Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2025.04.002
Mohamed Osama, Medhat Ahmed Abdalla
Objective
To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury. Prediction of complex repair helps in adequate patient counseling and preparation, and possible referral to high-volume reconstructive surgeons.
Methods
A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records. Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma. Defect length was measured and bladder neck position was verified. Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.
Results
Patients' ages ranged from 19 years to 53 years (median 34 years). The overall success rate of urethroplasty was 80%. Displacement of the bladder neck from the midline was significantly associated with prolonged operative time (p=0.004) and increased blood loss (p=0.002). There were strong positive correlations between preoperative defect length and operative time (rs=0.84) as well as blood loss (rs=0.78), which were statistically significant (p=0.001).
Conclusion
Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.
{"title":"Bladder neck displacement and its relevance to difficult repair of pelvic fracture urethral injury: A retrospective study","authors":"Mohamed Osama, Medhat Ahmed Abdalla","doi":"10.1016/j.ajur.2025.04.002","DOIUrl":"10.1016/j.ajur.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury. Prediction of complex repair helps in adequate patient counseling and preparation, and possible referral to high-volume reconstructive surgeons.</div></div><div><h3>Methods</h3><div>A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records. Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma. Defect length was measured and bladder neck position was verified. Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.</div></div><div><h3>Results</h3><div>Patients' ages ranged from 19 years to 53 years (median 34 years). The overall success rate of urethroplasty was 80%. Displacement of the bladder neck from the midline was significantly associated with prolonged operative time (<em>p</em>=0.004) and increased blood loss (<em>p</em>=0.002). There were strong positive correlations between preoperative defect length and operative time (<em>r<sub>s</sub></em>=0.84) as well as blood loss (<em>r<sub>s</sub></em>=0.78), which were statistically significant (<em>p</em>=0.001).</div></div><div><h3>Conclusion</h3><div>Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 529-533"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2024.12.001
Yuki Arita , Christian Roest , Thomas C. Kwee , Ramesh Paudyal , Alfonso Lema-Dopico , Stefan Fransen , Daisuke Hirahara , Eichi Takaya , Ryo Ueda , Lisa Ruby , Noam Nissan , Lawrence H. Schwartz , Amita Shukla-Dave , Oguz Akin
Objective
This review provides a comprehensive overview of the current research landscape on artificial intelligence (AI) in prostate cancer (PCa) management, highlighting its potential to enhance diagnosis, improve medical image quality, facilitate risk stratification, and aid prognosis. The review also identifies opportunities and challenges associated with integrating AI into clinical practice.
Methods
This review synthesizes findings from recent studies on AI applications in PCa management. It examines the use of machine learning and deep learning techniques in diagnostic imaging, surgical skill assessment, and outcome prediction. The analysis emphasizes empirical evidence demonstrating the efficacy and limitations of AI models in clinical settings.
Results
AI, particularly machine learning and deep learning algorithms, is improving diagnostic accuracy by analyzing medical images with greater efficiency and precision compared to traditional methods. AI-based tools are also being developed for surgical skill assessment, offering objective evaluations and feedback to surgeons. Additionally, AI applications in predicting patient outcomes are facilitating the creation of personalized treatment plans. Empirical evidence shows that AI models exhibit higher sensitivity and specificity in detecting clinically significant PCa, outperforming conventional diagnostic techniques.
Conclusion
AI holds significant promise for transforming PCa management by improving diagnostic accuracy, personalizing treatment plans, and enhancing patient outcomes. While the evidence underscores its potential, challenges such as the need for larger, more diverse datasets and addressing implementation barriers remain critical. Despite these hurdles, the benefits of AI in PCa management represent a compelling area for future research and clinical integration.
