World Journal of Urology最新文献

{"title":"Relationship between urinary pH and efficacy of Bacillus Calmette-Guérin treatment in patients with carcinoma in situ of the bladder.","authors":"Ryo Yamashita, Takashi Sugino, Akifumi Notsu, Yuichiro Nakaya, Kana Ito, Yuma Sakura, Hideo Shinsaka, Masato Matsuzaki, Masashi Niwakawa, Eiji Kikuchi","doi":"10.1007/s00345-025-05700-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05700-7","url":null,"abstract":"<p><strong>Purpose: </strong>Bacillus Calmette-Guérin (BCG) is the standard treatment for carcinoma in situ (CIS) in patients with urothelial bladder carcinoma. We aimed to determine whether average urinary pH before BCG instillation affects the BCG response.</p><p><strong>Methods: </strong>Between August 2003 and January 2023, 203 patients with CIS received BCG treatment (Tokyo strain, 80 mg, ≥ 5 times) at our hospital. Average urinary pH was calculated by summing each urinary pH measurement before BCG instillation and dividing by the number of instillations. The Fine-Gray method was used to assess the relationship between average urinary pH (as a continuous variable) and intravesical recurrence. We also analyzed the cumulative incidence of intravesical recurrence after BCG treatment using different cutoff values for average urinary pH (median and trisection of the cohort).</p><p><strong>Results: </strong>The median follow-up period was 45 months (interquartile range (IQR): 14-83 months). The median urinary pH was 6.07 (IQR: 5.68‒6.50). In multivariate analysis, average urinary pH before BCG was significantly associated with intravesical recurrence (hazard ratio: 0.53, 95% confidence interval 0.32-0.89, p = 0.017). The cumulative incidence of intravesical recurrence differed significantly when categorized by average urinary pH (median and trisection), with patients having higher urinary pH showing lower intravesical recurrence rates.</p><p><strong>Conclusion: </strong>This is the first study to examine the relationship between BCG response and average urinary pH in patients with CIS. Patients with higher urinary pH had lower intravesical recurrence rates after BCG treatment.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"317"},"PeriodicalIF":2.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do patients with intermediate-risk renal carcinoma who receive adjuvant pembrolizumab really benefit in recurrence-free survival? Analysis of a cohort of nephrectomies over 10 years.","authors":"Pablo A Rojas, David Carracedo, Pietro Moscatiello, Laura González, Helena Gimbernat, Marta Santiago, Miguel Toledo, Nathalie Pereira, Miguel Sánchez-Encinas","doi":"10.1007/s00345-025-05599-0","DOIUrl":"https://doi.org/10.1007/s00345-025-05599-0","url":null,"abstract":"<p><strong>Purpose: </strong>Pembrolizumab has shown benefits as adjuvant therapy in the Keynote-564 trial, improving disease-free survival (DFS) across broad patient subgroups. However, it remains unclear if all patients, including those potentially cured by surgery alone, derive real benefits or are unnecessarily exposed to adverse effects and costs. This study aimed to evaluate DFS in Keynote-564-like patients who underwent nephrectomy without adjuvant pembrolizumab.</p><p><strong>Methods: </strong>We included nephrectomy patients meeting Keynote-564 criteria. Clinical and pathological features were analyzed, and Cox regression was used to identify predictors. DFS and overall survival (OS) were assessed.</p><p><strong>Results: </strong>Forty-three patients met Keynote-564 criteria (100% intermediate risk). Among them, 12 patients (28%) experienced recurrence. Significant differences between recurrent (Re+) and non-recurrent (Re-) patients were observed in ECOG ≥ 1 frequency (25% vs. 0%; p < 0.05), tumour size (9.4 vs. 6.9 cm; p = 0.02), and renal pelvis invasion (50% vs. 19%; p = 0.04). Cox regression identified ECOG ≥ 1 as a predictor of recurrence (HR = 17.97, 95% CI 1.76-187.16; p = 0.016). After a median follow-up of 59.5 months, 2-year DFS and OS were 86% and 93%, respectively. Treating only relapsed patients with pembrolizumab would have saved €1,254,167.