Current Urology最新文献

Background: The use of tamsulosin before semirigid ureteroscopy (URS) for proximal ureteral stones increases operative success. Several authors have used α-blockers for dilation of the ureter, and most studies have observed a higher stone-free rate and fewer complications than those with a placebo or no use of drugs. Ureteroscopy is the standard treatment for ureteral stones and has excellent outcomes. This study aimed to assess the effect of preoperative tamsulosin on the intraoperative and postoperative outcomes of URS in the management of lower ureteric stones.

Materials and methods: This was a double-blind randomized placebo-controlled clinical trial. A total of 80 patients were included, 40 in each group. The closed envelope method of randomization was performed at the Assiut Urology and Nephrology Hospital (Urology Department), Faculty of Medicine, Assiut University, Egypt, from December 2019 to November 2021.

Results: Both groups showed no significant differences in age, and the majority of patients in both groups were male. Most patients had a moderate degree of obstruction, and the stones were radiopaque. Both groups showed insignificant differences in stone size (11.93 ± 3.39 vs. 12.40 ± 4.24 mm, p = 0.30). Operative time was significantly shorter in the study group than in the control group (61.50 ± 23.99 vs. 79.80 ± 23.22 minutes, p = 0.001). The control group had a significantly higher frequency of need for dilatation (80% vs. 20%, p < 0.001) and need to stent than the study group (60% vs. 22.5%, p = 0.001).

Conclusions: Preoperative tamsulosin facilitates URS for lower ureteric stones. It decreases operative time, the need for dilation, and the need for postoperative indwelling ureteral stenting. It also increases the success rate but does not significantly affect the complication rate.

Background: Lupus cystitis may cause significant lower urinary tract symptoms (LUTS). This study aimed to evaluate LUTS and identify potential risk factors in female patients with systemic lupus erythematosus (SLE).

Materials and methods: In this case-control study, 46 female patients with SLE were assessed for LUTS using the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The findings were compared with a control group of 20 women.

Results: The total incidence rates of LUTS in the SLE and control groups were 82.6% and 55%, respectively (p = 0.022). Statistically significant differences were observed between the 2 groups in symptom duration (p < 0.001), filling (p < 0.001), voiding (p = 0.001), incontinence (p < 0.001), and total LUTS scores (p < 0.001) as measured by ICIQ-FLUTS. Additional significant differences included renal echogenicity (p = 0.003), bladder wall thickness (p = 0.045), and the presence of pus cells in urine (p = 0.045). The possible risk factors for the occurrence of LUTS in patients with lupus cystitis included rapid weight loss (p = 0.025), easy fatigability (p = 0.006), fever (p = 0.046), psychosis (p = 0.033), and both renal (p = 0.025) and clinical (p = 0.047) SLE disease activity indices. The Spearman correlation between the total ICIQ-FLUTS score and the SLE Disease Activity Index was not significant (r = -0.203; p = 0.181). However, a statistically significant but weak correlation was observed between the ICIQ-FLUTS score and easy fatigability (r = 0.381; p = 0.013).

Conclusions: The ICIQ-FLUTS demonstrated acceptable content validity and consistency in evaluating LUTS in patients with lupus cystitis. Rapid weight loss, easy fatigability, fever, psychosis, and elevated renal and clinical SLE Disease Activity Index scores were significantly associated with the occurrence of LUTS in these patients.

Objectives: To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy.

Materials and methods: We analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022. Demographic information and data regarding preoperative factors including stage of disease, preoperative hydronephrosis, and history of pelvic radiotherapy were collected via review of electronic medical records. All operations were performed by 1 of 2 experienced urologists using the da Vinci X, Xi, or Si surgical platforms.

