Indian Journal of Urology最新文献

Introduction: Natural orifice specimen extraction surgery (NOSES), particularly transvaginal NOSES, is an innovative approach in laparoscopic urological surgery. This study aims to assess the feasibility, safety, and outcomes of transvaginal NOSES in women undergoing laparoscopic simple nephrectomy in an Indian cohort.

Methods: A prospective observational study was conducted from September 2022 to May 2024 in the department of urology, including 15 women with prior vaginal deliveries undergoing simple nephrectomy. Exclusion criteria were vaginal scarring, previous pelvic surgeries, active intravaginal infections, cervical neoplasia, unresolved pelvic inflammation, and patient refusal. Parameters assessed included operative time, specimen extraction time, blood loss, postoperative recovery metrics, Female Sexual Function Index, and Pelvic Floor Impact Questionnaire scores at the baseline and at 3 months.

Results: The mean age of the patients was 45.73 years. The average operative time, including the specimen extraction was 127.8 min and the average extraction time was 30.13 min. None required conversion to open surgery, and the average blood loss was 68.0 mL with no intraoperative transfusions. The postoperative recovery was rapid, with milestones achieved within 1 day, and the average hospital stay was 2.2 days. Pain scores were low (Visual Analog Scale: 2.87 at 24 h and 1.47 at 48 h). The complication rate was 6.67%, with one case of vaginal bleeding which was managed conservatively. Postoperative pelvic floor and sexual functions were preserved without significant adverse effects.

Conclusion: Transvaginal NOSES is a feasible and safe technique for nephrectomy, offering reduced postoperative pain, minimal blood loss, and rapid recovery, enhancing surgical outcomes and patient satisfaction.

Two complex small renal masses were operated using a novel method of utilising indocyanine green fluorescence for nephron-sparing surgery (NSS), overcoming its current limitations of short duration of effect and non-enhancement of the tumor. The dye was emulsified with ethiodized oil and a 1:1 mixture was administered on the morning of the surgery using superselective cannulation of the direct tumoral blood supply. The fluorescence could be used throughout the entire course of the surgery irrespective of arterial clamping, allowing quick tumor identification, edge marking, and near-enucleation over enucleoresection. This novel method has the potential to aid the surgeon during various critical steps of NSS.

Introduction: Adrenocortical cancer (ACC) is a rare malignancy with poor prognosis. Due to the widespread use of imaging, greater proportion of cases are being discovered at an early stage, and it is possible to surgically excise these tumors by minimally invasive (MIS) approaches, including pure laparoscopy and robotic assistance. However, due to the fear of capsular breach, tumor spill, and incomplete removal, open surgery (OS) is still the preferred option for managing ACC. The aim of this review is to compare the two approaches and assess where MIS can be option for the surgical management of ACC.

Methods: This review was performed as per the Preferred Reporting Items for Systematic Reviews statement. Studies comparing OS and MIS approaches for ACC were retrieved from the PubMed, Scopus, and Cochrane databases. The two approaches were compared for tumor characteristics and outcomes.

Results: A total of 22 studies comparing MIS with OS were included in this review. Out of the total 4639 patients, 1411 underwent surgery by MIS and 3228 by OS. Patients operated by MIS had smaller tumors, lower operative time and blood loss with higher positive surgical margin rate, and higher rate of local recurrence. However, the overall survival was comparable between the two approaches.

Conclusions: MIS can be used in localized Stage-I ACC but only at high-volume centers. Stage II ACC may be considered for MIS if there is no evidence of local invasion and the surgery can be performed without capsular perforation and conversion to OS.

Introduction: The minced buccal mucosal graft endourethral urethroplasty (MBGEU) is our novel technique of combining direct vision internal urethrotomy with buccal mucosal graft urethroplasty. We assessed success at 30-months of follow-up. Secondary objectives were to compare the changes in the American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVR) postoperatively.

Methods: This pilot study (CTRI/2021/09/036651) was conducted at a tertiary-care center and included 30 male patients with primary, <2 cm bulbar urethral strictures. A 1 cm × 1 cm buccal mucosal graft was harvested, minced, centrifuged, and suspended in fibrin glue. After a cold knife urethrotomy, a 12-Fr Foley was placed. An 11-Fr cystourethroscope was passed by the side of the catheter, and the suspension was instilled through a 5-Fr ureteric catheter over the urethrotomy site.

