Urologia Internationalis最新文献

Objective: The primary objective of this study was to evaluate the impact of vaginal uterosacral plication on urge symptoms and quality of life in a cohort of patients with uterosacral ligament insufficiency and urge symptoms.

Methods: A total of 40 female patients were included in the study, and their posterior fornix was supported with gauze to simulate the surgical procedure. Uterosacral plication was applied to patients who experienced a decrease in urinary incontinence, nocturia, a sense of urgency, and a decrease in urge urinary incontinence symptoms or complete recovery. Images of the bladder, bladder neck, urethra, and symphysis pubis were obtained preoperatively and 1 year postoperatively. POP-Q staging was also performed, and patients completed the Overactive Bladder Evaluation Form (OAB-V8) and the Incontinence Impact Questionnaire Short Form (ICIQ-SF).

Results: Results from the OAB-V8 questionnaire showed that postoperative nocturia scores improved by 72.1% compared to preoperative scores, and the need to urinate at night and waking up scores improved by 68.3%. Furthermore, the mean bladder neck thickness decreased from 10 to 9.2, and the mean detrusor thickness decreased from 8.7 to 6.4, indicating a significant change (p <0.0001). The ICIQ-SF questionnaire scores also showed a 68.4% improvement in urinary incontinence affecting daily life after the operation.

Conclusion: This study adds to the clinical evidence that uterosacral ligament support improves symptoms of overactive bladder syndromes, including urgency and nocturia. The use of pelvic floor ultrasound and the apical tamponade test is important in patient selection for the correct indication.

Introduction To evaluate if and when the presence of radiological urinary leakages of vesico-urethral anastomosis, after robotic radical prostatectomy, could provoke urethral strictures or affect continence recovery. Methods We enrolled 216 patients, undergoing Robot-Assisted-Radical-Prostatectomy between January 2020 and December 2022 in three high volume referenced centres for robotic surgery. Before removal of the bladder catheter, all patients underwent a cystourethrography in which the presence/absence of leakage was assessed at level of vesico-urethral anasotmosis. Based on degree of severity of urinary leakage on cystourethrography patients were classified as no-leakage or grade 0, grade 1 with transversal diameter ≤ 1 cm and grade 2 with transversal diameter ≥ 1 cm. At follow-up urethral stenosis formation and urinary continence recover was assessed; furthermore postoperative 12-month functional outcome was determined using EORTC-QLQ-PR25 questionnaire. Results Radiological urinary leakage was founded in 30 patients with grade 1 and 33 patients with grade 2, for a total of 63 patients. Only one patient (1,5%), grade 2 urinary leakage, developed significant urethral stricture and required endoscopic urethrotomy after 6 months. Analyzing the differences in those who removed the bladder catheter after 7-9 days and those who kept it longer, we found no statistically significant differences regarding recovery of continence (p=0.23) or about urinary symptoms (p= 0.94). Conclusions RARP remains gold standard approach for treatment of localised prostate cancer and the superiority of this technique is safe in preventing urethral strictures and continence recovery, even in presence of significant anastomotic urinary leakage.

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 one 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 sec and 3 sec, 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: Renal cancer (RC) is not typically symptomatic until it reaches a considerable size and an advanced stage [World J Oncol. 2020;11(3):79-87]. The 5-year survival rate for metastatic renal cancer (mRC) is estimated at 13% [CA Cancer J Clin. 2021;71(1):7-33]. Health-related quality of life (HRQoL), obtained as patient-reported outcomes (PRO), reflects the patient's subjective perception of the disease and treatment impact on their normal activity and well-being [Lancet Oncol. 2016;17(11):e510-4]. Measuring HRQoL can facilitate doctor-patient communication, aid in decision-making, and improve clinical outcomes [Eur Urol Focus. 2020;6(1):26-30]. We will analyse the baseline quality of life of patients diagnosed with mRC, who are candidates for systemic treatment, in our setting, as measured by responses to the NCCN-FKSI 19 questionnaire.

Methods: We analysed 78 consecutive patients diagnosed and treated for mRC from September 2012 to September 2019. We described the baseline questionnaire responses of our patients before initiating systemic treatment and analysed their responses.

