Purpose: Comparative studies on the outcomes of robot-assisted partial nephrectomy (RAPN) procedures conducted using the da Vinci Xi and Si platforms remain sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates of the two robotic surgical platforms. Materials and Methods: A total of 338 patients who had undergone RAPN using da Vinci Si platform or Xi platform were included. Pentafecta was defined herein as Trifecta (a warm ischemia time <25 min, a negative surgical margin, and the absence of significant perioperative complications) with the addition of estimated glomerular filtration rate preservation of over 90% and no chronic kidney disease stage progression by 12 months postsurgery. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement. Results: The trifecta and pentafecta rates were higher in the Xi group than in the Si group (65% vs. 29%, P < 0.001 for trifecta; 31% vs. 14%, P = 0.001 for pentafecta). In addition, a significantly shorter average WIT (19 vs. 28 min, P < 0.001) and console time (141 vs. 163 min, P = 0.004) were identified in the Xi group than in the Si group. RAPN conducted using the Xi platform was independently associated with both higher achievement rates of trifecta and pentafecta. In addition, multivariate regression analyses revealed that no history of hypertension, low tumor complexity as measured using the RENAL nephrometry score, anterior orientation of the renal tumor were associated with higher Trifecta rates; while history of diabetes and anterior–posterior renal tumor orientation were the significant predictors of Pentafecta achievement, respectively. Conclusion: A significantly higher rates of trifecta and pentafecta achievement were observed in the Xi group than in the Si group. The use of the Xi platform was also significantly associated with low operative times and acceptable complication rates.
我们回顾性地回顾并比较了两种机器人手术平台的三趾和五趾率。Pentafecta在这里被定义为三联(热缺血时间<25分钟，手术切缘阴性，无明显围手术期并发症)，外加肾小球滤过率估计保存超过90%，术后12个月无慢性肾脏疾病进展。进行多因素logistic回归分析，以确定三联曲和五联曲效果的预测因素。31% vs. 14%， P = 0.001)。此外，多变量回归分析显示，无高血压病史、低肿瘤复杂性(用肾肾测量评分测量)、肾肿瘤的前向与较高的三氟替卡发生率相关;而糖尿病史和前后肾肿瘤取向分别是Pentafecta成就的显著预测因素。
{"title":"Comparison between two da vinci surgical systems in trifecta and pentafecta rates for robot-assisted partial nephrectomy","authors":"Chih-Heng Chen, Kuo-How Huang, Shuo‐Meng Wang, Po-Ming Chow, Pei-Ling Chen, Jian-Hua Hong, Chao-yuan Huang","doi":"10.4103/UROS.UROS_172_21","DOIUrl":"https://doi.org/10.4103/UROS.UROS_172_21","url":null,"abstract":"Purpose: Comparative studies on the outcomes of robot-assisted partial nephrectomy (RAPN) procedures conducted using the da Vinci Xi and Si platforms remain sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates of the two robotic surgical platforms. Materials and Methods: A total of 338 patients who had undergone RAPN using da Vinci Si platform or Xi platform were included. Pentafecta was defined herein as Trifecta (a warm ischemia time <25 min, a negative surgical margin, and the absence of significant perioperative complications) with the addition of estimated glomerular filtration rate preservation of over 90% and no chronic kidney disease stage progression by 12 months postsurgery. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement. Results: The trifecta and pentafecta rates were higher in the Xi group than in the Si group (65% vs. 29%, P < 0.001 for trifecta; 31% vs. 14%, P = 0.001 for pentafecta). In addition, a significantly shorter average WIT (19 vs. 28 min, P < 0.001) and console time (141 vs. 163 min, P = 0.004) were identified in the Xi group than in the Si group. RAPN conducted using the Xi platform was independently associated with both higher achievement rates of trifecta and pentafecta. In addition, multivariate regression analyses revealed that no history of hypertension, low tumor complexity as measured using the RENAL nephrometry score, anterior orientation of the renal tumor were associated with higher Trifecta rates; while history of diabetes and anterior–posterior renal tumor orientation were the significant predictors of Pentafecta achievement, respectively. Conclusion: A significantly higher rates of trifecta and pentafecta achievement were observed in the Xi group than in the Si group. The use of the Xi platform was also significantly associated with low operative times and acceptable complication rates.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"99 - 106"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48315393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Chiu, Yu-Ching Chen, C. Huang, Yung-Ting Cheng, Y. Pu, Yu-chuan Lu, C. Chiang, Pei-Ling Chen, Jeff Chueh, Jian-Hua Hong
Purpose: The Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) are used as complementary tools for more accurate diagnosis in men with suspected prostate cancer (PCa). This study investigated whether the combination of PHI and mpMRI better predict clinically significant PCa (csPCa), defined as a Gleason score of ≥7. Materials and Methods: Ninety-four men with clinical suspicion of csPCa were prospectively included. PHI was determined before the prostate biopsy. A uroradiologist reviewed mpMRI findings by using the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS version 2.1). Fusion-targeted biopsy with systematic biopsy was performed in patients with any suspicious lesions on MRI (PI-RADS assessment category ≥3), whereas systematic biopsy was performed in patients without suspicious lesions. The diagnostic values of different biomarkers and PI-RADS were compared by the area under the receiver operating curve (area under the curve [AUC]) for detecting csPCa. Results: Forty-nine (52%) patients were diagnosed with csPCa. The csPCa group had higher median PHI and more abnormal MRI findings than did the non-csPCa group. The median total prostate-specific antigen (PSA) level was similar between the PI-RADS 3 and 4 lesion groups. The median PHI values increased and more patients were diagnosed as having csPCa with an increase in PI-RADS. The receiver operating characteristic curve indicated that PHI and MRI (AUC 0.85 and 0.82, respectively) predicted csPCa more accurately than did the total PSA, free PSA ratio, and PSA density. Adding PHI to mpMRI significantly increased the diagnostic accuracy for csPCa (P = 0.004). PHI remained the optimal biomarker in patients with “gray zone” PI-RADS 3 or PI-RADS 4 lesions. Conclusion: PHI can guide decision-making for prostate biopsy for patients with gray-zone mpMRI lesions. We proposed a biopsy strategy incorporating PHI and MRI which resulted in the avoidance of biopsies in 35% of the patients.
目的:前列腺健康指数(PHI)和多参数磁共振成像(mpMRI)作为辅助工具用于更准确的诊断男性前列腺癌(PCa)。本研究探讨了PHI联合mpMRI是否能更好地预测临床显著性PCa (csPCa)，定义为Gleason评分≥7。材料与方法:前瞻性纳入临床怀疑患有csPCa的男性94例。前列腺活检前测定PHI。一位泌尿外科医生使用前列腺成像报告和数据系统2.1版本(PI-RADS 2.1版本)对mpMRI结果进行了回顾。MRI上有可疑病变(PI-RADS评估类别≥3)的患者行融合靶向活检加系统活检，无可疑病变的患者行系统活检。通过受试者工作曲线下面积(area under The curve [AUC])对不同生物标志物和PI-RADS检测csPCa的诊断价值进行比较。结果:49例(52%)患者诊断为csPCa。与非csPCa组相比，csPCa组有更高的中位PHI和更多的异常MRI发现。PI-RADS 3和4病变组中位总前列腺特异性抗原(PSA)水平相似。随着PI-RADS的增加，中位PHI值增加，更多的患者被诊断为患有csPCa。受试者工作特征曲线显示，PHI和MRI (AUC分别为0.85和0.82)比总PSA、游离PSA比和PSA密度更准确地预测csPCa。在mpMRI中加入PHI可显著提高csPCa的诊断准确性(P = 0.004)。PHI仍然是PI-RADS 3或PI-RADS 4“灰色地带”病变患者的最佳生物标志物。结论:PHI可指导mpMRI灰色区病变患者前列腺活检的决策。我们提出了一种结合PHI和MRI的活检策略，这导致35%的患者避免了活检。