{"title":"Advancements in artificial intelligence for prostate cancer: Optimizing diagnosis, treatment, and prognostic assessment","authors":"Yuki Arita , Christian Roest , Thomas C. Kwee , Ramesh Paudyal , Alfonso Lema-Dopico , Stefan Fransen , Daisuke Hirahara , Eichi Takaya , Ryo Ueda , Lisa Ruby , Noam Nissan , Lawrence H. Schwartz , Amita Shukla-Dave , Oguz Akin","doi":"10.1016/j.ajur.2024.12.001","DOIUrl":"10.1016/j.ajur.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>This review provides a comprehensive overview of the current research landscape on artificial intelligence (AI) in prostate cancer (PCa) management, highlighting its potential to enhance diagnosis, improve medical image quality, facilitate risk stratification, and aid prognosis. The review also identifies opportunities and challenges associated with integrating AI into clinical practice.</div></div><div><h3>Methods</h3><div>This review synthesizes findings from recent studies on AI applications in PCa management. It examines the use of machine learning and deep learning techniques in diagnostic imaging, surgical skill assessment, and outcome prediction. The analysis emphasizes empirical evidence demonstrating the efficacy and limitations of AI models in clinical settings.</div></div><div><h3>Results</h3><div>AI, particularly machine learning and deep learning algorithms, is improving diagnostic accuracy by analyzing medical images with greater efficiency and precision compared to traditional methods. AI-based tools are also being developed for surgical skill assessment, offering objective evaluations and feedback to surgeons. Additionally, AI applications in predicting patient outcomes are facilitating the creation of personalized treatment plans. Empirical evidence shows that AI models exhibit higher sensitivity and specificity in detecting clinically significant PCa, outperforming conventional diagnostic techniques.</div></div><div><h3>Conclusion</h3><div>AI holds significant promise for transforming PCa management by improving diagnostic accuracy, personalizing treatment plans, and enhancing patient outcomes. While the evidence underscores its potential, challenges such as the need for larger, more diverse datasets and addressing implementation barriers remain critical. Despite these hurdles, the benefits of AI in PCa management represent a compelling area for future research and clinical integration.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 434-444"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2025.01.005
Guilherme M.M. Lopes , Lucas G.C.R. de Amorim , Giovanna V. Gomes , Thaise P. da Silva , Manuel G.R. Martínez , Mohammed A. Ramadhan , Bárbara Vieira Lima Aguiar Melão
Objective
We aimed to perform a systematic review and meta-analysis to assess the efficacy of virtual reality (VR) distraction technologies in managing pain and anxiety in patients undergoing cystoscopy procedures.
Methods
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2024, for studies comparing the use of VR distraction technologies versus no VR distraction in patients undergoing cystoscopy. The primary endpoints evaluated were patient-reported anxiety and procedural pain scores, and post-procedural heart rate (HR). Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. The statistical analysis was conducted using Review Manager 5.4.
Results
A total of 575 patients from four randomized controlled trials were included, of whom 289 (50%) underwent the cystoscopy procedure using VR distraction technologies. The mean age of all patients was 57.25 years old, and 395 (69%) of them were male. In our pooled analysis, we did not observe a statistically significant reduction in patient-reported procedural pain (SMD −0.16; 95% CI −0.32–0.00; p=0.060; I2=0%), anxiety (SMD −0.37; 95% CI −1.65–0.90; p=0.6; I2=93%), or post-procedural HR (SMD −0.58; 95% CI −1.62–0.45; p=0.3; I2=97%).
Conclusion
In this comprehensive meta-analysis comprising 575 patients who underwent cystoscopy, the use of VR was not associated with a significant difference in pain, anxiety, or HR levels.
目的：本研究旨在通过系统回顾和荟萃分析来评估虚拟现实（VR）分心技术在膀胱镜检查患者疼痛和焦虑治疗中的效果。方法：我们检索PubMed、Embase和Cochrane中央对照试验注册库（Central Register of Controlled Trials），从开始到2024年7月，比较在膀胱镜检查患者中使用VR牵张技术和不使用VR牵张技术的研究。评估的主要终点是患者报告的焦虑和手术疼痛评分，以及手术后心率（HR）。使用随机效应模型计算标准化平均差（SMDs）及其95%置信区间（ci）。使用Review Manager 5.4进行统计分析。结果4项随机对照试验共纳入575例患者，其中289例（50%）采用VR牵张技术进行膀胱镜检查。患者平均年龄57.25岁，其中男性395例（69%）。在我们的汇总分析中，我们没有观察到患者报告的手术疼痛（SMD - 0.16; 95% CI - 0.32-0.00; p=0.060; I2=0%）、焦虑（SMD - 0.37; 95% CI - 1.65-0.90; p=0.6; I2=93%）或手术后HR （SMD - 0.58; 95% CI - 1.62-0.45; p=0.3; I2=97%）的统计学显著降低。在这项包括575名接受膀胱镜检查的患者的综合荟萃分析中，VR的使用与疼痛、焦虑或HR水平的显着差异无关。
{"title":"Effectiveness of virtual reality to manage pain and anxiety in patients undergoing cystoscopy: A systematic review and meta-analysis","authors":"Guilherme M.M. Lopes , Lucas G.C.R. de Amorim , Giovanna V. Gomes , Thaise P. da Silva , Manuel G.R. Martínez , Mohammed A. Ramadhan , Bárbara Vieira Lima Aguiar Melão","doi":"10.1016/j.ajur.2025.01.005","DOIUrl":"10.1016/j.ajur.2025.01.005","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to perform a systematic review and meta-analysis to assess the efficacy of virtual reality (VR) distraction technologies in managing pain and anxiety in patients undergoing cystoscopy procedures.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2024, for studies comparing the use of VR distraction technologies versus no VR distraction in patients undergoing cystoscopy. The primary endpoints evaluated were patient-reported anxiety and procedural pain scores, and post-procedural heart rate (HR). Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. The statistical analysis was conducted using Review Manager 5.4.</div></div><div><h3>Results</h3><div>A total of 575 patients from four randomized controlled trials were included, of whom 289 (50%) underwent the cystoscopy procedure using VR distraction technologies. The mean age of all patients was 57.25 years old, and 395 (69%) of them were male. In our pooled analysis, we did not observe a statistically significant reduction in patient-reported procedural pain (SMD −0.16; 95% CI −0.32–0.00; <em>p</em>=0.060; <em>I</em><sup>2</sup>=0%), anxiety (SMD −0.37; 95% CI −1.65–0.90; <em>p</em>=0.6; <em>I</em><sup>2</sup>=93%), or post-procedural HR (SMD −0.58; 95% CI −1.62–0.45; <em>p</em>=0.3; <em>I</em><sup>2</sup>=97%).</div></div><div><h3>Conclusion</h3><div>In this comprehensive meta-analysis comprising 575 patients who underwent cystoscopy, the use of VR was not associated with a significant difference in pain, anxiety, or HR levels.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 462-470"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2024.09.002
Daniel Pérez-Fentes , Esteban Emiliani , Ernesto Donoso , Alba García-Catalán , Lucía Mosquera-Seoane , Beatriz Ulloa-Iglesias , María E. Martínez-Corral
Objective
Urinary stones in pregnancy are usually managed conservatively or with temporary drainage, but in some cases, intervention is needed. Percutaneous nephrolithotomy (PCNL) is generally avoided due to its invasiveness and the requirement for fluoroscopy. This study aimed to review the literature on the use of PCNL in pregnancy, focusing on its safety, efficacy, feasibility, and technical aspects.
Methods
A narrative literature review was conducted using PubMed, Embase, and Scopus databases, covering the period from January 2000 to March 2024. The search terms included “percutaneous nephrolithotomy”, “PCNL”, “pregnancy”, and relevant variations thereof. The initial search retrieved 27 articles, of which only six studies involving 14 patients met the inclusion criteria.
Results
The reviewed studies included patients aged 23–34 years who underwent PCNL between 8 weeks and 28 weeks of gestation. Preoperative evaluations were exclusively based on ultrasound imaging, with stone sizes ranging from 8 mm to 48 mm. Indications for PCNL were persistent pain despite urinary diversion or reluctance to undergo stent replacement. Fluoroscopy was avoided in 13 patients. No maternal or fetal complications were reported.
Conclusion
PCNL appears to be a safe and feasible treatment option for selected cases of urinary stone disease during pregnancy. It should be performed in experienced centers, with proper patient counseling and a multidisciplinary approach to ensure the best outcomes.
{"title":"Percutaneous nephrolithotomy in pregnancy: A comprehensive review and technical insights","authors":"Daniel Pérez-Fentes , Esteban Emiliani , Ernesto Donoso , Alba García-Catalán , Lucía Mosquera-Seoane , Beatriz Ulloa-Iglesias , María E. Martínez-Corral","doi":"10.1016/j.ajur.2024.09.002","DOIUrl":"10.1016/j.ajur.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>Urinary stones in pregnancy are usually managed conservatively or with temporary drainage, but in some cases, intervention is needed. Percutaneous nephrolithotomy (PCNL) is generally avoided due to its invasiveness and the requirement for fluoroscopy. This study aimed to review the literature on the use of PCNL in pregnancy, focusing on its safety, efficacy, feasibility, and technical aspects.</div></div><div><h3>Methods</h3><div>A narrative literature review was conducted using PubMed, Embase, and Scopus databases, covering the period from January 2000 to March 2024. The search terms included “percutaneous nephrolithotomy”, “PCNL”, “pregnancy”, and relevant variations thereof. The initial search retrieved 27 articles, of which only six studies involving 14 patients met the inclusion criteria.</div></div><div><h3>Results</h3><div>The reviewed studies included patients aged 23–34 years who underwent PCNL between 8 weeks and 28 weeks of gestation. Preoperative evaluations were exclusively based on ultrasound imaging, with stone sizes ranging from 8 mm to 48 mm. Indications for PCNL were persistent pain despite urinary diversion or reluctance to undergo stent replacement. Fluoroscopy was avoided in 13 patients. No maternal or fetal complications were reported.</div></div><div><h3>Conclusion</h3><div>PCNL appears to be a safe and feasible treatment option for selected cases of urinary stone disease during pregnancy. It should be performed in experienced centers, with proper patient counseling and a multidisciplinary approach to ensure the best outcomes.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 478-485"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While technical operating skills and clinical knowledge are often the goals of surgical training, for overall competency, the required skill set goes far beyond these. Social and cognitive abilities in the form of non-technical skills (NTS) are indispensable competencies that complement a surgeon's procedural efficiency and contribute towards patient safety. The NTS are classified into three unique groups: cognitive (decision-making and situational awareness), social (leadership, teamwork, and communication), and personal resource factors (an individual's ability to manage fatigue and stress). Inadequacy in the aforementioned is often the underlying cause of detrimental operating room outcomes and surgical errors universally.
