World Journal of Urology最新文献

Aims: To assess the outcomes of robotic surgery for patients with neurogenic lower urinary tract dysfunctions (NLUTD).

Materials and methods: Studies evaluating the outcomes (efficacy and safety) of robot-assisted ileal conduit creation or artificial urinary sphincter (R-AUS) implantation or augmentation cystoplasty or continent urinary diversion creation in patients with NLUTD were included. The search strategy and studies selection were performed on Medline, Embase and Cochrane using the PICOS method according to the PRISMA statement (PROSPERO 2022 CRD42022333157). The comparator, if available, was the use of open or laparoscopic technique. Meta-analysis was performed whenever possible. The remaining articles were synthesized narratively.

Results: Eight articles were included. Five described the outcomes of robot-assisted cystectomy with ileal conduit creation, two described the outcomes of augmentation cystoplasty and continent urinary diversion creation and one described R-AUS implantation in patients with NLUTD. The risk of bias was high. Three articles comparing the outcomes of robotic and open cystectomy and ileal conduit creation were suitable for meta-analysis. According to our meta-analysis, robot-assisted surgery had better outcomes compared to open surgery in terms of high-grade early postoperative complications (OR 0.39; 0.19-0.79; p = 0.01), days to bowel recovery (Cohen's D = - 0.62  ± 0.14, p < 0.001), length of hospitalisation (Cohen's D = - 0.28 ± 0.13; p = 0.03) and estimated blood loss (Cohen's D = - 1.17 ± 0.14, p < 0.001).Regarding AUS implantation, augmentation cystoplasty and continent urinary diversion creation, the outcomes from the articles included in our systematic review showed a 16-40% overall early complication rate in case of augmentation cystoplasty and 22% in case of AUS implantation.

Conclusions: Robot-assisted surgery may have several advantages over open surgery in the treatment of NLUTDs. However, current evidence is insufficient to draw firm conclusions. Further high-quality studies are needed to better understand the role of robotic surgery in the treatment of NLUTD.

Purpose: There is lack of evidence regarding the indication for re-transurethral resection of bladder tumor (reTURBT) for Ta high grade (HG) non-muscle invasive bladder cancer (NMIBC). This study aims to evaluate the oncological outcomes of patients with TaHG NMIBC to determine the benefit from performing reTURBT.

Methods: We relied on a multicenter cohort of 317 TaHG NMIBC from 12 centers who underwent TURBT and a subsequent complete Bacillus Calmette-Guérin induction from 2009 to 2021. Kaplan Meier analyses estimated recurrence free survival (RFS) and progression free survival (PFS) according to reTURBT. Sub-analyses evaluated PFS in patients with multiple risk factors indicating necessity for reTURBT according to international guidelines (multifocality, size > 3 cm, recurrent cancer, carcinoma in situ, lymph vascular invasion, histological variant, incomplete and absence of muscle layer at index TURBT). Multivariable cox-regression analysis predicted recurrence and progression.

Results: Of the 317 patients, 123 (39%) underwent reTURBT, while 194 (61%) did not. Residual disease was detected in 46% of cases, with a 3.2% upstaging rate. Median follow-up was 30 months. The 3-year RFS was higher in patients who underwent reTURBT (79% vs. 58%, p < 0.001), but no significant difference was observed in PFS. ReTURBT reduced the risk of recurrence [multivariable hazard ratio: 0.45, 95% Confidence interval (CI) 0.29-0.71]. Among patients who did not undergo reTURBT, those with ≥ 2 risk factors had lower 3-year PFS (73% vs. 92%, p < 0.001) than those with 0-1 risk factor, whereas no difference in 3-year PFS was observed in patients who underwent reTURBT regardless of the number of risk factors (85% vs. 87%, p = 0.8).

Conclusion: ReTURBT demonstrated efficacy in reducing recurrence among patients with TaHG NMIBC, yet its impact on progression remained uncertain. Our study underscores the importance of adhering to current international guidelines, particularly for patients with multiple risk factors indicating necessity for reTURBT.

Purpose: The purpose of this study was to clarify the appropriate cystoscopic interval after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) using a hypothetical model.

Methods: A total of 155 patients who underwent NU in 15 years were retrospectively evaluated. Three hypothetical models for surveillance intervals were created: 3 (model 1), 6 (model 2) and 12 months (model 3). We superimposed these models on the actual surveillance of each patient and analyzed the observed timing of recurrence. The time from recurrence to scheduled cystoscopy (timeRCS) was defined as the time from recurrence to estimated cystoscopy. The gap risk ratio was calculated based on the average of timeRCS for model 1 at 0-1 year after surgery.

