Cuaj-Canadian Urological Association Journal最新文献

Introduction: Vasectomy is a form of permanent contraception in men that is safe and effective. Complications are relatively uncommon, although patients may experience postoperative pain. Current literature quotes a broad range in the incidence of chronic orchialgia following no-scalpel vasectomy from 0.6-26%, while pain negatively affecting quality of life is about 1-2%. We sought to evaluate our incidence of post-vasectomy pain and surgical management for this pain.

Methods: A retrospective chart review was performed for all men who underwent a vasectomy at Men's Health Clinic Manitoba during a 22-month period. The presence of pain or complications was collected at a three-month followup appointment. Patients with pain were then followed every 6-8 weeks for continued assessment and management.

Results: A total of 350 men underwent elective no-scalpel vasectomy during this period. The majority of patients had no previous history of orchialgia (98%) or history of previous scrotal surgery (93%). At three months post-vasectomy, 38/350 (11%) of patients had ongoing pain and one patient required surgery (epididymectomy) for management of post-vasectomy pain syndrome three months following vasectomy.

Conclusions: Our retrospective analysis of 350 men who underwent no scalpel vasectomy shows a significant proportion of post-vasectomy pain at the three-month followup appointment, although most cases are resolving or minor and only one patient has required surgical management. This highlights the importance of counseling men undergoing vasectomy regarding the risks of post-procedure orchialgia and the small proportion of men who will require additional surgical intervention.

Introduction: This systematic review and meta-analysis provides estimates of major complications and blood loss for open partial nephrectomy, conventional laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation in patients with small renal masses.

Methods: We searched MEDLINE, EMBASE, and CINAHL from inception to the end of July 2023. We supplemented the electronic search with a hand search of references in the included studies and suggestions from two content experts. We used random effect meta-analysis to obtain pooled estimates of major complications and blood loss. We used the QUIPS tool for risk of bias assessment and applied a prognosis approach to rate the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework.

Results: We included 65 eligible studies that provided pooled estimates of major complications after open partial nephrectomy of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional laparoscopic partial nephrectomy of 4.7% (95% CI 2.6-8.3); after robot-assisted partial nephrectomy of 2.9% (95% CI 2.2-3.7); and after thermal ablation of 2.9% (95% CI 2.3-3.8). Pooled estimates demonstrating mean estimated blood loss of 262 ml (95% CI 200-324) for open partial nephrectomy; 224 ml (95% CI 193-254) for conventional laparoscopic partial nephrectomy; and 163 ml (95% CI 136-190) for robot-assisted partial nephrectomy.

Conclusions: This review provides the best available estimates of major complications and mean blood loss after partial nephrectomy in patients with small renal masses.

Introduction: Robotic-assisted surgery (RAS) is a vital modality in the armamentarium of minimally invasive surgeons. The HugoTM RAS system (Medtronic^®) is one of the newest platforms on the market and has little surgical outcomes data. We describe our early experience performing robotic-assisted partial nephrectomy (RAPNx) with the Hugo RAS platform.

Methods: We conducted a retrospective review of patients who underwent a RAPNx with the Hugo RAS platform between April and December 2023 at the University Health Network in Toronto, ON. One surgeon performed all procedures using a three-arm transperitoneal approach. Anesthetic, operative, and pathologic reports were assessed to collect pre-, intra- and postoperative variables.

Results: Eleven patients were included. The mean age was 51 years, 45.0% were female, and 63.6% had a right-sided mass. Mean tumor size was 2.9 cm. Mean warm ischemia time was 18.9 min (standard deviation [SD] 7.12) and mean estimated blood loss was 179 mL (SD 63.6). Mean robot docking time was 232 seconds (SD 106.5), mean total console time was 93 minutes (SD 21.4), and mean total operative time was 165.6 minutes (SD 34.1). There were no intraoperative complications. On pathology review, most tumors were a clear cell variant (72.7%) and staged pT1a (81.8%). All margins were negative. One patient sustained a port site infection.

Conclusions: This is the first North American case series using the Hugo RAS platform for RAPNx. Our findings underscore that the platform is safe and effective for performing RAPNx with comparable outcomes to other robotic platforms.

Introduction: In this study, we aimed to explore whether a Y chromosome microdeletion (YCM) confers adverse effects on surgical sperm retrieval potential and intracytoplasmic sperm injection (ICSI) outcomes in men with azoospermia and severe oligospermia.

Methods: This was a retrospective cohort study, which included infertile men with azoospermia or severe oligospermia who were evaluated for karyotype analysis and YCM testing at a university-affiliated hospital between 2010 and 2022. Outcomes of microdissection testicular sperm extraction (mTESE) for surgical sperm retrieval were compared between men diagnosed with YCM and the control group in which no YCM were found. Additionally, patients from each group who underwent in-vitro fertilization (IVF) - ICSI cycle using ejaculated sperm or surgically retrieved mature spermatozoa were compared regarding their IVF-ICSI cycle outcomes - fertilization rates, cleavage, and blastocyst formation and clinical pregnancy rates.

Results: A total of 116 azoospermic and oligospermic men who underwent Y chromosome microdeletion testing were included in the study: 19 men with YCM and 97 controls without YCM. Overall, nine mTESE procedures were performed for patients with YCM and 38 mTESE procedures were done on men from the control group. There were no significant differences between the YCM and control groups in mature sperm retrieval rates (11.1% vs. 26.3% p=0.663), though a trend towards higher rates of findings of elongated and round spermatids as the most mature germ cell was noted in the YCM group (66.7% vs. 28.9%, p=0.054). Out of the 13 men with mature sperm - either ejaculated or surgically retrieved (mTESE) - that had known ICSI cycle outcomes, three men had proven YCMs and 10 controls had no identified YCMs. Basic characteristics were similar between the groups, except for testosterone levels, which were higher in the YCM group (23.0±13.1 vs. 9.4±6.4 nmol/L, p=0.027). Fertilization rates and cleavage rates were similar between the YCM and control groups (42.3% vs. 49.7% and 42.3% vs. 39.3%, p=0.491 and 0.774, respectively). Blastocyst formation rates, and pregnancy rates, while not statistically significant, showed a trend for favorable outcomes in the control group compared to the YCM group (24.1% vs. 7.7%, 72.7% vs. 20.0%, p=0.078 and 0.106, respectively).

Conclusions: Y chromosome microdeletion does not affect sperm retrieval rates. Fertilization and cleavage rates are not impaired by microdeletions, while blastocyst formation rates and clinical pregnancy rates per embryo transfer follow a non-significant trend for unfavorable outcomes in the YCM group. Clinical and embryonic development results should be interpreted with caution, as these groups are relatively small.

Introduction: Amid substantial surgical wait lists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel, Canadian urologic clinic and surgical center.

Methods: A retrospective study was conducted at a novel, accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions.

Results: In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before their scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission.

Conclusions: Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.