BMC Urology最新文献

{"title":"The modified retroperitoneal laparoscopic adrenalectomy overcomes adhesive periadrenal fat and achieves superior outcomes than classical approach: a retrospective study.","authors":"Minxiong Hu, Wenchao Cai, Yupeng Chen, Xiao Xu, Yangbiao Wu, Yangpeng Lian, Qinguo Zhu, Liefu Ye","doi":"10.1186/s12894-025-01809-4","DOIUrl":"https://doi.org/10.1186/s12894-025-01809-4","url":null,"abstract":"<p><strong>Objectives: </strong>Mayo adhesive probability (MAP) score affects the outcomes of adrenaletomy. Aimed to determine whether the modified retroperitoneal laparoscopic adrenalectomy (MRLA) overcomes periadrenal fat adhesion compared to Classical retroperitoneal laparoscopic adrenalectomy (CRLA) to achieve better surgical outcomes.</p><p><strong>Patients and methods: </strong>Patients admitted from January 2016 to December 2022 were retrospectively analyzed and systematically categorized into two distinct cohorts: the MRLA group and the CRLA group, based on specific criteria.The main surgical techniques modified of MRLA is third separation level: between the edge of adrenal gland and the peripheral renal fat. The baseline characteristics and perioperative data, e.g., age, gender, BMI, tumor position, tumor size (cm), MAP score, P distance (cm), perinephric stranding, and periadrenal stranding, estimated blood loss, Operating time, were analyzed, with statistical significance defined as p < 0.05. We analyzed the differences between groups using the t test. For measurement data that didn't follow normal distribution, we described the concentration and dispersion trended using M (Q25, Q75) and analyzed the differences between groups using the M-U test. For data that met certain conditions like being linear, normal and independent, we used linear regression analysis. For binary classification of dependent variables, we used binary logistic regression analysis.</p><p><strong>Results: </strong>A total of 731 patients underwent adrenaletomy, and 651 patients had adequate data, were available for MAP score assessment. Of these patients, 247 were in the MRLA group, whereas 404 were in the CRLA group, baseline characteristics weren't found to be different between the two groups (p > 0.05). The MRLA group exhibited superior outcomes in terms of operating time, duration, postoperative hospital stay, estimated blood loss, and complications, in comparison to the CRLA group. Further analysis revealed that periadrenal stranding could be the underlying cause for this discrepancy.</p><p><strong>Conclusions: </strong>The MRLA effectively overcame the impact of adhesive periadrenal fat (APAF) compared to CRLA. We recommend to employ the MRLA for patients with preoperative CT images indicating periadrenal fat adhesion.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"143"},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroiliac ureter with persisting mesonephric duct and vesicoureteral reflux presenting as left inguinal mass during defecation: a case report.","authors":"Yijun Zhao, Linfeng Zhu, Fan Yang, Guangjie Chen","doi":"10.1186/s12894-025-01827-2","DOIUrl":"https://doi.org/10.1186/s12894-025-01827-2","url":null,"abstract":"<p><strong>Background: </strong>Retroiliac ureter is an extremely rare congenital anomaly, even more rarely accompanied by persisting mesonephric duct and vesicoureteral reflux(VUR). We report such a unique case involving a left inguinal mass that appeared during defecation.</p><p><strong>Case presentation: </strong>A two-year-old boy presented with a tubular structure resembling a dilated ureter discovered incidentally during open left inguinal hernia repair. Contrast radiography and voiding cystourethrogram(VCUG) revealed a tubular structure in the left groin mimicking a ureter, with grade IV reflux into a branch-shaped left renal pelvis. Three-dimensional CT reconstruction demonstrated a dilated left ureter and a tubular structure distortion, angulation, and depression at the L5-S1 level. Cystoscopy showed the left ureteral orifice near the midline of bladder trigone. Laparoscopic exploration revealed an abnormally deep aortic bifurcation in the left iliac fossa, superior to the left ureter and the tubular structure. The left vas deferens was absent, while the tubular structure traversed the internal