{"title":"Prostate biopsy strategy integrating prostate health index and multiparametric magnetic resonance imaging optimizes the predictive value of clinically significant prostate cancer in prostate imaging reporting and data system gray-zone imaging","authors":"S. Chiu, Yu-Ching Chen, C. Huang, Yung-Ting Cheng, Y. Pu, Yu-chuan Lu, C. Chiang, Pei-Ling Chen, Jeff Chueh, Jian-Hua Hong","doi":"10.4103/UROS.UROS_33_22","DOIUrl":"https://doi.org/10.4103/UROS.UROS_33_22","url":null,"abstract":"Purpose: The Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) are used as complementary tools for more accurate diagnosis in men with suspected prostate cancer (PCa). This study investigated whether the combination of PHI and mpMRI better predict clinically significant PCa (csPCa), defined as a Gleason score of ≥7. Materials and Methods: Ninety-four men with clinical suspicion of csPCa were prospectively included. PHI was determined before the prostate biopsy. A uroradiologist reviewed mpMRI findings by using the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS version 2.1). Fusion-targeted biopsy with systematic biopsy was performed in patients with any suspicious lesions on MRI (PI-RADS assessment category ≥3), whereas systematic biopsy was performed in patients without suspicious lesions. The diagnostic values of different biomarkers and PI-RADS were compared by the area under the receiver operating curve (area under the curve [AUC]) for detecting csPCa. Results: Forty-nine (52%) patients were diagnosed with csPCa. The csPCa group had higher median PHI and more abnormal MRI findings than did the non-csPCa group. The median total prostate-specific antigen (PSA) level was similar between the PI-RADS 3 and 4 lesion groups. The median PHI values increased and more patients were diagnosed as having csPCa with an increase in PI-RADS. The receiver operating characteristic curve indicated that PHI and MRI (AUC 0.85 and 0.82, respectively) predicted csPCa more accurately than did the total PSA, free PSA ratio, and PSA density. Adding PHI to mpMRI significantly increased the diagnostic accuracy for csPCa (P = 0.004). PHI remained the optimal biomarker in patients with “gray zone” PI-RADS 3 or PI-RADS 4 lesions. Conclusion: PHI can guide decision-making for prostate biopsy for patients with gray-zone mpMRI lesions. We proposed a biopsy strategy incorporating PHI and MRI which resulted in the avoidance of biopsies in 35% of the patients.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"86 - 92"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42352255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/UROS.UROS_134_22
Tai-Hua Chiu, Yi-Hsuan Wu, Yung-Chin Lee
Benign prostatic hyperplasia (BPH) is one of the widespread diseases affecting aging males globally. As prostatic cell proliferation, it clinically influences a great degree of bladder outlet obstruction and is characterized by bothersome lower urinary tract symptoms. Assessments and treatments should not only be conducted based on the prostate volume or condition, related symptoms and quality of life should be considered also. The present analysis focuses on the update of management for BPH, including pharmacotherapy and slightly invasive surgical options. Despite alpha-1 adrenoceptor antagonists, many other factors and even combination therapy were extensively studied. Regarding slightly invasive surgical treatments, including Aquablation, water vapor thermal therapy, prostatic artery embolization, prostatic urethral lift, and nitinol butterfly-like stent, we analyzed the latest findings of studies, as well as safety issues. Finally, we highlighted current guidelines for clinical practice and future direction for further investigation.
