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Reply to Wei Qi's letter to the editor about "Preoperative proteinuria correlates with renal function after partial nephrectomy for renal cell carcinoma". 回复 Wei Qi 就 "肾细胞癌肾部分切除术后术前蛋白尿与肾功能的相关性 "写给编辑的信。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-09 DOI: 10.1007/s00345-024-05305-6
Michele Nicolazzini, Carlotta Palumbo, Francesca Porté, Gianmarco Bondonno, Paolo De Angelis, Maria Teresa Del Galdo, Alessandro Volpe

In this Letter, we respond to Wei Qi's Letter to the editor regarding our paper, "Preoperative proteinuria correlates with renal function after partial nephrectomy for renal cell carcinoma" (World Journal of Urology, 2024), addressing the concerns raised with the aim of clarifying the potential benefits of our findings in clinical practice.

在这封信中,我们回应了 Wei Qi 就我们的论文《肾细胞癌肾部分切除术后术前蛋白尿与肾功能的相关性》(《世界泌尿外科杂志》,2024 年)写给编辑的信,解决了他提出的问题,目的是澄清我们的研究结果在临床实践中的潜在益处。
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引用次数: 0
Current era HOLEP with MOSES 2.0 technology compared to the gold standard TURP. 目前采用 MOSES 2.0 技术的 HOLEP 与黄金标准 TURP 的比较。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-08 DOI: 10.1007/s00345-024-05309-2
Jamie Michael, Perry Xu, Nick Dean, Meera Ganesh, Kyle Tsai, Nabila Khondakar, Aidan Raikar, Amy Krambeck

Purpose: Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.0 technology (MOLEP) and bTURP.

Methods: We performed a retrospective review of patients who underwent bTURP or MOLEP at our institution between 2018 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for analysis. Analysis was done with SPSS software with significance defined as p < 0.05.

Results: We identified 195 bTURPs and 918 MOLEPs performed at our institution. Men undergoing MOLEP had significantly higher pre-op prostate volume and resected weight (61 ml v 123 ml and 15 g v 70 g, p < 0.001, respectively) when compared to bTURP patients. MOLEP was completed in significantly less OR and procedure time compared to bTURP (66 min vs. 73 min, p < 0.001; 90 min vs. 111 min, p = 0.026, respectively). These results remained significant when controlling for age and prostate volume. At a mean follow up of 3.7 months, HOLEP patients were significantly more likely to be medication (0 vs. 35.84% p < 0.001) and catheter free post-operatively (0.95% vs. 5.68%, p < 0.001) compared to bTURP.

Conclusion: In our contemporary cohort, MOLEP is faster and more efficient than bTURP. These findings remained significant despite being performed on larger prostates and in patients more likely to be anticoagulated. Furthermore, MOLEP patients are more likely to remain catheter and medication free at follow-up when compared to bTURP.

目的:双极 TURP 被认为是治疗良性前列腺增生症的金标准。从历史上看,与 HOLEP 相比,双极 TURP 的手术时间更短,效率更高。我们试图比较目前的 HOLEP 与 MOSES 2.0 技术(MOLEP)和 bTURP 的效率、有效性和安全性:我们对 2018 年至 2023 年期间在本院接受 bTURP 或 MOLEP 的患者进行了回顾性审查。收集术前、术中和术后特征进行分析。使用 SPSS 软件进行分析,显著性定义为 p 结果:我们确定了在本院进行的 195 例 bTURP 和 918 例 MOLEP。接受 MOLEP 的男性术前前列腺体积和切除重量(61 毫升对 123 毫升,15 克对 70 克,P)明显更高:在我们的现代队列中,MOLEP 比 bTURP 更快、更有效。尽管对前列腺较大和更有可能接受抗凝治疗的患者进行了 MOLEP,但这些结果仍然很重要。此外,与 bTURP 相比,MOLEP 患者在随访时更有可能不使用导管和药物。
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引用次数: 0
Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011-2022). 八旬老人经尿道良性前列腺增生手术的围手术期疗效和趋势:利用 NSQIP 数据库进行的综合分析(2011-2022 年)。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-08 DOI: 10.1007/s00345-024-05285-7
Ahmad Abdelaziz, Mukund Bhandari, Emad Eddin Dalla, Shaun Trecarten, Michael Liss, Ahmed M Mansour

Introduction: Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022.

Methods: We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022.

Results: A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13-71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years.

