Therapeutic Advances in Urology最新文献

Urinary diversions are performed for a wide variety of indications, including bladder removal for cancer treatment, post-cancer treatment complications, trauma, or bladder pain. The robotic approach has been increasingly used in performing urinary diversions since the introduction of the surgical robot. A PubMed keyword search was performed on September 14, 2023 with the terms: robotic and urinary diversion. A narrative review of the literature was then conducted, with a focus on outcomes and complications following urinary diversion. Studies demonstrated that the robotic approach to cystectomy with urinary diversion was safe and productive, whether the diversion was performed intracorporeally or extracorporeally, and that outcomes are comparable to the open approach. Despite reports of successes and technique improvements, the complication rate following robotic cystectomy with urinary diversion is over 50%. Common complications associated with urinary diversion include bowel complications, ureteroenteric anastomotic strictures, urine leak, urinary tract infections, internal hernias, and parastomal hernias. Many strategies have been developed to improve the complication rate following robotic urinary diversion, including specialized training programs and enhanced recovery after surgery protocols. In conclusion, with the increasing adoption of the robotic approach for urinary diversions, it is important to continue to develop strategies to mitigate surgical risk. Future research should focus on further refinement of training and surgical approaches to prevent and treat complications following robotic urinary diversions.

What is this summary about? People with overactive bladder need to use the bathroom many times a day to urinate (pee). This need may often be sudden and may cause some people with overactive bladder to have accidental bladder leakage. The EMPOWUR trial looked at how well a medicine called vibegron worked to help people with overactive bladder. The study also included another drug that was already available for treating overactive bladder called tolterodine and a pill with no medicine called a placebo. Both vibegron and tolterodine were compared with placebo. Participants had improvements in their overactive bladder symptoms after taking either vibegron or tolterodine compared to placebo. The medicine vibegron was approved in 2020 by the US Food and Drug Administration (also called the FDA) to treat overactive bladder. Researchers next wanted to see how well vibegron worked in people from the EMPOWUR trial split into 2 groups. One group was made of participants with overactive bladder who have accidental leakage. The second group was made of participants with overactive bladder who do not have accidental leakage. This is a plain language summary of the study of how well vibegron works for those 2 groups from the EMPOWUR study that was published in the International Journal of Clinical Practice. What were the results? Study participants who took vibegron needed to pee fewer times per day. The number of times they had little warning before the need to pee was also lower. The results were the same for study participants who did and did not have accidental leakage related to overactive bladder. What do the results mean? This study suggests that vibegron can improve symptoms in people with overactive bladder whether or not they have accidental bladder leakage.

Background: The Optilume^® paclitaxel drug-coated balloon (DCB) is a relatively new-to-market alternative in the management of male anterior urethral stricture disease. The pivotal trial excluded patients with a history of urethroplasty, although these strictures may be amenable to endoscopic management. Therefore, we sought to assess the efficacy of the DCB in the management of recurrent strictures following urethroplasty.

Methods: A retrospective, multi-institutional review of male patients undergoing DCB dilation from 1/1/2022 to 11/1/2023 by five surgeons at four institutions was performed. Patients were stratified by history of urethroplasty; demographics, stricture characteristics, and outcomes (surgical success, time to recurrence). Success was defined as freedom from re-intervention in patients with at least 3 months of follow-up.

Results: Among the 122 cases assessed, 33 (27.0%) had previously undergone urethroplasty. Patients in the urethroplasty group were younger than those in the control group (51.6 vs 58.8 years, p = 0.022). The two groups were otherwise similar with regard to background characteristics and comorbidities. Patients in both groups had similar stricture characteristics with short bulbar strictures being the most common. When compared to the control group, those with a history of prior urethroplasty had a greater median number of interventions prior to DCB treatment (3 vs 1, p < 0.001). Postoperative cystoscopy was performed in 37 cases, with similar patency rates between groups (p > 0.999). Early success rates were similarly high in both groups (80.0% post-urethroplasty vs 88.9% control, p = 0.338), although follow-up was limited to a median of 3.5 months in the urethroplasty group and 2.9 months in the control group (p = 0.069).

