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This study investigated the oncological and functional outcomes of robot-assisted radical prostatectomy (RaRP) in high-risk and very high-risk prostate cancer patients. One hundred localized prostate cancer patients receiving RaRP from August 2015 to December 2020 were retrospectively enrolled. According to NCCN risk classification, patients were classified into two groups, below high-risk group, and high-risk/very high-risk group, to analyze continence outcome within postoperative year one and biochemical recurrence-free survival. The mean age of the cohort was 69.7 ± 7.4 years with a median follow-up of 26.4 (range 3.3-71.3) months. Among them, 53%, and 47% patients were below high-risk group, and high-risk/very high-risk group, respectively. The median biochemical recurrence-free survival of the entire cohort was 53.1 months. The high-risk/very high-risk group without adjuvant treatment had significantly worse biochemical recurrence-free survival than the high-risk/very high-risk group with adjuvant treatment (19.6 vs. 60.5 months, p = 0.029). Rates of postoperative stress urinary incontinence at 1 week, 1 month, and 12 months were 50.7%, 43.7%, and 8.5%, respectively. High-risk/very high-risk patients had significantly higher rates of stress urinary incontinence at postoperative week 1 (75.8% vs. 28.9%) and month 1 (63.6% vs. 26.3%) than the below high-risk group (both p < 0.01). Rates of stress urinary incontinence after RaRP did not differ between two groups from postoperative 3 months to 12 months. The factor of high-risk / very high-risk group was a predictor of immediate but not for long-term postoperative stress urinary incontinence. High-risk and very high-risk prostate cancer patients receiving a combination of RaRP and adjuvant treatment had comparable biochemical recurrence-free survival to below high-risk prostate cancer patients. The high-risk/very high-risk factor impeded early but not long-term postoperative recovery of continence. RaRP can be considered a safe and feasible option for high-risk and very high-risk prostate cancer patients.

Botulinum toxin A (BoNT-A) urethral sphincter injections have been applied in treating voiding dysfunction but the treatment outcome is not consistent. This study analyzed treatment outcomes between patients with different bladder and urethral sphincter dysfunctions. Patients with refractory voiding dysfunction due to neurogenic or non-neurogenic etiology were treated with urethral sphincter 100 U BoNT-A injections. The treatment outcomes were assessed by a global response assessment one month after treatment. The bladder neck opening and urodynamic parameters in preoperative videourodynamic study were compared between successful and failed treatment groups. A total of 80 non-neurogenic and 75 neurogenic patients were included. A successful outcome was noted in 92 (59.4%) patients and a failed outcome in 63 (40.6%). The treatment outcome was not affected by the gender, voiding dysfunction subtype, bladder dysfunction, or sphincter dysfunction subtypes. Except an open bladder neck and higher maximum flow rate, no significant difference was noted in the other variables between groups. Non-neurogenic patients with successful outcomes had a significantly higher detrusor pressure, and patients with neurogenic voiding dysfunction with successful results had higher maximum flow rates and smaller post-void residuals than those who failed the treatment. However, increased urinary incontinence was reported in 12 (13%) patients. BoNT-A urethral sphincter injection is effective in about 60% of either neurogenic or non-neurogenic patients with voiding dysfunction. An open bladder neck during voiding and a higher maximum flow rate indicate a successful treatment outcome.

Our aim was to analyze the clinical and survival differences among patients who underwent the two main treatment modalities, endoscopic ablation and radical nephroureterectomy. This study examined all patients who had undergone endoscopic management and RNU between Jul. 1988 and Mar. 2019 from the Taiwan UTUC registry. The inclusion criteria were low stage UTUC in RNU and all cases in endoscopic managed UTUC with a curative intent. The demographic and clinical characteristics were included for analysis. In total, 84 cases in the endoscopic group and 272 cases in the RNU group were enrolled for final analysis. The median follow-up period were 33.5 and 42.0 months in endoscopic and RNU group, respectively ( p  = 0.082). Comparison of Kaplan–Meier estimated survival curves between groups, the endoscopic group was associated with similar overall survival (OS), cancer specific survival (CSS), and intravesical recurrence free survival (IVRS) but demonstrated inferior disease free survival (DFS) ( p  = 0.188 for OS, p  = 0.493 for CSS and p  < 0.001 for DFS). Endoscopic management of UTUC was as safe as RNU in UTUC endemic region.

