Urologia Journal最新文献

Objectives: This study examines the current state of robotics for bladder cancer in recent years, thereby enabling researchers to gain a comprehensive understanding of the field and anticipate future advancements.

Methods: A thorough search was performed on the Web of Science Core Collection (WoSCC) to identify literature about bladder cancer robotics published from 2004 to 2023. Bibliometric methods, such CiteSpace and VOSviewer, were used to examine publications, nations, institutions, journals, authors, and keywords.

Results: The 1678 papers from 2004 to 2023 showed an increasing trend in yearly publications related to robotic surgery for bladder cancer. Regarding publishing volumes and citations in this field, the United States, Roswell Park Comprehensive Cancer Center, European Urology, and Guru Khurshid A were the top nation, organization, journal, and author. Interestingly, eight of the top 10 publications in terms of citations were published in JCR1 designated scientific journals. Terms like "complications," "outcomes," "trial," "enhanced recovery," and "minimally invasive diversion" are emphasized in the study, suggesting that they are important and current research issues.

Conclusions: Recent hotspots include clinical studies evaluating outcomes and problems across various procedures, nevertheless, more work is required in the areas of minimally invasive surgery and improved recovery.

This systematic and bibliometric review synthesizes current knowledge of the relationship between cycling, renal and urological health. A comprehensive search of databases from 2000 to 2023 yielded 38 relevant studies. Bibliometric analysis revealed research trends, key institutions, authors, and countries that contributed to this field. This review discusses the benefits and risks associated with cycling. Benefits included improved cardiovascular health and metabolic function. However, cycling was also associated with urological symptoms, particularly in women, and with risks of erectile dysfunction and genital numbness in both genders. Mountain biking demonstrated higher rates of scrotal pathologies. Saddle design, riding position, and cycling intensity significantly influenced perineal pressure and potential urological issues. Renal biomarkers indicated dehydration, muscle damage, and potential renal insufficiencies in cyclists, especially after prolonged and intense activity. Elevated inflammatory markers and reduced glomerular filtration rates were observed post-cycling. Sodium intake and L-tryptophan supplementation demonstrated positive effects on fatigue reduction and recovery. The review identified research gaps, including limited long-term studies and inconsistent methodologies. Future research should focus on the relationship between high-volume cycling and prostate cancer risk, optimizing bicycle design to reduce urological issues, and developing reliable methods to measure saddle pressure effects on renal health. This review provided valuable insights for cyclists, health professionals, and researchers, emphasizing the need for awareness of potential health impacts and the importance of proper equipment and techniques to minimize risks while maximizing cycling benefits.

To evaluate the role of intralesional steroid and hyaluronidase injection after direct visual internal urethrotomy in short segment (⩽2 cm) anterior urethral strictures.

Materials and methods: A prospective, interventional, randomized study involved 100 patients who underwent direct visual internal urethrotomy for short anterior urethral stricture (⩽2 cm). Patients were randomized into two groups: Group A where all patients had received intralesional triamcinolone and hyaluronidase and Group B where no intralesional injection was given after doing direct visual internal urethrotomy. Postoperatively, all patients were trained for clean intermittent self-dilatation (CISD) using a 14 Fr Foley catheter. Follow-up uroflowmetry was conducted on postoperative day 7 and at 1, 3, 6 and 12 months or when had symptoms such as poor stream of urine, acute urinary retention. Success was defined as Qmax > 12 mL/s for a minimum voided volume of 150 mL and absence of voiding symptoms.

Results: The recurrence rate was 24% in Group A compared to 46% in Group B, with a 22% absolute risk reduction (p = 0.021). The mean time to recurrence was 9.4 ± 2.5 months in Group A versus 7.5 ± 2.2 months in Group B (p = 0.039). The mean Qmax at 6 and 12 months post-DVIU were significantly higher in Group A (15.5 and 14.6 mL/s) than in Group B (14.6 and 13.6 mL/s), with p-values of 0.006 and 0.002 respectively.

Conclusion: Intralesional injection of triamcinolone and hyaluronidase following DVIU significantly reduces the recurrence rate, delays the time to recurrence and improves peak urinary flow rate in patients with short-segment (⩽2 cm) anterior urethral strictures compared to DVIU alone.

Introduction: Laparoscopic adrenalectomy technique has the advantage of reduction in morbidity and peri-operative mortality. This technique has been established in the management of benign small masses (<5-6 cm). A dilemma exists in the management of bigger lesions or potentially malignant tumours. This study aimed to assess the procedure in terms of preoperative requirements, technique itself, the outcome and complications.

Material and methods: This mixed design (retrospective and prospective) cohort study was conducted in the Department of Urology and Renal Transplant, at one of the largest tertiary care centre of north-western India. A total of 27 patients who underwent laparoscopic adrenalectomy from January 2022 to December 2023 were included in the study. Data was collected regarding patient's demographic profile, characteristics of adrenal lesions, surgical procedures, postoperative results, and histological diagnosis.

