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Background: Despite advanced medical technology, accurately predicting pelvic lymph node (LN) metastasis in patients with prostate cancer (PCa) remains a challenge. Various nomograms were utilised to enhance the accuracy of this prediction. Our goal was to determine if preoperative inflammation markers and transrectal prostate biopsy data offer extra insight into predicting pathological LN involvement in radical prostatectomy with extended pelvic LN dissection (RP + ePLND).
Methods: This study included patients with PCa who had a Briganti score of 5 or higher and were treated with RP + ePLND between January 2016 and May 2023. Physical examination findings, blood work within 1 month before biopsy and prostate biopsy results were recorded retrospectively. The patients were divided into two groups based on the presence or absence of pelvic LN metastasis (group 1 and group 2, respectively). The preoperative data of both groups were compared for analysis.
Results: The study involved 71 patients; 17 were in group 1, and 54 were in group 2. We observed significant differences between the groups in terms of bilateral tumour involvement in prostate, presence of perineural and lymphovascular invasion (LVI) in biopsy specimens, D’Amico risk group, as well as haematological and biochemical parameters such as the absolute counts of lymphocyte and monocyte, neutrophil-to-lymphocyte ratio and the levels of total and free prostate-specific antigen. Logistic regression analysis revealed that absolute lymphocyte count, presence of LVI and bilateral tumour involvement were independent predictors of pathological pelvic LN metastasis in PCa. The cut-off value of lymphocyte count for predicting LN metastasis was 1.57 (103/mL) with a sensitivity of 0.870 and a specificity of 0.412 (area under the curve (AUC): 0.675, p = 0.030).
Conclusions: According to our findings, LVI in biopsy specimens, bilateral lobe tumours and preoperative lymphocyte count are significant predictors of pelvic LN metastasis in patients with PCa and a Briganti score of ≥5.
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Background: Renal cell carcinoma (RCC) is the third most frequent urological neoplasia. Proper risk stratification is essential for adequate management. Various calculators are available. This project aims to evaluate the accuracy of the calculators applied to our patients.
Methods: We performed a retrospective study of the nephrectomies due to RCC performed from January 2008 to December 2013. We applied the most widely used predictive models (University of California, Los Angeles Integrated Staging System (UISS), Stage, Size, Grade and Necrosis (SSIGN), Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic RCC Database Consortium (IMDC)) to stratify patients in different risk groups. We evaluated progression-free survival (PFS) or death caused by RCC (cancer-specific survival (CSS)) or other causes (overall survival (OS)).
Results: We analysed 238 patients. The 5-year OS, CSS and PFS were 76%, 85% and 83%, whereas the 10-year OS, CSS and PFS were 47%, 75% and 77%, respectively. The 5-year survival analysis by risk groups according to the prognostic models showed that the PFS was 0% and 20.4% in high- and intermediate-risk metastatic RCC (mRCC). Moreover, the PFS was 90%, 95.2% and 98.9% in localised high-, intermediate- and low-risk RCC according to the UISS (area under the receiver operating characteristics curve (AUC): 0.93). The SSIGN model showed a CSS of 99% for the group with the lowest score and 5.3% for the group with the worst prognosis (AUC: 0.91). The OS of mRCC showed medians of 13.25 and 87 months according to MSKCC (AUC: 0.75) and 16, 23 and 85 months according to IMDC (AUC: 0.71) (high risk, intermediate and low).
Conclusions: The validation of the predictive models carried out with our patients showed consistency in many of the results. Risk stratification should be implemented.
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Background: Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome.
Methods: This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR.
Results: This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123–0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289–6.552, p = 0.011).
Conclusions: Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.
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Background: Ureteral calculi are a common diagnosis in the field of urology worldwide, and they represent a prevalent subtype of urolithiasis. Ureteroscopic stone surgery is the cornerstone treatment, but postoperative urinary tract infection (UTI) remains a clinical concern. Our study aims to analyse specific risk factors associated with postoperative UTIs following ureteroscopic stone surgery.
Methods: We conducted a case-control study and collected clinical data from 145 patients who underwent ureteroscopic lithotripsy at our hospital from January 2021 to January 2023. Binary logistic regression analysis was used to investigate risk factors for postoperative UTI. Receiver operating characteristic curves were plotted, and area under the curve (AUC) was calculated to evaluate the predictive value of each factor.
Results: Forty patients developed UTI after ureteroscopic stone surgery. Compared with the control group, the case group showed significant differences in stone size, history of diabetes mellitus and preoperative urine culture results (p < 0.05). Multivariable binary logistic regression analysis revealed that stone size (Odds Ratio (OR) = 1.952, p = 0.010), history of diabetes mellitus (OR = 2.438, p = 0.038) and preoperative urine culture (OR = 2.914, p = 0.009) were independent risk factors for postoperative UTI. The AUC values of stone size, history of diabetes mellitus and preoperative urine culture were 0.680, 0.627 and 0.630, respectively. The AUC of the combined prediction was 0.756.
