Urologia Internationalis最新文献

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: Fournier's gangrene (FG) is a life-threatening necrotizing infection of the perineal, genital, or perianal regions, often requiring extensive surgical intervention and prolonged recovery. Despite advances in acute management, the long-term impact of FG on patients' self-esteem and quality of life (QoL) remains underexplored.

Methods: This retrospective study included 48 patients treated for FG at seven urological centres in Austria between 2017 and 2022. Several in-house data were collected and patients were contacted after a mean of 4.5 years to complete a questionnaire including the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), Short Form (SF-12) QoL questionnaire, and the Rosenberg self-esteem scale (RSE).

Results: The study recruited 48 patients with a median age of 64 years; 58.7% required intensive care unit stays due to infection (median duration, 6 days). The in-house mortality rate was 8.3%. Survivors (n = 44) had a median hospitalization of 16 days. They were contacted by mail, and 18 completed the questionnaire. There was a high prevalence of urinary symptoms and erectile dysfunction, wound pain, and impaired QoL. Severe erectile dysfunction (IIEF-5 score ≤7) was reported by 46.2%, and 38.9% reported Visual Analog Scale pain score ≥4. Impaired self-esteem (mean RSE score: 12.4) correlated with functional impairments, including urinary symptoms (IPSS ≥20 in 55.6%), erectile dysfunction, and wound-related pain. Physical and mental health were strongly associated with decreased self-esteem, with hypertension (61.1%) and alcohol abuse (16.7%) negatively impacting outcomes.

Conclusion: FG negatively impacts patients' self-esteem and QoL, particularly in the presence of pre-existing risk factors. The findings highlight the importance of integrated rehabilitation approaches to mitigate long-term psychological and functional impairments.

Introduction This study aims to investigate the relationship between surgical difficulty and postoperative complications in kidney transplantation, as well as to develop a preoperative prediction model for assessing surgical difficulty. Methods This is a prospective cohort included 122 kidney transplant adult recipients. The subjective score for operative difficulty, ranging from 1 to 3 points, served as the quantitative measure of surgical difficulty. Analysis of Variance (ANOVA) and Chi-square tests were employed to investigate the differences in postoperative complications. Additionally, Pearson and Spearman correlation analyses were conducted to assess the relationship between preoperative data and surgical difficulty scores, while multiple linear regression analysis was utilized to develop a prediction model. Results With the increase of surgical difficulty, the incidence and severity of postoperative complications of kidney transplant recipients increased significantly (1 vs 2, P=0.009; 1 vs 3, P=0.004; 2 vs 3, P=0.004). The incidence of delayed graft function (DGF) and graft loss was relatively high(1 vs 2, P<0.001; 1 vs 3, P<0.001; 2 vs 3, P=0.131). The source of donor kidney, number of arteries after donor kidney trimming, end resistance index of in vitro perfusion, vascular anastomosis mode of recipient, BMI, and calcification of the vessels to be anastomosed were influencing factors of surgical difficulty. The results of linear regression analysis showed that the difficulty of surgery =0.30 (donated by relatives) +0.48× the number of arteries +0.58× end resistance index of isolated perfusion +0.24× the mode of arterial anastomosis+0.02×BMI+0.17 (calcification of the vessel). Conclusion Higher levels of difficulty in kidney transplantation are associated with increased incidence and severity of postoperative complications, as well as prolonged recovery times. Concurrently, we developed a predictive model to quantify the difficulty of kidney transplantation and validated its accuracy.

Introduction: SUI is a common pelvic floor dysfunction in middle-aged and elderly women, which has a serious negative impact on the patient's quality of life (QoL); pelvic floor muscle training (PFMT) and electrical stimulation (ES), as common non-surgical treatment modalities, have been widely used in the management of SUI. However, there is controversy about the effectiveness of the combined application of these two interventions. For this reason, this study evaluated the efficacy of PFMT combined with ES in the treatment of SUI by meta-analysis. To systematically evaluate the efficacy of PFMT combined with ES in improving urinary incontinence symptoms, increasing pelvic floor muscle strength, enhancing QoL, and improving clinical symptoms, with the aim of providing more adequate evidence to support clinical treatment.

Methods: A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases from database construction to October 2024 to include RCTs and case-control studies evaluating PFMT combined with ES for the treatment of SUI. The Cochrane Risk Assessment Tool and NOS were used to assess the quality of the included literature, and effect sizes were calculated by random-effects model and fixed-effects model, and the main outcome indicators included incontinence symptoms, pelvic floor muscle strength, QoL, and clinical symptoms.

Results: Eight studies were ultimately included, with a total sample size of 885 cases. Meta-analysis showed that PFMT combined with ES was significantly better than the control group on all outcome measures. The combined effect size for improvement in urinary incontinence symptoms was OR = 1.42 (95% CI: 1.10, 1.85, p < 0.05), the combined effect size for pelvic floor muscle strength was OR = 1.55 (95% CI: 1.20, 2.05, p < 0.01), the combined effect size for QoL improvement was OR = 4.29 (95% CI: 3.68, 4.99, p < 0.0001), and the combined effect size for clinical symptom improvement was OR = 1.35 (95% CI: 1.05, 1.70, p < 0.05). Heterogeneity between studies was low (I2 values were less than 40%), indicating a high degree of consistency in the effect of the combination treatment.

