Pub Date : 2023-11-06DOI: 10.1097/cu9.0000000000000225
Yavuz Güler
Abstract Objectives To compare the success rates of autologous fascial mesh (sling and transobturator tape [TOT]) with midurethral synthetic meshes (tension-free vaginal tape sling [TVT] and TOT) for stress urinary incontinence. Materials and methods A literature search for studies published in English was conducted from May 10, 2022, to June 1, 2022. The search included MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms{“Autologous fascial slings”}OR {“AFS”} AND{“TOT”} OR {“Transobturator tape”} OR{“TVT”} OR{“Transvaginal tape”}. A total of 20 studies, including 10 randomized controlled trials, were selected for the review. RevMan software (version 5.3) was used to calculate the pooled effect estimates for operative and postoperative variables. Results In the systemic review, 20 studies, including 10 randomized controlled trials, were assessed. In the TVT versus autologous pubovaginal sling (A-PVS) groups, the effect estimates for the surgical duration, catheter duration, success, and complication rates were more advantageous for TVT. However, in comparison to autologous transobturator tape groups, TOT provided better operative time and a shorter hospital stay. Moreover, in comparison to the A-PVS group, the TOT group was superior in terms of operating time, urethral catheterization, hospital stay, amount of residual urine, and wound complications. The A-PVS group had significantly more groin and thigh pain. Conclusions During medium- and long-term follow-ups, the use of autologous rectus fascia grafts using a A-PVS or TOT provided similar complication rates and urinary continence results as using midurethral synthetic meshes (TVT and TOT).
【摘要】目的比较自体筋膜网(吊带和经闭锁带[TOT])与尿道中合成网(无张力阴道带吊带[TVT]和TOT)治疗压力性尿失禁的成功率。材料与方法对2022年5月10日至2022年6月1日发表的英文研究进行文献检索。检索包括MEDLINE/PubMed、Cochrane Library、Scopus、Web of Science、Google Scholar和ProQuest，检索词为{“自体筋膜吊带”}或{“AFS”}和{“TOT”}或{“transsobturator tape”}或{“TVT”}或{“Transvaginal tape”}。本研究共纳入20项研究，包括10项随机对照试验。使用RevMan软件(version 5.3)计算手术和术后变量的合并效应估计。结果系统评价纳入20项研究，包括10项随机对照试验。在TVT组与自体耻骨阴道悬吊(A-PVS)组中，TVT在手术时间、导管时间、成功率和并发症发生率方面的效果估计更有利。然而，与自体通气带组相比，TOT提供了更好的手术时间和更短的住院时间。此外，与A-PVS组相比，TOT组在手术时间、导尿时间、住院时间、残尿量、伤口并发症等方面均优于A-PVS组。A-PVS组的腹股沟和大腿疼痛明显加重。结论在中期和长期随访中，使用a - pvs或TOT的自体直肌筋膜移植物与使用尿道中合成补片(TVT和TOT)的并发症发生率和尿失禁效果相似。
{"title":"Comparison of midurethral tape with autologous rectus fascial sling surgery for stress urinary incontinence: A systematic review and meta-analysis","authors":"Yavuz Güler","doi":"10.1097/cu9.0000000000000225","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000225","url":null,"abstract":"Abstract Objectives To compare the success rates of autologous fascial mesh (sling and transobturator tape [TOT]) with midurethral synthetic meshes (tension-free vaginal tape sling [TVT] and TOT) for stress urinary incontinence. Materials and methods A literature search for studies published in English was conducted from May 10, 2022, to June 1, 2022. The search included MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms{“Autologous fascial slings”}OR {“AFS”} AND{“TOT”} OR {“Transobturator tape”} OR{“TVT”} OR{“Transvaginal tape”}. A total of 20 studies, including 10 randomized controlled trials, were selected for the review. RevMan software (version 5.3) was used to calculate the pooled effect estimates for operative and postoperative variables. Results In the systemic review, 20 studies, including 10 randomized controlled trials, were assessed. In the TVT versus autologous pubovaginal sling (A-PVS) groups, the effect estimates for the surgical duration, catheter duration, success, and complication rates were more advantageous for TVT. However, in comparison to autologous transobturator tape groups, TOT provided better operative time and a shorter hospital stay. Moreover, in comparison to the A-PVS group, the TOT group was superior in terms of operating time, urethral catheterization, hospital stay, amount of residual urine, and wound complications. The A-PVS group had significantly more groin and thigh pain. Conclusions During medium- and long-term follow-ups, the use of autologous rectus fascia grafts using a A-PVS or TOT provided similar complication rates and urinary continence results as using midurethral synthetic meshes (TVT and TOT).","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135634214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.1097/cu9.0000000000000229
Kong Ren, Fei Wu, Haihu Wu, Hao Ning, Jiaju Lyu
Abstract Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the SEER database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the two groups. The risk factors for all-cause and RCC-related mortality were analyzed. Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group ( p < 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579–0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536–0.781; p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559–0.899; p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579–0.778; p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes. Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.