Results: The median follow-up was 20.5 months. Intravesical recurrence was observed in 63 patients (40.6%). The 3-year intravesical recurrence-free survival rate in patients without a history of bladder cancer before NU was significantly higher than in those with a history of bladder cancer (61% vs. 42%, P = 0.034). The medians of timeRCS for models 1, 2, and 3 were 1.9, 2.9, and 8.4 months, respectively. The gap risk ratios for model 1 at 1-3 years, model 2 at 2-3 years for patients with a history of bladder cancer, and model 2 at 1-3 years for patients without a history of bladder cancer were less than 1.0.

Conclusion: Model analysis shows that the cystoscopic follow-up interval can be extended depending on the presence or absence of a history of bladder cancer and the time after NU.

Purpose: To assess retrograde intrarenal surgery (RIRS) outcomes in children using ClearPetra, a flexible and navigable suction ureteral access sheath (FANS-UAS).

Methods: Children with kidney stone(s) only undergoing RIRS in 8 centers were prospectively included (September 2023-May 2024).

Exclusion criteria: ureteral stone, bilateral procedures, anomalous kidneys, surgery for residual fragments. Lithotripsy was performed using either a Holmium or Thulium fiber laser. Postoperative pain was assessed within 24 h using a 10-point visual analogue score. The use of FANS-UAS was graded by surgeons after each case using a 5-point likert scale. Low-dose non-contrast CT scan was performed before and within 30 days of RIRS to assess residual fragments (RFs). Stone-free status was defined as no RF or single RF up to 2 mm.

Results: 50 children were included. 66% were male. Mean age was 6.6 (± 3.38) years. 88% stones were < 2 cm. one-third of the patients had a stone volume > 1500mm³. 10-12 Fr FANS-UAS was used in 98% of the procedure. The mean operative time was 46.02 (± 20.72) minutes. 2 patients had Traxer grade1 distal ureter and 2 forniceal injuries on sheath placement. Mean pain score was 2.18 (± 1.34). Mean likert scale was 1.16 (± 0.47) for ease of suction, 1.24 (± 0.52) for manipulation, 1.02 (± 0.32) for visibility. 4 patients had post-operative fever lasting less than 24 h. No sepsis occurred. Stone-free rate was 100%.

Conclusions: Our study shows that the use of FANS-UAS in paediatric RIRS is feasible and safe with a low rate of complications and excellent stone-free rate.

Purpose: This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi.

Methods: The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro.

Results: The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2 cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5 F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts.

Conclusion: TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2 cm or greater, compared to T-UAS.

Purpose: Open simple prostatectomy (OSP) has been a cornerstone in treating large prostate volumes (> 80 ml) in benign prostatic hyperplasia (BPH). With evolving minimally invasive procedures like minimally invasive simple prostatectomy (MISP) and laser enucleation, the role of OSP needs contemporary evaluation. This way, we assessed the efficacy and safety of OSP to understand its current standing in the treatment of BPH, especially in comparison with newer surgical modalities.

Methods: A comprehensive search of MEDLINE, Cochrane and EMBASE was conducted to include randomized controlled trials (RCTs) comparing OSP with other treatments for BPH from 1993 to 2023. A total of 10 RCTs were included in the meta-analysis. Data on various outcomes including IPSS, Qmax, PVR, quality of life, perioperative factors, and postoperative complications were analysed.

Results: Our meta-analysis, covering 557 patients, confirms OSP's significant improvement in voiding symptoms and objective voiding metrics. However, it also reveals a higher incidence of postoperative complications, such as bleeding and transfusion requirements. The study found moderate to high heterogeneity in perioperative outcomes, indicating variations in surgical techniques and postoperative care. OSP remains a reliable option with an easily accessible and effective approach for managing large prostates, despite advancements in minimally invasive surgeries.

Conclusion: OSP continues to be a relevant surgical option for BPH in large prostates, offering significant symptom relief. However, the associated higher morbidity warrants careful patient selection and highlights the need for continued research into optimizing surgical techniques and improving outcomes.

Purpose: The objective of this scoping review was to identify the topics of research and the types of studies published by the French Association of Urologists in Training (AFUF) since it was created, 35 years ago and to perform a bibliometric analysis.

Methods: A scoping review on PubMed, Google scholar, Excerpta Medica database (EMBASE) was conducted from 1989 until the 31st of December 2023. The PRISMA extended guidelines for scoping reviews were followed. Articles were independently screened and analyzed by two reviewers. The theme type, primary results, language of publication, number of male and female authors and number of citations from each included article were extracted.

Results: A total of 32 articles were included among which 17 surveys and 11 cohort studies. There was a median percentage of 20% women among authors. Fifteen articles (47%) were published in French and 17 articles in English. The median number of citations was 4.5. The topics covered were urologist in training's surgical education, well-being, professional practice, and urologic emergencies: renal trauma and spermatic cord torsion. The creation of large national databases enabled the generation of multiple studies focusing on previously under-represented topics.

Conclusion: Over the 35 years since it was created, The AFUF has had an interesting and prolific scientific output. It has shown its concerns for urologists in training.