Conclusion: Despite a greater number of prior surgical interventions, patients with a history of urethroplasty achieve similarly high success rates after treatment with DCB compared to those without a history of urethroplasty.

Background: Clean intermittent catheterization (CIC) is the golden standard in patients with lower urinary tract dysfunction, leading to bladder emptying problems, due to neurogenic or non-neurogenic causes. CIC affects patient Quality of Life (QoL) both positively and negatively.

Objectives: The aim of this systematic review is to determine which measurements are used to report on the QoL of patients who are on CIC in the currently available literature, to determine the overall QoL of patients who are on CIC and lastly, to determine whether QoL in patients who are on CIC is dependent on the underlying cause (neurogenic vs non-neurogenic).

Design: This systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Data sources and methods: The Embase, Medline, Web of Science Core Collection, CINAHL, Google Scholar, and the Cochrane CENTRAL register of trials databases were systematically searched for relevant publications until March 2023.

Results: A total of 4430 abstracts were screened and 43 studies were included. Studies were published between 1993 and 2022 and consisted of only neurogenic patients in 22 studies, the others included a mixed population. The included patient populations and the used measurements/tools were heterogeneous. There were 21 measurements/tools used to measure QoL, of which 3 were not validated. One questionnaire was developed to measure QoL in patients on CIC (intermittent self-catheterization questionnaire). Other measurements were suitable for general health-related QoL, to evaluate neurogenic bladder symptoms or incontinence oriented.

Conclusion: The 43 included studies showed a great variety of used tools to measure QoL in patients on CIC due to neurogenic and non-neurogenic causes. Because of lacking uniformity of the measured aspects of QoL, the different included studies could not be compared and subgroup analysis was not performed. Recommendations for future research and practice are provided.

Trial registration: This systematic review was registered and published beforehand at Prospero (CRD42020181777; https://www.crd.york.ac.uk/prospero).

Background: The 3D models' use for surgical planning has recently gained an ever-wider popularity, in particular in the urological field. Different ways of fruition of this technology have been evaluated over the years. Today, new technological developments allow us to enjoy 3D models in the metaverse.

Objectives: The aim of this study is to report the preliminary experience and surgeon's perception of preoperative planning performed in the metaverse.

Design: During the eleventh edition of the Techno-Urology Meeting, all the attendees enjoyed the metaverse experience (META_EXP) for pre-surgical planning of both robot-assisted radical prostatectomy and partial nephrectomy. Users' perception was then evaluated with the Health Information Technology Usability Evaluation Scale (Health-ITUES) and the Face & Content validity questionnaire.

Methods: The 3D virtual models, obtained from standard bi-dimensional imaging, were uploaded on a metaverse platform. Surgeons, thanks to dedicated visors, could plan their surgical strategy immersed in this virtual environment and discuss it with other attendees. Answers to the questionnaires were then evaluated and a stratification was subsequently performed based on surgical expertise, dividing participants in residents (Re), young urologists (YU) and senior urologists (SU).

Results: Sixty-six participants filled out the questionnaires. As emerged from the Health-ITUES questionnaire, META_EXP covers an important role in the presurgical/surgical planning and decision-making process and appears to be useful for preoperative planning, with a median response of 4 and 5, respectively. Such results were also confirmed at the Face & Content validity questionnaire, with a median rate of 9/10 regarding its usefulness for surgical planning. Also, anatomical accuracy was positively rated regarding both organ's and disease's details, with a median response of 9.

Conclusion: In conclusion, the metaverse experience for preoperative surgical planning appears to be useful, user-friendly and accurate. This technology has been widely appreciated by surgeons, irrespective of their experience.