{"title":"Partial versus radical nephrectomy for T1b renal cell carcinoma: A comparison of efficacy and prognostic factors based on the Surveillance, Epidemiology, and End Results database","authors":"Kong Ren, Fei Wu, Haihu Wu, Hao Ning, Jiaju Lyu","doi":"10.1097/cu9.0000000000000229","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000229","url":null,"abstract":"Abstract Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the SEER database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the two groups. The risk factors for all-cause and RCC-related mortality were analyzed. Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group ( p < 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579–0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536–0.781; p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559–0.899; p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579–0.778; p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes. Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135635021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/cu9.0000000000000124
José A. Câncio Martins Bissaia Barreto, Maria I. Táboas Simões, Gonçalo Gomes Engenheiro, Joana I. Ferreira Matos, Joana A. Rodrigues Leal
Abstract Overactive bladder (OAB) is the most common voiding dysfunction in children; however, nonneurogenic or idiopathic OAB remains poorly studied. First-line treatment includes conservative measures; however, as many patients are refractory, have adverse effects, or are contraindicated for anticholinergics, new options must be explored. This review covers the use of intravesical botulinum toxin (BoNT) for idiopathic OAB treatment in children, emphasizing its efficacy, safety, differences between toxins, doses, and injection techniques. Clinical results were promising, with all 8 studies reporting good results. All authors used BoNT type A, either onabotulinum or abobotulinum toxin A. Response rates were variable, with full-response percentages of 32%–60%. As proven by the full-response rates of 50%, repeated injections are as safe and effective as first injections. Only a few cases of urinary tract infection, transient urinary retention, and hematuria have been reported, with no major local or systemic adverse effects. Despite these limitations, evidence encourages and supports BoNT type A use as a safe and effective treatment modality for refractory idiopathic OAB in pediatric settings, regardless of dosage and target toxin. To the best of our knowledge, this is the first systematic review of the use of intravesical botulinum toxin type A for idiopathic OAB treatment in children.
{"title":"The role of botulinum toxin in the management of nonneurogenic overactive bladder in children: Highlights for clinical practice. A systematic review","authors":"José A. Câncio Martins Bissaia Barreto, Maria I. Táboas Simões, Gonçalo Gomes Engenheiro, Joana I. Ferreira Matos, Joana A. Rodrigues Leal","doi":"10.1097/cu9.0000000000000124","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000124","url":null,"abstract":"Abstract Overactive bladder (OAB) is the most common voiding dysfunction in children; however, nonneurogenic or idiopathic OAB remains poorly studied. First-line treatment includes conservative measures; however, as many patients are refractory, have adverse effects, or are contraindicated for anticholinergics, new options must be explored. This review covers the use of intravesical botulinum toxin (BoNT) for idiopathic OAB treatment in children, emphasizing its efficacy, safety, differences between toxins, doses, and injection techniques. Clinical results were promising, with all 8 studies reporting good results. All authors used BoNT type A, either onabotulinum or abobotulinum toxin A. Response rates were variable, with full-response percentages of 32%–60%. As proven by the full-response rates of 50%, repeated injections are as safe and effective as first injections. Only a few cases of urinary tract infection, transient urinary retention, and hematuria have been reported, with no major local or systemic adverse effects. Despite these limitations, evidence encourages and supports BoNT type A use as a safe and effective treatment modality for refractory idiopathic OAB in pediatric settings, regardless of dosage and target toxin. To the best of our knowledge, this is the first systematic review of the use of intravesical botulinum toxin type A for idiopathic OAB treatment in children.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136022944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The correlation between the Controlling Nutritional Status (CONUT) score and the prognosis of patients with prostate cancer (PCa) has yet to be elucidated. Herein, we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy. Materials and methods Data of 244 patients were retrospectively evaluated. Perioperative variables and follow-up data were analyzed. The patients were categorized into 2 groups according to their preoperative CONUT scores. Postoperative complication and incontinence rates were also compared. The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival (BCRFS) between the 2 groups. Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS. Results Patients were categorized into the low-CONUT group (CONUT score <3, n = 207) and high-CONUT group (CONUT score ≥3, n = 37). The high-CONUT group had a higher overall complication rate (40.5% vs.19.3%, p = 0.004), a higher major complication rate (10.8% vs. 3.9%, p = 0.013), and longer postoperative length of stay (8 days vs. 7 days, p = 0.017). More fever, urinary infection, abdominal infection, scrotal edema, rash, and hemorrhagic events (all p values < 0.05) were observed in the high-CONUT group. A higher rate of urinary incontinence was observed in the high-CONUT group at 1 (34.4% vs. 13.2%, p = 0.030) and 3 months (24.1% vs. 8.2%, p = 0.023) postoperatively. The high-CONUT group had shorter medium BCRFS (23.8 months vs. 54.6 months, p = 0.029), and a CONUT score ≥3 was an independent risk factor for a shorter BCRFS (hazards ratio, 1.842; p = 0.026). Conclusions The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.
