Minerva Urology and Nephrology最新文献

{"title":"Aquablation vs. holmium laser enucleation of the prostate for benign prostatic hyperplasia: a 150-patients prospective comparative multicenter study.","authors":"Juan Justo Quintas, Esther García Rojo, Borja García Gómez, Fernando Lista Mateos, Renan J Otta Oshiro, Elena Peña Vallejo, Celeste Manfredi, Giorgio Bozzini, Alfredo Rodríguez Antolín, Javier Romero-Otero","doi":"10.23736/S2724-6051.24.05871-3","DOIUrl":"10.23736/S2724-6051.24.05871-3","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare the efficacy and safety of Aquablation^® with those of holmium laser enucleation of the prostate (HoLEP) for the treatment of patients with benign prostatic hyperplasia (BPH).</p><p><strong>Methods: </strong>Prospective comparative non-randomized multicenter study conducted between July 2021 and July 2023, consecutive patients undergoing BPH surgery were enrolled to each group. Patients had moderate to severe lower urinary tract symptoms (LUTS), International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate (Qmax) ≤15 mL/s, prostate volume ≥30 mL ≤120 mL, and BPH medical therapy failure. Primary outcome was short-term efficacy measured by IPSS, IPSS-QoL, Qmax, post-void residual volume (PVR), prostate-specific antigen (PSA); secondary outcome was safety (intra and post-operative complications, ejaculatory dysfunction, continence, blood transfusions). A six-month follow-up was performed.</p><p><strong>Results: </strong>Of 150 patients (75:75) enrolled, both groups showed improvements (P<0.05) in IPSS, IPSS-QoL, Qmax, and PVR at six months. No significant differences were observed between HoLEP and Aquablation^® in IPSS (7.6±6.9 vs. 5.05±4.9 points, P=0.11), IPSS-QoL (1.7±1.6 vs. 1.3±1.6 points, P=0.16), Qmax (28.6±8.8 vs. 23.8±9.3 mL/sec, P=0.12), and PVR (7.2±8.2 vs. 20.3±22.6 mL, P=0.19) at six months. No intraoperative complications occurred. Postoperative hemoglobin drop was higher in Aquablation^® group (2.6±1.33 vs. 0.4±0.67 g/dL, P<0.001), with no statistically significant differences in transfusion rate (1.3 vs. 1.3%, P=0.31). Ejaculatory dysfunction rate was significantly lower in Aquablation^® (6,6%) than HoLEP (89.3%, P<0.001). Mean prostate volume was (mean±SD) 81.8±37.4 and 71.9±34.8 mL (P=0.08) in HoLEP and Aquablation^® groups, respectively. Holep demonstrated a smaller prostate volume after treatment (18.1±6.5 vs. 46.5±25.02 mL P<0.001) as well as a significantly greater reduction and lower levels of PSA (1.2±1.4 vs. 2.65±2.8 ng/mL, P<0.001). Aquablation^® demonstrated significantly shorter tissue removal time (5.5±2.4 vs. 22.4±9.8 min, P<0.001), but no difference in total operative time (49.1±15 vs. 43.9±26.8 min, P=0.052).</p><p><strong>Conclusions: </strong>HoLEP and Aquablation^® show similar effectiveness and safety for BPH-related-LUTS at 6 months. Aquablation^® has lower ejaculatory dysfunction rates. Larger randomized trials and with longer follow-up time are needed for validation.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"111-119"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392514","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":"Current applications and future perspectives of artificial intelligence in functional urology and neurourology: how far can we get?","authors":"Maria Lucia Gallo, Martina Moriconi, Véronique Phé","doi":"10.23736/S2724-6051.25.06195-6","DOIUrl":"10.23736/S2724-6051.25.06195-6","url":null,"abstract":"<p><p>In the last few years, the scientific community has seen an increasing interest towards the potential applications of artificial intelligence in medicine and healthcare. In this context, urology represents an area of rapid development, particularly in uro-oncology, where a wide range of applications has focused on prostate cancer diagnosis. Other urological branches are also starting to explore the potential advantages of AI in the diagnostic and therapeutic process, and functional urology and neurourology are among them. Although the experiences in this sense have been quite limited so far, some AI applications have already started to show potential benefits, especially for urodynamic and imaging interpretation, as well as for the development of AI-based predictive models for treatment response. A few experiences on the use of ChatGPT to answer questions on functional urology and neurourology topics have also been reported. Conversely, AI applications in functional urology surgery remain largely unexplored. This paper provides a critical overview of the current evidence on this topic, highlighting the potential benefits for the diagnostic workflow, therapeutic evaluation and surgical training, as well as the current limitations that need to be addressed to enable the integration of this tools in the clinical practice in the future.