Methods
This review looks at various components of NTS and evaluation tools currently in use, their importance in urological training, and the need to introduce a formal programme. This would not only complement technical skills, but also serve as an integral and mandatory part of training years for all grades of urologists.
Results
Assessment of NTS through comprehensively validated rating tools allows for the evaluation of skills and therefore finds room for improvement in competencies. Commonly used systems include the Non-Technical Skills for Surgeons (NOTSS), Non-Technical Skills (NOTECHS), and Observational Teamwork Assessment for Surgery (OTAS).
Conclusion
The significance of associating team culture with the safety of surgery is increasingly recognised, given that human error is unavoidable and hard to eradicate. Whilst we now have a clear definition of the NTS and their importance in surgery and the operating theatre, there is still a lack of a validated and standardised NTS training programme directed at urologists, and that is applicable to all levels, whether they be trainees or consultants. Simulation-based learning is an excellent avenue for progressing surgical education and should be taken advantage of in developing a curriculum that is mandatory for NTS training in urology.
{"title":"Communication, teamwork, and the role of non-technical skills in Urology: A review by the European School of Urology","authors":"Mahir Akram , Bhaskar Somani , Evangelos Liatsikos , Vineet Gauhar , Steffi Kar Kei Yuen , Arnulf Stenzl","doi":"10.1016/j.ajur.2024.12.005","DOIUrl":"10.1016/j.ajur.2024.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>While technical operating skills and clinical knowledge are often the goals of surgical training, for overall competency, the required skill set goes far beyond these. Social and cognitive abilities in the form of non-technical skills (NTS) are indispensable competencies that complement a surgeon's procedural efficiency and contribute towards patient safety. The NTS are classified into three unique groups: cognitive (decision-making and situational awareness), social (leadership, teamwork, and communication), and personal resource factors (an individual's ability to manage fatigue and stress). Inadequacy in the aforementioned is often the underlying cause of detrimental operating room outcomes and surgical errors universally.</div></div><div><h3>Methods</h3><div>This review looks at various components of NTS and evaluation tools currently in use, their importance in urological training, and the need to introduce a formal programme. This would not only complement technical skills, but also serve as an integral and mandatory part of training years for all grades of urologists.</div></div><div><h3>Results</h3><div>Assessment of NTS through comprehensively validated rating tools allows for the evaluation of skills and therefore finds room for improvement in competencies. Commonly used systems include the Non-Technical Skills for Surgeons (NOTSS), Non-Technical Skills (NOTECHS), and Observational Teamwork Assessment for Surgery (OTAS).</div></div><div><h3>Conclusion</h3><div>The significance of associating team culture with the safety of surgery is increasingly recognised, given that human error is unavoidable and hard to eradicate. Whilst we now have a clear definition of the NTS and their importance in surgery and the operating theatre, there is still a lack of a validated and standardised NTS training programme directed at urologists, and that is applicable to all levels, whether they be trainees or consultants. Simulation-based learning is an excellent avenue for progressing surgical education and should be taken advantage of in developing a curriculum that is mandatory for NTS training in urology.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 455-461"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2024.10.004
Shuhang Luo , Xuanfan Liu , Nueraili Nuermaimaiti , Shuangjian Jiang , Chengqiang Mo , Baohua Bai , Rongpei Wu , Qinsong Zeng
Objective
This study developed a novel technique for performing percutaneous nephrolithotomy (PCNL) in the knee-flexion prone split-leg (KF-PSL) position; this technique aimed to address the shortcomings of the traditional prone (TP) position and the PSL position. The study evaluated the safety, advantages, and feasibility of the KF-PSL position compared to the TP position.
Methods
A novel technique was developed based on the common PSL position. A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023. Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared.
Results
A total of 276 patients were divided into two groups based on the operative position. The preoperative parameters of the two groups did not differ significantly. The mean stone size (represented by the aggregation of the diameter of all the stones) was 40.03 (SD 23.89) mm. Significant differences were found in both the mean operative time (80.9 [SD 47.2] min in KF-PSL vs. 107.3 [SD 57.7] min in TP, p<0.001) and the stone-free rates (73% in KF-PSL vs. 61% in TP, p=0.046). Braden Scale scores of the two groups did not differ significantly (p=0.12). No significant difference was observed between the groups in the total complication rate (p=0.6).
Conclusion
The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time, a higher stone-free rate, and a more simplified surgical procedure compared to the TP position without compromising outcomes. It is more convenient for combined therapy, allowing access to the entire urinary tract without the need for position changes.
