Urology Annals最新文献

Objective: The objective is to learn how Saudi Arabia's urologists treat patients with Bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC) and their choices in management for BCG-naive patients during the BCG shortage.

Materials and methods: A 10-min web-based survey was sent through the King Saud bin Abdul-Aziz University for Health Sciences' College of Medicine Clinical Affairs to urologists treating NMIBC based on the Saudi Urologic Association Database.

Results: The questionnaire was completed by 19 urologists, most of whom (68%) were self-identified as urologic oncologists. In the 6 months before survey administration, the majority of urologists (67% of those surveyed) had treated over five NMIBC patients who had failed BCG therapy. The preferred course of treatment for these patients was a radical cystectomy, as advised by 79% of the participants. Other preferred options were intravesical chemotherapy (16%) and repeat BCG therapy (5%). Clinical trials were never chosen. Sixty percent gemcitabine (Gem), 20% mitomycin C, 10% docetaxel (Doce), and 10% sequential Gem/Doce were rated as the most preferred intravesical chemotherapy regimens used. Saudi urologists were most reluctant to utilize intravesical chemotherapy because of uncertainty about the treatment's clinical effectiveness (oncological safety) and the absence of specific guidelines from urology societies regarding the use of these drugs. BCG shortages are still a problem in Saudi Arabia, as 79% of respondents reported shortages. Most commonly, during BCG shortages, Saudi urologists rationed BCG to patients with high-risk disease, preferring pT1and/or carcinoma in situ to Ta high grade. The minority (16%) switch to intravesical chemotherapy in these circumstances.

Conclusions: Saudi urologists have begun employing a bladder-sparing strategy, particularly intravesical chemotherapy, for BCG-unresponsive disease. To properly select treatment for this condition, there is an urgent need to implement initiatives to open clinical trials and provide guideline-based protocols to Saudi Arabia and throughout the Arab world.

Background: The aim of this study intends to assess prone and flexed prone positions for percutaneous nephrolithotomy (PNL) for safety and efficacy.

Methods: From May 2017 to August 2022, a stratified randomized approach was carried out to randomly assign 346 PNL candidates into prone or flexed prone groups. Perioperative data, such as stone-free rate, stay length, operative time, and complication rates, were studied.

Results: In the prone and flexed prone groups, the mean ages of 51.7 ± 12.2 and 49.4 ± 11.9 min, respectively (P = 0.1). The mean body mass indexes of 24.2 ± 13.4 and 29.9 ± 11.9, respectively (P = 0.03). The pyelocaliceal perforation occurred in 15 (8%) and 11 (6.4%) participants, respectively. In the prone and flexed prone postures, postoperative bleeding occurred in 15 (7.9%) and 9 (5.4%) patients, respectively (P = 1.0). The average percentage decrease in hemoglobin concentration was 1.29 ± 0.42 and 1.21 ± 0.32, respectively (P < 0.000). The success rates were 92 and 93.6%, respectively (P = 0.6). The average access length was 3.9 ± 1.2 and 4.8 ± 1.8 min (P = 0.08), whereas the average operation duration was 68.7 ± 37.4 and 50.4 ± 21.9 min (P = 0.04).

Conclusion: Both the prone and prone-flexed positions are equally safe for PNL. The flexed prone position is more likely to be beneficial for obese patients. The prone-flexed position enabled a somewhat shorter average operation time. The pelvicalyceal system could be more readily reached when the prone position was flexed.

Objective: Renal cell cancer (RCC) is the most typical form of kidney cancer in adults, which accounts for 80% to 85% of all primary renal neoplasms. RCC develops inside the renal cortex. This study aimed to systematically review the survival rate of patients treated with targeted therapy and/or RC. Surgery is the standard therapy for RCC, even though after surgery, 20%-40% of patients with localized RCC would experience distant metastases. Metastases or large RCC are not amenable to surgery. Unresectable RCC can be treated palliatively with angioembolization or neoadjuvant therapy. This study aims to review the survival rate comparisons of angioembolization and neoadjuvant targeted therapy on unresectable renal cell carcinoma.

Methods: A thorough search across databases such as PubMed, Cochrane Library, and ProQuest was conducted for articles published from 2018 to 2023. To uphold research integrity, duplicates, reviews, and incomplete articles were excluded, ensuring only pertinent and original research findings for subsequent analysis.

Results: Database search yielded 247 articles, which were systematically eliminated, leaving 6 relevant articles. Analyzed articles showed the overall survival of patients treated with angioembolization and neoadjuvant agents.

Conclusion: Unresectable RCC can be treated palliatively with angioembolization. Angioembolization may improve clinical effectiveness and lessen side effects by boosting local concentrations of drugs. Drug-eluting bead transarterial chemoembolization is a novel embolization option that can embolize the arteries that feed the tumor and cutoff the blood supply to the tumor. Sunitinib, the most studied medicinal agent, was found to have higher effectiveness when combined with angioembolization.

Objectives: The objective of the study was to investigate the long-term outcome and complication rate of laparoscopic sacrocolpopexy (LSC) using self-cut mesh as pelvic organ prolapse treatment.