Conclusions: This study identified risk factors for postoperative UTI following ureteroscopic stone surgery and emphasised the importance of stone size, history of diabetes mellitus and preoperative urine culture in the diagnosis.
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Objective: The occurrence of prostate hyperplasia has increased remarkedly, especially in elderly patients; However, research on which surgical treatment is effective and safe for benign prostatic hyperplasia (BPH) in elderly people over 70 years old is limited. This study aimed to investigate the clinical efficacy and safety of transurethral plasma kinetic prostatectomy (TUPKP) and holmium laser enucleation of prostate (HoLEP) as a therapy for benign prostatic hyperplasia (BPH) in the elderly.
Methods: A total of 148 patients with BPH admitted from December 2022 to December 2023 were chosen and divided into HoLEP (n = 74) and TUPKP (n = 74) groups according to the surgical operation. Perioperative related indexes, preoperative and postoperative international prostate symptom scores and life quality scores were compared between the two groups. The postoperative complications were also counted for the two groups.
Results: The HoLEP group had lower intraoperative bleeding, mean operative time, catheter indwelling time and hospital stays than the TUPKP group (p < 0.001). Before treatment, no significant difference in prostate symptom scores was found between the two groups (p > 0.05). After treatment, the prostate symptom scores in the HoLEP group were significantly lower than those in the TUPKP group (p < 0.001). However, the maximum urinary flow rate was significantly higher (p < 0.001) and the residual urine volume was significantly lower (p < 0.001) in the HoLEP group than in the TUPKP group after operation. The complication rate in the TUPKP group was 25.66%, which was significantly higher than the 9.46% in the HoLEP group (p < 0.05). The life quality scores of the HoLEP group were higher than those of the TUPKP group (p < 0.001).
Conclusions: HoLEP for BPH therapy is effective and safe with low incidence of postoperative complications.
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Background: Early diagnosis of postoperative acute kidney injury (AKI) is crucial. This study investigated the changes and early diagnostic value of Doppler ultrasound parameters in patients with AKI after laparoscopic radical prostatectomy (LRP).
Methods: This study retrospectively analysed the clinical data of 198 patients with LRP undergoing Doppler ultrasound from May 2020 to May 2022. The incidence of AKI after LRP was measured based on diagnostic criteria of AKI developed by Kidney Disease: Improving Global Outcomes. The patients were divided into AKI group (n = 12) and non-AKI group (n = 186) in accordance with the presence or absence of AKI. This study compared changes in Doppler ultrasound parameters between two groups, and evaluated the clinical efficacy of single and combined diagnosis of ultrasound parameters using receiver operating characteristic (ROC) curve and area under the curve (AUC).
Results: Twelve patients experienced postoperative AKI, with an incidence rate of 6.06%. No significant difference was found in baseline data, serum creatinine (Scr), urinary output and blood potassium levels of both groups (p > 0.05). The urinary output 1 day after surgery was significantly lower than that before surgery (p < 0.05). The AKI group demonstrated higher pulsatility index (PI) and resistive index (RI) of the renal interlobar artery than the non-AKI group (p < 0.05), with no significant difference in peak systolic velocity (PSV) in both groups (p > 0.05). No significant difference was observed in the Doppler ultrasound parameters of renal segmental artery and main renal artery (p > 0.05). The AUCs in the PI of the renal interlobar artery, the RI of the renal interlobar artery, and the combined diagnosis were 0.720, 0.704 and 0.724, respectively. ROC curve showed that the above two Doppler ultrasound parameters had good diagnostic efficacy for AKI after LRP (p < 0.05).
Conclusions: The PI and RI of renal interlobar artery in the AKI group after LRP were significantly different from those in the non-AKI group. These two Doppler ultrasound parameters had good diagnostic efficacy in the early identification of AKI after LRP. Thus, they could provide reference and guidance for clinical practice.
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Objective: This study aims to assess the effect of pelvic floor muscle exercise (PFME) on urinary incontinence after radical prostatectomy.
Methods: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP and other domestic and foreign databases were searched for published literature until December 2023 on the effect of pelvic muscle exercise on urinary incontinence in patients after radical prostatectomy. The retrieved literatures were screened, and data were extracted. After evaluating the quality of the literatures, RevMan 5.4 software was used for meta-analysis.
Results: This work included nine articles consisting of 1208 sufferers with urinary incontinence after radical prostatectomy. The forest plot showed that patients in the experimental group had better postoperative outcomes at 1 month (Relative Risk (RR) = 3.38, 95% confidence interval (CI) (1.83; 6.25)), 3 months (RR = 1.99, 95% CI (1.67; 2.38)) and 6 months (RR = 1.34, 95% CI (1.20; 1.49)). The incidence of urinary incontinence was statistically significant compared with the control group (p < 0.05). Patients in the experimental group 12 months after surgery (RR = 1.13, 95% CI (0.99; 1.23)) showed no significant difference in the incidence of urinary incontinence compared with the control group (p > 0.05).
