Indian Journal of Urology最新文献

Introduction: Transperineal access systems are commonly used to stabilize the biopsy needle with the ultrasound probe in local anesthetic transperineal biopsies (LATPs). However, these devices are expensive and nonreusable and restrict the access to some of the prostatic zones causing excessive probe movement and procedural pain. We aim to assess the pain tolerability, diagnostic value, and safety of the totally freehand LATP (tF-LATP) technique.

Methods: Patients undergoing tF-LATP for suspected prostate cancer (PCa) from February 2024 to June 2024 were prospectively included. Data on the prostate-specific antigen (PSA) levels, prostate size, prostate multiparametric magnetic resonance imaging findings, cancer detection, need for immediate rebiopsy due to undersampling (with predefined criteria for immediate rebiopsy), tolerability, and complications were collected. Pain levels were assessed using the Visual Analog Scale (VAS) scores (scores 1-10) at rectal probe insertion and immediately postbiopsy.

Results: Seventy-five patients (n = 75) underwent tF-LATP, with a median age of 67 years. The median PSA level was 7.05 ng/mL, and the median prostate size was 55 cc. During the procedure, the VAS ranged from 1 to 4 (median: 2). Postprocedure the VAS scores ranged from 1 to 2 (median: 1). Forty-four patients (59%) tested positive for PCa. There were no instances of urinary retention, sepsis, or hematuria requiring admission, and none required immediate rebiopsy due to undersampling as per the predefined rebiopsy criteria.

Conclusions: The tF-LATP technique demonstrateed excellent safety, diagnostic efficacy, and satisfactory tolerability. With its cost-effectiveness and enhanced accessibility to all the prostatic lobes, clinicians are encouraged to integrate this technique more widely into clinical practice to maximize its advantages.

Introduction: Robot-assisted radical prostatectomy (RP) or partial nephrectomy (PN) is often a daycare or overnight procedure in developed countries. This study assesses the safety and feasibility of discharging patients within 23 h after surgery in a developing country.

Methods: This retrospective cohort study examined patients who underwent RP and PN between June 2022 and December 2023. We analyzed the clinical-pathological profiles of patients discharged within 23 h after surgery versus later. A single surgeon performed all surgeries, and an early recovery protocol was practiced.

Results: Out of 71 PN patients, 62 (87.3%) were discharged within 23 h (of which, nine were discharged the same evening); the median stay for others was 3 days. Four patients had complications that delayed discharge, and one required readmission. Among 28 RP patients, 20 (71.5%) were discharged within 23 h; the median stay for others was 3 days. Two patients with complications had delayed discharge. There were no 30-day readmissions in the RP cohort. Factors such as comorbidities, American Society of Anesthesiologists grade, and tumor staging did not predict discharge timing in either the RP or PN cohort. Furthermore, none required blood transfusions or conversion to open surgical procedures, and there were no recorded fatalities in either cohort.

Conclusions: Twenty-three-hour discharge following robot-assisted RP and PN demonstrated both safety and feasibility in a developing country, which is contingent upon the implementation of an early recovery protocol in a tertiary or quaternary care setting. Effective preoperative counseling and interdepartmental communication are essential for success.

Introduction: Advancements in stent materials and designs are aimed at improving stent-related morbidities, lower urinary tract symptoms (LUTSs), pain, and compromised quality of life (QoL). Various stent materials and coatings have been investigated for their impact on stent-related symptoms. This prospective randomized study aimed to compare urinary symptoms and QoL in patients with polyurethane double J (DJ) stents, with or without hydrophilic polyvinylpyrrolidone coating.

Materials and methods: Sixty adult patients undergoing endourological procedures and DJ stent placement were randomized into two groups in 2:1 ratio. In 20 patients, polyurethane stents with hydrophilic coating and in 40 patients, stents without hydrophilic coating were placed. In all patients, a stent of 5F diameter and 26 cm length was used. Urinary symptoms, pain, and QoL were assessed at the time of stent removal, i.e., at 3-4 weeks using the validated ureteral stent symptom questionnaire (USSQ).

