Urologia Journal最新文献

Introduction: Kidney cancer (KC) with vena cava thrombus (VCT) is a rare but challenging disease. Surgery is associated with significant morbidity and mortality. The aim of our study is to report outcomes of patients with KC and VCT treated at our institution.

Materials and methods: We retrospectively analyzed data from 15 patients who underwent surgical treatment for KC with VCT at our institution between January 2004 and December 2022.

Results: Median age of patients was 70 years (range: 66-77 years) and 13 (86%) were males. The level of thrombus was infrahepatic in 11 patients (73%), retrohepatic in 1 case (6%), and atrial in 3 patients (20%). Radical nephrectomy with vena cava thrombectomy was performed in all patients. Cardiopulmonary bypass was required in three patients (20%). The median operative time was 4.2 h (range: 4.0-4.6 h) and median estimated blood loss was 675 ml (range: 300-1500 ml). Postoperatively, eight patients (53%) experienced complications, and 5 (62%) were Clavien-Dindo >3. After a median follow-up of 15 months (range: 10-49 months), seven patients (46.5%) were alive without evidence of disease, one was alive with disease, among the remainder 7 (46.5%), 5/7 (72%) patients died of other causes, only 2/7 (28%) died because of cancer.

Conclusions: Surgical resection of KC involving VCT represents a challenge for its high rate of complications. Multidisciplinary approach is often needed to achieve radicality safely. Oncological outcomes confirm the aggressiveness of the disease, with only roughly half (46.5%) of patients alive without disease at a median follow-up of 15 months.

Aims/introduction: Laparoscopic extravesical and intravesical (transvesicoscopic) ureteral reimplantation are widely accepted procedures but there is limited literature on comparison of these techniques. This study compares the efficacy and outcomes of laparoscopic intravesical and extravesical ureteral reimplantation for unilateral primary vesicoureteral reflux (VUR) in children.

Materials and methods: We retrospectively analysed the case records of 62 children between ages of 1 and 18 years who underwent laparoscopic unilateral ureteral reimplantation at our institute between January 2019 and January 2023. Patients divided into two groups; those who underwent laparoscopic intravesical ureteric reimplantation were Group A and those who underwent laparoscopic extravesical ureteric reimplantation were Group B. We analysed the blood investigations, pre- and post-operative grade of reflux, operative time, complications, analgesic requirements, and pre- and post-operative nuclear scans. The success of surgery was defined as the resolution of VUR on voiding cystourethrography (VCUG) performed 6 months post operatively.

Results: 24 patients were in Group A and 38 patients in Group B. The mean age and grades of reflux were comparable in the groups. The difference in operative time was statistically significant (Group A: 131.3 ± 30.4 min and Group B: 96 ± 20.4 min, p = 0.009). The success rate (95.8% vs 94.7%), complication rate (16.7% vs 15.7%), time to discharge (2.6 vs 3.3 days) of both group was comparable. Less analgesics were needed in intravesical group (186 vs 204 mg/kg) though it was not statistically significant (p = 0.22).

Conclusion: Laparoscopic ureteric reimplantation by both extravesical and intravesical route is equally safe and effective with similar efficacy, outcome and comparable acceptable complication rate.

Objective: The present study aimed to compare the effects of suppository diclofenac (an example of NSAIDs) and oral administration of the combination of oxycodone (an example of an opioid) and acetaminophen in managing pain in patients with renal colic after SWL treatment.

Method: The current study is a double-blind clinical trial involving individuals scheduled to receive elective SWL therapy for kidney and ureteral stones. Participants were randomly assigned to one of two groups using the block randomization technique: suppository Diclofenac (100 mg) or a combination of 325 mg Acetaminophen + 5 mg oxycodone administered orally for pain relief following SWL. Pain intensity was measured immediately after the SWL procedure, and analgesics were then given to the patients. After 30 min, pain severity was reassessed. The severity of pain in patients was documented before and after drug administration at 24, 48, and 72 h after the SWL intervention.

