Urology Annals最新文献

Frailty refers to a state of increased vulnerability and is recognised to be multifactorial. It is associated with a higher likelihood for functional dependency and a reduced life expectancy. In the surgical setting, frailty has attracted increased attention in regard to how it can impact post-operative outcomes. Many research groups have explored ways to translate frailty into a clinical marker and represent it as a quantifiable measurement. To this end, there now exist a plethora of tools (over 50 tools) available that have been applied in a clinical and/or research setting across nearly all medical and surgical specialities. However, the large number of tools can make it challenging for clinicians to know which one to adopt. This article provides an overview of the commonly used tools in urological surgery. Most tools have been studied in the context of urological cancer surgery and consistently show that frailty is associated with poorer outcomes. Of note, none of the systems described were developed exclusively for purely urological studies. Many of the abovementioned systems require a face-to-face assessment and therefore preclude retrospective data collection. Frail patients may not therefore be eligible on account of either one of these and it may account for why research in this field is lacking. Important outcomes such as the discharge location and how ADLs have changed are also challenging to collect retrospectively. Further research should focus on developing a frailty scoring system that is customised for urological surgeries.

The role of telemedicine (TM) in endourology has expanded significantly over the past decade, demonstrating benefits for both patient satisfaction and healthcare efficiency. We wanted to look at the role and effectiveness of using these technological innovations in endourology. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework and Population, Intervention, Comparison, and Outcome statement. Search was done for all English language articles, over several databases, from inception to Aug 2024. The inclusion criteria focused on studies involving patients with kidney stone disease and reporting outcomes related to healthcare delivery, cost savings, and environmental sustainability (green credentials). A total of 933 articles were initially identified and after screening of titles, abstracts, and full texts, 10 articles were finally included. Of these articles, 8 showed a cost-saving and 9 showed a greener credential of using TM. All included studies showed a positive impact of TM in terms of reduced time to access urology services, enhanced acute and follow-up efficiency, time to decision-making or treatment, patient satisfaction, and safety. Most studies showed more than one clinical and/or organizational benefit in the patient pathway. Our review shows that TM in endourology demonstrates multiple benefits, including cost savings, environmental sustainability, and improved healthcare delivery. The included studies highlight enhanced access to services, faster decision-making, and high patient satisfaction and safety. Given the pressures on the National Health Service and existing waiting times, more should be done to adapt and adopt this technological revolution.

Background: Minimally invasive surgical treatments (MISTs) are many promising approaches for the management of benign prostate hyperplasia (BPH) that might be performed under local anesthesia (LA) and have same-day discharge. To address the feasibility and efficacy of LA for BPH-MIST, a specific trifecta was conceptualized and tested: (1) no intraoperative complications, (2) reduced intraoperative pain, and (3) same-day discharge.

Materials and methods: We prospectively collected data from patients who underwent Rezum, Urolift, and iTIND treatments from January 01, 2023, to February 28, 2024, on an international database. All the patients received a local administration of two anesthetic gels in the urethra before the procedure; selected patients, in addition, received a transperineal anesthetic injection in the periprostatic space or transurethrally with a Schelin Catheter (SC) injection directly in the prostatic lobes. Reduced intraoperative pain was defined as <5 on the visual analogue scale (VAS range: 0-10).

Results: Overall, 156 patients were included in the study. Median age was 63.5 (interquartile range [IQR]: 56-70) years. Eleven patients (7.0%) had diabetes, and 29 (18.6%) received anticoagulant medication. Ten patients (6.4%) had indwelling catheters. The median prostate size was 45 ml (IQR: 34-60). Forty-eight patients underwent Urolift (30.8%), 70 (44.8%) Rezum, and 38 (24.4%) iTIND. The transperineal block and the SC were used in 21 patients (13.5%) and 32 (20.5%) patients, respectively, with 103 (66%) patients receiving only the anesthetic gels in the urethra. Performing MIST in pure LA achieved the trifecta outcome in 122 patients (78.2%). Six patients (3.8%) had intraoperative complications. One hundred and thirty patients (83.3%) experienced reduced intraoperative pain (<5 on VAS). One hundred and 47 (94.2%) patients were discharged on the same day of the procedure.

Conclusions: LA for MIST in BPH is feasible, with excellent success rates and reduced pain, as trifecta outcomes were achieved.

Background and objective: Percutaneous nephrolithotomy (PCNL) is the gold standard technique used for the treatment of large renal stones ≥ 2 cm. However, in patients with chronic kidney disease (CKD), the effect of PCNL remains underreported. We aimed to prospectively evaluate the changes in estimated glomerular filtration rate (eGFR) after PCNL in patients with stage 2-4 CKD.

Subjects and methods: This prospective study included patients with stage 2-4 CKD who underwent PCNL in the period from December 2020 to December 2023. eGFR was measured using the Cockroft-Gault formula preoperatively and 3 months postoperatively. Patients were classified as either improved/stable or deteriorated. Perioperative complications and stone-free rate (SFR) were also evaluated.

Results: The study included 50 patients (male/female = 33/17) with CKD who underwent PCNL. The mean operative time was 84.8 ± 27.4 min. A total number of 49 complications were reported in 21 patients. At a follow-up of 3 months, eGFR was improved/stable in 40 (80%) patients, and it deteriorated in 10 (20%) patients. The SFR was 76% at 3 months postoperatively. Factors that significantly affected the eGFR were bleeding, access number, incidence of perioperative complications, stone burden, and operative time.

Conclusions: PCNL is an effective and safe treatment option for patients with stage 2-4 CKD with renal stones ≥2 cm. It is advisable to avoid long operative time, excessive bleeding, and multiple accesses as possible in these patients to minimize the risk of renal function deterioration.