Results: Ten patients were identified for this study. The median age of participants was 73.5 years (range, 41-84 years). The median American Society of Anesthesiologists classification score was 3 (range, 3-4). The median Charlson Comorbidity Index was 6 (range, 2-12). Among the patients, 4 out of 10 patients (40%) had muscle invasive bladder cancer before salvage surgery. Intracorporeal ileal conduit urinary diversion was performed in 8 patients, whereas 2 patients underwent intracorporeal neobladder formation. Median intraoperative blood loss was 250 mL (range, 150-600 mL), and median operative duration was 390 minutes (range, 195-450 minutes). The overall 30-day complication rate was 60% with a Clavien-Dindo grade ≥3 complication rate of 15%. Perioperative mortality was 0%. Median duration of follow-up was 210 days (range, 60-1580 days).

Conclusions: This series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique. Further studies with long-term follow-up, including oncological outcomes, are required to support the widespread adoption of this procedure.

Background: Recent advances in endoscopic technology have empowered urologists to treat most types of stones within the urinary tract effectively. Available treatments for ureteral stones using a laser lithotripter include fragmentation, the active removal of fragments with a basket, and dusting. To date, only a few prospective randomized studies have endorsed the use of stone dusting, fragmentation, and active removal for ureteric stones.

Materials and methods: This randomized, prospective, comparative study was conducted in the Urology Department. Sixty patients with proximal ureteral stones from July 2019 to July 2020 were included and randomly divided into 2 groups using a random number generator program (version 2, 2015). In Group 1, the stones were fragmented into dust (n = 30), and in Group 2, lithotripsy produced extractable fragments (n = 30).

Results: In this study, the Ho:YAG laser was used to dust stones at low energy and high frequency (0.4-0.6 J and 20-30 Hz). Using the Ho:YAG laser set to high energy and low frequency (1.5-2 J and 8-10 Hz), stone fragmentation was achieved. The mean stone size was 1.63 cm in Group 1 and 1.69 cm in Group 2. The stone-free rates for the dusting and fragmentation groups were 96.6% and 86.6%, respectively. Meanwhile, the mean operative time was 87.6 ± 33.6 minutes in the dusting group and 80.4 ± 28.8 minutes in the fragmentation group. There were no postoperative complications with the dusting technique, compared with a 13.3% complication rate with the fragmentation technique.

Conclusions: For proximal ureteral stones, the stone-free rates between the dusting and fragmentation procedures were comparable. Both techniques proved to be effective.

Informed consent is a cornerstone of ethically acceptable surgical interventions. Traditional methods primarily rely on verbal explanations by clinicians and, at times, the use of supplementary resources such as information leaflets. In the modern era, novel tools have emerged to facilitate and enhance the consent process. Examples include multimedia, 3D models, virtual and augmented reality, quick response codes, and artificial intelligence technologies such as large language models. This narrative review provides an overview of these aids, discussing their potential advantages and limitations. In addition, the influence of social media on the consent process is explored.

Benign prostatic hyperplasia is commonly observed in older men, and surgery is the primary treatment. Management of prostatic hyperplasia nodules, especially embedded capsular hyperplasia nodules, is crucial for reducing the incidence of postoperative complications and the need for repeat surgery. We summarize the sources of prostatic hyperplasia nodules, relationship between the nodules and the surgical capsule of the prostate, advantages and disadvantages of various surgical procedures for hyperplasia nodules, and impact of surgery on the incidence of postoperative complications. Additionally, we share our experience with the management of embedded capsular hyperplasia nodules using thulium laser enucleation of the prostate. We hope that doctors will pay attention to the management of embedded capsular hyperplasia nodules during prostate surgery in their clinical practice.

