Urologia Journal最新文献

Objectives: The post-operative management of patients undergoing urogynecologic surgery remains controversial, despite the adoption of enhanced recovery protocols. This study aimed to evaluate the influence of moderate-to-high physical activity on functional and subjective outcomes after implantation of the Altis^® single-incision sling, with an 18-month follow-up (FU).

Methods: A total of 222 consecutive women treated for stress urinary incontinence (SUI) between December 2019 and March 2022 were retrospectively reviewed. At 3-month FU, participants completed the International physical activity Questionnaire-Short Form (IPAQ-SF). Based on IPAQ-SF results, patients were categorized into Low or Moderate-High activity groups. Objective and subjective outcomes were compared at 3 and 18 months.

Results: Both activity groups achieved high objective and subjective success rates, with no statistically significant differences at either follow-up interval. These results were maintained at 18 months. No correlation emerged in functional or objective results between activity level and surgical outcomes.

Conclusion: Moderate or high post-operative physical activity did not adversely affect functional or patient-reported outcomes after Altis^® sling implantation. These findings support the Enhanced Recovery After Surgery (ERAS) philosophy and highlight the importance of abandoning unnecessary post-operative rest recommendations following SUI surgery.

Background: Benign prostatic hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can significantly impair quality of life in aging men. Tamsulosin, a selective alpha-1 blocker, is widely used for symptom relief. Tadalafil, a phosphodiesterase-5 inhibitor, offers dual benefit for LUTS and erectile dysfunction (ED). However, limited comparative data exist from African populations.

Objective: To compare the efficacy and safety of tadalafil and tamsulosin monotherapy in the management of LUTS due to BPH in men attending a tertiary hospital in Ghana.

Methods: This prospective, randomized, open-label study was conducted over 12 weeks at the Korle-Bu Teaching Hospital. Eighty-two men aged ⩾40 years with moderate to severe LUTS due to BPH were randomized to receive either tadalafil 5 mg or tamsulosin 0.4 mg daily. Baseline, 4-week, and 12-week evaluations included International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual urine (PVR), and International Index of Erectile Function (IIEF-5). Statistical analyses included t-tests and linear regression.

Results: Both groups showed significant improvement in IPSS, QoL, Qmax, and PVR over time. At 12 weeks, Qmax was significantly higher in the tadalafil group compared to tamsulosin (18.7 ± 4.5 vs 16.9 ± 2.6 mL/s, p = 0.045). IPSS improvement was similar across both arms (Tadalafil: -9.3; Tamsulosin: -7.8). Tadalafil significantly improved IIEF-5 scores from 14.0 to 21.0 (p < 0.001), whereas tamsulosin showed minimal change. Subgroup analysis showed tadalafil's erectile function benefit was consistent across demographic and clinical subgroups except in diabetics. Side effects were mild (5.1%) and equally distributed between groups.

Conclusion: Tadalafil and tamsulosin are both effective in alleviating LUTS due to BPH. Tadalafil provides additional benefits in erectile function and superior improvement in urinary flow, making it a suitable first-line option, especially for patients with coexisting ED. These findings support individualized treatment decisions based on patient profile and symptom burden in resource-limited settings.

Introduction: In vesicovaginal fistula repair, studies have shown the utility of fibrin glue as interpositioning layer. Our goal in this study is to determine the effectiveness of fibrin glue as an interpositioning layer versus martius flap interposition and primary healing alone.

Materials and methods: We prospectively analyzed 64 patients over a period of 24 months from February, 2023 to January, 2025 and divided them as group-A in which fistulas were repaired anatomically using fibrin glue interpositioning, group-B in which fistulas were treated using only primary repair and group-C in which Martius flap was used during anatomical surgical repair as an intervening layer between the vaginal repair and bladder repair. The measured data included operative time, length of hospital stay, leak free status at POD 21, PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire) questionnaires and post-operative complications.