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"33-42"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782034","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 outcomes of BCG infections in patients undergoing intravesical immunotherapy for non-muscle-invasive bladder cancer: a systematic review and meta-analysis.","authors":"Alberto Artiles Medina, José D Subiela, Ana Tagalos Muñoz, Marta Tato Díez, César Mínguez Ojeda, David López Curtis, Álvaro Sánchez González, Jennifer Brasero Burgos, Alejandra Serna-Céspedes, Victoria Gómez Dos Santos, Miguel Á Jiménez Cidre, Francisco J Burgos Revilla","doi":"10.23736/S2724-6051.24.05910-X","DOIUrl":"10.23736/S2724-6051.24.05910-X","url":null,"abstract":"<p><strong>Introduction: </strong>Intravesical bacillus Calmette-Guérin (BCG) is the standard treatment for high- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC). Despite its 50-year history of use, there remains a paucity of data regarding infections associated with intravesical BCG immunotherapy in real-world clinical practice. Thus, this study aimed to assess the clinical outcomes of BCG infections in a high-volume center and systematically review the literature on the topic.</p><p><strong>Evidence acquisition: </strong>We retrospectively reviewed the records of patients who had experienced BCG infections following intravesical immunotherapy for NMIBC at our institution between 2001 and 2022, and systematically reviewed the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (PROSPERO registration: CRD42024497171). The PubMed, EMBASE and Scopus databases were searched in December 2023. Endpoints were: overall incidence of BCG infections, incidence of disseminated infection and mortality.</p><p><strong>Evidence synthesis: </strong>Twelve eligible references were identified through the search strategy (n=306 patients), while our series comprised 18 patients. A total of 324 patients were thus included for evidence synthesis. Meta-analysis results showed that the pooled incidence of BCG infection among patients treated with intravesical immunotherapy was 2% (95% CI 1-2%). The pooled mean age was 71.19 years (95% CI 65.89-76.50). The pooled mean duration of intravesical therapy until the diagnosis of BCG infection was 11.67 months (95% CI 4.62-18.71), and a low rate of urine culture positivity was observed (pooled rate of 23% [95% CI 13-34%]). Disseminated disease was present in 61% of cases (95% CI 45-77%), while the pooled rate of local (genitourinary) involvement was 32% (95% CI 17-50%). The proportion of deaths among these patients was 5% (95% CI 2-10%).</p><p><strong>Conclusions: </strong>BCG infections following intravesical immunotherapy are a rare condition (2%). While more than half of those who experience this complication present with a disseminated pattern, the associated mortality appears to be low (5%).</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"13-24"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782079","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 novel rat model for studying bilateral cavernous nerve damage in vivo: exploring the potential of chitosan-blended membranes for nerve regeneration post-radical prostatectomy.","authors":"Federica Fregnan, Luisa Muratori, Alessandro Crosio, Federica Zen, Cristian Fiori, Ilaria Tonazzini, Giovanna Gambarotta, Antonello Martinelli, Juliette Meziere, Stefania Raimondo, Matteo Manfredi, Luca Scaccini, Stefano Geuna, Francesco Porpiglia","doi":"10.23736/S2724-6051.25.06169-5","DOIUrl":"10.23736/S2724-6051.25.06169-5","url":null,"abstract":"<p><strong>Background: </strong>The primary treatment for localized prostate cancer involves radical prostatectomy (RP) often resulting in iatrogenic damage to the periprostatic neurovascular bundles (NVB), leading to erectile dysfunction. The current study devised an experimental model involving bilateral cavernous nerve (CN) lesions in rats to replicate nerve damage close to the injury of the NVB in humans following radical prostatectomy.