Urologia Internationalis最新文献

{"title":"Obstructive Urosepsis: Is It Possible to Personalize the Ureteral Endoscopic Treatment?","authors":"Ernesto Reggio, Glauco Adrieno Westphal, Natalia Silva Zahdi, José de Bessa, Cristiano Mendes Gomes, Eduardo Mazzucchi, William Carlos Nahas","doi":"10.1159/000539890","DOIUrl":"10.1159/000539890","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary tract infection involves mortality rate when combined with ureteral obstruction. Lithotripsy has been contraindicated; however, it has been shown to be safe in selected situations. No specific criteria have been widely accepted to indicate which patients are suitable for definitive treatment. The objective of this study was to identify prognostic factors associated with poor outcome but also those patients whose definitive treatment can be performed.</p><p><strong>Methods: </strong>Observational cohort study from a prospectively maintained database of septic patients defined by the Sequential Organ Failure Assessment (SOFA). Univariate analysis was used to compare prognostic factors with Δ-SOFA score <2 (group 1) and those with a Δ-SOFA ≥2 (group 2) obtained on day 3 and on admission. Different combinations of neutrophils, lymphocytes and platelets were tested as prognostic factors. Time to decompression calculated from the CT scan report to the end of surgery.</p><p><strong>Results: </strong>A total of 229 patients were enrolled during 11 years. Two patients died. Time from CT scan to urinary tract decompression was higher in the Δ-SOFA≥2 (p = 0.04). Thrombocytopenia and the platelet-to-lymphocyte ratio were associated with Δ-SOFA≥2. Stones were disintegrated in 33.48% in group 1 and 48.84% in group 2. Platelet count and time to decompression were associated with a worse prognosis (p = 0.0008 and 0.0017). On receiver operator curve analysis, platelets count <105,056 and time to decompression >4.72 hours were linked to poorer outcomes.</p><p><strong>Conclusions: </strong>Personalized treatment, based on accessible biomarkers, can be achieved in most patients. Early surgical decompression was associated with better prognosis and definitive treatment can be performed in selected patients.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"487-492"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421133","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":"Bladder Stones in Renal Transplant Patients: Presentation, Management, and Follow-up.","authors":"Maxwell Sandberg, Adam Cohen, Megan Escott, Davis Temple, Claudia Marie-Costa, Rainer Rodriguez, Alex Gordon, Anita Rong, Brian Andres-Robusto, Emily H Roebuck, Wyatt Whitman, Christopher J Webb, Robert J Stratta, Dean Assimos, Kyle Wood, Maajid Mirzazadeh","doi":"10.1159/000539091","DOIUrl":"10.1159/000539091","url":null,"abstract":"<p><strong>Introduction: </strong>The study aim was to analyze the presentation, management, and follow-up of renal transplant patients developing bladder calculi.</p><p><strong>Methods: </strong>Patients who underwent renal transplant with postoperative follow-up at our institution were retrospectively analyzed (1984-2023) to assess for the development of posttransplant bladder stones. All bladder stones were identified by computerized tomography imaging and stone size was measured using this imaging modality.</p><p><strong>Results: </strong>The prevalence of bladder calculi post-renal transplantation during the study window was 0.22% (N = 20/8,835) with a median time to bladder stone diagnosis of 13 years posttransplant. Of all bladder stone patients, 6 (30%) received deceased donor and 14 (70%) living donor transplants. There were 11 patients with known bladder stone composition available; the most common being calcium oxalate (N = 6). Eleven (55%) patients had clinical signs or symptoms (most commonly microhematuria). Fourteen of the bladder stone cohort patients (70%) underwent treatment including cystolitholapaxy in 12 subjects. Of these 14 patients, 9 (64%) were found to have nonabsorbable suture used for their ureteroneocystostomy closure.</p><p><strong>Conclusions: </strong>The prevalence of bladder stones post-renal transplant is low. The utilization of nonabsorbable suture for ureteral implantation was the main risk factor identified in our series. This technique is no longer used at our institution. Other factors contributing to bladder stone formation in this population warrant identification.