Urologia Internationalis最新文献

Introduction: This study aimed to compare spinal and general anesthesia methods in endoscopic management of proximal ureteral stones with a particular emphasis on total anesthesia time.

Methods: A total of 246 adult patients undergoing ureteroscopic management for proximal ureteral stones between January 2021 and March 2023 were enrolled. Two different types of anesthesia, namely, spinal (group 1, n = 109) and general (group 2, n = 137) anesthesia, were applied during these procedures.

Results: The mean total anesthesia time of group 1 was statistically significantly shorter than that of group 2 (61.4 ± 28.7 and 93.7 ± 29.2 min, respectively, p = 0.013). While 92.7% of patients in group 1 were stone free after the interventions, this value was 92% in group 2 (p = 0.828). There was no statistically significant difference between the two groups regarding peri- (p = 0.126) or postoperative (p = 0.284) complications.

Conclusions: Our results demonstrated well that both spinal and general anesthesia methods could be applied in a successful and safe manner in the endoscopic management of proximal ureteral stones. However, a shorter total anesthesia time under spinal anesthesia could be anticipated during endoscopic management of proximal ureteral stones.

Introduction: The aims of the study were to examine the value of tumor size, weight, and density in predicting pathological tumor stage in patients with suspected bladder cancer (BCa), minimize inter-observer variability of estimated tumor size, and thus provide a more objective instrument to describe the extent of local tumor growth.

Methods: An institutional dataset of 588 consecutive patients undergoing transurethral resection of bladder tumor (TUR-BT) for suspected BCa from 05/2016 to 09/2018 was used. Separate Mann-Whitney U tests examined differences in each unit between non-muscle-invasive BCa (NMIBC) and muscle-invasive BCa (MIBC) and between Ta/carcinoma in situ and T1 NMIBC. Intraoperative tumor size, weight, and respective density were calculated. We then calculated multivariable logistic regression models to examine each unit's predictive value and distinguish between endpoints.

Results: Overall, 367 patients undergoing TUR-BT were diagnosed with BCa. In patients with MIBC (n = 73), the median size (p < 0.001) and weight (p < 0.001) were higher compared to NMIBC. In contrast, tumor density (p < 0.001) was lower. On multivariable analysis, increasing size and weight were associated with higher odds of T1 (size: odds ratio [OR] 2.50, 95% confidence interval [CI]: 1.87-3.35; weight: OR 1.65, 95% CI: 1.26-2.15) and muscle-invasive disease (size: OR 1.51, 95% CI: 1.29-1.78; weight: OR 1.09, 95% CI: 1.03-1.15). Meanwhile, an increasing density was associated with lower odds of both outcomes (T1: OR 0.96, 95% CI: 0.89-1.02; MIBC: OR 0.81, 95% CI: 0.69-0.96).

Conclusion: In patients diagnosed with BCa, tumor size, and weight showed similar predictive power concerning T1 NMIBC and MIBC. Tumor density failed to predict the local tumor stage sufficiently. These results may lay the foundation for improving objective measurement of the local tumor burden in patients with BCa and may help guide further immediate treatment decisions.

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: This study aims to evaluate the impact of preoperative ureteral stenting on post-operative outcomes, especially the incidence of urinoma, in patients with complex renal tumours undergoing nephron-sparing surgery (NSS).

Methods: A retrospective analysis of 35 patients received preoperative ureteral stenting prior to NSS for complex tumours at the University Hospital of Würzburg between 2002 and 2021. A control group of 115 patients was established through 1:3 propensity score matching based on age, gender, T-stage, and RENAL score. Clinical parameters, surgical outcomes, and complications were assessed, and statistical comparisons were performed using the unpaired Student's t test and chi-square test.

Results: While both groups showed comparable tumour complexity (RENAL: 7 vs. 7, p = 0.58; PADUA: 9 vs. 8, p = 0.62), there were no significant differences in median hospital stay (12 vs. 11; p = 0.068), surgical time (183 vs. 190 min; p = 0.37), post-operative haemoglobin levels (11 g/dL vs. 11.1 day/dL; p = 0.9), and renal function (GFR 65 mL/min/m2 in both groups). Moreover complication severity during NSS, defined by Clavien-Dindo classification, was similar (none vs. grade I; p = 0.29). No significant difference in the rate of urinoma was observed (11% vs. 4%, p = 0.93).

