International Braz J Urol最新文献

Purpose: Tissue availability for revision vaginoplasty in trans feminine individuals is often limited, creating challenges in cases with prior surgery or inadequate local tissue. While not yet extensively studied in genital reconstruction, Kerecis SurgiClose®, a decellularized fish skin xenograft, has shown promise as a skin substitute in other surgical contexts, including burn care and chronic wound management. This study aims to describe the surgical technique and evaluate the short-term clinical outcomes of revision vaginoplasty using decellularized fish skin xenograft (FSXRV) in trans feminine individuals.

Materials and methods: A retrospective review of 27 trans feminine patients who underwent FSXRV between February 2023 and December 2024 was conducted. Data on preoperative characteristics, intraoperative details, and postoperative outcomes were collected from electronic medical records and analyzed.

Results: The median age was 36 years, and the median BMI was 27 kg/m². Median postoperative follow-up was 261 days. Indications for FSXRV included loss of neovaginal depth (81.5%), proximal introital narrowing (14.8%), and devitalized neovaginal grafts (3.7%). The xenograft was applied in various configurations and anatomical locations using either a perineal-only or combined perineal-robotic approach. No intraoperative or major (Clavien-Dindo ≥II) complications occurred within 30 days postoperatively. Five patients (18.5%) underwent subsequent canal revision after FSXRV. Positive outcomes were reported in 74% of patients using the Patient Global Impression of Improvement scale.

Conclusion: Fish skin xenograft revision vaginoplasty demonstrated early safety and feasibility for revision neovaginal lining and appeared to reduce reliance on autologous grafts or flaps in complex revision settings.

Purpose: Artificial urinary sphincter (AUS) is the gold standard treatment for severe male stress urinary incontinence (SUI). While survival outcomes after primary implantation are now well established, the prognosis following reintervention remains poorly understood. We aimed to assess long-term reintervention-free survival after a second AUS implantation and to compare outcomes between device replacement and reimplantation after removal.

Materials and methods: We performed a nationwide, population-based, retrospective cohort study including all men aged ≥18 years in France who underwent a second AUS implantation between 2006 and 2018 for SUI following prostate cancer or benign prostatic hyperplasia treatment. AUS procedures were identified through a unique device identifier. Of 5,132,311 eligible men, 8,475 received a first AUS and 1,619 a second AUS: 1,165 after device replacement and 454 after reimplantation following removal. The primary outcome was reintervention-free survival, estimated by Kaplan-Meier analysis. Secondary outcomes included replacement and removal rates. Predictors of reintervention were identified using multivariable Cox regression.

Results: Median follow-up was 53 months (IQR 26-81). Reintervention-free survival after second AUS was 81% (95% CI 79-83) at 2 years, 68% (95% CI 65-71) at 5 years, and 61% (95% CI 57-64) at 10 years. Device replacement achieved significantly better survival than reimplantation after removal (p <0.001). Notably, only 21% of patients whose first AUS was removed underwent reimplantation.

Conclusions: Second AUS implantation provides durable long-term outcomes, approaching those of primary implants. The indication for reintervention critically influences prognosis, with replacement outperforming reimplantation after removal. The low reimplantation rate after AUS removal provides a clinically relevant piece of information to counsel patients requiring device removal.

Purpose: To evaluate the prevalence, predictors, and progression of acute kidney injury (AKI) in patients undergoing mPCNL for nephrolithiasis.

Materials and methods: We retrospectively analyzed data from 569 patients who underwent mPCNL at a single tertiary academic center (01/2016-10/2024). AKI was defined per KDIGO criteria as sCr increase >0.3 mg/dL or ≥1.5× baseline. Stone-free status was no residual stones on CT at 3-month follow-up. Complications were classified using the modified Clavien system. Kidney function was reassessed 30-90 days post-op. Descriptive statistics, logistic regression, and Cox regression were applied.

Results: Median (IQR) age and stone volume were 57 (48-66) years and 2.1 (0.9-4.2) cm³. Median preoperative sCr and operative time were 0.9 (0.7-1.1) mg/dL and 90 (73-120) minutes. Post-mPCNL, 40 patients (7.0%) developed AKI. Complications occurred in 138 (24.2%) patients; 449 (78.9%) were stone-free. AKI patients had higher CCI (1.3 vs. 0.5, p=0.04), pre-op sCr (1.1 vs. 0.8 mg/dL, p<0.01), stone volume (5.7 vs. 2 cm³, p=0.02), and longer operative time (130 vs. 90 min, p=0.01). Complications were more frequent in AKI patients (42.5% vs. 22.8%, p=0.01). At multivariate analysis, operative time (OR 1.1, p=0.03), pre-op sCr (OR 3.8, p=0.001), and early complications (OR 2.5, p=0.02) were independently associated with AKI. AKI persisted in 9 (22.5%) patients, mainly those with complications (88.9% vs. 38.7%, p=0.01). On Cox analysis, lower BMI (HR 0.8, p=0.02) and absence of complications (HR 0.3, p=0.01) predicted faster AKI recovery.