Bladder neck dysfunction (BND) is a pathophysiology associated with voiding dysfunction in patients with neurogenic or non-neurogenic voiding dysfunction. Botulinum toxin A (BoNT-A) injection is a minimally invasive alternative for treating bladder outlet dysfunction; however, its efficacy for BND has not been well established. In this retrospective study, 41 patients with videourodynamic study-confirmed BND who failed medical therapy received a transurethral bladder neck injection of 100-U BoNT-A. Treatment outcomes were assessed using the Global Response Assessment. After BoNT-A injection, the patients were followed up and subsequent urological management was recorded. At 6 months, 65.9% of the patients reported satisfactory outcomes (26.8% successful and 39.0% improved). Patients with non-neurogenic BND had the highest satisfaction rate, higher than those with neurogenic BND (NBND) with and without detrusor sphincter dyssynergia (DSD). Among patients without detrusor acontractility (DA), a higher bladder outlet obstruction index predicted treatment failure. Patients with pure BND confirmed by urodynamics may benefit more from BoNT-A injections, whereas those with high baseline voiding detrusor pressure or spinal cord injury with detrusor sphincter dyssynergia may have less favorable results. Bladder neck BoNT-A injections for treating BND-associated voiding dysfunction did not achieve very successful outcomes. Only 26.8% of the patients had successful treatment outcomes, while 39.0% had improved outcomes and 34.1% failed the treatment.

Purpose: To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). Methods: This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. Results: At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). Conclusions: The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.

The prognostic value of central pathology review in upper urinary tract cancer (UTUC) remains inadequately addressed in existing literature. In this study, we conducted an extensive central pathology review and presented its influence on multi-center UTUC studies. We conducted a retrospective review of patients who underwent radical nephroureterectomy or segmental resection for UTUC to determine eligibility for central pathology review. In the Taiwan UTUC Collaboration cohort, 377 cases met the criteria for pathology review. We assessed agreement between pathologists using both the total percentage of agreement and simple kappa statistics. The prognostic implications of original and review pathology for various parameters were examined using the Cox regression model. This study included 209 female and 168 male participants. Pathology review revealed substantial interobserver variability in pT staging, with a particularly high rate of pT2 cases being upgraded to pT3 upon central review (17/70 pT2 stage made by local pathologists were finally confirmed as pT3 disease by the review pathologist). The local pathologist cohort identified fewer significant histological predictors in survival models compared to the review pathology cohort. Advanced pT stage, perineural invasion (PNI), and positive surgical margin were independent predictors of poorer overall survival and cancer-specific survival. PNI, lymphatic vascular invasion, and positive surgical margin were independent predictors of disease recurrence. Substantial interobserver variability in histological assessment underscores the importance of centralized pathology review for both multi-center studies and accurate post-operative management of UTUC patients. Advanced stage, perineural invasion, and margin status were significant histological predictors of oncological outcomes.

Urothelial dysfunction may be a key pathomechanism underlying interstitial cystitis/bladder pain syndrome (IC/BPS). We therefore examined if clinical severity is associated with the extent of urothelial damage as revealed by electron microscopic (EM) analysis of biopsy tissue. One hundred IC/BPS patients were enrolled and 24 patients with stress urinary incontinence served as controls. Clinical symptoms were evaluated by visual analog scale pain score and O’Leary-Sant Symptom score. Bladder biopsies were obtained following cystoscopic hydrodistention. The presence of Hunner’s lesions and glomerulation grade after hydrodistention were recorded and patients classified as Hunner-type IC (HIC) or non-Hunner-type IC (NHIC). HIC patients exhibited more severe defects in urothelium cell layers, including greater loss of umbrella cells, umbrella cell surface uroplakin plaque, and tight junctions between adjacent umbrella cells, compared to control and NHIC groups (all p  < 0.05). Both NHIC and HIC groups demonstrated more severe lamina propria inflammatory cell infiltration than controls ( p  = 0.011, p  < 0.001, respectively). O’Leary-Sant Symptom scores were significantly higher among patients with more severe urothelial defects ( p  = 0.030). Thus, urothelium cell layer defects on EM are associated with greater clinical symptom severity.

