Cuaj-Canadian Urological Association Journal最新文献

Introduction: Bladder cuff excision (BCE) is an integral component of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). While many approaches have been described, the optimal technique for BCE to provide maximal oncologic control remains unanswered. We performed a systematic review and meta-analysis to compare oncologic outcomes of different BCE techniques.

Methods: The Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases were searched for studies comparing oncologic outcomes of RNU for UTUC based on different BCE approaches. Techniques for BCE were categorized as intravesical, extravesical, or endoscopic. Our primary outcomes were intravesical recurrence rate (IVR) and intravesical recurrence-free survival (IVRFS). Secondary outcomes included recurrence-free survival (RFS) and cancer-specific survival (CSS). Meta-analysis was performed to compare the recurrence rates and survival outcomes associated with different BCE techniques.

Results: Forty studies assessing a total of 17 168 patients were identified for inclusion. Open intravesical BCE was associated with superior univariate IVRFS (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.13-1.42, p=0.04, I²=43%), multivariate IVRFS (HR 1.44, 95% CI 1.16-1.80, p<0.0001, I²=75%), univariate RFS (HR 2.30, 95% CI 1.04-5.10, p=0.0002, I²=71%), and multivariate CSS (HR 1.62, 95% CI 1.22-2.15, p=0.33, I²=14%) when compared to non-intravesical techniques. Subgroup analysis revealed that this difference was primarily driven by the inferiority of the open extravesical approach. Endoscopic and non-endoscopic BCE demonstrated equivalent univariate and multivariate IVRFS, RFS, and CSS.

Conclusions: Open intravesical BCE is associated with superior oncologic outcomes when compared to non-intravesical techniques. This difference is primarily driven by the open intravesical approach's superiority to the open extravesical approach. Endoscopic BCE showed equivalent outcomes when compared to non-endoscopic approaches. Prospective randomized trials can shed further light on the optimal approach to BCE.

Introduction: We aimed to evaluate the incidence and risk factors for lymphedema secondary to pelvic lymph node dissection (PLND) in urologic surgery. Secondary lymphedema is the most common type of lymphedema in the U.S. and the role of PLND in lower extremity lymphedema etiology is less well-defined.

Methods: We performed a retrospective review of all PLNDs performed for urologic malignancies at a single academic institution between April 2014 and April 2017. Patient demographics, comorbidities, cancer staging, and other treatment information were collected. Incidence of lower extremity lymphedema and associated risk factors were explored. Univariate analysis and multivariate logistic regression were performed.

Results: A total of 235 patients were included in our study. Mean (standard deviation) age was 68.8 (8.9) years, and the mean followup duration was 2.4 (1.7) years. Lymphedema occurred in 22 (9.4%) patients, and the mean time to lymphedema diagnosis was 7.4 (8.0) months. Age, body mass index, smoking, diabetes, pre- or postoperative radiation, number of resected lymph nodes, and number of positive lymph nodes were not significantly associated with postoperative lower extremity lymphedema; however, metastatic recurrence was significantly associated with the development of postoperative lymphedema. (odds ratio 2.83, 95% confidence interval 1.1-7.32, p=0.03).

Conclusions: While the incidence of lower extremity lymphedema after PLND is low in urologic cancer patients, this complication is associated with metastatic recurrence. These results may allow for improved preoperative counseling on the risk of lower extremity lymphedema and inform cancer surveillance in patients with this complication. More research is needed to elucidate this association.

Introduction: The aim of this study was to compare clinical outcomes and patient satisfaction rates after application of three different tunical shortening techniques - Yachia corporoplasty, Nesbit corporoplasty, and 16-dot plication - in patients undergoing surgery for congenital and acquired penile curvatures.

Methods: We retrospectively evaluated the postoperative outcomes of 68 patients who underwent penile curvature repair using one of three different surgical techniques between 2010 and 2023 and had been followed up for at least one year. Complications (if any) (e.g., penile shortening, loss of penile sensation, recurrence, presence of nodules, painful erection) and surgical satisfaction levels were assessed through medical records and telephone interviews.