Results: 154 renal stone patients (63 females) underwent SWL with a mean age of 41.52 ± 10.52 years. The two groups were similar in terms of age (p = 0.572), sex (p = 0.212), location of the stone (p = 0.868), size of the stone (p = 0.762), and occurrence of complication (p = 0.302). There was no significant difference in the reduction of pain severity between the two groups after 30 min (p = 0.224), 2 days (p = 0.501), and 3 days (p = 0.229) following SWL intervention. However, after a 24-h follow-up, pain severity decreased more in the diclofenac group compared to the other group (p = 0.002).

Conclusion: The combination of oxycodone and acetaminophen, including a multimodal analgesic approach, can be considered a preferred option in the clinical setting for pain management of patients undergoing SWL. It provides relief for patients as effectively as NSAIDs, with the same safety profile, leading to high patient satisfaction.

Introduction: In the field of urology, cystoscopy is one of the most common operations. A rigid cystoscope was used for each cystoscopy in this investigation. Given its dual function as a lubricant and local anesthetic, topical lignocaine gel is the most often utilized agent. However, there is currently no established protocol that evaluates the patient's tolerance to lignocaine gel alone or in conjunction with tramadol throughout the treatment.

Materials and methods: It was a prospective comparative observational study with 200 male participants, conducted at the department of urology, a tertiary care hospital. Male patients who came for rigid cystoscopy were divided into 2 groups. In Group A (n = 100) 10 ml 2% lignocaine gel and in group B (n = 100) 1 ml tramadol (50 mg) solution added to +10 ml 2% lignocaine gel and it was instilled transurethrally 10 min before the procedure respectively in both groups at room temperature. The patient's tolerance during the procedure was assessed using Visual Analog Score (VAS) score.

Results: In Group A and Group B there was no significant difference between the groups in terms of age (p = 0.393). There was a significant difference in terms of VAS score (p = < 0.001), with the median Score being lower in the Lignocaine gel + tramadol group and higher when lignocaine gel + tramadol used among patients with Diabetes mellitus.

Conclusion: The instillation of lignocaine gel in conjunction with tramadol in urethra could decrease pain perception during the procedure except in people with diabetes mellitus, hence make men undergoing rigid cystoscopy more comfortable during the procedure there by increase diagnostic and therapeutic outcome.

Introduction: This study investigates the intricate relationship between urodynamic findings and clinical symptoms in females with overactive bladder (OAB).

Methods: A retrospective cohort study, conducted at a tertiary university hospital, included female patients with positive detrusor overactivity (DO) OAB between November 2020 and November 2023. Patient demographics, OAB symptoms, and responses to anticholinergic treatment were recorded. Different Urodynamic features were analyzed.

Results: A total of 92 female patients with positive detrusor overactivity (DO) and overactive bladder (OAB) were included. The median age was 49 years (IQR: 30.75-61.75). Among them, 16 (17.4%) were diabetic, 18 (19.6%) had hypertension, and 69 (75%) were regular coffee drinkers. Over half of the participants, 56 (60.9%), were overweight (BMI 25-29.9). The prevalence of key symptoms included frequency in 54 (58.7%), urgency in 73 (79.3%), urgency incontinence in 33 (35.9%), and nocturia in 44 (47.8%). Frequency of urination was more common among non-diabetic patients (41/54, 75.9%; p = 0.04), and urgency was significantly associated with non-smoking status (51/73, 69.9%; p = 0.025). Most patients (84, 91.3%) had phasic DO, with a median maximum detrusor pressure (Pdet DO) of 30 cmH₂O (IQR: 20.0-53.0) and a median cystometric capacity of 385.5 mL (IQR: 296.25-443.75). Frequency was significantly associated with higher maximum Pdet DO pressure (p = 0.049). In terms of treatment response, 81 patients (88.0%) demonstrated a good response to anticholinergic therapy. Non-responders had significantly higher maximum Pdet DO pressure (median 59.0 cmH₂O, IQR: 30.0-66.0) compared to responders (median 30.0 cmH₂O, IQR: 19.5-47.0; p = 0.013).