Conclusions: PFME can significantly increase the recovery rate of urinary incontinence in sufferers with prostate cancer at 1, 3 and 6 months after radical surgery but have no significant improvement at 12 months. Urodynamic analysis may be needed for patients with long-term urinary incontinence.
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Background: Urinary tract infections (UTIs) are prevalent amongst paediatric patients, and they can lead to emergency department (ED) visits. A subset of patients requires a second ED visit, creating a burden on healthcare resources. This study aimed to shed light on the clinical, laboratory, treatment-related and environmental determinants associated with the recurrence of ED visits in this specific paediatric population.
Methods: This single-centre retrospective study involved paediatric patients diagnosed with UTIs and admitted to the paediatric ED of our hospital from September 2021, to August 2023. In accordance with whether a second visit was required, the ED patients were grouped into non-second-visit group or second-visit group. The demographic, clinical, laboratory, diagnostic, and environmental factors were analysed in detail. Statistical analyses, including chi-square tests, t-tests and correlation analyses, were employed to assess the associations between various factors and subsequent ED visits.
Results: A total of 357 patients, including 324 patients without a second visit and 33 patients with a second visit, were included in this study. Factors significantly associated with second ED visits included fever (≥38.5 °C) at initial presentation (p = 0.034), longer symptom duration (p = 0.022), increased C-reactive protein (CRP) levels (p = 0.018), hydronephrosis (p = 0.033) and lack of oral antibiotic use before the first visit (45.45% vs. 67.9%, p = 0.017). More bubble bath exposure (p = 0.037) and lower consultation rates with paediatric urology services (p = 0.020) were associated with repeated visits. Multifactor logistic regression analysis showed that the factors significantly associated with second ED visits were longer symptoms duration, fever (≥38.5 °C) at initial presentation, presence of flank pain, increased CRP levels, hydronephrosis, renal stones, vesicoureteral reflux, underlying anatomical abnormalities, lack of oral antibiotic use before the first visit, bubble bath exposure and lower consultation rates with paediatric urology services.
Conclusions: A series of clinical indicators, laboratory findings, diagnostic measures and environmental factors may be associated with the need for a second ED visit amongst paediatric patients with UTI. Early antibiotic intervention, identification of underlying anatomical anomalies and management of environmental exposures may mitigate recurrent ED visits.
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Background: Clear cell renal cell carcinoma (ccRCC) is the most prevalent subtype of renal cell carcinoma (RCC). Conventional pathological methods of Fuhrman pathological grading system have limitations. This study aims to investigate the efficacy of radiomics-based multilayer spiral computed tomography (CT) imaging of Fuhrman pathological grading in ccRCC.
Methods: A retrospective analysis was conducted on the clinical data of ccRCC patients admitted in our hospital from March 2023 to March 2024. The patients were classified as low-grade (Fuhrman pathological grades I and II) or high-grade (Fuhrman pathological grades III and IV). Statistical methods, including correlation analysis, receiver operating characteristic (ROC) curves and construction of a joint predictive model, were utilised to assess the predictive value of these imaging omics indicators for Fuhrman pathological grading in ccRCC. The primary outcome assessment parameter in this study was the predictive value of these imaging omics indicators for Fuhrman pathological grading in ccRCC.
Results: The clinical data from 101 ccRCC patients were examined, with 56 cases classified as low-grade and 45 cases as high-grade. The grey-level co-occurrence matrix (GLCM) features between low and high Fuhrman grading groups, including contrast (0.24 ± 0.08 vs. 0.33 ± 0.09), energy (0.73 ± 0.05 vs. 0.67 ± 0.06) and homogeneity (0.63 ± 0.05 vs. 0.57 ± 0.05), showed notable distinctions (p < 0.001). The CT imaging characteristics between low and high Fuhrman grading groups, including enhancement homogeneity (0.34 ± 0.08 vs. 0.26 ± 0.08) and washout half-time (28.57 ± 4.35 vs. 34.72 ± 5.62) demonstrated a substantial variation between the groups (p < 0.001). The enhancement homogeneity (r = 0.476), washout half-time (r = −0.519), contrast (r = 0.454), energy (r = −0.453) and homogeneity (r = −0.541) showed significant correlations with Fuhrman pathological grading. The predictive value of these features was evident, with a combined imaging genomics model exhibiting an area under the curve of 0.929.
Conclusions: This study demonstrated the potential of radiomics-based prediction using multilayer spiral CT imaging for accurately predicting Fuhrman pathological grading in ccRCC.
