International Braz J Urol最新文献

Purpose: There is substantial literature demonstrating minimal to no increased risk of three-piece penile prosthesis (PP) complications for patients undergoing placement with concomitant reconstructive urologic procedures. However, there is a paucity of research investigating outcomes for patients suffering from erectile dysfunction (ED) who undergo concomitant non-reconstructive urologic procedures at the time of PP placement.

Materials and methods: We performed a retrospective review of patients undergoing PP placement and a second non-reconstructive urologic procedure performed concomitantly at our institution between January 2007 and July 2021. This was compared to a control cohort of 127 patients who underwent PP placement only. Outcomes of interest were complications and device infections. Comparative statistics were used to compare the two groups, and the Kaplan-Meier method was used to estimate the rate of complications and infections over time.

Results: We identified 44 patients who underwent concomitant surgery and 127 patients who underwent single surgery only. The types of concomitant surgeries were as follows: 23 endoscopic (52.3%), 9 penile (20.5%), 10 scrotal (22.7%), 1 hardware placement (2.3%), and 1 oncologic (2.3%). Hypertension was the only comorbidity that was more prevalent in the concomitant group (65.9% vs. 43.8%, P < 0.01). Patients undergoing concomitant surgery had similar complication (4.6% vs. 3.6%, P=0.79) and device infection (2.3% vs. 0.7%, P=0.43) rates as the single surgery group.

Conclusions: In the largest study of its kind, we observed that patients undergoing concomitant non-reconstructive urologic procedures at the time of PP placement are not at an increased risk of adverse events.

Introduction: Some endourological surgeries require multiple screens to perform combined procedures, which can present ergonomic challenges (1, 2). Apple Vision Pro (AVP) is a spatial computing device developed by Apple that incorporates virtual reality (VR) for life-like simulations, realistic medical scenarios, interactive anatomical models, and augmented reality (AR) technologies (3). In health care, VR is used for pain management, physical therapy, psychological therapy, and surgical simulations, providing a controlled and safe environment for both patients and healthcare professionals (4).

Objective: To demonstrate the step-by-step technique of the Mini-Endoscopic Combined Intra-Renal Surgery (Mini-ECIRS) procedure guided by ultrasound and using mixed reality technology with the Apple Vision Pro (multiscreen and 3D reconstruction). To the best of our knowledge, this is the first report of this procedure being performed with AVP assistance.

Patient and methods: We present the case of a 40-year-old female with a history of right lumbar pain for one year. A CT scan revealed a proximal ureteral stone (20mm) and a lower pole stone (14mm) on the right side, with a Guys's Score grade 2 4. In this case, we opted for Ultrasound-Guided Mini-ECIRS (5, 6). This choice allowed for precise puncture and dilation, ensuring effective treatment and minimal invasiveness, assisted by the Apple Vision Pro. This device is equipped with eight external cameras that capture the real world at a resolution of 4K, enhancing the surgeon's experience with unparalleled efficiency and ease of mixed reality. This advanced imaging allows for precise visualization and integration of digital elements into the physical environment, significantly improving the accuracy and effectiveness of surgical procedures. During this procedure, the multitude of equipment in the operating room often obstructs the view of the physical monitors, including ultrasound. However, this technology addresses these challenges by offering enhanced ergonomics, efficiency, and safety to the surgeon. By providing seamless integration of digital overlays and real-world visuals, it ensures that crucial information is always within the surgeon's line of sight, thereby improving operational precision and overall outcomes. The surgeon had no previous contact with the AVP and was assisted by an AVP expert urologist throughout the procedure.

Results: The procedure was performed in the Barts flank-free position. Initially, ureterolithotomy was performed using holmium laser. After the dusting phase, an ultrasound-guided renal puncture was performed using a virtual screen, providing enhanced comfort and ergonomics for the surgeon. Throughout the procedure, the surgeon had simultaneous access to both screens (nephroscope and flexible ureteroscope), facilitating efficient location of any residual stones. The AVP functioned effect

Background: Different modalities of percutaneous thermal ablation (PTA) have been used as possible minimally invasive nephron-sparing treatments for small renal masses (SRMs). The present study aimed to compare long-term outcomes of two guidelines-recommended ablative techniques, cryotherapy (CRYO) and radiofrequency ablation (RFA).

Materials and methods: Data of patients with single cT1 solid renal mass undergoing CRYO or RFA between 2004 and 2020 were retrospectively retrieved from a multi-institutional international database. Oncologic outcomes included "technical success", local recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS). Intraoperative and postoperative complications, length of stay (LOS), and re-admission rate within 30 days were registered. Major complications were defined as CD grade ≥III. Baseline features and treatment outcomes were analyzed using descriptive statistics. RFS, MFS, and OS were estimated using the Kaplan-Meier method.

Results: Overall, 643 patients were included, of which 492 (71.2%) underwent CRYO, and 151 (21.8%) RFA, with a median follow-up of 43 and 37 months, respectively (p=0.07). Technical success was achieved in 96.5% of CRYO vs 93.4% of RFA (p=0.09). No difference in terms of overall (CRYO: 10.4% vs RFA: 6%; p=0.1) and "major" (CRYO: 0.8% vs RFA: 1.3; p=0.06) post-operative complications were observed. RFS (CRYO:85.7%; RFA:84.9%, p=0.2), MFS (CRYO: 96.9%; RFA: 95.8%, p=0.4) and OS (CRYO: 89%; RFA: 87.4%; p=0.8) were comparable.

