Urology Journal

Purpose: To compare the efficiency and safety between retroperitoneal laparoscopic nephrectomy and traditional
open nephrectomy to treat autosomal-dominant polycystic kidney disease before kidney transplantation.
Materials and Methods: A total of 57 patients diagnosed with huge autosomal-dominant polycystic kidney disease
between 2000 and 2020 at our center were included in this study. Patients were divided into a retroperitoneal
laparoscopic (RL; n=23) group and traditional open (TO; n = 34) group. We retrospectively analyzed and compared
preoperative and perioperative variables between the two groups.
Results: Patients in the RL group showed a longer operation time (201.09±83.76min) compared to patients in the
TO group (113.38 ± 51.84min, p < 0.001). The RL group also showed significantly less intraoperative blood loss
(p = 0.025) and less intraoperative blood transfusion volume (p = 0.016) compared to the TO group. Meanwhile,
time of gastrointestinal function recovery, bed leave, catheter indwelling and postoperative hospitalization in the
RL group were 2.13 ± 0.63, 1.30 ± 1.0, 5.22 ± 2.09, 7.35±2.48 days, respectively, which were significantly shorter
than the TO group (p < 0.05). Pain degree of patients during the first 48 hours after operation was similar between
the RL and TO groups, but the opioid use percentage in the RL group was 8.70% (2/23) and was lower than the
26.47% (9/34) in the TO group (p = 0.022). Meanwhile, 5 and 23 patients exhibited postoperative complications in
the RL and TO groups, respectively (p < 0.001).
Conclusion: Both retroperitoneal laparoscopic nephrectomy and traditional open surgery are feasible to treat huge
polycystic nephrectomy. However, patients who undergo retroperitoneal laparoscopic nephrectomy experience
higher levels of safety and recover more rapidly.

Purpose: Post prostatectomy PSA kinetics and General Grade Groups (GGG) are the strongest prognostic markers
of biochemical recurrence (BCR) and prostate cancer (PCa)-specific mortality after radical prostatectomy. Despite
having low-risk PCa, some patients will experience BCR, for some, clinically significant BCR. There is a need for
an objective prognostic marker at the time of prostatectomy to improve risk stratification within this population. In
this study, we investigated the prognostic potential of DNA ploidy.
Materials and Methods: Prostatectomy samples from 97 patients with GGG1 and GGG2 with a low-risk
CAPRA-S score were included in this study. PCa tissue with the worst Gleason pattern underwent tissue disaggregation, cell isolation and staining with a DNA stoichiometric stain. Using image cytometry, DNA ploidy was
measured and a Ploidy Score (PS) was generated.
Results: Among the 97 patients, 79 had no BCR, 18 experienced BCR, of which 14 had a PSA doubling time
(PSA-DT) >1 year (low-risk group) and 4 had a PSA-DT of <1 year (high-risk group). Using Logistic regression
analysis, only pathological T stage (pT) and PS independently predicted BCR with PS being the most significant
(p = 0.001). The number of aneuploid cells was significantly higher in the high-risk group compared to the other
groups (p = 1.7x10-11). PS combined with GGG diagnosis further stratified risk groups of biochemical recurrence
free survival within CAPRA-S low-risk cohort.
Conclusion: DNA ploidy is an independent prognostic marker of BCR in low-risk PCa after radical prostatectomy,
which could early on identify potentially aggressive PCa recurrences and introduce a more personalized approach
to salvage treatments.

Purpose: The present study aimed to develop nomograms based on the SEER database to predict the prognosis for
patients with primary sarcomatoid carcinoma of the urinary bladder (SCUB).
Materials and Methods: Patients with primary SCUB were identified in the Surveillance, Epidemiology, and
End Results (SEER) database, between 1975 and 2017. Univariate and multivariable Cox analysis were conducted
to identify the independent prognostic factors for developing the overall survival (OS) and cancer-specific survival
(CSS) nomograms. Then, concordance index (C-index), receiver operating characteristic (ROC) curve and
calibration curve were used to evaluate the accuracy of the nomogram model. In addition, the model was further
compared with TNM staging system.
Results: A total of 238 eligible patients with primary SCUB were selected from the SEER database. As suggested
by Cox-analysis, age, sex, T stage, M stage, tumor size, and surgery type of primary site were identified as the
independent factors for predicting both OS and CSS. We developed OS and CSS nomograms with a favorable
C-index by using these prognostic factors. The C-indexes of the OS and CSS nomogram in the present study were
0.738 (0.701-0.775) and 0.763 (0.724-0.802), which were superior to those of the AJCC TNM staging with 0.621
(0.576-0.666) and 0.637 (0.588-0.686) respectively, showing better discriminatory ability. Subsequently, the ROC
curves showed that the 1-, 3- and 5-year AUCs (area under the curve) of OS nomogram (i.e., 0.793, 0.807 and
0.793) were higher than those of the TNM stage((i.e., 0.659, 0.676, 0.659). Similarly, as for CSS model, them
((i.e., 0.823, 0.804 and 0.804) were aslo exceed those of TNM stage((i.e., 0.683, 0.682, 0.682). Furthermore, the
calibration curves indicated a good consistency between the predictive survival and the actual survival. Finally,
patients were stratified by risk, and Kaplan-Meier survival curve suggested that the prognosis of the low-risk group
was significantly better than that of the high-risk group.
Conclusion: We developed nomograms with the SEER database, which could help predict the prognosis of SCUB
individuals more accurately.