Conclusion: The amplitude of DO in female with idiopathic OAB is theoretically and clinically correlated to symptomatology and response to anticholinergic treatment.

Introduction: Currently, robot-assisted radical prostatectomy (RARP), extraperitoneal radical prostatectomy (ERPE), and laparoscopic radical prostatectomy (LRP) are frequently used for the treatment of localized prostate cancer.

Materials and methods: The study included 2,290 patients with localized prostate cancer. All patients underwent radical prostatectomy (RPE) performed by a single surgeon using different surgical approaches: robot-assisted (RARP, n = 888), laparoscopic (LRP, n = 965), and extraperitoneal (ERPE, n = 437). Oncological outcomes were assessed based on postoperative PSA levels. Functional status was assessed using the following questionnaires: IIEF-5, ICIQ-SF, DRIP-test, and 24-h pad test.

Results: In the NS group (LRP and RARP access), the operative time was (200.0 [180.0; 225.0] vs 180.0 [135.0; 230.0] min; p < 0.0001), and the volume of blood loss was (300.0 [200.0; 350.0] vs. 200.0 [150.0; 250.0]). According to the ICIQ-SF test, the presence of patients with symptoms of severe to moderate urinary incontinence (ICIQ-SF scale) in the early postoperative period (mean 9.0 [4.0; 14.0] for RARP vs 11.0 [5.0; 16.0] for LRP and 12.0 [11.0; 14.0] for ERPE, p < 0.0001) contrasted with the results 12 months after surgery, where only patients with mild to moderate urinary incontinence remained (mean 1.0 [0.0; 5.0] for RARP, 4.0 [2.0; 7.0] for LRP, and 5.0 [3.0; 8.0] for ERPE, p < 0.0001).Postoperative erectile function results were evaluated at 12, 24, and 36 months. In all three groups without the NS technique, all patients had significant erectile dysfunction (p < 0.0001). In contrast, at a median follow-up of 12 months, the postoperative questionnaire results for RARP using the NS technique averaged 14.0 [10.0; 18.0], and for LRP 9.0 [6.0; 11.0] (p < 0.0001).

Conclusion: Robot-assisted radical prostatectomy is the preferred method as it provides better functional outcomes. The use of the nerve-sparing technique significantly improved outcomes in terms of urinary continence and also resulted in fewer patients requiring urological pads.

Introduction: Zinner syndrome (ZS) is characterised by unilateral renal agenesis, ipsilateral seminal vesicle cyst and obstruction of the ejaculatory duct. Although rare, urologists may encounter it at some point in their clinical practice. The literature is largely limited to case reports, and the condition is poorly understood. Our objective was to report on cases of ZS that have been managed at two centres in order to gain further clinical insights on this condition.

Methods: A retrospective review was conducted on ZS cases presenting at two centres in Western Norway between January 2021 and June 2024. Data were collected on demographic details, symptomatology, imaging findings, management and fertility outcomes.

Results: Six cases were identified that met the full triad for ZS, with ages ranging from 18 to 70 years. Five patients were symptomatic at presentation, reporting issues such as anejaculation and testicular pain during sexual activity. Two cases presented as emergencies, one with acute urinary retention and the other with severe pelvic pain. Half of the patients were successfully managed with a conservative approach. Two-thirds had children, either through natural conception or assisted reproductive methods, while the remaining patients underwent sperm cryopreservation.

Conclusion: ZS presents with a wide range of symptoms and at varying ages. Not all symptomatic cases require surgical intervention, and management should be individualised. In select cases, a conservative approach can feasible.

Introduction: Patients with urinary stone disease may present with CKD. The incidence of developing end stage renal disease (ESRD) in patients with renal calculi is 0.2%-3.2%. In the present study we aim to discuss outcomes of PCNL in CKD patients.

