Cuaj-Canadian Urological Association Journal最新文献

Introduction: Flexible ureteroscopy is increasingly used for managing upper urinary tract pathologies, particularly kidney stones. With the emergence of affordable, single-use flexible ureteroscopes (fURS) as an alternative to reusable systems, the contemporary economic impact of each device is unclear. We performed a micro-cost evaluation comparing reusable fURS with two single-use models in a single-payer, Canadian healthcare system.

Methods: The costs of reusable fURS were divided into acquisition, repair, and reprocessing expenses. Per-procedure costs for reusable fURS were calculated by dividing the total annual costs by the average annual number of procedures, whereas single-use costs were based solely on device prices. The total number of repairs and specific reasons for repairs were also collected for the entire reusable fURS fleet from 2022-2024.

Results: At our center, an average of 418 procedures were performed annually using reusable fURS, with total annual costs of $102 420.60, equaling to $245.03 per procedure. Reusable fURS become more cost-effective at volumes exceeding 130 cases compared to EU-Scope™ US 31E-12 and 83 cases compared to the Standard LithoVue™. Additionally, 65 repair events were recorded from 2022-2024, mainly due to distal tip leakage (77%). One repair was required for roughly 20 procedures (20.22:1).

Conclusions: Our analysis indicates that reusable systems are more cost-efficient in high-volume settings, while single-use devices, especially the EU-Scope™, may be advantageous in lower-volume centers. In tertiary centers, the use of single-use fURS represents an excellent opportunity to preserve the durability of reusable fURS, particularly during complex procedures with a high risk of ureteroscope damage.

Introduction: Endourologic treatments are first-line interventions for short ureteral strictures. With long strictures and endourologic failures, open repair has historically been used; however, robotic-assisted approaches have recently been shown to be effective. As a quality measure, we wanted to assess the performance of robotic ureteral reconstruction compared with open surgical repair during our transition to robotic surgery at a Canadian tertiary care center.

Methods: From 2011-2024, 43 complex ureteral stricture cases (19 open, 24 robotic) were performed. The primary outcome was six-month success defined by a composite of stent/pain-free status and renogram elimination half-life (T½). Secondary outcomes included length of stay, operative time, estimated blood loss, and complications.

Results: Success rates at six months were non-significantly different between robotic and open repair (83% vs. 79%, p=0.36). Length of stay was shorter in the robotic group (3.1±1.9 vs. 4.9±3.3 days, p=0.018). Estimated blood loss (231±84 vs. 244±170 mL, p=0.30) and operative time (220±67 vs. 214±74 minutes, p=0.40) were comparable between groups. Complication rates were similar between groups.

Conclusions: Overall, robotic reconstruction yields equivalent six-month success to open repair, with shorter length of stay. These findings support continuing robotic-assisted ureteral reconstruction as a safe and effective alternative to open surgery, offering equivalent short-term success and reduced hospital stay.

Introduction: ExactVu micro-ultrasound generates high-resolution images and promises to improve prostate biopsy performance, while transperineal prostate biopsy (TPB) has gained popularity due to its sterile technique. The aim of this study was to compare TPB using ExactVu to transrectal biopsy (TRB).

Methods: A retrospective analysis of patients who underwent TPB (n=306) using ExactVu or TRB (n=392) from 2019-2023 was performed. Clinical parameters were compared between the groups using Chi-squared test. Putative predictors of cancer on biopsy and upgrading on radical prostatectomy were investigated using logistic regression.

Results: More transperineal than transrectal biopsy patients had a Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion (40% vs. 28%, p=0.001) and were biopsynaive (53% vs. 39%, p<0.001). In patients with no previous diagnosis of prostate cancer, the clinically significant prostate cancer detection rate was higher in the TPB group (53% vs. 42%, p=0.01). Transperineal patients required fewer cores to obtain equal cancer detection rates (11±5 vs. 15±4 cores, p<0.01). Upgrading from grade group 1 to grade group ≥2 on radical prostatectomy was more common with TRB (9.1% vs. 2.1%, p=0.04). Urinary retention rate did not differ by biopsy type and two transrectal but no transperineal patients developed urosepsis.

Conclusions: TPB required fewer cores to obtain a similar clinically significant prostate cancer detection rate when compared to TRB. TPB had fewer complications and a low upgrade rate. This suggests that cognitive fusion TPB using ExactVu is an excellent alternative to software fusion TRB.