</p><p><strong>Methods: </strong>Fifteen adult male Wistar rats were divided as follows: control rats without surgery (CTRL group); rats underwent bilateral resection of 2 mm of CN repaired with a glycerol-blended chitosan membranes (CS-MEM group); rats underwent a total resection of both CN and major pelvic ganglion (RES group). Two months after surgery, membranes with regenerated nerves were analyzed morphologically, and for gene and protein expression for the evaluation of nerve regeneration and vascularization. Rat penises were assessed for smooth muscle content, morphology, and tissue arrangement. Primary sensory neuron cultures and DRG explants were cultured on micro-grooved chitosan-blended membranes, to evaluate axonal orientation on different topographies.</p><p><strong>Results: </strong>Regenerated nerve fibers and newly formed vessels colonized the whole CS-membrane. The regenerative process was also confirmed by gene and protein expression analyses. The target organ exhibited remodeling of smooth muscle tissue around sinusoidal spaces, indicating potential restoration of cavernous tissue. The quantitative analyses of α-actin smooth muscle (α-SMA) expression in CS-MEM groups displayed α-SMA protein signals comparable to controls. In-vitro experiments on micro-patterned membranes displayed oriented axonal growth, showing valuable insights into the ways in which topographical features can be considered for a more effective performance in vivo.</p><p><strong>Conclusions: </strong>Chitosan-blended membranes promote nerve fiber regeneration in an in-vivo model of nerve lesion that resembles the damage to the NVB occurring in men after radical prostatectomy. These results highlight the promising potential of this device in the clinical urological field, thus suggesting that the application of orientated micro-patterned membranes could further improve nerve regeneration.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"91-110"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782048","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":"Robot-assisted redo ureteral reimplantation in adults after failed primary surgery: technique and outcomes from two centers.","authors":"Liqing Xu, Xinfei Li, Fangzhou Zhao, Zhihua Li, Guanpeng Han, Wencong Han, Yaming Gu, Bing Wang, Peng Zhang, Wenzhi Gao, Liang Cui, Liqun Zhou, Kunlin Yang, Xuesong Li","doi":"10.23736/S2724-6051.24.06009-9","DOIUrl":"10.23736/S2724-6051.24.06009-9","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report our technical experience and mid-term outcomes of robot-assisted redo ureteral reimplantation in adults following failed primary ureteral reimplantation.</p><p><strong>Methods: </strong>Twelve patients underwent robot-assisted redo ureteral reimplantation from December 2020 to May 2022 at double centers. Surgical procedures included anti-reflux dismembered submucosal tunnel reimplantation, anti-reflux dismembered nipple reimplantation, and anti-reflux non-dismembered submucosal tunnel reimplantation. The perioperative variables were prospectively collected, and the outcomes were assessed.</p><p><strong>Results: </strong>Twelve patients underwent 13 robot-assisted redo ureteral reimplantations. Anastomotic stenosis was the primary cause of redo surgery, accounting for 83.3% of cases. Additionally, 83.3% of patients had received balloon dilation, stent placement, and other urological treatments after primary surgery. All patients successfully underwent robot-assisted redo ureteral reimplantation without conversion to open or laparoscopic surgery. All patients underwent anti-reflux technique, with 9 patients undergoing submucosal tunnel reimplantation (75%) and 3 nipple reimplantation (25%). Psoas hitch was required in eight patients (66.7%). The mean operative time was 129.3±29.0 minutes. The median postoperative hospitalization time was 3.0 (IQR, 3.0, 3.0) days. At a mean follow-up of 15.7±5.9 months, all patients achieved complete success with no severe complication. Two patients (16.7%) still experienced vesicoureteral reflux related symptoms postoperatively, which improved compared to preoperatively.</p><p><strong>Conclusions: </strong>Robotic redo ureteral reimplantation is safe and effective. The success of redo surgery is attributed to preoperative nephrostomy, clearing the fibrous scar surrounding the ureter, appropriate selection of anti-reflux technique, and psoas hitch when needed.