World Journal of Urology最新文献

Purpose: Caudal analgesia (CA) is a widely used method to tackle pain after hypospadias repair. Complications related to temporary penile engorgement has made people concerned about CA and switch to pudendal analgesia (PA). In this prospective randomized blinded study we compared CA and PA among children undergoing hypospadias repair. We hypothesized that pudendal analgesia would be equally effective as caudal analgesia, with no altered risk of surgical complications.

Methods: All children undergoing single-stage distal hypospadias repair were randomized into CA or PA groups. In both groups, analgesia was provided under ultrasound guidance with 0.2% ropivacaine and 1 mcg/kg clonidine. FLACC score (Face, Leg, Anxiety, Crying, Consolability) for pain and urethroplasty complications were compared between the groups.

Results: During the study period, a total 72 patients were recruited (36 in each group). There was no significant difference between the groups in terms of FLACC score.Rescue analgesia was required in 2/36 (5%) in CA and 3/36(8%) in PA with no significant difference (p = 1). Post-operative complications were encountered in 4/36 (11.1%) in CA (1 glans dehiscence, 2 fistulae, 1 partial skin-flap necrosis) while 3/36 (8.3%) in PA group (1 glans dehiscence, 2 fistulae) with no significant difference (p = 1).

Conclusions: There was no difference between CA and PA in terms of analgesic effects or postoperative complications. While PA is as effective in pain relief, conventional CA is not associated with higher complications. Further larger studies are warranted comparing penile, caudal and pudendal blocks in hypospadias.

Purpose: Prostate cancer is under-researched in many Asian countries because the paucity of comprehensive cancer registries has prevented large studies from comparing primary prostate cancer therapies. We aimed to provide further insights into recent trends in primary prostate cancer management across multiple Asian countries and regions according to universal health coverage.

Methods: This is part of the Asian Prostate Cancer (A-CaP), a prospective and multicenter study conducted in 12 Asian countries. The study cohort comprised patients newly diagnosed between January 2016 and December 2018. Patients were allocated to three categories according to the universal health coverage effective coverage index (Category 1 ≥ 80; Category 2, 70-79; and Category 3, < 70). We assessed primary management of prostate cancer according to these categories and by clinic pathological characteristics such as clinical stage, and D'Amico risk group.

Results: In total, 34,994 patients were included in the final analysis. Category 1 had the highest proportion of patients diagnosed at early stages and Category 3 had the highest proportion of patients diagnosed at advanced stages. Most patients in Category 1 had undergone computed tomography scans, magnetic resonance imaging, and bone scans. In contrast, only 1.7% and 5.4% of men in Categories 2 and 3, respectively, had undergone all three of these investigations. The proportion of patients who had undergone radiation and androgen deprivation therapy as primary treatment was highest in Category 1, whereas the rate of conservative management was highest in Category 2. More patients in Category 3 than in the other two categories had undergone radical prostatectomy, but fewer had been treated with radiation therapy.

Conclusions: Our findings highlighted differences in patterns of treatment of newly diagnosed prostate cancer across 12 Asian countries and regions and suggest that, despite guidelines, health access affects treatment received.

Background: Laser Anatomical Endoscopic Enucleation of the Prostate (LAEEP) techniques offer a promising solution for patients seeking to alleviate urinary symptoms while preserving sexual function. The ejaculation preservation approach has been shown to achieve an impressive 90% success rate in maintaining antegrade ejaculation.

Purpose: To explore the effect of the ejaculatory preservation HoLEP technique on postoperative continence and ejaculation.

Patients and methods: We conducted a prospective randomized study adhering to CONSORT guidelines. Patients with prostate sizes between 40 and 80 gm, IPSS scores > 20, Qmax < 10 ml/s, and IIEF-5 scores  > 22 were eligible for inclusion. A total of 43 patients were randomized into two groups: Group 1 (n = 22) underwent HoLEP, while Group 2 (n = 21) underwent EP HoLEP. We assessed functional outcomes and ejaculatory dysfunction at baseline and 1-, 3-, and 6- month. The study period was from October 2022 to March 2024.