{"title":"Treatment of benign prostatic hyperplasia: Update and future","authors":"Tai-Hua Chiu, Yi-Hsuan Wu, Yung-Chin Lee","doi":"10.4103/UROS.UROS_134_22","DOIUrl":"https://doi.org/10.4103/UROS.UROS_134_22","url":null,"abstract":"Benign prostatic hyperplasia (BPH) is one of the widespread diseases affecting aging males globally. As prostatic cell proliferation, it clinically influences a great degree of bladder outlet obstruction and is characterized by bothersome lower urinary tract symptoms. Assessments and treatments should not only be conducted based on the prostate volume or condition, related symptoms and quality of life should be considered also. The present analysis focuses on the update of management for BPH, including pharmacotherapy and slightly invasive surgical options. Despite alpha-1 adrenoceptor antagonists, many other factors and even combination therapy were extensively studied. Regarding slightly invasive surgical treatments, including Aquablation, water vapor thermal therapy, prostatic artery embolization, prostatic urethral lift, and nitinol butterfly-like stent, we analyzed the latest findings of studies, as well as safety issues. Finally, we highlighted current guidelines for clinical practice and future direction for further investigation.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"55 - 63"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44876212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/uros.uros_117_22
H. Kuo, Lin-Nei Hsu, J. Jhang, Y. Ou, Y. Chuang, M. Jang, Cheih-Wen Chin, Y. Juan, Min-Hsin Yang, Weijie Lin, Hsin-Ho Liu, Jian-Ri Li
{"title":"Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury – Part 4: Patient risk, bladder management, and active surveillance","authors":"H. Kuo, Lin-Nei Hsu, J. Jhang, Y. Ou, Y. Chuang, M. Jang, Cheih-Wen Chin, Y. Juan, Min-Hsin Yang, Weijie Lin, Hsin-Ho Liu, Jian-Ri Li","doi":"10.4103/uros.uros_117_22","DOIUrl":"https://doi.org/10.4103/uros.uros_117_22","url":null,"abstract":"","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70853246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Khorrami, Amir Mohseni, Farshad Gholipour, F. Alizadeh, M. Zargham, M. Izadpanahi, Mehrdad Mohammadi Sichani, F. Khorrami
Purpose: Urinary incontinence (UI) is a common complication of radical prostatectomy (RP) affecting patient's quality of life (QoL). In the present study, we aimed to investigate the effects of single-session preoperative pelvic floor muscle training (PFMT) with biofeedback (BFB) on short- and mid-term postoperative UI and QoL. Materials and Methods: This study was performed between 2018 and 2020. The patients were randomized into two groups: the case group received a training session with BFB, supervised oral and written instructions on pelvic floor muscle exercises in a 1-h-long training session 1 month before the surgery. Patients were asked to regularly perform exercises immediately after the session until surgery. The controls received no instructions. We used the International Consultation on Incontinence Questionnaire-UI (ICIQ-UI) short-form and ICIQ-Lower Urinary Tract Symptoms QoL Module (ICIQ-LUTSqol) at 1, 3, and 6 months after removing the urinary catheter. Results: A total of 80 patients with a mean age of 63.83 ± 3.61 years were analyzed. Patient characteristics were similar between the groups. The mean ICIQ-UI score was significantly lower in the intervention group at 1 and 3 months after catheter removal (P = 0.01 and P = 0.029, respectively) but similar at 6 months (P = 0.058). The mean ICIQ-LUTSqol score was significantly lower in the intervention group at 1, 3, and 6 months after catheter removal (P < 0.001, P = 0.005, and P = 0.011, respectively). Conclusion: A single session of preoperative PFMT with BFB has significant short-term effects on UI after RP but not at 6 months. However, this intervention can improve LUTS-related QoL even at 6 months after catheter removal.
