Therapeutic Advances in Urology最新文献

Background: While the benefits of physical activity (PA) for cancer survivors are well-documented, there is limited research specifically exploring its effects on health-related quality of life (HRQoL) among testicular cancer (TC) survivors. This review aims to examine the available literature on the relationship between PA and HRQoL in TC survivors post-treatment.

Objective: To identify and synthesize existing studies on the effects of PA on HRQoL outcomes in TC survivors.

Eligibility criteria: Studies that examined the relationship between PA, TC survivorship, and HRQoL across various phases of survivorship were included. Only peer-reviewed articles and gray literature addressing these topics were considered.

Sources of evidence: A systematic search was conducted across seven databases and gray literature. Articles were evaluated based on titles, abstracts, and full-text reviews for inclusion.

Charting methods: Following Arksey and O'Malley's scoping review framework and PRISMA-ScR guidelines, studies were charted for key findings regarding the effects of PA on cancer-related fatigue, psychosocial outcomes, and HRQoL in TC survivors. The search also focused on identifying barriers to PA adherence and gaps in the current literature.

Results: Three studies were examined: one experimental study, one feasibility study, and one cross-sectional study. Findings suggested that PA interventions could reduce cancer-related fatigue, improve psychosocial well-being, and enhance HRQoL indicators such as vitality, self-esteem, and social functioning. High-intensity interval training showed short-term benefits, while low-intensity activities demonstrated feasibility for broader adoption. Adherence barriers included treatment side effects and psychosocial factors. Limitations included small sample sizes, self-reported data, and lack of long-term follow-up.

Conclusion: The findings suggest that PA can improve HRQoL in TC survivors, but significant gaps remain, particularly in terms of longitudinal studies, diverse populations, and tailored interventions. Future research should focus on developing scalable, sustainable PA interventions that address adherence and long-term health outcomes for TC survivors.

Purpose: The use of alternative treatment modalities for erectile dysfunction (ED) beyond phosphodiesterase inhibitors continues to grow within the practice of Urology. Utilizing U.S. Google trends as a novel epidemiological tool for geographically associating patient search intent, our study aims to capture trends relating to interest in stem cell therapy (SCT) as a potential treatment for ED.

Methods: An online search was conducted to identify centers in the United States offering stem cell therapy (SCT) for erectile dysfunction (ED), using specific keywords such as "ED treatment," "stem cells for ED," and "sexual health stem cell." The geographic distribution of these centers was mapped, and their publicly available information was evaluated based on strict inclusion criteria, including direct claims of SCT efficacy for ED and oversight by a licensed urologist. The public interest in SCT treatment was quantified using Google Trends data from July 2018 to July 2023, utilizing search terms related to SCT and comparing them to terms associated with alternative regenerative therapies like platelet-rich plasma and shockwave treatments, to extract the direction and magnitude of national interest over the preceding 5 years. The PubMed, Cochrane Library, and EMBASE databases were then searched from inception to May 2024 regarding evidence for the use of SCT to treat ED.

Results: Despite insufficient evidence, public search interest demonstrates an upward trajectory of this treatment when compared to alternative regenerative therapies for ED. This increased interest in SCT as a potential treatment option for ED may be linked to the marketing efforts of commercial entities. Throughout the qualitative analysis of advertisement sources, only two websites (Stem Cells Transplant Institute, and Ambrose Cell Therapy) summarized the collective results of a directed clinical trial investigating the utility of SCT in ED patients.

Conclusion: Our study demonstrates the public prevalence of patients seeking SCT as a treatment modality for ED is increasing. In addition, varied sources nationwide promote SCT despite limited scientific evidence and consensus. This disparity calls for additional prospective research on the viability, efficacy, and long-term safety of SCT in the context of ED.

Background: Pediatric urolithiasis, while less common than in adults, is increasing in incidence. However, current guidelines on the optimal management of this condition vary. Technological advances have led to improvements in the quality and size of ureteroscopes, thus enabling their use in children. Despite this, there remains some hesitancy about using ureteroscopic lithotripsy in the pediatric population, particularly in cases of large stones ⩾10 mm.

Objectives: In this study, our aim was to evaluate the efficacy and safety of ureteroscopy and laser stone fragmentation (URSL) for managing pediatric patients with a cumulative stone burden of ⩾10 mm in our tertiary referral center.

Methods: A dataset was collected of pediatric renal tract stone patients treated at a single tertiary urological center between June 2010 and May 2024 (15 years). Pediatric patients undergoing URSL procedures for a minimum cumulative stone burden ⩾10 mm were included. A retrospective analysis of the dataset was conducted. The primary outcomes measured were stone-free rates (SFR), complications classified according to the Clavien-Dindo classification, and hospital length of stay.

