World Journal of Urology最新文献

Purpose: As Bladder EpiCheck^® (BE) is a promising urinary biomarker for diagnosis and follow up of non-muscle-invasive bladder cancer (NMIBC), there are no studies evaluated this tool for second transurethral resection (TUR) indication. We aim to evaluate the performance of BE in predicting residual tumor before second TUR in NMIBC and its effects on clinical decision making.

Methods: A total of 50 patients who were diagnosed with NMIBC and indicated for a second TUR were included in the study prospectively. The urine sample taken one day before the second TUR operation was evaluated with BE and the results were compared with second TUR pathologies.

Results: The mean age was 65.3 and 45 of the patients were male. Specificity and negative predictive value of BE in primary tumor stage Ta were 100% and 87.5% while in primary tumor stage T1 were 71.4% and 68.2%, respectively. The specificity and negative predictive value of BE were 77.8% and 75%, respectively, in patients with high grade primary tumor. When all NMIBC were evaluated, the specificity and negative predictive value of BE were found to be 78.6% and 73.3% for second TUR, respectively. As an independent predictor of residual tumor in this group, positivity rates of BE were higher in T1 (p < 0.037) and high grade (p < 0.002) tumors.

Conclusions: BE may be useful in detecting residual tumor before second TUR and benefit in clinical decision making with high specificity and negative predictive value. These results encourage the use of BE to reduce number of unnecessary second TUR procedures. It may improve cost effectivity and quality of life as high numbered studies are needed to support these views and to incorporate BE into clinical practice.

Purpose: The Acute Cystitis Symptom Score (ACSS) is a clinically validated instrument to assess symptoms and quality of life in women with uncomplicated urinary tract infections (uUTIs). A previous study examining the content validity of the German version of the ACSS has shown some methodological limitations when rated against the criteria for content validity of the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) initiative. Extending the existing evidence, the present study aimed to assess the content validity of the German version of the ACSS according to the criteria of the COSMIN methodology.

Methods: In individual cognitive interviews following a structured, standardized interview guide, women with a history of uUTI and experts from different medical fields rated the instructions, items, response options and recall period of the ACSS in terms of relevance, comprehensiveness and comprehensibility. Additionally, the Content Validity Index (CVI) was calculated based on expert assessments to quantify content validity.

Results: A total of 14 patients and 14 experts participated in two rounds of interviews. The overall relevance and comprehensiveness of the instrument were rated as appropriate. Modifications focused on improving comprehensibility. Ten items underwent minor modifications or were given examples to enhance comprehensibility. The scales of five items were linguistically revised. Confirming good content validity, CVI was 0.97.

Conclusions: Comprehensive qualitative assessments support content validity of the ACSS for evaluating symptoms and quality of life in women with uUTIs. Minor modifications addressed comprehensibility. Psychometric validation of the revised ACSS is recommended.

Purpose: To compare outcomes of transurethral resection of the prostate (TURP) across different regions worldwide over the past two decades.

Methods: A systematic review and meta-analysis of randomized clinical trials indexed to PubMed that assessed TURP. A total of 102 studies with 8,454 patients were included and grouped by continents: Europe, Asia, Africa, and Others (North America, South America, and Australia). International Prostate Symptom Score (IPSS), peak flow (Qmax), postvoid residual urine (PVR), PSA levels, prostate volume, and Sexual Health Inventory for Men scores (at 3, 12, and 36 months) were assessed, along with postoperative complications. Heterogeneity across studies was classified as low (I² < 25%), moderate (I² = 25-75%), or high (I² > 75%).

Results: TURP consistently exhibited significant enhancements in IPSS, Qmax, and PVR across various regions. Notably, PVR demonstrated high heterogeneity (I²=100%). TURP presented low complication rates with TURP syndrome (2%), bleeding (8%), and blood transfusion (6%). However, significant heterogeneity was observed, particularly for clot evacuation (I² = 87%), irritative symptoms (I² = 96%), and incontinence (I² = 84%). The retreatment rates at 1 and 3 years were 5% and 7%, respectively, with significant differences across regions.

Conclusion: Global outcomes of TURP lack a discernible trend. The substantial heterogeneity observed among continents suggests a lack of standardization. Nevertheless, uniform symptomatic improvements among patients still support TURP as the gold-standard surgical treatment for benign prostatic hyperplasia, despite variations in its results worldwide.