Results: The demographic data were comparable in both groups. Patients with hydrophilic stents reported significantly fewer urinary symptoms (mean score 10.75 vs. 15.28, P < 0.001), lower pain scores (1.50 vs. 3.18, P < 0.001), and better QoL scores (3.0 vs. 5.23, P < 0.001). Symptoms such as frequency, nocturia, urgency, and burning micturition were notably reduced in the hydrophilic group. In addition, 60% of patients in the hydrophilic group reported no pain compared to only 7.5% in the nonhydrophilic group (P < 0.001).

Conclusion: Hydrophilic-coated DJ stents significantly alleviate LUTS and improve QoL, warranting further large-scale research to validate these findings. These findings align with previous studies suggesting that hydrophilic coatings improve stent-related outcomes.

Introduction: To compare the efficacy and safety of extended lymph node dissection (eLND) versus standard LND (sLND) in patients with bladder cancer undergoing radical cystectomy, focusing on overall survival (OS), recurrence-free survival (RFS), and complications, including symptomatic lymphoceles.

Materials and methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, MEDLINE, Embase, Scopus, and Cochrane databases for randomized controlled trials (RCTs) comparing eLND and sLND. The primary outcomes were OS and RFS, while secondary outcomes included complications such as lymphoceles, sepsis, and urinary tract infections. Data were extracted independently by two authors, and the risk of bias was assessed using the Cochrane RoB 2 tool.

Results: Two RCTs (Gschwend et al., 2019; Lerner et al., 2024) were included, with a total of 1,015 patients. No significant differences were observed in OS (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.66-1.37) or RFS (HR: 1.00, 95% CI: 0.77-1.29) between the eLND and sLND groups. However, eLND was associated with a significantly higher incidence of symptomatic lymphoceles (risk ratio: 2.21, 95% CI 1.13-4.34) and no other major complications. The risk of publication bias was high due to the limited number of included studies.

Conclusion: While eLND did not show a survival benefit over sLND, it was associated with a higher risk of lymphoceles. eLND may be beneficial in patients with higher-risk disease requiring precise staging, but sLND is a viable and less morbid alternative for most patients.

Introduction: Prior studies showed that oxidative stress (OS) is increased in patients with urolithiasis. Urinary 8-hydroxy 2-deoxyguanosine (8-OHdG) is a well-established marker of OS, and its levels are elevated in patients with urolithiasis. It is unknown whether this increased OS persists even after stone removal. We aimed to evaluate the change in urinary 8-OHdG levels in patients with urolithiasis following complete stone clearance.

Methods: A prospective pre-post study was conducted at a single center (Institute Ethics Committee approval: NK/5965/MS/029). Patients with urolithiasis undergoing surgery for stone clearance were included. Patients with known comorbidities, malignancy, systemic illnesses, body mass index >30 kg/m², age >50 years, serum creatinine >1.5 mg/dl, and incomplete clearance were excluded. Twenty-four-hour urinary 8-OHdG levels were measured using the Enzyme-Linked Immunosorbent Assay method preoperatively and 3 months post-surgery.

Results: Forty patients (24 males) with a mean age of 34.65 (±11.02) years were analyzed. Thirty-seven patients had renal stones, while 3 had proximal ureteral stones (median stone size = 20 mm). Percutaneous nephrolithotripsy was performed in 33 patients, while 7 underwent various other surgical procedures for stone removal. There was no significant difference in urinary 8-OHdG levels following stone clearance; preoperative 25.770 (1.47-60.38)-μg/g-creatinine versus postoperative value of 32.00 (6.57-117.35)-μg/g-creatinine; P = 0.63. No significant correlation was found between age, gender, smoking or alcohol consumption, degree of hydronephrosis or stone burden, and urinary 8-OHdG levels.

Conclusions: The baseline OS in urolithiasis patients does not change after complete stone clearance. Whether this persistent OS is responsible for stone recurrence needs to be explored.

Introduction: Transurethral resection of bladder tumor (TURBT) harbors the risk of intraoperative obturator jerks in lateral wall tumors due to obturator nerve stimulation, resulting in bladder perforation. This study aims to compare the safety and efficacy of ultrasound-guided proximal obturator nerve block (PONB) with regional anesthesia (RA) versus general anesthesia (GA) during bipolar TURBT.