Conclusion: Acute kidney injury remains a clinically significant complication following mPCNL.

Purpose: To assess the distribution of neuroendocrine cells in the male penile urethra and the influence of age and estrogen therapy.

Materials and methods: A retrospective immunohistochemical cohort study was conducted on 26 penile urethras obtained during feminizing genitoplasty. Three anatomical regions were analyzed: bulbar, distal, and glans urethra. Neuroendocrine cells were identified by double immunohistochemistry and quantified as chromogranin A-positive cells per mm² of epithelium.

Results: Patients were divided according to estrogen exposure: Group 1 (n=12, median age 23.5 years, estrogen 5.5 years) and Group 2 (n=14, median age 43.0 years, estrogen 18.0 years). A clear gradient of neuroendocrine cell density was observed, with the bulbar urethra showing the highest values compared to distal urethra and glans. Group 2 had significantly higher bulbar urethral cell density than Group 1 (p<0.005). A negative correlation between age and bulbar density was observed.

Conclusions: This study provides evidence of a neuroendocrine cell gradient in the human male urethra, concentrated in the bulbar region. Cell density declines with age but is preserved by long-term estrogen therapy. These findings underscore the bulbar urethra as a key sensory structure that should be preserved during surgery and suggest that hormone therapy may mitigate age-related sensory decline.

Objective: To evaluate the impact of dynamic Magnetic Resonance of the Urethra (d-MRU) on postoperative results and their agreement with intraoperative findings in patients with urethral stricture after radical prostatectomy.

Methods: Forty-eight male patients (mean age 65.2 ± 8.1 years) with vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy confirmed by cystoscopy were evaluated using dynamic MRU and cystourethrography (CUG). They were divided into two groups: d-MRU and CUG. Patients in the d-MRU group were evaluated using a new MRI protocol: urethral filling with lidocaine gel and distal urethral obstruction with sterile gas tourniquet; MR urethrography including axial T1-weighted images, coronal space, sagittal T2-weighted, axial T2-weighted, sagittal maximum intensity projection (MIP) with urographic effect, voiding sagittal MIP, and T1-weighted with fat saturation (T1 fat-sat) before and after gadolinium enhancement. Dynamic imaging acquisition with motion images was performed during voiding.

Results: No significant difference in restenosis rates was observed between the D-MRI and UCG groups (5.6% vs. 16.7%, respectively; p = 0.261), but a significant difference in vascular preservation (94.4% vs. 63.3%, p=0.016). We found consistent dynamic MRU and intraoperative measurements of VUAS. Intraclass correlation coefficients showed satisfactory to excellent levels of agreement between the two imaging modalities and a strong correlation of dynamic MRU and intraoperative findings. Additionally, the Bland-Altman analysis revealed an agreement bias close to zero.

Conclusions: Dynamic MRU is a safe and appropriate evaluation method that can provide guidance for surgical treatment planning in patients with VUAS after radical prostatectomy.

Objective: To investigate the efficacy and safety of robotic-assisted bladder neck reconstruction in patients with refractory vesicourethral anastomotic stenosis (VUAS) following radical prostatectomy (RP) or radical cystectomy (RC) with orthotopic neobladder (ONB) reconstruction.

Methods: The clinical data from patients with VUAS who underwent robot-assisted bladder neck reconstruction at our center from August 2022 to February 2025 were retrospectively analyzed. The minimum postoperative follow-up period was 3 months, and bladder neck patency was defined as either the passage of a F16 flexible cystoscope or a maximum urinary flow rate (Qmax)>15 mL/s.

Results: A total of 27 patients were analyzed, including 25 with a history of RP and 2 with a history of RC with ONB reconstruction. The median operative time was 210 min (interquartile range [IQR]:168-259), with a median estimated blood loss of 152 mL (IQR: 80-255) and a median postoperative hospital stay of 3.5 d (IQR: 3-6 d). At the median follow-up of 11 months (IQR: 3-34), 20 patients (74.1%) achieved patent reconstruction and 9 patients (75%) remained continent in 12 patients without preexisting stress urinary incontinence (SUI) at last follow-up. Postoperative complications occurred in five patients (18.5%), including two cases of Clavien-Dindo grade Ӏ and three cases of grade ӀӀ.

Conclusions: Robotic-assisted bladder neck reconstruction represents a safe and effective surgical option with high patency and low de novo SUI rates for refractory VUAS following RP or RC with ONB reconstruction.