Urologia Journal最新文献

Introduction and objective: Radical Cystectomy (RC) is one of the most common and complex surgical procedures in urologic surgery, and benign ureteroenteric anastomosis strictures (UAS) are complications described in about 15% of patients undergoing RC with different urinary diversion (UD). The aim of this study is to evaluate and analyze risk factors related to the development of ureteral stenosis after RC.

Materials and methods: All consecutive patients who underwent RC with ileal conduit from December 2019 to December 2022 were included. According to the guidelines patients with hydronephrosis were investigates with CT-scan or Ultrasound and blood tests at 3-6-12 months and then early. UAS was confirmed with CT-scan and eventually treated with nephrostomies with (with or without descendent pyelography). Several potential risk factor releated to UAS were analyzed by univariate analysis including preoperative, intraoperative and postoperative variables.

Results: In total 116 patients were included. At 30 months mean follow up, 21 patients (19%) were diagnosed with UAS. Median time from RC to diagnosis of benign UAS was 6 months (IQR: 4-9). At the univariable analysis previous abdominal surgery (OR 13.5 CI 3.4-63.4, p < 0.001) had the strongest association with shorter time to stricture development and six-fold highest risk of UAS development (OR 6.41, IC 95%; 2.16-21.1, p < 0.001). Also, gender, age, body mass index, lower albumin serum level, higher fibrinogen serum level showed statistically significant association (p < 0.05).

Conclusion: Patients with preoperative lower albumin serum level, lower albumin/fibrinogen ratio and higher fibrinogen level are more likely to develop UAS. Moreover, having a history of PAS significantly increases the risk of strictures formation.

Kidney cancer is one of the most dangerous cancer mainly targeting men. In 2020, around 430, 000 people were diagnosed with this disease worldwide. It can be divided into three prime subgroups such as kidney renal cell carcinoma (KIRC), kidney renal papilliary cell carcinoma (KIRP) and kidney chromophobe (KICH). Correct identification of these subgroups on time is crucial for the initiation and determination of proper treatment. On-time identification of this disease and its subgroup can help both the clinicians and patients to improve the situation. Hence, this study checks the possibility of using multi-omics data in the kidney cancer subgrouping, whether integrating multiple omics data will increase the subgrouping accuracy or not. Four different molecular data such as genomics, proteomics, epigenomics and miRNA from The Cancer Genome Atlas (TCGA) are used in this study. As the data is in a very high dimension world, this study starts with selecting the relevant features of the study using Pearson's correlation coefficient. Those selected features are used with three different classification algorithms such as k-nearest neighbor (KNN), supporting vector machines (SVMs) and random forest. Performances are compared to see whether the integration of multi-omics data can improve the accuracy of kidney cancer subgrouping. This study shows that integration of multi-omics data can improve the performance of the kidney cancer subgrouping. The highest performance (accuracy value of 0.98±0.03) is gained by top 400 features selected from integrated multi-omics data, with support vector machines.

Background: Vesicourethral anastomosis stenosis (VUAS) is a well-known complication of prostate cancer treatments, observed in up to 26% of the cases after radical prostatectomy. Conservative management, with single or even repeated transurethral dilation or endoscopic incision of the stenosis, is successful in many cases, but up to 9% of patients are destined to fail after endoscopic treatment. In these cases, a revision of the vesicourethral anastomosis is necessary and can be realized with different surgical approaches. We aim to describe the technique and the outcomes of a new prerectal approach for VUAS repair.

Methods: Twelve patients with recalcitrant VUAS following radical prostatectomy were enrolled between May 2014 and September 2018 for prerectal transperineal re-anastomosis. The evaluated outcomes were: the rate of successful anatomical repair at 3 months after surgery and at the last follow-up, postoperative incontinence and complications rate, and the need for further treatments.

Results: No major intraoperative complications occurred. After a median follow-up of 46 months (IQR 36-55), 10 patients (83.3%) achieved a good anatomical repair even if one man required an endoscopic urethrotomy, while two patients (16.67%) with a history of pelvic radiotherapy developed a surgical site infection that required toilette and external urinary diversion. Among the others, nine (75%) developed severe stress urinary incontinence, with resolution of their condition. No patient reported significant postoperative pain or fecal incontinence.

Conclusions: The prerectal approach to VUAS repair allows direct access to the posterior urethra and the anastomosis, providing a better mobilization of the bladder neck for tension-free anastomosis. However, patients with a history of pelvic radiotherapy have a higher risk of complications. Postoperative incontinence is very common, but urinary continence could be restored with subsequent artificial urinary sphincter placement.

Background: To evaluate the potential capability of preoperative urinary Prostate Cancer Antigen 3 (PCA3) in predicting adverse pathologic features in patients with any- risk prostate cancer undergoing open retro-pubic radical prostatectomy.

Methods: Sixty-one biopsy-proven, clinically localized prostate cancer patients who underwent open radical prostatectomy were included in a prospectively designed cohort to evaluate the association of PCA3 score with various Adverse Pathologic Features (APF). The Area Under the Curve (AUC) of the Receiver Operating Characteristics (ROC) curve was used to quantify the predictive accuracy of PCA3 and a cut-off point was calculated to determine the predictability potential of PCA3 in foretelling the study parameters.