Methods: This prospective observational study enrolled 131 patients with lateral or posterolateral bladder tumors over 1.5 years. Patients were divided into two groups: Group I received PONB + RA (n = 63), while Group II received GA (n = 68). In Group I, 9 patients received unilateral (IA) and 54 bilateral PONB (IB). The primary objectives were to compare the incidence of obturator jerks and bladder perforations. Secondary objectives included comparing time taken for anesthesia, surgery, and associated complications.

Results: Obturator jerks were observed in 60% of Group IA patients. Considering patient safety, the remaining 54 patients in Group I received bilateral PONB. Only 5% of patients in IB had obturator jerks. No obturator jerk was seen in the GA group. No patient had bladder perforation. Surgery and anesthesia times were 32 ± 6 min and 63 ± 13 min in Group IA, 37 ± 5 min and 65 ± 10 min in Group IB, and 28 ± 5 min and 64 ± 15 min in Group II, respectively, all statistically nonsignificant.

Conclusion: Bilateral PONB significantly reduced obturator jerks compared to unilateral PONB providing similar safety and efficacy as GA. It is a viable alternative for patients unfit for GA.

Introduction: Bilateral synchronous adrenalectomy has the potential for significant surgical and functional morbidity. We reviewed our 15-year experience with bilateral synchronous adrenalectomy to assess the safety, surgical outcomes, morbidity, and impact on health-related quality of life (QoL).

Materials and methods: In an IRB-approved study, we reviewed our database of patients who underwent bilateral synchronous adrenalectomy for functional tumors between April 2008 and August 2022. Demographic profile, metabolic and radiological parameters, operative details, and complications were recorded. Follow-up was obtained either in-person or telephonically and analyzed for resolution of symptoms, QoL using the WHO-QoL BREF questionnaire, and complications of chronic steroid intake. Data were reported descriptively and compared between laparoscopic and open approaches.

Results: During the study period, 337 adrenalectomies were performed, of which, 51 were bilateral and in 48 patients both the surgeries were performed synchronously. Thirty-three of these 48 patients had bilateral pheochromocytomas and 15 had Cushing's syndrome. Among patients with Cushing's syndrome, three had life-threatening symptoms requiring urgent bilateral surgery. Forty patients underwent transperitoneal laparoscopic surgery and 8 underwent open surgery. There were two intraoperative and 7 post-operative complications. Forty-three patients were available for follow-up. All had resolution of symptoms and body mass index (BMI) changes, and only two patients continued to receive one antihypertensive medication. Episodes of steroid deficiency occurred in 7 patients while steroid excess occurred in 3 patients. QoL was satisfactory in all the patients in all the domains.

Conclusions: Bilateral synchronous adrenalectomy is safe and feasible for functional adrenal tumors. It leads to symptom resolution with amelioration of hypertension and BMI changes with satisfactory overall QoL.

Introduction: This study delved into the responses generated by ChatGPT-4 (artificial intelligence-language model) regarding queries on sexually transmitted urethritis in men and investigated the impact of "knowledge of conversing with a urologist" on the accuracy of its responses.

Methods: A total of 272 questions from the "sexually transmitted infections treatment guidelines" (US Centers for Disease Control and Prevention) were prepared by a urology specialist and arranged to cover various levels of difficulty. The questions were presented in the formats of multiple-choice and true/false. Two groups were created: In Group 1, ChatGPT-4 was only provided with the questions, whereas in Group 2, it was explicitly stated that ChatGPT-4 was engaging in a conversation with a urology specialist. The accuracy of ChatGPT-4's responses was evaluated.

Results: In Group 1, the accuracy rate was 81% (94/116), whereas in Group 2, it was 77.5% (90/116). Subgroup A, which consisted of multiple-choice questions, had accuracy rates of 77.5% (45/58) for Group 1 and 74.1% (43/58) for Group 2. Subgroup B, which included true/false questions, had accuracy rates of 84.4% (49/58) for Group 1 and 81% (47/58) for Group 2. The mean accuracy score was higher in Group 1, whereas the mean completeness score was higher in Group 2.

Conclusions: Providing ChatGPT-4 with the information that it was conversing with a urologist did not enhance the accuracy of its responses regarding sexually transmitted urethritis in men. The consistently high accuracy observed in ChatGPT-4's responses demonstrates that this system can be reliably used as a question-and-answer tool.