World Journal of Urology最新文献

Introduction: In an effort to address the limitations of current lasers, pulsed-waved Thulium: YAG laser devices were released. The purpose of this systematic review is to present all existing data, arising exclusively from human studies and clinical practice, regarding the endourological applications of the new pulsed-waved Thulium: YAG laser technology in stone disease management.

Patients and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, three databases (PubMed, Scopus and Cochrane) were thoroughly investigated from inception to 30 December 2024. The following search string was utilized: (pulsed OR hybrid) AND (thulium: YAG OR Tm: YAG).

Results: In total eight studies satisfied all inclusion criteria and were finally included in the qualitative analysis. Six studies reported the use of the pulsed-waved Thulium: YAG laser during ureteroscopic lithotripsy (URSL) or retrograde intrarenal surgery (RIRS) and two studies reported its use during percutaneous nephrolithotomy (PCNL). In included studies, the lasing time ranged from 6.7 (2.7-13.9) to 36 (11-52) minutes. Stone-free rates (SFRs) ranged from 82 to 95%, while the Grade I-II and III-IV complications, based on the Clavien-Dindo Classification System, ranged from 3.3 to 30% and from 0 to 2%, respectively.

Conclusion: The purely pulsed Thulio^® and hybrid RevoLix^® Thulium: YAG lasers demonstrate promising safety and efficacy for RIRS and PCNL, with high peak power enabling efficient stone disintegration and effective dusting. However, the evidence is limited by small sample sizes, heterogeneity, and a lack of high-quality comparative trials. Further robust studies are needed to confirm these findings and draw reliable conclusions.

Purpose: To compare the visual quality amongst the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S flexible ureteroscopes (FUS) and determine whether urologists can distinguish which FUS is in use.

Methods: In this prospective survey, 6 patients were prospectively randomized to the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS for retrograde intrarenal surgery (RIRS) for nephrolithiasis. Each RIRS was performed by a single-surgeon and recorded. 9 fellowship-trained endourologists were blinded to which FUS was used. They were asked to view the recordings, answer which FUS was used, and fill out a 7-question survey grading parameters from 0 to 5. Statistical analysis was performed with SPSS. ANOVA with Tukey's posthoc analysis confirmed significance defined as p < 0.05.

Results: 78%, 89%, and 78% of endourologists correctly identified which FUS was used between the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS's respectively. The digital FUS outperformed the others in overall score (p < 0.001). The only visual parameter that was not statistically different amongst FUS's was Laser Activation Interference (p = 0.97). After Tukey's posthoc analysis, the digital FUS outperformed the fiberoptic scope in all parameters except LAI. The disposable FUS outperformed the fiberoptic scope in all parameters except for LAI, tissue interference (TI), and overall impression. The digital FUS was superior to the disposable FUS only in Visual quality (Color) and TI.

Conclusions: The majority of fellowship-trained endourologists can distinguish which type of KARL STORZ FUS is in use. The KARL STORZ digital and disposable FUS's outperform the KARL STORZ fiberoptic FUS in nearly all visual parameters. The KARL STORZ disposable FUS is comparable to the KARL STORZ digital FUS except for Visual Quality (Color) and Tissue Interference.

Clinical trial registration: This study was approved by the Northwestern Institutional Review Board and was assigned study ID STU00217933. It is also registered under NCT05646069, titled "Evaluation of Novel Disposable Flexible Ureteroscope for the Treatment of Renal Calculi."

Introduction: The European Board of Urology (EBU) In-Service Assessment (ISA) test evaluates urologists' knowledge and interpretation. Artificial Intelligence (AI) chatbots are being used widely by physicians for theoretical information. This research compares five existing chatbots' test performances and questions' knowledge and interpretation.

Materials and methods: GPT-4o, Copilot Pro, Gemini Advanced, Claude 3.5, and Sonar Huge chatbots solved 596 questions in 6 exams between 2017 and 2022. The questions were divided into two categories: questions that measure knowledge and require data interpretation. The chatbots' exam performances were compared.

Results: Overall, all chatbots except Claude 3.5 passed the examinations with a percentage of 60% overall score. Copilot Pro scored best, and Claude 3.5's score difference was significant (71.6% vs. 56.2%, p = 0.001). When a total of 444 knowledge and 152 analysis questions were compared, Copilot Pro offered the greatest percentage of information, whereas Claude 3.5 provided the least (72.1% vs. 57.4%, p = 0.001). This was also true for analytical skills (70.4% vs. 52.6%, p = 0.019).

Conclusions: Four out of five chatbots passed the exams, achieving scores exceeding 60%, while only one did not pass the EBU examination. Copilot Pro performed best in EBU ISA examinations, whereas Claude 3.5 performed worst. Chatbots scored worse on analysis than knowledge questions. Thus, although existing chatbots are successful in terms of theoretical knowledge, their competence in analyzing the questions is questionable.