{"title":"Single session pre-operative pelvic floor muscle training with biofeedback on urinary incontinence and quality of life after radical prostatectomy: A randomized controlled trial","authors":"M. Khorrami, Amir Mohseni, Farshad Gholipour, F. Alizadeh, M. Zargham, M. Izadpanahi, Mehrdad Mohammadi Sichani, F. Khorrami","doi":"10.4103/UROS.UROS_12_22","DOIUrl":"https://doi.org/10.4103/UROS.UROS_12_22","url":null,"abstract":"Purpose: Urinary incontinence (UI) is a common complication of radical prostatectomy (RP) affecting patient's quality of life (QoL). In the present study, we aimed to investigate the effects of single-session preoperative pelvic floor muscle training (PFMT) with biofeedback (BFB) on short- and mid-term postoperative UI and QoL. Materials and Methods: This study was performed between 2018 and 2020. The patients were randomized into two groups: the case group received a training session with BFB, supervised oral and written instructions on pelvic floor muscle exercises in a 1-h-long training session 1 month before the surgery. Patients were asked to regularly perform exercises immediately after the session until surgery. The controls received no instructions. We used the International Consultation on Incontinence Questionnaire-UI (ICIQ-UI) short-form and ICIQ-Lower Urinary Tract Symptoms QoL Module (ICIQ-LUTSqol) at 1, 3, and 6 months after removing the urinary catheter. Results: A total of 80 patients with a mean age of 63.83 ± 3.61 years were analyzed. Patient characteristics were similar between the groups. The mean ICIQ-UI score was significantly lower in the intervention group at 1 and 3 months after catheter removal (P = 0.01 and P = 0.029, respectively) but similar at 6 months (P = 0.058). The mean ICIQ-LUTSqol score was significantly lower in the intervention group at 1, 3, and 6 months after catheter removal (P < 0.001, P = 0.005, and P = 0.011, respectively). Conclusion: A single session of preoperative PFMT with BFB has significant short-term effects on UI after RP but not at 6 months. However, this intervention can improve LUTS-related QoL even at 6 months after catheter removal.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"23 - 27"},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41686182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/uros.uros_169_21
C-C Kuo, Chia-Hao Kuei, C. Liao, Yu-hua Lin
Purpose: To evaluate the use of the Holmium: Yttrium-aluminum-garnet (YAG) laser versus the conventional dorsal-slit procedure for adult male circumcision. Materials and Methods: From January 2020 to December 2020, 60 adult men diagnosed with as having phimosis and received circumcision were enrolled. Patients received either Holmium: YAG laser circumcision or conventional circumcision. In this study, we assessed the difference between the groups. Results: Although the operative time and blood loss decreased more in the Holmium: YAG laser circumcision group than in the conventional circumcision group (P < 0.001), a longer short-term delay in wound healing was observed in the laser circumcision group than in the conventional circumcision during the follow-up course (20.0% vs. 3.3%, P = 0.04). Our results also demonstrated no significant difference between the two groups in pain control, postoperative prepuce edema, prepuce redundancy, infection, or hematoma occurrence (P > 0.05). Microscopy findings of the resected prepuce in the Holmium: YAG laser circumcision group demonstrated a high percentage of coagulated small capillaries near the cutting edge. Conclusion: The holmium laser seems to be a concrete and feasible option for circumcision. Although patients undergoing holmium laser circumcision benefit from less blood loss and a rapid surgery compared to the conventional procedure, there is a higher risk of poor wound healing in short-term follow-up.
