World Journal of Urology最新文献

{"title":"Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women.","authors":"Juhana Rautiola, Alberto Martini, Laura S Mertens, Viktor Skokic, Luca Di Gianfrancesco, Carlo Andrea Bravi, Julia Heinzelbecker, Mikolaj Mendrek, Stephan Buse, Guillaume Ploussard, Hubert John, Abdullah Erdem Canda, Mevlana Derya Balbay, Sebastian Edeling, Charles Van Praet, Sami-Ramzi Leyh-Bannurah, Alexander Mottrie, Frederiek D'Hondt, Hendrik van der Poel, Camille Berquin, Karel Dacaestecker, Richard Gaston, Peter Wiklund, Abolfazl Hosseini","doi":"10.1007/s00345-024-05339-w","DOIUrl":"10.1007/s00345-024-05339-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.</p><p><strong>Methods: </strong>From a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.</p><p><strong>Results: </strong>The study involved 146 patients with the median age 60 years (IQR, 51-66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.</p><p><strong>Conclusions: </strong>Robot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"617"},"PeriodicalIF":2.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565052","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":"Tumor regression after neoadjuvant hormonal therapy in high risk prostate cancer: pathological outcomes from a randomized phase II trial.","authors":"Leonardo Cardili, Diogo Assed Bastos, Eder Nisi Ilario, Marina Alessandra Pereira, Giuliano Bettoni Guglielmetti, Maurício Cordeiro, José Pontes, Rafael Ferreira Coelho, William Carlos Nahas, Katia Ramos Moreira Leite","doi":"10.1007/s00345-024-05323-4","DOIUrl":"https://doi.org/10.1007/s00345-024-05323-4","url":null,"abstract":"<p><strong>Purpose: </strong>High-risk localized prostate cancer (HRLPC) commonly progresses to metastatic disease after local treatment. Neoadjuvant androgen deprivation therapy (nADT) before radical prostatectomy (RP) has recently been suggested to improve early oncological outcomes in HRLPC. We aimed to perform an exploratory analysis of the pathological outcomes from a prospective trial testing nADT before RP.</p><p><strong>Methods: </strong>Prospective, single-centered, phase II, randomized trial performed between October 2018 and July 2021. Random assignment (1:1) for nADT modalities: goserelin (10.8 mg) plus abiraterone acetate (1000 mg/d) plus prednisone (5 mg/d), with or without apalutamide (240 mg/d) for 12 weeks, followed by RP (within 30 days) and extended lymph node dissection. Baseline clinical and pathological variables were assessed in needle biopsies before nADT. Tumor regression was histologically evaluated in surgical specimens using the residual cancer burden index (RCB).</p><p><strong>Results: </strong>Sixty-two patients reached the surgical phase. Good response (RCB ≤ 0.25 cm³) was achieved in 14 patients (22.5%). Overall stage migration rate between baseline status (MRI before nADT) and final status (after surgery) was 27.4%. Late stage detection (high tumor burden, perineural invasion) and altered PTEN/ERG immunostatus showed significant association with poor response in univariate analysis. Higher baseline tumor burden was the only independent factor related to poor response in multivariate analysis.</p><p><strong>Conclusions: </strong>There are subgroups of patients, such as those with low baseline cancer burden and PTEN/ERG wild-type status, more likely to achieve good response with nADT. In the case of long term oncological benefit to be proven, nADT might be an additional therapeutic resource for these patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"618"},"PeriodicalIF":2.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565104","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":"Influence of metastatic sites and burden on oncological outcomes in patients progressing to metastatic castration resistant prostate cancer.","authors":"Mike Wenzel, Benedikt Hoeh, Clara Humke, Florestan Koll, Cristina Cano Garcia, Carolin Siech, Thomas Steuber, Markus Graefen, Miriam Traumann, Luis Kluth, Felix K H Chun, Philipp Mandel","doi":"10.1007/s00345-024-05341-2","DOIUrl":"10.1007/s00345-024-05341-2","url":null,"abstract":"<p><strong>Purpose: </strong>Metastatic castration-resistant prostate cancer (mCRPC) patients harbor reduced life expectancy after first-line treatment progression. Currently, no information is available regarding the influence of metastatic sites and osseous burden on progression-free (PFS) and overall survival (OS) of mCRPC patients.</p><p><strong>Methods: </strong>We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to select patients progressing to mCRPC and stratified them according to lymph node vs. osseous vs. visceral metastatic sites. Moreover, we stratified osseous mCRPC patients regarding the number of metastatic lesions. Endpoints were PFS and OS in uni- and multivariable Cox regression models.