Nomogram predicting the efficacy of transurethral surgery in benign prostatic hyperplasia patients.

PURPOSE: This study aimed to develop and validate a nomogram for predicting the efficacy of transurethral surgery in benign prostatic hyperplasia (BPH) patients. METHODS: Patients with BPH who underwent transurethral surgery in the West China Hospital and West China Shang Jin Hospital were enrolled. Patients were retrospectively involved as the training group and were prospectively recruited as the validation group for the nomogram. Logistic regression analysis was utilized to generate nomogram for predicting the efficacy of transurethral surgery. The discrimination of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots were applied to evaluate the calibration of the nomogram. RESULTS: A total of 426 patients with BPH who underwent transurethral surgery were included in the study, and they were further divided into a training group (n = 245) and a validation group (n = 181). Age (OR 1.07, 95% CI 1.02-1.15, P < 0.01), the compliance of the bladder (OR 2.37, 95% CI 1.20-4.67, P < 0.01), the function of the detrusor (OR 5.92, 95% CI 2.10-16.6, P < 0.01), and the bladder outlet obstruction (OR 2.21, 95% CI 1.07-4.54, P < 0.01) were incorporated in the nomogram. The AUC of the nomogram was 0.825 in the training group, and 0.785 in the validation group, respectively. CONCLUSION: The nomogram we developed included age, the compliance of the bladder, the function of the detrusor, and the severity of bladder outlet obstruction. The discrimination and calibration of the nomogram were confirmed by internal and external validation.

Enhanced recovery after surgery in transurethral surgery for benign prostatic hyperplasia.

Enhanced recovery after surgery (ERAS) measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia (BPH). This study was performed on patients with BPH who required surgical intervention. From July 2019 to June 2020, the ERAS program was applied to 248 patients, and the conventional program was applied to 238 patients. After 1 year of follow-up, the differences between the ERAS group and the conventional group were evaluated. The ERAS group had a shorter time of urinary catheterization compared with the conventional group (mean ± standard deviation [s.d.]: 1.0 ± 0.4 days vs 2.7 ± 0.8 days, P < 0.01), and the pain (mean ± s.d.) was significantly reduced through postoperative hospitalization days (PODs) 0-2 (POD 0: 1.7 ± 0.8 vs 2.4 ± 1.0, P < 0.01; POD 1: 1.6 ± 0.9 vs 3.5 ± 1.3, P < 0.01; POD 2: 1.2 ± 0.7 vs 3.0 ± 1.3, P < 0.01). No statistically significant difference was found in the rate of postoperative complications, such as postoperative bleeding (P = 0.79), urinary retention (P = 0.40), fever (P = 0.55), and readmission (P = 0.71). The hospitalization cost of the ERAS group was similar to that of the conventional group (mean ± s.d.: 16 927.8 ± 5808.1 Chinese Yuan [CNY] vs 17 044.1 ± 5830.7 CNY, P =0.85). The International Prostate Symptom Scores (IPSS) and quality of life (QoL) scores in the two groups were also similar when compared at 1 month, 3 months, 6 months, and 12 months after discharge. The ERAS program we conducted was safe, repeatable, and efficient. In conclusion, patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.

The relationship between exposure to phthalate metabolites and adult-onset hypogonadism.

Objective: Adult-onset hypogonadism (AOH) is a common disease for males >40 years old and is closely associated with age-related comorbidities. Phthalates are compounds widely used in a number of products with endocrine-disrupting effects. However, little is known about the association between exposure to phthalates and the risk of AOH. Thus, we conducted this study to explore the potential association using the 2013-2016 National Health and Nutrition Examination Survey (NHANES) data. Method: Data on AOH and urinary phthalate metabolites were collected, and univariable and multivariable logistic regression analyses were adapted to evaluate the association. The concentrations of each metabolite were calculated and grouped according to their quartiles for the final analysis. Result: Finally, we found that the odds ratio (OR) increased with increased concentrations of di-(2-ethylhexyl) phthalate (DEHP) metabolites, including mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP). Simultaneously, a significant dose-dependent effect was also observed. The OR for the fourth quartile was highest among all three groups. Specifically, the ORs for the third quartile and fourth quartile were 1.774 and 1.858, respectively, in the MECPP group. For the MEHHP group, the OR increased from 1.580 for the second quartile to 1.814 for the fourth quartile. Similarly, the OR for the higher three quartiles varied from 1.424 to 1.715 in the MEOHP group. Conclusion: This study first revealed that there was a positive association between exposure to DEHP metabolites and the risk of AOH. These findings add limited evidence to study this topic, while further studies are needed to explain the potential molecular mechanisms.