Results: Patients with APFs (e.g. extra-capsular extension, higher tumor volume, etc.) had a higher mean level of PCA3 compared to patients without these features, with statistically significant differences. PCA3 was a significant predictor of any APFs except perineural invasion in our study cohort.

Conclusion: Increasing PCA3 level was associated with any APFs except perineural invasion in our study, which comprised mostly of intermediate and high-risk prostate cancer patients. Therefore, PCA3 could be used as an adjunctive measure in selecting patients for definitive treatments.

Technological advancements have revolutionized surgical methods, with laparoscopic and robotic surgeries offering significant benefits over traditional open procedures. These benefits include reduced intraoperative blood loss, shortened hospital stays, faster recovery, and improved cosmetic outcomes. However, the learning curve for laparoscopic surgery remains a challenge. Robotic systems, like the da Vinci Surgical System, address many limitations of laparoscopic surgery, including limited range of motion and tremors, and offer superior ergonomics. Despite concerns over cost and tactile feedback, innovations like telesurgery and augmented reality are enhancing robotic surgery's potential. Moreover, robotic surgery generally results in less blood loss, fewer complications, and quicker recovery compared to open surgery. Robotic surgery tends also to be less physically demanding for surgeons, reducing fatigue and musculoskeletal strain. However, research also reveals that many surgeons still experience discomfort, particularly in the neck and shoulders, emphasizing the need for ergonomic training and improved workstation setups. The review also explores the impact of pre-procedure fatigue on surgical performance, noting that fatigue can impair performance on surgical simulators, particularly among residents. Despite this, studies showed that performing consecutive surgeries in a single day does not appear to adversely affect patient outcomes. Overall, ergonomic interventions are crucial in both laparoscopic and robotic surgeries to enhance surgeon efficiency and well-being, and further research is needed to optimize these surgical methods and understand the long-term impacts of fatigue on performance and patient outcomes.

Background and objective: Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) is the most common and preferred imaging modality for evaluating urethral strictures, despite its well-known limitations and disadvantages. In this study, we assessed the clinical relevance of RUG + VCUG, along with intraoperative assessment in measuring male urethral strictures.

Method: This study was a single-center retrospective study involving 134 male patients diagnosed with urethral stricture disease. All participants underwent RUG + VCUG before the intervention, and the results were interpreted by a single radiologist. The location and length of urethral strictures were assessed. The accuracy of urethral stricture measurements obtained from combined VCUG and RUG imaging was compared to intraoperative measurements, which served as the reference standard. Urethral strictures were classified into three types: membranous and bulbomembranous, bulbar, and penile.

Results: A total of 130 patients were included (38.14 ± 12.05 years) in the study. For patients with membranous and bulbar strictures, there were statistically significant differences in stricture length measurements between VCUG + RUG and surgical evaluation (p < 0.05). However, for patients with penile strictures, the differences in stricture length measurements between VCUG + RUG and surgical evaluation were not statistically significant (p = 0.448).

Conclusion: This study suggests that RUG + VCUG may underestimate urethral stricture, particularly in the membranous and bulbar regions.

Introduction: Laparoscopic simple nephrectomy (LSNx) is among the gold standard options for management of selected poorly functioning and most non-functioning kidneys (PFK/NFKs). Our objective was to audit our patients who had undergone LSNx for benign causes and assess their perioperative outcomes and analyse the factors correlating with these outcomes.

Materials and methods: We reviewed our prospectively collected data of patients with PFK/NFKs due to benign causes who underwent a LSNx on a three-dimensional (3D) system via a transperitoneal approach between January 2017 and June 2023. Details on clinical profile, radiological findings and peri-operative details were recorded and analysed.

Results: A total of 302 patients underwent LSNx in the study duration. Urolithiasis was the most common cause of PFK/NFKs in 66.5% of patients followed by pelvi-ureteric junction obstruction in 14.9%. Rate of conversion to open surgery was 5.3%. Final histopathology revealed chronic pyelonephritis in 82% patients and Xanthogranulomatous pyelonephritis (XGPN) in 14%. Multivariate analysis revealed presence of pre-operative fat stranding on imaging, larger kidney size, presence of XGPN and pyonephrosis to be significantly associated with longer operation times. Prior renal surgery, positive urine culture, presence of XGPN and a higher body mass index was associated with a longer hospital stay and increased rate of post-operative complications.

Conclusion: LSNx is commonly employed for management of PFK/NFKs from various aetiologies, the most common of which is urolithiasis in our experience. Multiple clinico-radiological factors as described correlated with longer operative times and prolonged hospital stay, which aids in surgical planning and patient counselling.

Objective: To compare the clinical and operative outcomes of transobturator hybrid tape versus synthetic tapes during mid-urethral sling in treating female stress urinary incontinence (SUI).