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"399-405"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Music from Noise-Canceling Headphones Is Beneficial against Anxiety in Male Bladder Cancer Patients Undergoing Follow-Up Cystoscopy: A Prospective Randomized Trial.","authors":"Hyun-Jin Cho, Ho Seok Chung, Eu Chang Hwang, Seung Il Jung, Dongdeuk Kwon, Kwangsung Park, Darshan P Patel, Tung-Chin Hsieh","doi":"10.1159/000539312","DOIUrl":"10.1159/000539312","url":null,"abstract":"<p><strong>Introduction: </strong>Bladder cancer, with a greater incidence in males than in females, requires frequent cystoscopies. We aimed to evaluate the effect of music played through noise-canceling headphones on male bladder cancer patients during follow-up cystoscopy.</p><p><strong>Methods: </strong>A total of 160 male bladder cancer patients undergoing follow-up flexible cystoscopy were randomly divided into the noise-canceling headphones without music group and the noise-canceling headphones with music group (groups 1 and 2, respectively; n = 80 per group). The patients' clinical characteristics were examined, and objective and subjective measurements were compared before and after cystoscopy. The primary outcomes that were evaluated included the visual analog scale (VAS, 0-10) and the state-trait anxiety inventory (STAI, 20-80). Other outcomes, including vital signs and scores for assessing satisfaction and the willingness to repeat the procedure, were also examined.</p><p><strong>Results: </strong>The characteristics of the patients in groups 1 and 2, and their pre-cystoscopy status, did not differ significantly. Although post-cystoscopy vital signs for the objective parameters and VAS pain scores were similar between the groups, subjective parameters were not. When compared with group 1, post-cystoscopy STAI-state scores were significantly lower in group 2, whereas patients' satisfaction scores and the willingness to repeat the procedure were significantly higher in group 2 (p = 0.002, 0.001, and 0.001, respectively). Additionally, in group 2, STAI-state scores changed significantly after the procedure when compared with before the procedure (p = 0.002).</p><p><strong>Conclusion: </strong>Providing music to male bladder cancer patients through noise-canceling headphones was found to reduce anxiety during cystoscopy and to improve patient satisfaction and willingness to undergo repeat cystoscopy.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"414-420"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Prostate Cancer Positive Cores and 68Ga-PSMA Distribution in Prostate Gland.","authors":"Süleyman Çankaya, Ahmet Ender Caylan, Funda Aydin, Murat Uçar, Ömer Kutlu","doi":"10.1159/000535466","DOIUrl":"10.1159/000535466","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of our study was to evaluate reliability of 68Ga-labeled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) and identify appropriate SUVmax cutoff values in order to use for diagnosis, especially in patients remained clinically suspicious for prostate cancer (PCa).</p><p><strong>Methods: </strong>Eighty-four patients applied 68Ga-PSMA PET/CT subsequent to transrectal ultrasound-guided prostate biopsy (TRUS-bx) involved in this study retrospectively. 68Ga-PSMA PET/CT imagings were analyzed by a nuclear medicine physician, and region of interests were drawn manually in prostate diagrams including 6 segments for each patient. These marked diagrams were analyzed with histopathology reports TRUS-bx. 504 segments were grouped with Gleason scoring system, and all groups were compared with mean SUVmax values.</p><p><strong>Results: </strong>Mean SUVmax value of Gleason grade group 1 (GG1, n: 352 segments) was 6.6 (±4.6) and significantly lower than the other groups (p &lt; 0.001). No significant difference was detected within GG2-5 groups (p &gt; 0.05). According to receiver operating characteristic curve analysis, SUVmax cutoff values were 1.0 (AUC: 0.961) for tumor detection, yielding a sensitivity, specificity, positive predictive value, negative predictive value of 99.4%, 92.1%, 96.5%, 98%, respectively, and 4.2 (AUC: 0.853) for detection of clinically significant PCa with 88.8%, 62.4%, 84.5%, and 71%, respectively. Although tumor percentage of biopsy core and Gleason group were correlated with SUVmax uptake, but patient age was not.