</p><p><strong>Conclusion: </strong>Our recurrence rate was lower than Keynote-564, whereby no strong predictors of recurrence were identified. Although ECOG ≥ 1 was statistically significant, its clinical utility remains limited. Further research is needed to determine if adjuvant pembrolizumab provides a true benefit in intermediate-risk patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"307"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the learning curve of total ultrasound guided percutaneous nephrolithotomy in complex renal stones using\"30-degree triangulation\"technique.","authors":"Bo Xiao, Yang Chen, Shen Lin, Xue Zeng, Yubao Liu, Yangyang Xu, Haiwen Huang, Zhichao Luo, Wenjie Bai, Jianxing Li","doi":"10.1007/s00345-025-05674-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05674-6","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the learning curve of in the training of total ultrasound(US) guided percutaneous nephrolithotomy(PCNL) in complex renal stones using \"30-degree principle\" technique.</p><p><strong>Patients and methods: </strong>A total of 80 patients were included in this study to evaluate the learning curve of US guided PCNL in an inexperienced novice. They were divided into 8 groups based on timing of the surgery to evaluate the outcomes within the groups. The operator has mastered the\"30-degree triangulation\" technique for US-guided percutaneous renal puncture by education and theoretical study. Two important parameters were reviewed, namely US screening time and puncture time. Other peri-operative data were also recorded.</p><p><strong>Results: </strong>The mean US screening time was 509.3 s for the first 10 cases. It decreased significantly to an average of 226.3 s through 30 to 40. Although the US screening time gradually shortened with accumulated experience and stabilized at an average of 152.5 s through 70-80 cases, there was no significant difference between the following groups. Puncture time declined from 558.8 s in the first group to a mean of 202.3 s in the patients 30 to 40. Consistent with the trend in US screening time, although puncture time continued to decrease, there was no significant difference between them in subsequent patient groups. There were no significant differences in the hemoglobin drop, stone-free rate(SFR), post-hospitalization, or severe complication rate between each groups.</p><p><strong>Conclusions: </strong>The acceptable outcome of PCNL guided by total ultrasound in complex stones could be achieved after 40 cases under the premise of mastering the \"30-degree triangulation\"technique. The US screening time and puncture time dropped to a relative steady level after 40 times of practice.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"312"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and self-confidence of healthcare workers to perform transurethral catheterization: a matter deserving attention!","authors":"Gokhan Calik, Zeynep Bahadır, Berk Madendere, Ozgur Arikan, Vahit Guzelburc, Engin Evci, Suleyman Sami Cakir, Bulent Altay, Pilar Laguna, Mehmet Kocak, Selami Albayrak, Rahim Horuz, Kubilay Sabuncu, Mustafa Boz, Bulent Erkurt, Mohamad Aosama Alrifaai, Abdullah Al Chaabawi, Mahmoud Alrais, Ibrahim Abdi Ali, Shaban M S Ashour, Jean de la Rosette","doi":"10.1007/s00345-025-05677-3","DOIUrl":"10.1007/s00345-025-05677-3","url":null,"abstract":"<p><strong>Background: </strong>Patients may suffer from the sequela of complicated transurethral catheterization (TUC) such as urethral injury, infection, and stricture formation. We assessed the self-confidence, knowledge, and experience of healthcare professionals performing TUC.</p><p><strong>Methods: </strong>A multi-center, prospective, cross-sectional questionnaire-based study was performed among healthcare workers from 5 university hospitals. Data was transferred to an online Data Management System and self-confidence, knowledge, and experience levels among different healthcare roles were compared.</p><p><strong>Findings: </strong>Of all 747 participants, 8% did not feel confident, had enough knowledge or preparation skills regarding TUC. 23% never asked for help while performing TUC whereas 42% always asked for assistance (p < 0.0001). Healthcare roles did not differ statistically in terms of TUC knowledge and understanding. However, healthcare workers in surgical specialties felt more confident in their knowledge (29% vs 21%). Confidence in male catheterization skills rated as 'well' and 'very well' were reported highest by paramedics (71%, 20%) followed by nurses (48%, 20%), physicians (53%, 30%) and residents (50%, 36%). In the event of difficult catheterizations, physicians mostly preferred the assistance of \"urologists and urology residents\" (64%) while nurses mostly reached out to other nurses (39%). Paramedics were the least likely to ask for assistance (40%) followed by nurses (26%), doctors (24%), and residents (13%) (p < 0.0001).