Traumatic ureteral injury is a rare and challenging condition of the urinary system. To summarize the clinical features of patients with traumatic ureteral injury and examine the literature on traumatic ureteral injuries from the past 20 years. The clinical data of 30 patients with traumatic ureteral injury in Peking University First Hospital, Beijing Jiangong Hospital, as well as Emergency General Hospital from August 2015 to August 2023 were retrospectively collected. The clinical characteristics, management strategies, and follow-up outcomes were analyzed, and a review of the literature on traumatic ureteral injury from the past 20 years was conducted. The traumatic types in the case series was composed of sharp injury, impact injury, and falling injury, with 9, 16, and 5 cases, respectively. Ureteral injury was diagnosed immediately in 12 cases, while 18 cases had a delayed diagnosis. Besides, the median time from ureteral injury to operations was 8.5 months (IQR: 4-13 months) in the patients who received upper urinary tract repair surgery, including ureteral stenting in one case, ureteroureterostomy in four cases, pyeloplasty in two cases, lingual mucosal graft ureteroplasty in one case, ileal ureter replacement in five cases, and nephrectomy in one cases. The mean follow-up time is 39.1 ± 24.8 months. Concerning renal function, postoperative creatinine was substantially lower than preoperative one (78.6 ± 13.7 µmol/L vs 88.8 ± 17.0 µmol/L, p = 0.0009), and postoperative urea was significantly lower than preoperative one (4.6 ± 1.6 µmol/L vs 5.9 ± 1. 3 mmol/L, p = 0.0016). Traumatic ureteral injury is challenging to recognize due to its deep anatomical location, making timely diagnosis crucial. It is important to choose an appropriate reconstruction method based on severity, location, length to restore urinary tract continuity as early as possible.

The advancements of technological devices and software are putting mixed reality in the frontline of teaching medical personnel. The Microsoft^® HoloLens 2^® offers a unique 3D visualization of a hologram in a physical, real environment and allows the urologists to interact with it. This review provides a state-of-the-art analysis of the applications of the HoloLens^® in a medical and healthcare context of teaching through simulation designed for medical students, nurses, residents especially in urology. Our objective has been to perform a comprehensively analysis of the studies in PubMed/Medline database from January 2016 to April 2023. The identified articles that researched Microsoft HoloLens, having description of feasibility and teaching outcomes in medicine with an emphasize in urological healthcare, have been included. The qualitative analysis performed identifies an increasing use of HoloLens in a teaching setting that covers a great area of expertise in medical sciences (anatomy, anatomic pathology, biochemistry, pharmacogenomics, clinical skills, emergency medicine and nurse education, imaging), and above these urology applications (urological procedures and technique, skill improvement, perception of complex renal tumors, accuracy of calyx puncture guidance in percutaneous nephrolithotomy and targeted biopsy of the prostate) can mostly benefit from it. The future potential of HoloLens technology in teaching is immense. So far, studies have focused on feasibility, applicability, perception, comparisons with traditional methods, and limitations. Moving forward, research should also prioritize the development of applications specifically for urology. This will require validation of needs and the creation of adequate protocols to standardize future research efforts.

What is this summary about? This is a plain language summary of an article published in the journal Clinical Pharmacology in Drug Development. It is about a study of a medicine called vibegron. Vibegron is approved by the US Food and Drug Administration (also called the FDA) to treat overactive bladder, also known as OAB. It may be easier for people with swallowing issues to take a pill by crushing it and mixing it with applesauce instead of swallowing it whole. Researchers did this study to find out if vibegron could be safely crushed and mixed with applesauce. Participants took vibegron that was either crushed or intact, and researchers compared how much vibegron made it into the bloodstream over time. The researchers asked whether people who took crushed vibegron had more unwanted medical events (called adverse events) than people who took vibegron as an intact pill. What were the results? Crushed vibegron tablets did not change in applesauce for 4 h at room temperature. Just over half of the participants (53%) said that the taste was not different than expected. The amount of vibegron in blood over time was similar between those who took crushed vibegron and those who took intact vibegron. The most common adverse events were headache, constipation, and nausea. No participant experienced a serious adverse event during the study, meaning that no adverse events required hospital care or caused permanent damage or disability. Adverse events that might be related to vibegron occurred in seven participants (23%) after they took crushed vibegron and six participants (20%) after they took the intact pill. What do the results mean? The results of this study show that vibegron can be crushed and taken with applesauce without increases in adverse events compared to taking the intact pill. Crushed vibegron did not change in applesauce and the amount of vibegron in blood over time was similar when vibegron was crushed in applesauce or taken whole. This means that people may take vibegron as a crushed or intact pill for overactive bladder. This may be particularly important for people with difficulty swallowing. Who should read this article? This article is for people with overactive bladder symptoms who have a hard time swallowing pills. It may also be helpful for their families and care partners, and for health care professionals who care for people with overactive bladder. Where can I find the original article on which this summary is based? The original article is called "Pharmacokinetics and Safety of Vibegron 75 mg Administered as an Intact or Crushed Tablet in Healthy Adults." You can read the original article published in Clinical Pharmacology in Drug Development at this link: • https://accp1.onlinelibrary.wiley.com/doi/10.1002/cpdd.1169.

