Journal of Urology最新文献

Purpose: Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) affects quality of life. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30cc-80 cc with minimal de-novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH.

Materials and methods: Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in IPSS pre-CWVTT compared post-CWVTT between PV tertiles - small (≤38.5 cc), medium (38.5 - ≤55.6cc), and large (>55.6cc). Secondary outcome was time to a minimally clinically important difference (MCID) of 25% decrease in IPSS.

Results: 171 patients were divided into small (n=56), medium (n=54), and large (n=61) PV tertiles. The change in IPSS pre-operatively to 3-months was significant for all tertiles with mean difference of [-7.51 (-10.14, -4.83)], [-10.12 (-12.71, -7.53)], and [-11.72 (-14.14, -9.29)] for small, medium, and large PV, respectively (p=<0.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3mo with average increase (95% CI) of [3.67 (0.23,7.11), p=0.037] compared to not having diabetes The median time (Q1, Q3) to -25% in IPSS for small, medium, and large PV were 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared to small PV [HR (95%CI): 2.10 (1.19, 3.72), p=0.011].

Conclusions: CWVTT results in significant and durable LUTS improvement across the prostate volume spectrum. All prostate volumes experience the same improvement in LUTS post-CWVTT. However, medium and large glands may improve more quickly than small glands.

Purpose: In patients with residual stone fragments, ultrasonic propulsion (UP) increased fragment passage rate by 58% and reduced risk of relapse by 70% vs. untreated controls with minor associated adverse events. This study presents a second, independent trial of UP to demonstrate replication of those results and effective training of a novice team of users.

Materials and methods: This was a multi-center, prospective, open label, randomized, controlled trial. Adults with residual fragments ≤ 5 mm seen on clinical imaging at least 4 weeks post-lithotripsy were enrolled. The treatment group underwent UP; the control group did not. The effectiveness endpoints included the proportion of subjects reporting visual observation of stone passage within 3 weeks post-procedure (treatment group) or randomization (controls) and the reduction in stone burden on follow-up imaging captured within 90 days post-procedure/randomization. The safety endpoints were adverse events (AEs) within 3 weeks post-procedure/randomization. Fisher's Exact test was used for comparison.

Results: The trial was conducted April - October 2024. Fragments remained a median of 6 months after surgery before study enrollment. Ten of 12 treated participants passed fragments vs. 2 of 12 controls (P=0.003). Nine of 12 treated participants saw stone burden reduction on imaging vs. 1 of 11 controls (P=0.003). All AEs were mild, occurring in 7 of 12 treated participants and 4 of 12 controls.

Conclusions: Consistent with the index study, UP conducted by an independent group of operators demonstrated a higher rate of fragment passage and greater reduction in stone burden following UP compared to controls, with minor associated risk.

Purpose: There are no standardized guidelines for evaluation of pediatric renal trauma. We hypothesize that screening radiographic studies performed to rule out traumatic renal injuries in children can initially be evaluated by contrast-enhanced CT scans that lack an excretory phase.

Materials and methods: We retrospectively collected data from five pediatric trauma centers between 2007-2020. Patients younger than 18 years old with renal trauma AAST grade 3 or higher were included. Outcomes data includes the rate for delayed surgical or radiologic interventions, complications, or readmissions related to the initial renal injuries.

Results: 351 children were included. 36% (127/351) had excretory-phase CT (EPCT) at initial evaluation. Median age was 13.6 (IQR 9.1-16.3) years. 56.7% (72/127) EPCT patients had grade IV/V injury vs. 53.6% (120/224) in NEPCT (p=0.3). 96% (338/351) were blunt injuries. NEPCT patients had higher median injury severity scores (21 vs. 16, p<0.01). EPCT children did not have more urinary drainage procedures (ureteral stent or percutaneous drain) (18% vs. 12%, p=0.11). Patients with initial NEPCT did not experience longer hospital stay (p=0.46), increased complications (p=0.52) or readmissions (p=0.54). Importantly, gross hematuria significantly predicted need for renal procedures (OR = 2.06, 95% CI 1.28-5.2, p < 0.001).

Conclusion: Patients with initial NEPCT did not experience increased adverse outcomes or readmission. Those presenting with gross hematuria had increased risk of higher-grade renal injury and need for renal procedure. This study suggests that high-grade pediatric renal trauma can be safely evaluated with NEPCT in initial trauma workup unless they present with gross hematuria.