Urologia Internationalis最新文献

Introduction: There are conflicting results in the literature regarding the efficacy of retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups.

Methods: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status 1 month after RIRS.

Results: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40-58) in Group 1 and 50 years (IQR: 35-60) in Group 2 (p = 0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1-858.2) and 503.3 mm3 (IQR: 282.5-864), respectively (p = 0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2%) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p = 0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p = 0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p = 0.393), and median operation time (60 min in both, p = 0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 s and 3 s, respectively, p = 0.013).

Conclusions: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones.

Introduction: The impact of surgical therapy on selected patients with limited metastatic/recurrence burden has not yet been well studied. We investigated the outcome of surgical resection for patients with local recurrence only or oligometastatic urothelial carcinoma (UC) of the bladder.

Methods: We identified patients with oligometastatic UC or local recurrence only after radical cystectomy who underwent surgical resection with curative intent between 2003 and 2022 at our center. Oligometastatic UC was defined as three or fewer resectable lesions, regardless of the number of organs involved. We studied the surgical outcome, progression-free survival (PFS) and overall survival (OS) in this selected group of patients.

Results: A total of 39 patients were selected, including 18 (46%) with local recurrence and 21 (54%) with oligometastatic UC. Nine patients (23%) experienced intraoperative complications, all of whom belonged to the local recurrence group, while 8 patients (20.5%) experienced major postoperative complications, including 6 patients from the local recurrence group and 2 patients with oligometastatic disease. The median PFS following surgery was 19 months (95% CI; 2.5-35.5) with 1- and 3-year progression rates of 47% and 29%, while the median OS was 24 months (95% CI; 8.6-39.3) with 1- and 3-year survival rates of 51% and 30%. A significantly better median PFS was observed in the metastatic versus local recurrence group (35 vs. 8 months, p = 0.01). Similarly, a median OS of 41 months was observed in the metastatic group compared to only 12 months for the local recurrence group (p = 0.12). Overall, a better survival time of 30 months was observed in the metachronous group compared to 6 months in the synchronous group (p = 0.046). In a further analysis of the metastatic group, metachronous oligometastasis was associated with a longer survival of 43 months compared to 9 months for synchronous metastasis (p = 0.18). Some differences were not significant, which may be due to sample size.

Conclusion: Our study shows reasonable surgical and survival outcomes of metastasectomy, especially in the metachronous subgroup, for UC without risk of higher perioperative morbidity. On the other hand, resection of local recurrence is associated with a higher risk of incomplete resection and higher intraoperative and postoperative morbidity without offering a survival benefit.

Introduction: The aim of this study was to evaluate the feasibility and safety of using the novel flexible vacuum-assisted ureteral access sheath (FV-UAS) in flexible ureteroscope (F-URS) treatment of impacted non-distal ureteral stones.

Methods: We analyzed data from patients who underwent FV-UAS treatment for impacted non-distal ureteral stones between January 2022 and September 2023. Perioperative parameters were evaluated, including operative time, ureteral injury, and complications. The FV-UAS have a 10-cm passive deflection segment at the distal end of the ureteral access sheath that can bend following the deflection of the F-URS, while also being connected to a vacuum device for aspiration.

Results: A total of 62 consecutive patients (35 females) were included. Mean (range) patient age was 50.0 (29-75) years. Mean (range) largest stone size was 13.8 (9-16) mm. Mean (range) total time was 34.2 (18-46) min. In 57 patients (91.9%), no residual stones were detected in the renal, while 5 patients (8.1%) had residual stones smaller than 4 mm. A 5-tier classification quantified ureteral injury severity at stone impaction sites: grade 0 (n = 10); grade 1 (n = 47); grade 2 (n = 5); and grades 3 and 4 (n = 0). Nine patients (14.5%) underwent the placement of two double-J stents. Two patients (3.2%) developed postoperative fever requiring antibiotics and conservative management. Mean (range) postoperative hospital stay was 1.2 (1-2) day. At the 3-month follow-up, no ureteral strictures had occurred. No additional surgical interventions were necessary during the follow-up.

Conclusion: The use of the FV-UAS for the treatment of impacted non-distal ureteral stones is a safe and effective surgical method.

Introduction: This study aimed to evaluate the initial outcomes of a novel transfixing uretero-enteral anastomosis technique in robot-assisted radical cystectomy (RARC) with ileal conduit in an intracorporeal urinary diversion (ICUD), focusing on its potential to reducing the incidence of uretero-enteric anastomotic stricture.

