Urology Journal

Purpose: The study is intended to identify the independent predictors of clinical T1 (cT1) renal cell carcinoma upstaging to pathological T3a (pT3a) and construct the predictive nomogram model.

Methods: The data of cT1 renal cell carcinoma was collected from patients who were treated in the Second Hospital of Tianjin Medical University from January 2010 to December 2016. Mann–Whitney U and chi-square tests were performed to analyze continuous and categorical variables respectively. Univariate and multivariate logistic regression were used to identify the predictors of upstaging. Kaplan-Meier method, log-rank test and Cox regression were performed to analyze survival materials.

Results: Among 1,376 cT1 renal cell carcinoma patients, 75 patients were observed upstaging to pT3a, accounting for 5.5%. There were 6 potential predictors of upstaging, i.e age, clinical symptom, tumor size, Fuhrman grade, tumor necrosis and tumor edge regularity. The 5-year recurrence free survival probabilities of upstaging and non-upstaging patients were 73.3% and 91.1%, respectively and upstaging was an independent predictor of recurrence free survival. Two predictive nomograms were constructed and the C-index of them were 0.842 and 0.806, and the calibration curve and decision curve analysis showed highly clinical accuracy of the nomograms.

Conclusion: Two nomogram models were built to predict the probability of cT1 renal cell carcinoma upstaging to pT3a with highly accuracy and specificity. Upstaging was an independent risk factor of recurrence free survival for cT1 renal cell carcinoma patients.

Purpose: The current study aims to compare the effectiveness of pre-urodynamic single-dose levofloxacin and post-urodynamic levofloxacin for three days related to the incidence of urinary tract infections post-urodynamic examination.

Materials and Methods: This is a single-blind randomized clinical trial conducted in three outpatient urology centers in Jakarta: Cipto Mangunkusumo General Hospital, Siloam Asri Hospital, and Persahabatan General Hospital using a consecutive sampling method between July 2019 - February 2022. The outcome of the study is the incidence of urinary tract infections in both treatment groups. Urinary tract infection was defined as a patient with one or more clinical symptoms of lower urinary tract infection and one or more urinalysis parameters positive for urinary tract infections. Chi-square was used to evaluate the association where p < 0.05 was used to determine statistical significance.

Results: A total of 126 patients (63 patients in each arm) were included in the evaluation and analysis. Overall, urinary tract infections were detected in 25 cases (19.8%), 12 patients from the pre-urodynamic antibiotic group (9.5%) and 13 patients from the post-urodynamic antibiotic group (10.3%) (P = .823). E.coli was the most common bacteria found in the urine culture.

Conclusion:There is no significant difference between a single dose of 500 mg of Levofloxacin administered one hour before the urodynamic study and a once-daily dose of 500 mg of Levofloxacin for three days following the urodynamic study related to urinary tract infections prevention post-urodynamic examination.

Background

Publication bias is one of the most important biases in systematic reviews and meta-analyses. This bias occurs when the results of an article affect its publication, in other words positive or significant findings are more likely to be published than the other probable results. Previous studies have shown that publication bias has been a matter of concern in the meta-analysis and systematic reviews conducted in some medical fields.  There is not a study that has evaluated the status of publication bias assessment in urology systematic reviews. We decided to assess the status of publication bias evaluation in systematic reviews and meta-analyses published in high impact urology journals.

Methods

This cross-sectional study was performed on 200 systematic reviews and meta-analysis published in four top urology journals based on their impact factor (European Urology, The Journal of Urology, BJU International and Prostate Cancer and Prostatic Diseases). Two independent reviewers performed data extraction about publication bias evaluation in included systematic reviews.

Results

From the 200 included studies only 65 (32.5%) evaluated the publication bias in the review process and 31 reviews had reported publication bias in their study. Visual inspection of a funnel plot was the most frequent method used for evaluation of publication bias (61 from 65, 93.85%); this method was used alone in 34 articles and in combination with other methods in 27 papers.

Conclusion

The present study confirms that publication bias was formally evaluated in a small number of reviews and meta-analysis published in urology journals, therefore, this may be a risk factor that could decrease the robustness of outcomes and results of these studies. It seems that there is an essential need for authors, reviewers, and editors to pay better attention to evaluation of publication bias besides reporting it based on the aforementioned reporting guidelines.

 we present a case  of bladder and rectum perforation due to dislodgement of leg brace during holmium laser lithotripsy. A 66-year-old man admitted to the hospital due to "intermittent pain in the left lumbar region for more than 30 days" and was performed with Holmium laser lithotripsy  after routine perioperative preparation.The right leg brace suddenly fell off during the operation, and  caused perforations in  the posterior wall of the bladder and the anterior wall of the rectum. we finally treated the rectal perforation with enteroscopic titanium clip closure and bladder perforation with indwelling catheter. The patient was discharged after the urinary catheter was removed two weeks after surgery.

N/A  As submitted as a letter to the editor