomes were documented.</p><p><strong>Results: </strong>Clinical pregnancy rates were 64.7% in the AZO group, 50% in the DOR group, and 34.4% in the DOR + AZO group. In pairwise comparisons, the clinical pregnancy rate was significantly higher in the AZO group than in the DOR + AZO group (p = 0.014). The live birth rate was also significantly lower in the DOR + AZO group than in the AZO group (p = 0.022). In the DOR group, 70.6% of achieved pregnancies resulted in live birth and 29.4% in missed abortion.</p><p><strong>Conclusion: </strong>Clinical pregnancy and live birth rates were found to be significantly higher in couples with AZO compared to those with both DOR and AZO. This suggests that the woman's ovarian reserve is more decisive than sperm quality in the success of IVF/ICSI.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the impact of chronotype, chrononutrition and lifestyle on bladder cancer.","authors":"Zofia Strojny, Edyta Kawka, Marcin Strojny, Agata Kucz-Chrostowska, Joanna Żuraszek-Szymańska, Wiesław Sikora, Tomasz Deja, Maciej Konopka, Maki Sato, Tomoko Wakamura, Hiromitsu Negoro, Anna Surdacka, Katarzyna Korybalska, Andrzej Bręborowicz, Janusz Witowski, Dominika Kanikowska","doi":"10.1007/s11255-025-04371-y","DOIUrl":"https://doi.org/10.1007/s11255-025-04371-y","url":null,"abstract":"<p><strong>Background: </strong>The misalignment of sleep and eating patterns with biological cycles is a significant issue that could have detrimental effects on health and is prevalent among cancer patients. Sleep duration, chronotype, and nutrition may be linked to the presence of urothelial tract cancer. Bladder cancer is the most frequently diagnosed cancer in the urinary system. The study estimated bladder cancer patients' nutrition behavior, sleep preferences, and chronotype.</p><p><strong>Methods: </strong>101 patients were enrolled. Based on histopathological examination, they were divided into the cancer group (n = 69) and the non-cancer group (n = 32). Lifestyle was assessed through three questionnaires about sleep, chronotype patterns, and chrononutrition behaviors: social jet lag, eating jet lag, eating window, evening and morning latency. The analysis was also completed by assessing salivary alpha-amylase and immunoglobulin A (IgA).</p><p><strong>Results: </strong>In cancer and non-cancer patients, we did not find differences between the chronotypes (p = 0.0634) or other measured factors. Most of the studied population did not present social or eating jet lag and morning or evening latency. In addition, the total sleep duration in these groups was similar 8.5 (5.0-13.0) vs 9.0 (5.0-11.5) hours per day (p > 0.99). The eating window did not differ between the groups (p = 0.061). Furthermore, the assessment of salivary alpha-amylase 193.9 U/ml (10.2-1173.0) and IgA 129.0 μg/ml (5.1-801.1) (p = 0.43; p = 0.18, respectively) showed no differences.</p><p><strong>Conclusions: </strong>In this preliminary study, we did not observe a domination of particular types of chronotypes in the cancer and non-cancer groups. Moreover, there were no significant changes in lifestyle and chrononutrition behavior, except weak difference between groups in eating window. However, it provides a robust foundation for further research and clinical applications.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global epidemiology of HIV among dialysis patients: a systematic review and meta-analysis.","authors":"Shahad Saif Khandker, Safrin Jahan, Adiba Ayesha Khan, Begum Faijunnesa Abrittee, Rifah Nanjiba, Dewan Zubaer Islam, Ehsan Suez, Md Habibur Rahman, Farha Farahim, Talat Ali, Rahima Begum","doi":"10.1007/s11255-025-04421-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04421-5","url":null,"abstract":"<p><p>HIV transmission and infection among dialysis patients have become a major healthcare concern and a rising threat throughout the world. Our current systematic review and meta-analysis targeted to determine the global epidemiologic state of HIV infection among dialysis patients. Three online databases: Google Scholar, PubMed, and ScienceDirect were searched for eligible studies using specific keywords. 15 studies matched our eligibility criteria and were included in the study. The worldwide pooled prevalence of HIV among dialysis patients was 0.8% (95% CI 0.4 to 1.2) with a high degree of heterogeneity (95%) among the included studies. Substantial variations in pooled prevalence were found among different continents in our subgroup analysis. Africa (21.1%, 95% CI 6.4 to 35.8) and North America (19.3%, 95% CI 0.0 to 39.8) had a higher prevalence of HIV in dialysis patients whereas in Europe (0.3%, 95% CI 0.0 to 0.6), South America (0.7%, 95% CI 0.0 to 1.6) and Asia (0.7%, 95% CI 0.0 to 1.6) the frequency was much lower. Perhaps, due to the lack of awareness and preventive knowledge, insufficient healthcare facilities and breaches in infection control protocols in dialysis centers, risky attitudes and practices immigration issues the prevalence of HIV among dialysis patients in Africa and North America enhanced as compared to that of Europe, Asia and South America. Strict adherence to HIV preventive practices, raising public awareness, and advanced healthcare systems are suggested to reduce the prevalence of HIV among dialysis patients all over the world.