Introduction: Despite increasing interest in the potential associations between kidney stones and kidney cancer, their relationship remains incompletely characterized. This systematic review and meta-analysis evaluated the association between a history of kidney stones and the future risk of kidney cancer.

Methods: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for observational studies of renal cell carcinoma risk in adults with kidney stones. A random-effects meta-analysis was performed to calculate the pooled risk ratio and 95% confidence interval (CI). Subgroup analyses and meta-regression were conducted to assess the associations with study design, data sources, risk of bias, control group type, and sex.

Results: Thirteen studies (five cohort, eight case-control) were included in the meta-analysis. A history of kidney stones was associated with a significantly higher risk of developing kidney cancer (risk ratio 2.36; 95% CI 1.74, 2.98, p<0.001, I²=94%). Subgroup analysis showed a consistently elevated risk of kidney cancer in stone formers across all subgroups. No significant differences were observed between subgroups, except that more recent studies demonstrated significantly stronger associations between stone disease and risk of kidney cancer (p<0.001).

Conclusions: This meta-analysis demonstrates a significant association between kidney stones and increased risk of kidney cancer, with affected individuals having approximately twice the risk of developing kidney cancer. These findings highlight the importance of enhanced cancer surveillance in patients with a history of kidney stones and suggest the need for further research into shared pathophysiologic mechanisms and potential preventative strategies.

Introduction: Type and screen testing (T&S) is routinely performed preoperatively for many endoscopic procedures, despite low transfusion rates. While important, T&S can be costly, unnecessary, and burdensome for patients to obtain in a short timeframe due to expiry. We aimed to assess and reduce unnecessary T&S in a safe and collaborative manner through a Transfusion Dashboard. We assessed the effect of reduced testing on patient safety, cost, and the environment.

Methods: This quality improvement study used the Transfusion Dashboard, a web-based, institutional platform tracking blood transfusion trends. During the observation phase (2016-2019), procedure-specific preoperative T&S recommendations were developed. Following implementation of these recommendations in 2020, the incidence of T&S, perioperative transfusion rates, and rescue transfusion rates were assessed pre- and post-intervention using the Chi-squared test. Cost and environmental savings were also evaluated.

Results: From 2016-2023, outcomes were tracked for 4375 pre-initiative and 2488 post-initiative patients who underwent endoscopic procedures. We found a statistically significant decrease in T&S following initiative implementation for transurethral resection of the prostate (TURP), percutaneous nephrolithotomy (PCNL), holmium e-nucleation of the prostate (HoLEP), and transurethral resection of bladder tumor (TURBT) by as much as 51.2%. There was no change in uncrossed or overall blood transfusions. Since the implementation of the initiative, $45 362.81 in testing materials were saved and an associated reduction of 697 kg CO₂ was observed.

Conclusions: Institutional- and procedure-specific testing guidelines decreased unnecessary tests, leading to improved resource stewardship, reduced cost, improved patient experience, and environmental savings. Initial modest cost savings and care improvements may be amplified safely in larger organizations and across more procedures.

Introduction: Several studies have reported the preoperative and intraoperative predictors of urinary continence after robotic-assisted laparoscopic radical prostatectomy (RARP). No studies have addressed the impact of surgeon satisfaction and perceived surgical difficulty on continence recovery after RARP.

Methods: We conducted a retrospective study of prospectively collected data for patients treated with RARP for clinically organ-confined prostate cancer. Perioperative variables were recorded and studied. Patients were followed with regular visits at one, three, six, 12, and 24 months after surgery. The primary endpoint of the study was time to continence.

Results: A total of 322 patients treated with RARP were included. At least 80% of patients had 24-month postoperative continence followup. Continence rates were 39.1, 58.2, 71.1, 80.9, and 90.7% at one, three, six, 12, and 24 months, respectively. Perceived intermediate and high difficulty cases were associated with lower hazards of continence after RARP compared to low-difficulty cases (hazard ratio [HR] intermediate vs. low: 0.63, p=0.006; HR high vs. low: 0.52, p<0.001). Similarly, increased prostate size and decreased operative time were associated with low hazard of continence after RARP. Conversely, no statistically significant differences were recorded for surgeon satisfaction and preoperative Sexual Health Inventory for Men score (all p>0.05) at multivariate analysis.

Conclusions: Overall difficulty encountered by the surgeon at time of RARP is an independent predictor of continence recovery, in addition to prostate size and preoperative International Prostate Symptoms Score. Predictive preoperative factors for difficult surgery should be dealt with by an experienced surgeon to hasten continence recovery after surgery.