Results: A total of 61 pediatric patients with a mean age of 10 years (range: 2.3-16) underwent 83 URSL procedures in a tertiary endourology pediatric center over a 15-year period (2010-2024). The median initial stone burden was 17 mm (IQR: 12.5-24 mm), acquired from preoperative ultrasonography (USS). Results showed a first-pass SFR of 63.9% and a cumulative SFR of 93.4% (on USS) following one or multiple URSL procedures (1.4 procedures/patient). Immediate postoperative complications were minimal, with 6% experiencing complications classified as Clavien-Dindo I or II. The average hospital length of stay was 1.4 days.

Conclusion: The findings in this study support that URSL is effective in treating pediatric urolithiasis, even for larger stone burdens. Further research is needed to standardize guidelines and optimize management strategies in this population.

Background: The direct in-scope suction (DISS) involves a two-way adaptor mounted on a scope to aspirate and irrigate the pelvicalyceal system during flexible ureteroscopy. While integrated suction single-use scopes manage small dust particles effectively, they cannot remove particles >250 µm and are limited by single use.

Objectives: To evaluate perioperative outcomes of the GLITZ system, a lightweight suction accessory for flexible ureteroscopes, facilitating laser lithotripsy with integrated aspiration.

Design: Prospective, multicenter study.

Methods: The GLITZ system, a 100 g trigger mounted on the ureteroscope handle, integrates with an irrigation and aspiration apparatus featuring a flow-regulating sensor. A finger-trigger activates suction, stopping irrigation until released, enhancing visibility and safety by automatically stopping irrigation if blockages occur. The study involved 29 patients (November 2023-April 2024). Procedures were performed using a disposable 7.5 Fr ureteroscope, ureteral access sheath, and thulium fiber or 100 W holmium:YAG laser. Surgeons evaluated ease of use and performance. Stone-free status was evaluated at a 30-day CT scan and classified as follows: Grade A: zero RF; Grade B: single RF not up 2 mm; Grade C: single RF 2.1-4 mm; and Grade D: single/multiple RFs > 4 mm. Data are reported as median and (interquartile range).

Results: A total of 31.1% of patients were female. The median age was 54 years. Pain was the most common complaint, and 41.8% had multiple stones. GLITZ system showed satisfactory performance in 93.1% of cases, with complete dust aspiration achieved in 62.1%. Device dislodgement occurred in 24.1% of cases. Median operative time was 40 min, achieving postoperative CT at 30 days confirmed Grade A stone-free status in 75.9%. Fever was the most common complication (10.3%), with no sepsis case.

Conclusion: The GLITZ system in DISS shows effectiveness with a 96.6% stone-free rate (Grade A + B) at 30 days, indicating strong potential for flexible ureteroscopy, though additional studies are needed to optimize flow rates and usability.

Over the past two decades, there have been significant developments in paediatric urodynamic studies focusing on less-invasive monitoring devices, as well as re-defining normative values. This article reviews current paediatric urodynamic study methods and their reliability, and discusses new emerging ambulatory urodynamics and novel telemetric urodynamic devices. Traditional urodynamic studies are performed in specialised suites in real-time with artificial bladder filling. Ambulatory models allow for measurements in a more authentic environment and with natural bladder filling. Novel implanted telemetric monitoring devices provide a catheter-free solution but are inherently invasive in nature. Exploration of indirect measurements to obtain urodynamic data warrant further investigation. Definitive progress will require strong and sustained collaboration between end users and developers.

Continent urinary diversion is the preferred method of bladder substitution for many patients who undergo cystectomy for benign conditions. Additional interventions are often necessitated after a continent diversion to achieve continence. One such procedure is the injection of botulinum toxin into the neobladder. Previous injections into the pouch bladder have been performed percutaneously. Here we present a less invasive endoscopic injection technique where flexible equipment has been used successfully to inject botulinum toxin into the pouch bladder via the pouch stoma. We demonstrate the feasibility of the injection and its efficacy in reducing pouch contractions and the patient's symptoms. A 36-year-old female presented with persistent urinary incontinence symptoms 1 year after Indiana pouch diversion. Despite previous conservative measures and ileocecal valve reinforcement surgery, incontinence persisted. The endoscopic injection, facilitated through the pouch stoma, proved effective in decreasing muscle contractions and alleviating spasm-like sensations without observed side effects. This case shows the feasibility, safety and efficacy of botulinum toxin injection into Indiana pouch endoscopically.

Objectives: To review outcomes for patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) who undergo holmium laser enucleation of prostate (HoLEP) for bothersome urinary symptoms related to benign prostatic hyperplasia (BPH).

Methods: We performed a retrospective review of patients who had undergone HoLEP by a single surgeon between January 2021 and August 2023. Preoperative, intraoperative, and postoperative characteristics were compared between patients with an ICD-10 diagnosis of IBS or IBD and those without, using Chi-square and paired T-tests as appropriate.