ring with the left spermatic vessels and inserted into the distal ipsilateral ureter. Four years later, the patient was readmitted due to decreased left renal function. VCUG persistent left-sided grade IV VUR. Robot-assisted laparoscopic left ureter reimplantation via the Lich-Gregoir technique was conducted, along with resection of the abdominal and inguinal segment of the dilated tubular structure and closure of the ipsilateral internal ring. The tubular structure was ultimately confirmed as an abnormally dilated left vas deferens, and the diagnosis of retroiliac ureter accompanied by persisting mesonephric duct and VUR was made. At the 3-month follow-up, ultrasonography revealed mild hydronephrosis and ureteral dilation of left kidney.</p><p><strong>Conclusion: </strong>Diagnosing retroiliac ureter with persisting mesonephric duct and VUR is challenging. Although imaging provide critical information, surgical exploration is often required for definitive diagnosis. Treatment involves vas deferens excision and ureteral reimplantation to preserve renal function.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"142"},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of factors predicting adherent perinephric fat in laparoscopic retroperitoenal partial nephrectomy.","authors":"Samet Senel, Antonios Koudonas, Fatih Sandikci, Jens Rassweiler","doi":"10.1186/s12894-025-01826-3","DOIUrl":"https://doi.org/10.1186/s12894-025-01826-3","url":null,"abstract":"<p><strong>Background: </strong>Adherent perinephric fat (APF) represents a clinical situation, which increases the complexity of renal surgery. We aimed to elucidate the common characteristics of patients with APF and to evaluate the extent of outcome differentiation depending on the presence of APF.</p><p><strong>Methods: </strong>We made a retrospective review of a prospectively maintained database of patients who underwent laparoscopic retroperitoneal partial nephrectomy for a localized renal tumor at our institution from May 2010 to January 2022. 238 patients were included in this study. Demographic, intraoperative, postoperative data and characteristics and comorbidities of all patients were evaluated. Radiographic data (tumor size, localization, side, exophytic rate, perinephric fat density [PFD]) were determined from preoperative contrast-enhanced abdominal computed tomography imaging studies. Adherent perinephric fat was classified intraoperatively by the operating surgeon. The patients were divided into two groups as the APF group and the non-APF group and predictors causing APF were investigated.</p><p><strong>Results: </strong>Intraoperative and postoperative complication rates were higher in the APF group, but the difference between intraoperative complication rates, operation duration and amount of bleeding were statistically significant. (11.6% vs. 5.9%, p = 0.033; 130 vs. 120 min, p = 0.024; 60 vs. 30 cc, p = 0.016, respectively). The most common complications were conversion to open surgery due to failure of dissection of the tumor and bleeding requiring intraoperative transfusion in the groups. On multivariable analysis using stepwise regression model, we identified male gender (OR = 3.328; 95% Cl = 1.552-7.133; p = 0.002), PFD>-100.4 Hounsfield Unit (HU) (OR = 3.24; 95% Cl = 1.549-6.777; p = 0.002) and presence of diabetes mellitus (DM) (OR = 2.513; 95% Cl = 1.192-5.299; p = 0.015), as predictor of APF.</p><p><strong>Conclusion: </strong>Male gender, presence of DM and PFD>-100.4 HU are predictors of APF. This endpoint is promising for application in gaining knowledge preoperatively about the dissection difficulty level.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"141"},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of apparent diffusion coefficient values and magnetic resonance imaging histogram analysis for identifying histological types of preoperative testicular tumors.","authors":"Yuka Yasuda, Akiyoshi Osaka, Keita Izumi, Toshiyuki Iwahata, Akinori Nakayama, Kazunori Kubota, Kazutaka Saito","doi":"10.1186/s12894-025-01825-4","DOIUrl":"https://doi.org/10.1186/s12894-025-01825-4","url":null,"abstract":"<p><strong>Background: </strong>Only a few studies have performed histogram analysis for the differential diagnosis of testicular tumors. Therefore, the aim of this study was to evaluate the ability of magnetic resonance imaging, including diffusion-weighted imaging with apparent diffusion coefficient values, to differentiate between the histological types of testicular tumors.