Urologia Journal最新文献

Background: We created a classification system for encrusted ureteral stents (ES) (Grading system for Additional lithiasis and uReteral Stent cAlcification -GARSA-, I-III grades), we demonstrate its utility for predicting the surgical outcome and the need of complex surgery.

Methods: Retrospective review of patients with ES; clinico-demographics, additional lithiasis (AL), stent calcification characteristics, surgeries performed, complications and stone free rate were collected. Chi-square was used to compare the categorical variables and Kruskal-Wallis test for the comparison > 2 numerical groups; a p-value < .05 was considered significant.

Results: We included 190 ES; 163 (85.8%) stents underwent one-time surgical removal. Most Grade I catheters were removed in a single surgery, without invasive/multimodal therapy; Grade II-III catheters required multimodal and invasive therapies. The presence of AL in kidney increased the number of surgical interventions performed in Grade I/II catheters (p < 0.05) and the likelihood of requiring multimodal (Grade I: 90%, Grade II: 83.3%, Grade III: 100%) or invasive surgery (Grade I: 38.1%, Grade II 58.3%, Grade III 90.9%) to achieve successful treatment.

Conclusions: Incorporating both the calcified stent characteristics and the presence of AL, GARSA score can be used to determine the selection of the optimal surgical approach for patients with encrusted stents.

Background: Radical prostatectomy is the standard of care for prostate cancer. Identification of the association between post-operative lower urinary tract symptoms and quality of life (QOL) is critical for enhancing patient self-management.

Aims: This study identified the factors associated with the QOL of patients with cancer post-prostatectomy.

Methods: Participants were patients with lower urinary tract symptoms who had undergone prostatectomy at one of four institutions and had completed the QOL questionnaire. Descriptive statistics and correlations were obtained, and multiple regression analyses were conducted with QOL as the dependent variable.

Results: Except for "personal relationships," the eight sub-domains of QOL in the King's Health Questionnaire were significantly positively correlated with International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores. The ICIQ-SF was a predictor of all QOL sub-domains. Marital status and IPSS were associated with "general health perception," "role limitations" were associated with post-operative radiation therapy and cohabitation status, "emotions" were associated with frequent urination/incontinence medication use, and "sleep/energy" was associated with IPSS and post-operative hormone therapy.

Conclusions: Providing anticipatory information to at-risk patients before treatment may reduce post-operative life disturbances. Healthcare providers should ensure seamless coordination and promptly collaborate with specialists post-discharge.

Objective: To determine whether flexible ureteroscopies (f-URS) affect renal function by performing dynamic renal scans (DTPA or MAG3) pre- and post-operatively.

Patients and methods: Between April 2010 and March 2024, 945 renal units underwent ureterorenoscopy, of which 101 renal units with upper urinary tract stones (UUTS) completed a renal scan, either DTPA or MAG3 pre- and post-f-URS. The cases were divided into three groups: worsened (>10%), improved (>10%), or unaffected (stable) renal function (⩽10% change). Patient demographics, imaging data, stone properties, and treatment outcomes were comprehensively evaluated. The evaluation of postoperative complications was performed using the Clavien-Dindo classification.

Results: The mean patient age was 53.4 years. The mean stone size was 11.4 mm. Renal pelvis, upper, and middle calyces, and lower pole stones were found in 12.9% (13), 28.7% (29), and 34.7% (35) of cases, respectively. Single- and second-session SFRs were 95% and 99%, respectively. A third auxiliary procedure was needed in one renal unit (1%). The mean number of procedures per renal unit was 1.06 (107/101). The mean renal function pre and post-operatively was 47.3% and 48%, respectively. The majority of patients (94.1%) had unchanged renal function. However, three female patients (3%) had a decline in differential renal function (>10%) while three patients (two males and one female) (3%) had an improvement (>10%). A re-intervention was necessary in one patient, interestingly not among those with declined renal function.

Conclusions: Flexible ureteroscopy due to renal or ureteral stones has minimal to no impact on renal function. Renal scans pre- and post-operatively may be used in potentially high-risk patients.

Introduction: The objective of the present study was to carry out a real-world clinical practice study, verifying through prospective analysis whether the Allium stent could resolve different types of ureteral pathologies, with strictures of different etiology and cases of urine leakage.

Material and methods: Prospective observational study collecting all cases of Allium ureteral stent placement in our center between 2021 and 2022. Descriptive and comparative analyses were carried out to verify the success rate of Allium stents and pinpoint patient profiles in whom stent implantation would provide effective resolution of stricture or leakage.

Results: A total of 30 Allium stent cases were collected in 30 patients, 10 of which were considered successful procedures (eight cases of stricture and two leakage) while 20 were classed as failures (15 stricture and five ureterointestinal urine leakage). The most frequent pathology was ureterointestinal stricture (33.3%) in patients with an ileal conduit, followed by retroperitoneal fibrosis (26.7%) and ureterointestinal urine leakage (16.7%). Furthermore, up to 40% of the sample had an infectious complication 1 month after stent implantation, while the most common cause of failure was persistent hydronephrosis (36.7%). Notably, only two of the 10 ureterointestinal stricture cases and one of the five cases of ureterointestinal urine leakage were resolved with the stent. Furthermore, a statistically significant relationship was found between the indication of the stent and its success: specifically, all cases of poor tolerance to DJ stents and ureteral urine leakage were resolved (OR: 12.66) with the Allium stent.