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of gut microbiota variations in patients with Henoch-Schönlein purpura: a comprehensive systematic review.","authors":"Khaled Saad, Muhammad Abd-Ellatif, Nehal E Abdel-Hakem, Abdelrahman Ali, Osama Ahmed Khalil, Tasbih Emad, Omar Abo-Gazia, Asmaa Eldamaty, Yusof M Omar, Mohammad Alzu'bi, Mohammad Bazzazeh, Ahmed Afifi, Amira H El-Ashry, Sherin A Taha, Hoda Atef Abdelsattar Ibrahim, Thamer Alruwaili, Amira Elhoufey, Hamad Ghaleb Dailah, Anas Elgenidy","doi":"10.1007/s11255-025-04406-4","DOIUrl":"https://doi.org/10.1007/s11255-025-04406-4","url":null,"abstract":"<p><strong>Objective: </strong>The primary purpose of our study was to perform a comprehensive systematic review, aiming to bring out the association between gut microbiota, Henoch-Schönlein Purpura (HSP) and Henoch-Schönlein nephritis (HSPN) patients.</p><p><strong>Methods: </strong>A systematic review was performed using five electronic databases, including Medline (through PubMed), Scopus, Embase, Cochrane, and Web of Science, from inspection up to March 21, 2024, to detect the studies that assessed the gut microbiota variation in Henoch-Schönlein Purpura (HSP) and Henoch-Schönlein nephritis (HSPN) patients.</p><p><strong>Results: </strong>Microbial diversity, richness, and composition in HSP patients are decreased compared to the healthy control group. In addition, HSP patients display a different microbiota structure and show a significant difference in taxonomic abundance between HSP and health control, which differs from one level to another. At the phylum level, Bacteroidetes, Fusobacteria, and Blastocladiomycota were more abundant; at the class level, Bacteroidetes were more abundant; at the order level, Bacteroidetes were more abundant in the HSP group-stage and site of HSP involvement effect on microbiota. Gastrointestinal tract involvement is characterized by increased abundance of Streptococcus and Fusobacteria and a decrease in Faecalibacterium. Kidney involvement is characterized by increased abundance of Streptococcus spp, which can be used as an indicator of disease severity. Escherichia-Shigella can be used as a diagnostic for the recurrence of HSP because its abundance is higher than primary HSP.</p><p><strong>Conclusion: </strong>Gut microbiota can be utilized to assess the severity, recurrence, and site of HSP infection by analyzing the diversity, richness, and abundance of specific microorganisms associated with the condition.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of robotic prostatectomy techniques post TURP/HOLEP: retzius-sparing vs. non-retzius approaches: evaluation of perioperative, functional, and oncological outcomes.","authors":"Atanu Kumar Pal, Jeni Mathew, Sandeep Prabhakaran, T A Kishore","doi":"10.1007/s11255-025-04423-3","DOIUrl":"https://doi.org/10.1007/s11255-025-04423-3","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluated the perioperative, functional, and oncological outcomes of Retzius-sparing and conventional non-Retzius-sparing robotic radical prostatectomy (RS-RARP and NRS-RARP) in the patients with a prior history of transurethral resection and enucleation of prostate (Post TURP/HOLEP).</p><p><strong>Methods: </strong>A total of 47 patients who had at least completed one year of follow-up after robotic radical prostatectomy and had a prior TURP/HOLEP were included in this retrospective analysis. The clinico-demographic data, perioperative parameters such as mean operating time, blood loss, mean hospital stay, complications as per Clavien-Dindo grading, and readmission were evaluated. Continence, potency, and biochemical recurrence were assessed to check the functional and oncological outcomes.</p><p><strong>Results: </strong>There was no significant difference in mean age, body mass index (BMI), co-morbidities, D-Amico risk stratification, preoperative PSA level and positive cores in TRUS-guided biopsy. The console time and blood loss were significantly less in the RS-RARP group (91.6 ± 24.2 vs. 128.9 ± 38.7 min vs. 110.3 ± 57.5 vs. 152.9 ± 64.9 ml, p = 0.0002 and p = 0.02, respectively). The complication rate, mean postoperative catheter duration, lymph nodes, readmission rates, final histopathology, and invasion status were similar in both groups. Continence achieved at 1,3,6,9 and 12-month follow-up was significantly more in the RS-RARP group (90% vs. 64.7% at 12-month; p = 0.01). The potency rates in nerve-sparing cases at 6-month and 1-year follow-ups were similar. Margin positivity rates and Biochemical recurrence were comparable and statistically insignificant in both groups.</p><p><strong>Conclusion: </strong>Retzius-sparing RARP had less console time, less intraoperative blood loss and better continence recovery in both immediate and at 12-month follow-up. The potency, biochemical recurrence and margin status in both approaches were similar.