Results: Age of patients ranged from 9 to 65 years, 15 (55.6%) were male. Common indication for laparoscopic adrenalectomy was Pheochromocytoma (40.7%), Non-Functioning Adrenal Tumour (29.6%), and Conn's syndrome (18.5%). Histopathology confirmed pheochromocytoma in 10 (37%) patients. Adenoma was found in eight (29.6%) patients. The average intra op blood loss was 174.63 ± 90.98 ml, and nine (33.3%) required post operative blood transfusion. The mean duration of surgery was 140.19 ± 26.51 min. Conversion to open surgery was required in two (7.4%) patients. Post op complications included deranged LFT (3.7%), fever (3.7%), and ileus (7.4%). The duration of the hospital stay ranged from 3 to 5 days.

Conclusion: Laparoscopic adrenalectomy can be considered a safe and effective procedure with relatively low rate of morbidity.

Purpose: Lower calyceal stones are more challenging to treat due to their anatomical position and consequences. Therapies such as Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy often offer limited efficacy or involve significant complications. This study aimed to assess the safety and effectiveness of advanced Flexible Ureteroscopy using six specific techniques compared to conventional in situ laser lithotripsy for large lower calyceal stones 10-25 mm.

Methodology: Prospective Randomized Controlled Study Design, in which 104 patients were divided into two groups. Group A underwent FURS with six specific (tips & tricks) including Modified T-tilt position (45° Trendelenburg position, 45° lateral tilt opposit the stone side ), bendable access sheaths with suction, modern laser techniques (combination of dusting & pop-corn) using dormia basket to move the stone to renal pelvis or to align the stone with the laser if it was too large to remain in the calyx plus using thin flexible ureteroscopy 7 FR for easy maneuverability and constant irrigation to maintain visibility. Conventional in situ laser lithotripsy was performed for Group B. The primary measure was the stone-free status with analysis of operative time, complications, hospital stay, and further treatments needed and recovery.

Results: The stone-free rate was found to be better in Group A 90.38% compared to Group B 71.15% with p-value 0.025. The median operative time for Group A was longer than Group B, with a median operative time of 78 min. which statistically significant (p < 0.001). Study reports better overall outcomes for Group A, including higher stone-free rate and lower need for additional interventions.

Conclusion: Analysis of the techniques shows that their application significantly improves stone clearance rates increases the efficiency of stone removal without increasing risk of complications. These findings support integrating innovative strategies into routine clinical practice.

Purpose: Assessing the association between Testosterone (T)-level in patients with urethral stricture (US) and its effect on surgery outcome.

Methods: This prospective study includes 70 cases of developing US disease and anastomotic Urethroplasty. All patients underwent retrograde and voiding urethrography, pelvi-abdominal ultrasound, and T (free and total) measurements.

Results: A significant negative association was found between free T, age, and post-void residual volume (PVR) pre. Also, a positive association between free T and Hemoglobin (Hb) levels. Besides, an association between wound infection and total T. There was a significant lower in PVR and higher in Q-max post-urethroplasty than pre-urethroplasty. International prostate symptom score (IPSS) showed a significant decrease in post-urethroplasty and at 3 months follow up than pre-urethroplasty (p < 0.05). Diabetes mellitus, free, and total T showed significant differences between the studied groups. Also, it can predict failure results respectively at cut-off ⩽123.75 and ⩽765.8 with 85.70% sensitivity, 98.40%, and 88.90% specificity.

Conclusions: Diabetic status, wound infection, and free and total T significantly affect the success rate in patients with the US, while preoperative PVR, Q-max, and IPSS did not affect the success rate.

Context: Large adrenal tumors (LATs) pose challenges in clinical management, with varied approaches and outcomes reported.

Aims: To analyze the surgical outcomes of large adrenal tumors and compare the minimally invasive and open approaches.

Settings and design: Retrospective analysis of large adrenal tumors operated at a tertiary care center.

Methods and material: Tumors ⩾6 cm on preoperative imaging were included. Data encompassing demographics, preoperative evaluations, surgical techniques, perioperative outcomes, and histopathological findings were analyzed. Receiver Operating Characteristic (ROC) analysis was used to determine a tumor size threshold predictive of malignancy. Statistical analysis was performed using SPSS v26.0.

Results: The mean age was 46.9 years, with a female predominance (70%). Incidental findings accounted for 52.2% of cases, while pain was the most common presenting symptom. Functioning tumors comprised 52.17% of cases, with no significant association between functioning status and malignancy risk. ROC analysis identified 7.4 cm as a malignancy-predictive cutoff (AUC = 0.77, p = 0.027). Laparoscopic and open approaches demonstrated comparable outcomes, with laparoscopy associated with lesser blood loss (90 vs 232 ml, p = 0.001) and significantly fewer major complications (0% vs 17.3%, p = 0.022).

Conclusions: Our study underscores the importance of vigilant evaluation and multidisciplinary management in LATs. Tumor size emerged as a critical determinant of malignancy, with laparoscopic surgery offering safe and comparable outcomes to open surgery in selected cases. Prospective studies are needed to validate these findings.