Results: The operative time was minimum in Group-B as compared to Group-A & C. (Group-A [183.64 ± 13.46 min.], Group-B [163.33 ± 14.60 min.] & Group-C [218.57 ± 24.75 min.]) which was significant (p = 0.000). The mean post operative hospital stay was minimum in Group-A, which were 7 ± 0.92, 8.19 ± 0.75 and 7.62 ± 0.74 days in A, B, and C groups (p = 0.01), respectively. Leak free status at POD-21 days after removal of catheter was comparable in Group-A & Group-C (Group-A was 90.9% vs 81% in Group-B vs 90.5% in Group-C) (p = 0.541). PISQ-12 in Group-A was 23.23 versus 23.76 in Group-B versus 22.14 in Group-C and which was significant (p = 0.002).

Conclusions: The study revealed that interposing layer in the form of glue is not an inferior option when compared to primary repair alone and martius flap as the total operative time, need for hospital stay and leak free status was comparable with lesser complications and comorbidities.

Introduction and objectives: Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are common causes of lower urinary tract symptoms (LUTS) in men. This multicenter study evaluated the efficacy of an entomological extract-based treatment (EEBT) as monotherapy and in combination with standard drugs.

Materials and methods: A total of 6375 men with LUTS (IPSS ⩾ 10, Qmax 5-15 mL/s) were included; 1498 had BPH, 3060 had CP, and 1817 had both. Group I received EEBT monotherapy, while Group II underwent combination therapy with α1-adrenergic blockers, NSAIDs, antibiotics, and other agents. Outcomes were assessed after 30 days using NIH-CPSI, IPSS, IIEF-5, QoL, Qmax, prostate volume, and residual urine.

Results: Both regimens significantly improved LUTS. In BPH patients, monotherapy reduced prostate and residual urine volumes and improved IIEF-5, whereas combination therapy provided greater symptom relief. In CP patients, both regimens improved NIH-CPSI, IPSS, and urinary flow, with monotherapy showing superior QoL benefits. In men with BPH + CP, monotherapy favored erectile function, while combination therapy improved IPSS. All subgroups demonstrated significant gains in Qmax. Treatment was well tolerated; only mild Clavien-Dindo grade I and II adverse events were reported, with no serious complications.

Conclusion: EEBT is effective as both monotherapy and in combination therapy for LUTS associated with BPH and CP, supporting its role in personalized treatment strategies.

Background: Pediatric urolithiasis is increasingly managed with minimally invasive approaches. Retrograde Intrarenal Surgery (RIRS) offers a promising treatment option, though data on its outcomes in children remain limited.

Objective: To evaluate the safety, efficacy, and predictors of outcomes following Retrograde Intrarenal Surgery (RIRS) in pediatric patients with renal or upper urinary tract stones.

Methods: From September 2022 to August 2024, retrospective observational research was carried out at the Pakistan Kidney and Liver Institute and Research Center in Lahore. Included were pediatric patients (less than 14 years old) who had RIRS for upper tract or renal stones up to 27 mm. Demographics, stone features, surgical parameters, complications, and follow-up imaging results were among the data that were taken from electronic medical records. Statistical analysis was performed using SPSS v27; multivariate logistic regression identified predictors of postoperative complications and stone clearance.

Results: A total of 24 pediatric patients underwent RIRS. Mean age was 9.0 ± 4.27 years; 18 (75.0%) were male. Stones were more often left-sided (14/24, 58.3%) and commonly located at multiple sites (11/24, 45.8%). RIRS was the primary treatment in 17 (70.8%) patients. Complete stone clearance was achieved in 17 (70.8%); access failure occurred in 4 (16.7%). Postoperative complications occurred in 5 (20.8%), including sepsis in 4 (16.7%). Anatomical abnormalities were seen in 5 (20.8%). Multivariate analysis showed anatomical abnormalities were protective against complications (p = 0.037), while stone size >15 mm significantly reduced clearance odds (p = 0.009). The predictive model for clearance was significant (p = 0.013, R² = 0.519).

Conclusion: RIRS is a safe and effective treatment modality for pediatric urolithiasis, achieving high stone-free rate with minimal complications. Anatomical abnormalities may reduce risk of complications, while larger stone size negatively impacts clearance. These findings support the selective use of RIRS in children with careful preoperative evaluation to optimize outcomes.

Introduction: Ureteral strictures are a recognised late complication post ureteroscopy (URS). Most research on the pathology focuses on mechanisms of injury and preventative strategies. There is limited data describing follow up patterns and treatment outcomes. The aim was to evaluate the subsequent management and outcomes of de novo ureteral strictures post URS.