{"title":"Prognostic value of Controlling Nutritional Status score for postoperative complications and biochemical recurrence in prostate cancer patients undergoing laparoscopic radical prostatectomy","authors":"Tianyu Xiong, Xiaobo Ye, Guangyi Zhu, Fang Cao, Yun Cui, Liming Song, Mingshuai Wang, Wahafu Wasilijiang, Nianzeng Xing, Yinong Niu","doi":"10.1097/cu9.0000000000000231","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000231","url":null,"abstract":"Abstract Background The correlation between the Controlling Nutritional Status (CONUT) score and the prognosis of patients with prostate cancer (PCa) has yet to be elucidated. Herein, we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy. Materials and methods Data of 244 patients were retrospectively evaluated. Perioperative variables and follow-up data were analyzed. The patients were categorized into 2 groups according to their preoperative CONUT scores. Postoperative complication and incontinence rates were also compared. The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival (BCRFS) between the 2 groups. Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS. Results Patients were categorized into the low-CONUT group (CONUT score <3, n = 207) and high-CONUT group (CONUT score ≥3, n = 37). The high-CONUT group had a higher overall complication rate (40.5% vs.19.3%, p = 0.004), a higher major complication rate (10.8% vs. 3.9%, p = 0.013), and longer postoperative length of stay (8 days vs. 7 days, p = 0.017). More fever, urinary infection, abdominal infection, scrotal edema, rash, and hemorrhagic events (all p values < 0.05) were observed in the high-CONUT group. A higher rate of urinary incontinence was observed in the high-CONUT group at 1 (34.4% vs. 13.2%, p = 0.030) and 3 months (24.1% vs. 8.2%, p = 0.023) postoperatively. The high-CONUT group had shorter medium BCRFS (23.8 months vs. 54.6 months, p = 0.029), and a CONUT score ≥3 was an independent risk factor for a shorter BCRFS (hazards ratio, 1.842; p = 0.026). Conclusions The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"30 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-25DOI: 10.1097/cu9.0000000000000228
Leon Chertin, Binyamin B. Neeman, Jawdat Jaber, Guy Verhovsky, Amnon Zisman, Ariel Mamber, Ilan Kafka, Ala Eddin Natsheh, Dmitry Koulikov, Ofer Z. Shenfeld, Boris Chertin, Stanislav Koucherov, Amos Neheman
Abstract Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23–36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12–54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1–2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
{"title":"Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience","authors":"Leon Chertin, Binyamin B. Neeman, Jawdat Jaber, Guy Verhovsky, Amnon Zisman, Ariel Mamber, Ilan Kafka, Ala Eddin Natsheh, Dmitry Koulikov, Ofer Z. Shenfeld, Boris Chertin, Stanislav Koucherov, Amos Neheman","doi":"10.1097/cu9.0000000000000228","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000228","url":null,"abstract":"Abstract Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23–36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12–54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1–2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135215990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of renal calculi in the presence of emphysematous pyelonephritis (EPN) is challenging. The optimal management strategy for patients with EPN and renal calculi remains unclear. This study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the management of these patients and to provide insights into the postoperative outcomes and complications of PCNL according to the modified Clavien-Dindo classification. This retrospective study included patients with EPN and renal stones who underwent PCNL, after initial conservative management, between January 2012 and December 2021. Patient demographics, presenting symptoms, features of septicemia, preoperative drainage, postoperative complications, and outcomes were recorded. Postoperative complications were categorized according to the modified Clavien-Dindo classification. A total of 48 patients with EPN and renal calculi were included in this study. Percutaneous nephrolithotomy was performed 4–6 weeks later after obtaining a negative urine culture or under appropriate antibiotic coverage if