Urology最新文献

{"title":"Reply to Editorial Comment on \"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.2025.06.048","DOIUrl":"10.1016/j.urology.2025.06.048","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512560","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 Editorial Comment on \"A Comparison of Preoperative Frailty Indices Correlation With Perioperative Risk for Patients Undergoing Sacrocolpopexy\".","authors":"Rachel C Bernardo, Maria J D'Amico, Rishabh K Simhal, Kerith R Wang, Courtney E Capella, Yash B Shah, Joon Yau Leong, Patrick J Shenot, Whitney R Smith, Alana M Murphy","doi":"10.1016/j.urology.2025.06.049","DOIUrl":"10.1016/j.urology.2025.06.049","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512562","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":"Association of Elevated Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and De Ritis Ratios With Major Complications After Surgery for Renal Cell Carcinoma: A Pathway to Optimize Charlson Comorbidity Index and Preoperative Predictive Modeling.","authors":"Giacomo Musso, Natalie Birouty, Andrea Salonia, Giuseppe Garofano, Mai Dabbas, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Cesare Saitta, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Umberto Capitanio, Alessandro Larcher, Giuseppe Rosiello, Yasuhisa Fujii, Viraj A Master, Ithaar H Derweesh","doi":"10.1016/j.urology.2025.06.052","DOIUrl":"10.1016/j.urology.2025.06.052","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive value of De Ritis ratio (DRR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) for major post-operative complications following Renal Cell Carcinoma (RCC) surgery, and to assess their predictive utility in addition to Charlson Comorbidity Index (CCI).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective analysis of patients who underwent surgery for M0 RCC. Primary outcome was the occurrence of major complication (Clavien-Dindo >2). Optimal thresholds for DRR, NLR, and PLR were identified using Akaike Information Criterion (AIC). Multivariable logistic regression (MVA) assessed associations between biomarkers and complications, adjusting for CCI, estimated glomerular filtration rate (eGFR), tumor size, surgery type, pT/pN stage, R.E.N.A.L. score. Predictive performance was evaluated using the Area under Curves (AUC) from ROC curves. Internal validation was performed with 1000-sample bootstrapping.</p><p><strong>Results: </strong>Among 4122 patients, 198 (4.8%) experienced major complications [urinary leak (n = 90, 35.7% of all major complications), bleeding/hematoma (n = 38, 15.1%), and cardiac events (n = 15, 6.0%)]. AIC identified thresholds of 2.3 for elevated DRR (EDRR), 2.7 for NLR (ENLR), and 200 for PLR (EPLR). 191 (4.6%), 1243 (30.2%), and 684 (16.6%) patients had elevated EDRR, ENL, and EPLR. On MVA, all three biomarkers independently predicted major complications: EDRR [Odds ratio (OR) = 3.06, P = .02], ENLR (OR = 1.25, P = .01), EPLR (OR = 1.30, P = .01). AUCs were 0.63 for CCI alone, 0.77 with additional covariates, and 0.85 for the model with all biomarkers. Bootstrapped AUC for the full model was 0.77.</p><p><strong>Conclusion: </strong>Preoperative DRR, NLR, and PLR improve prediction of major complications after RCC surgery in addition to CCI. Our findings point towards an enhanced model to risk stratify and optimize patient outcomes in RCC surgery.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512558","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":"Post-Circumcision Bleeding in Male Infants Who Do Not Receive Prophylactic IM Vitamin K.","authors":"Anika Tomlinson, Hsi-Yang Wu, Leslie E Wolf, Rebecca Plank","doi":"10.1016/j.urology.2025.06.050","DOIUrl":"10.1016/j.urology.2025.06.050","url":null,"abstract":"<p><strong>Objective: </strong>To review Vitamin K deficiency bleeding as it relates to infant male circumcision and provide insights and recommendations on how to provide the best care for infants who did not receive prophylactic intramuscular (IM) Vitamin K.</p><p><strong>Methods: </strong>This is a clinical perspective that was informed by a targeted literature review to identify current evidence and best practices related to Vitamin K deficiency bleeding as it related to infant male circumcision.</p><p><strong>Results: </strong>When appropriately counseled and with contingency protocols in place, circumcision may be safely performed in select infants without prophylactic IM Vitamin K.</p><p><strong>Conclusion: </strong>This paper offers a reasoned framework for safely performing infant male circumcision when prophylactic IM Vitamin K is declined.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512561","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":"Single-center Experience With Surgical Management of Tumor Thrombus Intravascular Extension in Pediatric Renal Neoplasms: Case Series.","authors":"Adree Khondker, Ihtisham Ahmad, David Dan-Nguyen, Anudari Zorigtbaatar, Leonardo R Brandão, Jack Brzezinski, Mandy Rickard, Rodrigo Romao, Blayne A Sayed, Armando J Lorenzo","doi":"10.1016/j.urology.2025.06.053","DOIUrl":"10.1016/j.urology.2025.06.053","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate surgical strategies and outcomes for children with intravascular extension of pediatric renal tumors by reviewing intraoperative observations and individual surgical challenges.