{"title":"Comparison of Holmium: YAG laser circumcision with conventional circumcision in adult male","authors":"C-C Kuo, Chia-Hao Kuei, C. Liao, Yu-hua Lin","doi":"10.4103/uros.uros_169_21","DOIUrl":"https://doi.org/10.4103/uros.uros_169_21","url":null,"abstract":"Purpose: To evaluate the use of the Holmium: Yttrium-aluminum-garnet (YAG) laser versus the conventional dorsal-slit procedure for adult male circumcision. Materials and Methods: From January 2020 to December 2020, 60 adult men diagnosed with as having phimosis and received circumcision were enrolled. Patients received either Holmium: YAG laser circumcision or conventional circumcision. In this study, we assessed the difference between the groups. Results: Although the operative time and blood loss decreased more in the Holmium: YAG laser circumcision group than in the conventional circumcision group (P < 0.001), a longer short-term delay in wound healing was observed in the laser circumcision group than in the conventional circumcision during the follow-up course (20.0% vs. 3.3%, P = 0.04). Our results also demonstrated no significant difference between the two groups in pain control, postoperative prepuce edema, prepuce redundancy, infection, or hematoma occurrence (P > 0.05). Microscopy findings of the resected prepuce in the Holmium: YAG laser circumcision group demonstrated a high percentage of coagulated small capillaries near the cutting edge. Conclusion: The holmium laser seems to be a concrete and feasible option for circumcision. Although patients undergoing holmium laser circumcision benefit from less blood loss and a rapid surgery compared to the conventional procedure, there is a higher risk of poor wound healing in short-term follow-up.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"28 - 32"},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41397652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aimed to analyze the association between bladder conditions and Neurogenic lower urinary tract dysfunction (NLUTD) characteristics in patients with spinal cord injury (SCI) with different injury levels using a videourodynamic study (VUDS). Materials and Methods: A single-center, retrospective review of the VUDS database on patients with NLUTD and chronic SCI from 1997 to 2020. A total of 507 patients were enrolled. All patients had a comprehensive chart review, including the injury level, period from diagnosis to VUDS, and VUDS characteristics. Results: The mean age and duration from SCI diagnosis to VUDS were 44.2 ± 15.7 years and 81.8 ± 89.0 months. Detrusor overactivity (DO) was observed in 67.7% of patients and detrusor underactivity (DU) in 26.0%. Bladder outlet obstruction was noted in 78.3% of patients, including detrusor sphincter dyssynergia (DSD) in 53.3% and bladder neck dysfunction in 25.0%. DO and DSD were more commonly observed in patients with suprasacral lesions (P = 0.000 and P = 0.000, respectively), whereas DU had a higher prevalence in patients with lumbar or sacral lesions (P = 0.000). No statistically significant difference was observed in the prevalence of vesicoureteral reflux among different SCI levels. Bladder sensation parameters were more preserved in patients with cervical SCI than in those with lumbar SCI; however, no significant difference in bladder compliance was observed among patients with different SCI levels. Conclusion: The VUDS in patients with SCI revealed a high prevalence of DO, DU, and DSD, which varied among different injury levels. A precise VUDS is necessary for deciding bladder management for patients with SCI and voiding dysfunction.