</p><p><strong>Methods: </strong>Of the 156 testicular tumors diagnosed at our hospital between January 2010 and July 2023, 65 cases diagnosed with magnetic resonance imaging were included. Tumors were categorized as seminoma, non-seminoma, and malignant lymphoma. Apparent diffusion coefficient values were calculated and analyzed using the ratio to non-tumor testes and histograms according to tumor subtypes.</p><p><strong>Results: </strong>Among the 65 cases, 46, 14, and 5 entailed seminomas, non-seminomas, and malignant lymphomas, respectively. The apparent diffusion coefficient value ratio of seminomas (0.745 ± 0.132) was significantly higher than that of malignant lymphomas (0.531 ± 0.119, p = 0.013), and the apparent diffusion coefficient value ratios of non-seminomas (1.197 ± 0.430) were significantly higher than those of seminomas and malignant lymphomas (p = 0.0013 and p < 0.001, respectively). Seminomas and malignant lymphomas had significantly higher kurtosis values (8.55 ± 5.76 and 18.11 ± 5.22, respectively) than non-seminomas (4.92 ± 3.85, p = 0.012 and p = 0.0022, respectively). Malignant lymphomas had significantly higher kurtosis values than seminomas (p = 0.0123). Seminomas and malignant lymphomas had significantly higher skewness values (1.77 ± 1.00 and 3.12 ± 0.28, respectively) than non-seminomas (0.52 ± 1.17, p = 0.0016 and p < 0.001, respectively). Malignant lymphomas had higher skewness than seminomas (p < 0.001).</p><p><strong>Conclusions: </strong>The present results demonstrate the efficacy of magnetic resonance imaging with apparent diffusion coefficient values and histograms in the differentiation of testicular tumor subtypes. A pre-operative diagnosis of testicular tumor subtypes may enable more effective management of testicular tumors, including pre-operative counseling and early treatment planning.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"140"},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of greenlight laser in ureteroscopic parapelvic cyst incision: a retrospective analysis.","authors":"Yongxiang Shao, Meng Cheng, Conglei Hu, Lingchen Kong, Zilong Liang, Haofeng Pang, Haiyang Du, Liping Yao, Qian Zhang, Fei Liu","doi":"10.1186/s12894-025-01813-8","DOIUrl":"https://doi.org/10.1186/s12894-025-01813-8","url":null,"abstract":"<p><strong>Objective: </strong>Different surgical managements for parapelvic cysts may vary in efficacy and safety. Considering the distinct characteristics of greenlight laser, this study aimed to compare three treatments for parapelvic cysts: flexible ureteroscopic internal incision and drainage with greenlight laser, or with holmium laser, and retroperitoneal laparoscopic cyst unroofing. The focus was on evaluating and contrasting the advantages of greenlight versus holmium laser in this context.</p><p><strong>Patients and methods: </strong>A total of 62 patients with parapelvic cysts who underwent surgical treatment from January 2018 to January 2023 and met the inclusion and exclusion criteria were retrospectively collected. All patients received CT or ultrasound examination, and were diagnosed with parapelvic cysts by radiologists and urologists. Patients were divided into three groups according to treatment: (1) flexible ureteroscopy with greenlight laser internal incision (n = 18), (2) flexible ureteroscopy with holmium laser internal incision (n = 21), and (3) laparoscopic cyst unroofing decompression (n = 23). Outcomes of the 3 groups were analyzed. The safety and effectiveness of the three surgical methods were evaluated by comparing the imaging examination data before and 6 months after the operation.</p><p><strong>Results: </strong>There were no significant differences in age, gender, side, or size of the cysts among the three groups. Shorter operation time, less intraoperative blood loss, and fewer postoperative complications were observed in flexible ureteroscopic laser endotomy groups, compared to laparoscopic group.