International Braz J Urol最新文献

Purpose: Currently, detethering surgery (DS) is the modality most extensively utilized to treat primary Tethered cord syndrome (TCS). Disappointingly, some children without bladder impairment showed a deterioration of bladder function after surgery, which critically influences the health-related quality of life. It was hypothesized that the DS might have a significant effect on bladder function and psychology. Therefore, the purpose of this study was to investigate the effect of DS on bladder function and quality of life in children with primary TCS.

Materials and methods: A retrospective study of 83 patients aged 6 to 10 years who were diagnosed with TCS and underwent DS between 2022 and 2023. The urodynamic parameters and score, psychological-behavioral profile, and lower urinary tract symptoms were compared before and after DS. Additionally, the patients were divided into the normal group and the abnormal group according to the preoperative urodynamics parameters.

Results: A total of 66 children fulfilled the criteria, with a mean age at surgery of 89.5 ± 13.7 months. There were statistically significant differences in bladder detrusor sphincter synergy and urodynamic score and no statistically significant difference in the remaining urodynamic parameters and psychological-behavioral items before and after DS. The proportion of bladder dysfunction that improved or did not worsen after surgery was higher in the Abnormal group than in the Normal group. Nevertheless, the detection rate of each psychological behavior abnormality in children with TCS was higher compared with that of normal children, both preoperatively and postoperatively.

Conclusions: DS could not considerably ameliorate pre-existing bladder dysfunction and patients exhibiting non-progressive bladder dysfunction could be treated conservatively with close observation. TCS plagues patients all the time even if detethering. Psychological counseling for children with TCS should be strengthened after DS.

Introduction: In the last two decades, several Da Vinci robotic platforms have been released in the market, revolutionizing the field of robotic-assisted surgery (1, 2).The system has seen numerous modifications, with several Da Vinci® robotic models being introduced, each featuring ongoing technological advancements in ergonomics,instrumentation,high-definition imaging, EndoWrist™ technology, and single-port surgery capabilities (3, 4).Building on this, the new generation Da Vinci 5 robot promises significant hardware and software improvements, with the potential for enhanced operative performance (2, 5). In this video, we will illustrate several technical advancements of the Da Vinci 5.

Material and methods: We performed a video compilation comparing the Da Vinci 5 and Da Vinci Xi during radical prostatectomy. The video will highlight the technical modifications of the new platform, showcasing the advancements and improvements in the Da Vinci 5 system. Additionally, this video will illustrate key aspects of the surgery, including anterior bladder neck access, lateral bladder dissection from the prostate, posterior prostate dissection and anastomosis.

Surgical technique: We performed our RARP technique with our standard approach in all patients (6-8). With this new platform, we maintained our conventional technique without any modifications or adaptions from the trocar placement until anastomosis. The beginning of the case is performed as usual, we first identify the anterior bladder neck and then complete its dissection with Maryland and Scissors. Then, we proceed to the posterior bladder neck dissection, seminal vesicles control and nerve-sparing. In sequence, we control the prostate arterial pedicles with hem-o-lok clips and then we perform the apical dissection until dividing the urethra. Finally, we perform the hemostasis, posterior reconstruction (Rocco's technique) and anastomosis with barbed suture.

Results: The Da Vinci 5 features several key upgrades. The first part of our video described the console, patient cart, and energy tower modifications. The console has been ergonomically redesigned for a flat neck posture to decrease muscle fatigue, and the handgrip now includes a rubber surface for better grip (9). The patient cart, similar to the previous generation, has updated helm interfaces and integrated commands with the console and vision tower. In sequence, we described the instrument modifications and the step-by-step technique showing the DV5 and DV-Xi. Force feedback instruments provide three degrees of tactile feedback, enhancing tissue manipulation. A new security system ensures instruments can only be inserted when clear of tissues and obstructions, reducing the risk of errors. Another modification regards the ability to switch instruments and camera.