Results: The mean age of the patients included in the study was 37.34±16.81 years. Yachia corporoplasty was performed in 27 (39.70%), Nesbit corporoplasty in 15 (22.06%), and 16-dot penile plication in 26 (38.24%) patients. There was no difference between the techniques in terms of surgical complications, such as shortening of penile length (p=0.096), loss of penile sensation (p=0.892), recurrence (p=0.302), and presence of nodules at the operation site (p=0.239), while painful erection was most common in the Nesbit corporoplasty group (n=5, 33.33%) (p=0.020). Postoperative dissatisfaction rate was highest in the 16-dot penile plication group (n=6, 23.07%) (p=0.557). There was a negative correlation between satisfaction level and recurrence in the 16-dot penile plication and corporoplasty groups (r=-0.516, p=0.006; r=-0.659, p<0.001, respectively). In addition, a negative correlation was observed between satisfaction levels, shortening of penile length, and presence of nodules in the corporoplasty group (r=-0.482, p=0.001; r=-0.320, p=0.044, respectively).

Conclusions: In patients who underwent penile curvature surgery using penile shortening techniques, low complication and high satisfaction rates were observed in all three corporoplasty techniques. Recurrence, presence of palpable nodule(s), and shortening of penile length are important parameters affecting the level of satisfaction.

Introduction: Radical cystectomy (RC) is associated with significant morbidity and mortality. While frailty and nutritional status have emerged as important predictors of surgical outcomes, their impact on RC complications remains incompletely characterized. We aimed to evaluate the relationship between frailty (using the Modified Frailty Index-5 [mFI-5], nutritional status (using the Nutritional Risk Index [NRI]), and postoperative outcomes in patients undergoing RC.

Methods: We conducted a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Frailty was defined as mFI-5 score ≥2 and malnutrition as NRI ≤97.5. Hypoalbuminemia was defined as preoperative albumin ≤3.5. Outcomes included 30-day complications, length of stay, and mortality.

Results: Among 8297 patients, 1793 (21.6%) were classified as frail. Frail patients experienced higher rates of infectious (sepsis: 10.2% vs. 6.72%, p<0.001), cardiopulmonary (myocardial infarction: 2.56% vs. 1.09%, p<0.001), and renal (renal insufficiency: 9.53% vs. 5.23%, p<0.001) complications. Mortality was twice as high in frail patients (2.45% vs. 1.17%, p<0.001). Among 8297 patients with nutritional data, 668 (8.05%) were malnourished, and 910 (15.2%) had hypoalbuminemia. Malnourished patients had higher rates of transfusion requirements (46.4% vs. 24.9%, p<0.001) and mortality (2.54% vs. 1.35%, p=0.032). Hypoalbuminemic patients demonstrated increased major complications (56.7% vs. 38.5%, p<0.001). The predictive accuracy of these indices varied by outcome, with area under the curve values ranging from 0.53-0.63.

Conclusions: Both frailty and poor nutritional status are associated with increased postoperative complications and mortality following RC; however, the modest predictive accuracy of these indices indicates they should be used as part of a broader risk assessment strategy.

Introduction: Herein, we report our single-center experience with long-term outcomes over a period of 15 years.

Methods: Between 2005 and 2020, a prospectively maintained database for patients undergoing GreenLight photoselective vaporization of the prostate (PVP) for symptomatic benign prostatic hyperplasia (BPH) was reviewed. Three generations of GreenLight laser were used over this period. Patients with ≥10 years of followup were included. Demographic and perioperative data were collected, including International Prostate Symptom Score (IPSS), quality of life (QoL), peak flow rate (Qmax), postvoid residual urine (PVR), and prostate-specific antigen (PSA) changes. Perioperative and late adverse events were also recorded.

Results: A total of 712 patients with a mean age of 73.9±7.8 years were included in the study, with a median followup of 12.1 years and a mean preoperative prostate size of 72.4±15.3 mL. There were significant reductions in mean IPSS, QoL, and PVR (60.4%, 65%, and 72.6%, respectively; all p<0.001) at the most recent followup compared to baseline values. Likewise, a significant improvement in Qmax (8.2 to 17.7 ml/sec, p<0.001) and a PSA reduction of 64.2% were noted at the most recent followup. The blood transfusion rate was 1.5 %. Transient postoperative dysuria was encountered in 44 (6.2%) patients. Development of bladder neck contracture and urethral stricture were encountered in 18 (2.5%) and 15 (2.1%) patients, respectively. Twenty-four (3.37%) patients required repeat surgery for adenoma regrowth.

Conclusions: Our long-term functional outcomes support the durability of the GreenLight laser PVP, with acceptable long-term adverse events after a decade of surgery.