</p><p><strong>Conclusion: </strong>Flexible ureteroscopic laser internal incision demonstrated several advantages over laparoscopic surgery, including shorter operation time and less blood loss. The greenlight laser exhibited obvious advantage of shorter incision time in the treatment of parapelvic cyst, which made it worthy of clinical application. Our findings might provide evidence to the selection of ideal methods for treating parapelvic cysts.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"139"},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-depth exploration and initial clinical practice of the ratio of endoscope-sheath diameter theory: smaller flexible ureteroscope with smaller ureteral access sheath.","authors":"Haowen Gu, Pengfei Qin, Jian Shan, Guohai Xie, Jiasheng Hu, Qiang Li, Ting Huang, Jingyu Shi, Yue Cheng, Zejun Yan, Li Fang","doi":"10.1186/s12894-025-01823-6","DOIUrl":"https://doi.org/10.1186/s12894-025-01823-6","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the outcomes of combining a 7.5Fr flexible ureteroscope (fURS) with a 10/12F ureteral access sheath (UAS) through a comprehensive in vitro and in vivo evalu-ation.</p><p><strong>Methods: </strong>We conducted a comparative analysis, evaluating the impact of a 7.5Fr fURS in contrast to others on in trapelvic pressure (IPP) and perfusion fluid flow rate (PFFR) in vitro. This assessµent involved varying ratios of endoscope-sheath diaµeter (RESDs). Subsequently, we prospectively enrolled 23 patients with renal calculi <2 cm who underwent laser lithotripsy using the coµbination of a 7.5Fr fURS and a 10/12F UAS. The patients' profiles, including preoperative, operative inforµation and postoperative coµplications, were recorded.</p><p><strong>Results: </strong>In vitro experi-ments revealed that IPP and PFFR remained optimal when the RESDs were ≤ 0.75. Notably, only the 7.5Fr fURS ensured a safe IPP when combined with a 10/12F UAS. In clinical research, the sheath placement success rate was 100%, with an average operation time of 55.0 ± 20.0 min and a lithotripsy time of 150.4 ± 199.0 s. Mild ureteral injury necessitated the retention of a double-J stent in five cases for a month. The hospitalization duration and 24-h pain score averaged 45.6 ± 15.5 h and 4.3 ± 3.5, respectively. The one-month stone-free rate was 91.3%. Regarding stent-related symptoms, the overactive bladder symptom score averaged 1.7 ± 1.5, the international prostate symptom score was 3.3 ± 2.8, and the quality of life was 1.3 ± 1.7.</p><p><strong>Conclusions: </strong>Combining a 7.5Fr fURS with a 10/12Fr UAS is recommended as a secure option for treating renal calculi < 2 cm. Postoperative pain management is a future concern.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"138"},"PeriodicalIF":1.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The comparison of outcomes between neoadjuvant novel and classical hormonal therapy in patients with locally advanced prostate cancer: a retrospective study.","authors":"Zhen Yang, Yang Liu, Yuan Shao, Yudong Wu, Yong Wang, Jianing Guo, Zihao Liu, Hua Huang, Jing Tian, Yuanjie Niu, Simeng Wen","doi":"10.1186/s12894-025-01811-w","DOIUrl":"10.1186/s12894-025-01811-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the outcomes of neoadjuvant novel hormonal therapy (NHT) versus classical hormonal therapy (CHT) before radical prostatectomy (RP) in patients with locally advanced prostate cancer.</p><p><strong>Methods: </strong>Propensity score matching (2:1) was performed to minimize the effect of confounders at our center. We retrospectively analyzed 99 patients who received neoadjuvant hormonal therapy for 3-6 months from March 2019 to April 2023. The novel hormonal agents included apalutamide, darolutamide, or enzalutamide, whereas the classical hormonal agent was bicalutamide. The primary endpoint was pathological response. Secondary outcomes included prostate specific antigen (PSA) complete response rate, biochemical recurrence-free survival (bRFS), and biochemical response rate.