Urological Centers Research Articles

#2275 Beyond glucose control: SGLT2 inhibitors' impact on hematological parameters in lupus nephritis patients

Abstract Background and Aims There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. Anemia worsens the prognosis of many chronic diseases including lupus nephritis. A recent systematic review and metanalysis showed that hemoglobin and hematocrit levels were significantly increased with SGLT2i therapy when compared to placebo. This study aimed to investigate the effect of SGLT2 inhibitors on hematological parameters including iron profile, hepcidin and erythropoietin levels in lupus nephritis patients. Method Double blind randomized controlled trial. The material of the current study included 79 Lupus nephritis patients who were recruited from Nephrology clinic- Urology and Nephrology Center- Mansoura University. Patients with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2 had been randomly assigned to 2 groups Study group: included 38 lupus nephritis patients who were randomly assigned to receive dapagliflozin (10 mg once daily) Placebo group: included 41 lupus nephritis who were assigned to receive placebo. The two groups were randomly assigned using computer-generated random tables in a 1:1 ratio and followed up for 12 months. The findings were recorded, tabulated, and analyzed using SPSS22 for windows. Results Both groups had similar ages and gender distribution. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and management approaches did not differ. Biopsy results indicated no differences in the class of lupus nephritis. Serum chemistry, including serum creatinine, was similar between groups. The mean hemoglobin levels, MCV and MCH are similar between the control and study groups, with no statistically significant difference (p = 0.5, 0.9 and 0.9 respectively). Regarding iron indices, the median ferritin, TSAT levels show a numerical difference, but it does not reach statistical significance (p = 0.09, 0.05), The mean erythropoietin and hepcidin levels are not significantly different between the groups (p value= 0.1 and 0.9 respectively) also, platelet counts are similar between the groups (p = 0.7). compares hematological investigations before and after the intervention in the study group. There is a statistically significant increase in mean hemoglobin levels post-intervention compared to baseline (p = 0.02) and the mean MCH levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1), but the mean MCV levels do not show a statistically significant change post-intervention (p = 0.7). The median ferritin levels and TSAT values show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.8 and 0.9 respectively). There is a statistically significant decrease in mean hepcidin levels post-intervention (116 ± 15 from baseline 181 ± 76) and (p = 0.001). erythropoietin levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1). there is a slight decrease in platelets counts after intervention but make statistically significant (p = 0.01), but The hematological data after 12 months suggest overall similarity between the control and study groups in terms of hemoglobin, MCV, MCH, ferritin, TSAT, and platelet count, also hepcidin and erythropoietin levels were comparable between both groups (P = 0.7). percentage of participant with anemia (Hgb< 12 g/dl) decreased in study group after intervention from 61% to 42% but with no significant difference with control group (p = 0.3) Conclusion Anemia in lupus nephritis patients is primarily due to iron deficiency, associated with elevated hepcidin levels. Further research is needed to explore these patients' underlying causes of anemia. SGLT2 inhibitors are important add on drugs that has positive effect on varies hematological parameters in lupus nephritis patients in addition to their renal benefits.