Methods: A retrospective cohort study on patients undergoing LSC was done at Kameda Medical Center from January 2013 to January 2018. Data for this study were taken from all women with pelvic organ prolapse who had undergone LSC using self-cut polypropylene mesh. Patients with a previous history of hysterectomy were excluded from the study. An evaluation was done preoperatively, on 6-month and 1-year postoperative follow-up period using Pelvic Organ Prolapse Quantification (POP-Q) and The International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) questionnaire.

Results: There were 702 subjects who met the inclusion and exclusion criteria. The clinical characteristics of the subjects were recorded. The scores during admission, 6 months and 1 year postoperative are: POP Q scores: 6.50 ± 5.69 vs. 5.11 ± 4.85 vs. 4.78 ± 4.31, P = 0.049 and ICIQ SF scores: 2.92 ± 0.62 vs. 1.10 ± 0.36 vs. 1.13 ± 0.41, P < 0.001). A total of 17 (2.4%) perioperative and postoperative complications were observed on subjects.

Conclusion: LSC using self-cut mesh could produce satisfactory results in pelvic organ prolapse patients on 6-month and 1-year follow-up period with minimal perioperative complications.

Introduction: Retrograde intrarenal surgery (RIRS) is the standard treatment for renal calculi. Direct visualization and fragmentation are its major advantages. The variable stone clearance rates and the ergonomic challenges faced by urologists are a few limitations. Table tilt enhances stone clearance and improves surgical ergonomics by facilitating better access to stones and reducing procedural strain.

Subjects and methods: In this prospective study, patients with intrarenal calculi were randomized into standard lithotomy RIRS (S-RIRS) and table-tilted RIRS (T-RIRS) groups. Specified table tilts were suggested for each of the stone locations. The outcomes with regard to stone clearance, operative and lasing time, and ergonomics were studied.

Results: About 100 patients were studied, with 50 in each group. The overall operating time and lasing time in the T-RIRS group were less than that in the S-RIRS group (P < 0.001). The complication rates were the same in both groups. Most surgeons felt that the surgical ergonomics was better in the T-RIRS group (P < 0.001). When stone-free status was analyzed, seven patients in the S-RIRS group and one in the T-RIRS group had residual stones. The mean Borg category-ratio 10 (CR-10) scores in the S-RIRS and T-RIRS groups were 4.18 and 2.20, respectively (P < 0.001).

Conclusions: This is the first study to document the distinct advantages of T-RIRS and its benefits on surgical ergonomics. T-RIRS resulted in significantly shorter operative and lasing times, particularly for stones in lower calyces. Surgical ergonomics, assessed by the Borg CR-10 scale, were significantly better in the T-RIRS group. T-RIRS should become a standard of care for patients undergoing RIRS.

Background: We present retrospective data of patients with nonmuscle invasive bladder cancer (NMIBC) who underwent restaging transurethral resection of bladder tumor (Re-TURBT) at a tertiary care center.

Materials and methods: Records of all NMIBC patients undergoing Re-TURBT between March 2021 and September 2023 were retrospectively analyzed. Patients were risk stratified based on TURBT pathology. Re-TURBT was performed between 4 and 6 weeks. Adverse features such as number, size, and appearance were noted. Patients with persistent disease at Re-TURBT were counseled for early cystectomy with urinary diversion or intravesical Bacillus Calmette-Guerin (BCG). In case of disease upstaging, patients were counseled for radical cystectomy.

Results: Thirty-eight NMIBC patients (30 males and 8 females) underwent Re-TURBT. Six patients had residual/persistent disease at 6 weeks, all high risk and high grade (HG, P value not significant, P = 0.31). There was no association with number and appearance of tumors with residual/persistence at 6 weeks. The mean lesion size on imaging in cases with and without residual disease was 3.32 ± 0.86 versus 3.39 ± 0.92 cm, respectively, P value not significant (0.868). There was no residual disease in the low-grade (LG) pT1 group, but HG pTa and pT1 (n = 3) had residual disease. Four HG pT1 patients opted for early cystectomy. Two patients each had pT0 and two pT2. At 3 months of follow-up, urethral strictures were seen both in high risk and intermediate risk. Among four patients who had stricture, meatal stenosis was common (50%, n = 2). Two patients had long-segment stricture requiring perineal urethrostomy with stage I Johannsen repair. All HG pT1 lesion patients eventually underwent cystectomy (3 were under staged and two treated completely with TURBT, one with TURBT + BCG and one patient progressed to metastasis).

Conclusion: Re-TURBT is essential for the management of HG pTa and HG pT1 lesions for accurate staging and treatment of residual disease. However, LG pT1 patients can safely be excluded from Re-TURBT.

Purpose: Urolithiasis in infants is uncommon. Percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and retrograde intrarenal surgery (RIRS) are the management options. RIRS is the least studied of these options in infants. In our series of 23 cases, we aim to assess the feasibility, efficacy, and safety of RIRS in <1-year age group.

Materials and methods: This was a retrospective analysis of a series of 23 infants who underwent RIRS in our hospital from January 2018 to March 2021. Children who were <12 months of age and had the largest stone size of <20 mm were included in the study.