Purpose: To evaluate the feasibility and clinical efficacy of transvesical robotic assisted radical prostatectomy (TvRARP) for the treatment of recurrent recalcitrant bladder neck contracture (rBNC) after holmium laser enucleation of prostate (HoLEP).

Methods: In this retrospective study, 8 patients diagnosed with rBNC were enrolled for TvRARP. The patients' preoperative data median age: 73 years (Interquartile range (IQR) 72-74), median body mass index (BMI): 29.8 kg/m² (IQR 20.5-31.5), median prostate volume: 29 ml (IQR 25-45.3), median peak urinary flow (Qmax): 4.15 ml/s (IQR 3.65-4.35), median post-void residual urine (PVR): 190 ml (IQR 145-220), median International Prostate Symptom Score (IPSS): 31 (IQR 29.8-32.5), and median quality of life (QoL): 5 (IQR 5-6) were collected. All patients were excluded from prostate tumors through PSA testing or magnetic resonance imaging (MRI). The surgical outcomes and perioperative complications were evaluated. All patients received follow-up for a minimum of 6 months postoperatively, and their post-operative data were subsequently collected and analyzed.

Results: The median surgical time was 123 min (IQR 119-130), and the median intraoperative blood loss was 50 ml (IQR 50-62.5). The median hospital stay was 7.5 days (IQR 7-8). No severe intraoperative complications occurred, nor did any major postoperative complications arise. All patients achieved continence at postoperative 3 months. All patients achieved treatment success, as evidenced by the successful passage of a 17Fr cystoscope into the bladder or a postoperative uroflow rate exceeding 15 ml/sec. At the 6-month postoperative assessment, the Qmax significantly improved from 4.15 ml/s (IQR 3.65-4.35) to 17.7 ml/s (IQR 17.5-18.6) (p < 0.05). The PVR notably reduced from 190 ml (IQR 145-220) to 17.5 ml (IQR 13.8-36.3) (p < 0.05). The IPSS improved significantly postoperatively, decreasing from 31 (IQR 29.8-32.5) to 10.5 (IQR 9.8-12) (p < 0.05), while the QoL score improved dramatically from 5 (IQR 5-6) to 1 (IQR 1-1) (p < 0.001). Additionally, the OAB-V8 score demonstrated significant improvement after the surgery, decreasing from 17 (IQR 11.8-23.5) to 7.5 (IQR 6.8-9.5) (p < 0.05).

Conclusion: TvRARP is a valid and safe alternative for the treatment of rBNC with an acceptable risk of intraoperative and postoperative complications. It also is a reasonable approach providing promising success rates and continence outcomes. Long-term functional results require further investigation.

Aim of the study: To investigate the time points at which different major complications occur and their temporal distribution over the postoperative intervals.

Patients and methods: Patients who underwent RC between January 2003 and March 2024 at the university hospital Essen and had complete records regarding postoperative complications and their timing were included. All major complications with Clavian-Dindo (CD) grading III-V were identified and recorded according to a predefined morbidity catalog. The time to occurrence of complications, readmission and mortality, was plotted against the postoperative day over a 90-day period to illustrate the distribution of events in the postoperative period. For each complication group, the median timing and the interquartile range (IQR) as well as the incidence during the postoperative weeks were calculated.

Results: Out of 757 patients, 282 (37.2%) suffered at least one major complication (CDC grade III-IV) with a total of 452 major complications. Most common complications were gastrointestinal, genitourinary and wound complications. Median (IQR) time to first major complication was 7 (4-17) days. Hospital readmission due to major complications was required in 68 (9%) patients at a median of 47 days. Most of cardiac, pulmonary, bleeding and gastrointestinal complications occurred very early in the first week, at a median of 3, 4, 4 and 5 days, respectively. Wound complications were more likely to occur within the second and third week, with a median time of 13 days. Thromboembolism developed at similar rates throughout the first 3 weeks. The other groups of complications including infectious, genitourinary and miscellaneous (mostly lymphocele) complications showed no specific pattern and occurred in a wide range over the 90 days and were considered intermediate and late events. Further analysis of the time to all complications (first major and secondary), showed an increase in median time to occurance for all complications except genitouranry and lymphocele, which occurred earlier. Deaths related to major complications were observed in 50 (6.6%) patients at a median time of 17 days.

Conclusion: The current study shows the temporal patterns of the major complications within the RC morbidity catalog. Physicians should be aware of these patterns to facilitate anticipation and prevent fatal outcomes.

Purpose: Despite the high incidence of perioperative complications following cystectomy, there is a lack of evidence regarding patients' perceptions. Moreover, discrepancies between established complication grading systems and the patient's perspective remain unexplored.