</p><p><strong>Conclusion: </strong>A significant proportion of healthcare workers do not have the necessary knowledge and understanding of TUC and do not feel confident in their catheterization and preparation skills when challenged by a difficult TUC, which requires the reassessment of the training programs pre- and post-graduation. This will facilitate and create a safer environment for both the patient and the healthcare professionals.</p><p><strong>Trial registry: </strong>ClinicalTrials.gov NCT05334225.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"311"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on:'' A systematic review and meta-analysis of alpha-adrenergic antagonists for the treatment of pain in chronic prostatitis''.","authors":"Yun Deng, Changhong Xu, Li Yang","doi":"10.1007/s00345-025-05693-3","DOIUrl":"https://doi.org/10.1007/s00345-025-05693-3","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"308"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the cost-effectiveness and evidence base for perioperative chemotherapy in muscle-invasive bladder cancer.","authors":"Takeshi Takahashi","doi":"10.1007/s00345-025-05681-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05681-7","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"310"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temperature variations with Ho: YAG and thulium fiber lasers, including advanced fragmentation pulse (AFP) technology: an experimental analysis.","authors":"Nariman Gadzhiev, Aram Aloyan, Ivan Gorgotsky, Nikolai Piven, Alexey Martov, Vineet Gauhar, Selcuk Güven","doi":"10.1007/s00345-025-05675-5","DOIUrl":"https://doi.org/10.1007/s00345-025-05675-5","url":null,"abstract":"<p><strong>Purpose: </strong>Recent developments in high-power systems and the super-pulsed thulium fiber laser (TFL) promise enhanced efficiency but raise concerns about thermal safety. This study examines the intrarenal temperature profiles of Ho: YAG and TFL systems including the advanced fragmentation pulse (AFP) mode under simulated conditions.</p><p><strong>Methods: </strong>A custom-designed kidney and ureter model was used to measure intrarenal temperature changes during laser activation. Real-time temperature data were recorded via thermocouples placed in collecting system. Results were analyzed to compare water temperature increases with the safety threshold of 43 °C.</p><p><strong>Results: </strong>At an irrigation flow rate of 23 mL/min and an initial water temperature of 22 ± 1 °C, WTIs for all laser systems remained below the safety threshold of temperature increase (STTI) during 60 s of laser activation. Ho: YAG consistently demonstrated the lowest WTIs, whereas TFL in AFP mode showed higher WTIs comparable to Ho: YAG but lower compared to TFL standard mode. Across all settings, WTIs were highest in the pelvis due to proximity to the laser fiber, with lower values in the upper and lower poles. The rapid temperature rise observed in the first 10-15 s was followed by a slower, steady increase. These findings confirm that with proper irrigation, even high-power laser lithotripsy systems, including TFL with AFP, operate within thermally safe limits.</p><p><strong>Conclusion: </strong>This study confirms that both Ho: YAG and TFL systems, including AFP mode, remain thermally safe with adequate irrigation (23 mL/min) during 60-second activation sessions.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"309"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective randomized study on the efficacy of tamsulosin, solifenacin, and their combination in relieving lower urinary tract symptoms in ureteric stent patients: insights from the brief-form Chinese USSQ.","authors":"Peter Hanna, Mohamed A Fahmy, Mohamed M Hussein, Amr Alam El-Din","doi":"10.1007/s00345-025-05695-1","DOIUrl":"10.1007/s00345-025-05695-1","url":null,"abstract":"<p><strong>Purpose: </strong>Assess the efficacy of selective alpha-1 blocker (tamsulosin) and antimuscarinic (solifenacin) as well as their combination in alleviating lower urinary tract symptoms in patients with ureteric stents using the brief-form Chinese version of the USSQ.