Urologia Journal最新文献

Purpose: To compare the efficacy and safety of mini-percutaneous nephrolithotomy versus flexible ureteroscopy with laser lithotripsy in the management of calyceal diverticulum stones.

Methods: The study performed a prospective analysis of 91 patients with confirmed calyceal diverticulum stones in Saudi Arabia from January 2020 to June 2024. A total of 78 patients with CD (calyceal diverticulum) stones were randomly divided into two groups: Group A (n = 39) FURSL and Group B (n = 39) mini-PCNL. The study analyzed patient demographics, stone complexity, operative parameters, postoperative results, and postoperative outcomes, including stone-free rates, operative time, hospital stay, complication rates, and recovery time.

Results: Both groups showed similar baseline characteristics and surgical feasibility, with the mini-PCNL group showing a higher SFR (84.62% vs 71.79%), but not statistically significant. Hospital stay was significantly shorter in the FURSL group (17.31 ± 3.06 h vs 30.03 ± 7.18 h; p < 0.001). Patients undergoing FURSL returned to normal activity sooner (5.1 ± 1.37 days vs 8.03 ± 1.05 days; p < 0.05). Complication rates were low and nearly similar across groups.

Conclusions: Both mini-PCNL and FURSL are effective strategies for treating calyceal diverticulum stones. Notably, mini-PCNL offers superior stone-free rates, while FURSL offers shorter operative times, hospital stays, and fast recovery.

Introduction: Partial nephrectomy is the gold standard treatment for incidentally detected small renal tumors. To optimize the outcomes, use of intra operative imaging techniques like ultrasound (IOUS), OCT (optical coherence technique) and fluorescence along with augmented reality is indicated. However, these are not available in all the centers and may also not be needed for predominantly exophytic tumors with low RENAL nephrometry scores.

Aim and objective: To evaluate the oncological outcomes and efficacy of transperitoneal laparoscopic partial nephrectomy (LPN) in patients with RENAL nephrometry score of ⩽9 without the use of IOUS.

Material and methods: This was a single centered, single surgeon, retrospective, descriptive, record-based study carried out from January 2013 till December 2018 at postgraduate department of Urology GMC Jammu with a follow up 5 years. After initial evaluation by CECT abdomen with CT renal angio the patients were subjected to transperitoneal LPN and outcomes were recorded in the patient data sheet. Demographic, intra and post op data including RENAL nephrometry score and follow up was retrieved from the patient chart after taking the due clearance from Institutional Ethics Committee.

Results: Sixty-five patients were included in the study and the average age was 52.6 ± 8 years of 40 were males and 25 were females with average BMI of 23.84 ± 5. Right sided tumors accounted for 62% of cases with upper polar 38%. Total operative time was 100 ± 20 with an average warm ischemia time of 21.55 ± 2. Average size of the tumor in our series was 4.1 ± 2 cms. One patient required blood transfusion. Surgical margins were negative in all. Average follow up in our series was 5.5 ± 1 years.

Conclusion: Transperitoneal laparoscopic partial nephrectomy for low to intermediate RENAL nephrometry score (score ⩽9) without the use of IOUS is feasible and safe with acceptable surgical and oncological outcomes on long term follow up.

Objectives: This study aimed to assess the clinical outcomes of Fournier's gangrene and its predisposing factors in male diabetic and non-diabetic patients. We also evaluated the disease severity using the Fournier's Gangrene Severity Index and examined management outcomes, including mode of wound closure and complications related to the disease and treatment.

Methods: Patients with Fournier's gangrene underwent admission, with detailed history collection. Disease severity was clinically and laboratory assessed. Empirical antibiotics preceded surgical management and microbial evaluation. Wound closure involved primary suturing, skin grafting, or flaps. Patients were called for regular follow-up after discharge, and complications were identified.

Results: Our study has shown that the overall FGSI was much higher among diabetics as compared to non-diabetics, and the same goes for the mortality rate, which was much higher in diabetics, owing to the higher rate of complications among them. It was also found that the prognosis of Fournier's gangrene is worse among diabetics. The mean number of debridement's in the diabetic group (3.00 ± 1.016) was higher than the non-diabetic group (2.22 ± 1.003). The association between number of debridement's in the two groups was statistically significant (p = 0.001).

Conclusion: Early diagnosis and aggressive management are crucial to reduce Fournier's gangrene mortality. Effective diabetic control and repeated debridement are necessary to successfully manage these complex cases.

The purpose of this study is that the combination effects of Peyronie's disease (PD) therapy with Phosphodiesterase type 5 inhibitors (PDE5i) plus acetylsalicylic acid on improve curvature progression and pain in the active phase of disease. We performed a retrospective cohort study of 161 patients affected by PD in active stage and erectile dysfunction treated with tadalafil 5 mg once daily were divided in two groups. Group A(GA): 93 men treated with only PDE5i (tadalafil 5 mg) for 1 year or more and Group B(GB): 68 men that received tadalafil 5 mg plus aspirin 100 mg with the same protocol of GA. The patients of both groups were assessed at baseline and follow-up (6 months) for erectile function, painful erections, penile plaque size, and penile curvature. Six months after the treatment the patients in both groups had a non-significantly reduction of penile plaques. However, in GB patients had a clinically significant reduction of the curvature after 6 months by treatments 20.21° ± 7.20 versus 28.13° ± 8.11 (GA), (p < 0.001). In the analysis of our secondary endpoint, we demonstrated a significantly lower intensity of pain during erection in GB (1.43 ± 1.12) compared GA (1.89 ± 1.25; p < 0.001). We observed that the regular use of this therapeutic combination significantly provided more benefit in patients with active stage PD in terms of penile deformity, pain, and discomfort during penetrative intercourses.

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.