the culture was unsterile. Of the total, 39 (81.25%) patients had postoperative complications, but only 9 (18.75%) patients had grade III or higher complications. Of these, 3 (6.25%) patients had grade IIIa complications, 3 (6.25%) had grade IIIb complications, 2 (4.1%) had grade IVa complications, and 1 (2.08%) had grade IVb complications and was admitted to the intensive care. No mortality was observed during the postoperative period. Initial conservative management of EPN followed by PCNL after initial infection control is an effective strategy for managing these patients. Patients with higher EPN grades have a higher risk of major postoperative complications after PCNL for renal stones. Specifically, patients with an EPN class 3 or 4 had a higher risk of complications than those with an EPN class 2 or lower. Patients with EPN class 1 have a relatively uncomplicated postoperative course after PCNL.
{"title":"Feasibility and safety of percutaneous nephrolithotomy in the management of renal stones with emphysematous pyelonephritis following control of infection","authors":"Anshuman Singh, Surag K.R., Anupam Choudhary, Suraj Jayadeva Reddy, Kasi Viswanath Gali, Abhijit Shah","doi":"10.1097/cu9.0000000000000232","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000232","url":null,"abstract":"Management of renal calculi in the presence of emphysematous pyelonephritis (EPN) is challenging. The optimal management strategy for patients with EPN and renal calculi remains unclear. This study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the management of these patients and to provide insights into the postoperative outcomes and complications of PCNL according to the modified Clavien-Dindo classification. This retrospective study included patients with EPN and renal stones who underwent PCNL, after initial conservative management, between January 2012 and December 2021. Patient demographics, presenting symptoms, features of septicemia, preoperative drainage, postoperative complications, and outcomes were recorded. Postoperative complications were categorized according to the modified Clavien-Dindo classification. A total of 48 patients with EPN and renal calculi were included in this study. Percutaneous nephrolithotomy was performed 4–6 weeks later after obtaining a negative urine culture or under appropriate antibiotic coverage if the culture was unsterile. Of the total, 39 (81.25%) patients had postoperative complications, but only 9 (18.75%) patients had grade III or higher complications. Of these, 3 (6.25%) patients had grade IIIa complications, 3 (6.25%) had grade IIIb complications, 2 (4.1%) had grade IVa complications, and 1 (2.08%) had grade IVb complications and was admitted to the intensive care. No mortality was observed during the postoperative period. Initial conservative management of EPN followed by PCNL after initial infection control is an effective strategy for managing these patients. Patients with higher EPN grades have a higher risk of major postoperative complications after PCNL for renal stones. Specifically, patients with an EPN class 3 or 4 had a higher risk of complications than those with an EPN class 2 or lower. Patients with EPN class 1 have a relatively uncomplicated postoperative course after PCNL.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"158 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.1097/cu9.0000000000000230
Silu Chen, Yuye Wu, Peng Zhang, Zhihua Li, Xinfei Li, Zhenyu Li, Kunlin Yang, Xuesong Li
Abstract Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable. The Yang–Monti channel is an alternative to the tunneled appendix for urinary diversion. We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously. No tumor recurrence was observed; however, the patient experienced severe catheter-related bladder irritation after the procedure. The patient was readmitted to the authors’ hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang–Monti channel. The operation lasted 232 minutes, with an estimated blood loss of 10 mL. The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube. After this, clean intermittent catheterization was performed every 3 hours for 4 weeks. Five years after the procedure, the modified Yang–Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed. The patient was satisfied with his postoperative quality of life.