Results: Over 60% of the patients reported some degree of lack of energy or fatigue, 60.8% were very or extremely worried about their disease worsening, and 47.9% had some issues related to rest. Additionally, 26.8% of the patients were not at all satisfied with their quality of life at that time.

Conclusions: Patients diagnosed with mRC exhibit deterioration in their quality of life, mostly showing asthenia and concern about their disease. The quality of life of "real-life patients" seems to be worse than that of those included in clinical trials.

Background: Urinary system stones are a common clinical disease, with significant differences in incidence and recurrence rates between different countries and regions. The etiology and pathogenesis of urinary system stones have not been fully elucidated, but many studies have found that some bacteria and fungi that are difficult to detect in urine constitute a unique urinary microbiome. This special urinary microbiome is closely related to the occurrence and development of urinary system stones. By analyzing the urinary microbiome and its metabolic products, early diagnosis and treatment of urinary system stones can be carried out.

Summary: This article reviews the relationship between the urinary microbiome and urinary system stones, discusses the impact of the microbiome on the formation of urinary system stones and its potential therapeutic value, with the aim of providing a reference for the early diagnosis, prevention, and treatment of urinary system stones.

Key messages: (i) Urinary stones are a common and recurrent disease, and there is no good way to prevent them. (ii) With advances in testing technology, studies have found that healthy human urine also contains various types of bacteria. (iii) Is there a potential connection between the urinary microbiota and urinary stones, and if so, can understanding these connections offer fresh perspectives and strategies for the diagnosis, treatment, and prevention of urinary stones?

Introduction: Penile squamous cell carcinoma (PSCC) is a rare malignancy in men with poor survival in metastatic disease. Lynch syndrome (LS) is a cancer predisposition, autosomal-dominant, inherited disorder arises from loss of function variants in mismatch repair genes.

Case presentation: Here, we reported a PSCC patient who was suspected with LS caused by a heterozygous PMS2 D526Afs*69 variant. A 57-year-old male with PSCC underwent pelvic lymph node dissection and bilateral groin lymph node dissection due to metastatic disease. He has a family history of colon cancer and brain cancer. Comprehensive genomic sequencing of his tumor specimen identified 19 somatic mutations with a high tumor mutation burden (14.03 mutations per Mb) and a high frequency of microsatellite instability (MSI-H). Additionally, a germline PMS2 D526Afs*69 mutation was identified in the peripheral blood sample. Immunohistochemistry analysis showed complete loss of PMS2 and MLH1 expression in his tumor cells.

Conclusion: These observations provided evidence suggesting that PSCC could be part of the LS spectrum.

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: Multiparametric MRI (mpMRI) is gold standard for the primary diagnostic work-up of clinically significant prostate cancer (csPCa). The aim of this study was to assess the benefit of the perfusion sequence and the non-inferiority of an MRI without contrast administration (bpMRI) compared to mpMRI while taking clinical parameters into account.

Methods: In this retrospective, non-interventional study we examined MRI data from 355 biopsy-naïve patients, performed on a 3T MRI system, evaluated by a board-certified radiologist with over 10 years of experience with subsequent mpMRI-TRUS fusion biopsy.

Discussion: Only 16/355 (4.5%) patients benefited from dynamic contrast enhanced. In only 3/355 (0.8%) patients, csPCa would have been missed in bpMRI. BpMRI provided sensitivity and specificity (81.4%; 79.4%) comparable to mpMRI (75.2%; 81.8%). Additionally, bpMRI and mpMRI were independent predictors for the presence of csPCa, individually (OR: 15.36; p < 0.001 vs. 12.15; p = 0.006) and after accounting for established influencing factors (OR: 12.81; p < 0.001 vs. 6.50; p = 0.012). When clinical parameters were considered, a more balanced diagnostic performance between sensitivity and specificity was found for mpMRI and bpMRI. Overall, PSA density showed the highest diagnostic performance (area under the curve = 0.81) for the detection of csPCa.

Conclusion: The premise of the study was confirmed. Therefore, bpMRI should be adopted as soon as existing limitations have been lifted by prospective multi-reader studies.