</p><p><strong>Results: </strong>After propensity score matching, 63 patients were matched to the CHT group and 36 patients were matched to the NHT group. All patients received androgen deprivation therapy. Pathological response Group 0 was not observed in either group; 41.3% (26/63) of patients in the CHT group achieved a complete response (Group 1), compared with 52.8% (19/36) in the NHT group. Neoadjuvant NHT showed significant advantages over CHT in reducing prostate volume (p < 0.001), downstaging (p = 0.012), and the PSA complete response rate (p = 0.002). PSA complete response was an independent predictor for complete response (OR 2.8, 95%CI 1.14-6.88, p = 0.025). Neoadjuvant NHT also demonstrated a significant improvement in bRFS compared with CHT, and there was a 70% lower risk of biochemical recurrence in the NHT group (HR 0.3, 95% CI 0.17-0.55, p = 0.0006).</p><p><strong>Conclusion: </strong>Neoadjuvant NHT resulted in superior pathological responses and PSA responses compared with neoadjuvant CHT in patients with locally advanced prostate cancer. Lower PSA values prior to RP were associated with complete response. Our findings highlighted a significant benefit of neoadjuvant NHT in improving bRFS.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"136"},"PeriodicalIF":1.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of tumor-infiltrating lymphocytes and depth of invasion in T1 bladder cancer: a retrospective analysis.","authors":"Busra Yaprak Bayrak, Hatice Nese Dogan, Kerem Teke, Hakkıcan Yuvak, Ozdal Dillioglugil","doi":"10.1186/s12894-025-01822-7","DOIUrl":"10.1186/s12894-025-01822-7","url":null,"abstract":"<p><strong>Background: </strong>Tumor-infiltrating lymphocytes (TILs) are integral components of the tumor microenvironment and have been extensively studied across various cancers. In bladder cancer, the prognostic significance of TILs remains uncertain. This study aimed to analyze the impact of muscularis mucosa invasion and TILs ratios on clinical outcomes, tumor aggressiveness, and prognosis in pT1 urothelial carcinoma of the bladder.</p><p><strong>Methods: </strong>This retrospective study included 154 patients with pT1 bladder urothelial carcinoma, categorized into pT1a and pT1b groups based on the extent of muscularis mucosa invasion. TILs ratios were stratified into three groups: <1%, 1-5%, and > 5%. Clinical and pathological characteristics, including tumor diameter, necrosis, tumor thickness, recurrence, and progression rates, were compared. Depth of invasion and tumor features were assessed using standard histopathological methods. Recurrence and progression-free survival (PFS) were evaluated during a median follow-up of 20 months.</p><p><strong>Results: </strong>By definition, pT1b tumors demonstrated significantly deeper invasion into the muscularis mucosa (p < 0.0001) compared to pT1a tumors. They were also associated with larger tumor diameter (p = 0.023), greater tumor thickness (p < 0.0001), and increased necrosis (p = 0.0012). Radical cystectomy was performed more frequently in pT1b patients (19.2%) than in pT1a patients (7.9%), although recurrence and PFS rates did not differ significantly between the groups. Higher TILs ratios were linked to increased tumor thickness (p = 0.0299) and more extensive invasion into TURBT chips (p = 0.0025), but no significant differences in recurrence or PFS rates were observed across TILs groups.</p><p><strong>Conclusions: </strong>Muscularis mucosa invasion is a defining feature of pT1b bladder cancer and serves as a key indicator of tumor aggressiveness. While TILs were associated with aggressive tumor characteristics, their prognostic role remains inconclusive. These findings highlight the need for aggressive management strategies for pT1b disease and underscore the importance of further research into the complex interplay between TILs and tumor progression in bladder cancer.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"135"},"PeriodicalIF":1.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous single-tract bilateral percutaneous nephrolithotomy in bilateral large complex renal stones is not associated with increased complications: series of 36 consecutive patients.","authors":"Yu-Ming Shen, Pao-Hwa Chen","doi":"10.1186/s12894-025-01821-8","DOIUrl":"10.1186/s12894-025-01821-8","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous bilateral percutaneous nephrolithotomy (PCNL) offers the advantage of treating stones in both kidneys, thereby reducing the need for multiple surgeries. Due to the limited number of cases, simultaneous PCNL has unwarranted safety and efficacy concerns. This study aimed to evaluate the complications and stone-free rates of simultaneous bilateral PCNL in the treatment of bilateral large complex stones and to compare different access methods.