{"title":"Laparoscopic continent cutaneous urinary diversion using a modified Yang–Monti technique in an adult: A case report including 5-year follow-up","authors":"Silu Chen, Yuye Wu, Peng Zhang, Zhihua Li, Xinfei Li, Zhenyu Li, Kunlin Yang, Xuesong Li","doi":"10.1097/cu9.0000000000000230","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000230","url":null,"abstract":"Abstract Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable. The Yang–Monti channel is an alternative to the tunneled appendix for urinary diversion. We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously. No tumor recurrence was observed; however, the patient experienced severe catheter-related bladder irritation after the procedure. The patient was readmitted to the authors’ hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang–Monti channel. The operation lasted 232 minutes, with an estimated blood loss of 10 mL. The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube. After this, clean intermittent catheterization was performed every 3 hours for 4 weeks. Five years after the procedure, the modified Yang–Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed. The patient was satisfied with his postoperative quality of life.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1097/cu9.0000000000000221
Siying Yeow, Ahmed Goolam, Amanda Chung
Abstract Ileocystoplasty is one of the treatment options in the armamentarium for the management of adults with neurogenic bladder dysfunction, after failure of less invasive treatment alternatives, such as intravesical onabotulinum toxin A injection therapy and sacral neuromodulation. It has traditionally been performed as open surgery and can be associated with significant morbidity, especially in the early postoperative period. [ 1] Complications associated with open ileocystoplasty include prolonged postoperative ileus, wound infections, and pain. Performing robot-assisted ileocystoplasty can reduce the morbidity associated with open surgery [ 2] and has been shown to be safe and feasible in experienced hands, [ 3] although it may be associated with increased operative duration because of its learning curve. Our technique of robot-assisted ileocystoplasty and early postoperative outcomes is demonstrated in this video (Supplemental Digital Content, http://links.lww.com/CURRUROL/A47). Robotic console time was 180 minutes, with minimal blood loss. Eight-hourly catheter aspiration and flushes were performed to manage the mucus in the urine. There were no metabolic acidosis or electrolyte derangements postoperatively. The patient was discharged on postoperative day 5. Postoperative cystogram at week 2 showed no leak and the patient is doing well at 1 year postoperatively. Robotic ileocystoplasty is safe and feasible and can reduce the morbidity associated with open surgery with good outcomes.
{"title":"Robot-assisted ileocystoplasty for the treatment of adult neurogenic bladder: A video demonstration and outcomes","authors":"Siying Yeow, Ahmed Goolam, Amanda Chung","doi":"10.1097/cu9.0000000000000221","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000221","url":null,"abstract":"Abstract Ileocystoplasty is one of the treatment options in the armamentarium for the management of adults with neurogenic bladder dysfunction, after failure of less invasive treatment alternatives, such as intravesical onabotulinum toxin A injection therapy and sacral neuromodulation. It has traditionally been performed as open surgery and can be associated with significant morbidity, especially in the early postoperative period. [ 1] Complications associated with open ileocystoplasty include prolonged postoperative ileus, wound infections, and pain. Performing robot-assisted ileocystoplasty can reduce the morbidity associated with open surgery [ 2] and has been shown to be safe and feasible in experienced hands, [ 3] although it may be associated with increased operative duration because of its learning curve. Our technique of robot-assisted ileocystoplasty and early postoperative outcomes is demonstrated in this video (Supplemental Digital Content, http://links.lww.com/CURRUROL/A47). Robotic console time was 180 minutes, with minimal blood loss. Eight-hourly catheter aspiration and flushes were performed to manage the mucus in the urine. There were no metabolic acidosis or electrolyte derangements postoperatively. The patient was discharged on postoperative day 5. Postoperative cystogram at week 2 showed no leak and the patient is doing well at 1 year postoperatively. Robotic ileocystoplasty is safe and feasible and can reduce the morbidity associated with open surgery with good outcomes.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134960280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1097/cu9.0000000000000224
Lin Wang, Wenxiong Song, Xufeng Peng, Rong Lyu, Jijian Wang, Chongrui Jin, Chao Feng, Xiangguo Lyu, Yinglong Sa, Yidong Liu
Abstract Objectives To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury (PFUI) in patients with a history of failed anastomotic urethroplasty. Materials and methods We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021. Patients with incomplete data and those who were lost to follow-up were excluded. Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention. Functional results, including erectile function and urinary continence, were evaluated. Descriptive statistical analyses were then performed. Results Thirty-one patients were included in this study. Among them, concomitant urethrorectal fistula occurred in 2 patients, and concomitant enlarged bladder neck occurred in 1. The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29. The mean length of urethral stenosis in all patients was 3.1 cm (range, 2.0–5.0 cm). After a mean follow-up of 34.6 months, the final success rate was 96.8%. The incidence of erectile dysfunction reached 77.4% (24/31). Normal continence was achieved in 27 (87.1%) patients. One patient developed urinary incontinence of grade II requiring urinal pads because of an enlarged bladder neck. According to the Clavien-Dindo classification, postoperative complications of grade I occurred in 7 patients and grade II in 4. Conclusions Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI. In complicated cases, it must be known and mastered.