Primary Diffuse Large B-Cell Lymphoma of the Urinary Tract: A Population-Based Analysis.

OBJECTIVE: Diffuse large B-cell lymphoma (DLBCL) is the most common histopathological type of non-Hodgkin's lymphoma, which may arise from various extranodal sites. Little is known about the clinical characteristics and survival outcomes of primary DLBCL of the urinary tract (UT). Thus, we conducted this study to explore the independent prognostic factors of patients with UT-DLBCL using the Surveillance, Epidemiology, and End Results (SEER) database. MATERIALS AND METHODS: We searched the Surveillance, Epidemiology, and End Results (SEER) database for the data of patients diagnosed with UT-DLBCL between 1975 and 2016. Data, including demographic tumour stage and therapeutic strategies, such as surgical resection, radiation therapy, and chemotherapy, were collected. The impact of these factors on survival outcomes, including overall survival (OS) and disease-specific survival (DSS), was analysed using Kaplan-Meier curves. RESULTS: Four-hundred and eighty-nine patients who met the inclusion criteria were enrolled in the data analysis. The median age was 69 years old. Most cases of UT-DLBCL (72.39%) originated from the kidney, followed by the urinary bladder (24.95%). Both surgical resection and chemotherapy can significantly improve OS and DSS. Patients older than 75 years had the worst survival outcomes. Stage IV DLBCL may be a poor prognostic factor. CONCLUSION: To the best of our knowledge, this is the largest population-based study of UT-DLBCL. Advanced age, male gender, lack of surgical resection or chemotherapy, and stage IV DLBCL were poor prognostic factors.

Retroperitoneal or transperitoneal approach in robot-assisted partial nephrectomy, which one is better?

PURPOSE: To systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot-assisted partial nephrectomy (RAPN), we conducted an updated meta-analysis. METHODS: A literature retrieval of multi-database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications (major complications and overall complications). Outcomes of data were pooled and analyzed with Review Manager 5.4.1. RESULTS: Twenty-one studies involving a total of 2482 RP and 3423 TP approach RAPN patients met the inclusion criteria. Operating time (OT) (weighted mean difference [WMD] -16.60; 95% confidence interval [CI] -23.08, -10.12; p < 0.01) and PLOS (WMD -0.46 days; 95% CI -0.69, -0.23; p < 0.01) were shorter in RP-RAPN. Besides, lower EBL (WMD -21.67; 95% CI -29.74, -13.60; p < 0.05) was also found in RP-RAPN. Meanwhile, no significant differences were found in other outcomes. CONCLUSIONS: RP-RARN was superior to TP-RAPN in patients undergoing RAPN in terms of OT, PLOS, and estimated blood loss. Besides these two approaches have no significant differences in PSMs or perioperative complications.

Will the resection of pheochromocytoma improve preoperative diabetes mellitus?

OBJECTIVE: To explore the likelihood of resolution of diabetes postoperatively. Besides, we would like to determine the risk factors associated with development and prognosis of diabetes. METHODS: All patients in our hospital undergoing surgical removal of pheochromocytoma (PHEO) from 10 October 2010 to 21 July 2017 were retrospectively analyzed to determine those with preoperative diabetes. Preoperatively demographic data and information on diabetes were recorded. The median follow-up was 45.2 months. RESULTS: Finally, 67 (36.2%) patients were with diabetes among 185 patients undergoing surgery. Furthermore, 47 patients had complete follow-up. And 37 (78.7%) patients had improvement of diabetes after resection of PHEO. In details, 29 (61.7%) patients had complete resolution. Older patients were more likely to develop diabetes, and symptomatic patients with longer course of PHEO were also more susceptible to preoperative diabetes. Elevated body mass index (BMI) was a risk factor of persistent diabetes postoperatively after surgery. CONCLUSIONS: 36.2% of PHEO patients might be with preoperative diabetes mellitus. Older patients were more likely to present diabetes preoperatively. And the increasing length of PHEO course might be another risk factor on developing diabetes preoperatively. Resection of tumors improved diabetes in 78.7% of patients, with resolution in 61.7%. Patients with higher BMI might need treatment for diabetes postoperatively.