Results: Out of 918 men, 24 (2.6%) had a diagnosis of IBS, and 36 (3.9%) had a diagnosis of IBD. There were no differences in age, BMI, preoperative American Urological Association symptoms score (AUASS), preoperative Michigan Incontinence Symptom Index (MISI) score, and history of urinary retention or incontinence. The IBS + IBD cohort had smaller prostates (100.9 vs 124.2 mL, p = 0.01) and shorter procedure times (57.0 vs 66.5 min, p = 0.02) than controls. IBS patients were more likely to require anticholinergic therapy at a 3-month follow-up (31% vs 13%, p = 0.03) and had more postoperative encounters within 90 days of HoLEP (3.7 vs 2.6, p = 0.01). There were no differences regarding changes in AUASS and MISI scores, same-day trial of void and same-day discharge rates, or complication rates.

Conclusion: IBS patients who underwent HoLEP had more symptomatic postoperative courses requiring higher rates of anticholinergic medication use and more provider interactions compared to men without IBS, despite similar AUASS and MISI scores. These trends were not observed in patients with IBD.

Urinary tract fistulas (UTFs) are abnormal connections between the urinary tract and adjacent structures such as the bowel, vagina, or blood vessels. UTFs result in significant personal, social, and financial challenges to patients worldwide. This review investigates the various causes, risk factors, symptoms, and historical evolution of repair techniques of UTFs. This focuses on the shift from open surgery to minimally invasive techniques, particularly the growing utilization of robot-assisted laparoscopic (RAL) approaches. This review emphasizes the growing role of RAL surgery in treating UTFs, citing its advantages of reduced blood loss, low recurrence rates, and decreased postoperative complications while acknowledging challenges such as limited access to the RAL platform and longer surgical times. The study concludes with advocacy for more widespread access to the RAL platform as well as more research, including randomized controlled trials, to further refine the body of evidence and promote patient outcomes.

Background: Transurethral resection of the bladder (TURB) harbors a high-risk for postoperative bleeding, especially in patients requiring anticoagulation. Recently, direct oral anticoagulants (DOACs) have become a popular alternative to vitamin K antagonists (VKAs), though their impact on TURB complications remains unclear.

Objectives: To assess the postoperative complications of TURB from patients taking DOACs and VKAs.

Design: Retrospective cohort study.

Materials and methods: We retrospectively identified anticoagulated patients undergoing a TURB at our institution between 2012 and 2022 and divided them into two groups: whether they received VKA or DOAC. Follow-up of each patient was performed for 3 months. Occurrence and time to event of postoperative bleeding and thromboembolic events were recorded. A multivariable regression analysis was performed to assess risk differences.

Results: A total of 167 patients (11.7%) fulfilled the inclusion criteria, of which 102 patients (61.1%) received a DOAC and 65 patients (38.9%) a VKA. Postoperative bleeding led to re-catheterization in 13 (12.8%) DOAC and 6 (9.2%) VKA patients (p = 0.49) and re-intervention in 7 (6.9%) DOAC and 4 (6.2%) VKA patients (p = 0.86). Blood transfusions were administered to 3 DOAC patients (2.9%), none in the VKA group. No thromboembolic events were reported.

Conclusion: TURB carries low morbidity in anticoagulated patients. Thromboembolic events and the need for blood transfusion are infrequent. No substantial difference between the postoperative bleeding risk of patients receiving DOAC or VKA was found. All bleeding complications occurred within 2 weeks, marking it a potentially safe point in time to restart the OAC thereafter.

Background: Technical advancements and intrarenal pressure are synergistic in improving perioperative outcomes during flexible ureteroscopy (FURS). Mismanaged intra-renal pressure (IRP) has negative consequences and it is associated with an increased risk of sepsis, bleeding, pelvicalyceal fluid extravasation, and even collecting system injuries and acute as well as chronic renal failure. The cornerstone of a safe FURS is the ability to continuously monitor IRP to avoid elevation of IRP above the normal range of 10 mmHg.

Objectives: This scoping review aims to report the current state of real-time IRP monitoring in in vivo clinical studies and the various monitoring methods and technology to understand how this may be best used in daily clinical practice.

Eligibility criteria: A systematic literature search was conducted. Only in vivo clinical studies published in English documenting IRP measurement methodologies during semirigid or flexible ureteroscopy for urolithiasis management were included.

Results: Out of 1326 retrieved papers, 17 studies met the inclusion criteria, comprising 2 randomized controlled trials, 2 retrospective studies, and 13 observational studies. Current noninvasive IRP monitoring devices include ureteric catheters placed retrogradely or via percutaneous tubing and connected to pressure transducers, amplified by cardiology-used pressure sensing systems or urodynamic systems, automated pressure-regulating systems, pressure sensing guidewires, and IRP sensing flexible ureteroscopes. The review revealed significant variations in IRP measurement methods, reporting units, and irrigation techniques. Notably, elevated IRP above 30 mmHg was consistently associated with increased postoperative complications, including sepsis.

Conclusion: Current clinical studies have only ascertained that increased IRP above 40 mmHg positively correlates with infectious complications and postoperative pain. No standardized values are available to predefine safe thresholds in practice. With the availability of noninvasive tools for IRP monitoring, future research should focus on multicenter studies to establish reference ranges and best practices for IRP management, ultimately improving patient outcomes in endourological procedures.