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A meta-analysis examining the impact of prostaglandins on diabetic nephropathy.","authors":"Xiafei Guo","doi":"10.1007/s11255-025-04424-2","DOIUrl":"https://doi.org/10.1007/s11255-025-04424-2","url":null,"abstract":"<p><strong>Background: </strong>In 2021, approximately 537 million adults globally had diabetes, with projections estimating an increase to 643 million by 2030 and 783 million by 2045. Uncontrolled diabetes can cause severe complications, including diabetic nephropathy, a prevalent microvascular disease and a primary contributor to end-stage renal failure, with an increasing mortality rate.</p><p><strong>Methods: </strong>Conduct a search for randomized controlled trials (RCTs) on the use of prostaglandins in treating diabetic nephropathy across PubMed, Cochrane Library, Web of Science, CNKI, and Wanfang databases. Two researchers will independently screen the retrieved literature, assess the methodological quality using the bias risk assessment tool from the Cochrane 5.1 manual, and conduct statistical data analysis.</p><p><strong>Results: </strong>A total of 1019 patients were included in 11 studies. The meta-analysis results show the effective rate of the test group, which was significantly higher (P < 0.01, OR 1.32; 95% CI 1.13-1.55) than the control group.24-h urinary protein quantification of the test group was lower (P < 0.01, SMD  - 2.12; 95% CI  - 3.26 to  - 0.99). The test group exhibited significantly lower levels of blood creatinine (P < 0.01, SMD  - 0.99; 95% CI  - 1.42 to  - 0.57) and blood urea nitrogen (P < 0.01, SMD  - 0.93; 95% CI  - 1.34 to  - 0.51).</p><p><strong>Conclusion: </strong>The findings suggest that prostaglandins enhance the effective rate and improve 24-h urinary protein quantification, blood creatinine, and blood urea nitrogen levels in diabetic nephropathy patients.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An updated systematic review and meta-analysis on the efficacy of supine versus prone position for pediatric PCNL.","authors":"Honggang Fang, Fuming Zhu, Kongkong Cui, Xing Liu, Shengde Wu, Yi Hua, Tao Lin, Dawei He, Guanghui Wei, Deying Zhang","doi":"10.1007/s11255-025-04428-y","DOIUrl":"https://doi.org/10.1007/s11255-025-04428-y","url":null,"abstract":"<p><strong>Background: </strong>The incidence of pediatric kidney stones is increasing with recurrence rates ranging from 35 to 50%. Supine percutaneous nephrolithotomy (PCNL) presents a viable alternative to the conventional prone position, offering specific benefits but also posing certain risks.</p><p><strong>Objective: </strong>To update a previously published systematic review and meta-analysis comparing the efficacy of PCNL in the supine versus prone positions in children.</p><p><strong>Methods: </strong>A systematic search of Web of Science, Cochrane Library, PubMed, and Embase was conducted to identify eligible studies. Two authors independently screened the literature and extracted data. The meta-analysis was performed using StataMP 17. The study was prospectively registered in PROSPERO (ID: CRD42024545145). The sensitivity and subgroup analyses explored sources of heterogeneity, and publication bias was assessed with a funnel plot. The study adhered to PRISMA guidelines and the Cochrane Handbook.</p><p><strong>Results: </strong>This study included a total of nine studies, comprising five randomized controlled trials and four case-control studies, with 614 patients in total. Compared with the prone position group, the supine position group demonstrated significant advantages in terms of operative time (WMD = - 15.43, 95% CI: - 22.18 to - 8.69, P = 0.0001), hospital stay (WMD = - 0.77, 95% CI: - 1.12 to - 0.42, P = 0.0001), overall complication rate (OR = 0.46, 95% CI: 0.42-0.99, P = 0.046), and hemoglobin decrease (WMD = - 0.22, 95% CI: - 0.40 to - 0.05, P = 0.013). However, no significant differences were observed between the two groups in stone clearance rate, high-grade complication rate, or radiation exposure time. Subgroup analysis revealed that in studies published after 2024, cases of small stones (< 2 cm), and older children (> 9 years), the supine position group had fewer low-grade complications. Additionally, in the supine PCNL group with ultrasound or endoscopy-assisted puncture, radiation exposure time was significantly reduced.</p><p><strong>Conclusion: </strong>This study shows that supine position PCNL in children is superior to the prone position in terms of operative time, hospital stay, complication rate, and hemoglobin decrease, with no significant difference in stone clearance, high-grade complications, or radiation exposure. The subgroup analysis found that supine position resulted in fewer low-grade complications in studies published after 2024, small stones, and older children. It also significantly reduced radiation exposure with ultrasound or endoscopy-assisted puncture, suggesting that supine position is a safer and more effective option.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}