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"69-78"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774623","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 narrative review on extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy in patients with anomalous kidneys.","authors":"Angelo Cormio, Matteo Mantovan, Vanessa Palantrani, Mattia Beltrami, Demetra Fuligni, Valerio Passarella, Vanessa Cammarata, Carlo Brocca, Bhaskar K Somani, Vineet Gauhar, Giuseppe Carrieri, Luigi Cormio, Andrea B Galosi, Daniele Castellani","doi":"10.23736/S2724-6051.25.06001-X","DOIUrl":"10.23736/S2724-6051.25.06001-X","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this paper was to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) in kidney stone patients with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).</p><p><strong>Evidence acquisition: </strong>A literature search was performed on 15th November 2023 and updated on 18^th October 2024 using Cochrane Central Register of Controlled Trials, PubMed, Scopus and Google Scholar with no date limit. Preclinical and animal studies, reviews, letters to editor, case reports, pediatric studies were excluded. Only English papers were included.</p><p><strong>Evidence synthesis: </strong>Forty-one articles were accepted. Seventeen studies focused on horse-shoe kidney (HSK). Among these, 3 papers focused on RIRS, 9 on PCNL, 5 compared RIRS vs PCNL. The remaining ones explored SWL, RIRS, PCNL in ectopic, malrotated and medullary sponge kidney and caliceal diverticulum stones. HSK, caliceal diverticulum and malrotated kidneys stones treated with SWL have poor stone-free rate, while the best choices are PCNL and ureteroscopy. In ectopic kidneys the best choice is ureteroscopy, SWL has poor stone-free rate, while PCNL is less safe for higher bowel injury risk. In medullary sponge kidneys regardless of the treatment used, stone-free rate is low, with a higher rate of retreatment.</p><p><strong>Conclusions: </strong>SWL has lower stone-free rate and higher retreatment in all types of CAKUT but has the lowest rate of complications. PCNL has the best stone-free rate in large stone burdens and RIRS is effective procedure although higher reintervention rate and need of pre-stenting in some cases.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"43-51"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781939","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":"Life's Essential 8 and kidney stones in US adults: mediating roles of HDL and insulin resistance.","authors":"Qinglong Yang, Hanyuan Lin, Xuan Zhang, Haoxian Tang, Jingtao Huang, Nan Luo, Qingtao Yang","doi":"10.23736/S2724-6051.24.05774-4","DOIUrl":"10.23736/S2724-6051.24.05774-4","url":null,"abstract":"<p><strong>Background: </strong>The rising incidence of kidney stones underscores the imperative to devise effective preventive measures. While a robust association between cardiovascular disease (CVD) and kidney stones exists, the current research landscape lacks investigations between cardiovascular health (CVH) and kidney stones. This study aims to explore the association between CVH, assessed by Life's Essential 8 (LE8), and kidney stones, with the role of blood lipids and insulin resistance in this relationship.</p><p><strong>Methods: </strong>The study included 19,942 adults aged ≥20 from the National Health and Nutrition Examination Survey of the US from 2007 to 2018. LE8, measuring CVH, includes four behavior and four factor metrics. Participants were categorized into high, moderate, and low CVH levels according to LE8 Scores: 80-100, 50-79, and 0-49, respectively. Kidney stones cases were identified through interviews and self-reported records. Weighted multivariate linear regressions, weighted logistic regressions, restricted cubic spline (RCS) analysis, mediation analyses, and sensitivity analyses were conducted.</p><p><strong>Results: </strong>In the fully adjusted logistic model, 10-point increase in LE8 Score exhibited a significant 19% reduction in kidney stones prevalence (OR=0.81, 95% CI: 0.77-0.85). The RCS confirmed the nonlinear association between LE8 Score and kidney stones (P for non-linearity: 0.004). Mediation analyses showed the mediation proportions of 19.62%, 24.26%, and 27.82% for high-density lipoprotein (HDL), insulin resistance (HOMA-IR), and serum insulin, respectively. The mediation proportions of the HOMA-IR-HDL and serum insulin-HDL pathways were 6.62% and 5.96%, respectively.</p><p><strong>Conclusions: </strong>This study illuminates a negative association between CVH and kidney stones, providing an effective strategy for kidney stones prevention.