{"title":"The videourodynamic characteristics of patients with chronic spinal cord injury with different injury levels and bladder conditions","authors":"T. Chang, H. Kuo","doi":"10.4103/UROS.UROS_76_22","DOIUrl":"https://doi.org/10.4103/UROS.UROS_76_22","url":null,"abstract":"Purpose: This study aimed to analyze the association between bladder conditions and Neurogenic lower urinary tract dysfunction (NLUTD) characteristics in patients with spinal cord injury (SCI) with different injury levels using a videourodynamic study (VUDS). Materials and Methods: A single-center, retrospective review of the VUDS database on patients with NLUTD and chronic SCI from 1997 to 2020. A total of 507 patients were enrolled. All patients had a comprehensive chart review, including the injury level, period from diagnosis to VUDS, and VUDS characteristics. Results: The mean age and duration from SCI diagnosis to VUDS were 44.2 ± 15.7 years and 81.8 ± 89.0 months. Detrusor overactivity (DO) was observed in 67.7% of patients and detrusor underactivity (DU) in 26.0%. Bladder outlet obstruction was noted in 78.3% of patients, including detrusor sphincter dyssynergia (DSD) in 53.3% and bladder neck dysfunction in 25.0%. DO and DSD were more commonly observed in patients with suprasacral lesions (P = 0.000 and P = 0.000, respectively), whereas DU had a higher prevalence in patients with lumbar or sacral lesions (P = 0.000). No statistically significant difference was observed in the prevalence of vesicoureteral reflux among different SCI levels. Bladder sensation parameters were more preserved in patients with cervical SCI than in those with lumbar SCI; however, no significant difference in bladder compliance was observed among patients with different SCI levels. Conclusion: The VUDS in patients with SCI revealed a high prevalence of DO, DU, and DSD, which varied among different injury levels. A precise VUDS is necessary for deciding bladder management for patients with SCI and voiding dysfunction.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"46 - 52"},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42788934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arun Chawla, Mummalaneni Sitaram, SurajJayadeva Reddy, JeanJ M C H de la Rosette, Pilar Laguna, SunilPillai Bhaskara, BathiSourabh Reddy, Shruti Pandit, Anupam Choudhary
Purpose: To evaluate the patient-reported outcomes of primary direct visual internal urethrotomy (DVIU) and nontransecting bulbar urethroplasty techniques (NTBU) for the short segment (<2 cm) nontraumatic bulbar urethral stricture using the modified urethral stricture surgery patient-reported outcome measures (USS PROMs). Materials and Methods: The USS PROM questionnaire used to evaluate lower urinary tract symptom (LUTS) was modified by adding a six-item International Index of Erectile Function and a four-item version of MSHQ-EjD to evaluate erectile and ejaculatory domains. All cases of short nontraumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM at initial evaluation, at 6 months, and at 1 year. Results: The LUTS score for NTBU at 12 months is significantly better (1.93 ± 2.13 vs. 8.76 ± 5.92, P = 0.000). The Peeling score of the NTBU is significantly better at 12 months (1.41 ± 0.68 vs. 2.67 ± 0.73, P = 0.000). The erectile function score at 12 months for NTBU is better than DVIU (24.37 ± 3.2 vs. 21.143 ± 2.86, P = 0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Receiver operating characteristic (ROC) AND Odd's Ratio analysis for analyzing patient satisfaction showed erectile function (area under ROC [AUROC] - 0.889, P < 0.001), ejaculatory function (AUROC - 0.957, P < 0.001) at 1 year and maximum flow rate of urine on uroflometry (Qmax) (AUROC - 0.928, P < 0.001) at 6 months and (AUROC - 1.000, P < 0.001) at 1 year. The overall satisfaction rates in patients undergoing NTBU is 96.5%. Conclusion: NTBU shows superior outcomes in almost all domains of USS-PROM with better overall satisfaction rates. Improvement of sexual function domain, followed by the LUTS domain was the best predictor of overall patient satisfaction and improvement in the quality of life at 1 year.