Conclusions: The resolution rate of ureteral pathology with the Allium stent is relatively low. The patients who can benefit the most from this device are those with ureteral urine leakage or poor tolerance to the DJ stent. Among the possible complications, urinary infection in the first month after implantation is the most common.

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men, significantly impacting quality of life. Although pharmacological therapies, especially alpha-blockers, are the standard first-line treatment, their long-term adherence is limited by side effects and insufficient symptom control. Transurethral resection of the prostate (TURP) remains the surgical gold standard but is associated with notable morbidity, prompting interest in minimally invasive alternatives. The temporary implantable nitinol device (I-Tind) offers a tissue-sparing approach designed to remodel the prostatic urethra and relieve LUTS without compromising sexual function. This multicenter prospective study evaluated the safety, efficacy, and functional outcomes of I-Tind in 120 patients with symptomatic BPH unresponsive to alpha-blockers, treated between 2019 and 2023. Follow-up assessments were done at 3, 6, and 12 months. The study showed significant improvements in urinary flow and symptom scores. Mean Qmax improved from 7.6 to 15.7 mL/s, and mean IPSS decreased from 21.5 to 9.7 at 12 month-follow-up (p < 0.001). Quality of life measures also improved, and sexual and ejaculatory functions were fully preserved. The procedure was well-tolerated, with all implants successfully retrieved after a mean of 6 days and a low complication rate. I-Tind appears to be a safe and effective minimally invasive option for selected BPH patients, combining symptom relief with preservation of quality of life. Further randomized trials are needed to confirm these findings and better define its role in the BPH treatment algorithm.

Objectives: Hematological toxicities are a common sequelae of radiation therapy (RT), and pelvic RT is of particular concern as the pelvic marrow contributes nearly 50% of total body hematopoiesis. We evaluated the impact of pelvic RT on hematological toxicities in pediatric patients with pelvic genitourinary rhabdomyosarcoma (GU-RMS).

Methods: A secondary evaluation of 448 pediatric patients (53.8% male) with intermediate-risk RMS in the ARST0531 trial included 65 with pelvic GU-RMS (who received pelvic RT). Multivariable logistic regression was used to compare cytopenias and complications (febrile neutropenia, infectious complications) between GU-RMS and non-GU-RMS. Primary analysis assessed toxicities over the study period (weeks 1-43), with secondary analysis evaluating T1 (weeks 1-15), T2 (weeks 16-30), and T3 (weeks 31-43).

Results: GU-RMS patients did not have a significantly higher risk of cytopenias than non-GU RMS patients. Neutropenia was the most common, affecting 79.4% of subjects, with no significant difference between the GU (73.8%) and non-GU (80.4%) groups (OR 0.64, 95% CI 0.34-1.19, p = 0.16). Anemia rates were similar in the GU (36.9%; n = 24) and non-GU (35.2%; n = 135) groups (OR 0.96, 95% CI 0.54-1.70, p = 0.89). Thrombocytopenia occurred slightly more often in the GU group (33.8%) than the non-GU group (28.4%) but was not statistically significant (OR 1.49, 95% CI 0.81-2.73, p = 0.20). Pelvic RT for GU-RMS in T1 was linked to a significantly higher risk of thrombocytopenia compared to non-GU subjects (OR 2.79, 95% CI 1.25-6.23, p = 0.01), which declined over time (T2, T3). Rates of febrile neutropenia (3.1%-9.2%) and infectious complications (4.6%-15.4%) in GU patients did not differ significantly from those in non-GU cohorts (febrile neutropenia: 7.3%-13.05%; infectious complications: 5.5%-9.7%) across T1-T3.

Conclusions: Hematological toxicities were comparable between pediatric GU and non-GU RMS patients. Pelvic RT for GU-RMS increased the risk of early thrombocytopenia, which diminished over time.

Introduction: In men older than 50 years, benign prostatic hyperplasia (BPH) is a common disease and progressive disease. Acute Urinary Retention (AUR) is one of the most common and painful long-term outcomes of BPH. Our study aimed at determining the risk factors which are responsible for developing AUR and formulating a novel scoring system known as "Retention Score" or "CLAMP Score" to predict the risk of developing AUR in BPH patients in future and manage them in advance.

Materials and methods: The present study was a hospital-based comparative study which was conducted at the department of Urology, Nil Ratan Sircar Medical College and Hospital. Two groups were compared one "with AUR" and another "without AUR." Various risk factors have been studied including age, international prostate symptom score (IPSS), comorbidities like diabetes mellitus, serum PSA etc. From the study we have formulated and validated a simple out-patient based risk scoring known as "CLAMP Score" by which we can stratify the BPH patients into various risk groups of developing AUR.

