Journal of endourology最新文献

Purpose: Poor adherence to potassium citrate (KCit) therapy due to palatability issues and gastrointestinal side effects presents a significant barrier to effective kidney stone prevention. While liquid and powder alternatives have emerged as potential solutions, comprehensive comparative palatability data remain limited, hampering evidence-based recommendations for clinical practice. This study aimed to evaluate and compare the palatability of four commercially available liquid KCit formulations (Litholyte, Moonstone StoneStopper, KSPTabs, and Bulk Supplements) in healthy non-stone-forming adults. Material and Methods: We conducted a blinded swish-and-spit taste-testing study enrolling 63 healthy participants who sampled each liquid KCit formulation in a randomized order. Participants rated each formulation using a validated five-point Likert scale survey assessing overall palatability, mouthfeel, taste intensity, and aftertaste. Swish-and-spit protocol was followed to minimize systemic absorption while allowing thorough taste evaluation. Results: Moonstone StoneStopper (cranberry-raspberry flavored) demonstrated superior overall palatability (mean score: 4.3 ± 0.6), followed by KSPTabs (3.2 ± 0.8), Litholyte (2.8 ± 1.1), and Bulk Supplements (1.7 ± 0.7). Mouthfeel and aftertaste scores correlated strongly with overall preference (r = 0.87 and r = 0.82, respectively). Conclusions: Flavor-masked formulations consistently outperformed unflavored options across all taste parameters. These findings suggest that flavored liquid alternatives to KCit therapy are preferred in non-stone formers. Further studies in stone-forming populations are warranted to confirm these results, assess gastrointestinal side effects and evaluate long-term adherence.

Introduction: The RADPAD is a novel lead-free shield that can be positioned directly in the surgical field to block scatter radiation. The primary objective of this study was to assess the effectiveness and added protection of the RADPAD compared with conventional lead during simulated percutaneous nephrolithotomy (PCNL). Methods: To simulate a PCNL, a radiographical phantom patient and a mannequin surgeon were utilized. Using a real-time dosimeter, radiation doses were measured in µSv at seven surgeon locations: head, neck, chest, abdomen, pelvis, forearm, and leg. Two shielding strategies were evaluated: conventional lead apron and thyroid shield (LATS) and triple-thickness RADPAD. The effectiveness of combining LATS with RADPAD was compared with baseline (no lead). Five trials of 5 seconds of fluoroscopy were conducted for each location and shielding combination. The Mann-Whitney U test was used to compare exposures with p < 0.05 considered significant. Results: LATS alone significantly reduced radiation exposure at all locations compared with baseline (>95%; p < 0.05) except the surgeon head, forearm, and leg. RADPAD alone significantly reduced radiation at all tested locations (p < 0.05), except the legs. Compared with LATS alone, RADPAD significantly reduced radiation exposure to the head (as much as 48%) and forearm (as much as 84%; p < 0.05). LATS with RADPAD yielded the greatest radiation reduction, performing significantly better than LATS alone at the head, pelvis, and forearm (p < 0.05). No device or combination significantly reduced radiation exposure to the leg. Conclusions: The LATS alone reduced radiation >95% at shielded sites, but provided no protection to the head, forearm, and leg. Addition of the RADPAD to conventional LATS functions as an effective and novel strategy that reduces radiation exposure at all measured sites except the legs and provides important protection to the head and arms of the surgeon without increasing the weight burden.

Introduction: This study aims to develop a predictive model for identifying patients at increased risk of prolonged hospital stay after robotic-assisted radical prostatectomy, either via multi-port or single-port techniques, to improve postoperative care and assist in selecting ideal candidates for same-day discharge. Methods: The study included patients who underwent robotic-assisted radical prostatectomy at the University of Illinois at Chicago between January 2013 and December 2022. The dataset comprises preoperative variables such as age, race, body mass index, comorbidities, prostate-specific antigen levels, Gleason score, surgical approach, and length of hospital stay. A logistic regression model was employed to predict the likelihood of a hospital stay exceeding 24 hours. The model's performance was assessed using the area under the Receiver Operating Characteristic curve and fivefold cross-validation. Results: The predictive model identified significant factors associated with prolonged hospital stays, including body mass index, prostate-specific antigen levels, Gleason score, surgical approach, and specific comorbidities. The transperitoneal approach was strongly associated with lower chances of same-day discharge, demonstrating an odds ratio of 4.23 (p < 0.00001). The model achieved an accuracy of 73.7% as evaluated by cross-validation. Discussion: The nomogram effectively predicts the likelihood of prolonged hospital stay following robotic-assisted radical prostatectomy, enabling surgeons to make informed decisions about patient counseling, surgical planning, and postoperative management. This model may assist in identifying ideal candidates for same-day discharge while improving hospital resource utilization. Future studies should validate this model externally and explore the impact of additional perioperative and social factors.

