World Journal of Urology最新文献

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.

Background: Percutaneous nephrolithotomy (PCNL) frequently encounters postoperative infectious complications, notably fever and urosepsis. Although preoperative urine culture guides antibiotics, delayed reporting hampers timely risk stratification. Urinalysis is simple, cost-effective, and repeatable; however, most existing studies focus on single static measurements and lack systematic evaluation of temporal trends.

Objective: To evaluate the association between temporal changes in preoperative urinary white blood cells (uWBC) and nitrite (NIT) and the risk of postoperative fever and urosepsis in patients undergoing PCNL.

Methods: We conducted a prospective observational study of 346 culture-positive patients undergoing PCNL (March 2021-July 2025). Urinalysis was performed at admission and on the morning of surgery. All patients received 5-7 days of pathogen-directed intravenous antibiotics before surgery. Patients were classified according to the trend of uWBC and NIT changes between the two tests. Both univariate and multivariate logistic regression models were applied to assess the relationships with postoperative fever and urosepsis, and pre-specified clinical subgroup analyses were conducted.

Results: Postoperative fever and urosepsis occurred in 20.8% (72/346) and 3.2% (11/346) of patients, respectively. Compared with patients whose uWBC decreased or remained negative, those with persistently positive or increased uWBC independently predicted postoperative fever (adjusted OR 1.95-2.62, P < 0.05), with a significant dose-response relationship (P for trend = 0.011). Using persistently negative NIT as the reference, persistently positive NIT independently predicted urosepsis (adjusted OR 7.32, P = 0.012) and postoperative fever (adjusted OR 2.41, P = 0.024). Associations were consistent across clinical subgroups.

Conclusions: Dynamic preoperative urinalysis offers a simple, inexpensive, and reproducible approach to stratify infection risk in culture-positive PCNL candidates; lack of improvement or persistent positivity in uWBC, as well as persistently positive NIT, identifies high-risk patients and supports individualized perioperative management, whereas conversion from NIT-negative to NIT-positive status-an infrequent pattern in our cohort-was not independently predictive of postoperative infectious complications. Incorporating dynamic urinalysis changes with stone burden, diabetes, and other clinical characteristics may facilitate preoperative risk stratification and individualized infection-prevention strategies.

Background: Early postoperative urinary incontinence (UI) after thulium laser enucleation of the prostate (ThuLEP) can significantly affect postoperative quality of life. Predictive models for UI following ThuLEP are currently lacking. Prostatic apex shape (PAS), initially proposed in prostate cancer research, has shown value in predicting surgical outcomes but remains underexplored in benign prostatic hyperplasia (BPH). This study aimed to develop a nomogram based on PAS and clinical parameters to provide a noninvasive estimate of short-term UI risk after ThuLEP.

Methods: Patients who underwent ThuLEP for BPH at a high-volume center were retrospectively included. Inclusion criteria were preoperative BPH diagnosis, mpMRI examination, and complete follow-up data. PAS was classified into four subtypes (A, B, C, D) using a modified MRI-based method. Clinical variables, including intravesical prostatic protrusion (IPP), were collected. Logistic regression analysis was used to identify independent predictors of early postoperative UI, and a nomogram was developed and evaluated using the area under the curve (AUC), calibration analysis, and decision curve analysis.

Results: A total of 106 patients were included. Early postoperative UI at 1 month occurred in 40 patients (37.7%), with type D showing a significantly lower incidence (p = 0.029). On univariable analysis, PAS (A-C vs. D), IPP > 2.4 cm, and PV > 100 mL were associated with UI. In multivariable models, PAS types A-C (OR 11.721, 95% CI 1.431-85.996; p = 0.022) and IPP > 2.4 cm (OR 11.543, 95% CI 1.350-74.322; p = 0.026) remained independent predictors. P.I. nomogram (PAS, IPP) achieved an AUC of 0.758, demonstrated good calibration (Hosmer-Lemeshow P = 0.993), and showed greater net benefit particularly at threshold probabilities 0.4-0.6.

Conclusion: PAS types A-C and IPP > 2.4 cm were independently associated with 1-month postoperative urinary incontinence after ThuLEP. Our P.I. nomogram showed acceptable discrimination and calibration for short-term UI risk in this exploratory cohort. If confirmed in external populations, this tool may assist preoperative risk stratification and counselling in patients undergoing ThuLEP.