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Objective: Changes in glucolipid metabolism parameters in patients undergoing renal transplantation (RT) and their influences on the incidence of postoperative complications were analysed. The objective was to provide a reference for clinical practice and reliable and safe implementation of RT.
Methods: A total of 131 patients treated with RT at our institution from January 2019 to March 2024 were selected for retrospective analysis: 71 patients who developed postoperative complications (research group) and 60 patients who did not (control group). Differences in fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), total cholesterol (TC) and triglyceride (TG) levels before and three days after surgery were compared, and their predictive value for postoperative complications was analysed. In addition, relevant factors influencing complications after RT were identified.
Results: HbA1c level changed significantly in neither group after surgery (p > 0.05), but FPG, TG and TC levels increased in both groups (p < 0.05). Differences in FPG and TC levels before and after surgery were larger than those in the control group (p < 0.05). The receiver operating characteristic curve revealed the excellent diagnostic value of differences in FPG and TC levels for postoperative complications, and logistic regression analysis indicated that such differences were independent risk factors for complications after RT (p < 0.05).
Conclusions: The early evaluation of postoperative complications can be achieved by monitoring differences in FPG and TC levels before and after RT, allowing for the timely formulation and implementation of interventions.
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Background: Acute immune rejection remains a challenge in the post-transplant period, with approximately 7.8% of renal transplant recipients experiencing rejection episodes within the first year. Genetic polymorphisms in the CYP3A5 gene, which influences tacrolimus metabolism, have garnered interest regarding their association with clinical outcomes in renal transplantation.
Methods: This retrospective correlation study analysed clinical data from kidney transplant patients who received tacrolimus treatment at our hospital from June 2015 to June 2023. The presence of CYP3A5 gene polymorphisms, tacrolimus trough levels, and demographic and clinical data were collected and analysed.
Results: A total of 105 kidney transplant patients were included. Patients were divided into acute immune rejection (n = 56) and non-acute immune rejection (n = 49) groups. The distribution of CYP3A5 gene polymorphisms differed significantly between the acute rejection and non-acute rejection groups (p = 0.037). The acute rejection group exhibited a higher frequency of CYP3A5 *1/*1 or *1/*3 genotypes than the non-acute rejection group. No statistically significant differences were found in the tacrolimus trough levels between the two groups. Correlation analysis revealed a statistically significant correlation between CYP3A5 gene polymorphism and post-transplant acute immune rejection (r = 0.223, p < 0.05).
Conclusions: This study demonstrated a significant association between CYP3A5 gene polymorphism and the risk of post-transplant acute immune rejection in renal transplant recipients receiving tacrolimus therapy. These findings highlighted the importance of genetic variability in tacrolimus metabolism when managing immunosuppressive therapy in transplant recipients.
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Objective: Patients with advanced prostate cancer commonly experience psychological issues and have a low quality of life. This study aims to analyse the application of supportive psychotherapy combined with analgesic management on the pain and quality of life of patients with advanced prostate cancer.
Methods: Patients with advanced prostate cancer admitted to our hospital from February 2018 to December 2022 were continuously selected as the research objects. In accordance with the different management methods recorded in the medical record system, the patients were divided into a control group (routine nursing + analgesic management) and an observation group (routine nursing + analgesic management + supportive psychotherapy). The Athens Insomnia Scale (AIS), State Anxiety Scale (S-AI), Trait Anxiety Scale (T-AI), Numeric Rating Scale (NRS) and 36-Item Short-Form Health Survey (SF-36) scores between the two groups were compared.
Results: A total of 125 patients with advanced prostate cancer participated in this study, with 60 patients in the control group and 65 patients in the observation group. No significant difference was found in the scores of the AIS, S-AI, T-AI, NRS and SF-36 of the two groups before management (p > 0.05). After management, the AIS (4.00 vs. 5.00, p = 0.002), S-AI (38.88 vs. 41.12, p = 0.002), T-AI (39.17 vs. 41.65, p = 0.001) and NRS (3.00 vs. 3.00, p < 0.001) scores of the observation group were lower than those of the control group. However, the SF-36 scores of the observation group were higher than those of the control group in the dimensions of physiological enginery (75.85 vs. 68.75, p < 0.001), physiological function (71.85 vs. 67.75, p = 0.004), body pain (73.15 vs. 69.33, p = 0.006), social function (73.88 vs. 69.85, p = 0.004), emotional function (72.92 vs. 68.98, p = 0.006), mental health (73.52 vs. 69.83, p = 0.008), vitality (72.09 vs. 69.52, p = 0.044) and general health (70.65 vs. 66.23, p = 0.002).
Conclusions: Supportive psychotherapy combined with analgesic management for patients with advanced prostate cancer may help improve the pain, anxiety and quality of sleep and life of patients.
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