#2252 Outcome of pregnancy after kidney transplantation

Abstract Background and Aims Background The possibility of a term pregnancy is one of the benefits of solid organ transplantation for women. The gonadal dysfunction, caused by the failure of the kidney or another organ, is reverted within a few months after normal graft function. Unplanned pregnancies in transplant recipients, however, may compromise graft function and survival, and may also risk unnecessary fetal exposure to immunosuppressive medications. Aims To study the prevalence of pregnancy and pregnancy related complication after kidney transplantation (KT). Method Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019. divided into group I; 118 kidney transplant female's recipient experienced pregnancy at any time after kidney transplant and group II; 118 kidney transplant female's recipients who didn't experience pregnancy after renal transplantation, they were matched according to age and duration of renal transplantation and comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication. Results Prevalence of pregnancy in our center is 191 pregnancies in 118 women who had underwent kidney transplantation between 1976 and 2019. We have found that the mean age of pregnancy between (26.27 ± 4.37 - 29.89 ± 4.6), the mean gestational age between (33.69 ± 6.4 - 33 ± 7.5) weeks, the live birth rate is 126 (66%). Preterm delivery rate in our study is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine fetal death 6 (3.1%) and birth defect 4 (2%). The prevalence rates of gestational hypertension is 87 (45.5%), pre-eclampsia 48 (25.1%), gestational diabetes 19 (9.9%), urinary tract infection 36 (18.8%), and graft rejection 8 (4.1%) during pregnancy. caesarean section is the most common method of delivery in our study 133 (69.6%). Kidney transplant recipients who aged more than or equal to 30 years at time of pregnancy are at higher risk for having non live-birth outcome (OR: 3.2, p value: 0.05). Proteinuria more than or equal to 0.5 g/day before pregnancy is a significant risk factor for having non live-birth outcome (OR: 4.7, p value: 0.009). Also, proteinuria ≥0.5 g/day during pregnancy is associated with increases risk for non-live-birth (OR: 10.2, p value: 0.013). Gestational hypertension is associated with increases risk for non-live-birth (OR: 8.3, p value: 0.010).Preeclampsia is associated with increases risk for non-live-birth ( OR: 4.6, p value: 0.005). Conclusion Although the outcome of live births is favourable, the risks of maternal and fetal complications are high in kidney transplant recipients including pregnancy-induced hypertension, increased rates of preeclampsia, gestational diabetes, and caesarean section rates. The risk of miscarriage, prematurity, and low birth rate is also high.

#1847 Pregnancy impact on kidney transplant outcome

Abstract Background and Aims Renal transplantation improves the fertility of women of childbearing age. The possibility of a term pregnancy is one of the benefits of solid organ transplantation for women. Studies have also shown an increase in graft loss during and after pregnancy among sensitized patients and a higher risk of graft failure due to rejection in pregnancies occurring in the first and second-year post-transplantation. Most of these observations were found in studies using controls of non-pregnant recipients, but most did not match the study group in several critical clinical parameters, such as the gender of the controls, the creatinine level prepregnancy, or the cause of native kidney failure. The aim of our study is to investigate the long-term effects of pregnancy on graft function in female renal transplant recipients at Mansoura Urology and Nephrology center who experienced pregnancy after kidney transplantation. Method Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019. divided into group I; 118 kidney transplant female's recipient experienced pregnancy at any time after kidney transplant and Group II; 118 kidney transplant female's recipients who didn`t experience pregnancy after renal transplantation, they were matched according to age and duration of renal transplantation and comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication. Results Our study included 118 kidney transplant recipients who got pregnant 191 times, 64 kidney transplant recipients got pregnant for the second time, while 9 of them got pregnant for the third time. We retrospectively evaluated the maternal, fetal complications and evolution of graft function after each pregnancy. Main maternal complications were gestational hypertension developed in 87 pregnancy cases out of 191 (45.5%), preeclampsia (25.1%), UTI (18.8%), gestational DM (9.9%), and graft rejection during pregnancy (4.1%). Longer hemodialysis duration (OR: 0.45, p value: 0.05), Calcineurin-based immunosuppressive protocols (Tacrolimus; OR: 2.3, p value: 0.02; Cyclosporine; OR: 0.36, p value: 0.007), Proteinuria more than or equal to 0.5 g/day (OR: 5.4, p value: 0.001) and/or serum creatinine more than or equal to 1.3 mg/dl (OR: 3.75, p value: 0.001) before pregnancy and rising of serum creatinine and/or proteinuria (Proteinuria; OR: 20.84, p value: 0.001; serum creatinine ≥1.3 mg/dl; OR: 4.3, p value: 0.001) are important risk factors associated with gestational hypertension. The mean serum creatinine level pre-pregnancy (mean ± SD) was (0.9 ± 0.2) mg/dL and 24-hour urinary protein mean ± SD before pregnancy was (0.4 ± 0.2) g/day. Serum creatinine and 24-hour urinary protein were higher during and after pregnancy with a statistically significant difference when compared to before pregnancy data (P-value: 0.001), (P- value: 0.04) retrospectively. At last follow-up, the majority of patients were alive with functioning graft with no statistically significant difference between two groups (P-value: 0.07), also no significant difference as regard graft failure incidence (p-value: 0.52). Conclusion Although the outcome of live births is favourable, the risks of maternal and fetal complications are high in kidney transplant recipients including pregnancy-induced hypertension, increased rates of preeclampsia, gestational diabetes, and caesarean section rates. The risk of miscarriage, prematurity, and low birth rate is also high. Serum creatinine and 24-hour urinary protein tend to increase during and after pregnancy which may impair the graft outcome. pregnancy counselling is necessary to avoid high-risk or unwanted pregnancies.