Purpose: The objective of this study was to explore the feasibility of using the TianJi Robot system for navigated needle positioning in the PCNL procedure in vitro.

Methods: A pig kidney with a segment of ureter was selected as the in vitro organ model. Iodine contrast agent was infused into the renal pelvis to dilate the renal pelvis and calyx to establish the in vitro hydronephrosis model. Fluoroscopic images were obtained using a 3D C-arm and transferred to the robotic workstation. Three-dimensional reconstructed images were generated and displayed on the monitor screen. The surgeon planned the optimal puncture trajectory on the workstation. After that, the robotic arm was instructed to move to the surgical field. The guiding cannula was placed onto the robotic arm and brought close to the skin. The needle was placed along the guiding cannula. An 18G needle was inserted manually. Finally, a second CBCT scan was performed to validate the needle's location.

Results: Three hydronephrosis models were used in the study, and a total of seven target calyces were planned. six target calyces were successfully punctured in one attempt, with a single-puncture success rate of 87.5%.

Conclusions: A high single-puncture success rate is achieved using the TianJi Robot system for navigated needle positioning in the PCNL procedure in vitro, marking an innovative step forward in urological interventions.

Purpose: To assess differences in safety and efficacy between 24 and 18 Fr pneumatic balloon dilators for percutaneous nephrolithotripsy (PCNL) of renal stones between 10 and 20 mm.

Methods: Patients were randomized to dilatation with a 24 Fr (Group A) versus 18 Fr (Group B) Ultraxx pneumatic dilator (Cook Medical^®). In all procedures percutaneous puncture was performed under ultrasound guidance. In both groups the Holmium: YAG Cyber Ho laser generator was used (Quanta System^®). Stone-free rate (SFR) and postoperative complications were assessed.

Results: 42 and 44 patients were assigned to Groups A and B, respectively. Preoperative features were comparable. Mean stone size was 17.8 vs. 16.6 mm in Group A vs. B (p = 0.21). SFR was 95.2% in Group A and 95.4% in Group B (p = 0.19). Postoperative gross haematuria was observed in 5 vs. 2 cases in Group A vs. B (p = 0.04). Mean haemoglobin drop at first postoperative day (POD) was higher in Group A (2.4 vs. 1.1 mg/dl, p = 0.04), while comparable at third POD. Blood transfusion was required in 2 cases in Group A and 1 case in Group B. No patients required embolization. No significant difference was observed in terms of postoperative pain and urinary infection.

Conclusions: 24 and 18 Fr pneumatic dilators are both effective to access renal cavity during PCNL for the treatment of renal stones between 10 and 20 mm. Gross haematuria rate and mean haemoglobin decrease at first POD were significantly higher with 24 Fr dilator, but with no differences in the need for blood transfusions and renal embolization.

Objective: To investigate the relationship between the grip strength (GS) and stress urinary incontinence (SUI) after endoscopic enucleation of the prostate (EEP).

Methods: We retrospectively collected 87 patients who underwent EEP at our center from January to December 2023. The associations between GS and post-surgical SUI at immediate, 1, 4, 12 and 24 weeks were analyzed. The cohort was then divided into the SUI and non-SUI group based on the presence of the SUI at 4-week postoperatively.

Results: Of overall 87 patients, 49 (56.3%), 40 (46.0%), 33 (37.9%), 20 (23.0%), and 9 (10.3%) patients presented SUI at immediate, 1, 4, 12 and 24 weeks postoperatively. Significant negative correlations were consistently observed between the GS and SUI till 12 weeks postoperatively, with patients requiring more daily pads presenting lower GS. Compared to the non-SUI group, the SUI group had significantly higher average age (76.0 ± 8.4 vs. 70.1 ± 6.3, P = 0.001), BMI (25.1 ± 2.9 vs. 23.8 ± 2.9, P = 0.040), rates of PKEP (90.9% vs. 72.2%, P = 0.037), CSEA (69.7% vs. 42.6%, P = 0.014) and III/IV ASA score (33.3% vs. 14.8%, P = 0.043), but lower GS (26.2 ± 8.2 vs. 33.3 ± 6.5 kg, P < 0.001). Multivariate analyses identified BMI and GS as independent risk factors for post-operative SUI.

Conclusions: The GS was found to be negatively correlated with post-operative SUI within 12 weeks after EEP and was an independent predictor of SUI at 4 weeks postoperatively.