World Journal of Urology最新文献

Purpose: Buccal mucosal grafts have a well-established role in urology regarding the management of ureteric stricture disease. Despite its established use as a graft material there is a lack of data on the mechanical properties of buccal mucosa. We aim to compare the passive mechanical properties of porcine buccal mucosa with the ureter.

Materials and methods: Buccal mucosa (n = 20) and ureteric specimens (n = 21) were harvested from 19 domestic pigs at the time of euthanasia. Mechanical testing was performed using a uniaxial tensometer to generate stress-strain curves. From these curves, ultimate tensile strength and elastic modulus were calculated. Data was analysed, and one-way ANOVA testing was used to assess for significance variation in mechanical response due to direction of testing, and between tissue types.

Results and conclusions: Porcine ureteric specimens displayed mechanical anisotropy, with a significant difference in the elastic modulus depending on the direction of testing (p = 0.005), and a higher mean ultimate tensile strength in the longitudinal (498.09 kPa) compared to the transverse (263.99 kPa) direction (p = 0.0005). Buccal mucosa was isotropic with no significant difference in elastic modulus or ultimate tensile strength according to direction of testing. Comparison of tissue types showed a significantly greater mean ultimate tensile strength in the longitudinal direction (p = 0.002) in ureter compared to buccal mucosa. We present the first comparison of the mechanical properties of buccal mucosa with ureter, and demonstrate significant variation in elastic modulus and ultimate tensile strength between the tissue types. These findings have important clinical implications for physiological function and in the design of alternative approaches for reconstruction in buccal mucosa grafted ureters.

Purpose: To evaluate the predictors of delayed discharge for patients undergoing robot-assisted partial nephrectomy (RAPN) at our Institution since the introduction of the single port (SP) robotic system.

Methods: We performed a retrospective review of our prospectively maintained database of patients undergoing RAPN from September 2020 to August 2024. Patients were categorized by the postoperative day of their discharge: POD1 (single overnight stay) or POD > 1 (more than one night stay). Multivariable logistic regression analysis was used to test the probability of prolonged hospital stay (defined as more than one night stay) adjusting for age at surgery, surgical approach, Charlson comorbidity index, baseline hemoglobin, antiplatelet or anticoagulant medications, clinical tumor stage, and intraoperative blood transfusion.

Results: Overall, 255 patients were identified for the analysis. Patients discharged on POD1 were younger (p = 0.004), reported a lower Charlson Comorbidity Index (p = 0.002), higher preoperative hemoglobin levels (p = 0.005), and smaller tumor size (p < 0.001). Higher rates of discharge on POD1 were recorded for both multiport transperitoneal (59.5 vs. 40.5%, p = 0.02) and SP retroperitoneal (81.5 vs. 18.5%, p = 0.004). Clinical tumor stage (p = 0.02) and intraoperative blood transfusion (p = 0.05) emerged as independent risk factors for POD > 1. Baseline hemoglobin emerged as a protective factor (p = 0.05) as well as SP approach (p = 0.03).

Conclusion: SP-RAPN holds potential to shorten hospitalization without hampering surgical outcomes. By maximizing the adoption of a RP approach and minimizing surgical invasiveness, SP robotic surgery allows to significantly expand the pool of RAPN patients that can be discharged after a single overnight stay.

Purpose: Controversies exist regarding the prevailing spectrum of microorganisms in microbial ureteral stent colonization (MUSC) and their clinical significance. The aim of this comprehensive review is to determine the predominant microbial spectrum in patients with an indwelling ureteral stent in comparison to catheter-associated urinary tract infections (CAUTI) and uncomplicated urinary tract infections (UTI).

Methods: Google scholar, PubMed, Embase, Medline, and Cochrane literature databases were searched from inception to April 2022 to identify manuscripts on MUSC, uncomplicated UTI and CAUTI. A principal component analysis (PCA) was performed to identify patterns of the pathogen spectrum of the different groups.

Results: We included 29 studies on MUSC, 28 studies on uncomplicated UTI and 23 CAUTI studies. The proportion of Staphylococci, Enterococci and Candida were significantly higher in MUSC and stent associated bacteriuria compared to their proportion in uncomplicated UTIs where E. coli dominates. By comparing MUSC, CAUTI and UTI with a PCA, the detected pathogen spectrum exhibited clearly distinguishable trends in the frequency of the main isolated pathogens influencing these three groups of urinary tract infections. With respect to MUSC and UTI, their 95% confidence interval ellipse only showed minimal overlap emphasizing that the spectrum of pathogens in the two groups is clearly distinct.

Conclusions: The frequency of detection of Staphylococci, Enterococci and Candida is more common in MUSC as compared to UTI. Thus, patients with indwelling ureteral stents should undergo an antimicrobial prophylaxis targeting this microbial spectrum in case of further surgery.