Objective: This study evaluates surgical outcomes in benign prostatic hyperplasia (BPH) patients undergoing transurethral enucleation using various holmium laser (HoLEP) settings and/or bipolar devices (BipoLEP).

Design: This study was retrospective.

Methods: We retrospectively analyzed 158 BPH patients treated surgically, categorized by method: BipoLEP (n = 28), HoLEP with short pulse (HoLEP-SP, n = 26), HoLEP with long pulse and low energy (HoLEP-LP/LE, n = 29), HoLEP with long pulse and high energy (HoLEP-LP/HE, n = 26), HoLEP using Moses technology (HoLEP-Mo, n = 19), and a combination of HoLEP and BipoLEP (HoLEP-mix, n = 30). We assessed enucleation, morcellation, coagulation, and overall operation efficiency, along with complications at immediate, 2-week, and 3-month postoperative intervals.

Results: The HoLEP-LP/LE group exhibited the highest overall operation efficiency (p < 0.05). The BipoLEP and HoLEP-SP groups had lower enucleation efficiency (p < 0.05). HoLEP-LP/LE and BipoLEP showed superior coagulation efficiency (p < 0.05). Excluding hard nodule cases, the HoLEP-mix group had reduced morcellation efficiency compared to HoLEP-LP/LE (p < 0.05). Complication rates did not significantly differ between groups (p > 0.05).

Conclusion: The HoLEP-LP/LE procedure demonstrated superior performance in enucleation, morcellation, coagulation, and overall operation efficiency. Complication rates were comparable across all groups. BipoLEP, while less efficient in enucleation than some HoLEP settings, proved effective and safe. In addition, the Moses technology may offer enhanced bleeding control.

In this paper, we explore the usage of decision aids, patient information leaflets (PILs), videos, social media and modern technology to empower patients and enable shared decision-making (SDM). It explores the role of enhanced consent processes in urology. A re-evaluation of the conventional consent process is required towards more patient-centred care and SDM, which prioritises patient education and understanding of their medical conditions and treatment pathways. The use of decision aids, such as multimedia resources and PILs, is crucial in enhancing patients' understanding, level of satisfaction, quality of life and healthcare utilisation. New tools are opening exciting possibilities for patient education and information distribution, such as Chat Generative Pre-Trained Transformer (ChatGPT). The effectiveness of ChatGPT in comparison to well-established PILs is still up for debate, despite the fact that it makes information easily accessible. Improving patients' involvement, understanding and engagement in SDM procedures relies heavily on decision aids, PILs and current technological integration. Patients and healthcare practitioners should work together in accordance with the principles of SDM, which include considering patients' values, backgrounds, priorities and preferences when making treatment decisions. The emphasis on patient-centred care has prompted a re-evaluation of traditional consent processes in urology, with more emphasis on the shared decision-making process. Several informative aids are currently available as reported in the literature, ranging from 3D models, multimedia presentations and virtual reality (VR) devices. While the costs of these tools might be substantial, the advantages of adopting such informative resources are unmistakable. Social media and platforms such as patient-physician blogs are increasingly popular sources of medical information. Urologists should embrace these platforms to enhance patient engagement and the quality of information provided. Despite recent progress, there remains significant room for improvement in patient education and engagement which is achievable via concerted efforts of a wider medical community.