World Journal of Urology最新文献

{"title":"Direct-in-scope suction with a 5.1Fr large working channel ureteroscope: what stone dust size for effective evacuation during laser lithotripsy? An in vitro analysis by PEARLS and section of EAU Endourology.","authors":"Ming Chun Chan, Vineet Gauhar, Soon Hock Koh, Frédéric Panthier, Eugenio Ventimiglia, Vincent De Coninck, Stefano Moretto, Aideen Madden, Anil Shrestha, Sung Yung Cho, Esteban Emiliani, Steffi Kar Kei Yuen, Thomas R W Herrmann, Bhaskar Somani, Olivier Traxer, Etienne Xavier Keller, Jia-Lun Kwok","doi":"10.1007/s00345-025-05579-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05579-4","url":null,"abstract":"<p><strong>Purpose: </strong>A novel larger 5.1Fr working channel flexible ureteroscope for Direct-In-Scope Suction (DISS) has recently been introduced. However, the optimal stone dust size for successful evacuation without working channel blockage is currently unknown.</p><p><strong>Methods: </strong>In vitro assessment of the PU400A 9.2Fr ureteroscope (Zhuhai Pusen Medical Technology Co., Ltd, China) was performed with BegoStone particle sizes ≤ 2000 μm (size range 1000-2000 μm), ≤ 1000 μm (500-1000 μm), ≤ 500 μm (250-500 μm), ≤ 250 μm (125-250 μm) and ≤ 125 μm (63-125 μm), in a kidney calyx model. This was conducted with an empty working channel, and with occupancy by 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fibers. Primary outcome was complete suction-evacuation without working channel blockage. Secondary outcome was evacuation speed for particle sizes that did not have blockage.</p><p><strong>Results: </strong>A stone particle size upper limit of 250 μm was found to achieve complete suction-evacuation without blockage, across all working channel occupancy situations. For stone particle size of range 125-250 μm, evacuation speeds were 35, 26, 13, 11 mm³/s across empty, 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fiber occupancy, respectively (ANOVA = p < 0.001). For stone particle size range 63-125 μm, evacuation speeds were 19, 14, 9, 8 mm³/s respectively (ANOVA = p < 0.001).</p><p><strong>Conclusion: </strong>The 5.1Fr working channel DISS ureteroscope allows a stone particle size limit of 250 μm to be suction-evacuated without blockage, even with laser fiber occupancy. With a laser fiber, a smaller 150 μm fiber size allows better particle evacuation speeds. Urologists should therefore aim for a dust particle size of ≤ 250 μm in routine DISS with the 5.1Fr working channel ureteroscope, for effective intraoperative stone evacuation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"198"},"PeriodicalIF":2.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754808","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":"Perioperative cisplatin-based chemotherapy for muscle-invasive bladder cancer: a decision analysis.","authors":"Luca Afferi, Beate Jahn, Amar H Kelkar, Stijntje W Dijk, Zach M Feldman, Zachary J Ward, Marco Moschini, Richard Cathomas, Joaquim Bellmunt, Andrea Gallioli, Alberto Breda, Christian D Fankhauser, Agostino Mattei, Steven L Chang, Uwe Siebert","doi":"10.1007/s00345-025-05584-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05584-7","url":null,"abstract":"<p><strong>Purpose: </strong>While meta-analyses of randomised studies suggest that neoadjuvant (NAC) or adjuvant (ACT) cisplatin-based chemotherapy improve overall survival in patients with muscle-invasive bladder cancer (MIBC), there are no trials comparing NAC against ACT in terms of quality-adjusted life years (QALYs) and costs. We aimed to evaluate the long-term QALYs, costs, and cost-effectiveness of different strategies for treating patients with MIBC.</p><p><strong>Methods: </strong>An individual-level state transition microsimulation model was developed for patients with urothelial non-metastatic MIBC eligible for surgery and NAC at diagnosis. Four treatment strategies were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC, and (iv) RC followed by ACT. Primary endpoints were QALYs and costs. Sensitivity analysis on the probability of being fit for ACT after surgery was conducted to account for the uncertainty of this parameter. The model was face-validated independently by two urologists.</p><p><strong>Results: </strong>Life-expectancy was 4.54 QALYs for ACT, 4.38 QALYs for NAC, 4.28 QALYs for RC without perioperative chemotherapy, and 2.84 QALYs for no treatment. Costs were lowest for ACT (US$45,805), compared to NAC (US$48,160), RC without perioperative chemotherapy (US$48,703), and no treatment (US$59,948). Sensitivity analysis suggested that NAC is associated with increased QALYs compared to ACT if the estimated probability of being fit for ACT is less than 38%. Limitations include the US-centric cost perspective.