Results: TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%.

介绍:随着医疗保健的发展,美国的八旬老人越来越多。在这个亚群体中,良性前列腺增生症(BPH)导致的下尿路症状(LUTS)发病率超过 70%。本研究试图评估不同经尿道技术在八旬老人中的围手术期效果,并确定其在 2011 年至 2022 年的使用趋势:我们从美国外科学院 NSQIP 中提取了因良性前列腺增生而接受前列腺切除术的八旬老人的数据。手术使用 CPT 代码分类,结果包括术后并发症、再入院、30 天再次手术以及 2011 年至 2022 年的使用趋势:结果:共纳入 21,314 名八旬老人。TURP是实施最多的手术(53.13%-71.17%),其次是PVP和HoLEP。到 2022 年,HoLEP 的使用率将上升至 19%。据观察,TURP组的美国麻醉医师协会(ASA)评分较高。HoLEP 的手术时间一直最长。最初,HoLEP 的输血率相对较高,到 2022 年降至 0%。尿路感染率在大多数年份中没有明显差异:结果:在NSQIP参与机构中,TURP仍是八旬老人治疗良性前列腺增生症的最常用方法。然而,从 2011 年到 2021 年,HoLEP 的使用率增加了近 2.5 倍,从 2.5% 增加到 6.4%。
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引用次数: 0
The outcomes of robot-assisted surgery in the treatment of neurogenic lower urinary tract dysfunctions: a systematic review and meta-analysis. 机器人辅助手术治疗神经源性下尿路功能障碍的效果:系统综述和荟萃分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-07 DOI: 10.1007/s00345-024-05312-7
Paolo Geretto, Sabrina De Cillis, Nadir I Osman, Fabiana Cancrini, Mehmet Gokhan Culha, Steeve Doizi, Cyrille Guillot-Tantay, Francois Herve, Mikolaj Przydacz, Nicholas Raison, Antonio Tienza Fernandez, Manuela Tutolo, Luis Vale, Véronique Phé

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.

目的:评估机器人手术治疗神经源性下尿路功能障碍(NLUTD)患者的效果:纳入评估机器人辅助回肠导尿管成形术或人工尿道括约肌(R-AUS)植入术或增强膀胱成形术或大陆性尿分流术对神经源性下尿路功能障碍患者的治疗效果(有效性和安全性)的研究。根据 PRISMA 声明(PROSPERO 2022 CRD42022333157),采用 PICOS 方法在 Medline、Embase 和 Cochrane 上进行了检索策略和研究筛选。如有可比性,则使用开腹或腹腔镜技术进行比较。尽可能进行荟萃分析。对其余文章进行了叙述性综合分析:结果:共纳入八篇文章。其中五篇文章介绍了机器人辅助膀胱切除术和回肠导尿管成形术的结果,两篇文章介绍了膀胱成形术和大陆性尿流改道术的结果,一篇文章介绍了在NLUTD患者中植入R-AUS的情况。偏倚风险很高。有三篇文章比较了机器人膀胱切除术和开放式膀胱切除术以及回肠导尿管置入术的结果,适合进行荟萃分析。根据我们的荟萃分析,与开放手术相比,机器人辅助手术在术后早期高级并发症(OR 0.39;0.19-0.79;P = 0.01)、肠道恢复天数(Cohen's D = - 0.62 ± 0.14,P 结论:机器人辅助手术在术后早期高级并发症(OR 0.39;0.19-0.79;P = 0.01)、肠道恢复天数(Cohen's D = - 0.62 ± 0.14,P与开腹手术相比,机器人辅助手术在治疗 NLUTDs 方面可能具有一些优势。然而,目前的证据还不足以得出肯定的结论。需要进一步开展高质量的研究,以更好地了解机器人手术在治疗 NLUTD 中的作用。
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引用次数: 0
Letter to the editor for the article "The impact of non-structured PSA testing on prostate cancer-specific mortality on New Zealand Māori men". 就 "非结构性 PSA 检测对新西兰毛利男性前列腺癌特异性死亡率的影响 "一文致编辑的信。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1007/s00345-024-05327-0
Melissa McLeod, Belinda Loring
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引用次数: 0
The role of re-transurethral resection of bladder tumor in patients with TaHG non muscle invasive bladder cancer. TaHG非肌层浸润性膀胱癌患者再次经尿道切除膀胱肿瘤的作用。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1007/s00345-024-05342-1
Pietro Scilipoti, Marco Moschini, Mario de Angelis, Luca Afferi, Chiara Lonati, Mattia Longoni, Giovanni Tremolada, Paolo Zaurito, Alessandro Viti, Alfonso Santangelo, Renate Pichler, Andrea Necchi, Francesco Montorsi, Alberto Briganti, Andrea Mari, Wojciech Krajewski, Ekaterina Laukthina, Benjamin Pradere, Francesco Del Giudice, Laura Mertens, Andrea Gallioli, Francesco Soria, Paolo Gontero, Simone Albisinni, Shahrokh F Shariat, Roberto Carando

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.

