The latest medical research on Urology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about urology gathered by our medical AI research bot.

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Miniaturised ultrasound evaluation at the bedside.

World Journal of Diabetes

"Point-of-Care Ultrasound" (POCUS) is now a familiar term. Although the European Federation of Societies for Ultrasound in Medicine and Biology (ESFUMB) published a position paper about its usage (Nielsen et al. in Ultraschall Med 40(1):30-39. https://doi.org/10.1055/a-0783-2303 , 2019), there has not been much scientific focus on its utility in uro-nephrological clinical practice thus far. The aim of this study was to evaluate the present usage of pocket ultrasound devices at the bedside.

27 investigators (all medical doctors with at least 6 months of experience in sonography) performed 280 bedside examinations using a pocket ultrasound device for common clinical issues.

The most frequent indications included evaluation of hydronephrosis (147), volume management including assessment of dimension of the vena cava inferior (IVC) (195), detection of pleural, pericardial and abdominal effusions (113) as well as residual urine (52). In 90%, specific clinical questions were effectively answered by the pocket ultrasound device alone.

POCUS can be useful in the uro-nephrological field. In the hands of an experienced investigator, it saves time and, when it is realised that departmental ultrasound is not cheap, there is also an economic benefit with applicability within both inpatient and outpatient clinic settings. While acknowledging its technical limits, pocket ultrasound devices may nevertheless be helpful in targeted situations for triage or for bedside follow-up exams after earlier high-end ultrasound-based diagnosis.

The stability investigation of variable viscosity control in the human-robot interaction.

Int J Med

For many co-manipulative applications, variable damping is a valuable feature provided by robots. One approach is implementing a high viscosity at low velocities and a low viscosity at high velocities. This, however, is proven to have the possibility to alter human natural motion performance.

We show that the distortion is caused by the viscosity drop resulting in robot's resistance to motion. To address this, a method for stably achieving the desired behavior is presented. It involves leveraging a first-order linear filter to slow the viscosity variation down.

The proposition is supported by a theoretical analysis using a robotic model. Meanwhile, the user performance in human-robot experiments gets significantly improved, showing the practical efficiency in real applications.

This paper discusses the variable viscosity control in the context of co-manipulation. An instability problem and its solution were theoretically shown and experimentally evidenced through human-robot experiments. This article is protected by copyright. All rights reserved.

A novel virtual cutting method for deformable objects using high-order elements combined with mesh optimization.

Int J Med

Virtual cutting of deformable objects plays an important role in many applications, especially in digital medicine, such as soft tissue cutting in virtual surgery training system.

We developed a novel virtual cutting algorithm, combined with mesh optimization. A new local mesh processing method is used to control the number and quality of the elements created during the cutting process. At the same time, high-order tetrahedral elements are used to fit the cutting surface and reduce the mesh size.

In this paper, single cut, multiple cut and intersecting cut are performed on the mesh model, combined with a force feedback device, and the result obtained is that the visual feedback is higher than 30Hz, and the tactile feedback is 800∼1000Hz.

Experimental results show that the method proposed in this paper can effectively eliminate low-quality elements and control the mesh size, thereby ensuring real-time simulation. This article is protected by copyright. All rights reserved.

Evaluating post radical prostatectomy mechanisms of early continence.

Prostate

To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP).

We compared total continence results between four different techniques of robot-assisted radical prostatectomy (RARP). Specifically, we studied 1-week and 1-month zero-pad continence rates of anterior (n = 60), posterior (n = 59), a novel hybrid posterior-anterior (n = 12), and transvesical (n = 12) approaches of RARP. Each technique preserved a unique set of periprostatic anatomic structures, thereby, allowing evaluation of the individual impact of preservation of nerves, bladder neck, and space of Retzius with associated anterior support structures on early continence. Urethral length was preserved in all approaches. The space of Retzius was preserved in posterior and transvesical approaches, while the bladder neck was preserved in posterior and hybrid approaches. Nerve sparing was done per preoperative oncological risk. For all patients, 24-h pad usage rates and 24-h pad weights were noted at 1 week and 1 month after catheter removal. Multivariable logistic regression analysis was performed to identify predictors of early continence. Data were obtained from prospective studies conducted between 2015 and 2021.

At 1 week, 15%, 42%, 45%, and 8% of patients undergoing anterior, posterior, hybrid, and transvesical RARP approaches, respectively, were totally continent (p = 0.003). These rates at 1 month were 35%, 66%, 64%, and 25% (p = 0.002), respectively. The transvesical approach, which preserved the space of Retzius but not the bladder neck, was associated with the poorest continence rates, while the posterior and hybrid approaches in which the bladder neck was preserved with or without space of Retzius preservation were associated with quickest urinary continence recovery. Bladder neck preservation was the only significant predictor of 1-week and 1-month total continence recovery in adjusted analysis, Odds ratios 9.06 (p = 0.001) and 5.18 (p = 0.004), respectively.

The beneficial effect of the Retzius-sparing approach on early continence recovery maybe associated with bladder neck preservation rather than space of Retzius preservation.