Results: The success rate of MBGEU was 93.33% at 12 months, 90% at 18 months, 83.3% at 24 months, and 76.6% at 30 months. The stricture recurred in seven patients. The AUA score reduced by 15, 15, 16, 16, 15.5, and 15.5 points from the baseline at 3, 6, 12, 18, 24, and 30 months (P < 0.01). There was a significant increase in the Qmax by 17 ml/s and a significant reduction in the PVR by 73.5 ml at 30 months (P < 0.01). No donor site morbidity was seen. There were no postoperative complications.

Conclusion: The medium-term success of MBGEU is encouraging. However, a longer follow-up and further studies with a larger sample size and a comparative arm are required.

MicroRNAs, small noncoding RNA molecules, are critical in modulating gene expression and contribute substantially to the initiation and progression of urinary bladder cancer (UBCa), a major malignancy affecting people globally. UBCa is known for its high recurrence rates and significant heterogeneity. The stability of miRNAs in body fluids such as urine and blood are excellent potential noninvasive markers for early detection, monitoring treatment progress, and predicting outcomes of patients with UBCa. In addition, miRNAs could also improve the effectiveness of immunotherapy and support the development of personalized treatment strategies. Despite their significant potential, challenges such as variability in the expression of miRNAs and shortcomings in their delivery systems must be carefully addressed. This strength, weakness, opportunity, and threat (SWOT) analysis highlights the crucial role of miRNAs in UBCa and explores their potential in advancing precision oncology.

We report our experience with nephron-sparing surgery for a completely endophytic small renal mass in an allograft kidney. A 37-year-old female, 14 years post live-related renal transplant for end-stage renal disease due to crescentic glomerulonephritis, presented with a 3.6 cm renal mass. She underwent open allograft partial nephrectomy and was discharged on the 5^th postoperative day. Six months postsurgery, she showed excellent graft function with no tumor recurrence. Nephron-sparing surgery of the allograft kidney presents challenges regarding vascular anatomy, hilar, and parenchymal adhesions making the surgery difficult, but is feasible and oncologically safe for transplant recipients with tumors in the allograft kidney.

A 52-year-old female presented with a history of left partial nephrectomy performed 1 year ago for a left renal mass. She was asymptomatic and was under post-operative follow-up. A contrast-enhanced computed tomography scan of the abdomen was obtained which revealed a large renal artery pseudoaneurysm (of size 79 mm ×67 mm ×78 mm). In view of large size, therapeutic angioembolization was performed safely without any post intervention complications.

Introduction: A study was performed to determine the most common and most bothersome symptoms and clinical associations in young men (18-40 years) presenting with lower urinary tract symptoms (LUTS).

Methods: Cross-sectional study was conducted across 16 centers. Urinary symptoms, impact of bladder problems, bowel symptoms, erectile dysfunction, premature ejaculation, bladder pain, non-bladder myofascial pain, and general well-being were assessed by validated questionnaires.

Results: A total of 448 men (median age 30 years) were included. Nocturia ≥1 (89.1%) and feeling of incomplete bladder evacuation (76.6%) were the most common symptoms while the most bothersome symptoms were daytime frequency and nocturia (median score 5; interquartile range 2-8, for both) on the International Consultation on Incontinence Questionnaire for Male LUTS questionnaire. Bladder symptoms were associated with severe or many severe problems (response 5 or 6, on the Patient Perception of Bladder Conditions Questionnaire) in 17.8% of the patients. Men between 18 and 20 years reported greater bother with their bladder condition. Normal erections and "very good" control over ejaculation were reported by 49.8% and 15.6%, respectively. Constipation and loose stools were reported by 22.8% and 12.9%, while bladder pain and non-bladder myofascial pain were reported by 72.5%, and 48.2%, respectively. 17.0% of the patients reported low scores on the WHO-5 Well-Being Scale. Two distinct patient clusters were identified. A larger cluster (63.9%) that presented with voiding symptoms and urgency but fewer sexual or pain symptoms, and a smaller cluster that showed pronounced sexual symptoms, pain, daytime frequency, and nocturia.

Conclusions: The most common urinary symptoms in young men are nocturia and a sense of incomplete evacuation. Daytime frequency and nocturia are the most bothersome symptoms. It is important to assess associated symptoms in young men presenting with LUTS.