目的:采用改良尿道狭窄手术患者报告结果测量法(USS PROMs)评价直接目视内尿道切开术(DVIU)和非横断球尿道成形术(NTBU)治疗短段(< 2cm)非外伤性球尿道狭窄的患者报告结果。材料与方法:对用于评估下尿路症状(LUTS)的USS PROM问卷进行修改，加入6项国际勃起功能指数和4项版本的MSHQ-EjD来评估勃起和射精域。所有接受原发性DVIU和nbu治疗的短期非外伤性球尿道狭窄患者均被要求在初始评估、6个月和1年时填充改良的PROM。结果:nbu组12个月时LUTS评分明显优于nbu组(1.93±2.13比8.76±5.92,P = 0.000)。nbu在12个月时的剥皮评分(1.41±0.68比2.67±0.73,P = 0.000)明显优于nbu。nbu组12个月的勃起功能评分优于DVIU组(24.37±3.2比21.143±2.86,P = 0.001)。nbu在6个月和12个月时的射精功能评分明显更好。用于分析患者满意度的受试者工作特征(ROC)和Odd’s Ratio分析显示，1年时勃起功能(ROC下面积[AUROC] - 0.889, P < 0.001)、射精功能(AUROC - 0.957, P < 0.001)， 6个月时尿量测定最大尿流量(Qmax) (AUROC - 0.928, P < 0.001)， 1年时尿量测定最大尿流量(AUROC - 1.000, P < 0.001)。nbu患者总体满意度为96.5%。结论:nbu在USS-PROM的几乎所有领域都有较好的疗效，总体满意度较高。性功能领域的改善，其次是LUTS领域，是患者总体满意度和1年生活质量改善的最佳预测指标。
{"title":"Patient-reported outcome measures using modified urethral stricture surgery: Patient-reported outcome measure for direct visual internal urethrotomy and nontransecting urethroplasty for short nontraumatic bulbar urethral stricture – A prospective comparative observational study from a university teaching hospital","authors":"Arun Chawla, Mummalaneni Sitaram, SurajJayadeva Reddy, JeanJ M C H de la Rosette, Pilar Laguna, SunilPillai Bhaskara, BathiSourabh Reddy, Shruti Pandit, Anupam Choudhary","doi":"10.4103/uros.uros_86_22","DOIUrl":"https://doi.org/10.4103/uros.uros_86_22","url":null,"abstract":"Purpose: To evaluate the patient-reported outcomes of primary direct visual internal urethrotomy (DVIU) and nontransecting bulbar urethroplasty techniques (NTBU) for the short segment (<2 cm) nontraumatic bulbar urethral stricture using the modified urethral stricture surgery patient-reported outcome measures (USS PROMs). Materials and Methods: The USS PROM questionnaire used to evaluate lower urinary tract symptom (LUTS) was modified by adding a six-item International Index of Erectile Function and a four-item version of MSHQ-EjD to evaluate erectile and ejaculatory domains. All cases of short nontraumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM at initial evaluation, at 6 months, and at 1 year. Results: The LUTS score for NTBU at 12 months is significantly better (1.93 ± 2.13 vs. 8.76 ± 5.92, P = 0.000). The Peeling score of the NTBU is significantly better at 12 months (1.41 ± 0.68 vs. 2.67 ± 0.73, P = 0.000). The erectile function score at 12 months for NTBU is better than DVIU (24.37 ± 3.2 vs. 21.143 ± 2.86, P = 0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Receiver operating characteristic (ROC) AND Odd's Ratio analysis for analyzing patient satisfaction showed erectile function (area under ROC [AUROC] - 0.889, P < 0.001), ejaculatory function (AUROC - 0.957, P < 0.001) at 1 year and maximum flow rate of urine on uroflometry (Qmax) (AUROC - 0.928, P < 0.001) at 6 months and (AUROC - 1.000, P < 0.001) at 1 year. The overall satisfaction rates in patients undergoing NTBU is 96.5%. Conclusion: NTBU shows superior outcomes in almost all domains of USS-PROM with better overall satisfaction rates. Improvement of sexual function domain, followed by the LUTS domain was the best predictor of overall patient satisfaction and improvement in the quality of life at 1 year.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/UROS.UROS_116_22
Yao-Lin Kao, Jian-ting Chen, Sung-Lang Chen, I. Shao, Chung-Cheng Wang, I. Chiang, Yu-Chao Hsu, Kau-Han Lee, Wei-Chia Lee, T. Yeh, Y. Kuo, B. Chiang, C. Liao, Po-Cheng Chen, E. Meng, Yung-Chin Lee, H. Kuo
Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.
{"title":"Clinical guidelines of patient-centered bladder management of neurogenic lower urinary tract dysfunction due to chronic spinal cord injury - Part 2: Conservative and minimally invasive treatment","authors":"Yao-Lin Kao, Jian-ting Chen, Sung-Lang Chen, I. Shao, Chung-Cheng Wang, I. Chiang, Yu-Chao Hsu, Kau-Han Lee, Wei-Chia Lee, T. Yeh, Y. Kuo, B. Chiang, C. Liao, Po-Cheng Chen, E. Meng, Yung-Chin Lee, H. Kuo","doi":"10.4103/UROS.UROS_116_22","DOIUrl":"https://doi.org/10.4103/UROS.UROS_116_22","url":null,"abstract":"Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"34 1","pages":"10 - 17"},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42458256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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