Objective: This study compared the stone-free rate (SFR) and complications of two holmium laser lithotripsy techniques-active fragment extraction (FRAG) and dusting (DUST)-during flexible ureteroscopy (FURS) for renal stones using noncontrast computed tomography (NCCT). Materials and Methods: A total of 100 patients with renal stones (5-20 mm) undergoing FURS were randomized into FRAG and DUST groups. All surgical parameters, except lithotripsy strategy, were standardized, and ureteral access sheaths were used. The primary outcome was SFR at 90 days, defined as residual fragments ≤2 mm (Grade A + B) on NCCT. Secondary outcomes included the influence of stone volume, density, and complication rates. Results: Ninety-three patients completed follow-up (FRAG: 45; DUST: 48). Baseline demographics and stone parameters (diameter, density, volume, location) were similar. Mean stone size (FRAG: 13.9 ± 5.2 mm vs DUST: 13.0 ± 4.7 mm, p = 0.378) and density (FRAG: 999.7 ± 267.6 Hounsfield unit [HU] vs DUST: 1,111.8 ± 249.1 HU, p = 0.044) were comparable. SFRs were 66.7% (FRAG) and 68.8% (DUST) (p = 0.751). Multivariate analysis identified higher body mass index as a predictor of improved SFR (odds ratio 1.17, p = 0.022), whereas stone volume (p = 0.179) and density (p = 0.884) had no significant impact. Operative time, complications, and ancillary procedure rates were comparable. Conclusions: Both techniques achieved similar SFRs, with no significant influence from stone volume or density. Postoperative complications and ancillary procedures were comparable. These findings suggest either method is effective, with technique selection based on surgeon preference.

Introduction and Objective: Throughout the last several years various robotic platforms have emerged with increasing relevance in clinical practice. However, direct comparisons of their perioperative outcomes in robot-assisted radical prostatectomy (RARP) are limited. To address this gap, we conducted a systematic review and network meta-analysis of RARP outcomes across different robotic platforms. Methods: A systematic search was carried out using PubMed, CINAHL, Scopus, and Cochrane for cohort studies, randomized controlled trials (RCTs), and non-RCTs, focusing on patients undergoing RARP for localized prostate cancer. Key outcomes included operative time (OT), estimated blood loss (EBL), and length of stay (LOS). Results: Eighteen studies with 3511 patients were included, representing 9 robotic platforms. LOS was reported in 11 studies, with a mean range of 1.34 to 9.5 days. Compared with the da Vinci Multiport (MP) platforms (XI and SI), the MP1000 platform showed the lowest mean difference (MD) of 1.08 days (95% confidence interval [95% CI]: 0.04-2.13), although this was not statistically significant. OT, reported in 16 studies, showed significant differences. Da Vinci MP platforms had longer OT than Shurui Single-Port (SP), KangDuo, Revo-i, and da Vinci SP, with MDs ranging from 17.16 to 111.83 minutes. In contrast, Senhance showed a shorter OT, with an MD of -34.5 minutes (95% CI: 9.02-59.98). EBL data from 15 studies revealed no significant differences across platforms. Conclusion: This is the first network meta-analysis comparing perioperative outcomes of RARP across emerging robotic platforms. Our findings suggest no clinically significant differences in LOS and EBL, but significant variation in OT, potentially reflecting the impact of novel robotic technologies.