目的:关于Ta高级别(HG)非肌浸润性膀胱癌(NMIBC)再次经尿道膀胱肿瘤切除术(reTURBT)的适应症尚缺乏证据。本研究旨在评估 TaHG 非肌层浸润性膀胱癌患者的肿瘤治疗效果,以确定实施再经尿道膀胱肿瘤切除术的益处:方法:我们对 2009 年至 2021 年间来自 12 个中心的 317 例 TaHG NMIBC 患者进行了多中心队列研究,这些患者接受了 TURBT 和随后的完全卡介苗诱导治疗。卡普兰-梅耶尔分析根据再TURBT估计了无复发生存期(RFS)和无进展生存期(PFS)。子分析评估了根据国际指南(多发、大小大于 3 厘米、复发癌、原位癌、淋巴管侵犯、组织学变异、初次 TURBT 时肌肉层不完整或缺失)显示有必要再次进行 TURBT 的多重风险因素患者的 PFS。多变量考克斯回归分析预测了复发和进展情况:在317名患者中,123人(39%)接受了TURBT,194人(61%)未接受TURBT。46%的病例发现了残留疾病,上行分期率为3.2%。中位随访时间为 30 个月。接受再TURBT治疗的患者的3年RFS较高(79%对58%,P 结论:再TURBT治疗显示了疗效:ReTURBT在减少TaHG NMIBC患者复发方面具有疗效,但其对病情进展的影响仍不确定。我们的研究强调了遵守现行国际指南的重要性,尤其是对于具有多种风险因素,表明有必要进行再TURBT的患者。
{"title":"The role of re-transurethral resection of bladder tumor in patients with TaHG non muscle invasive bladder cancer.","authors":"Pietro Scilipoti, Marco Moschini, Mario de Angelis, Luca Afferi, Chiara Lonati, Mattia Longoni, Giovanni Tremolada, Paolo Zaurito, Alessandro Viti, Alfonso Santangelo, Renate Pichler, Andrea Necchi, Francesco Montorsi, Alberto Briganti, Andrea Mari, Wojciech Krajewski, Ekaterina Laukthina, Benjamin Pradere, Francesco Del Giudice, Laura Mertens, Andrea Gallioli, Francesco Soria, Paolo Gontero, Simone Albisinni, Shahrokh F Shariat, Roberto Carando","doi":"10.1007/s00345-024-05342-1","DOIUrl":"https://doi.org/10.1007/s00345-024-05342-1","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"630"},"PeriodicalIF":2.8,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ideal cystoscopic interval after nephroureterectomy in patients with upper tract urothelial carcinoma. 上尿路上皮癌患者肾切除术后理想的膀胱镜检查间隔时间。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1007/s00345-024-05302-9
Shuto Konta, Kohei Hashimoto, Tetsuya Shindo, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori

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.