Conclusions: This study found no significant benefits of preoperative ipsilateral ureteral stenting on post-operative outcomes, particularly concerning the development of urinoma. Given these findings, preventive ureteral stenting is not recommended prior to partial kidney resection for complex renal tumours.

Introduction: Ureteral access sheaths (UASs) are widely used in the endoscopic treatment of urolithiasis. In modern medicine, radiation exposure from diagnostics and therapy is increasing; however, the impact of UAS on procedure duration, fluoroscopy time, and radiation exposure is still uncertain.

Methods: This retrospective study included 1,026 patients who received ureterorenoscopic treatment for nephrolithiasis between 2016 and 2018 at a large academic center. Patients were dichotomized according to the use of UAS, and propensity-score matching was performed based on age, BMI, and stone size. Patient demographics, stone size, radiographic density, perioperative complications, and postoperative outcome were assessed. Procedure time and radiation exposure, recorded as the fluoroscopy time and area dose product, were analyzed.

Results: In total, 300 patients were successfully matched to the cohort with UAS (n = 150) and the cohort without UAS (n = 150). Patients' demographics were similar for age, gender, BMI, and ASA score (each p > 0.05). Median stone size was 8 mm and 7.5 mm in the cohort with and without UAS (p = 0.335). Procedure time showed no differences between the two cohorts (p = 0.749). Fluoroscopy time and area dose product were significantly lower in patients treated with the use of UAS (p = 0.004; p < 0.001).

Conclusion: The use of a UAS does not prolong operation time in patients with an equivalent stone burden. In addition, the use of a UAS reduces fluoroscopy time and radiation exposure. In the future, to reduce radiation exposure to the patient and medical staff, the use of a UAS should also be considered for limited stone disease.

Introduction: A comprehensive understanding of the renal vascular anatomy variations is paramount to a successful kidney transplant. This reduces vascular injury risks and minimizes ischemia duration, optimizing surgical outcomes. The current study aims to assess the accuracy of renal computed tomography angiography (CTA) findings of live renal donors by comparing them with intraoperative findings.

Methods: This prospective cross-sectional study was conducted between October 2018 and February 2020. It included all healthy donors with two kidneys of normal size, shape, and position who were deemed suitable for nephrectomy. The CTA examinations were performed with the same protocol, which combined the vascular-excretory phase. Anatomical findings were recorded by a specialized radiologist. The CTA results were compared with intraoperative findings, which were documented by the transplantation team.

Results: The study included 220 patients. The preoperative CTA was highly sensitive and accurate, reaching 99.5% and 98.6%, respectively, for single vessels and 100% sensitivity and accuracy for triple vessels, pelvicalyceal system, and ureter duplication. The sensitivity of CTA for double vessels (vein and artery) was 90% and 92.6%, respectively, while accuracy was 98.6% for both.

Conclusion: CTA can be used to assess renal arteries and veins for potential renal donors with high accuracy. Although the CTA's minor, statistically nonsignificant discordance with the surgical findings regarding double arteries and veins, no artery or vein was missed on the CTA. Therefore, the sensitivity of CTA can reach 100%.

Introduction: The aim of the study was to analyze contemporary treatment trends in bladder stone management in Germany over a 15-year period.

Methods: We analyzed data from the nationwide German hospital billing database from 2006 to 2020. The significance of changes over time was evaluated via linear regression analysis.

Results: Total case numbers of therapeutic interventions for lower urinary tract calculi increased from 6,770 in 2006 to 9,037 in 2020 (p < 0.001). Transurethral cystolithotripsy (TUCL) was the predominant procedure with increasing case numbers from 5,552 in 2006 to 7,699 in 2020 (p < 0.001). Also, the share of TUCL increased by 4% during the study period. TUCL with laser fragmentation was coded in 82 cases in 2006 and in 1,527 cases in 2020 (p < 0.001). Case numbers of percutaneous cystolithotripsy also increased over time from 406 to 430 cases (p = 0.005), but the share decreased by 20%. Inpatient shock wave lithotripsy is very rarely performed for bladder calculi with an average of 22 cases per year in all hospitals in Germany. Case numbers of open cystolithotomy (OCL) also increased from 614 cases in 2006 to 692 cases in 2020 (p = 0.006), but the share decreased by 15.5%. On average, 164 cases of stone removal from neobladders per year were performed, mainly transurethrally (47%) or via an open approach (21%). Case numbers of TUCL combined with transurethral resection of the prostate (TUR-P) declined from 1,712 in 2006 to 1,450 in 2020 (p = 0.014). However, this might be attributed to the concomitant rise of laser enucleation of the prostate with steadily increasing case numbers in Germany.