Posterior urethral valves (PUVs) are a common cause of congenital bladder outlet obstruction and obstructive uropathy in male infants and are a leading cause of chronic kidney disease (CKD)/end-stage renal failure (ESRF) in the pediatric population. Despite this, it remains challenging to predict which patients will go on to develop CKD/ESRF, and thus management and follow-up are left to the discretion of the treating department. Many different methods have been proposed to predict outcomes in these patients and several tools, including predictive scores and models, have been published. Here, we provide an up-to-date summary of the tools currently published. A comprehensive search of literature available on MEDLINE and Google Scholar was performed to identify scoring systems, predictive models, and predictive tools relating to progression to CKD/ESRF/bladder dysfunction in patients with PUVs. Six predictive tools were identified and so were included in the analysis. Three are based on clinical/biochemical findings, 2 utilize machine learning/artificial intelligence, and one is purely based on radiological findings. Three out of 6 have undergone some form of external validation. Four provide a numerical risk and 2 stratify patients into risk categories. There are currently 6 predictive tools that have been published that quantify the risk of developing long-term complications associated with PUVs. Further validation is required to establish these scores/predictive models as a clinical standard of care.

Introduction: Although the usage rates of ureterorenoscopy (URS) for treatment of urolithiasis have increased, extracorporeal shock wave lithotripsy (ESWL) remains a widely employed primary treatment option due to its less invasive character. However, in cases of primary ESWL failure, the optimal choice of secondary treatment, whether secondary ESWL (sESWL) or secondary URS (sURS) in terms of safety and efficacy, remains uncertain.

Patients and methods: A total of 62 urolithiasis patients who underwent sESWL (n = 31) or sURS (n = 31) at a single tertiary referral center between March 2014 and November 2019 were retrospectively analyzed. Key outcome parameters included tertiary reintervention rates, stone-free rates, and complication rates. Subgroup analyses were performed based on stone localization (kidney versus ureter) and stone size (<10 mm versus >10 mm).

Results: Tertiary reintervention rates were significantly higher in the sESWL group (42%) compared to the sURS group (16%, P = 0.05). Stone-free rates at 6 weeks were lower in the sESWL group (29%) compared to the sURS group (84%, P < 0.01). Complication rates were 13% (4/31) in the sESWL group versus 6% (2/31) in the sURS group (P = 0.06).

Conclusion: sESWL is associated with a significantly higher rate of tertiary reintervention compared to sURS. However, in terms of safety, no statistically significant differences in complication rates between the two modalities were observed, and choice of tertiary treatment may therefore be made on individual discussion with the patients.

Objective: The aim is to evaluate the benefits of percutaneous nephrostomy (PCN) for urinary drainage in patients with malignancy-associated urinary obstruction (MUO). This study examines the impact of PCN on immediate renal recovery, procedural morbidity, short-term outcomes, and patient survival.

Methods: A total of 477 patients with ureteric obstruction underwent PCN placement, of whom one-third had MUO. Demographic and clinical parameters were reviewed to assess renal outcomes, complication rates, hospital stay, and overall survival.

Results: Nearly two-thirds of the patients with MUO had a primary urological malignancy (bladder cancer 30% and prostate cancer 25%). The mean hospital stay was <7 weeks, with patients with gynecological malignancies experiencing the shortest admissions. During the study period, 59 (37%) patients died. The overall median survival was 107 weeks, with the shortest survival observed in patients with primary colorectal cancer (median 34 weeks). Patients with primary bladder and prostate malignancies demonstrated higher median survival compared to other malignancies.

Conclusion: MUO often represents advanced disease in colorectal and gynecological cancers. PCN can be beneficial for selected patients who are candidates for further oncological treatment. However, it should be considered only after careful discussion regarding the potential need for long-term nephrostomy, procedural morbidity, and quality-of-life impact. Although PCN achieved high rates of renal function recovery and had low complication rates (12%-17%), the underlying malignancy and associated social factors contributed to prolonged hospital stays, sometimes accounting for up to one-third of a patient's remaining life.

Objective: The aim of this study was to compare the accuracy of five different manual urine pH measurement devices against the laboratory reference method.

Materials and methods: Fresh second-morning midstream urine samples were collected from patients with a history of urolithiasis and from healthy volunteers. Measurements were performed using five different models of manual pH meters purchased from a popular general online shopping platform: Two were paper strip meters (Just Fitter and Simplex Health) and three were electronic meters (Pancellent, Yummici, and GuDoQi [QBY]). Results were compared to the reference method used in the institution's laboratory which uses the Siemens Clinitek Novus machine (Siemens AG, Munich, Germany). The degree of correlation between each device was assessed by calculating the intraclass correlation coefficient (ICC).

Results: Seventy-two fresh urine samples were analyzed. The ICC for Just Fitter paper strip meter was 0.792 (95% confidence interval [CI] 0.685-0.865), for Simplex Health paper strip meter was 0.830 (95% CI 0.723-0.895), for Pancellent electronic meter was 0.873 (95% CI 0.804-0.919), for Yummici electronic meter was 0.866 (95% CI 0.780-0.918), and for GuDoQi electronic meter was 0.848 (95% CI 0.555-0.93).

Conclusions: All five urinary pH measuring tools showed good correlation with the reference method (ICC > 0.75), with electronic meters being superior to paper strips, and Pancellent brand being the closest to the reference test. According to these results, manual pH meters, especially electronic models may be considered an acceptable alternative to frequent hospital urinary pH measurements.