目的:本研究的目的是通过一个假设模型,明确上尿路上皮癌(UTUC)肾切除术(NU)后膀胱镜检查的适当间隔时间:方法: 对 15 年来接受肾切除术的 155 名患者进行了回顾性评估。建立了三种监测间隔假设模型:3个月(模型1)、6个月(模型2)和12个月(模型3)。我们将这些模型叠加到每位患者的实际监测中,并分析了观察到的复发时间。从复发到预定膀胱镜检查的时间(timeRCS)被定义为从复发到估计膀胱镜检查的时间。根据模型1中术后0-1年的平均时间RCS计算间隙风险比:中位随访时间为 20.5 个月。63例患者(40.6%)观察到膀胱内复发。NU 前无膀胱癌病史患者的 3 年无膀胱内复发生存率明显高于有膀胱癌病史的患者(61% 对 42%,P = 0.034)。模型1、2和3的时间RCS中值分别为1.9、2.9和8.4个月。对于有膀胱癌病史的患者,模型 1 在 1-3 年时、模型 2 在 2-3 年时、模型 2 在 1-3 年时对于无膀胱癌病史的患者的差距风险比均小于 1.0:模型分析表明,膀胱镜随访时间间隔可根据有无膀胱癌病史以及NU后的时间而延长。
{"title":"Ideal cystoscopic interval after nephroureterectomy in patients with upper tract urothelial carcinoma.","authors":"Shuto Konta, Kohei Hashimoto, Tetsuya Shindo, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori","doi":"10.1007/s00345-024-05302-9","DOIUrl":"https://doi.org/10.1007/s00345-024-05302-9","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"629"},"PeriodicalIF":2.8,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is flexible and navigable suction ureteral access sheath (FANS-UAS) the next best development for retrograde intrarenal surgery in children? Results of a prospective multicentre study. 柔性可导航抽吸输尿管通路鞘(FANS-UAS)是儿童逆行肾内手术的下一个最佳发展方向吗?一项前瞻性多中心研究的结果。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-06 DOI: 10.1007/s00345-024-05337-y
Vineet Gauhar, Yesica Quiroz Madarriaga, Bhaskar Somani, Rohit Joshi, Yiloren Tanidir, Daniele Castellani, Deepak Ragoori, Khi Yung Fong, Steffi Kar Kei Yuen, Anna Bujons Tur, Azimdjon N Tursunkulov, Chandra Mohan Vaddi

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.

目的:评估使用ClearPetra(一种灵活、可导航的抽吸输尿管通路鞘管(FANS-UAS))的儿童逆行肾内手术(RIRS)的结果:排除标准:输尿管结石、双侧手术、异常肾脏、残留碎片手术。碎石术使用钬或铥光纤激光器。术后24小时内使用10点视觉模拟评分对疼痛进行评估。每例手术后,外科医生都会使用5点Likert量表对FANS-UAS的使用情况进行评分。在 RIRS 之前和之后 30 天内进行低剂量非对比 CT 扫描,以评估残留碎片 (RF)。无结石状态定义为无RF或单个RF不超过2毫米:结果:共纳入 50 名儿童。66%为男性。平均年龄为 6.6 (± 3.38) 岁。88%的结石为1500mm3。98%的手术使用了10-12 Fr FANS-UAS。平均手术时间为 46.02 (± 20.72) 分钟。2名患者的输尿管远端为Traxer 1级,2名患者在放置鞘管时穹窿受伤。平均疼痛评分为 2.18(± 1.34)分。抽吸难易度的平均Likert评分为1.16(± 0.47)分,操作难易度的平均Likert评分为1.24(± 0.52)分,可视度的平均Likert评分为1.02(± 0.32)分。4 名患者术后发热持续时间少于 24 小时,无败血症发生。无结石率为 100%:我们的研究表明,在小儿 RIRS 中使用 FANS-UAS 是可行和安全的,并发症发生率低,无结石率高。
{"title":"Is flexible and navigable suction ureteral access sheath (FANS-UAS) the next best development for retrograde intrarenal surgery in children? Results of a prospective multicentre study.","authors":"Vineet Gauhar, Yesica Quiroz Madarriaga, Bhaskar Somani, Rohit Joshi, Yiloren Tanidir, Daniele Castellani, Deepak Ragoori, Khi Yung Fong, Steffi Kar Kei Yuen, Anna Bujons Tur, Azimdjon N Tursunkulov, Chandra Mohan Vaddi","doi":"10.1007/s00345-024-05337-y","DOIUrl":"10.1007/s00345-024-05337-y","url":null,"abstract":"<p><strong>Purpose: </strong>To assess retrograde intrarenal surgery (RIRS) outcomes in children using ClearPetra, a flexible and navigable suction ureteral access sheath (FANS-UAS).</p><p><strong>Methods: </strong>Children with kidney stone(s) only undergoing RIRS in 8 centers were prospectively included (September 2023-May 2024).</p><p><strong>Exclusion criteria: </strong>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.</p><p><strong>Results: </strong>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 > 1500mm<sup>3</sup>. 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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"627"},"PeriodicalIF":2.8,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy analysis of tip-flexible suction access sheath during flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi. 在柔性输尿管镜碎石术治疗单侧上尿路结石时使用尖端柔性抽吸通道鞘的疗效分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-05 DOI: 10.1007/s00345-024-05325-2
Zhaoxin Ying, Hao Dong, Chao Li, Shuwei Zhang, Yin Chen, Minjie Chen, Yonghan Peng, Xiaofeng Gao

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.

