World Journal of Urology最新文献

Purpose: To evaluate the feasibility, and outcomes of partial nephrectomy (PN) for clinical T2b, T3a, and T3b renal mass in a high-volume tertiary care setting.

Methods: We retrospectively analyzed patients who underwent open or robotic-assisted PN between 2017 and 2024 at a single academic center. Patients had imperative indications for PN [solitary kidney, chronic kidney disease CKD, bilateral neoplasm]. Data on perioperative outcomes, renal function, oncologic endpoints, and Trifecta achievement [no major surgical complications according to Clavien-Dindo classification (CD ≥ 3), negative surgical margins, 80% of estimated new baseline estimated glomerular filtration rate (eGFR)] were collected. Multivariable Firth logistic regression (MLRA) assessed predictors of failure to achieve Trifecta.

Results: We analyzed 103 patients with (12 T2b/88 T3a/3 T3b) renal mass (median tumor size 6.0 cm/median R.E.N.A.L. score 10). Median ischemia time was 37.0 min (cold in 45.6%, warm in 44.7% and segmental/clampless in 9.7%). Median blood loss was 200 mL. Major post-operative complications occurred in 20.4% [urine leak (9.7%), fluid collection (6.7%), hematoma (2.9%)]. Intraoperative complication rate was 1.9% (2 enterotomies). Microscopic positive surgical margins were observed in 10.7%; mean ΔeGFR was - 14.6 ml/min/1.73m². At median 38-month follow-up, 3-year overall, cancer-specific and recurrence-free survival rates were 92%, 94% and 75%, respectively. Trifecta was achieved in 43.7% patients. On MLRA, receipt of neoadjuvant therapy was associated with higher odds of failure to achieve Trifecta (OR 3.25, 95%CI 1.15-9.20; p = 0.03).

Conclusion: PN for large and complex locally-advanced renal tumors is feasible with acceptable outcomes in carefully selected patients with imperative indication for nephron preservation. Further investigation is requisite to delineate role of PN in locally-advanced renal mass.

Purpose: Intravesical onabotulinum toxin-A (BTX-A) has been studied as a curative therapy for overactive bladder (OAB), neurogenic bladder, and interstitial cystitis. Limited evidence supports adjunctive BTX-A during urologic surgeries to reduce bladder spasms and improve outcomes. This study examines the role of adjunctive BTX-A at the time of urologic surgery.

Methods: A literature search of four databases (MEDLINE, Embase, Cochrane Library, and Web of Science) was performed for studies describing adjunctive BTX-A during urologic surgery and its impact primarily on quality of life and urinary outcomes. Studies investigating BTX-A as a curative therapy or in the post-operative setting were excluded.

Results: Literature search identified 2175 studies. Thirteen studies were included. Three studies investigated BTX-A at the time of benign prostatic hyperplasia surgery. All studies found that combination therapy led to improved patient-reported continence scores. Seven studies investigated BTX-A at the time of mid-urethral sling to treat urgency incontinence (UI) in patients with mixed incontinence. Five of seven studies found that combination therapy led to improved OAB and UI symptom scores. Two studies explored BTX-A at the time of bladder reconstruction and found that BTX-A reduced postoperative pain and improved lower urinary tract symptoms. One study found that pre-operative BTX-A use before vesicovaginal fistula repair reduced bladder spasms. No studies found a significantly increased risk of urinary retention with adjunctive BTX-A.

Conclusion: Initial evidence supports the use of BTX-A at the time of urologic surgeries to decrease bladder spasms and improve post-operative pain and continence without increasing the risk of urinary retention. Further study is required to understand its optimal role and indication.

Purpose: To provide a detailed description of the Swiss Society of Urology prospective database of radical cystectomy (RC) due to bladder cancer (BC) about differences in operative outcomes between teaching and non-teaching RC.

Methods: We collected the data of all RCs for BC from the register from March 2017 to March 2025, leading to 1587 cases. Afterwards, we decided about the extraction of 34 variables, e.g. operating approach and intraoperative complications. Furthermore, we determined that only complete data sets for our pre-defined variables will be included in the analysis, which led to 1304 RC cases.