Safety and outcomes of laparoscopic adrenalectomy for metastatic tumors - experience in a high-volume urological center

Safety and outcomes of laparoscopic adrenalectomy for metastatic tumors - experience in a high-volume urological center

Predicting clinically significant prostate cancer following suspicious mpMRI: analyses from a high-volume center

PurposempMRI is routinely used to stratify the risk of clinically significant prostate cancer (csPCa) in men with elevated PSA values before biopsy. This study aimed to calculate a multivariable risk model incorporating standard risk factors and mpMRI findings for predicting csPCa on subsequent prostate biopsy.MethodsData from 677 patients undergoing mpMRI ultrasound fusion biopsy of the prostate at the TUM University Hospital tertiary urological center between 2019 and 2023 were analyzed. Patient age at biopsy (67 (median); 33–88 (range) (years)), PSA (7.2; 0.3–439 (ng/ml)), prostate volume (45; 10–300 (ml)), PSA density (0.15; 0.01–8.4), PI-RADS (V.2.0 protocol) score of index lesion (92.2% ≥3), prior negative biopsy (12.9%), suspicious digital rectal examination (31.2%), biopsy cores taken (12; 2–22), and pathological biopsy outcome were analyzed with multivariable logistic regression for independent associations with the detection of csPCa defined as ISUP ≥ 3 (n = 212 (35.2%)) and ISUP ≥ 2 (n = 459 (67.8%) performed on 603 patients with complete information.ResultsOlder age (OR: 1.64 for a 10-year increase; p < 0.001), higher PSA density (OR: 1.60 for a doubling; p < 0.001), higher PI-RADS score of the index lesion (OR: 2.35 for an increase of 1; p < 0.001), and a prior negative biopsy (OR: 0.43; p = 0.01) were associated with csPCa.ConclusionmpMRI findings are the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history are independent predictors. They must be considered when discussing the individual risk for csPCa following suspicious mpMRI and may help facilitate the further diagnostical approach.

Stone centers: a national survey on surgical techniques performed in Italy.

Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones. A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL. Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center. Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.

Multicenter evaluation of complex urinary diversion for renal transplantation: outcomes of complex surgical solutions

PurposeAn abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult.MethodsThe indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up.ResultsOf 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4).ConclusionThe mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary.

Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement.

We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.

COVID-19 outbreak impact on urolithiasis treatments: A multicenter retrospective study across 9 urological centers in Italy

Abstract Background The coronavirus disease (COVID-19) pandemic has posed challenges to the global health care community, affecting the management of upper urinary tract stones. Materials and methods This retrospective study involved 9 Italian centers. We compared the 12-month period prior to COVID-19 (March 1, 2019, to February 28, 2020; Period A) with the COVID-19 period (March 1, 2020, to February 28, 2021, Period B). This study aimed to compare outcomes during Periods A and B, specifically focusing on the overall number of treatments, rate of urgent/elective cases, and operational complexity. Results A total of 4018 procedures were collected, comprising 2176 procedures during Period A and 1842 during Period B, indicating a loss of 15.35% (p &lt; 0.001). In the elective cases, 1622 procedures were conducted in Period A, compared with 1280 in Period B, representing a 21.09% reduction in cases (p = 0.001). All types of stone treatments were affected: extracorporeal shock wave lithotripsy (−29.37%, p = 0.001), percutaneous nephrolithotomy (−26.47%, p = 0.008), retrograde surgeries for renal stones (−10.63%, p = 0.008), and semirigid ureterolithotripsy (−24.86%, p = 0.008). Waiting lists experienced significant delays during Period B. The waiting time (WT) for elective procedures increased during Period B (p &lt; 0.001). For ureteral stones, the mean WT in Period A was 61.44 days compared with 86.56 days in Period B (p = 0.008). The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery (p = 0.008) and from 96.9 days to 1103.9 days (p = 0.035) for percutaneous nephrolithotomy procedures. Conclusions Our study demonstrates that COVID-19 significantly disrupted endourological services across the country. Our data underline how patients received treatment over a prolonged period, potentially increasing the risk of stone-related complications and patient discomfort.