</p><p><strong>Methods: </strong>A retrospective chart review was undertaken on patients undergoing radical nephrectomy at our institution between 2005 and 2023. Patients identified with intravascular (vena cava) extension were included. Demographics, Daum stage from imaging, peri-operative course, surgical details, complications, and survival was collected. Descriptive statistics were calculated.</p><p><strong>Results: </strong>A total of 11 patients were included (10 Wilms tumors, 1 Ewing's Sarcoma). The median age at presentation was 4 years (IQR 3, 5) and the median follow-up was 27 months (IQR 3, 37). In total, 8 patients (73%) underwent thrombectomy with cavotomy and 3 patients (27%) underwent thrombectomy with cavectomy for total occlusion, and 2 patients (18%) required cardiopulmonary bypass. Three patients (27%) had >500 mL intraoperative blood loss. Median length of surgery was 10 hours (IQR 8, 12). Three patients (27%) experienced complications, including hemoperitoneum requiring laparotomy, chylothorax managed conservatively, and post-operative fever requiring antibiotics, respectively. By the last follow-up, the overall survival rate was 100% and event-free survival was 89%.</p><p><strong>Conclusion: </strong>In our study, tumor thrombus extension into the vena cava did not appear to have a negative effect on survival. The surgical approach should be tailored to pre- and intra-operative findings, including resection of a completely occluded cava with development of a collateral network.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512563","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":"Cystectomy and Ileal Conduit for Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review of Outcomes for Different Surgical Approaches.","authors":"Amaury Vigneau, Thomas Batard, Maximilien Delay, Maxime Chabenes, Amélie Bazinet, Thibaud Garnier, Gaelle Fiard, Clement Sarrazin","doi":"10.1016/j.urology.2025.06.041","DOIUrl":"10.1016/j.urology.2025.06.041","url":null,"abstract":"<p><strong>Objective: </strong>To assess the outcomes of cystectomy and ileal conduit for managing neurogenic lower urinary tract dysfunction and compare different surgical approaches (open, laparoscopic, and robotic-assisted).</p><p><strong>Design, setting, and participants: </strong>This systematic review was conducted in accordance with PRISMA guidelines, and the protocol was registered in the PROSPERO database (CRD42024512893). A systematic search of MEDLINE/PubMed, Embase, and CENTRAL identified original articles reporting surgical outcomes of cystectomy and ileal conduit in adult neuro-urological patients. Our primary outcome was 30-day high-grade complications. Secondary outcomes included perioperative parameters, late complications, quality of life, and kidney function.</p><p><strong>Results and limitations: </strong>Ten studies with a high risk of bias were included, comprising 721 patients. Minimally invasive approaches had longer operative times. Mean blood loss was 872 ± 325 mL for open, 376 ± 62 mL for laparoscopic, and 291 ± 29 mL for the robotic-assisted approach. Reported hospital stay durations varied (open: 21 ± 3.3 days; laparoscopic: 17 ± 5.8 days; robotic-assisted: 13 ± 1.9 days). Early complication rates were similar across approaches (15%-20% for high-grade complications). Late high-grade complication rates ranged from 19% to 26%. Studies reported improved post-operative quality of life and generally stable kidney function, though assessment methods varied considerably.</p><p><strong>Conclusion: </strong>Cystectomy with ileal conduit in neurogenic lower urinary tract dysfunction patients is associated with substantial complication rates across all surgical methods. The available evidence is heterogeneous and subject to significant confounding factors. Differences observed between surgical approaches should be interpreted with caution. Prospective comparative studies with standardized reporting are needed to determine the optimal surgical approach for this specific patient population.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498113","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 Editorial Comment on \"Systematic Review on the Learning Curve of Percutaneous Nephrolithotomy: Operative Time, Fluoroscopy Time, Stone-Free Rate, Puncture Performance, Complications, and Safety Indicators\".","authors":"Nathan Wirtzfeld, Vincent De Coninck","doi":"10.1016/j.urology.2025.06.036","DOIUrl":"10.1016/j.urology.2025.06.036","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486068","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":"Influence of Physician-Patient Gender Congruence and Language Interpreter Services in Urology.","authors":"Grace K Sarris, Max D Sandler, Adam D Williams, Katherine Amin, Alan J Wein, Raveen Syan","doi":"10.1016/j.urology.2025.06.042","DOIUrl":"10.1016/j.urology.2025.06.042","url":null,"abstract":"<p><strong>Objective: </strong>To examine how physician gender and language concordance impact patient satisfaction in a primarily Hispanic population.