World Journal of Urology最新文献

Purpose: To compare the erectile and urinary functions of ventral and dorsal onlay buccal mucosal graft (BMG) urethroplasty in the management of proximal bulbar urethral strictures (PBUS) in sexually active men.

Patients and methods: We retrospectively included patients with primary non-traumatic PBUS who were treated with (BMG) urethroplasty at our department between March 2019 and March 2023 either ventral or dorsal approaches. Patients were assessed at 3- and 12-months postoperatively for urinary and erectile functions.

Results: 133 patients were identified and underwent either ventral repair (n = 60, group I) or dorsal repair (n = 73, group II). There was no significant difference in baseline urinary and sexual function between both groups (p > 0.05). Overall, the success rate was 91.7% in Group I and 90.4% in Group II (p = 0.801). Transient ED (at 3 months) was detected in 5% and 25% (p = 0.002), while permeant ED (at 12 months) was 1.7% and 13.7% (p = 0.012) in group I and group II, respectively. Group I had significantly higher mean IIEF scores; 28.2 and 28.4 at 3 months (p < 0.001) and 12 months (p < 0.001); compared to Group II; 22.1 and 24.4, respectively.

Conclusion: The ventral approach had better erectile functional outcomes compared to the dorsal approach in the management of non-traumatic PBUS in sexually active men. This might be related to less urethral mobilization and no dissection of the intercrural space during ventral onlay graft urethroplasty.

Objectives: To assess the complication rates associated with split versus intact appendix Mitrofanoff procedures using a single-center retrospective analysis and a systematic review with meta-analysis.

Subjects and methods: The study comprised a retrospective cohort analysis at a single institution, analyzing patients who underwent a laparoscopic-assisted Mitrofanoff with or without splitting the appendix from 2005 to 2016. The focus was on complications related to both Mitrofanoff and ACE channels. Kaplan-Meier survival analysis, log-rank tests, and Cox regression were utilized to determine hazard ratios. Additionally, a PROSPERO (CRD42023481627)-registered systematic review and meta-analysis were conducted, evaluating complication rates across diverse patient populations using the Mantel-Haenszel method with a random-effects model.

Results: A total of 22 patients with intact appendix Mitrofanoff and 10 with split appendix for both Mitrofanoff and ACE creation were compared. The time to complications did not differ significantly, with a log-rank p-value of 0.72. The adjusted hazard ratio for the split appendix group was 1.26 (95% CI: 0.32-4.99). The systematic review and meta-analysis included 565 patients and indicated a higher, albeit non-significant, complication rate in the split appendix group (29.2%) compared to the intact group (20.4%), with an odds ratio of 1.49 (95% CI: 0.82-2.73).

Conclusion: The analysis showed that, compared to appendicovesicostomy performed in isolation, the split appendix technique may be associated with slightly higher complication rates, though not statistically significant. The choice of surgical technique should be tailored to the individual anatomical and functional needs of patients, emphasizing the importance of personalized surgical planning and skilled execution.

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.