</p><p><strong>Results: </strong>Of 363 patients, 9.4% harbored M1a vs. 78% M1b vs. 12% M1c mCRPC with significantly higher PSA in M1b (9 vs. 22 vs. 8ng/ml). Rates of DeNovo (15% vs. 60% vs. 56%) were significantly lower in the M1a mCRPC group, compared to M1b and M1c (p < 0.001). In PFS analyses, a median of 12.7 vs. 10.1 vs. 15.9 months for M1a vs. M1b vs. M1c mCRPC was observed (p > 0.05). In multivariable Cox regression models, M1c mCRPC was independently at higher risk for progression (hazard ratio [HR]: 5.93, p = 0.048), relative to M1a. Regarding OS, significant differences were observed (p = 0.002), with median OS of 58 vs. 42 vs. 25 months for M1a vs. M1b vs. M1c mCRPC and corresponding HRs of 1.54 (p = 0.11) and 2.76 (p < 0.01). In multivariable models M1c mCRPC was associated with higher risk of death (HR: 3.56, p = 0.049), relative to M1a. No differences were observed after stratification according to number of bone lesions (all p ≥ 0.05).</p><p><strong>Conclusion: </strong>M1c mCRPC patients are independently at higher risk for progression and death, while M1a patients harbor best cancer-control outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"615"},"PeriodicalIF":2.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565044","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 infection post flexible UreteroreNoscopy (I-FUN) predictive model based on machine learning: a new clinical tool to assess the risk of sepsis post retrograde intrarenal surgery for kidney stone disease.","authors":"Daniele Castellani, Virgilio De Stefano, Carlo Brocca, Giorgio Mazzon, Antonio Celia, Andrea Bosio, Claudia Gozzo, Eugenio Alessandria, Luigi Cormio, Runeel Ratnayake, Andrea Vismara Fugini, Tonino Morena, Yiloren Tanidir, Tarik Emre Sener, Simon Choong, Stefania Ferretti, Andrea Pescuma, Salvatore Micali, Nicola Pavan, Alchiede Simonato, Roberto Miano, Luca Orecchia, Giacomo Maria Pirola, Angelo Naselli, Esteban Emiliani, Pedro Hernandez-Peñalver, Michele Di Dio, Claudio Bisegna, Davide Campobasso, Emanuele Serafin, Alessandro Antonelli, Emanuele Rubilotta, Deepak Ragoori, Emanuele Balloni, Marina Paolanti, Vineet Gauhar, Andrea Benedetto Galosi","doi":"10.1007/s00345-024-05314-5","DOIUrl":"10.1007/s00345-024-05314-5","url":null,"abstract":"<p><strong>Purpose: </strong>To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis.</p><p><strong>Methods: </strong>All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023).</p><p><strong>Inclusion criteria: </strong>adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days).</p><p><strong>Exclusion criteria: </strong>concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds.</p><p><strong>Results: </strong>1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"612"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562876","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":"Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic.","authors":"Zhiyu Qian, Dejan Filipas, Edoardo Beatrici, Jamie Ye, Mansoo Cho, Filippo Dagnino, Hanna Zurl, Daniel Stelzl, David F Friedlander, Quoc-Dien Trinh, Stuart R Lipsitz, Alexander P Cole, Lori B Lerner","doi":"10.1007/s00345-024-05343-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05343-0","url":null,"abstract":"<p><strong>Introduction: </strong>Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak.</p><p><strong>Methods: </strong>We identified BPO surgeries from the California State Inpatient and State Ambulatory Surgery Databases between 2018 and 2020. Our primary outcome was the proportion of procedures performed in ambulatory settings with a length of stay of zero days. Univariable and multivariable analyses were performed to analyze factors associated with ambulatory surgery around the COVID-19 outbreak. Spline regression with a knot at the pandemic outbreak was performed to compare time trends pre- and post-pandemic.</p><p><strong>Results: </strong>Among 37,148 patients who underwent BPO procedures, 30,067 (80.9%) were ambulatory. Before COVID-19, 80.1% BPO procedures were performed ambulatory, which increased to 83.4% after COVID-19 outbreak (p < 0.001). In multivariable model, BPO procedures performed after COVID-19 outbreak were 1.26 times more likely to be ambulatory (OR 1.26, 95% CI 1.14-1.40, p < 0.0001). Spline curve analysis indicated significantly different trend of change pre- and post-pandemic (p = 0.006).</p><p><strong>Conclusions: </strong>We observed a rising trend of BPO surgeries performed in ambulatory setting post-pandemic. It remains to be seen if the observed ambulatory transition remains as we continue to recover from the pandemic.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"613"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562880","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":"Exposure to the herbicide 2,4-dichlorophenoxyacetic acid and prostate cancer among U.S. adult men.","authors":"Frank Glover, Michael Eisenberg, Francesco Del Giudice, Federico Belladelli, Albert Ha, Michael Scott, Christopher Filson","doi":"10.1007/s00345-024-05336-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05336-z","url":null,"abstract":"<p><strong>Purpose: </strong>Prostate cancer is the second most diagnosed male malignancy in the U.S. 2,4-Dichlorophenoxyacetic acid (2,4-D) is a commonly used herbicide and potential carcinogen. The researchers evaluated the association between prostate cancer and 2,4-D.