Methods: We prospectively evaluated perioperative complications after cystectomy using the Clavien-Dindo Classification (CDC) and the Comprehensive Complication Index (CCI). The CDC and CCI were compared to patient-reported complication grades through Spearman correlation analysis. Discrepancies between physician-assessed and patient-reported complication grades were then evaluated. The study was registered at ClinicalTrials.gov (NCT05153694).

Results: Between December 2021 and March 2024, 172 patients underwent open cystectomy at our department. Of those, 154 provided written consent to participate in the study, and 111 completed the post-discharge questionnaire. We found a moderate correlation between physician-assessed and patient-reported complication grades (CDC: r = 0.34, CCI: r = 0.39; p < 0.001). Patients with matching grades were defined as realists (50%). Those who reported lower complication grades than assessed by physicians were defined as optimists (38%), while those who reported higher grades were defined as pessimists (12%). Optimists rated the preoperative medical information better than pessimists ("very good": 79% vs. 38%, p = 0.006). We found no significant differences between optimists and pessimists regarding age, gender, tumor characteristics or educational level.

Conclusion: In our prospective study, the correlation between physician-assessed and patient-reported complication grades was only moderate. Only half of the cystectomy patients accurately perceived the severity of their complications. Our findings represent the first study to investigate patients' perspectives on complications in urology and underscore the importance of thorough preoperative medical information.

Purpose: To prospectively evaluate prognostic capabilities of non-muscle invasive bladder cancer (NMIBC) biomarkers for predicting disease recurrence or progression after radical TURB (transurethral resection of bladder tumor).

Methods: Evaluated biomarkers included blood: plasminogen activator inhibitor 1 (PAI-1), soluble urokinase plasminogen activator receptor (suPAR), interleukin 8 (IL-8) and urine: IL-8, vascular endothelial growth factor (VEGF) and apolipoprotein E (APOE). Blood and urine samples acquired before TURB for NMIBC from 223 subjects were analysed. The primary outcome was tumor recurrence or progression.

Results: After 3 months follow-up with cystoscopy or TURB- 92 patients were tumor free (Group 1). In 131 subjects (Group 2) a recurrence of NMIBC (n = 120) or progression to muscle invasive bladder cancer (MIBC) (n = 11) has been observed. No major clinical differences between these two groups were spotted. The group 2 has presented with significantly higher concentrations of blood IL-8 and suPAR as well as urine VEGF and APOE. The serum IL-8 and urinary VEGF showed the highest prognostic abilities with AUROC of 0.611 (95% CI: 0.534-0.687, p = 0.0044) and 0.632 (95% CI: 0.557-0.707, p = 0.0006), respectively. Multivariable machine learning models which included all investigated biomarkers and European Organisation for Research and Treatment of Cancer (EORTC) risk scores have allowed to discriminate the two patient entities with AUROC of 0.84 (95% CI: 0.73-0.95, p < 0.0001).

Conclusions: The assessed biomarkers alone have shown unsatisfactory prognostic capabilities to be used for prognostication of outcomes after TURB. More complex multivariable prediction models may improve their prognostic performance.

Trial registration: The study was retrospectively registered at clinicaltrails.gov with National Clinical Trial number (NCT): NCT06235853.

Background: Retrograde intrarenal surgery (RIRS) is a preferred treatment for renal stones, yet challenges such as kidney movement due to respiration hinder surgical precision and outcomes. The introduction of flexible and navigable suction ureteral access sheaths (FANS) and novel techniques like gated respiration aim to improve stone-free rates (SFR) and reduce complications. This study evaluates the impact of gated respiration on perioperative outcomes in RIRS with FANS.

Methods: A prospective multicenter study enrolled 562 adult patients undergoing RIRS with FANS under general anesthesia. Patients were divided into two groups: non-gated respiration (Group 1) and gated respiration (Group 2). Stone-free status (SFS) was assessed at 30 days using NCCT scans. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤ 2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments > 4 mm. Procedural efficiency, perioperative complications, and surgeon-reported outcomes were compared.

Results: Patients in Group 2 had significantly higher zero residual fragment (Grade A) rates (64.2% vs. 59%) and overall SFR (Grade A + B: 98.3% vs. 91.3%, p = 0.001). Gated respiration improved sheath navigation (91.2% vs. 85.1%, p = 0.038) and visibility during lithotripsy (p = 0.004), while reducing complications like mild bleeding due to sheath movement (3.1% vs. 11.2%, p < 0.001). Logistic regression identified gated respiration as a significant predictor of SFS (OR 6.26, 95% CI 2.28-22.6, p < 0.001).

Conclusion: Gated respiration synergistically enhances the efficacy of FANS in RIRS, improving SFR, procedural safety, and surgeon experience. This study highlights the importance of respiratory control as an adjunct to RIRS, emphasizing the need for interdisciplinary collaboration between surgical and anesthesiology teams.