Result: A total of 240 patients has been divided into two groups; 120 in each group. It was found that, majority number of patients with AUR are more than 60 years of age (92.5%) and has comorbidities (84.0%). 68% of these patients has a serum PSA over 1.4 ng/dL and a history of AUR (75%). The mean IPSS was 26.8 and intravesical prostatic projection is more than 12 mm. Our proposed scoring system has a significant association with the patients with AUR group.

Conclusion: Our study provides valuable insights into the associations between various risk factors and AUR in BPH patients. Our proposed scoring system will be of great help in predicting AUR in BPH patients on out-patient basis and treat them accordingly in advance.

Introduction: Medical expulsive therapy (MET) has been shown to be a safe and effective option for the spontaneous passage of uncomplicated ureteric stones sizing ⩽10 mm in selected cases. However, there is lack of evidence on the predictors of successful MET. Our objective was to identify parameters that can accurately predict the spontaneous passage of ureteral stones during MET.

Methods: Patients receiving MET (Tamsulosin 0.4 mg once daily (OD)) for a single unilateral ureteral calculi sizing ⩽10 mm were followed after 1 month using Non contrast Computed tomography (NCCT). Various parameters such as stone-related parameters (location, density, volume and transverse, longitudinal, and sagittal diameters), ureter-related parameters (diameter, density, and wall thickness at the stone site) and grade of hydronephrosis were evaluated on CT images and analyzed by using univariate, multivariate and receiver operating characteristic (ROC) curve analyses.

Results: Of 55 patients, 31 (56.4%) passed the stone successfully within 4 weeks of MET. Univariate analysis revealed these patients tended to have lower ureteric stones (p-value- 0.048), lower longitudinal (p-value- 0.024) and transverse stone diameters (p-value- 0.006), lower stone volume (p-value- 0.015) and ureteral wall thickness (UWT; p-value- 0.001). In multivariate analysis, only UWT at the stone site (p 0.036) was a significant predictor of the successful passage of calculus. The UWT cut-off was 2.1 mm with sensitivity and specificity of 83.8% and 62.5%, respectively, with an Area Under Curve (AUC) of 0.7856.

Conclusion: The most significant predictor of successful stone passage in MET of unilateral ureteral stones was maximal UWT, with an optimal cut-off point of 2.1 mm.

Telemedicine and telesurgery emerged as transformative innovations in urology. These approaches overcome challenges such as geographic barriers, resource limitations, and increasing demand for specialized care. Telemedicine is applied across the surgical continuum, including preoperative, perioperative, and postoperative phases. Telesurgery during the perioperative phase achieves outcomes comparable to onsite guidance, while postoperative teleconsultations are well-accepted by patients, offering results equivalent to face-to-face visits. Benefits include fewer patient visits, reduced infection risks, enhanced convenience, and economic advantages. The advent of ultrabroadband 5G has significantly expanded telemedicine's scope, enabling real-time remote consultations and advanced telesurgical procedures. Robotic systems such as Toumai, Hinotori, Edge, KangDuo, and Microport Medbot demonstrate promising applications in urological surgery. Despite these advancements, telemedicine faces challenges, including data security, adherence to professional guidelines, and physician adaptability. Legal and ethical issues such as informed consent, patient privacy, licensing, and electronic documentation highlight the need for standardized frameworks. This review analyzes the current state of telemedicine and telesurgery in urology, emphasizing their benefits, challenges, and potential to transform patient care and improve outcomes.

Objectives: To assess the efficacy and safety of clean intermittent catheterisation (CIC) in the management of acute urinary retention (AUR) and identify factors those affect the likelihood of recovery of spontaneous urination and the development of adverse events.

Materials and methods: A prospective multicentre comparative randomised study included 129 patients hospitalised in urological hospitals with AUR due to benign prostatic hyperplasia. Patients were randomised into two groups. In group I, the classical tactics of TWOC (drainage of the bladder with a urethral Foley catheter for 3 days) were used, whereas in group II, patients underwent CIC for 3 days. A comparative assessment of the effectiveness of intermittent catheterisation was carried out and compared to the classical tactics of TWOC (trial without catheter/attempt without catheter).

Results: Normal voiding was restored in 25 (35.7%) patients in group I and 26 (44%) patients in group II. The point estimate of the probability of urination recovery on the third day of therapy in group II was 1.5 times higher than that in group I. The difference between these estimates was not statistically significant. In group II, 1 (3.8%) patient recovered spontaneous urination within 1 day, 12 (46.2%) within 2 days, and 13 (50%) by the end of 3 days. On the seventh day, AUR recurred in three (2.3%) patients: two (2.8%) in group I and one (1.7%) in group II. Statistically significant relationships were found between the probability of developing gross haematuria and patient age, as well as between possible urethrorrhagia and a history of AUR, between age and the use of α1-blockers at the time of AUR.

Conclusion: Intermittent catheterisation is an effective treatment for AUR. Its main advantages include the possibility of outpatient management, earlier recovery of spontaneous urination and significantly less severe catheter-associated lower urinary tract symptoms.