Results: Twenty-three patients (male - 15; female - 8) were included in the study. The mean age was 10 ± 2.31 months (range, 4-12 months). The mean stone size was 11.6 ± 2.96 mm (range, 7.5-19 mm). The mean operative time was 29.44 ± 7.45 min (range, 17-42 min). Six patients (22.2%) had mild hematuria (Clavien I), and seven patients (25.9%) had postoperative fever. Stone size had a significant positive correlation with laser time, operative time, and intraoperative intravasation, but no significant association with stone-free rate. At 2-month follow-up, 4 (three patients) out of 27 renal units had residual stones (stone-free rate [SFR] - 85.1%). No patient had long-term complications like urethral or ureteric stricture or stone recurrence during the given follow-up period.

Conclusion: RIRS is a feasible and minimally invasive treatment for renal stones in infants with acceptable SFRs.

Objective: Laparoscopic repair of vesicovaginal fistula (VVF) is gaining popularity day by day, but we have limited literature on it. This study is to evaluate the safety, feasibility, and outcomes of laparoscopic VVF repair in a tertiary care center in Eastern India.

Subjects and methods: This study is a single-center retrospective study in which 11 patients of supratrigonal VVF were evaluated who underwent laparoscopic repair. Preoperative workup included history, examination, computed tomography urography, cystoscopy, and vaginoscopy. After informed consent, laparoscopic VVF repair was done under general anesthesia. Duration of surgery, the need for conversion to open procedure, intraoperative bowel injury, the need for postoperative blood transfusion, postoperative hospital stay, postoperative urinary leak, and any incontinence after catheter removal were noted.

Results: All the patients had primary supratrigonal fistula of approximate size in the range of 1.5-2.0 cm. All the included patients were operated on successfully by laparoscopic technique with a mean duration of surgery of 177.91 ± 6.14 min. The mean duration of postoperative hospital stay was 4.45 ± 0.52 days. There was no incidence of postoperative urine leak in any patient. After urethral catheter removal, all the patients voided well without any incontinence.

Conclusions: Laparoscopic VVF repair is a safe and feasible option with satisfactory intraoperative and postoperative outcomes.

Purpose: The purpose of this study was to evaluate risk factors associated with positive urine cultures following holmium laser enucleation of the prostate (HoLEP).

Materials and methods: The data from a prospectively maintained database were analyzed to evaluate urine culture results following HoLEP and determine the contribution of predefined variables (age, prostate size, Charlson comorbidity score, surgical time [surrogate for case difficulty], the presence of a catheter preoperatively, postoperative urinary retention, and preoperative positive culture) on urine culture positivity at 60 days postoperatively. Statistical analyses included logistic regression and ANOVA.

Results: The data from 136 subjects were included in the database and were evaluated at a median of 13.37 ± 6.72 months after their HoLEP. Postoperative positive cultures were noted in 23 subjects (16.91%). Preoperative positive cultures were found to predict positive postoperative urine cultures (odds ratio: 3.78, confidence interval: 1.18-12.78, P = 0.03). However, the preoperative and postoperative results were discordant in 9 of 14 subjects with both positive preoperative and postoperative cultures.

Conclusions: Positive preoperative cultures were predictive of positive postoperative cultures. However, the pre- and postoperative results were often discordant. Host factors increasing susceptibility to bacteriuria may explain these findings.

Introduction: Renal cell carcinoma (RCC) often develops a tumor thrombus extending into the inferior vena cava (IVC). Radical nephrectomy with IVC thrombectomy is the standard treatment, although prognostic factors are yet to be properly established.

Objectives: The objectives of this study were to review the clinicopathological features of surgically treated patients with RCC and IVC thrombus and to investigate potential prognostic factors.

Materials and methods: This retrospective analysis covered patients with RCC and IVC thrombus who underwent surgical treatment at a tertiary center over 12 years.

Results: Of the 32 patients included, 56% and 41% had nodal (N1) and metastatic (M1) diseases, respectively. Thrombus level was 1 in 25% and 4 in 21.9% of cases, according to the Mayo classification. The median follow-up was 17.0 months. The median overall survival (OS) was 20.0 months, with a median OS of 36.0 months in M0 patients and 10.0 months in M1 patients (log-rank P = 0.029). Stage IV disease (T4 and/or M1 status) (hazard ratio [HR]: 2.85, P = 0.021), fat invasion (HR: 2.52, P = 0.044), positive margins (HR: 2.54, P = 0.037), American Society of Anesthesiologists score (HR: 2.59, P = 0.033), tumor size >100 mm (HR: 2.538, P = 0.033), and higher neutrophil-to-lymphocyte ratio (r ² = 0.304, P = 0.001) were significantly associated with worse OS in univariate analysis. Thrombus level did not impact prognosis.

Conclusions: Certain clinicopathological factors, but not thrombus level, appear to influence prognosis. Prospective multicentric randomized studies are needed to better stratify patient risk, improve prognostic prediction, and evaluate systemic therapy responses.