An update on the current status and future prospects of erectile dysfunction following radical prostatectomy.

Prostate

Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies.

This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research.

Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database.

Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies.

This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.

Guideline of guidelines: management of recurrent urinary tract infections in women.

BJU International

To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy.

PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI.

Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.

Optimised detection of germ cell neoplasia in situ in contralateral biopsy reduces the risk of second testis cancer.

BJU International

To evaluate if optimised and standardised diagnostic procedures would improve detection of germ cell neoplasia in situ (GCNIS) in the contralateral testis of patients with testicular germ cell tumour (TGCT), and decrease the rate of metachronous tumours, which in the nationwide Danish study was estimated as 1.9%.

This is a retrospective analysis of the outcome in 655 patients with TGCT who underwent contralateral biopsies (1996 - 2007), in comparison to 459 non-biopsied TGCT controls (1984 -1988). The biopsies were performed using a standardised procedure with immunohistochemical GCNIS markers and assessed by experienced evaluators. Initial histopathology reports were reviewed, and pathology and survival data were retrieved from national Danish registers. In 604/608 patients diagnosed as GCNIS-negative (4 were lost to follow-up), the cumulative incidence of metachronous TGCT was estimated in a competing risk setting by the Gray method. All cases of metachronous TGCT were re-examined by immunohistochemistry.

GCNIS was found in 47/655 biopsied patients (7.2%, 95% CI 5.4-9.5%). During the follow-up period (median 17.3 years) five of the 604 GCNIS-negative patients developed a TGCT. In 1/5 false-negative biopsies GCNIS was found upon revision and 2/5 biopsies were too small. The estimated cumulative incidence rate of the second tumour after 20 years of follow-up was 0.95% (95%CI 0.10%-1.8%) compared with 2.9% (1.3%-4.4%) among the non-biopsied TGCT patients (p=0.012). The estimates should be taken with caution due to small numbers of men with metachronous TGCT.

Optimised diagnostic procedures improved the detection rate of GCNIS in patients with TGCT and minimized their risk of developing metachronous bilateral cancer. Urologists must be aware of the importance of the surgical procedure and an adequate biopsy size. Performing contralateral biopsies is beneficial for the patients' care and should be offered as a part of the management.

Operation Behaviors of Surgical Forceps in Continuous Circular Capsulorhexis.

Int J Med

Continuous circular capsulorhexis (CCC) is a delicate ophthalmic procedure which may benefit from robot technology. Measuring the behaviors (physiological tremor, operation force) of surgeons provides baseline data to develop assistive CCC robot.

A forceps with fiber bragg grating and inertial sensors is used to measure the surgeons' behaviors while experts/novices perform CCC on ex-vivo pig eyes, in-vivo rabbit eyes and ex-vivo human lens.

In pig / rabbit tests, the RMS tremor amplitude is 35.26 / 59.04 μm (expert/novice, transverse), 13.3 / 20.55 μm (axial). The RMS voluntary force (VF) and involuntary force (IF) are 8.97 / 17.16 mN, and 0.66 /1.90 mN, respectively. In human lens test, the RMS tremor amplitude is 24.0 μm (transverse, expert only), 9.88 μm (axial). The RMS VF and RMS IF are 9.04 mN (expert only) and 0.17 mN, respectively.

The expert surgeons have better precision and less operation force. This article is protected by copyright. All rights reserved.

Phase 1/2 Trial Results of a Large Surface Area Microparticle Docetaxel for the Treatment of High-Risk Non-muscle Invasive Bladder Cancer.

J Urol

We investigated the safety, preliminary efficacy, and immune effects of large surface area microparticle docetaxel (LSAM-DTX) administered by direct-injection after transurethral resection of bladder tumor (TURBT) and by intravesical instillation in high-risk non-muscle invasive bladder cancer (NMIBC).

The trial followed an open-label 3+3 dose-escalation with additional enrollment at the high-dose. After TURBT, subjects received direct-injection LSAM-DTX into the resection site and intravesical LSAM-DTX, followed by 6-week induction and 3-week maintenance intravesical LSAM-DTX courses. Tumor recurrence was evaluated by cytology, cystoscopy, or biopsy. Pharmacokinetic analysis of blood and multiplex immunofluorescence of tumor microenvironment occurred pre- and post-LSAM-DTX.

Nineteen subjects were enrolled, 14 with prior bacillus Calmette-Guérin (BCG) exposure and 16 with ≥1 prior TURBT. Direct-injection and intravesical LSAM-DTX were well-tolerated. In the three lowest dose-escalation cohorts the median recurrence free survival (RFS) was 5.4-months (n=10; median follow-up = 8.6-months). In the high dose and expansion cohorts median RFS was significantly increased (p<0.05; hazard ratio=0.29) to 12.2-months (n=9; median follow-up = 12.4-months). Systemic docetaxel exposure was negligible and increases in anti-tumor immune cells were found in the tumor microenvironment along with elevations in the PD-1, PD-L1 and CTLA-4 immune checkpoint inhibitor) targets.