The diagnostic yield of the Meares & Stamey test can be significantly improved by symptom-based patient selection and the experience of the test performer.

Even if Meares-Stamey 4-glass (M&S) test is regarded a decisive tool for diagnosing prostatitis its use is only rarely performed in everyday clinical practice. Here, we analyze if the diagnostic yield of the M&S test could be improved by a pre-test categorization of patients due to undergo a M&S test. All clinical and microbiological data of patients who underwent M&S test in two urological centers from January 2004 to December 2021 were analyzed in this retrospective cohort study. One center has a dedicated staff member for the study of prostatitis (Cohort I), while the other center is a general urological unit (Cohort II). All patients were divided into 3 groups on the basis of the assembled data: patients with symptoms related to prostatitis only (Group I), patients with symptoms related to both prostatitis and BPH (Group II), patients with symptoms related to BPH only (Group III). The rates of positive microbiological results in each group were compared. In the whole period, 9347 patients were analyzed and categorized as follows: Group I, 1884; Group II, 5151; Group III, 2312. Three-thousand and eight-hundred twenty-three patients showed positive culture results (40.9%). The most common isolated species was Escherichia coli (49.7%), followed by Enteroccus spp. (31.8%). The rates of positive M&S tests in the different symptom groups were: Group I, 1532 (81.4%); Group II, 1494 (29.0%); Group III, 797 (34.4%). The overall rate of positive M&S tests in each urology center showed that the center with a staff member who is dedicated to prostatitis studies (Cohort I) had a significantly higher rate of positive M&S tests than the general urological department (Cohort II) (64.3% vs 31.4%; p < 0.001). Symptom-based patient selection and dedicated staff members will increase the diagnostic yield of the M&S test and reduce the number of unnecessary tests.

Comparative Evaluation of the Results of Radical Surgical Treatment of Patients with Muscle-Invasive Bladder Cancer

Malignant neoplasms of the bladder with invasion into the muscle layer of the organ wall (MIBC) are recognized as a highly aggressive pathology with a poorly predicted outcome, a high mortality rate, involving patients of any age without gender differences. Radical surgery’s in patients with MIBC has long and highly established itself as one of the main methods of treatment. However, the results of open surgical interventions are still accompanied by a high level of complications. The materials of medical literature (PubMed, CrossRef) for 2000–2023 were studied, with the issues of comparative evaluation of the results of surgical treatment of patients with MIBC, complications of the postoperative period. The search was conducted on the key phrases “bladder cancer”, “open cystectomy”, “robot-assisted cystectomy”, “cancer-specific survival”. The widespread introduction of video-endoscopic methods of treating patients with this disease into clinical practice has made it possible to speak about a decrease in the volume of intraoperative blood loss, the frequency of infectious complications of the wound and inpatient stay. The development of robot-assisted bladder surgery (RARC) demonstrates a number of advantages of using the daVinci robot in terms of reducing the number of postoperative complications during the traditional to study the 30–60–90-day follow-up periods. The issues of rehabilitation of patients after various methods of urine diversion, the medical-economic aspects for RARC in expert urological centers and the feasibility of the widespread introduction of this technique in medical institutions remain unclear. The coverage of these issues in the medical scientific literature is ambiguous, and therefore requires additional analysis.

Robot-assisted radical prostatectomy in patients after endoscopic surgeries on the prostate