</p><p><strong>Conclusions: </strong>In lack of comparative studies, simulated data suggests that ACT leads to increased QALYs and is cost-effective compared to NAC.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"197"},"PeriodicalIF":2.8,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754810","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":"Optimizing treatment selection: outcomes of radical cystectomy in patients eligible for trimodal therapy.","authors":"Maurin Helen Mangold, Malin Nientiedt, Frank Waldbillig, Maurice Stephan Michel, Nicolas Carl, Britta Grüne, Maximilian Christian Kriegmair","doi":"10.1007/s00345-025-05566-9","DOIUrl":"https://doi.org/10.1007/s00345-025-05566-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines oncological and functional outcomes in a subset of patients eligible for trimodal therapy (TMT) within a large radical cystectomy (RC) cohort. It aims to determine whether TMT should be offered to all eligible patients, rather than exclusively to patients with significant comorbidities who are at high perioperative risk.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 509 patients with urothelial carcinoma (pT1-pT4) who underwent RC between 2014 and 2020. Patients were divided into TMT eligible (n = 74), and TMT ineligible (n = 431) cohorts based on preoperative criteria. Key endpoints included blood loss, operative duration, urinary diversion type, adjuvant chemotherapy, and overall and progression-free survival (OS, PFS). Functional outcomes were assessed using validated quality of life (QoL) questionnaires.</p><p><strong>Results: </strong>RC patients who were eligible for TMT demonstrated significantly better oncological outcomes, with higher overall survival (OS) (HR: 2.774, p < 0.001) and progression-free survival (PFS) (HR: 3.689, p < 0.001). They also experienced lower intraoperative blood loss (544.59 ml vs. 740.50 ml, p = 0.002) and were more likely to receive continent urinary diversion (55.1% vs. 38.8%, p = 0.01), with nearly 50% undergoing ileal neobladder reconstruction. Adjuvant chemotherapy was administered more frequently in the TMT-ineligible group (20.8% vs. 6.4%, p = 0.003). Apart from a significant difference in the positive support domain of the ISSS (p = 0.01), no significant differences in functional outcomes were observed.</p><p><strong>Conclusion: </strong>TMT eligible patients undergoing RC have better oncological outcomes and more favourable perioperative parameters compared to TMT ineligible patients. These findings highlight the need for careful patient counselling when considering TMT as an alternative to RC. Future prospective studies are warranted to optimise treatment selection and functional outcome assessment in bladder cancer.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"196"},"PeriodicalIF":2.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744084","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":"Comment on:\"Environmental sustainability in urologic practices: a systematic review\".","authors":"Kangyu Wang, Li Yang","doi":"10.1007/s00345-025-05590-9","DOIUrl":"https://doi.org/10.1007/s00345-025-05590-9","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"195"},"PeriodicalIF":2.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735775","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":"Residual stone fragments: systematic review of definitions, diagnostic standards.","authors":"O F Çavdar, A Aydin, T Tokas, A Tozsin, N Gadzhiev, M G Sönmez, R Tekeli, G Ortner, P Kallidonis, B Akgül, T Knoll, G Bianchi, J Rassweiler, K Ahmed, S Guven","doi":"10.1007/s00345-025-05572-x","DOIUrl":"10.1007/s00345-025-05572-x","url":null,"abstract":"<p><strong>Purpose: </strong>Residual stone fragments (RSFs) remain a determining factor for evaluation of outcome an intervention for management of renal tract stones. However, there is a lack of consensus on size, location, diagnosis and management of RSF. This systematic review aims to assess definitions and diagnostic approaches to RSF across urolithiasis treatment modalities while standardizing their definition and diagnosis through a systematic review, stratifying RSF patients into risk groups, and proposing an approach for management.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was conducted, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD42024603807). Embase, MEDLINE (PubMed) and Cochrane databases were searched until July 2024. Twentynine studies were included and categorized according to treatment choices i.e. extra-corporeal shockwave lithotripsy (ESWL) (n = 12), retrograde intrarenal surgery (RIRS) (n = 7), and percutaneous nephrolithotomy (PCNL) (n = 10). Each study's quality was evaluated using the Quadas Scoring System to determine the risk of bias and concerns regarding applicability. We included original studies that systematically defined and proposed approaches for RSF definition and diagnosis. Based on the emerging categories, we proposed a risk stratification model to classify patients accordingly.