</p><p><strong>Methods: </strong>A prospective randomized control study was conducted from May 2023 to October 2024 in the Urology department at Aswan University Hospital involving 160 consecutive patients undergoing DJ insertion after uncomplicated ureteroscopy. All patients are randomized into 4 groups receiving different treatments. Groups A, B, C, and D received a placebo, tamsulosin 0.4 mg, solifenacin 5 mg, and combinations respectively. IPSS and USSQ (brief-version) were collected and analyzed on the 1st day, 1st week, and 3rd week postoperative.</p><p><strong>Results: </strong>In all, 158 patients completed the study, 39 patients for Group A and Group B, while 40 patients for Group C and Group D. Baseline characteristics were comparable among all groups. Group (D) showed a significant decrease in mean ± (SD) IPSS 9.5 (± 1.4), and 7.7 (± 1.3) on 1st week and 3rd week postoperative respectively. Regarding USSQ, group (D) showed significantly lower scores compared to groups (A), (B), and (C) on the 1st day, 1st week, and 3rd week postoperatively (p < 0.001, p < 0.001, p < 0.001; respectively).</p><p><strong>Conclusion: </strong>The brief-form USSQ is a useful, reliable substitute for evaluating stent-related symptoms. Our findings support the notion that tamsulosin/solifenacin combinations have considerably reduced LUTS linked to the placement of ureteral stents.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"313"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-assisted education for informed consent in percutaneous nephrolithotomy: a prospective study on patient comprehension.","authors":"Mucahit Gelmis, Yasar Pazir, Ufuk Caglar, Ahmet Halis, Caglar Dizdaroglu, Furkan Gunay, Sedat Cakmak, Faruk Ozgor","doi":"10.1007/s00345-025-05690-6","DOIUrl":"10.1007/s00345-025-05690-6","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of urinary stone disease is increasing due to climate change, dietary habits, and obesity. Percutaneous nephrolithotomy (PCNL) remains the preferred treatment for large kidney stones. The informed consent process is essential for patient understanding; however, conventional verbal and written methods may be inadequate. This study aimed to evaluate the effectiveness of video-assisted education in improving informed consent for PCNL.</p><p><strong>Methods: </strong>This randomized controlled study was conducted from January to July 2023. Eighty patients scheduled for PCNL were randomly assigned to either a written-consent-only group or a video-assisted consent group that received both written consent and a seven-minute 3D-animated video. Comprehension was assessed using a 17-question knowledge assessment questionnaire before and after the consent process. Improvements in knowledge and differences in comprehension were compared.</p><p><strong>Results: </strong>The video-assisted consent group showed significantly greater comprehension improvement than the written-only group, benefiting patients across all education levels. Multivariate analysis confirmed the strong association between video education and knowledge gain, though older age was linked to lower improvement. Despite its effectiveness, two patients withdrew due to increased anxiety, underscoring the need to balance understanding with emotional reassurance.</p><p><strong>Conclusion: </strong>Video-assisted informed consent significantly improves comprehension in PCNL patients, particularly in those with lower education levels. However, an increased awareness of surgical risks may contribute to preoperative anxiety. Future research should refine video content, assess long-term outcomes, and explore strategies to balance comprehension with emotional reassurance.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"305"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 for the article \"influence of metastatic sites and burden on oncological outcomes in patients progressing to metastatic castration resistant prostate cancer\".","authors":"Yi Zhang, Shaoping Feng, Yao Shi, Jianfeng Chen, Zhigang Zhou, Chenghua Zhu","doi":"10.1007/s00345-025-05682-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05682-6","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"304"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}