Purpose: The artificial urinary sphincter (AUS) remains the gold standard to treat stress urinary incontinence related to sphincter insufficiency in patients with neurogenic lower urinary tract dysfunction (NLUTD). This study aims to assess the incidence of de novo neurogenic detrusor overactivity or low bladder compliance after AUS implantation in adult spinal cord injured patients.

Methods: Retrospective observational study, descriptive by analysis of the medical records of patients followed in a department of Neuro-Urology from January 01, 2003 to March 31, 2023. The procedures followed were in accordance with the regulations of the Clinical Research and Ethics Committee and the Declaration of Helsinki of the World Medical Association.

Results: Thirty-nine patients with spinal cord lesion were included. The incidence of de novo low bladder compliance or neurogenic detrusor overactivity with high pressure (≥ 40 cmH₂O) was 48.72% with a median onset delay of 11 months (IQR 8-55.5) after surgery. The need for medical treatment for the detrusor overactivity prior to AUS insertion was associated with deterioration of cystometric parameters at 2 years (p = 0.032).

Conclusion: This study reveals an important incidence of deterioration in cystometric parameters after AUS implantation in patients with spinal cord injury. A larger prospective study is needed to confirm these results and to identify risk factors.

Background: Circumcision is essential for male health, yet traditional methods are plagued by issues such as lengthy operative times, bleeding, and slow recovery. This study explores the application of biological welding technology in circumcision, assessing its potential as a safe and efficient novel surgical approach.

Methods: In this study, 24 male adult dogs were randomly divided into two groups. The biological welding group underwent circumcision using biological welding technology, while the control group received traditional cut-and-suture circumcision. Clinical indicators such as surgical time, blood loss, pathological changes, and recovery time were observed and compared.

Results: The biological welding group had a significantly shorter surgical time compared to the control group (2.33 ± 0.55 min vs. 27.06 ± 5.77 min, p < 0.001). The control group had an average blood loss of 22.35 ± 5.17 ml, whereas the biological welding group experienced zero blood loss (p < 0.001). Recovery time was also significantly shorter in the biological welding group (12.33 ± 3.50 d vs. 16.50 ± 2.57 d, p = 0.004), with a lower incidence of postoperative complications. Pathological analysis indicated that the thermal injury range in the biological welding group was controlled within 2 mm.

Conclusion: Biological welding technology demonstrated advantages in circumcision, including short surgical time, no bleeding, minimal thermal damage, and rapid recovery, proving to be a safe and effective novel circumcision technique with potential clinical application value.

Purpose: Urgency urinary incontinence (UUI) is a prevalent condition with significant implications for quality of life, yet its association with mortality was less examined by a few studies. Using data from representative U.S. population, this study aims to investigate the relationship between UUI and cause-specific mortality.

Methods: We utilized data from the NHANES collected between 2005 and 2014, comprising 21,973 patients (median age 49, 50.3% male). All data were combined with the National Death Index (NDI), which assessed mortality in December 2019. UUI was characterized by at least one incident of involuntary urination before reaching a toilet within a year. The Cox regression analysis was applied to compute the adjusted hazard ratios for mortality, with further subgroup and cause-specific analyses to assess the differential risk of mortality associated with UUI.

Results: Of the participants, 21.8% (4781/21,973) reported experiencing UUI over the year. The average duration of follow-up was 9.3 years, during which 2968 (13.5%) subjects passed away. Controlling for potential confounders, individuals with UUI exhibited an elevated mortality risk. Interaction analyses did not show statistical interactions between UUI and age- and sex-stratified subgroups. However, the findings were consistently indicative of an increased risk of mortality from cardiovascular disease, cancer and other causes.  CONCLUSIONS: UUI presents a significant burden across all ages and sexes, being associated with various conditions and an increased risk of overall mortality including cardiovascular disease and cancer-related death. The causal relationship between UUI and mortality can provide a basis for understanding the mechanism.

Purpose: To investigate the current thoughts and perspectives on kidney stone analysis amongst urologists and urology residents worldwide.

Methods: In October 2022 an online survey supported by the EULIS was circulated amongst urologists and urology residents worldwide. The survey was based on the current EAU guidelines regarding stone analysis and its role in urolithiasis management. Responses were collected until February 2023.

Results: The survey was completed by 351 urologists (75.4%) and 115 urology residents (24.7%). 49.1% of the participants stated that performing kidney stone analysis was of utmost importance in every patient. 91.8% were of the opinion that stone analysis changes KSD management. 62.3% of the participants declared to adhere to the guidelines. 44.7% aim to perform stone analysis in first-time stone formers. 1 out of 11 does not send stones for kidney stone analysis at all. Urologists that pursued an additional endo-urology sub-specialism performed stone analysis more frequently compared to those who were not endo-urologists.

Conclusion: Although majority of urologists consider stone analysis an essential part of kidney stone management, in reality the practice patterns regarding stone analysis deviate from the EAU guidelines. Our aim should be to bridge the knowledge gap regarding stone analysis, foster collaboration to streamline logistics regarding stone analysis and enhance the quality of care we provide for kidney stone patients.