Cuaj-Canadian Urological Association Journal最新文献

Introduction: Our aim was to assess how monoplanar fluoroscopy-guided access affects the outcomes of percutaneous nephrolithotomy (PCNL).

Methods: This retrospective study included all patients who had renal stones and underwent prone PCNL using monoplanar fluoroscopy-guided access in a single tertiary care center between January 2015 and January 2024. Preoperative and postoperative patient- and procedure-related variables, such as operative time, intraoperative blood loss, number of tracts, complications, stone-free rate (SFR), and hospital stay, were assessed. Multivariable analysis was performed to detect predictors of residual stones and complications.

Results: A total of 662 patients with an average age of 47±12 years were included. Comorbidities were reported in 26.1%. American Society of Anesthesiologists (ASA) score was I in 64.8%. The mean stone diameter was 2.8±0.9 cm. Only 6% had positive preoperative urine culture. The mean stone Hounsfield unit (HU) was 1054±304 with a mean operative time of 94±31 minutes. Most cases (74.9%) required only one tract. Postoperative fever was reported in 22.4%. The median estimated blood loss (EBL) was 160 mL. The complications included urine leak (4.1%), blood transfusion (1.5%), sepsis (1.5%), renal pelvic perforation (0.8%), superselective angio-embolization (0.6%), pleural injury (0.6%), and colonic injury (0.2%). The median hospital stay was three days. Approximately 73% were stone-free. The only predictor of residual stone was higher stone diameter (odds ratio [OR] 1.536, p=0.001). Predictors of complications were three tracts (OR 4.501, p=0.033) and higher EBL (OR 1.003, p<0.001).

Conclusions: The monoplanar fluoroscopy-guided approach has demonstrated a noteworthy success rate, rendering it a safe modality for prone conventional PCNL.

Introduction: We sought to evaluate multiparametric magnetic resonance imaging (mpMRI) findings and biopsy results in men with an indwelling catheter undergoing prostate cancer screening. mpMRI is central to the evaluation of prostate cancer. Little is known about the effect of an indwelling urinary catheter on prostate mpMRI findings and the results of subsequent biopsies.

Methods: We retrospectively reviewed 5820 mpMRI exams performed from 2017-2023. Forty-eight patients underwent mpMRI with an indwelling urinary catheter. Using propensity score matching, patients were matched 1:1 for age, pre-biopsy prostate-specific antigen (PSA), and prostate volume. Clinical characteristics, mpMRI findings, and targeted biopsy results were compared between the groups.

Results: After propensity score matching, clinical characteristics of the study groups did not differ significantly. Prostate Imaging-Reporting & Data System (PI-RADS) distribution did not show a significant difference (p=0.51); PI-RADS ≥3 lesions were identified in 20/48 (42%) patients with indwelling catheters and in 18/50 (36%) patients without catheters. Among patients with a PI-RADS score ≥3, clinically significant prostate cancer (csPCa) was identified in 5/20 patients carrying catheters and 6/18 patients without catheters (p=0.152). A higher rate of any cancer was identified in patients without a catheter (67% vs. 35%, p=0.049). PSA >9.79 ng/ml predicted the finding of csPCa in patients carrying urinary catheters with PI-RADS ≥3 lesions.

Conclusions: Our findings suggest no significant difference in mpMRI findings and csPCa rates for patients with and without indwelling urinary catheters. Patients carrying urinary catheters suspected to harbor csPCa based on an elevated PSA level should undergo further evaluation, including mpMRI and biopsies when necessary before benign prostatic hyperplasia treatment.

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: 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.