</p><p><strong>Conclusion: </strong>68Ga-PSMA PET appears to be a reliable option for diagnosis and disease management in PCa and can be considered especially in discrimination of csPCa, and patients remained suspicious for disease.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"65-72"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452583","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":"Comparison of Monotherapies and Combination Therapy of Tamsulosin and Tadalafil for Treating Lower Urinary Tract Symptoms Caused by Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Meta-Analysis.","authors":"Jianping Liu, Weijian Zhou, Peng Zhang, Wei Zhang, Congwang Chang, Guanghua Fu","doi":"10.1159/000535606","DOIUrl":"10.1159/000535606","url":null,"abstract":"<p><strong>Background: </strong>There is limited research into the efficacy and safety of tadalafil combined with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), with or without erectile dysfunction (ED). Therefore, we aimed to investigate the efficacy and safety of combination therapy compared to that of monotherapy.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, WanFang Data Service Platform, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> to identify eligible studies. A total of 639 articles were retrieved, of which 12 were randomized controlled trials (RCTs) published as of February 2023 and included in this meta-analysis.</p><p><strong>Results: </strong>After screening 639 articles, 12 RCTs including 1,531 subjects were considered eligible for the meta-analysis. The results showed that the total International Prostate System Score (total IPSS), maximum flow rate (Qmax), and quality of life (QoL) in tadalafil combined with tamsulosin were significantly better than those in monotherapy. Compared with tadalafil monotherapy, combination therapy mainly improved IPSS voiding. As for postvoid residual urine (PVR), the combination therapy did not improve PVR compared to the tadalafil group, but significantly improved PVR compared to the tamsulosin group. For the International Index of Erectile Function (IIEF), the curative effect of the combined group was better than that of the tamsulosin group but not better than that of the tadalafil group. In terms of safety, the adverse reactions (AEs) in the combined treatment group were significantly higher than those in the monotherapy group. None of the 12 RCTs reported serious adverse events.</p><p><strong>Conclusions: </strong>Tadalafil combined with tamsulosin was more effective in the treatment of male LUTS/BPH, with or without ED, on the improvement of total IPSS, QoL, and Qmax. However, the benefits of combination therapy for ED remain unclear. However, combination therapy seemed to have a higher incidence of adverse reactions.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"89-99"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809320","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":"Staghorn Caliceal Hem-o-lok Stone: A Long-Term Complication of Robotic Partial Nephrectomy - A Case Report and Literature Review.","authors":"Francesco Dibitetto, Pierluigi Russo, Filippo Marino, Mauro Ragonese, Domenico Nigro, Nazario Foschi","doi":"10.1159/000536090","DOIUrl":"10.1159/000536090","url":null,"abstract":"<p><strong>Introduction: </strong>Hem-o-lok clips (HOLCs) are a useful tool in mini-invasive surgery, especially for renal surgery. However, in rare cases, they could migrate into the collecting system and be calculogenic.</p><p><strong>Case presentation: </strong>We present a case of a 53 years old man with an incidental CT finding of a left staghorn caliceal stone increasing its size in the last 2 years. He had a medical history of ipsilateral robotic partial nephrectomy (RAPN) at another institution 8 years before and a previous renal colic with spontaneous stone elimination about 20 years before. The stone was located in the upper calyx. He underwent a flexible ureteroscopy. After an initial fragmentation, a Hem-o-lok was reported, partially wedged into the renal parenchyma. After removing the HOLC with a basket, a small urinary leak was observed and managed with a JJ stent placement. In the postoperative period, the patient had a fever managed with antibiotics and was discharged on the 4th postoperative day without problems.