Background. In literature, data on the results of robot-assisted radical prostatectomy (RARP) in patients after transurethral resection of the prostate (TURP) are contradictory.Aim. To evaluate surgical, functional, and oncological outcomes of RARP after TURP.Materials and methods. At the Urology Center of the Mariinsky Hospital (Saint Petersburg), RARP was performed on 410 patients. Among them, 28 (6.8 %) patients (1st group) previously underwent TURP due to infravesical obstruction. Among them, 18 (64.3 %) patients were diagnosed with prostate cancer after pathomorphological examination of the tissue resected during TURP, and on them RARP was performed on average 3.2 months later. In 10 (35.7 %) patients, prostate cancer was diagnosed during transrectal biopsy due to increased prostate-specific antigen level; on them RARP was performed on average 42.0 months after TURP. The following parameters were evaluated: operative time, time of bladder neck reconstruction and urethrovesical anastomosis formation, blood loss volume, tumor pathological stage, Gleason score, surgical margin status, rates of urine continence and preservation of erectile function.Results. Mean operative time was higher in the 1st group compared to the 2nd: 210 ± 36 min versus 180 ± 25 min (р &lt;0.0001). In the 1st group compared to the 2nd, reconstruction of bladder neck was necessary more frequently (82.1 % versus 10.7 %; р &lt;0.0001), urethrovesical anastomosis took longer time (32 ± 2.3 min versus 24.5 ± 3.1 min; р &lt;0.0001), mean blood loss volume was higher (240 ± 39 mL versus 170 ± 32 mL; р &lt;0.0001). Frequencies of positive surgical margin were 14.3 and 10.7 % respectively in the 1st and 2nd groups (р = 0.840). Frequencies of all complications were 28.6 and 21.4 %, respectively. Severe complications (≥IIIb grade per the Clavien classification) were observed in 2 (7.1 %) patients in both groups. Frequency of anastomosis stricture after surgery was significantly higher in the 1st group: in 2 (7.1 %) and 1 (3.6 %) case, respectively (р &lt;0.05). In the 1st group, total urinary continence was achieved in 14 (50.0 %), 20 (71.5 %), 22 (78.5 %) and 25 (89.3 %) patients at early and 3-, 6and 12-month follow-up after RARP; in the 2nd group, it was achieved in 18 (64.3 %), 22 (78.6 %), 24 (85.7 %) and 26 (92.9 %) patients in the same follow-up periods. After 6 and 12 months, in the 1st group among 15 (53.6 %) patients with normal initial erectile function, satisfactory erectile function was preserved in 46.7 and 93.3 % of patients; in the 2nd group among 19 (67.8 %) patients, in 57.8 and 94.7 % patients, respectively.Conclusion. RARP after TURP is a relatively complicated surgical intervention with long operative time and high blood loss volume. However, functional and short-term oncological outcomes of RARP in these patients do not differ at 12 months.

The Added Value of MRI-Based Targeted Biopsy in Biopsy-Naïve Patients: A Propensity-Score Matched Comparison.

Multiparametric Magnetic Resonance Imaging (mpMRI)-based targeted biopsy has shown to be beneficial in detecting Clinically Significant Prostate Cancer (csPCa) and avoiding diagnosis of Non-csPCa (ncsPCa); however, its role in the treatment of biopsy-naïve patients is still under discussion. After identifying predictors for the diagnosis of csPCa via Multivariate Logistic Regression Analysis (MLRA), a propensity-score (1:1 nearest neighbor) matched comparison was performed between a Systematic-Only Biopsy (SOB) cohort and a mpMRI-based Combined (systematic + targeted) Biopsy (CB) cohort from two tertiary urologic centers (SOB: Department of Urology, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Crete, Greece; CB: LKH Hall in Tirol, Austria). Only biopsy-naïve patients were included in the study. The study period for the included patients was from February 2018 to July 2023 for the SOB group and from July 2017 to June 2023 for the CB group. The primary outcome was the diagnosis of csPCa (≥ISUP 2); secondary outcomes were overall cancer detection, the added value of targeted biopsy in csPCa detection, and the reduction in ncsPCa diagnosis with CB compared to SOB. To estimate the Average Treatment effect of the Treated groups (ATT), cluster-robust standard errors were used to perform g-computation in the matched sample. p-values < 0.05 with a two-sided 95% confidence interval were considered statistically significant. Matching achieved well-balanced groups (each n = 140 for CB and SOB). In the CB group, 65/140 (46.4%) patients were diagnosed with csPCa compared to 44/140 (31.4%) in the SOB group (RR 1.48, 95%-CI: 1.09-2.0, p = 0.01). In the CB group, 4.3% (6/140) and 1.4% (2/140) of csPCa cases were detected with targeted-only and systematic-only biopsy cores, respectively. In the CB group, 22/140 (15.7%) patients were diagnosed with ncsPCa compared to 33/140 (23.6%) in the SOB group (RR = 0.67, 95% CI: 0.41-1.08, p = 0.1). When comparing SOB to CB (ATT), the marginal OR was 0.56 (95% CI: 0.38-0.82, p = 0.003) for the diagnosis of csPCa and 0.75 (95% CI: 0.47-1.05, p = 0.085) for the diagnosis of overall cancer (≥ISUP 1). The CB approach was superior to the SOB approach in detecting csPCa, while no additional detection of ncsPCa was seen. Our results support the application of mpMRI for biopsy-naïve patients with suspicions of prostate cancer.