</p><p><strong>Methods: </strong>Data was leveraged from the National Health and Nutrition Examination Survey (NHANES), a population-based, cross-sectional study of men and women in the U.S. Our cohort of interest was men aged 50 years and over. Urinary 2,4-D served as the measure of exposure. Our primary outcome was history of prostate cancer based on an individual's reply of \"yes\" to either ever having been diagnosed with prostate cancer and/or having received treatment for prostate cancer. Chi-square, one-way analysis of variance (ANOVA), and multivariable, weighted logistic regression were used to analyze the relationship between 2,4-D and prostate cancer.</p><p><strong>Results: </strong>We identified 1,788 eligible men, representing an estimated 691,709 men after survey weighting. The median 2,4-D level was 0.28 µg/L (IQR: 0.26-0.53), and the geometric mean was 0.38 µg/L. Increasing exposure of 2,4-D was associated with prostate cancer (OR 1.72, 95% CI [1.2,2.4]). Individuals in the highest quartile of 2,4-D exposure had a higher odds of a prostate cancer diagnosis compared to the lowest quartile (OR = 3.46 95% CI [1.11,10.72]). Age stratification revealed statistically significant associations between 2,4-D and prostate cancer in men age 70 + who were in the highest quartile of exposure (OR = 3.79 95% CI [1.51,9.52]).</p><p><strong>Conclusions: </strong>These findings implicate 2,4-D exposure in the risk of prostate cancer. Future studies are warranted to corroborate these findings and elucidate potential mechanisms underlying these associations.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"611"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558977","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":"Clinical significance of stone culture during endourological procedures in predicting post-operative urinary sepsis: should it be a standard of care-evidence from a systematic review and meta-analysis from EAU section of Urolithiasis (EULIS).","authors":"Francesco Ripa, Clara Cerrato, Zafer Tandoğdu, Christian Seitz, Emanuele Montanari, Simon Choong, Alimuddin Zumla, Thomas Herrmann, Bhaskar Somani","doi":"10.1007/s00345-024-05319-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05319-0","url":null,"abstract":"<p><strong>Purpose: </strong>Urinary sepsis is the leading cause of mortality in the setting of endourological procedures for stone treatment such as URS and PCNL; renal stones themselves may be a source of infection. Aim of this study is to determine the diagnostic accuracy of stone cultures (SC) collected during URS and PCNL in predicting post-operative septic complications, compared to preoperative bladder urine culture (BUC).</p><p><strong>Methods: </strong>We performed a systematic review (SR) of literature according to the PRISMA guidelines; Literature quality was evaluated according to The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. A univariate meta-analysis (MA) was used to estimate pooled log odds ratio of BUC and SC, respectively.</p><p><strong>Results: </strong>Overall, 14 studies including 3646 patients met the inclusion criteria. Eight studies reported data from PCNL only; three from URS only; three from both URS and PCNL. Stone cultures showed a higher sensitivity (0.52 vs 0.32) and higher positive predictive value (0.28 vs 0.21) in predicting post-operative sepsis, compared to bladder urine cultures. The pool-weighted logarithmic odd risk (LOR) for BUC was 2.30 (95% CI 1.51-3.49, p < 0.001); the LOR for stone cultures (SC) in predicting post-operative sepsis was 5.79 (95% CI 3.58-9.38, p < 0.001).</p><p><strong>Conclusion: </strong>The evidence from this SR and MA suggests that intraoperative SC from stone fragments retrieved during endourological procedures are better predictors of the likelihood of occurrence of post-operative sepsis compared to pre-operative BUC. Therefore, SC should be a standard of care in patients undergoing endourological interventions.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"614"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565032","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":"A nomogram to predict \"pure\" vs. \"mixed\" uric acid urinary stones.","authors":"Liran Zieber, Gherman Creiderman, Muhammad Krenawi, Daniel Rothenstein, Dmitry Enikeev, Yaron Ehrlich, David Lifshitz","doi":"10.1007/s00345-024-05340-3","DOIUrl":"10.1007/s00345-024-05340-3","url":null,"abstract":"<p><strong>Purpose: </strong>Uric acid stones (UAS) can be treated non-invasively by oral chemolysis. However, it is crucial to identify individuals who are most likely to benefit from this approach, specifically, patients with pure UAS. The aim of this study was to develop a nomogram that can differentiate between pure and mixed UAS.