Purpose: To describe our 10-year experience with EBD for primary obstructive megaureter. Materials and Methods: Children needing intervention for primary obstructing megaureters (POM) (based on increasing distal dilatation >1.4 cm, differential renal function [DRF] <40%, or symptoms) were counseled to undergo a trial of EBD. A 9.5Fr cystoscope and stent "pusher" were used to insert a 14'' guidewire to allow insertion of a 4/25 mm coronary dilatation balloon that was insufflated to 15 ATM for 5 minutes. Afterwards a 4.7Fr Double-J stent was positioned for 6 weeks. Ureteral diameter, DRF, length of obstruction, and complications were registered. Success was defined as improvement of the indication without further need for a more invasive procedure. Results: A total of 31 dilated ureters in 28 patients (23/5 M/F) were included, with a median age of 9 months (M) (range: 1-111) and a follow-up of 41 M (range: 12-84). EBD showed a narrow ring in 29 (93.5%) and longer narrow distal ureters in 2 (6%). EBD was successful in 29/31 ureters (93.5%), with different success rates for a narrow ring (96.6%) and a longer narrow distal ureter (50%). Conclusion: As most POM resolve spontaneously, hard indications are needed before treatment is offered. Symptomatic patients (e.g., infections) and declining DRF with dilated ureters are strong indications. In such cases, EBD with a coronary dilatation balloon has a high success rate and provides diagnostic information regarding the length of the narrow ureteral segment. Longer narrow ureteral segments are rare but result in a higher failure rate.

Objectives: One of the major limitations of the current diagnostic techniques for upper urinary tract carcinoma (UTUC) is the risk of both understaging and overstaging, highlighting the need for real-time, high-resolution intraoperative imaging. We evaluated the diagnostic accuracy and safety of ureteral optical coherence tomography (OCT) under ureterorenoscopy for T staging of UTUC. Materials and Methods: In this study, patients with suspected UTUC were prospectively enrolled. The safety analysis set included 16 patients who underwent ureteral OCT for ureteral tumors. Because two (13%) patients underwent ureterorenoscopic ablation therapy, the diagnostic accuracy analysis set included 14 of 16 patients who had both ureteral OCT data and a final pathological T (pT) stage from surgical specimens. The concordance, underdiagnosis, and overdiagnosis rates were compared between radiographical imaging-based T (cT) and OCT-based T (octT) diagnoses. The primary outcome was the diagnostic accuracy of ureteral OCT in discriminating between pTis/Ta/T1 (non-muscle-invasive UTUC) and T2/T3 (muscle-invasive UTUC) cancers. Results: Concordance between cT-based and pT-based diagnoses was observed in 11 (79%) of the 14 patients, whereas a higher concordance rate (13/14, 93%) was noted for octT diagnosis. Additionally, the underdiagnosis and overdiagnosis rates of octT were 0% and 7.1%, respectively, which were lower than those of cT (7.1% and 14%, respectively). Although no intraprocedural urinary injury was observed, postprocedural complications included hematuria in five patients (31%), urinary tract pain in two (13%), and urinary tract infection in one patient (6.3%). Conclusion: Ureteral OCT exhibited a high diagnostic performance in discriminating between non-muscle-invasive UTUC and muscle-invasive UTUC with a safety profile. Further prospective trials with large sample sizes are necessary to determine the true diagnostic value and the wide use of ureteral OCT.

Background: Robot-assisted radical prostatectomy (RARP) is the most common surgical approach in the management of localized prostate cancer. Early evidence suggests that single-port (SP) RARP is a safe and feasible alternative to the conventional multiport (MP) RARP. We compared the perioperative and functional outcomes of SP vs MP RARP performed by a single high-volume robotic surgeon, assessing the efficacy of SP RARP in an academic setting. Methods: We retrospectively analyzed data from 145 consecutive patients who had undergone SP RARP performed by a single surgeon after the initial adoption of this technique. Continence and potency were evaluated at 3 and 6 months postoperatively. After propensity score matching (PSM), outcomes were compared with a historical cohort of patients who had undergone MP RARP performed by the same surgeon. Results: The median estimated blood loss (EBL) was 200 mL (100-300), and the median operative time (OT) was 210 minutes (180-240). Most patients showed intermediate Gleason risk (3 + 4, n = 99, 68.3%; 4 + 3, n = 30, 20.7%). When compared with the MP cohort after PSM, there were no differences in EBL and a positive surgical margin rate (p = 0.749 and 0.194, respectively). SP RARP patients showed longer OT (p = 0.007) and lower early continence rate after operation (3 months, 47.2% vs 65.9%, p = 0.003; 6 months, 55.3% vs 82.9%, p < 0.001) compared with patients who underwent MP RARP. The majority of the SP RARP patients were discharged on the day of operation. Conclusion: In this single-surgeon series, EBL and surgical margin positivity rate were similar between the SP and MP groups. However, OT was longer, and early continence rates were worse in the SP group. These findings suggest that SP RARP may yield suboptimal functional outcomes in the initial phase of the learning curve.