</p><p><strong>Results: </strong>RSF definitions varied, with most studies defining RSF as fragments < 4 mm, though thresholds of < 2 mm and < 5 mm were also common. Definitions typically included only asymptomatic fragments without obstruction or infection. Computed tomography (CT) was the imaging modality most selected for diagnosis and was used in 14 studies. The timing of imaging modalities for follow-up was highly heterogeneous. The incidence of RSFs following ESWL has been reported between 21% and 59% across the studies. Among the RIRS studies, RSF rates varied between 20 and 60.5% of patients, and RSFs were observed between 20 and 60% after PCNL. The variability in RSF definitions affects comparability and may impact reintervention rates and treatment outcomes.</p><p><strong>Conclusion: </strong>This systematic review highlights inconsistencies in defining RSFs, with common thresholds being < 2 mm, < 4 mm, or < 5 mm. CT is noted as the most reliable method for assessing fragment size and location. RSFs over 4 mm, particularly in the lower pole, are associated with higher risks of progression and complications. The review advocates to adopt standardized definitions and imaging protocols to enhance comparability and patient outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"194"},"PeriodicalIF":2.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732013","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":"Association of energy source with outcomes in en bloc TURB: secondary analysis of a randomized trial.","authors":"Stefano Mancon, Francesco Soria, Rodolfo Hurle, Dmitry Enikeev, Evanguelos Xylinas, Lukas Lusuardi, Axel Heidenreich, Paolo Gontero, Eva Compérat, Shahrokh F Shariat, David D'Andrea","doi":"10.1007/s00345-025-05565-w","DOIUrl":"10.1007/s00345-025-05565-w","url":null,"abstract":"<p><strong>Purpose: </strong>To comprehensively evaluate the efficacy of different energy sources used for en-bloc transurethral resection of bladder tumors (ERBT) on perioperative outcomes.</p><p><strong>Methods: </strong>This sub-analysis derived from a prospective randomized study that enrolled patients undergoing ERBT vs conventional transurethral resection of the bladder (cTURB) from January 2019 to January 2022 (NCT03718754). Endpoints were pathological specimen quality and perioperative outcomes after either monopolar (m-ERBT) or bipolar (b-ERBT) or laser (l-ERBT) ERBT.</p><p><strong>Results: </strong>237 bladder tumors resected in 188 patients included in the analyses: 29 (12.2%) m-ERBT, 136 (57.4%) b-ERBT and 72 (30.4%) l-ERBT. Detrusor muscle (DM) was detected in 191 (80.6%) specimens. Per-tumor analysis revealed comparable rate of DM in the specimens obtained via different energy modalities (p = 0.7). Operative time was longer in the l-ERBT cohort compared to m-ERBT and b-ERBT (p = 0.02) and no obturator nerve reflex (ONR) onset was reported. On logistic regression analysis, b-ERBT was associated with negative lateral resection margins (OR 2.81; 95% CI 1.02-7.70; p = 0.04). There was no significant association of the resection technique with perforation and conversion rates (all p > 0.05). Within a median follow up of 22mo (IQR 11-29), a total of 35 (18.6%) patients had a local recurrence. On Cox regression analysis, patients resected with b-ERBT were less likely to have a recurrence (HR 0.34; 95% CI 0.15-0.78; p = 0.01); When adjusting for established confounders, this association was confirmed (HR 0.24; 95% CI 0.10-0.60; p = 0.002).</p><p><strong>Conclusions: </strong>Different energy sources might achieve comparable perioperative outcomes. Further perspectives involve the assessment of long-term differential oncological outcomes associated with various energy modalities.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"191"},"PeriodicalIF":2.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721770","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":"Diagnostic efficacy of serum microRNAs in predicting pathology of retroperitoneal lymph node dissection in patients with testicular germ cell tumors: a systematic review and meta-analysis.","authors":"Mehdi Kardoust Parizi, Nirmish Singla, Siamak Daneshmand, Axel Heidenreich, Aditya Bagrodia, Vitaly Margulis, Akihiro Matsukawa, Ichiro Tsuboi, Shahrokh F Shariat","doi":"10.1007/s00345-025-05571-y","DOIUrl":"10.1007/s00345-025-05571-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic efficacy of serum microRNAs in predicting pathologic findings of retroperitoneal lymph node dissection (RPLND) in patients with testicular germ cell tumors (TGCT).