International Braz J Urol最新文献

Introduction: Prostate cancer is one of the most common malignancies in men, significantly impacting quality of life and survival (1, 2). Radical prostatectomy remains a key treatment for localized disease, with ongoing advancements in surgical techniques (3-5). The lateral approach in robotic-assisted prostatectomy was developed by Professor Richard Gaston and has emerged as a method designed to enhance anatomical preservation and functional outcomes, aligning with the growing demand for precision in prostate cancer management (6-8).

Objective: To present for the first time in Brazil the step-by-step technique and initial experience with the lateral approach to radical prostatectomy, emphasizing its safety, feasibility, and reproducibility as a novel surgical option for prostate cancer treatment.

Materials and methods: This video demonstrates a lateral approach to radical prostatectomy in a 51-year-old male patient diagnosed with localized prostate cancer (Gleason 7 (3+4) in 2 out of 17 fragments). The surgical procedure was performed using a transperitoneal robotic approach, with lateral entry via the right paravesical space to optimize access and exposure of pelvic structures. Key technical steps included precise dissection of the endopelvic fascia, early identification and preservation of neurovascular bundles, and bladder neck preservation to enhance postoperative functional outcomes. Hemostasis was achieved using selective bipolar energy and clips, and urethrovesical anastomosis was performed using a running suture technique with barbed sutures.

Results: The surgery was performed without complications, with an operative time of 150 minutes and estimated blood loss of 100 mL. The patient was discharged on the first postoperative day with adequate pain control. The urinary catheter was removed on the seventh postoperative day, and the patient reported complete continence from catheter removal onwards, requiring no pads. At three-month follow-up, the patient continued to report full urinary continence and satisfactory erectile function with phosphodiesterase type 5 inhibitors. His PSA levels remained undetectable at 3 and 6 months postoperatively.

Conclusions: The lateral approach to radical prostatectomy represents a safe and reproducible technique for localized prostate cancer treatment. To our knowledge, this is the first reported case of this approach performed in Brazil, marking an important step in expanding surgical options for prostate cancer. Further studies are required to evaluate long-term clinical outcomes and comparative benefits.

Purpose: The adoption of novel multi-port, single-port and modular robotic platforms has significantly increased in the last years. We aim to provide an overview of the preliminary clinical outcomes of the procedures performed with these new robotic systems, assessing their particular features and safety profile during the learning curve Material and methods: A systematic literature search was performed on 15th May 2023 on PubMed, Embase, Scopus and Web of Science databases, to identify original articles presenting clinical outcomes of new robotic systems for abdominal urologic surgery. The study protocol was registered on PROSPERO (CRD 42023437863).

Results: Six new robotic platforms were identified. Of 2925 papers identified, 71 met our inclusion criteria: 49 on single-port system and 22 on novel multi-port systems. We found variable outcomes for the most common procedures performed with these new systems. However, all of them showed acceptable perioperative and oncologic outcomes during the learning curve and good safety profile. Functional outcomes were underreported Conclusions: The adoption of novel multi-port and single-port robotic systems in urologic surgery can offer new opportunities for enhanced precision, reduced invasiveness, and potentially improved patient outcomes. The variability in outcomes across different platforms underscores the need for continued research and standardized training.

Quality management is essential to ensure consistent, safe, and effective outcomes in assisted reproductive technology (ART) centers. However, traditional quality assessments often overlook male infertility, which contributes to nearly half of all infertility cases. This article explores the implementation of a quality management system (QMS), specifically ISO 9001, tailored to ART centers that prioritize male reproductive health. Drawing from our experience at ANDROFERT, a male-focused fertility clinic, we demonstrate how process standardization, structured workflows, and continuous improvement strategies can optimize diagnostics, microsurgical procedures, and laboratory practices. Integrating male-specific procedures-such as varicocele repair, microdissection testicular sperm extraction (micro-TESE), and vasovasostomy-into the QMS is discussed, along with performance monitoring tools, including key performance indicators and patient satisfaction metrics. Collaboration with an academic institution is essential to support education and ensure training is aligned with quality and safety protocols. Our center's dual IVF laboratories and andrology services exemplify how advanced testing, including sperm DNA fragmentation analysis and handling of surgically retrieved sperm, are seamlessly integrated into quality pathways. By embedding male reproductive health into QMS frameworks, ART centers can improve clinical outcomes, foster interdisciplinary collaboration, and enhance patient engagement. We advocate for a multidimensional approach to quality-beyond pregnancy rates-encompassing safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. This model strengthens clinical performance and ensures sustainable, evidence-based fertility care for male patients.

Purpose: To evaluate the efficacy of parasacral transcutaneous electric nerve stimulation (PTENS), in comparison to darifenacin for the reduction of OAB symptoms in patients infected with HTLV-1.

