Cuaj-Canadian Urological Association Journal最新文献

Introduction: Treatment of de novo vesicoureteral reflux (VUR) into the transplanted kidney constitutes a clinical challenge. Herein, we present our data on patients who underwent endoscopic subureteric injection for the treatment of VUR following renal transplantation (RT) in our center.

Methods: The patients who underwent endoscopic subureteric injection for VUR into the transplanted kidney after RT in our department between 2008 and 2023 were reviewed retrospectively. Indication for subureteric injection, age, gender, laterality, number of injections, amount of material used, renal failure etiology, auxiliary procedures, and treatment success were noted. All interventions were performed by pediatric urologists who also perform RT.

Results: During a median followup of 27.5 (4-160) months, 22 patients (17 women, 77.2%) and 23 transplanted ureters (13 right, eight left, one bilateral) were treated with subureteric injections. In all patients, the indications for subureteric injection were recurrent febrile urinary tract infection (UTI), and the grades of VUR varied between I and IV. Patients received a median of 1.65 cc (0.7-2.7) dextranomer-hyaluronic acid copolymer. In total, 10 RTs (eight from living donors, two from cadaveric donors) were performed in another center, whereas 13 RTs were carried out in our center (eight from cadaveric donors and five from living donors). Among the patients who were transplanted in our center, the rate of subureteric injections due to de novo symptomatic VUR after RT was 2.2% (13/593 patients). After subureteric injections, five patients required a second injection due to the recurrence of VUR. Ureteroureterostomy (to the native ureter) was performed in two patients who had further UTIs after the second endoscopic treatment. Eventually, 19/21 patients (90.4%) benefited clinically from the endoscopic treatment and none of the patients underwent re-do ureteroneocystostomy. It is noteworthy that the etiology of renal failure was VUR nephropathy in seven (31.8%) patients.

Conclusions: Subureteric injection provides a high clinical success for the treatment of de novo VUR after RT.

Introduction: We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL).

Methods: Patients who undergoing ESWL for a single radio-opaque renal or proximal ureteric calculus ≤2 cm in size were randomized into two groups. The oral hydration group (OHG) administered 600 ml of water before ESWL, while the control group (CG) did not. The urine was held during ESWL to create a full bladder induced hydronephrosis. Both groups received the same ESWL protocol at four-week intervals and a maximum of three sessions. The primary outcome was stone-free rate (SFR) at 12 weeks and the secondary outcomes were the total number of shockwaves and the number of ESWL sessions.

Results: A total of 154 patients completed the study, 77 patients in each group; both groups were comparable in demographic data and stone characteristics. The SFR was 84.4% in the OHG and 68.8% in the CG group (p=0.036). Stone fragmentation in OHG was significantly higher than CG, 75.3% vs. 58.4% (p=0.040). OHG had more cases of artificial hydronephrosis (55.8% vs. 27.3%, p=0.001) and higher urine volume (375 [148] ml vs. 230 [110] ml, p<0.001). There were no statistically significant differences in the total number of shockwaves and the number of ESWL sessions. The auxiliary procedures in OHG were less than CG (15.6% vs. 31.2%, p=0.049).

Conclusions: Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.

Introduction: Although the Prostate Imaging-Reporting and Data System (PI RADS) categorization represents the standard method for assessing the risk of prostate cancer using prostate magnetic resonance imaging (MRI), there exists wide variation in cancer detection rates (CDRs) in real-world practice. We therefore evaluated the association of clinical and radiographic features with CDRs and developed a predictive model to improve clinical management.

Methods: We identified men aged 18-89 years with elevated prostate-specfic antigen (PSA) or on active surveillance for prostate cancer who underwent MRI-ultrasound (US) fusion biopsy or in-bore MRI-targeted biopsy. The associations of features with the per-lesion CDR (Gleason 6- 10) and clinically significant (cs) CDR (Gleason 7-10) were examined using logistic regression, and results were operationalized into a predictive model.

Results: Targeted biopsy was performed for 347 lesions in 281 patients. Overall, the CDR was 49.0% and the csCDR was 28.0%. On multivariable analysis, increasing PI-RADS category, no prior prostate biopsies, smaller prostate size, and increasing PSA density were independently associated with higher CDR, while 0-1 prior prostate biopsies, and a solitary PI-RADS 3-5 lesion were associated with higher csCDR. A predictive model provided a greater net benefit than a strategy of performing biopsy in all PI-RADS 3-5 lesions across a wide range of threshold probabilities.