Methods: Retrospective review was conducted of patients diagnosed with a de novo ureteral stricture post URS at a tertiary centre between 2014 and 2024. Eligible cases were identified by manual review of ICD-coded records (N13.0-N13.5), yielding 40 patients for analysis. Baseline and procedural data were summarised descriptively, and group comparisons were performed using the Mann-Whitney U and Fisher's exact tests.

Results: Among 40 patients (median age 69 years), most strictures were detected symptomatically (67.5%) and were located proximally or distally (each 43%). Median time to diagnosis was 3.8 months, and median follow-up was 4.3 years. Overall, 45% achieved successful resolution after a median of two procedures, while 15% underwent nephrectomy. Higher age-adjusted Charlson Comorbidity Index scores and older age were significantly associated with poorer outcomes, although interpretation is limited by the sample size. Stricture length and a history of stone impaction showed no significant associations.

Conclusions: In this cohort, fewer than half of patients with de novo ureteral strictures following URS achieved lasting resolution despite multiple interventions. These findings highlight the potential clinical burden of this complication and support the importance of preventive strategies, timely detection and structured follow-up, while underscoring the need for further studies to better define long-term outcomes.

Introduction: Kidney hemorrhage is one of the most common and significant complications of percutaneous approaches for renal stone removal. This study evaluated the effectiveness and safety of hemostatic completion in minimally invasive percutaneous nephrolithotomy (mini-PCNL) using monopolar electrocautery in patients with intrarenal tract bleeding.

Materials and methods: We prospectively investigated 200 consecutive patients presenting to a single institution and classified them into two groups. The experimental group consisted of 28 patients receiving monopolar coagulation for intrarenal bleeders in the percutaneous tract. The control group included 172 patients in whom fulguration was not done. Perioperative outcomes were compared between the groups.

Results: The two groups had no statistical difference in operative times and transfusion rates. Patients who received electrocauterization demonstrated a significantly shortened duration of double J stent removal (p = 0.011), more rapid recovery of hemoglobin levels, particularly in cases of significant bleeding (p < 0.001), and a lower rate of angiography (p = 0.047). No embolization was needed in the electrocauterization group. No significant complications were observed in either group.

Conclusions: These findings suggest that monopolar electrocautery might effectively reduce the risk of postoperative bleeding and alleviate the burden on patients who may require additional blood transfusions in patients undergoing tubeless mini-PCNL.

Background: Overactive bladder (OAB) is a prevalent condition, and patients increasingly turn to online platforms such as YouTube for information, raising concerns about accuracy and reliability.

Purpose: This study aimed to evaluate the quality and reliability of YouTube videos related to overactive bladder (OAB) using two validated instruments: the DISCERN tool and the Global Quality Scale (GQS).

Methods: A systematic and structured YouTube search strategy, adapted from systematic review methodology but tailored for digital platforms, was conducted using the keyword overactive bladder. The first 100 videos retrieved were screened, and 60 met the inclusion criteria: English language, duration of at least 60 s, and relevant educational content. Exclusion criteria included non-English language, duplicates, advertisements, and purely promotional material. Two independent urologists evaluated each video using the DISCERN tool (range: 16-80) and GQS (range: 1-5). Additional data collected included video length, view count, uploader type, and thematic content. Descriptive statistics and correlation analyses were performed.

Results: The median video duration was 5.6 min (IQR: 3.4-8.2), with a median view count of 34,200 (IQR: 12,500-89,000). The mean DISCERN and GQS scores were 45.2 ± 10.1 and 2.9 ± 0.8, respectively, indicating moderate overall quality. Videos uploaded by healthcare professionals or institutions had significantly higher DISCERN and GQS scores compared to those uploaded by individuals or commercial entities (p < 0.001). Only 28% of videos addressed neurogenic causes of OAB, and 41% did not mention behavioral therapy. A weak but statistically significant positive correlation was observed between GQS score and view count (ρ = 0.34, p = 0.01).

Conclusions: YouTube contains a wide array of OAB-related videos, but their quality and reliability vary considerably. While some content is accurate and informative, significant gaps remain, particularly regarding neurogenic etiologies and behavioral management. Healthcare professionals should guide patients toward trustworthy resources and consider producing evidence-based content to improve digital health literacy.