Methods: The study subjects were 11 patients who underwent RARC and ileal conduit created as an ICUD at a single cancer center between 2022 and 2024. The technique involved opening the ventral side of the oral end of the separated ileum approximately 5 cm apart. Two small holes were made 2 cm from the oral end on the dorsal side, through which the ureter passed to the luminal side. The distal end of the ureter was spatulated, and four knotted sutures were placed at the base using 4-0 absorbable sutures. The distal end of the ureter was anchored using two knotted sutures, and the liberated portion was closed using 3-0 absorbable suture in a running fashion.

Results: The median total operation time was 418 min (range: 269-467 min), with a median console time of 93 min (range: 80-129 min) for urinary diversion. Two patients required temporary stent reinsertion because of hydronephrosis; however, no pyelonephritis occurred. Two patients (18.2%) had complications of Clavien-Dindo classification 3 or higher, both of which only required temporary stent reinsertion. Postoperative renal function was preserved in all the patients.

Conclusions: In our initial experience, the transfixing uretero-enteral anastomosis technique was successful in stabilizing anastomoses in ICUD.

Introduction: The primary objective of the study was to assess the impact of EF in women with rUTI on quality of life and sexual health.

Methods: This prospective observational clinical study included 152 women who underwent EF because of rUTI and were followed for a minimum of 18 months. The SF-12 questionnaire and the Female Sexual Function Index (FSFI) are used to evaluate quality of life and sexual dysfunction. The Patient Global Impression of Improvement (PGI-I) scale was assessed to evaluate subjective cure. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during cystoscopy. Clinical success was defined as no urinary tract infections at the last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year. Chi-square test, Wilcoxon, and Student's paired t test were used.

Results: Seventy patients (52.6%) were defined as cured with at least 1-year follow-up. The subjective cure rate was 71.4% (N = 95) according to PGI-I scores. Women had significantly higher average FSFI scores (p = 0.001) in the 1-year postoperative assessment. Overall, pathological mental health and physical health scores were significantly higher after the intervention (p = 0.00). Thirty-one (23.3%) patients improved clinically with <3 infections per year, and 32 (24.1%) patients failed with >3 infections per year. A total of 97 (74.4%) patients had endoscopic resolution on postoperative evaluation.

Conclusion: EF resulted in clinical cure and improvement in the large majority of the patients. A significant proportion of the patients demonstrated enhanced sexual function and quality of life.

Introduction: Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort.

Methods: Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1-2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated.

Results: Data of 43 individuals (mean age 49 ± 13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p < 0.0001) from 58.1% (42.1-73.0%) to 23.3% (11.8-38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p = 0.001) from 14.0% (5.3-27.9%) to 39.5% (25.0-55.6%). In addition, there was a significant (p = 0.008) decrease in the number of antibiotic prescriptions.

Conclusion: Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs.

Introduction: Half of all patients with testicular germ cell tumors (GCTs) present with metastases to retroperitoneal lymph nodes or visceral organs. Inguinal metastases (I/Ms) are very rare. We aimed to evaluate the relative frequency and clinical features of I/Ms and look for predisposing factors.

Methods: A cohort of 740 GCT patients treated between 2010 and 2022 was analyzed. The frequency of I/M and their clinical features were statistically compared among the subgroups.

Results: Eight patients had I/M, with a median age of 55 years, all of whom had primary seminoma and six had previous groin surgery. The relative frequency of I/M is 1.1% and 8.3% in the GCT patient cohort and the metastasized seminoma subgroup, respectively. All patients were cured, six underwent surgery and additional chemotherapy, and two received cisplatin-based chemotherapy alone.

Discussion: I/Ms occur in approximately 1% of GCT patients. Prior groin surgery, bulky retroperitoneal metastases, and possibly histology of seminoma represent risk factors for I/M. The presence of I/M does not adversely affect prognosis, and all cases can be cured with standard therapeutic measures. Lymph node excision may be required to establish the diagnosis. In patients with risk factors, follow-up examinations should include the groins.

Introduction: This study evaluates the predictive value of the Mayo Adhesive Probability (MAP) score for surgical outcomes in obese patients undergoing miniaturised percutaneous nephrolithotomy (m-PCNL). The primary research question is whether the MAP score can predict intraoperative and postoperative complications in patients with a BMI greater than 30.