</p><p><strong>Methods: </strong>PUBMED, SCOPUS, and Cochrane Library were searched in August 2024 to identify eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines.</p><p><strong>Results: </strong>Nine studies comprising 603 patients were selected in this review. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of microRNA-371a-3p for predicting viable tumor other than pure teratoma in RPLND specimen were 0.76 (95% CI 0.49-0.90), 0.97 (95% CI 0.81-0.99) and 31.75 (95% CI 9.24-109.10), respectively. The pooled sensitivity for primary and post-chemotherapy RPLND (PC-RPLND), were 0.77 (95% CI 0.47-0.93) and 0.73 (95% CI 0.28-0.95), respectively. The pooled specificity for primary and PC-RPLND were 0.92 (95% CI 0.72-0.98) and 0.99 (95% CI 0.62-1.00), respectively. The pooled DOR for primary and PC-RPLND were 13.86 (95% CI 2.97-64.79) and 64.11 (95% CI 13.09-313.98), respectively. The major limitation is the lack of standardization of miR371 testing.</p><p><strong>Conclusion: </strong>miR-371a-3p is a relatively sensitive and highly specific marker for predicting viable tumors in RPLND pathologic findings. The DOR was particularly significant for patients who underwent PC-RPLND. While serum microRNAs may be useful in distinguishing viable germ cell tumors from necrosis, fibrosis, and teratomas, their ability to differentiate teratomas from necrosis is limited. Well-designed prospective studies are essential to enhance our understanding of the predictive performance of microRNAs.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"192"},"PeriodicalIF":2.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721771","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":"The effectiveness of remote interventions based on digital health technology in kidney transplant recipients: a systematic review.","authors":"Mingxi Kuang, Zhiling Yao, Jiayuan Chen, Youqing Yan, Zhen Li","doi":"10.1007/s00345-025-05582-9","DOIUrl":"10.1007/s00345-025-05582-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the application effect of remote interventions based on digital health technology in kidney transplant patients through a systematic review.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were systematically searched for randomized controlled trials and quasi - experimental studies on remote interventions based on digital health technology in kidney transplant recipients. The search time limit ranged from the establishment of the databases to September 2024.</p><p><strong>Results: </strong>A total of 10 articles were included, involving 535 patients. A total of 21 clinical outcomes were identified in this study and they were classified into three categories, namely: ① Health-related conditions: Number of steps (n = 1), heart rate (n = 1), self-burden score (n = 1), self-management ability (n = 1), quality of life score (n = 2), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) (n = 1), psychological distress (n = 1). ② Medication adherence and average tacrolimus concentration: Medication adherence (n = 5), number of missed doses (n = 1), medication errors (n = 1), rejection reactions (n = 1), average creatinine level (n = 1), tacrolimus blood concentration level (n = 2), within-patient variability of tacrolimus (n = 1), coefficient of variation (CV) of tacrolimus (n = 1). ③ Medical economic status: Nursing satisfaction (n = 1), incidence of adverse events (n = 1), rate of unplanned hospitalization (n = 3), duration of unplanned hospitalization (n = 1), one-year medical cost (n = 2), nursing cost (n = 1).</p><p><strong>Conclusion: </strong>Remote interventions based on digital health technology can improve the health - related conditions, medication adherence and medical economic status of kidney transplant recipients. However, its impact on tacrolimus concentration remains unclear. Clinical medical staff should fully recognize its positive effects.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"193"},"PeriodicalIF":2.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732016","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":"Bioinformatic strategies in metagenomics of chronic prostatitis.","authors":"Elmira Davasaz Tabrizi, Mushteba Sevil, Ercan Arican","doi":"10.1007/s00345-025-05514-7","DOIUrl":"10.1007/s00345-025-05514-7","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological condition in young men, significantly affecting quality of life due to persistent discomfort and neuropsychological symptoms. Despite its high prevalence, the etiology of CP/CPPS remains poorly understood. This study investigated urinary microbiota differences between CP/CPPS patients and healthy controls to identify microbial contributors, antibiotic resistance genes (ARGs), and virulence factors of dominant bacteria, as well as to explore potential therapeutic targets.