{"title":"Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury","authors":"Lin Wang, Wenxiong Song, Xufeng Peng, Rong Lyu, Jijian Wang, Chongrui Jin, Chao Feng, Xiangguo Lyu, Yinglong Sa, Yidong Liu","doi":"10.1097/cu9.0000000000000224","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000224","url":null,"abstract":"Abstract Objectives To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury (PFUI) in patients with a history of failed anastomotic urethroplasty. Materials and methods We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021. Patients with incomplete data and those who were lost to follow-up were excluded. Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention. Functional results, including erectile function and urinary continence, were evaluated. Descriptive statistical analyses were then performed. Results Thirty-one patients were included in this study. Among them, concomitant urethrorectal fistula occurred in 2 patients, and concomitant enlarged bladder neck occurred in 1. The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29. The mean length of urethral stenosis in all patients was 3.1 cm (range, 2.0–5.0 cm). After a mean follow-up of 34.6 months, the final success rate was 96.8%. The incidence of erectile dysfunction reached 77.4% (24/31). Normal continence was achieved in 27 (87.1%) patients. One patient developed urinary incontinence of grade II requiring urinal pads because of an enlarged bladder neck. According to the Clavien-Dindo classification, postoperative complications of grade I occurred in 7 patients and grade II in 4. Conclusions Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI. In complicated cases, it must be known and mastered.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134960278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background We investigated potential disparities in health-related quality of life, particularly concerning urinary function, between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy (RARP). Materials and methods Between December 2012 and April 2020, 704 men underwent RARP in our hospital. This study included 155 patients with a preoperative 5-item International Index of Erectile Function (IIEF-5) of ≥12 points and an assessable IIEF-5 at 12 months postoperatively. Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC) preoperatively and at 3, 6, and 12 months postoperatively. A logistic regression analysis and Wilcoxon rank sum tests were performed. Results Patients were grouped according to the median IIEF-5 score 12 months after surgery: those with preserved sexual function ( n = 71) and those with impaired sexual function ( n = 84). The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function ( p < 0.01). In the EPIC, the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points compared with the group with impaired sexual function ( p < 0.01). In the comparison of the urinary subdomains of the EPIC, there were no significant differences in urinary function or incontinence, but there were significant differences in urinary distress and irritative/obstructive scores ( p < 0.01). Conclusions Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function. Hence, preserved sexual function is closely associated with urinary function.
{"title":"Impact of postoperative sexual function on health-related quality of life after robot-assisted radical prostatectomy","authors":"Yuya Iwahashi, Ryusuke Deguchi, Satoshi Muraoka, Takahito Wakamiya, Shimpei Yamashita, Kazuro Kikkawa, Yasuo Kohjimoto, Isao Hara","doi":"10.1097/cu9.0000000000000227","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000227","url":null,"abstract":"Abstract Background We investigated potential disparities in health-related quality of life, particularly concerning urinary function, between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy (RARP). Materials and methods Between December 2012 and April 2020, 704 men underwent RARP in our hospital. This study included 155 patients with a preoperative 5-item International Index of Erectile Function (IIEF-5) of ≥12 points and an assessable IIEF-5 at 12 months postoperatively. Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC) preoperatively and at 3, 6, and 12 months postoperatively. A logistic regression analysis and Wilcoxon rank sum tests were performed. Results Patients were grouped according to the median IIEF-5 score 12 months after surgery: those with preserved sexual function ( n = 71) and those with impaired sexual function ( n = 84). The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function ( p < 0.01). In the EPIC, the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points compared with the group with impaired sexual function ( p < 0.01). In the comparison of the urinary subdomains of the EPIC, there were no significant differences in urinary function or incontinence, but there were significant differences in urinary distress and irritative/obstructive scores ( p < 0.01). Conclusions Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function. Hence, preserved sexual function is closely associated with urinary function.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135864741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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