Results: Data from 40 patients were analyzed. Functional outcomes showed significant improvement in Group 1, with IPSS (median 12.5, P < 0.006) and Qmax (median 15, P < 0.04) at 3-month. ICIQ-UI SF scores showed a significant difference in the incontinence episodes (domain Q3), which were lower (P < 0.023) in Group 2 compared to Group 1 during the 1-month visit. MSHQ-EjD-SF scores were significantly higher in Group 2 at both 3- and 6- month (P < 0.01 and P < 0.02, respectively). IIEF-5 scores showed no significant difference between both groups during the study period.

Conclusion: Implementing the ejaculation preservation technique during HoLEP appears to improve early postoperative continence and preserve ejaculation.

Purpose: Endoscopic lithotripsy has become widely adopted worldwide and is considered the gold standard for managing upper urinary tract lithiasis. One of its possible complications is post-operative infection. We aimed to review available literature about the role of preoperative antibiotic prophylaxis and its indications.

Methods: We performed a systematic search of the literature including "ureteroscopy", "PNL", "retrograde intrarenal surgery", "antibiotic prophylaxis" and "sepsis" as keywords. Out of 760 relevant studies only 13 met our inclusion criteria: at least 10 adult patients (≥ 18 years old) diagnosed with kidney or ureteral stones; antibiotic prophylaxis described and reported; post-operative sepsis, UTI or SIRS assessed.

Conclusions: Antibiotic prophylaxis strategies for stone surgery show different degrees of effectiveness depending on both the approach and the patient's condition. Today's evidence suggests that while routine antibiotic prophylaxis might not be necessary for all patients with sterile urine undergoing ureterorenoscopy and lithotripsy vs. percutaneous nephrolithotripsy, for those patients with positive preoperative urine cultures it is beneficial reducing the risk of postoperative infective complications.

Purpose: To assess the 30-day stone-free rate and peri-operative outcomes of flexible ureteroscopy (FURS) with flexible and navigable suction ureteral access sheaths (FANS) in adults undergoing same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS).

Methods: Prospectively data of 115 adult patients with bilateral kidney stone disease undergoing SSB-RIRS across 14 global centers between July 2023 and March 2024 were analyzed. Patient demographics, stone characteristics and operative outcomes were recorded. A low-dose non contrast CT scan was performed at 30 days to assess the stone-free rate and clinical outcomes.

Results: Overall bilateral zero residual fragment(ZRF) was 42.6%; unilateral ZRF was 75.7%. Only two patients were noted to have residual fragments > 4 mm. 1.7% experienced Traxer-Thomas grade 1 ureteric injury which was managed with a ureteral stent for four weeks. No pelvicalyceal injury occured. Postoperative mean loin pain score was 1.7 ± 1.0. None had sepsis nor required blood transfusion. 4.3% required readmission within 30 days of surgery. Multivariate analysis indicated longer total operation time correlated with lower odds of achieving a 100% bilateral stone-free (ZRF) (OR 0.978, 95%CI = 0.959-0.994, p = 0.013).

Conclusion: To our knowledge, this is the first multicenter study demonstrating the use of FANS in SSB-RIRS can achieve bilateral ZRF with low complication and re-intervention rates. However, prolonged surgical time may negatively impact outcomes. The indications of bilateral renal stones management with FURS can be expanded in appropriate chosen patients.

Purpose: Pelvic mesh has been used for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Between 3 and 20% suffer complications with debilitating long-term outcomes. Uncommon complications include mesh perforation into viscus however there is minimal published data regarding outcomes following surgical management.

Methods: A retrospective observational study of patients with diagnosis of mesh in viscus at three tertiary urogynaecology units was performed to report on clinical outcomes following surgical management.