</p><p><strong>Method: </strong>Between January 2012 and December 2022, 36 consecutive patients who underwent simultaneous bilateral PCNL for large complex renal stones were enrolled. Guy's stone score (GSS) was used to assess the complexity of stone. The preoperative, intraoperative, and post-operative parameters were assessed. The patients were first categorized based on channel size (conventional vs. mini-PCNL), and then further sub-grouped according to specific combinations of tract size and dilation method for comparative analysis.</p><p><strong>Results: </strong>Thirty-six consecutive patients (72 renal units) underwent simultaneous bilateral PCNL. The median stone burden was 602.43 mm2 (interquartile range: 225-1332.72 mm2), mean surgical duration was 70.9 ± 29.6 minutes for each renal unit (range, 30-140 minutes), and the mean hematocrit reduction was 6.8±8.4%. The mean length of stay was four days, and the stone-free rate was 81.9%. Notably, eGFR (estimated Glomerular filtration rate) values showed significant improvement at one-year follow-up (p < 0.001), with 29.4% of patients showing clinical downstaging. The overall complication rate was 16.7%, with the majority of complications being transient fever. Mini-PCNL had a shorter length of stay (p < 0.05). The complication rates for Amplatz, balloon, and mini-PCNL were 13.3%, 23.1%, and 12.5%, respectively. The post-operative radiographic stone-free rate (SFR) for 72 renal units was 81.9%, with the highest rate in the mini-PCNL group (93.7%).</p><p><strong>Conclusions: </strong>There was no increase in the rate of complications compared to unilateral PCNL. This study provides valuable insights into surgical outcomes using different access methods.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"137"},"PeriodicalIF":1.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram for predicting risk factors of postoperative residual stones in patients after pure ultrasonography-guided access mini-percutaneous nephrolithotomy.","authors":"Fuyang Lin, Chao Cai, Huan Deng, Jianpeng Zhang, Mengting Wang, Sizhe Wang, Zezhen Liu, Yongda Liu","doi":"10.1186/s12894-025-01819-2","DOIUrl":"10.1186/s12894-025-01819-2","url":null,"abstract":"<p><strong>Background: </strong>Some urologists prefer to perform PCNL by using pure ultrasonography-guided access (USGA), but some potential factors that may cause the residual stones need to be excavated. This retrospective case-control study is designed to confirm the risk factors for residual stones after pure USGA mini-percutaneous nephrolithotomy (mPCNL) in patients and develop a nomogram for predicting postoperative residual stones based on the risk factors.</p><p><strong>Methods: </strong>From October 2019 to August 2021, our department recorded a retrospective record of 227 patients with kidney stones treated with pure USGA mPCNL. The risk factors for postoperative residual stones were confirmed by univariate and multivariate logistic regression analysis, and a nomogram was developed. As a result, the nomogram was accessed with discrimination, calibration, and clinical applicability in mind.</p><p><strong>Results: </strong>The rate of residual stones in patients was 34.4% during the management of USGA mPCNL. The independent risk factors for residual stones were history of ipsilateral PCNL surgery (OR = 3.163, P = 0.020 ), calyx number with stones (OR = 5.628, P = 0.006 ), stone burden (OR = 1.004, P = 0.008 ). Calculated by receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.884 (95% CI 0.829-0.940). The concordance index (C-index) of calibration curves was 0.842, meaning good concordance. The clinical decision curve analysis (DCA) showed a good clinical practicability in clinical practice.</p><p><strong>Conclusions: </strong>Patients with history of ipsilateral PCNL surgery, calyx number with stones and stone burden may be at increased risk of residual stones. The nomogram can evaluate the risk of residual stones in patients who undergo USGA mPCNL.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"25 1","pages":"134"},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}