Materials and methods: This proof-of-concept randomized clinical trial was carried out at the HTLV-1 Outpatient Clinic of the University Hospital. Participants included 42 HTLV-1 infected subjects with symptoms OAB. The OAB symptoms score questionnaire (OABSS) was applied before and after treatment to evaluate each group: group1-received darifenacin and group 2-treated with PTENS. Random sequences and statistical analysis were generated by SPSS statistical package, version 27 (IBM Inc™).

Results: There was no difference between groups regarding demographic, socio-economic and clinical characteristics. The initial median and interquartile (IQR) range of OABSS were 11.2 (9.5 - 14.0) in G1 and 10.7 (8.0 - 12.7) in G2. There was a reduction in the frequency, nocturia and urgency in both groups. However, 5 (23.8%) of the patients in the group treated with darifenacin abandoned the therapy, while only 1 patient (4,8%) stopped PTENS.

Conclusions: Both protocols used in this study were effective in treating OAB syndrome and reducing OABSS. However, therapy abandonment and adverse events were more frequent in the darifenacin group compared to the PTENS group.

We describe the novel use of dynamic sentinel node biopsy (DSNB) in five patients with primary urethral squamous cell carcinoma (U-SCC) and no evidence of inguinal node disease across two centers in North America and Europe between 03/2021 and 06/2024. Each of these referral centers sees over 75 cases of penile cancer per year and approximately 10 cases of U-SCC per year. Patients underwent DSNB concomitant to surgical resection of the primary tumor (n=3), or in a deferred manner (n=2), six weeks after primary surgery. In the five DSNBs performed, clinically occult nodal metastasis was discovered in one patient. In this patient DSNB was performed after local recurrence and repeat imaging confirming cN0 status. Only one minor complication with DSNB was observed. Awaiting further investigations in larger series, this study highlights the feasibility of DSNB in primary U-SCC with clinically node negative disease.

Objectives: This study, conducted by the Bladder Cancer in Latin America (BLATAM) group, aims to analyze epidemiological and therapeutic data on non-muscle invasive bladder cancer (NMIBC) in Latin American patients. It seeks to identify factors contributing to suboptimal responses to Bacillus Calmette-Guérin (BCG) therapy and assess areas for improvement in regional treatment practices.

Materials and methods: A multicenter retrospective study was carried out in collaboration with reference Urology Departments across Latin America. Data were collected using an electronic Case Report Form (CRF) from 2011 to 2021, capturing demographics, clinical presentation, treatment details, and follow-up of NMIBC patients treated with BCG. Statistical analyses included Kaplan-Meier survival analysis for relapse-free survival (RFS).

Results: Data from 292 patients across five countries were analyzed, with a mean age of 70.3 years and a male prevalence of 74%. Smoking history was reported in 70.6% of patients. The mean time to the first BCG dose was 2.4 months post-TURBT, with 26.7% of patients exceeding the recommended 60-day window for induction initiation. While 84% of patients completed BCG induction, only 45.9% followed the recommended Lamm maintenance schedule. Delays in starting maintenance cycles were observed, with a median delay of over 36 days for the first cycle and 65 days for the second cycle. RFS at 1 year and 5 years for high-risk patients was 87.3% and 53.3%, respectively.

Conclusions: This study highlights critical deviations from recommended NMIBC management protocols in Latin America, including delayed BCG initiation and inconsistencies in maintenance therapy. These findings emphasize the need for standardized treatment protocols and improved adherence to international guidelines, which could enhance NMIBC patient outcomes in the region. Collaborative efforts are essential to develop region-specific strategies, improve data collection, and ultimately provide better care for bladder cancer patients in Latin America.

Objective: This meta-analysis aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI), specifically T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps, in the pathological grading of prostate cancer.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, the China National Knowledge Infrastructure dataset, Web of Science, Springer Link and Cochrane Library. Studies evaluating the use of mpMRI for prostate cancer grading were included. The quality of the included studies was assessed using the risk of bias tool. Meta-analyses were performed to calculate pooled areas under the curve (AUC) and prostate cancer detection rates.

Results: Seven studies met the inclusion criteria, comprising 843 patients in the experimental group and 962 in the control group. The meta-analysis revealed a significant improvement in diagnostic performance with mpMRI, with a pooled mean difference in AUC of 0.10 (95% confidence interval [CI]: 0.04-0.16, p = 0.002) favouring the mpMRI group. The odds ratio for prostate cancer detection was 2.60 (95% CI: 1.57-4.29, p = 0.0002), indicating a higher detection rate with mpMRI compared with standard techniques. Substantial heterogeneity was observed among the studies (I² = 73% for AUC and 66% for detection rate).

Conclusion: This meta-analysis demonstrates that mpMRI, particularly T2WI and ADC imaging, has a significant predictive value in the pathological grading of prostate cancer. The technique shows improved diagnostic accuracy and higher cancer detection rates compared with conventional methods. However, the substantial heterogeneity among studies suggests that standardisation of mpMRI protocols and interpretation criteria is needed.