Materials and methods: This was a prospective observational study done, from January 2023 to March 2024. Data of 96 CKD patients with renal stones who underwent standard PCNL were recorded. Patients were followed up with urinalysis, serum creatinine and ultrasound KUB. Preoperative eGFR were compared with eGFR 36 months follow up. Patients were divided into two groups. Group 1- improved and group 2- stable or worsened disease since the final follow up visit.

Observations and results: After PCNL renal function improvement was seen in 52 (54%) patients that is, Group I & in 44 (46%) patients it was stable or declined that is, Group II. In Group I, mean preoperative eGFR was 41.13 ± 14.23 ml/min/m² which improved to 46.91 ± 12.14. In Group II mean preoperative eGFR was 37.14 ± 12.32 which declined to 33.17 ± 12.57. The statistically significant factor decreasing the efficacy of PCNL in CKD patients were presence of co morbidities (Hypertension, DM; p = 0.007), staghorn stones (p = 0.001), history of previous renal surgery (p = 0.001), operation time > 100 min (p < 0.0001), post PCNL stone free status(p < 0.0001), and Complications(p = 0.03). After 6 months follow up 8 patients in Group I shifted from CKD stage 4 to CKD stage 3 and four patients in group II shifted from CKD stage 3 to CKD stage 4.

Conclusion: Factors like presence of comorbidities, staghorn calculus, previous surgery operative time and post operative complications affects improvement of renal function in CKD patients after stone clearance.

Purpose: To evaluate the association of traditional and novel nutritional measurements with survival in Fournier's gangrene (FG) patients.

Methods: We reviewed records of FG patients from our tertiary center (Jan 2013-Jan 2022). Radiomic sarcopenia parameters (Psoas Muscle Area [PMA], Roundness, Solidity, and calculated PMA-Index) were measured from admission CT scans at the L3 level using ImageJ software. We assessed sarcopenia's impact on survival through three analyses: Model 1 used a PMI below the sex-adjusted median; Models 2 and 3 used published cutoffs. Kaplan-Meier curves were used to compare survival between sarcopenic and non-sarcopenic patients. Multivariable Cox and logistic regression analyses adjusted for age and the Charlson Comorbidity Index (CCI) to assess mortality risk.

Results: Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, p < 0.001) and had higher median CCI (4.8 vs 3; p < 0.001).In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, p = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, p = 0.325; HR 1.35, 95% CI 0.70-2.61, p = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI.

Conclusions: Despite a mild trend, none of the sarcopenia models were able to predict long-term mortality in FG patients in our cohort. This well-known, cost-effective nutritional predictor still requires further research to optimize its utilization in the FG patient population.

Purpose: To investigate the factors influencing the length of percutaneous nephrolithotomy (PCNL) procedures and identify predictive variables for operation time using machine learning models.

Materials and methods: A retrospective, observational cohort study was conducted at King Abdullah University Hospital, including 352 patients who underwent PCNL between January 2017 and September 2023. Data on preoperative and postoperative variables were collected from electronic health records. Four machine learning algorithms (Random Forest Classifier, AdaBoost Classifier, eXtreme Gradient Boosting Classifier, Logistic Regression) were employed to predict operation time, with features standardized using the StandardScaler module and Synthetic Minority Over-sampling Technique (SMOTE) used to address data imbalance. The dataset was split into training (80%) and testing (20%) sets. Model performance was evaluated using ROC curves, AUC scores, accuracy, precision, recall, and F1-score.

Results: Stone burden, gender, and hydronephrosis were significantly associated with longer operation times. Machine learning analysis identified stone-free status, stone burden, and gender as key predictors, with the eXtreme Gradient Boosting Classifier achieving the highest AUC (0.789). Patients with non-stone-free status had longer operation times (p < 0.001). Stone burden and specific stone locations also significantly impacted procedure duration.

Conclusion: Stone-free status followed by stone burden and gender are critical predictors of PCNL operation time. Achieving stone-free status significantly reduces procedure duration. Machine learning models, particularly eXtreme Gradient Boosting, provide valuable predictive insights, aiding in surgical planning and optimizing patient outcomes.