</p><p><strong>Conclusion: </strong>HOLC migration into the collecting system is a rare complication following robotic and laparoscopic renal surgery. HOLC could act as a nidus for stone formation. Avoiding too much tension during renal sutures using HOLC could reduce the possibility of migration. Simple knotting in particular conditions is a valuable option. However, this kind of stone can be managed endoscopically without complaints, minding the possibility that HOLC could be partially wedged into renal parenchyma leading to a urinary leak. With the widening indications for RAPN, this kind of complication could be more frequent.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"570-573"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404548","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":"Evaluation of the Management of Urachal Carcinoma: A Single-Center Experience over 13 Years.","authors":"Hengxin Chen, Menghai Wu, Minfeng Chen","doi":"10.1159/000539760","DOIUrl":"10.1159/000539760","url":null,"abstract":"<p><strong>Introduction: </strong>Urachal carcinoma is characterized by high malignancy, poor prognosis, and late stage of diagnosis. There is a lack of unanimous clinical treatment guidelines. We summarize the characteristics, treatment, and outcomes of urachal carcinoma from our center, hoping to provide a reference for diagnosis and treatment.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 21 patients with urachal carcinoma who were treated at our center from January 2010 to August 2022, and all patients were followed up.</p><p><strong>Results: </strong>The average survival time was 67.1 ± 9.1 (ranging from 49.3 to 84.9) months. The average relapse-free survival was 48.8 ± 9.9 (ranging from 29.5 to 68.2) months. Six patients received adjuvant therapy, mainly chemotherapy. Five patients died during follow-up.</p><p><strong>Conclusions: </strong>Early physical examination may be helpful for early detection of urachal carcinoma. Surgical treatment is still preferred for localized urachal carcinoma. Lymph node dissection may facilitate accurate staging, and positive margin usually results in a worse prognosis. Adjuvant therapy, mainly chemotherapy, may help improve the prognosis. The application of radiotherapy, targeted therapy, and immunotherapy still needs further exploration.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"508-516"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535418","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":"How Might the Number of Lymph Nodes Removed during RARP Impact the Postoperative Outcomes?","authors":"Mahmoud Farzat, Florian M Wagenlehner","doi":"10.1159/000536317","DOIUrl":"10.1159/000536317","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic lymphocele remains a relevant complication after pelvic tumor surgery. This study aims to investigate how the number of lymph nodes removed may influence postoperative outcomes and if it increases the probability of detecting lymph node metastasis.</p><p><strong>Methods: </strong>The study included 500 patients who underwent RARP including lymphadenectomy performed by a single surgeon. Patients were divided into two groups: group 1 consisted of 308 patients with 20 or fewer lymph nodes removed (mean 15), while group 2 had 192 patients with over 20 nodes removed (mean 27). Perioperative data were analyzed, and postoperative outcomes were compared between groups.</p><p><strong>Results: </strong>Overall, lymph node metastasis was detected in 17.8% of men. In detail, out of 19.6 lymph nodes removed, an average of 3.14 lymph nodes per patient showed metastasis, with a slightly higher incidence of 19.7% in group 2 compared to 16.5% in group 1, though not statistically significant (p = 0.175). The number of lymph node metastases was significantly higher in group 2 patients (3.47) versus group 1 (2.37) (p = 0.048). All complications except symptomatic lymphoceles (p = 0.004) were not significantly different between groups. Univariate linear regression analysis revealed no correlation between the number of removed lymph nodes and symptomatic lymphocele. However, it did correlate with catheter days and readmissions.</p><p><strong>Conclusion: </strong>A correlation may exist between the number of lymph nodes removed during RARP and an increased incidence of complications, particularly symptomatic lymphocele. A more extensive PLND may result in prolonged catheter days and increased readmissions. With the increased extent of pelvic lymphadenectomy, the probability of detecting lymphogenic metastasis rises. The diagnostic value of PLND is well established. Further randomized trials are needed to weigh its necessity and extent.