</p><p><strong>Methods: </strong>An anonymous survey was distributed at an academic urology clinic, assessing factors influencing physician selection, comfort with physician gender, language preferences, and interpreter impact. Chi-square tests analyzed categorical variables, with significance set at P <.05. Odds ratios (OR) reported with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 255 participants, 51.4% preferred a same-gender physician, though most were comfortable discussing urinary (60%) and sexual health (58.4%) issues with opposite-gender physicians. Age correlated with comfort discussing urinary (P = .02) and sexual health (P = .01) issues; higher education also showed significant associations (P <.01). Black patients reported greater discomfort discussing urinary concerns with opposite-gender physicians (OR: 3.03, CI:1.1-7.6, P = .02). Language concordance was important to 38.4% of patients. Nearly half (45.9%) found interpreters beneficial, while 29% were neutral. Patients with at least a high school education were more likely to perceive interpreters negatively (OR: 3.8, CI: 1.4-10.5, P = .01).</p><p><strong>Conclusion: </strong>While patients are often comfortable discussing sensitive health issues with physicians of different genders, preferences still exist, particularly among certain demographic subsets. Our research suggests that language concordance and the resultant use of interpreter services may affect the experience of patients with higher education levels and, thus, the perceived quality of care. These findings highlight the importance of recognizing patient preferences and cultural sensitivities to create a more inclusive, comfortable healthcare environments.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486066","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":"Editorial Comment on \"Association Between Kidney Stones and Subsequent Risk of Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis\".","authors":"Marcelo Mass Lindenbaum, Nima Almassi","doi":"10.1016/j.urology.2025.06.037","DOIUrl":"10.1016/j.urology.2025.06.037","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486064","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":"Development and Validation of an Automated Intermittent Bladder Irrigation System for the Prevention of Catheter-Associated Urinary Tract Infections: A Preclinical Study Using a Porcine Model.","authors":"Myungchan Park, Hyun Cheol Jeong, Sung Jin Kim, Sang Hyun Park, Jae-Seung Chung, Cheol Kyu Oh, Kyoko Sakamoto, Mahadevan Raj Rajasekaran","doi":"10.1016/j.urology.2025.06.045","DOIUrl":"10.1016/j.urology.2025.06.045","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a novel automated intermittent bladder irrigation system designed to prevent catheter-associated urinary tract infections and manage catheter-related complications by addressing operator dependency, inconsistent outcomes, and potential complications associated with traditional techniques in patients requiring long-term catheterization, using a porcine model.</p><p><strong>Methods: </strong>A quantitative evaluation method using standardized agar specimens was used to assess the clearance rate. Bladder irrigation procedures were performed on four female pigs to compare the automated system with conventional manual irrigation. Each method was tested with 13 repeated procedures per animal. The primary outcome was particle clearance rate, and the secondary outcomes were procedure time, pressure stability, and safety parameters.</p><p><strong>Results: </strong>The automated irrigation system demonstrated superior efficacy for agar specimen removal compared with manual irrigation (94.4% vs 89.4%, P = .041). The automated system significantly improved procedural consistency (standard deviation: ±4.94% vs ±11.47%) and shortened irrigation time (8.2 ± 0.5 vs 12.4 ± 3.2 minutes, P <.001) compared with manual irrigation, despite the latter being performed by an experienced urologist. The automated system maintained stable irrigation pressures within physiological limits for all procedures, and no complications such as mucosal injury or severe hematuria were observed in either group.</p><p><strong>Conclusion: </strong>This preclinical study demonstrated that our automated intermittent bladder irrigation system provided superior clearance rates and significantly reduced procedural variability compared to manual techniques, highlighting the importance of automation in ensuring consistent and safe clinical outcomes independent of operator variables.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476893","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}