{"title":"Contralateral knee-flexion prone split-leg percutaneous nephrolithotomy: A versatile technique","authors":"Shuhang Luo , Xuanfan Liu , Nueraili Nuermaimaiti , Shuangjian Jiang , Chengqiang Mo , Baohua Bai , Rongpei Wu , Qinsong Zeng","doi":"10.1016/j.ajur.2024.10.004","DOIUrl":"10.1016/j.ajur.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>This study developed a novel technique for performing percutaneous nephrolithotomy (PCNL) in the knee-flexion prone split-leg (KF-PSL) position; this technique aimed to address the shortcomings of the traditional prone (TP) position and the PSL position. The study evaluated the safety, advantages, and feasibility of the KF-PSL position compared to the TP position.</div></div><div><h3>Methods</h3><div>A novel technique was developed based on the common PSL position. A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023. Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared.</div></div><div><h3>Results</h3><div>A total of 276 patients were divided into two groups based on the operative position. The preoperative parameters of the two groups did not differ significantly. The mean stone size (represented by the aggregation of the diameter of all the stones) was 40.03 (SD 23.89) mm. Significant differences were found in both the mean operative time (80.9 [SD 47.2] min in KF-PSL <em>vs.</em> 107.3 [SD 57.7] min in TP, <em>p</em><0.001) and the stone-free rates (73% in KF-PSL <em>vs.</em> 61% in TP, <em>p</em>=0.046). Braden Scale scores of the two groups did not differ significantly (<em>p</em>=0.12). No significant difference was observed between the groups in the total complication rate (<em>p</em>=0.6).</div></div><div><h3>Conclusion</h3><div>The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time, a higher stone-free rate, and a more simplified surgical procedure compared to the TP position without compromising outcomes. It is more convenient for combined therapy, allowing access to the entire urinary tract without the need for position changes.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 544-553"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2024.11.001
Ahmed Assem , Wahed Fawzy , Islam Nasser Abd Elaziz , Samer Morsy , Islam Kamal , Ahmed Abdalla Ashmawy
Objective
This study attempted to compare the laser energy-based enucleation with the mechanical dissection-based enucleation regarding the enucleation efficiency and the functional outcomes.
Methods
This was a prospective multicenter study including patients with a prostate exceeding 80 g. Thulium laser enucleation of the prostate was conducted using a high-power thulium laser either through mechanical dissection-based enucleation (Group A) or through laser energy-based enucleation (Group B) according to the preoperative randomization. In Group A, the resectoscope sheath beak was used to liberate the prostate adenoma and laser energy was reserved for adhesions and for hemostasis. In Group B, laser energy was implemented throughout the procedure.
Results
Groups A and B included 68 and 71 patients, respectively, for analysis. The mean (standard deviation [SD]) enucleation time was shorter in Group A than in Group B (55.2 [SD 9.4] min vs. 77.3 [SD 12.5] min, p=0.021). The enucleation efficiency and total operative time were statistically different between the two groups (p=0.032 and 0.039, respectively). Black eschars were observed in 21% of Group A and 100% of Group B. A larger percentage of Group B (35%) expressed more storage symptoms in the first 3 months after surgery than that of Group A (13%). There was no statistically significant difference between the two groups regarding the postoperative transient stress urinary incontinence. Additionally, there was no statistically significant difference between the two techniques regarding the overall bleeding, or the hospital stay in patients on antiplatelet or anticoagulant therapy.
Conclusion
Both mechanical dissection-based and laser energy-based thulium laser enucleation of the prostate are safe and feasible for successful reduction of bladder outlet resistance. The mechanical dissection-based enucleation technique provides higher enucleation efficiency with lower postoperative transient storage symptoms.