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"120-129"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958768","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":"Giant cell inflammatory reaction to hemostatic cellulose matrix mimicking renal cell carcinoma recurrence.","authors":"Riccardo Bertolo, Francesco Cianflone, Riccardo Negrelli, Giovanni Corghi, Michele Boldini, Francesco Ditonno, Luca Roggero, Antonio B Porcaro, Alessandro Veccia, Elena Marastoni, Stefano Gobbo, Matteo Brunelli, Mirko D'Onofrio, Alessandro Antonelli","doi":"10.23736/S2724-6051.24.06210-4","DOIUrl":"10.23736/S2724-6051.24.06210-4","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"6-12"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958849","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 pretreatment nomogram to predict muscle-invasiveness in high-risk upper tract urothelial carcinoma (ROBUUST 2.0 collaborative group).","authors":"Francesco Ditonno, Antonio Franco, Eugenio Bologna, Alessandro Veccia, Riccardo Bertolo, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andres Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Enrico Checcucci, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Stephan Broenimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P Sundaram, Farshad S Moghaddam, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, Zhenjie Wu, Alessandro Antonelli","doi":"10.23736/S2724-6051.25.05934-8","DOIUrl":"10.23736/S2724-6051.25.05934-8","url":null,"abstract":"<p><strong>Background: </strong>The ability to predict muscle invasion in the final pathology of upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) potentially influences the selection of the most appropriate treatment modality. The present study aims to develop a model predicting muscle-invasive status in high-risk UTUC.</p><p><strong>Methods: </strong>The ROBUUST (RObotic surgery for Upper tract Urothelial cancer - UTUC - STudy) 2.0 dataset is an international, multicenter registry of patients undergoing curative surgery for UTUC between 2015 and 2022. Data about high-risk patients, classified according to EAU and NCCN prognostic stratification criteria, who underwent RNU were retrieved. The primary outcome was the identification of muscle-invasiveness. Two multivariable models, differing in the inclusion of biopsy-related data, were fitted with pT stage results at final pathology. Their predictive ability was calculated using the area under the receiver operating characteristic curve and decision curve analysis (DCA). A nomogram was developed using the model demonstrating the highest area under the curve (AUC) and clinical net benefit.</p><p><strong>Results: </strong>In the overall cohort, 1558 patients met the inclusion criteria, with 934 patients having ≥pT2 disease. Patients in the ≥pT2 cohort had significantly worse oncological outcomes in terms of metastases, all-cause, and cancer-specific deaths (all P<0.001). The biopsy-related model had the highest AUC (74%) and the highest net benefit in DCA. The DCA showed an improvement in the clinical risk prediction of muscle-invasiveness, and a reduction in the number of upfront or unnecessary RNU, at every ≥pT2 probability threshold.</p><p><strong>Conclusions: </strong>The proposed prognostic model is a valuable tool for estimating the risk of muscle-invasiveness in high-risk UTUC patients, owing to its optimal predictive ability and user-friendly design.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 1","pages":"57-68"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782068","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":"Which is easier for beginners: supine or prone position percutaneous nephrolithotomy? Assessment of the learning curve in novice urologists through a randomized clinical trial.","authors":"Ahmed Zoeir, Hussein Mamdoh, Ayman Moussa, Ali Abdel-Raheem, Tarek Gameel, Ahmed Elsherbeny, Abdullah Al Debeiky, Khaled Almekaty, Maged Ragab, Ahmed Tawfik, Stefano Puliatti, Stefania Ferretti, Salvatore Micali, Silvia Proietti, Mon Mon Oo, Guido Giusti, Osama Elashry, Abdelhamid Elbahnasy, Magdy Sabaa, Mohamed Abo El-Enen, Giampaolo Bianchi, Ahmed Eissa","doi":"10.23736/S2724-6051.24.05974-3","DOIUrl":"10.23736/S2724-6051.24.05974-3","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. \"Learning curve\" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners.</p><p><strong>Methods: </strong>One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications.</p><p><strong>Results: </strong>The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups.</p><p><strong>Conclusions: </strong>Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 6","pages":"748-758"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016190","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}