Purpose: Upper tract urothelial carcinoma (UTUC) can be divided into renal pelvis tumor (RPT) and ureteral tumor
(UT) based on the tumor origin. This study aimed to evaluate the efficacy of neoadjuvant chemotherapy with
gemcitabine and cisplatin (NAC-GC) in terms of the pathological outcomes and oncological prognoses in patients
with UTUC. We also compared its efficacy between RPT and UT.
Materials and Methods: Patients who underwent radical nephroureterectomy for clinical T (cT)3N0M0 UTUC
between 1999 and 2021 were included. Patients who underwent NAC-GC and those who did not were included in
the NAC-GC and non-NAC-GC groups, respectively. Based on the tumor origin, we divided patients with UTUC
into RPT and UT groups. Oncological prognosis was assessed using progression-free survival (PFS) and overall
survival.
Results: Of 44 patients, 20 (45.5%) and 24 (54.5%) patients were in the NAC-GC and non-NAC-GC groups,
respectively. The NAC-GC group had significantly lower pathological T stage and negative lymphovascular invasion
(LVI), and a better PFS (p < .05) compared to those in the non-NAC-GC group. Among patients with RPT, the
NAC-GC group had significantly negative LVI and better PFS than the non-NAC-GC group (p < .05). In contrast,
in patients with UT, the NAC-GC group had no significant difference in pathological outcomes, and no significant
difference in oncological prognosis was observed between the NAC-GC and non-NAC-GC groups.
Conclusion: NAC-GC improves both pathological outcomes and oncological prognosis in patients with cT3N0M0
UTUC. With regard to tumor location, RPT has better pathological outcomes and oncological prognoses than UT.

Purpose: To evaluate the diagnostic accuracy of single and multiple fluorescence in situ hybridization (FISH) tests
for upper urinary tract cancer (UTUC), we analyzed the diagnostic efficacy of FISH in patients with UTUC and the
difference between it and the Tumor Node Metastasis (TNM) stage and grade of the tumor.
Materials and Methods: Patients treated for UTUC at our institution between 2011 and 2021 who had not been
previously diagnosed with UTUC were included. Patients were divided into single, two, and multiple (three times
or four times) FISH groups based on the number of FISH tests performed on different samples from the same
patient, and the diagnostic efficiency of single, two, and multiple FISH tests for muscle-invasive tumors and highgrade tumors were assessed.
Results: We included a total of 207 patients with UTUC, and when compared to single FISH, the sensitivity of
multiple and double FISH for the diagnosis of UTUC increased from 62% to 76% and 78%, respectively. It went
from 67% to 78% and 80% for muscle-invasive UTUC (> = pT2) and from 71% to 79% and 81% for the highest-
grade UTUC.
Conclusion: Multiple FISH improves the diagnostic efficacy of UTUC and helps to differentiate aggressive tumors.

Purpose: To assess outcomes of bilateral single-session percutaneous nephrolithotomy (PCNL) with minimally
invasive techniques in pediatric population.
Materials and Methods: From August 2015 to July 2021, 45 children (including 12 infants) were treated with
bilateral single-session PCNL, which included miniPCNL (12-16-Fr) and Microperc (4.8-Fr). Patient, stone and
operation-related characteristics, stone-free rate (SFR) and complication rate (CR) were compared using ANOVA.
Independent predictors were determined using multivariate linear regression.
Results: The mean stone burden was 3.2 cm in sum diameter for both kidneys. For bilateral kidneys, the mean
operative time was 61.6min and SFR was 93.3%; CR was 53.3%, of which complications of Clavien grade 1 and
2 accounted for 46.7%. Bilateral Microperc, bilateral miniPCNL and Microperc plus miniPCNL was performed
in 19, 14 and 12 children respectively. Both irrigation volume and postoperative stay were less in groups with Microperc. Both SFRs and CRs were satisfactory for the three groups. Self-limiting hematuria represented the most
common complication of all cases (33.3%), especially in groups with miniPCNL. The stone burden was the only
independent predictor for operative time (P < .001) and the postoperative complication (P = .008). Children with
older age (P = .009), higher body mass index (P = .016) or a higher stone burden (P < .001) received larger irrigated
fluid volume. Microperc was associated with less irrigated fluid volume (P = .001). Children with Clavien grade 3
complications (P = .004) spent prolonged postoperative hospital stay.
Conclusion: With favourable SFR and acceptable CR, bilateral single-session PCNL with minimally invasive
techniques might be an effective and safe procedure for pediatric nephrolithiasis.