</p><p><strong>Methods: </strong>Urine samples were collected from 58 CP/CPPS patients and 25 controls. Symptom severity was assessed by a specialist urologist using the NIH Chronic Prostatitis Symptom Index and UPOINT classification. Bacterial-specific 16 S rRNA sequencing was performed using nanopore technology, with bioinformatics analyses conducted via ONT guppy 5.0.11, NCBI and SLV 16 S bacterial taxonomic databases, UPGMA hierarchical clustering, and the Bacterial and Viral Bioinformatics Resource Center (BV-BRC). Pairwise comparisons were analyzed using the Mann-Whitney U test.</p><p><strong>Results: </strong>Distinct microbial diversity patterns were observed between patients and controls. Bacillus species were significantly enriched in CP/CPPS patients, while Enterococcus species predominated in controls. Younger patients exhibited unique microbiome profiles compared to older groups. Bioinformatics analyses identified ARGs and virulence factors associated with Bacillus species, implicating them in localized inflammation. Antibiotics like pleuromutilin or vancomycin were identified as potential therapeutic options, though experimental validation was beyond the study's scope.</p><p><strong>Conclusion: </strong>These findings highlight microbial imbalances and provide a foundation for microbiome-targeted therapeutic strategies for CP/CPPS management in the future. Additionally, the identification of bacterial virulence factors and ARG provides insights into the potential mechanisms driving persistent symptoms. Future research with larger cohorts and experimental validation of the suggested therapeutic options may contribute to more effective treatment for CP/CPPS.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"188"},"PeriodicalIF":2.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732009","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":"Application of human breast acellular dermal matrix (hbADM) in sling surgery for female stress urinary incontinence: a phase 1 clinical trial.","authors":"Amir Kian Moaveni, Mahtab Zargham, Simin Vahidi, Masoumeh Majidi Zolbin, Maryam Amiri, Mozaffar Mahmoodi, Mohammad Nazir Menbari, Masoumeh Ekhtiari, Ashkan Azimzadeh, Reyhane Ebrahimi, Nazanin Rajipour, Abdol-Mohammad Kajbafzadeh","doi":"10.1007/s00345-025-05562-z","DOIUrl":"https://doi.org/10.1007/s00345-025-05562-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and feasibility of human breast acellular dermal matrix (hbADM) as an alternative to synthetic mesh and autologous fascia in sling surgery for female stress urinary incontinence (SUI), and to assess its preliminary efficacy in a phase 1 clinical trial.</p><p><strong>Methods: </strong>Twenty-five women with pure SUI underwent hbADM sling surgery at two centers. The primary outcomes were safety (adverse events) and feasibility. Secondary outcomes included changes in International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores, Patient Global Impression of Improvement (PGI-I), cough stress test results, and uroflowmetry parameters. Patients were followed up for 3 years. Statistical analysis included descriptive statistics, paired t-tests, and Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>The hbADM sling procedure was performed as planned in all patients. Adverse events occurred in 10 patients (40%). Intraoperative and early postoperative events (9/25, 36%) were mild and consistent with standard sling procedures. Late complications, observed in 2 patients (8%), were limited to recurrent urinary tract infections (UTIs); one of these patients had also presented a UTI in the early phase. No cases of sling erosion or chronic pain were observed. Objective cure rates (negative cough stress test) remained high at 100% at 1 year and 95% at 3 years. However, patient-reported success (PGI-I ≤ 2) declined from 92% at 1 month to 65% at 3 years. The mean ICIQ-SF score improved significantly from 15.3 ± 3.4 at baseline to 5.8 ± 2.4 at 3 years post-surgery (p < 0.001). Uroflowmetry parameters remained stable throughout the follow-up. The recurrence rate was 10% at 3 years.</p><p><strong>Conclusion: </strong>This phase 1 trial demonstrates the safety and feasibility of hbADM slings for female SUI treatment, with promising efficacy outcomes up to 3 years post-surgery. These results support further investigation of hbADM sling in larger, randomized controlled trials.</p><p><strong>Clinical trial registration: </strong>This study was registered in the Iranian Registry of Clinical Trials (IRCT).</p><p><strong>Registration number: </strong>IRCT201611278554N3 Registration Date: 2017-05-28.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"190"},"PeriodicalIF":2.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721769","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}