Because of the anatomical characteristics of the prostate, benign prostatic hyperplasia (BPH) often occurs in the transition zone, whereas prostate cancer (PCa) tends to occur in the peripheral zone. This distribution characteristic indicates that the prostate gland has cell type and distribution heterogeneity. However, the current research cannot answer these questions precisely. As research has progressed, the significance of many newly discovered cell types for the treatment of BPH and PCa has sparked widespread concern. Prostate heterogeneity is closely associated with gland development and formation and the regional distribution of the disease. Prostate heterogeneity can be observed at the gland and cell levels and determines disease distribution, presentation, and characteristics, including changes in the microenvironments of BPH and PCa. Cell population interactions promote disease onset and development; single-cell sequencing techniques may help elucidate specific cell types and gene expression patterns in different prostate zones. The stem cell characteristics of club/hillock cells and the inflammatory environment induced by immune cells offer alternative interpretations of the pathogenic mechanisms of BPH and PCa, and molecular omics studies can help identify novel avenues for treatment development.

Background: Systemic sclerosis (SSC) affects the urinary bladder and many other body organs. Systemic sclerosis commonly manifests as lower urinary tract symptoms (LUTS), which are usually reported using validated questionnaires. This study aimed to correlate questionnaire-reported LUTS with urodynamic findings in patients with SSC.

Materials and methods: This cross-sectional study was performed at our center between August 2018 and July 2021. Lower urinary tract symptoms were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms Modules and ICIQ Male Lower Urinary Tract Symptoms Module and urodynamic studies. Univariate analyses were then performed on variables affecting detrusor activity.

Results: This study included 22 patients (5 men, 17 women). The mean ± standard deviation age, body mass index, and disease duration were 37.2 ± 11.1 years, 25.5 ± 4.2 kg/m², and 6.2 ± 5.3 years, respectively. Lower urinary tract symptoms occurred in 19 (86.4%) patients, of whom 18 (94.7%) had mild to moderate symptoms. The ICIQ scores for voiding and filling symptoms were higher than those for incontinence. The most frequent organ involvements included Raynaud's phenomenon in 22 (100%), skin conditions in 20 (90.9%), gastrointestinal tract maladies in 17 (77.3%), joint disorders in 16 (72.7%), and lung diseases in 14 (63.6%) patients. Abnormal detrusor contractions occurred in only 5 patients (22.7%). Univariate analyses showed that disease duration <5 years (p = 0.010), nonobstructive uroflowmetry findings (p = 0.024), absence of incontinence (p = 0.024) and telangiectasia (p = 0.010), and negative rheumatoid factors (p = 0.043) were significantly associated with normal detrusor contractions.

Conclusions: Mild to moderate severity of ICIQ-measured LUTS affected most patients with SSC but was not correlated with urodynamic findings. Normal detrusor contractions were significantly associated with shorter disease duration, nonobstructive uroflowmetry findings, absence of incontinence and telangiectasia, and negative rheumatoid factors.

Background: Limited published data exist regarding the utility of sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD), consisting of only small case series, and, to our knowledge, no Australian data have been published. The aim of this study was to evaluate the clinical outcomes of SNM for treatment of NLUTD in Australian patients.

Methods: A retrospective analysis was conducted of patients who received a permanent SNM implant between December 2014 and March 2021. Patients completed a urodynamic test preoperatively. They completed a 3-day bladder diary, uroflowmetry, and postvoid residual measurement preoperatively and at 6-month intervals postoperatively following SNM insertion. Urinary function, patient-reported outcome measures, and adverse events were assessed.

Results: A total of 36 patients received a permanent SNM implant. The mean duration of follow-up was 25 ± 20 months, with the majority (89%, n = 32) of patients reporting a >50% improvement on bladder diary evaluation. There was a significant increase in void volume (p < 0.001), decrease in postvoid residual (p < 0.001), decrease in voiding frequency (p < 0.001), decrease in incontinence episodes (p = 0.002), and decrease in pad number (p < 0.001). There was no significant difference in peak flow (p = 0.21). There was no significant difference in SNM efficacy between patients with progressive or nonprogressive neurological conditions.

Conclusions: Sacral neuromodulation is a safe and effective therapy for NLUTD in the context of both progressive and nonprogressive neurological conditions. It should be offered more readily to patients with NLUTD as a minimally invasive treatment option with the potential to make clinically meaningful improvements in quality of life.