Conclusions: Several clinical and radiographic features are independently associated with the risk of prostate cancer in men undergoing MRI-targeted biopsy. A predictive model based on these features can improve clinical decisions regarding biopsy compared to the conventional strategy of performing biopsy for all PI-RADS 3-5 lesions.

Introduction: In the context of the increasing incidence of kidney stones, we aimed to assess the percentage of the population who are eating an at-risk diet for kidney stones and to understand the baseline diet for future counseling.

Methods: The 2015 Canadian Community Health Survey, a national, cross-sectional instrument administered by Statistics Canada and Health Canada, was queried. Intake of relevant nutrients was compared to dietary risk factors for kidney stone formation. Factors associated with nutrient intake were analyzed in a multivariable regression.

Results: Data for 14 275 participants was included, of whom 24% consumed >2.5 of fluid per day and 9.4% consumed 1000-1200 mg of dietary calcium; 53.9% consumed too much sodium but 61% of the population had the recommended protein intake. Ninety-nine percent (99%) of the population had at least one dietary risk factor for kidney stone formation, while 92% had two or more risk factors. Fluid, sodium, calcium, and protein intake increased significantly with education level, income, and if employed (p<0.05 for all); however, fluid, protein, and sodium intake were lower in patients with hypertension and heart disease (p<0.05 for all).

Conclusions: While only a subset of the population will develop stones, this study shows that 99% of the population has a diet that elevates the risk of stone disease. As the incidence of kidney stones increases, population-based dietary interventions should be considered. Furthermore, clinicians may use these data to understand the average diet as a starting point for questioning and counseling patients.

Introduction: Tissue morcellation has become increasingly efficient, yet remains a rate limiting step in holmium enucleation of the prostate (HoLEP). Limited data exists on how the rate of oscillation by the morcellator blades affects morcellation efficiency (ME).

Methods: We undertook a retrospective review of HoLEP procedures performed by two surgeons from July 1, 2019 to August 25, 2022. All morcellation was performed with the Wolf Piranha device and enucleation was performed with Moses 2.0 technology. Surgeon 1 routinely uses 1500 oscillations/min (low rate [LR]) and Surgeon 2 uses a rate of 6000 oscillations/min (high rate [HR]). These rates were confirmed upon EMR review of each case. The primary endpoint was ME (g/minute). Secondary endpoints included enucleation efficiency (EE), mean tissue specimen weight, and preoperative prostate volume.

Results: A total of 894 HoLEPs were analyzed, 592 by Surgeon 1 and 302 by Surgeon 2. Surgeon 1 had larger preoperative prostate volumes (126 vs. 101, p<0.001) and specimen tissue weights (86.0 vs, 61.1, p<0.001). EE was higher in the LR group (1.67 vs. 1.33 g/min, p<0.001). Morcellation time was longer in the LR group (11.3 vs. 6.09 min, p<0.001) and ME was lower in the LR group (9.26 vs. 12.1 g/min, p<0.001). The difference in ME was inversely proportional to specimen weight.

Conclusions: Increased oscillation rate during morcellation may lead to decrease in morcellation time and increased ME during prostate enucleation. The primary limitation of this paper is the inclusion of only two surgeons. Future studies will serve to evaluate this finding across a larger number of institutions, and evaluate ways to increase ME in large prostate cohorts.

Introduction: Tension and malalignment of vasectomy reversal (VR) anastomoses are hypothesized to contribute to failure. We report VR outcomes using a novel technique introducing a tension-reliving hitch in the multi-layer microdot vasovasostomy (VV) and longitudinal intussuscepted vasoepididymostomy (LIVE; VE).

Methods: All vasectomy reversal patients between May 2019 and September 2023 from a single surgeon were reviewed. Patients were included if they underwent a VR, with at least one semen analysis within six months of surgery and a minimum of six months of followup after the surgery to deem a failure. The primary outcome was patency, which was defined as 1) any sperm in the ejaculate; and B) functionally as at least two million motile sperm. Late failure was defined as an azoospermic semen analysis result after previously documented presence of sperm.

Results: A total of 159 patients were evaluated, of which 136 patients met the inclusion criteria. The patency rate among all VRs was 97.7 %, with an overall functional patency rate of 93.1%. One hundred and one patients underwent bilateral VVs, with a 99% patency rate and 95.5% functional patency rate. Twenty-three patients underwent a mixed VV/VE with a patency rate of 100% and a functional patency rate of 88.8%. Finally, 12 patients underwent bilateral VE, with a patency rate of 83.3% and a functional patency rate of 77.7%. Among these patients, four VV patients were identified to have a late failure.

Conclusions: The combination of tension-relieving stitches for VVs and VEs, along with attention to symmetrical and precise stitch placement, results in high patency rates.