Patients and methods: This prospective randomized study included 63 women with SUI. Patients were categorized into two groups: Group I included 32 patients who underwent midurethral sling procedure using hybrid tape; and Group II included 31 patients that had synthetic sling, using transobturator tape approach (TOT) in both groups. Two patients in group I lost to follow up and one patient in group II lost to follow up. The primary endpoint was the safety of sling erosion and major complications. The 2ry endpoint was the efficacy that was assessed objectively by the Cough stress test and subjectively by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) and this was assessed at 1, 6, and 12 months. The following variables were compared: operative time, post-operative pain scores, duration of indwelling urethral catheter, hospital stay, and quality of life (QoL) assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) assessing the continence status before and after discharge from hospital.

Results: Patients among the two groups were normally distributed with no statistical significant difference in patient's demographic data and comorbidities. The hybrid tape procedure had a longer mean (SD) operative time of 45.3 ± 3.6 min, which was longer than that of synthetic tape procedure, at a mean (SD) of 29.5 ± (3.5) min. This increase was statistically significant (p < 0.001). The mean time to return to normal activity was significantly shorter in Group II patients compared to those in Group I. Overall cure rate (defined as no more episodes of SUI or pad use) was statistically insignificant in both groups being 86.7% and 83.3% respectively. No bladder, vascular, nervous or intestinal injuries were encountered in either group. Pain was significantly higher in hybrid tape (Group I). Post operative urgency, and urge incontinence rates were not significantly different between in both groups. Two cases in group 1 and one case in the other group, and these cases were managed by medical treatment. Vaginal sling erosion was encountered in one case in group II which was managed by sling removal.

Conclusion: Hybrid tape may be considered as a treatment option during TOT for female SUI with comparable efficacy and safety to synthetic tape. Long term follow up should be considered.

Purpose: To assess the utility and reliability of cost-effective cystography-measured bladder capacity as a prognostic tool for predicting very early continence recovery following radical prostatectomy. Additionally, the study aims to discuss the clinical implications of the findings, including their potential impact on patient management, postoperative rehabilitation strategies, and the development of personalized care pathways for prostate cancer patients.

Methods: In this prospective monocentric study, we analyzed 223 patients who underwent either robot assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between January 2022 and January 2024. Postoperative cystography was routinely performed 5 days after robot-assisted radical prostatectomy and 7 days after open radical prostatectomy. Very early continence rates were determined using a standardized pad-test conducted on the first day following catheter removal. The bladder capacity during cystography was measured and documented for every patient. The correlation between the rate of continence recovery and the bladder capacity was then assessed. To determine other predictive factors for recovery of continence, several parameters were analyzed using multivariate logistic regression analysis, including age, prostate volume, nerve-sparing technique and surgical procedure.

Results: Urinary continence rates at day 1 after catheter removal were 73.5% for patients who underwent RARP and 72.6% for patients who underwent ORP. A strong prognostic value of cystography-measured bladder capacity on very early continence rates was reported (p < 0.001), with a cut-off value calculated to be 140 ml of bladder capacity. After adjusting for additional variables such as age, surgical procedure, prostate volume and nerve-sparing technique, multivariate linear model analysis still found a strong correlation between cystography-measured bladder capacity and very early continence rates (p < 0.001).

Conclusions: The cystography-measured bladder capacity may be a good predictor of the recovery of post-prostatectomy urinary continence.

Background: Thanks to the improved accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) to detect and localize the dominant index lesion on prostate cancer (PCa), the concept of minimally invasive focal treatments (FT) has gained popularity. Nevertheless, although high-quality evidence that FT has favorable functional outcomes, definitive proof of its oncological effectiveness compared to standard treatments remains underreported.

Objective: This study aims to explore the efficacy, safety, oncologic and functional outcomes of different type of FT for PCa.

Evidence acquisition: A non-systematic literature review was conducted by searching on PubMed "prostate cancer" AND "focal treatment" OR "HIFU" OR "irreversible electroporation" OR "cryoablation" OR "focal laser ablation." Overall, 22 articles published in English literature from 2018 to 2023 describing FT techniques for PCa were included.

Evidence synthesis: Related to the field ablated, focal therapies include hemiablation (half gland), focal ablation (zonal-base) or targeted therapy (lesion-based). FT modalities can be categorized in thermal and non-thermal energy: thermal energy techniques include high-intensity focused ultrasound (HIFU), cryotherapy, radiofrequency ablation (RFA), and focal laser ablation (FLA). Focal brachytherapy, irreversible electroporation (IRE), and vascular-targeted photodynamic therapy (VTP) are classified as non-thermal ablation. Each focal ablative treatments could be promising alternative to conventional radical therapies to treat PCa in term of mid-term oncologic and functional outcomes, however, limited data are available in comparison with standardized radical treatments. HIFU and Cryo are the most studied techniques and seem to be superior to radical treatments in term of functional outcomes despite associated with higher recurrence and retreatment rate.

Conclusions: Current evidences of oncologic and functional outcomes of FT are based mainly on retrospective, non-comparative and single center studies. Thus, none of the focal therapies available should be considered safe alternative to standardized treatments in routine practice and should be offered only for well selected PCa patients with low or at least favorable-intermediate risk disease, unfit for radical options.