Conclusion: PFMT combined with ES showed significant benefits in improving incontinence symptoms, enhancing pelvic floor muscle strength, boosting QoL, and improving clinical symptoms. Future studies should further standardize the intervention parameters and extend the follow-up period to fully assess the long-term effects of the combined treatment.

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: Subfertility is a well-known aftermath of treatment of testicular germ cell tumours (GCTs). Growing evidence suggests reduced semen quality also before therapy. The present study aimed to evaluate pre-orchiectomy semen parameters in GCT patients and to compare the results with controls.

Methods: GCT patients providing semen for cryopreservation before orchiectomy during 2012-2023 were retrospectively enrolled (TT cohort). Controls consisted of healthy volunteers for sperm donation (HD), and of patients with other malignancies (OMs). The following parameters were recorded in each participant: ejaculate volume (EV; ml), total sperm count in ejaculate (TSC), and proportion of progressive motility (PM) (%). Descriptive statistical methods were used to compare the 3 populations with each other.

Results: A total of 664 subjects were included, thereof 163 TT, 289 HD, and 212 OM. Median EV was 3.0 mL, 3.5 mL, and 3.4 mL; median TSC was 56.9 × 106, 207 × 106, and 152 × 106; median PM was 40%, 40.2%, and 43% in TT, HD, and OM, respectively. TSC, EV, and several secondary parameters of semen quality observed in TT were significantly worse than those in the two control cohorts. HD and OM were within normal limits with regard to TSC and PM and were different in only a few secondary parameters.

Conclusion: This study confirmed significantly lower pre-orchiectomy semen quality in GCT patients in comparison to healthy males and to patients with OM. Subfertility is an intrinsic feature of GCT preceding treatment that needs to be considered by care-givers.

Introduction: Auto-expandable ureteral stents can be an alternative to percutaneous nephrostomy (PCN) in refractory ureteral stenosis. Our aim was to analyse results and complications of ureteral stents in our centre.

Methods: Retrospective review of OptiMed® expandable ureteral stents placed in our centre (1996-2022). Analysis of complications (Clavien-Dindo classification) was performed. Kaplan-Meier curves (long-rank test) to assess stent permeability and Cox regression for associated factors were performed.

Results: Fifty-eight patients were included. Median follow-up was 36 months (11-82). Median age was 61 years (48-68). Most frequent aetiology of ureteral stenosis was malignancy in 30 cases (53.6%). The most common location of stricture was distal ureter in 44 (63.8%) ureteral strictures. Creatinine levels improved in 28 (48.3%) cases. Most common acute complication was urinary tract infection in 6 (3.4%) patients (Clavien-Dindo II). Twenty patients presented with stent obstruction. Fourteen (24.1%) were solved with double J stenting and 6 (10.3%) cases with PCN. Mean stent survival time was 50 months (34.3-65.8). By the end of follow-up, 23 (39.6%) patients were alive. Of those, 9 (39.1%) had a functioning stent. No association of any factor with patency of stent was found.

Conclusions: Expandable ureteral stents are an alternative to PCN in fragile patients with refractory stenosis, which offers a better quality of life.

Introduction: Studies comparing refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion (CCUD) are scarce and often characterized by heterogeneous study populations. This work therefore aimed at comparing both techniques regarding long-term outcomes in a propensity-scored approach.

Methods: We identified n = 19 patients, totaling n = 38 renal units (RU), who underwent CCUD surgery at our hospital out of a pool of 120 patients. Of these 38 RU, 27 RU were implanted via refluxing ureteric implantation utilizing various procedures due to special intraoperative circumstances (short ureters, damage due to radiation). In terms of preoperative renal function, a comorbidity index (Age-Adjusted Charlson Comorbidity Index [ACCI]), and gender, we compared them to n = 38 patients with a total of 76 RU with non-refluxing ureteric implantation in all RU (1:2 matching). The mean follow-up was 56 (IQR: 23-112) months.

Results: Long-term renal function was comparable in CCUD patients receiving refluxing versus non-refluxing ureteric implantation (estimated glomerular filtration rate: 63.11 mL/min vs. 71.7 mL/min, p = 0.22) with an average decline of 17.4 mL/min and 13.69 mL/min during the follow-up period, respectively. Also, the rate of new-onset chronic kidney disease (CKD) (both 15%, p = 1), the need for alkalizing medication, or the number of pyelonephritis episodes did not significantly differ between the groups. In Cox regression analysis, ACCI was the single most predictive parameter for the development of new-onset CKD (HR: 1.71 [1.10-2.66], p = 0.0167). None of the RU in the refluxing group needed revisional surgery concerning the ureterointestinal anastomosis, whereas 7 RU of the non-refluxing group did.

Conclusions: Our study confirms that refluxing ureteric implantation in CCUDs is a valid and safe procedure regarding long-term renal, metabolic and functional outcomes. Our data also suggest that patients should be counseled according to their comorbidities regarding long-term renal function.

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: 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.