Results: Fifty-eight patients were diagnosed with mesh in viscus following cystourethroscopy and thorough examination of vagina/rectum. Mesh involved included mid-urethral slings-retropubic (36.9%), transobturator (18.5%), single incision slings (10.8%); transvaginal POP mesh (15.4%); sacrocolpopexy (13.8%); uncertain type (4.6%). Viscus involved included bladder (39.7%), urethra (50%), bladder and urethra (3.4%), and rectum (6.9%). Main presenting symptoms included mixed urinary incontinence (UI) (75.9%), recurrent urinary tract infections (rUTIs) (48.3%) and rectal/pelvic pain (56.9%). Fifty-one patients underwent mesh excision and viscus repair, with successful repair in all (100%). 48% had complete mesh excision. Mean follow up was 9.5 months (range 0.5-96 months). Post-operatively, there was a statistically significant reduction in rUTIs (p = 0.0004) as well as pain (p = 0.000005). None had recurrent mesh erosion, lower genitourinary tract fistula or wound breakdown.

Conclusions: All patients required thorough examination and cystourethroscopy for diagnosis. Surgical management of mesh in viscus appears to have low morbidity and is shown to reduce symptoms of rUTIs and pain as well as risk of recurrent mesh erosion and fistulae.

Background: Urolithiasis, a prevalent condition characterized by a high rate of incidence and recurrence, necessitates accurate preoperative diagnostic methods to determine stone composition for effective clinical management. Current diagnostic practices, reliant on postoperative specimen analysis, often fail to facilitate timely and precise therapeutic decisions, leading to suboptimal clinical outcomes. This study introduces an artificial intelligence model developed to predict infectious and non-infectious urolithiasis preoperatively using clinical data and CT imaging.

Methods: Data from December 2014 to November 2021 involving 642 patients undergoing surgical treatment for urolithiasis were used to train and validate the model. The model integrates Visual and Textual Transformation (VTT) and Multimodal-Segmentation Attention Fusion (MSAF) modules to enhance the diagnostic process.

Results: The model demonstrated superior accuracy and reliability in differentiating between infectious and non-infectious urolithiasis compared to traditional diagnostic methods. It achieved a classification accuracy of 79.66%, Area Under Curve of 86.74%, significantly outperforming conventional ResNet architectures and similar models. The inclusion of clinical parameters substantially improved the model's predictive capabilities.

Conclusions: Our model provides an efficient tool for the preoperative identification of urolithiasis type, supporting clinical decisions regarding surgical planning and postoperative care. Its ability to process and analyze complex clinical and imaging data preoperatively positions it as a valuable adjunct in urological practice, particularly in settings with limited access to specialized medical resources.

Purpose: Endoscopic enucleation of the prostate (EEP) is a preferred treatment for benign prostatic hyperplasia (BPH). This bibliometric analysis aims to analyze the application trends and research hotspots of EEP.

Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science Core Collection from 1989 to 2023. The techniques examined include holmium laser enucleation (HoLEP), thulium laser enucleation (ThuLEP/ThuFLEP), bipolar/monopolar transurethral enucleation (b-TUEP/m-TUEP), GreenLight laser enucleation (GreenLEP), and diode laser enucleation (DiLEP). We utilized VOSviewer, CiteSpace, and the R package 'bibliometrix' for the analysis.

Results: A total of 739 English-language studies were analyzed, revealing a steady increase in EEP-related publications. HoLEP was the most extensively studied technique, followed by ThuLEP and b-TUEP, while ThuFLEP gaining emerging interest. There has been a notable lack of high-quality randomized controlled trials (RCTs) for GreenLEP, DiLEP and m-TUEP. China, the United States, and Germany led in publication volume and collaboration networks. Key contributors in the field were identified, with recent research focusing on topics like postoperative transient urinary incontinence (TUI) and the role of robot-assisted simple prostatectomy (RASP) in comparison to EEP.

Conclusions: EEP is gaining widespread clinical acceptance for BPH treatment. Future research should focus on addressing the gap in high-quality RCTs, especially for underexplored techniques like GreenLEP, DiLEP and m-TUEP, and explore strategies to reduce postoperative TUI. Prospective comparisons between RASP and EEP will be crucial for optimizing surgical approaches in BPH management.

Aim: This study aims to evaluate the success rate of Shock Wave Lithotripsy (SWL) in treating kidney stones using the Modulith SLK Inline lithotripter, with a focus on the importance of device efficacy as emphasized in EAU guidelines.