Purpose: This study aimed to identify the predictive factors for successful or failed treatment outcomes following intravesical injection of botulinum toxin A (BoNT-A) through an analysis of baseline video urodynamic characteristics and parameters. Methods: This study retrospectively analyzed the therapeutic outcomes of intravesical BoNT-A injection in patients who had an overactive bladder (OAB), who were diagnosed with detrusor overactivity (DO), and who had been refractory to OAB medications or intolerant of the adverse events associated with them. Treatment outcomes were classified as successful, improved, or failed according to the patients’ subjective report of improvement in OAB symptoms at three months post-injection. The patients were split into male and female cohorts and neurogenic or non-neurogenic DO for data analysis. The video urodynamic study characteristics and parameters were compared across the successful, improved, and failed subgroups. Results: This study included 571 patients who received intravesical BoNT-A injections for treating their OAB and urodynamic DO, of which 272 were men and 299 were women. The treatment outcome of BoNT-A injection was successful in 55.7%, improved in 27.8%, and failed in 16.5% of the patients. Patients with urodynamic detrusor underactivity (DU) and neurogenic DO due to diseases of the central nervous system did not usually achieve a successful outcome. The following factors predicted successful treatment outcomes following BoNT-A injection: lower baseline detrusor pressure, higher maximum flow rate (Qmax), larger voided volume, and smaller post-void residual (PVR) in men; larger voided volume and smaller PVR in women. Conclusions: The therapeutic success of intravesical BoNT-A injection for treating refractory OAB can be predicted by lower Pdet, higher Qmax, larger voided volume, and smaller PVR in men and by higher Qmax and smaller PVR in women. Patients with neurogenic DO and DU usually have unsuccessful treatment outcomes.

Purpose: Existing T3 subclassifications for upper tract urothelial cancer (UTUC) are limited by heterogeneity and a primary focus on renal pelvis tumors. Our study aimed to propose a novel pT3 subclassification system specifically tailored to pT3 UTUC patients. Materials and Methods: This study analyzed 120 pT3 UTUC cases from a Taiwanese multicenter registry, using a standardized pathology report and a single pathologist for evaluation. Results: Univariate analysis revealed survival differences based on existing subclassifications. Multivariate analysis identified concurrent fat and parenchyma invasion as an independent predictor of worse overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Conclusions: This study proposes a novel pT3 subclassification incorporating fat and parenchyma invasion, applicable to all UTUC sites. This subclassification may improve risk stratification, guide treatment decisions, and ultimately enhance patient outcomes.

Urothelial carcinomas of the upper urinary tract (UTUC) are rare tumors with a high malignancy degree. Radical nephroureterectomy (RNU) with bladder cuff excision remains one of the standard treatments in clinically localized or locally advanced UTUCs. However, the role of cytoreductive RNU in treating clinically lymph node-positive (N+) UTUCs remains unclear. A nationwide retrospective study was conducted by the Taiwan UTUC Collaboration Group from July 1988 to June 2022. Patients with clinical N + UTUC before initiation of cancer therapy were included in this study. Initial clinically node-positive disease was noted in 288 (5.4%) of the 5,301 patients. Of the patients, 239 (83%) patients underwent RNU. UTUC-related mortality was markedly higher among patients not receiving RNU than among those who underwent surgery (69.4% vs. 36%). After adjusting for the effects of stepwise enrolled parameters, multivariate analysis showed that undergoing RNU (or not) and smoking (or not) were the only independent predictors of overall survival (OS). After adjusting for the effects of significant stepwise enrolled variables, multivariate analysis showed that RNU and smoking (or not) were the only independent predictors of cancer-specific survival (CSS). Our findings showed that RNU is associated with better OS and CSS in Taiwanese patients with N + UTUC. Common patient characteristics and most cancer characteristics were not related to the outcome. Our results provide new evidence on the efficacy of RNU for patients with N + UTUC, which could alter and guide the direction of future treatment guidelines.