Urology最新文献

{"title":"The Statistical Fragility of Randomized Controlled Trials in Kidney Stone Management: An Analysis of AUA and EAU Guidelines.","authors":"Esther Kim, Daniel Wang, Nathan Nguyen, Micah Levy, Christopher Connors, Juan Arroyave Villada, Modassar Awan, Osama Zaytoun, Herik Acosta-Gonzalez, Michael A Palese","doi":"10.1016/j.urology.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.039","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the statistical fragility of randomized controlled trials (RCTs) outcomes cited by the American Urological Association (AUA) and European Association of Urology (EAU) nephrolithiasis management guidelines using the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ).</p><p><strong>Methods: </strong>Two-armed RCTs with at least one dichotomous outcome cited by the AUA and EAU were identified. FI was calculated using a 2x2 contingency table, adjusting events until statistical significance was lost (p≥0.05). rFI was determined by modifying nonsignificant outcomes until significance was achieved (p<0.05). FQ was calculated by dividing FI by sample size.</p><p><strong>Results: </strong>A total of 1210 outcomes from 138 RCTs were analyzed. The median FI for AUA-cited studies was 4 (IQR 3-6) with an FQ of 0.05 (0.03-0.09), while for EAU-cited studies, median FI was 5 (3-7) with an FQ of 0.04 (0.02-0.06). Over 62% of outcomes required fewer than five event reversals to alter significance. No significant difference in FI (p=0.375) or FQ (p=0.080) was found between AUA and EAU studies. With respect to median publication year, FI significantly increased in EAU studies published after 2015 (p=0.001), and FQ in AUA studies was significantly higher after 2006 (p=0.004). In 11.8% of AUA and 14.2% of EAU outcomes, loss to follow-up exceeded the FI.</p><p><strong>Conclusion: </strong>RCTs cited in AUA and EAU nephrolithiasis guidelines demonstrate statistical fragility. The findings underscore the limitations of p-values as a sole measure of evidence strength. Future research should incorporate FI, rFI, and FQ to enhance clinical decision-making.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on \"Association between Kidney Stones and Subsequent Risk of Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis\".","authors":"Hongnan Shen, Yirui Chen, Jinguo Cheng","doi":"10.1016/j.urology.2025.05.041","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.041","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond citations: exploring gender and racial gaps in urology publications through citation and Altmetric analysis.","authors":"Betty Wang, Devika Nandwana, Emma Helstrom, Laura E Davis, Kirtishri Mishra, Rebecca Campbell, Salvador Jaime-Casas, Mohit Sindhani, Andres Correa, Adam Calaway, Christopher Weight, Laura Bukavina","doi":"10.1016/j.urology.2025.05.042","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.042","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the effects of author gender and race on citation metrics, including Altmetric Attention Scores (AAS), in urology publications.</p><p><strong>Methods: </strong>We analyzed 91,100 urology publications published between 2009 and 2023, retrieved from the Altmetric database via Drexel University. Author gender was identified using GenderGuesser, and race was estimated using a published name-based algorithm. Publications were grouped by the gender of the first and last authors (e.g., MF: male first, female last). We compared AAS and calculated the Mean Citation Difference (MCD) to measure citation disparities against gender- and race-neutral models.</p><p><strong>Results: </strong>Publications with male first and last authors (MM) comprised 44%, while female-female (FF) authorship accounted for only 6% of all publications. FF-authored studies were the most under-cited (MCD: -1.9), whereas FM-authored studies were the most over-cited (+2.53). Although female-authored papers had higher AAS scores, they remained under-cited across most urologic subspecialties. Racial disparities in citation metrics were less pronounced than those related to gender, and AAS differences between racial groups were not statistically significant.</p><p><strong>Conclusions: </strong>Publications authored by female first and last authors continue to be under-cited despite receiving higher AAS scores, and funding. In contrast, racial citation disparities appear to be minimal. These findings highlight the need to address gender-based inequities in academic recognition, as doing so may foster a more inclusive academic environment and ultimately improve access to equitable patient care.</p><p><strong>Patient summary: </strong>This study examined how often urology research papers are cited based on the gender and race of the authors. We found that studies led by women are cited less frequently than those led by men, despite receiving more online attention and funding. These findings underscore the need for fairer recognition of all researchers, as greater equity in academic publishing may help promote more inclusive and accessible patient care.