Patients and methods: This retrospective single-center study was conducted between June 2023 and June 2024. Inclusion criteria were adult patients (> 18 years) with radiologically confirmed renal stones smaller than 15 mm in diameter. Exclusion criteria included patients with solitary kidneys, significant renal functional deterioration, skeletal deformities, active urinary tract infections, pregnancy, or coagulopathies. Treatment outcomes were collected and analyzed in detail, considering patients' demographic characteristics (age, gender) and stone parameters (size, location, and hardness [Hounsfield Unit, HU]). The SWL procedures were performed using the Modulith SLK Inline lithotripter (Storz Medical, Switzerland). The success of SWL was defined as achieving complete stone clearance or the presence of clinically insignificant residual fragments (CIRF) (< 4 mm). This study seeks to provide detailed insights into the optimal use cases of SWL as a non-invasive yet effective treatment option for smaller, more manageable stones.

Results: The mean age of the 208 patients included in the study was 42.2 ± 12.7 years (18-75), with a male-to-female ratio of 1.9:1. The mean stone size across all patients was 10.3 mm, and the average HU value was 874.0 ± 283.2. Patients who achieved a completely stone-free status had significantly lower HU values (p = 0.049). The overall success rate of SWL was 78.8%, with 164 patients achieving complete stone clearance. When cases with clinically insignificant residual fragments (CIRF, < 4 mm) were included as successful outcomes, the overall success rate increased to 92.3%. This distinction highlights the inclusion of patients with small residual fragments that are deemed clinically irrelevant in the adjusted success rate. In cases with successful outcomes, the mean stone size was 10.3 mm, whereas it was 12.5 mm in patients with residual fragments or treatment failure. A statistically significant relationship was identified between stone size and treatment success rates (p < 0.001). In contrast, stone localization did not have a significant impact on SWL success rates (p = 0.377).

Conclusions: SWL has demonstrated its effectiveness in kidney stone treatment with a 78.8% complete stone-free rate using the Modulith SLK Inline lithotripter. Higher success rates were achieved with smaller stones (< 15 mm) and lower HU values. These findings support the significance of advanced lithotripter technology in establishing SWL as a valuable non-invasive option for stones under 15 mm.

Objectives: To evaluate the occurrence, risk factors, and outcomes of post PCNL (Percutaneous Nephrolithotomy) Acute Kidney Injury (AKI), with a secondary goal of developing a nomogram for post-PCNL AKI prediction.

Methods: A prospective observational study was conducted enrolling 333 patients who underwent PCNL between February 2022 and February 2023. Patient demographics, comorbidities, perioperative lab parameters, stone characteristics, intraoperative details, and postoperative AKI were assessed. Logistic regression analyses were employed to construct a nomogram for predicting post-PCNL AKI.

Results: 40 patients (12.4%) experienced postoperative AKI, with recovery observed in all cases during the 3-month follow-up. Female gender (p = 0.002), hypertension(p = 0.022), higher serum uric acid levels(p = 0.003), staghorn calculi(p = 0.001), higher Hounsfield Units(p = 0.013), bilateral PCNL(p < 0.001), larger tract size(p = 0.017), longer operative time(p < 0.001), greater stone volume(p = 0.025), higher baseline serum creatinine levels(p < 0.001), higher postoperative total leukocyte count(p = 0.005), and postoperative fever(p < 0.001) were significantly associated with the AKI group. Regression analysis identified female gender (OR = 0.26, p = 0.035), higher serum uric acid levels(OR = 1.62, p = 0.013), bilateral PCNL(OR = 12.55, p < 0.001), longer operation time(OR = 1.02, p = 0.047), and larger stone volume(OR = 1.12, p = 0.015) as independent risk factors for postoperative AKI. The internally validated nomogram(n = 70) for predicting AKI demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.984(95% CI, p < 0.001).

Conclusion: AKI occurs in approximately 12% of patients undergoing PCNL. We identified several significant predictors of post-PCNL AKI, including female gender, hypertension, hyperuricemia, higher Hounsfield units, larger stone volume, bilateral PCNL, larger access tract size, and longer operative time. Awareness of these factors is crucial for optimizing management and improving patient outcomes.