目的比较激光能量型去核术与机械解剖型去核术在去核效率和功能方面的差异。方法本研究为前瞻性多中心研究，纳入前列腺超过80g的患者。根据术前随机分组，采用高功率铥激光进行以机械解剖为基础的去核（a组）或以激光能量为基础的去核（B组）。A组采用切除镜鞘喙释放前列腺腺瘤，保留激光能量粘连止血。在B组，整个过程中都使用激光能量。结果A组68例，B组71例。A组平均去核时间（标准差[SD]）短于B组（55.2 [SD 9.4] min vs. 77.3 [SD 12.5] min, p=0.021）。两组患者的去核效率和总手术时间比较，差异有统计学意义（p分别为0.032和0.039）。A组21%和B组100%出现黑痂。B组患者术后3个月出现积存症状的比例（35%）高于A组（13%）。两组术后一过性应激性尿失禁的发生率差异无统计学意义。此外，两种技术在总体出血或抗血小板或抗凝治疗患者住院时间方面没有统计学上的显著差异。结论机械解剖法和激光能量法均可成功降低膀胱出口阻力，安全可行。以机械解剖为基础的去核技术具有更高的去核效率和更低的术后短暂储存症状。
{"title":"Mechanical dissection-based enucleation versus laser energy-based enucleation during thulium laser enucleation of a large prostate: A prospective randomized analysis","authors":"Ahmed Assem , Wahed Fawzy , Islam Nasser Abd Elaziz , Samer Morsy , Islam Kamal , Ahmed Abdalla Ashmawy","doi":"10.1016/j.ajur.2024.11.001","DOIUrl":"10.1016/j.ajur.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study attempted to compare the laser energy-based enucleation with the mechanical dissection-based enucleation regarding the enucleation efficiency and the functional outcomes.</div></div><div><h3>Methods</h3><div>This was a prospective multicenter study including patients with a prostate exceeding 80 g. Thulium laser enucleation of the prostate was conducted using a high-power thulium laser either through mechanical dissection-based enucleation (Group A) or through laser energy-based enucleation (Group B) according to the preoperative randomization. In Group A, the resectoscope sheath beak was used to liberate the prostate adenoma and laser energy was reserved for adhesions and for hemostasis. In Group B, laser energy was implemented throughout the procedure.</div></div><div><h3>Results</h3><div>Groups A and B included 68 and 71 patients, respectively, for analysis. The mean (standard deviation [SD]) enucleation time was shorter in Group A than in Group B (55.2 [SD 9.4] min <em>vs.</em> 77.3 [SD 12.5] min, <em>p</em>=0.021). The enucleation efficiency and total operative time were statistically different between the two groups (<em>p</em>=0.032 and 0.039, respectively). Black eschars were observed in 21% of Group A and 100% of Group B. A larger percentage of Group B (35%) expressed more storage symptoms in the first 3 months after surgery than that of Group A (13%). There was no statistically significant difference between the two groups regarding the postoperative transient stress urinary incontinence. Additionally, there was no statistically significant difference between the two techniques regarding the overall bleeding, or the hospital stay in patients on antiplatelet or anticoagulant therapy.</div></div><div><h3>Conclusion</h3><div>Both mechanical dissection-based and laser energy-based thulium laser enucleation of the prostate are safe and feasible for successful reduction of bladder outlet resistance. The mechanical dissection-based enucleation technique provides higher enucleation efficiency with lower postoperative transient storage symptoms.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 504-511"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.ajur.2025.03.004
Omer Anis , Vered Bar , Adi Zundelevich , Seegehali M. Anil , Yaron Shav-Tal , Amos Toren , Dan Dominissini , Gil Raviv , Menachem Laufer , Alon Lazarovich , Tomer Drori , Jacob Ramon , Zohar Dotan , Hinanit Koltai
Objective
This study aimed to explore the anticancer potential of Cannabis sativa (C. sativa) strains, specifically PARIS, Dairy Queen (DQ), and super cannabidiol (sCBD), on bladder cancer cells. Given the increasing interest in cannabinoids like cannabichromene (CBC) and delta-9-tetrahydrocannabinol (THC) for their therapeutic properties, we evaluated their cytotoxic effects on urothelial carcinoma (UC) cell lines and their ability to inhibit cell migration and induce apoptosis in both two-dimensional cell models and three-dimensional ex vivo organ cultures (EVOCs).
Methods
C. sativa strains were screened for their cytotoxicity against UC cell lines (HTB-4 and HTB-9) using XTT assays. Their phytocannabinoid content was analyzed using high-performance liquid chromatography. We employed fluorescence-activated cell-sorting to determine apoptosis and cell cycle, migration assays to determine cell migration, and EVOCs to evaluate the cytotoxic effect on UC. Gene expression was determined by quantitative polymerase chain reaction.
Results
Three commercial C. sativa strains, PARIS, DQ, and sCBD, were found to have the most potent anticancer effects on bladder cancer cells. All extracts contain CBC and THC at different concentrations. In XTT assays on UC cell lines, PARIS had a half-maximal inhibitory concentration (IC50) of 21.58 μg/mL, while DQ and sCBD had similar cytotoxic activity with IC50 values for 48-h treatment of 17.99 μg/mL and 17.88 μg/mL, respectively. DQ and sCBD extracts were found to significantly reduce cell migration and increase the percentage of cells in S phase and G2/M phase within the cell population. In EVOCs, the extracts initiated cell death with the expression of apoptosis-related genes increased following exposure to treatment.
Conclusion
The findings suggest that C. sativa strains PARIS, DQ, and sCBD, containing CBC and THC, exhibit significant anticancer activity against UC cell lines and ex vivo models. These results underscore the therapeutic potential of CBC- and THC-rich C. sativa extracts in bladder cancer treatment.