Background: Although parasacral TENS (pTENS) has been employed in various centers, there is a lack of studies on how children with overactive bladder (OAB) respond after failing to complete pTENS sessions. This study aimed to describe and assess treatments for OAB in children who did not respond to pTENS.

Material and methods: This retrospective case series examined patients aged 4-17 years. Patients were given subsequent treatment options, including: behavioral therapies; oxybutynin; imipramine; a combination of oxybutynin and imipramine; parasacral percutaneous electrical nerve stimulation (PENS); or a repeat course of pTENS. Outcomes were evaluated using the Dysfunctional Voiding Scoring System (DVSS) and the Visual Analogue Scale (VAS).

Results: Thirty children were included, with a median age of 7 years. Patients received one or more treatments. Of these, 70% underwent monotherapy. Among them, 57% experienced complete resolution of symptoms, 28% had partial resolution and were satisfied with the results, and 14% discontinued treatment. 30% out of the whole sample continued to experience bothersome symptoms. Complete response, according to initial subsequent, was achieved in: 54% with intensified behavioral therapies, 33% with oxybutynin, and 50% with imipramine alone. The median DVSS score decreased from 7.0 to 2.0 (p=0.025), while the median VAS score increased from 80 to 100 (p<0.001).

Conclusion: Children with OAB refractory to pTENS who received structured subsequent treatments showed partial response in all cases, with complete symptom resolution in half of the patients. More intensive urotherapy, medications, or repeat pTENS in combination with oxybutinin can be effective for managing this challenging condition.

Purpose: Prostate Cancer (PCa) is the most common non-cutaneous cancer in males, and Radical Prostatectomy (RP) is among the primary treatments for this condition. Our study aims to investigate the prevalence of climacturia (urine leakage at the moment of the climax), a potential post-RP change related to orgasm.

Material and methods: A systematic review was conducted following PRISMA guidelines and registered on the PROSPERO platform. The search was performed using MEDLINE via PubMed.

Results: Thirteen studies met the inclusion criteria and were described separately. Within these studies, 5,208 patients were evaluated, among which 1,417 cases of climacturia were identified, with a prevalence of 27.2%. When we analyzed the robot-assisted radical prostatectomy (RARP) subgroup, the prevalence of climacturia was 5.7% vs 1.8% the open radical prostatectomy (ORP) subgroup.

Conclusion: Climacturia is a frequently underestimated complication by urologists. Given its significant impact on quality of life, it warrants greater attention from specialists following RP.

Purpose: The external ureteral catheter (EUC) and double-J stent (DJ-stent) are frequently used for drainage in tubeless percutaneous nephrolithotomy (PCNL). This study aims to compare the outcomes and effectiveness of these two methods.

Materials and methods: We conducted a detailed literature search using relevant key words on Google Scholar, Europe PMC, Medline, and Scopus databases. Continuous variables were combined using mean difference (MD), while binary variables were analysed using risk ratio (RR) with 95% confidence intervals through random-effects models.

Results: Our analysis included nine studies. The results showed that EUC was associated with a significantly lower incidence of stent-related symptoms [RR 0.32 (95% CI 0.19 - 0.54), p < 0.0001, I² = 24%] compared to the DJ-stent. There were no significant differences between EUC and DJ-stent in terms of postoperative fever (p = 0.92), urine leakage (p = 0.21), perinephric collection (p = 0.85), haemoglobin drop (p = 0.06), transfusion rate (p = 0.27), VAS score (p = 0.67), analgesic requirements (p = 0.59), stone-free rate (p = 0.14), duration of surgery (p = 0.10), and duration of hospitalization (p = 0.50).

Conclusion: The EUC demonstrated fewer stent-related symptoms than the DJ-stent in tubeless PCNL, while both methods showed comparable safety and efficacy. The choice between EUC and DJ-stent should consider patient preferences and surgeon expertise. Further randomized controlled trials (RCTs) with larger sample sizes are needed to affirm these results.