Methods: A retrospective analysis was conducted on patients who underwent m-PCNL at a tertiary care centre between August 2018 and August 2023. Patients with kidney stones larger than 2 cm and a BMI >30 were included. They were categorised based on MAP scores (<3 vs. ≥3). Data on operation time, fluoroscopy time, hospital stay, and complications were compared. Statistical analyses included t tests, chi-square tests, and logistic regression to assess risk factors for postoperative fever.

Results: Among 87 patients, those with a MAP score ≥3 had a significantly higher rate of postoperative fever (17.1% vs. 3.8%, p = 0.035). There were no significant differences between groups in operation time, fluoroscopy time, hospital stay, or blood transfusion needs. Logistic regression showed that a higher MAP score (OR: 6.614, p = 0.045) and increased stone burden (OR: 1.003, p = 0.040) were significant predictors of postoperative fever.

Conclusion: The MAP score is a significant predictor of postoperative fever in obese patients undergoing m-PCNL. Higher MAP scores are associated with a greater risk of fever, suggesting that careful monitoring and preventive measures are essential for patients with higher MAP scores. Further multicentre studies are needed to validate these findings and improve predictive accuracy.

Introduction: The aim of this study was to evaluate the kidney tumor characteristics in surgically treated patients in Turkey.

Methods: Patients who underwent surgical treatment for kidney tumors between January 2017 and December 2022 in Turkey were retrospectively reviewed through the Health Information Systems of the Ministry of Health. Patient's age, gender, comorbidities, surgical methods, and tumor characteristics were evaluated.

Results: The most common subtype of RCC was clear cell RCC (ccRCC) in 4,892 patients (72%). Papillary RCC (pRCC) was less frequent in patients under 50, with its incidence increasing with age compared to other subtypes (p = 0.006). There was a significant relationship found between hypertension and pathological subtypes (p = 0.002), with pRCC and unclassified RCC contributing to this difference. Among RCC subtypes, as the ISUP/Fuhrman grade increased, the tumor stage also progressed (p < 0.001). Tumors in males and tumors in the left kidney were at more advanced cancer at the time of diagnosis (p < 0.001 and p = 0.006, respectively). In multivariate logistic regression analysis, advanced age (odds ratio [OR]: 1.007, 95% confidence interval [CI]: 1.001-1.014, p = 0.04), male gender (OR: 0.416, 95% CI: 0.350-0.493, p < 0.001), increased tumor size (OR: 1.117, 95% CI: 1.079-1.156, p < 0.001), and the presence of diabetes mellitus (OR: 1.222, 95% CI: 1.007-1.483, p = 0.042) were found to be independent risk factors for malignancy.

Conclusions: Our study identifies key factors associated with surgically treated renal tumors in Turkey. While aligning with prior research, these findings highlight the need for detailed studies to clarify the impact of biological, demographic, and lifestyle factors on RCC risk and progression, enabling more accurate diagnosis and tailored treatment.

Introduction: This study aimed to investigate the patient-, stone-, and laboratory-related parameters to predict the likelihood of spontaneous stone passage (SSP) in uncomplicated 5-10 mm ureteral stones.

Methods: Between August 2020 and April 2024, 421 patients presenting with 5-10 mm ureteral stones were included in the study program. Patients were divided into two groups based on the spontaneous passage status of the stones during the 4-week close follow-up period: group 1 (n: 252 [59.8%]) patients passing the stones during this period and group 2 (n: 169 [40.2%]) patients who could not pass the stones. In addition to the stone (size and location), patient (associated comorbidities, presence of UTI) and degree of hydronephrosis were assessed in all patients. Urinary tract infection (UTI) without pyuria was defined as the absence of pyuria in urinalysis due to ureteral obstruction despite the presence of an elevated blood level of white blood cells or C-reactive protein. UTI without pyuria patients were tested by a midstream urine sample for culture and were defined as no bacterial growth (<105 cfu/mL) in the urine culture.

Results: The presence of comorbidities (p = 0.006), degree of hydronephrosis (grade 3 vs. grade 2, p = 0.011 and grade 3 vs. grade 1, p = 0.008), transverse stone size (p = 0.004), ureteral stone location (proximal vs. distal, p = 0.010), and UTI without pyuria (p < 0.001) were found to be independent predictors for SSP. Spontaneous passage of ureteral stones could be predicted with the help of some patient- and stone-related parameters.

Conclusion: Associated comorbidities and, most importantly, the presence of UTI without pyuria (due to luminal obstruction) were the most important independent predictors that decreased SSP in ureteral stones.