{"title":"Targeting bladder cancer: Potent anti-cancer effects of cannabichromene and delta-9-tetrahydrocannabinol-rich Cannabis sativa strains","authors":"Omer Anis , Vered Bar , Adi Zundelevich , Seegehali M. Anil , Yaron Shav-Tal , Amos Toren , Dan Dominissini , Gil Raviv , Menachem Laufer , Alon Lazarovich , Tomer Drori , Jacob Ramon , Zohar Dotan , Hinanit Koltai","doi":"10.1016/j.ajur.2025.03.004","DOIUrl":"10.1016/j.ajur.2025.03.004","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the anticancer potential of <em>Cannabis sativa</em> (<em>C. sativa</em>) strains, specifically PARIS, Dairy Queen (DQ), and super cannabidiol (sCBD), on bladder cancer cells. Given the increasing interest in cannabinoids like cannabichromene (CBC) and delta-9-tetrahydrocannabinol (THC) for their therapeutic properties, we evaluated their cytotoxic effects on urothelial carcinoma (UC) cell lines and their ability to inhibit cell migration and induce apoptosis in both two-dimensional cell models and three-dimensional <em>ex vivo</em> organ cultures (EVOCs).</div></div><div><h3>Methods</h3><div><em>C. sativa</em> strains were screened for their cytotoxicity against UC cell lines (HTB-4 and HTB-9) using XTT assays. Their phytocannabinoid content was analyzed using high-performance liquid chromatography. We employed fluorescence-activated cell-sorting to determine apoptosis and cell cycle, migration assays to determine cell migration, and EVOCs to evaluate the cytotoxic effect on UC. Gene expression was determined by quantitative polymerase chain reaction.</div></div><div><h3>Results</h3><div>Three commercial <em>C. sativa</em> strains, PARIS, DQ, and sCBD, were found to have the most potent anticancer effects on bladder cancer cells. All extracts contain CBC and THC at different concentrations. In XTT assays on UC cell lines, PARIS had a half-maximal inhibitory concentration (IC<sub>50</sub>) of 21.58 μg/mL, while DQ and sCBD had similar cytotoxic activity with IC<sub>50</sub> values for 48-h treatment of 17.99 μg/mL and 17.88 μg/mL, respectively. DQ and sCBD extracts were found to significantly reduce cell migration and increase the percentage of cells in S phase and G<sub>2</sub>/M phase within the cell population. In EVOCs, the extracts initiated cell death with the expression of apoptosis-related genes increased following exposure to treatment.</div></div><div><h3>Conclusion</h3><div>The findings suggest that <em>C. sativa</em> strains PARIS, DQ, and sCBD, containing CBC and THC, exhibit significant anticancer activity against UC cell lines and <em>ex vivo</em> models. These results underscore the therapeutic potential of CBC- and THC-rich <em>C. sativa</em> extracts in bladder cancer treatment.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 534-543"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ajur.2025.03.002
Bin Xu , Linhui Wang , Qingyi Zhu , Xing Ai , Wei Guan , Guoqing Ding , Dongliang Xu , Liaoyuan Li , Gutian Zhang , Liping Xie , Chinese Benign Prostatic Hyperplasia Consortium
Objective
Robot-assisted simple prostatectomy (RASP) is increasingly used as a surgical treatment option for large benign prostatic hyperplasia (BPH) (>80 mL). However, there is no sufficient expert consensus or guidelines to guide clinical practice. We aimed to obtain expert opinions for RASP for large BPH.
Methods
A systematic review of the literature was performed in April 2024 using the PubMed, Embase, and Web of Science databases. Search terms were combined to construct the following search strings: (robotic) AND (simple OR benign) AND (prostatectomy). Search results were filtered by language (English only), species (human), and publication type (original article). This study used a two-phase modified Delphi approach.
Results
In this expert consensus, some frequently used RASP techniques, including robot-assisted retropubic prostatectomy, robot-assisted transvesical prostatectomy, and robot-assisted urethra-sparing prostatectomy, are described. RASP offers a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RASP.