Conclusion: We present contemporary population-based data on bladder stone treatment in Germany. TUCL is the predominant therapeutic modality with increasing case numbers, but OCL is still performed frequently. TUR-P is the procedure that is most often combined with TUCL.

Introduction: The aim of the study was to explore the application value of three-dimensional (3D) model in partial nephrectomy across varying RENAL scores.

Methods: A total of 126 patients were enrolled, divided into three groups: 25 cases in the 3D-partial nephrectomy (3D-PN), 86 cases in the 2D-partial nephrectomy (2D-PN), and 15 cases in the 3D-robot-assisted PN (3D-RAPN). Preoperative basic data were collected, including age, gender, neutrophil ratio, platelet count, blood glucose, GFR of the kidney, tumor diameter, tumor staging, RENAL score, Mayo Adhesive Probability (MAP) score, surgical time, warm ischemia time, intraoperative bleeding, postoperative drainage volume, postoperative hospital stay, change in creatinine level at 3 months postoperatively, and pathological results. Perioperative data between 3D-PN and 2D-PN, between the RENAL score 4-6 subgroup of 3D-PN and 2D-PN, between the RENAL score ≥7 subgroup of 3D-PN and 2D-PN, and between the 3D-PN and 3D-RAPN were compared. Statistical analysis was performed using SPSS version 26.0.

Results: The 3D-PN showed statistically significant differences compared to the 2D-PN in warm ischemia time, intraoperative bleeding volume, postoperative drainage volume, and postoperative hospital stay (p < 0.05). In the RENAL score 4-6 subgroup, the 3D-PN showed statistically significant differences in intraoperative bleeding volume compared to the 2D-PN (p < 0.05). In the RENAL score ≥7 subgroup, the 3D-PN showed statistically significant differences compared to the 2D-PN in surgical time, warm ischemia time, postoperative drainage volume, and postoperative hospital stay (p < 0.05). There were statistically significant differences between the 3D-PN and the 3D-RAPN in warm ischemia time, intraoperative bleeding volume, and postoperative hospital stay (p < 0.05).

Conclusion: Patients with RENAL score ≥7 benefit more from preoperative evaluation with 3D model. The combination of 3D model and RARP can further enhance the advantages and expand the convenience of surgery.

Introduction: This study aims to assess and enhance the application value of ureteral stents in the adjunctive treatment of renal tuberculosis, thus providing a robust evidence-based framework for guiding clinical management strategies.

Methods: A total of 360 patients diagnosed with renal tuberculosis between January 2019 and December 2023 were meticulously selected for this study. Utilizing a random number table, the patients were stratified into a control group and a study group, with 180 patients in each cohort. The control group received standard antituberculosis treatment, while the study group underwent adjunctive treatment with ureteral stents. A comparative analysis was conducted to evaluate the differential clinical efficacy, renal excision rate, renal function, degree of renal pelvis separation, and renal parenchymal thickness between the two groups.

Results: The study group showed significantly better clinical cure rates and effectiveness compared to the control group. While the 12-month renal excision rate was similar between groups, the 18-month rate was significantly lower in the study group. The study group also had lower posttreatment BUN and serum creatinine levels, reduced renal pelvis separation, and greater renal parenchymal thickness. At 3 and 9 months, complications were significantly fewer in the study group (p < 0.001, p < 0.05), with no severe complications reported. Additionally, the study group had higher overall SF-36 scores (p < 0.001), indicating better quality of life. The treatment success rate (87.2% vs. 70.6%, p < 0.001), renal function preservation (76.7% vs. 60.6%, p = 0.001), and lower recurrence rate (16.1% vs. 26.1%, p = 0.028) further highlighted the benefits of ureteral stenting.

Conclusion: The adjunctive use of ureteral stents in the treatment of renal tuberculosis presents a significantly enhanced application value. It not only improves clinical efficacy but also diminishes the need for renal excision, effectively preserves renal function, reduces the degree of renal pelvis separation, and maintains optimal renal parenchymal thickness. Thus, advocating for the widespread implementation of ureteral stents as an adjunctive therapeutic modality for managing renal tuberculosis is strongly recommended.