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter to the Editor on \"Minimal Approach to Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia: Is Less More?\"","authors":"Vi Nguyen, Clara Cerrato, Mimi V Nguyen, Michelle C Leach, Jamie L Finegan, Kevin C Zorn, Dean Elterman, Naeem Bhojani, Bilal Chughtai, Seth K Bechis","doi":"10.1016/j.urology.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.038","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal Onlay Labial Mucosal Graft Urethroplasty in Female Urethral Stricture: Outcomes of Over 200 Cases from a Single Surgeon.","authors":"Ajit Kumar Jena, Rahul Jena, Manupirya Madhavan, Kumar Madhavan","doi":"10.1016/j.urology.2025.05.040","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.040","url":null,"abstract":"<p><strong>Ovjectives: </strong>To evaluate the outcomes of dorsal onlay labial mucosal graft urethroplasty in female urethral stricture (FUS), a condition that remains challenging and frequently underdiagnosed due to nonspecific symptoms and diagnostic limitations.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database was conducted, including 204 patients who underwent dorsal onlay labial mucosal graft urethroplasty for FUS between June 2013 and July 2024. Patients were included if they had symptomatic FUS confirmed by uroflowmetry, micturating cystourethrogram (MCU), or urethral calibration. Outcomes assessed included clinical success rates, recurrence, complications, and subjective improvement based on the Global Impression of Improvement (GII).</p><p><strong>Results: </strong>The mean operative time was 97.7 ± 13 minutes, with a median hospital stay of 2 days (range: 2-11). Perioperative complications were minimal, with six cases (2.94%) of Clavien-Dindo grade 2-3 complications and no significant donor-site morbidity. At a median follow-up of 29 months (range: 7-231), clinical success rates were 98.5%, 97.5%, and 93.5% at 1-3 months, 6 months, and 2 years, respectively. Recurrence was observed in 6.5% of patients at 2 years, with 4 requiring repeat urethroplasty. Symptom improvement was reported by 95% of patients at 1-3 months and 88.1% at 2 years.</p><p><strong>Conclusions: </strong>Dorsal onlay labial mucosal graft urethroplasty is a safe and effective treatment for FUS, with high success rates, minimal complications, and durable outcomes. This study, the largest single-surgeon series, highlights the utility of this approach as a reliable option for managing this underdiagnosed condition.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and Age Variation for Nephrolithiasis Risk Factors on 24-Hour Urine Metabolic Evaluation: A Real-World Single-center Retrospective Analysis.","authors":"Mark I Sultan, Muhammed A M Hammad, Ramy F Youssef","doi":"10.1016/j.urology.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.009","url":null,"abstract":"<p><strong>Objectives: </strong>To determine how age and sex relate to metabolic abnormalities in stone-forming patients, while quantifying risk variation across groups, given the influence of demographic factors on 24-hour urine analytes.</p><p><strong>Methods: </strong>All 24-hour urine collections for nephrolithiasis evaluated at our institution between 2004-2020 were retrospectively reviewed. Only the first, pre-treatment Litholink™ urine collection per patient was included. Patients were stratified by sex and age (<50, 50-65, >65 years), and analytes were evaluated using multivariable linear regression with sex, age, and BMI as predictors. Abnormal thresholds were based on LabCorp® sex-specific ranges. High urine pH (>6.8), urea nitrogen (UUN24), and sulfate (Sul24) were included in secondary analyses.</p><p><strong>Results: </strong>Of 4216 initial collections, 2131 met inclusion criteria after exclusions based on cystinuria, duplicate or follow-up studies, and Cr24/kg-based under- or over-collection. The cohort was 50.0% female, 50.0% male; mean (SD) age was 56.5 (15) years and BMI 26.8 (5.6) kg/m². Males showed higher 24-hour oxalate, sodium, uric acid, urea nitrogen, and sulfate. Females exhibited higher calcium and higher urine pH. Younger patients had higher calcium phosphate supersaturation and urine calcium, while older patients had more acidic urine.</p><p><strong>Conclusions: </strong>Sex and age are independently associated with urine analyte values and stone risk. Male and younger patients are more likely to exhibit diet-driven abnormalities, whereas females and older patients present with risks linked to intrinsic physiology. These findings enhance the understanding of patient-specific stone risk and support tailored approaches to evaluation and prevention.