Conclusion
RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
目的：机器人辅助的单纯前列腺切除术（RASP）越来越多地被用作大型良性前列腺增生（BPH） （>80 mL）的手术治疗选择。然而，没有足够的专家共识或指南来指导临床实践。我们的目的是获得RASP治疗大型BPH的专家意见。方法于2024年4月使用PubMed、Embase和Web of Science数据库对相关文献进行系统综述。将搜索词组合起来构建以下搜索字符串：（机器人）和（简单或良性）和（前列腺切除术）。搜索结果按语言（仅限英语）、物种（人类）和出版物类型（原创文章）进行过滤。本研究采用两阶段改进的德尔菲法。结果在专家共识中，介绍了一些常用的RASP技术，包括机器人辅助耻骨后前列腺切除术、机器人辅助经膀胱前列腺切除术和机器人辅助保留尿道前列腺切除术。RASP为有机器人手术经验的外科医生提供了一个简短的学习曲线。接受RASP的患者很少出现严重的并发症。结论rasp技术可作为一种安全有效的微创治疗伴有大前列腺的症状性前列腺增生患者。
{"title":"A review based on expert opinions for robot-assisted simple prostatectomy for large benign prostatic hyperplasia","authors":"Bin Xu , Linhui Wang , Qingyi Zhu , Xing Ai , Wei Guan , Guoqing Ding , Dongliang Xu , Liaoyuan Li , Gutian Zhang , Liping Xie , Chinese Benign Prostatic Hyperplasia Consortium","doi":"10.1016/j.ajur.2025.03.002","DOIUrl":"10.1016/j.ajur.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>Robot-assisted simple prostatectomy (RASP) is increasingly used as a surgical treatment option for large benign prostatic hyperplasia (BPH) (>80 mL). However, there is no sufficient expert consensus or guidelines to guide clinical practice. We aimed to obtain expert opinions for RASP for large BPH.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was performed in April 2024 using the PubMed, Embase, and Web of Science databases. Search terms were combined to construct the following search strings: (robotic) AND (simple OR benign) AND (prostatectomy). Search results were filtered by language (English only), species (human), and publication type (original article). This study used a two-phase modified Delphi approach.</div></div><div><h3>Results</h3><div>In this expert consensus, some frequently used RASP techniques, including robot-assisted retropubic prostatectomy, robot-assisted transvesical prostatectomy, and robot-assisted urethra-sparing prostatectomy, are described. RASP offers a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RASP.</div></div><div><h3>Conclusion</h3><div>RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 290-294"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ajur.2024.10.008
Xintao Tian , Huiqing Jia , Yue Liu , Ye Liang , Shaonan Yang , Zhijuan Liang , Guofeng Ma , Haitao Niu
Objective
This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder (SCCUB).
Methods
Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University (from January 2016 to December 2021) were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma (HG-UC) during the same period. The study endpoints were disease-free survival (DFS) and overall survival (OS).
Results
Of the 24 patients with SCCUB, 19 were male and five were female. Eight (33%) cases were pure SCCUB (pSCCUB). Sixteen (67%) cases were mixed SCCUB (mSCCUB), all of which were mixed with urothelial carcinoma. All patients underwent surgery and 13 (76%, 13/17; seven patients were lost to follow-up) patients received postoperative adjuvant chemotherapy. We found no significant difference in clinicopathological features between pSCCUB and mSCCUB. However, compared to HG-UC, SCCUB had higher lymph node metastasis (p=0.014), more lymphovascular invasion (p=0.024), higher Ki-67 expression (p<0.001), and more disease progression events (p=0.001). Median DFS and OS for SCCUB were 22 months and 38 months, respectively. The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB. However, SCCUB patients had worse DFS and OS than HG-UC patients (both p<0.05). The multivariate Cox analysis showed that the tumor size (hazard ratio 1.44, 95% CI 1.96–2.15, p=0.048) was an independent factor affecting DFS of SCCUB patients.
Conclusion
Compared with the common HG-UC, SCCUB is rare with specific clinicopathological features and a worse prognosis.
{"title":"Clinicopathological features and prognosis of small cell carcinoma of the urinary bladder","authors":"Xintao Tian , Huiqing Jia , Yue Liu , Ye Liang , Shaonan Yang , Zhijuan Liang , Guofeng Ma , Haitao Niu","doi":"10.1016/j.ajur.2024.10.008","DOIUrl":"10.1016/j.ajur.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder (SCCUB).</div></div><div><h3>Methods</h3><div>Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University (from January 2016 to December 2021) were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma (HG-UC) during the same period. The study endpoints were disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Of the 24 patients with SCCUB, 19 were male and five were female. Eight (33%) cases were pure SCCUB (pSCCUB). Sixteen (67%) cases were mixed SCCUB (mSCCUB), all of which were mixed with urothelial carcinoma. All patients underwent surgery and 13 (76%, 13/17; seven patients were lost to follow-up) patients received postoperative adjuvant chemotherapy. We found no significant difference in clinicopathological features between pSCCUB and mSCCUB. However, compared to HG-UC, SCCUB had higher lymph node metastasis (<em>p</em>=0.014), more lymphovascular invasion (<em>p</em>=0.024), higher Ki-67 expression (<em>p</em><0.001), and more disease progression events (<em>p</em>=0.001). Median DFS and OS for SCCUB were 22 months and 38 months, respectively. The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB. However, SCCUB patients had worse DFS and OS than HG-UC patients (both <em>p</em><0.05). The multivariate Cox analysis showed that the tumor size (hazard ratio 1.44, 95% CI 1.96–2.15, <em>p</em>=0.048) was an independent factor affecting DFS of SCCUB patients.</div></div><div><h3>Conclusion</h3><div>Compared with the common HG-UC, SCCUB is rare with specific clinicopathological features and a worse prognosis.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 393-401"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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