(330) Testosterone Replacement Therapy in Hypogonadism: A Single Center Longitudinal Analysis of Treatment Patterns and Clinical Outcomes

Abstract Introduction Male hypogonadism impacts the production of hormone production, which plays a key role in masculine growth. It has also been shown to impair certain male reproductive functions or delay development. Objective The goal of this study is to describe the characteristics and treatment outcomes for patients with a diagnosis of Hypogonadism (HG) presenting to an academic urology center. Methods An IRB was approved to conduct a longitudinal study on the outcomes of male hypogonadism at a high-volume tertiary referral center. Men diagnosed with hypogonadism were identified by ICD 10 code (E 29.1). Clinical, demographic, laboratory, and testosterone replacement therapy and outcomes were extracted from the EMR. Results This retrospective study included 537 patients with a median age of presentation of 52 years (IQR: 42-68). At the initial visit, 66% presented with low libido, 65% with erectile dysfunction (ED), and 6% with depression. On initial hormonal evaluation, median (IQR) measurements for testosterone, free testosterone, and estradiol were 294 (217.5-417), 6.1 (4.45-8.0), and 4 (2-17) respectively. 227 (56.5%) patients elected to begin Testosterone Replacement Therapy (TRT). Of these, five treatment types of TRT were observed: 114 (53%) patients elected for intramuscular TRT, 25 (12%) utilized a pellet implant, 74 (34%) utilized topical treatment TRT, 3 (1.4%) used pellet and topical, and 1 (0.5%) used topical and intramuscular. Following TRT, 143 (79%) patients endorsed an improvement in ED, 175 (84%) reported improved libido, 176 (84%) reported increased energy levels, and 88 (59%) showed improvement in muscle mass. Follow-up labs measuring testosterone, free testosterone, and estradiol demonstrated medians of 486 (IQR: 296.5-802.8), 15.3 (IQR: 6.9-88.7), and 16.45 (IQR: 3-28.85) respectively. Adverse events while on TRT were 32 (15%) polycythemia, 3 (1.4%) VTE’s, and 3 (1.4%) MI. Conclusions Sexual dysfunction is a prominent symptom encountered by men with hypogonadism. However, only 56.5% of hypogonadal men pursue TRT, with intramuscular injections being the most commonly prescribed formulation. In our longitudinal cohort, we report that polycythemia and cardiovascular events are uncommon sequela after TRT. Further randomized control trials are warranted to better understand cardiovascular events' association with TRT. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

A prospective cohort of men with localized prostate cancer on active surveillance protocol in Hong Kong, China: what did we learn?

This study aimed to report the outcomes of active surveillance (AS) in the management of low-risk prostate cancer (PCa). It recruited 87 men who were prospectively followed up according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol with local adaptation at SH Ho Urology Centre, Prince of Wales Hospital, Hong Kong, China. We investigated the predictors of disease progression and found that baseline prostate-specific antigen density (PSAD) and the presence of the highest Prostate Imaging-Reporting and Data System (PI-RADS) score 5 lesion on magnetic resonance imaging (MRI) are significantly correlated with disease progression. Moreover, men with PSAD >0.2 ng ml -2 or PI-RADS 4 or 5 lesions had significantly worse upgrading-free survival compared to those with PSAD ≤0.2 ng ml -2 and PI-RADS 2 or 3 lesions. The study concludes that AS is a safe and effective management strategy for selected patients to defer radical treatment and that most disease progression can be detected after the first repeated biopsy. The combination of PSAD >0.2 ng ml -2 and PI-RADS 4 or 5 lesions may serve as a useful predictor of early disease progression and provide a guide to optimize follow-up protocols for men in different risk groups.

Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score

BackgroundPartial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patients with high nuclear grades treated with PN had poorer prognosis compared with those treated with radical nephrectomy (RN). Therefore, this study was designed to evaluate the associations of PN and RN in the four nuclear grade subsets with oncologic outcomes.MethodsA retrospective study was conducted in three Chinese urological centers that included 1,714 patients who underwent PN or RN for sporadic, unilateral, pT1, N0, and M0 ccRCC without positive surgical margins and neoadjuvant therapy between 2010 and 2019. Associations of nephrectomy type with local ipsilateral recurrence, distant metastases, and all-cause mortality (ACM) were evaluated using the Kaplan–Meier method and multivariable Cox proportional hazards regression models after overlap weighting (OW).ResultsA total of 1675 patients entered the OW cohort. After OW, in comparison to PN, RN associated with a reduced risk of local ipsilateral recurrence in the G2 subset (HR = 0.148, 95% CI 0.046–0.474; p < 0.05), G3 subset (HR = 0.097, 95% CI 0.021–0.455; p < 0.05), and G4 subset (HR = 0.091, 95% CI 0.011–0.736; p < 0.05), and resulting in increased five-year local recurrence-free survival rates of 7.0%, 17.9%, and 36.2%, respectively. An association between RN and a reduced risk of distant metastases in the G4 subset (HR = 0.071, 95% CI 0.016–0.325; p < 0.05), with the five-year distant metastases-free survival rate increasing by 33.1% was also observed. No significant difference in ACM between PN and RN was identified.ConclusionsOur findings substantiate that opting for RN, as opposed to PN, is more advantageous for local recurrence-free survival and distant metastases-free survival in patients with high nuclear grade (especially G4) pT1-ccRCC. We recommend placing a heightened emphasis on enhancing preoperative nuclear grade assessment, as it can significantly influence the choice of surgical plan.Trial registrationThis study was registered at Chinese Clinical Trial Registry (ID: ChiCTR2200063333).

The landscape of penile cancer research in Germany and Austria: a survey among professors in academic centers holding chair positions and results of a literature search.

Research on penile cancer (PeCa) is predominantly conducted in countries with centralized treatment of PeCa-patients. In Germany and Austria (G + A), no state-regulated centralization is established, and no information is available on how PeCa-research is organized. Current research competence in PeCa was assessed by a 36-item questionnaire sent to all chairholders of urological academic centers in G + A. Based on PubMed records, all scientific PeCa-articles of 2012-2022 from G + A were identified. Current research trends were assessed by dividing the literature search into two periods (P1: 2012-2017, P2: 2018-2022). A bibliometric analysis was supplemented. Response rate of the questionnaire was 75%, a median of 13 (IQR: 9-26) PeCa-patients/center was observed in 2021. Retrospective case series were conducted by 38.9% of participating clinics, while involvement in randomized-controlled trials was stated in 8.3% and in basic/fundamental research in 19.4%. 77.8% declared an interest in future multicenter projects. 205 PeCa-articles were identified [median impact factor: 2.77 (IQR: 0.90-4.37)]. Compared to P1, P2 showed a significant increase in the median annual publication count (29 (IQR: 13-17) vs. 15 (IQR: 19-29), p < 0.001), in multicenter studies (79.1% vs. 63.6%, p = 0.018), and in multinational studies (53% vs. 28.9%, p < 0.001); the proportion of basic/fundamental research articles significantly declined (16.5% vs. 28.9%, p = 0.041). Four of the top-5 institutions publishing PeCa-articles are academic centers. Bibliometric analyses revealed author networks, primary research areas in PeCa, and dominant journals for publications. Given the lack of centralization in G + A, this analysis highlights the need for research coordination within multicenter PeCa-projects. The decline in basic/fundamental research should be effectively addressed by the allocation of funded research projects.

Initial experience of the Versius robotic system in robot-assisted radical prostatectomy: a study of 58 cases.