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor on \"Effect of Age on Robotic-Assisted Radical Prostatectomy Outcomes: A Multicenter Analysis\".","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1016/j.urology.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.037","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of sperm DNA fragmentation on clinical pregnancy and miscarriage following intrauterine insemination: updated systematic review and meta-analysis.","authors":"Xinyan Liu, Li Zhao, Yayun Lin, Yi Liu","doi":"10.1016/j.urology.2025.05.036","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.036","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of sperm DNA fragmentation (SDF) on clinical pregnancy and miscarriage after intrauterine insemination (IUI).</p><p><strong>Methods: </strong>A systematic search of the PubMed, Embase, Web of Science and Cochrane Library was performed to identify all relevant studies published up to July 2024. The outcomes of interest were clinical pregnancy rate (CPR) and miscarriage rate (MR). Relative risk (RR) and 95% confidence intervals (CI) were calculated to analyze the effect of SDF on the CPR and MR after IUI.</p><p><strong>Results: </strong>A total of 7 studies (4018 cycles) were included in the analysis of CPR. Among these, 3 studies (361 cycles) that mentioned MR were included in the analysis of MR. The meta-analysis revealed that high SDF didn't significantly affect the CPR (RR=0.82, 95% CI:0.52-1.29, P=0.38). The MR in the high SDF group was numerically higher than that in the low SDF group, but the trend was not statistically significant (RR=2.11, 95%CI:0.93-4.8, P=0.07). Furthermore, five studies that used the sperm chromatin structure assay to measure SDF were included in the meta-analysis. The pooled analysis still suggested no statistically significant difference in CPR between the high SDF group and the low SDF group (RR=0.76, 95%CI:0.43-1.31, P=0.32).</p><p><strong>Conclusion: </strong>The pooled analysis suggested that high SDF didn't decrease the CPR after IUI. The MR tended to be higher in the high SDF group compared to the low SDF group, but the trend was not statistically significant. Given the limited number of included studies, the findings should be interpreted with caution.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Editorial Comment on Trilogy™ vs. Ho:YAG Laser in Mini-PCNL: Focus on Suction Mechanism.","authors":"Manzo Braulio O, Sanchez Hector M","doi":"10.1016/j.urology.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.032","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHARACTERIZATION OF FEMALE UROLOGISTS' PREGNANCY, PERINATAL AND BREASTFEEDING OUTCOMES.","authors":"Katelyn A Spencer, Tessa London-Bounds, Will Cranford, Yana B Feygin, Brittany E Levy, Nikita Gupta, Alexandra E Kejner, Haley Copeland, Christopher McLouth, Amanda F Buchanan","doi":"10.1016/j.urology.2025.05.035","DOIUrl":"https://doi.org/10.1016/j.urology.2025.05.035","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate pregnancy outcomes and breastfeeding (BF) practices for female surgeons and identify modifiable factors improve outcomes.</p><p><strong>Methods: </strong>A survey was distributed to practicing surgeons including general surgery, urology, otolaryngology, orthopedics, general surgery, plastic surgery, vascular surgery, and other surgical specialties. Survey questions regarding demographics, career stage, maternity leave, pregnancy/delivery, perinatal complications, BF goals, and barriers to meeting those goals were asked. Responses were analyzed and then stratified based on meeting a personal breastfeeding goal or not and by those who felt they missed out on career opportunities due to pregnancy.</p><p><strong>Results: </strong>Information on 1,227 births by female surgeons with 13.3% urologists were reported. The median maternal age at delivery was 34y (IQR: 32-37y). Only 59.5% of respondents reported meeting their personal breastfeeding goal and this was significantly different based on specialty (p=0.021). Lactation spaces at work were only available for 56.6% of respondents, and access to one was significantly associated with meeting a breastfeeding goal and feeling as if BF did not negatively impact their career (p<0.001). A quarter of female surgeons (24.9%) felt BF contributed to missed career opportunities and this was significantly associated with levels of support from colleagues and administration (p<0.001).</p><p><strong>Conclusions: </strong>Female surgeons still have external (i.e. lack of lactation spaces, etc.) and internal (i.e. perception of lack of support from colleagues, etc.) barriers to achieving their BF goals. Further research to identify specific modifiable factors to improve outcomes for all child-bearing surgeons, and targeted interventions regarding maternity leave and flexible scheduling to allow direct BF to infants should be encouraged to support surgeon mothers.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}