Background and Objective: Benign prostatic hyperplasia (BPH) represents a common condition in aging males. For prostates exceeding 80 g, robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation have emerged as leading treatments. This study aimed to comprehensively compare outcomes between these approaches. Methods: We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials and cohort studies. Outcomes included changes in urinary flow rate, International Prostate Symptom Score (IPSS), complication rates, operative bleeding, operative time, hospitalization duration, and catheterization period. Robotic interventions were classified as single-port (SP) or multiport with transvesical (TV), transperitoneal, or transcapsular techniques. Enucleation methods included holmium laser (HoLEP), thulium laser, bipolar, and GreenLight laser vapo-enucleation. Key Findings and Limitations: We included data from 25 studies with 3924 patients. Network meta-analysis showed no significant difference in overall complication rates between RASP and enucleation techniques, though RASP had the highest surface under the cumulative ranking curve scores in the SP approaches, particularly the SPTV approach. Both RASP and enucleation approaches showed similar improvements in urinary flow rates. RASP approaches, particularly SPTV, had the highest decrease in IPSS, but the changes were not statistically significant. Despite longer operative times and Foley catheterization durations for RASP, blood loss was comparable to enucleation techniques. Conclusion and Clinical Implications: Our results suggest that robotic approaches have similar performance to HoLEP when managing large prostates. However, robotic approaches may have slight differences including improved symptom scores, lower incontinence rates, longer operative times, and longer hospital stays. Patient Summary: In this study, we compared two modern surgical approaches for treating enlarged prostates over 80 g-robotic surgery and laser/electrical techniques that remove prostate tissue through the urethra. We found both approaches work equally well for improving urinary flow, with similar bleeding risks, though the robotic approach may better reduce urinary symptoms but requires longer surgery and hospital stays. This information helps doctors and patients choose the most suitable treatment option for large prostate enlargement.

Purpose: This study investigates the efficacy of an innovative anatomical enucleation prostate technique, utilizing a low-energy pulsed thulium:YAG laser emission, to spare the ventral urethral plate (or "lissosphincter") and the ejaculatory hoods in 50 patients with high-volume benign prostatic hyperplasia (BPH). The primary aim was to assess its impact on preserving antegrade ejaculation while obtaining relief from obstruction. Materials and Methods: In this prospective study, 50 patients were evaluated using the following validated instruments: the International Prostate Symptom Index (IPSS), Quality of Life (QoL) score, and Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD SF). Assessments were performed preoperatively and at 6 months postoperation. Results: Significant improvements were observed postoperatively in functional outcomes: IPSS decreased from 20.42 to 5.76, and QoL score improved from 4.2 to 1.2 (both p < 0.001, if significant). Mean Qmax significantly increased from 8.11 mL/min preoperatively to 20.6 mL/min at 6 months (p < 0.001), accompanied by a significant reduction in postvoid residual (PVR) volume. Crucially, antegrade ejaculation was preserved. While MSHQ-EjD SF analysis indicated a nonsignificant reduction in semen volume (Item 3), other parameters, including ejaculation frequency (Item 1), strength of expulsion (Item 2), and bother/satisfaction (Item 4), were not significantly modified, but the patients were satisfied. Conclusion: The ejaculation-sparing pulsed thulium:YAG laser anatomical enucleation technique shows promising results for preserving antegrade ejaculatory function (70% preservation rate) while achieving effective relief of cervico-prostatic obstruction. However, these preliminary findings from a limited cohort require validation through larger, randomized controlled studies with longer follow-up before establishing this technique as a standard approach for ejaculation preservation in BPH operations.