Results: Median patient age was 72.0 years (IQR 64.0-78.0). The majority of patients underwent open RC (n = 838; 64.3%). More than one quarter (n = 344; 26.4%) were teaching surgeries and there was no significant difference between both groups regarding demographic characteristics. There were no significant differences between teaching and non-teaching operative results in terms of surgical resection (R1 status; p = 0.295), duration of inpatient treatment (p = 0.394), infection (p = 0.023), wound healing disorders (p = 0.484), duration of surgery (p = 0.365), intraoperative bleeding (p = 0.635) and intraoperative blood loss (p = 0.074). However, in terms of the number of resected lymph nodes, blood transfusion rate, number of transfused packed red blood cells, intraoperative complications as well as the highest grade of complication during inpatient treatment teaching RC showed less favorable results, e.g. number of evaluated lymph nodes (teaching median 18.0 versus non-teaching median 20.0, p < 0.001).

Conclusion: Teaching RC is safe, for a high complex procedure, according to our prospective pilot study.

Purpose: Several radiological predictors of pelvic fracture urethral injuries (PFUI) repair complexity have been proposed, but they have not been compared in external cohorts or tested against each other. This study evaluates the reliability and accuracy of indicators from Koraitim et al. and Yepes et al. in predicting surgical complexity in adult men with PFUI.

Methods: Retrospective review of adult men who underwent PFUI repair between January 2011 and February 2024 in our center. Preoperative urethrocystographies (UCG) were analyzed for urethral gap length and gapometry index (Koraitim), and for the position of the proximal urethral stump (PUS) relative to the inferior margin of the pubic symphysis (Yepes). Predictors were compared with intraoperative complexity, defined by the need for advanced maneuvers or abdomino-perineal access. Accuracy parameters were calculated for each predictor and their combination.

Results: Of 81 patients treated in this period (median age 36 years), 55.6% (45/81) were excluded from analysis, with the absence of bladder neck opening being the most common cause (30/45). In the 36 evaluable cases, neither gapometry (p = 0.069) nor gapometry index (p = 0.158) were associated with complexity. Only PUS location above the inferior margin of the pubic symphysis was associated with it (p = 0.031). The presence of any predictor yielded 100% sensitivity and 42.3% specificity for predicting complexity. All patients without predictors underwent non-complex repairs (p = 0.071).

Conclusion: Radiological predictors showed limited reliability and accuracy, though PUS position correlated with complexity. The absence of radiological criteria may help identify straightforward cases.

Purpose: Urolithiasis is a common condition in urological practice. Retrograde intrarenal surgery (RIRS) is widely accepted as a safe and effective treatment modality. However, acute ureteral injuries during ureteral access sheath (UAS) placement remain a significant concern. Although beta-adrenergic receptors have been identified in the ureteral wall, studies investigating beta-agonists for ureteral protection are lacking. This study aimed to assess whether short-term preoperative administration of mirabegron, a beta-3 adrenoreceptor agonist, can reduce the incidence of UAS-related ureteral injuries during RIRS.

Methods: In this prospective non-randomized study, 60 patients undergoing RIRS were enrolled. Allocation was based on clinical indications due to ethical considerations: 30 patients with existing overactive bladder symptoms received preoperative mirabegron, while 30 patients served as controls. Baseline characteristics were comparable between the groups. Ureteral injuries were assessed endoscopically and graded using the Post-Ureteroscopic Lesion Scale (PULS).

Results: The mirabegron group showed a lower incidence of high-grade ureteral injuries compared to the control group, but the difference was not statistically significant (p = 0.123). No adverse events related to mirabegron were reported. Limitations include the lack of randomization, modest sample size, and single-center design.

Conclusions: Short-term preoperative mirabegron use appears to be safe. While our results suggest a potential trend towards reducing high-grade ureteral injuries, this did not reach statistical significance, likely due to the limited sample size of this preliminary cohort. Further large-scale, multicenter studies with longer follow-up are necessary to confirm these findings.