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"175-182"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Evidence of Tumor and Patient Characteristics and Survival with Avelumab Maintenance after Chemotherapy for Advanced and Metastatic Urothelial Carcinoma.","authors":"Séverine Banek, Mike Wenzel, Benedikt Lauer, Quynh Chi Le, Benedikt Hoeh, Florestan Koll, Cristina Cano Garcia, Clara Humke, Jens Köllermann, Felix K H Chun, Marina Kosiba, Luis A Kluth","doi":"10.1159/000538237","DOIUrl":"10.1159/000538237","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the prospective randomized controlled JAVELIN Bladder 100 trial, no real-world evidence exists regarding tumor characteristics, adverse events (AEs), and survival of avelumab maintenance (AVM)-treated patients with partial/complete response or stable disease after previous platinum-based chemotherapy for advanced/metastatic urothelial carcinoma (mUC).</p><p><strong>Methods: </strong>We relied on our institutional database to identify mUC patients who received AVM between January, 2021 and December, 2023. The main outcomes consisted of overall survival (OS) and progression-free survival (PFS) and were computed by Kaplan-Meier estimates. Stratification was performed according to programmed death ligand 1 (PD-L1) status.</p><p><strong>Results: </strong>Overall, 24 AVM patients were identified at a median age of 71 (interquartile range [IQR]: 67-76) years, of which 67% were males. Of these, 63%, 21%, and 17% received AVM therapy for bladder cancer and upper tract urothelial carcinoma or both, respectively. PD-L1 status was positive in 45% of patients. During AVM treatment, AEs were observed in 33% of patients; however, they were limited to ≤2 grade AEs. At a median follow-up of eight (IQR 4-20) months, 71% of patients had progressed under AVM with median PFS of 6.2 months (confidence interval [CI]: 3.2-18.2). Median OS was 13.4 (CI: 6.9 - not reached [NR]) months. One-year OS after AVM was 52%. In PD-L1-positive patients, median PFS and OS were 6.4 (CI: 2.7 - NR) months and 13.4 (CI: 7.7 months - NR), respectively.</p><p><strong>Conclusion: </strong>AVM is associated with moderate AE rates. Despite similarities in baseline characteristics compared to trial-selected JAVELIN Bladder 100 mUC patients, AVM resulted in longer/similar PFS but significantly shorter OS in real-world setting.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"285-291"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Chemotherapy after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma with Variant Histology: A Systematic Review and Meta-Analysis of Survival Outcomes.","authors":"Jinhyung Jeon, Jae Heon Kim, Jee Soo Ha, Won Jae Yang, Kang Su Cho, Do Kyung Kim","doi":"10.1159/000538545","DOIUrl":"10.1159/000538545","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to determine effects of adjuvant chemotherapy (AC) on survival outcomes compared to surgery alone without AC for upper tract urothelial carcinoma (UTUC) patients with variant histology (VH).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies investigating AC for UTUC in Medline, Embase, the Cochrane Library up to January 2023. Population, intervention, comparator, and outcome were UTUC patients with VH, radical nephroureterectomy with AC, radical nephroureterectomy only, and oncological survival, respectively.</p><p><strong>Results: </strong>Four retrospective studies were included. Regarding overall survival (OS), the pooled hazard ratio was 0.61 (95% confidence interval: 0.42-0.87; p = 0.007) across two studies. Regarding cancer-specific survival (CSS), the pooled hazard ratio was 0.46 (95% confidence interval: 0.25-0.84; p = 0.01) across three studies. All included studies had a high quality based on the Newcastle-Ottawa Scale. Certainty of evidence for OS was low. Certainty of evidence for CSS was moderate due to a strong association (hazard ratio &lt;0.5). Publication bias was not significant for any studies.</p><p><strong>Conclusion: </strong>In UTUC patients with VH, administration of AC after surgery might have better survival outcomes than surgery alone. Our study provides evidence for decision-making of clinicians who treat UTUC patients with VH.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"339-348"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294709","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}