Purpose: The choice between using the internal or external iliac arteries to supply a transplanted kidney poses
a dilemma during renal transplantation. As the internal iliac artery branches to the genital tract, cutting it could
potentially result in sexual dysfunction. The purpose of this study was to compare the effects of these two surgical
methods on sexual function.
Materials and Methods: 122 sexually active male patients under the age of sixty were randomly divided into two
groups: the internal iliac anastomosis group and the external iliac artery anastomosis group. Before surgery and one year after the procedure, patients completed the International Index of Erectile Function-15 questionnaire (IIEF-
15), and the difference in scores of each domain was measured.
Results: Statistically, kidney transplantation improved all domains of IIEF in both groups, except for erectile
function in patients who underwent internal iliac artery anastomosis group. Additionally, there were significant
differences between the two groups in the domains of erectile function (p-value=0.04) and overall satisfaction
(p-value = 0.002), while other domains such as orgasmic function, sexual desire, and intercourse satisfaction did
not show any statistically significant differences.
Conclusion: In conclusion, the choice between using the internal or external iliac artery for arterial anastomosis
during kidney transplantation does not significantly impact graft function. However, it may negatively affect erectile
function in patients who undergo internal iliac artery anastomosis.

Purpose: Evaluation of preliminary cosmetic and functional outcomes of biodegradable scaffolds covered with
platelet-rich plasma in penile girth augmentation.
Materials and Methods: Between June 2016 and June 2018, 36 males who had a mean age of 28.91 years (range
20 - 48 years) with micropenis underwent this procedure. A mixture of platelets-fibrin glue and mesenchymal cells
obtained from dermal fat tissue were prepared. Then the mixture was seeded on the pretreated tube-shaped poly
lactic-co-glycolic acid scaffold and underwent a whole day of incubation. Following penile degloving, scaffolds
were surgically implanted within the interface region of dartos and Buck's fascia. The 5-point Likert scoring scale
was used to evaluate the patients’ satisfaction with surgery.
Results: Patients followed up for 6-12 (8 ± 2.86) months. The penile length in an erected state before surgery was
6.5 - 12.5 cm (9.08 ± 1.6) which enhanced to 7 - 14 cm (10.59 ± 1.71) after surgery (P < .0001). The penile girth
before and after surgery were 8.49 ± 1.53 and 10.91 ± 1.96 cm, respectively (P < .0001). An augment in penile
length and girth of 1.5 and 2.6 cm were achieved, respectively. Patients appraised surgical intervention on a rating
of one to five. The highest possible score (5) was assigned by 27 %, 33 % expressed a very good mark (4), and 19
% gave a good mark (3).
Conclusion: Covering the scaffold with a mixture of Platelets-Fibrin glue and mesenchymal cells seems a safe and
feasible method for penile reconstruction surgery. More studies should be done to determine the effect of platelets-
fibrin glue and mesenchymal cells for treating micropenis.

Purpose: Few studies have evaluated the usefulness of anteroposterior dissection holmium laser enucleation of the prostate (HoLEP). Thus, this study investigated the incidence of stress urinary incontinence (SUI) after HoLEP and usefulness of anteroposterior dissection HoLEP in preventing postoperative SUI.

Materials and Methods: In total, 288 patients who underwent HoLEP performed by a single experienced surgeon between May 2014 and September 2021 were enrolled. Furthermore, 134 patients underwent retrograde dissection using the modified Gilling method (surgery 1) and 154 patients underwent anteroposterior dissection HoLEP (surgery 2). The risk factors for SUI, as well as the rates of SUI improvement for the two surgical procedures, were evaluated.

Results: Postoperative SUI was observed in 58 (20.1%) of 288 patients, of whom, 48 (82.8%) recovered continence within 6 months. Ten patients (17.2%) required more than 6 months to recover continence. SUI incidence 1 month after HoLEP was 29.9% (40/134 patients) for surgery 1 and 11.7% (18/154 patients) for surgery 2; a statistically significant difference was observed between the two groups (odds ratio [OR], 0.311; 95% confidence interval [CI], 0.168–0.575; p < 0.001). In addition, surgery 2 was significantly associated with early recovery from SUI compared with surgery 1 (stratified hazard ratio, 0.782; 95% CI, 0.615–­­­­­0.995; p < 0.001). The multivariable analysis demonstrated that only surgical procedure (OR, 0.350; 95%CI, 0.168–0.732; p=0.005) was an independent predictor of SUI.­

Conclusion: We reaffirmed that anteroposterior dissection HoLEP is a useful procedure for reducing the risk of postoperative SUI and early recovery of urinary continence.