目的:本研究旨在评估尖端柔性抽吸输尿管通路鞘管(TFS-UAS)与传统输尿管通路鞘管(T-UAS)在柔性输尿管镜碎石术(FURL)治疗单侧上尿路结石中的疗效:该研究回顾性比较了2023年1月至10月使用TFS-UAS治疗单侧上尿路结石的103例病例和使用T-UAS治疗单侧上尿路结石的138例病例的疗效。评估参数包括患者人口统计学特征、结石特征、术前尿液培养、输尿管预置支架、合并症、手术时间、无结石率(SFR)、取石篮使用率和术后全身炎症反应综合征(SIRS)发生率。此外,还测量了柔性输尿管镜位于体外不同直径的 TFS-UAS 不同部位时的最大偏转角度:结果:TFS-UAS 组的即时 SFR(76.70% vs. 63.77%,p = 0.031)和最终 SFR(89.32% vs. 73.91%,p = 0.003)均高于 T-UAS 组,尤其是在下萼结石(80.00% vs. 41.18%,p = 0.018)和累计直径大于等于 2 厘米的上尿路结石(68.97% vs. 42.11%,p = 0.029)方面。值得注意的是,内径为 10 英尺(F)的 TFS-UAS 比内径为 12.5 英尺(F)的 TFS-UAS 获得了更高的 SFR(88.57% vs. 70.59%,p = 0.041)和更大的偏转角。在手术时间、住院时间和 SIRS 发生率方面,比较组间未观察到明显差异:结论:与 T-UAS 相比,TFS-UAS 能明显改善 FURL 治疗单侧上尿路结石的 SFR,尤其是位于下肾萼或累计直径大于或等于 2 厘米的结石。
{"title":"Efficacy analysis of tip-flexible suction access sheath during flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi.","authors":"Zhaoxin Ying, Hao Dong, Chao Li, Shuwei Zhang, Yin Chen, Minjie Chen, Yonghan Peng, Xiaofeng Gao","doi":"10.1007/s00345-024-05325-2","DOIUrl":"https://doi.org/10.1007/s00345-024-05325-2","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"626"},"PeriodicalIF":2.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Open simple prostatectomy in the last three decades: results of a meta-analysis. 过去三十年的开放式单纯前列腺切除术:荟萃分析结果。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-05 DOI: 10.1007/s00345-024-05315-4
Renil S Titus, Ansh Bhatia, Joao G Porto, Khushi Shah, Diana M Lopategui, Thomas R W Herrmann, Robert Marcovich, Hemendra N Shah

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.

目的:开放式单纯前列腺切除术(OSP)一直是治疗良性前列腺增生症(BPH)中大体积前列腺(> 80 毫升)的基石。随着微创前列腺切除术(MISP)和激光去核术等微创手术的不断发展,需要对开放式单纯前列腺切除术的作用进行当代评估。因此,我们评估了前列腺电切术的有效性和安全性,以了解其在治疗良性前列腺增生症方面的现状,尤其是与较新手术方式的比较:方法:我们对MEDLINE、Cochrane和EMBASE进行了全面检索,纳入了1993年至2023年间比较OSP与其他治疗良性前列腺增生症方法的随机对照试验(RCT)。荟萃分析共纳入了 10 项 RCT。分析了包括IPSS、Qmax、PVR、生活质量、围手术期因素和术后并发症在内的各种结果数据:我们的荟萃分析涵盖了 557 名患者,证实了 OSP 能显著改善排尿症状和客观排尿指标。但同时也发现术后出血和输血需求等并发症的发生率较高。研究发现围手术期结果存在中度到高度异质性,这表明手术技术和术后护理存在差异。尽管微创手术取得了进步,但前列腺电切术仍是一种可靠的选择,它是一种易于接受且有效的方法,可用于治疗巨大前列腺:结论:前列腺电切术仍然是治疗大前列腺增生症的相关手术选择,能显著缓解症状。结论:OSP仍然是治疗大前列腺增生症的有效手术方案,能明显缓解症状,但由于其发病率较高,因此需要谨慎选择患者,并强调需要继续研究优化手术技术和改善疗效。
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World Journal of Urology
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