Conclusions: CRYO and RFA are both valid minimally invasive options for the treatment of small renal tumors. They are particularly suitable for patients who are not good surgical candidates as they offer very low risk of major procedure-related complications. For the right indication, they both offer favorable mid to long term oncologic outcomes.

Purpose: The accurate diagnosis of prostate cancer (PCa) remains challenging, particularly because standard biopsy techniques do not routinely include anterior zone, leading to potential missed diagnoses in this region. This study evaluates the accuracy and safety of biplanar stereotactic biopsy for diagnosing anterior clinically significant PCa (csPCa).

Materials and methods: After propensity score matching analysis, data from 256 patients were retrospectively analyzed, including 128 in the biplanar group (transrectal targeted biopsy with transperineal systematic biopsy) and 128 in the monoplanar group (transperineal targeted biopsy with transperineal systematic biopsy). PCa detection rates, lesion locations, csPCa, clinically insignificant PCa (ciPCa), and complication incidences were compared. Univariable and multivariable logistic regression models evaluated factors influencing biopsy outcomes.

Results: No significant differences were observed in overall PCa detection, ciPCa, posterior lesions, or postoperative complications between biplanar and monoplanar groups. The biplanar group demonstrated a higher detection rate for anterior csPCa (P=0.025). The overall International Society of Urological Pathology grade group (ISUP GG) distributions for Prostate Imaging Reporting and Data System (PI-RADS) scores 3 to 5 were not significantly different. Logistic regression identified age and PSA levels as independent predictors of higher detection rates, while univariable analysis showed that prostate volume had a significantly smaller effect on PCa detection rates in the biplanar group compared to the monoplanar group. Postoperative complications showed no statistically significant differences.

Conclusions: In conclusion, biplanar stereotactic biopsy was superior to monoplanar biopsy in detecting anterior csPCa. Both methods demonstrated no significant differences in overall PCa detection rates and safety.

Purpose: to review the more relevant aspects of urogenital tuberculosis (UGT) and make recommendations about the diagnosis and treatment.

Materials and methods: a literature review was conducted in the Pubmed, Embase and Scielo databases in search of studies on UGT in the past 60 years. A narrative review was performed concerning six topics of UGT diagnosis and treatment. Recommendations were made supported on degrees of evidence according to the modified GRADE system.

Results: UGT suspicion occurs in persistent hematuria or pollakiuria with sterile pyuria; stenosis and/or thickening of the urinary tract; or chronic prostatitis or epididymitis. Urinary bacteriological tests have low sensitivity, and a negative test does not rule out UGT diagnosis. In ureteral stenosis, a double-J catheter or nephrostomy should be used early (up to 1 month) during pharmacological treatment and in single less than 2 cm stenosis endoscopic treatment may be attempted. Bladder augmentation with ileum, sigmoid or ileocecal segments should be performed when the contracted bladder capacity is less than 100 mL. Spontaneous voiding occurs in most patients after bladder augmentation.

Conclusion: The diagnosis of UGT depends on a high degree of suspicion based on non-specific symptoms and radiological findings. Urinary bacteriological tests have low sensitivity, but even in the absence of diagnostic confirmation, treatment can be carried out through a combination of drugs for a period of six months. In the presence of ureteral stenosis or contracted bladder, complex but well stablished reconstruction procedures are necessary.

Objective: The aim of this study is to evaluate the integrity and the microstructural characteristics of the bladder mucosa graft harvested using a minimally invasive technique with the Holmium laser (Ho-YAG) for the treatment of urethral stricture.

Materials and methods: We studied patients with urethral strictures greater than 2 cm, with a urethroplasty indication. The patients were submitted to urethroplasty with the dorsal onlay reconstruction by a single surgeon. After the urethral dissection we use the Ho-YAG laser with a 550µg end fire laser fiber to obtain a fragment of bladder mucosa for the graft confection. A fragment of the bladder mucosa was fixed in a 10% buffered formalin to HE and Masson's trichrome analysis for the tissue integrity. Five sections were stained, and five fields of each section were selected. We used the Image J software, version 1.46r, loaded with its own plug-in to determine tissue integrity.

Results: We studied 11 patients (Mean age= 47.64); 9 (81.8%) with bulbar stricture and 2 (18.2%) with penile stricture (mean size = 4.63mm). The mean of bladder graft size was 53.64mm and the meantime of harvesting was 47.63 minutes. The histological study of the bladder wall graft showed an organization in accordance with normal standards, with the presence of an intact urothelium in the bladder graft. The submucosal layer is preserved, joining the detrusor to the urothelium and the collagen and elastic fibers are well organized.

Conclusion: The graft harvested from the bladder uroepithelium using Ho-YAG has its histological integrity preserved, which makes this technique a viable option for reconstructive surgery. However, more studies are needed to establish its long-term efficacy and safety of this new technique.