The study presents the initial outcomes of robot-assisted radical prostatectomies (RARPs) using the Versius robotic system in a urological centre with no prior robotic surgery experience. A retrospective analysis of 58 RARPs was conducted, including patients' parameters as well as Versius system performance. The study involved 58 patients (average age 66.9 years). Median preoperative prostate specific antigen (PSA) was 9.8 ng/ml, with 48% having ISUP grade group ≥ 3 on biopsy and 25.8% showing extraprostatic extension on MRI. Median blood loss was 437 ml, with complications (10.3% Clavien-Dindo grade II and 4 grade III cases). One conversion to open surgery occurred (0.58%). Final pathology revealed 46.5% extraprostatic disease, and 25.8% had positive margins. Post-surgery, 96.5% had undetectable PSA at 6 weeks. Continence rates were 89.7% at 6 weeks, increasing to 91.3% at 12 months. Median catheter duration was 7.9 days, and the hospital stay was 4.5 days. Console time averaged 150.9 minutes, with a median operative time of 213 minutes. The Versius system reported medium priority alarms in 24.1% of operations, including 1266 alarms related to robotic arm clashes and 43 instrument swaps. One bedside unit exchange occurred with no console or robotic system failures. The Versius robotic system can be successfully introduced in a urological centre without prior robotic surgery experience. Our setup and operating room positioning are effective, safe, and reproducible. We encountered and resolved surgical and technical challenges. Further follow-up studies are needed to assess the system's performance.

Treatment of stress incontinence by trans-obturator tension: A retrospective study, Aden, Yemen

Background: Stress urinary incontinence is the complaint of involuntary leakage on effort or exertion or on sneezing or coughing. Objectives: To evaluate the effectiveness of transobturator approach in the treatment of female stress urinary incontinence and to analyze functional results. Materials and methods: We retrospectively reviewed all medical files of patients presenting with urinary incontinence to our Urology Center in Aden, Yemen, over a 2-year period. There were 42 patients treated with TOT and the postoperative follow up of the patients was at least 10 months. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations. Results: The age of the patients ranged between 40 to 80 years and their mean age was 62.1 ± 9.7 years. We grouped the study patients in two age groups, 60 years and &gt; 60 years. We found the patients of the age group &gt; 60 years were (57.1%) while the patients of the age group 60 years were (42.9%). The mean weight of the patients is 67.5 ± 7.0 kilograms (kg). We categorized the number of vaginal deliveries in 2 groups: 5 – 7 vaginal deliveries were (31.0%), and 8 – 10 vaginal deliveries (69.0%). The Mean number of vaginal delivery was 8.0 ± 1.2. Concomitant operations were posterior colpotomy (7.0%) and anterior colpotomy (4.8%). The Mean operative time was 48 ± 8.9 minutes. Four cases developed complications, (4.8%) major bleeding; (2.4%) of them had bladder injury and (2.4%) urine retention. Additionally, (93.0%) of the outcome of operated women were with excellent success while those with failed results were (7.0%). Conclusion: The transobturator approach is an effective treatment of stress urinary incontinence with low morbidity and with acceptable success and outcome. Keywords: Stress urinary incontinence, transobturator approach, Aden, Yemen

Do Stone Characteristics and Laser Fiber Size Affect Ho: YAG Laser Time and Energy During Ureteroscopy?

To assess the correlation of attenuation value measured as HU in Non-contrast computed tomography, stone size, location, fibre size and stone composition with Holmium: yttrium-aluminium garnet (Ho: YAG) laser parameters including, cumulative laser energy and final laser time. We prospectively analyzed 118 patients undergoing flexible/semirigid ureteroscopy and Holmium: YAG laser lithotripsy from October 2022 to October 2023 at Mogadishu Urological Centre. Our study parameters encompass preoperative stone characteristics determined in NCCT (stone size, attenuation value, and stone location), fibre size, cumulative laser energy and time, overall operative time, and postoperative stone composition analysis. There were 118 patients eligible for our prospective study. In the logistic regression model for retrograde intrarenal surgery with a fibre size of 272μm, cumulative laser energy showed a significant difference among stone size, location, fibre size, and calcium oxalate stones (P > 0.05). However, no significant difference was noticed in the attenuation value (P = 0.078) (R2 = 0.053). Our analysis showed a positive significance among all the parameters (P < 0.05) for laser time. In logistic regression for a rigid ureteroscope with a fibre size of 365μm, cumulative laser energy showed a significant difference between the location stone and fibre size (P < 0.05) (R2 = 0.09). However, no significant difference was seen among stone size, attenuation value, and calcium oxalate stones (P > 0.05). For laser time, our analysis showed a positive significance among all parameters except the calcium oxalate stones, which showed no significant difference (P > 0.05). Our study showed that stone location, hardness, and fibre size are the most critical factors influencing the outcome of Ho: YAG laser parameters. The study revealed that CaOMH stones require more time to disintegrate into smaller ones, while PH-dependent stones such as carbonate apatite may require less time to fragment.