</p><p><strong>Methods: </strong>A retrospective analysis of demographic, clinical and stone composition data of patients with a predominant UAS composition (≥ 50%) treated between 2014 and 2022.</p><p><strong>Results: </strong>A total of 135 patients were included in the analysis, 37.8% had mixed UAS (50-90% UA) and 62.2% had pure UAS (≥ 95% UA). The mean stone density and the percentage of radiopaque stones in the pure UAS group were significantly lower than those in the mixed UAS group (450 Hounsfield Units [HU] vs. 600 HU, and 24% vs. 58%, respectively). A stepwise multivariate logistic regression revealed that lower stone density, bigger size, decreased stone opacity and older age are predictive variables for pure UAS. Accordingly, a nomogram was generated with a receiver operating characteristic (ROC) curve that showed an area under the curve (AUC) of 0.78. A patient with a total score of 156 has a probability of > 95% for pure UAS.</p><p><strong>Conclusion: </strong>Imaging and demographic data can be used to identify patients with pure UAS. The nomogram may be useful for counseling patients regarding oral chemolysis. Future validation of the nomogram with a different data set is required to assess its efficacy.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"610"},"PeriodicalIF":2.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558976","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":"A 3-arm randomized control trial to compare the efficacy of re-circulant hyperthermic intravesical chemotherapy versus conventional intravesical mitomycin C and BCG therapy for intermediate-risk non-muscle invasive bladder cancer.","authors":"Ankit Sachan, Rishi Nayyar, Sahil Pethe, Prashant Singh, Amlesh Seth","doi":"10.1007/s00345-024-05338-x","DOIUrl":"10.1007/s00345-024-05338-x","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the efficacy and side effects of re-circulant hyperthermic intravesical chemotherapy versus conventional treatments for intermediate risk non-muscle invasive bladder cancer (NMIBC).</p><p><strong>Methods: </strong>A randomized 3-arm, parallel group trial was conducted at a single tertiary care centre. 135 patients with low-grade intermediate-risk cancer, having undergone complete resection of bladder tumor were included. Patients were assigned 1:1:1, to receive intra-vesical chemo-hyperthermia (C-HT), mitomycin-C (MMC) or BCG therapy. There was no treatment crossover. Patients were followed up with check cystoscopy every 3 months for histopathological recurrence.</p><p><strong>Results: </strong>The three arms were comparable in terms of age, gender, tumor size, number of tumors and clinical stage or grade of tumors. Mean tumor size was 2.58 (± 0.88) cm and the mean number of tumors resected was 2.04 (± 1.02) (Range 1-5). There was no significant difference between the various groups for tumor recurrence (χ2 = 1.96, p = 0.375) or time to recurrence (13.6 vs. 10.8 vs. 9.8 months, p = 0.844) though incidence of non-healing necrotic area was higher with C-HT (22.2% vs. 11.1% and 4.8%, χ2 = 6.093, p = 0.048). Median (IQR) follow up period was 26 (12-52) months. Treatment discontinuation or drug intolerance was significantly higher in BCG arm (p = 0.03).</p><p><strong>Conclusions: </strong>Intravesical C-HT with MMC, conventional MMC and BCG are equally effective and comparable alternatives for intravesical therapy in low-grade intermediate-risk NMIBC. Higher incidence of non-healing resection site with C-HT and higher local symptoms with BCG are a concern.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"609"},"PeriodicalIF":2.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558975","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":"Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy.","authors":"Diederik J H Baas, Bas Israël, Joost M S de Baaij, Henricus J E J Vrijhof, Robert J Hoekstra, Heidi Kusters-Vandevelde, Peter F A Mulders, J P Michiel Sedelaar, Diederik M Somford, Jean-Paul A van Basten","doi":"10.1007/s00345-024-05321-6","DOIUrl":"10.1007/s00345-024-05321-6","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence.</p><p><strong>Methods: </strong>Between January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up.</p><p><strong>Results: </strong>The median LNI risk was 18% (IQR 9-31%). A median of 22 LN (IQR 16-28) were removed, with se-PLND yielding a higher number: 25 (IQR 20-32) compared to e-PLND: 17 (IQR 13-24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7-33), BCR incidence was comparable between the two groups.</p><p><strong>Conclusion: </strong>Compared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"605"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547936","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}