Post-TURBT direct-injection and intravesical LSAM-DTX was well tolerated and demonstrated clinical response for patients with high-risk NMIBC. Favorable immune cell infiltration and checkpoint receptor increases following LSAM-DTX treatment warrants investigation alone as well as in combination with immune checkpoint inhibitor therapy.

Association between use of ERAS protocols and complications after radical cystectomy.

World Journal of Diabetes

Implementation of enhanced recovery protocols in cystectomy patients has significantly changed the perioperative course of this major operation. This paper summarizes evidence based interventions to enhance the postoperative course of radical cystectomy.

A comprehensive search of PubMed and Embase databases was performed and also the results of our institutional enhanced recovery protocol were discussed.

One of the major advantages of such changes is the reduced rate of postoperative gastrointestinal (GI) complications especially postoperative ileus which could be contributed to several components of these protocols. However, Alvimopan is the only component which its use is supported by level I evidence. Although there are some evidence suggesting the decreased rate of urinary tract infection with the use of prophylactic antibiotics and wound complications by the use of negative wound pressure devices, their clear benefit is yet to be shown. Although robotic approach has proven advantages in intraoperative blood loss and postoperative blood transfusion rate, surgical team's experience and dedicated infrastructure seem to be more influential in optimized outcome than just the surgical approach.

current evidence suggests that such protocols have not only reached the goal of maintaining complication rate while decreasing length of hospital stay, but it might have caused a decrease in the rate of low-grade complications, especially GI complications.

High intratumoral plasma cells content in primary prostate cancer defines a subset of tumors with potential susceptibility to immune-based treatments.

Prostate Cancer and Prostatic Diseases

Data on advanced prostate cancer (PCa) suggest more prior systemic therapies might reduce tumor immune responsiveness. In treatment-naïve primary PCa, recent work correlated intratumoral plasma cell content with enhanced tumor immune-responsiveness. We sought to identify features of localized PCa at a high risk of recurrence following local treatment with high plasma cell content to help focus future immune-based neoadjuvant trials.

We performed retrospective analyses of molecular profiles from three independent cohorts of over 1300 prostate tumors. We used Wilcoxon Rank Sum to compare molecular pathways between tumors with high and low intratumoral plasma cell content and multivariable Cox proportional hazards regression analyses to assess metastasis-free survival.

We validated an expression-based signature for intratumoral plasma cell content in 113 primary prostate tumors with both RNA-expression data and digital image quantification of CD138+ cells (plasma cell marker) based on immunohistochemisty. The signature showed castration-resistant tumors (n = 101) with more prior systemic therapies contained lower plasma cell content. In high-grade primary PCa, tumors with high plasma cell content were associated with increased predicted response to immunotherapy and decreased response to androgen-deprivation therapy. Master regulator analyses identified upregulated transcription factors implicated in immune (e.g. SKAP1, IL-16, and HCLS1), and B-cell activity (e.g. VAV1, SP140, and FLI-1) in plasma cell-high tumors. Master regulators overactivated in tumors with low plasma cell content were associated with shorter metastasis-free survival following radical prostatectomy.

Markers of plasma cell activity might be leveraged to augment clinical trial targeting and selection and better understand the potential for immune-based treatments in patients with PCa at a high risk of recurrence following local treatment.

Alternative- and focal therapy trends for prostate cancer: a total population analysis of in-patient treatments in Germany from 2006 to 2019.

World Journal of Diabetes

Focal therapy (FT) offers an alternative approach for prostate cancer (PCa) treatment in selected patients. However, little is known on its actual establishment in health care reality.

We defined FT as high-intensity focused ultrasound (HIFU), hyperthermia ablation, cryotherapy, transurethral ultrasound ablation (TULSA) or vascular-targeted photodynamic therapy (VTP) TOOKAD®. We analyzed the nationwide German hospital billing database for a PCa diagnosis in combination with FT. For analyses on the hospital level, we used the reimbursement.INFO tool based on hospitals' quality reports. The study period was 2006 to 2019.

We identified 23,677 cases of FT from 2006 to 2019. Considering all PCa cases with surgery, radiotherapy or FT, the share of FT was stable at 4%. The annual caseload of FT increased to a maximum of 2653 cases in 2008 (p < 0.001) and then decreased to 1182 cases in 2014 (p < 0.001). Since 2015, the cases of FT remained on a plateau around 1400 cases per year. The share of HIFU was stable at 92-96% from 2006 to 2017 and decreased thereafter to 75% in 2019 (p = 0.015). In 2019, VTP-TOOKAD® increased to 11.5% and TULSA to 6%. In 2006, 21% (62/299) of urological departments performed FT and 20 departments reached > 20 FT procedures. In 2019, 16% (58/368) of urological departments performed FT and 7 departments reached > 20 FT. In 2019, 25 urological departments offered FT other than HIFU: 5 centers hyperthermia ablation, 11 centers VTP TOOKAD®, 3 centers cryotherapy, 6 centers TULSA.

The FT development in Germany followed the Gartner hype cycle. While HIFU treatment is the most commonly performed FT, the share of newer FT modalities such as VTP-TOOKAD® and TULSA is remarkably increasing.