Minerva Urology and Nephrology最新文献

Background: Double-J stents are commonly inserted following ureteroscopy and stone lithotripsy, potentially leading to various urinary and pain-related symptoms and affecting patients' quality of life. This study aimed to compare the impact of soft and firm silicone stents on stent-related symptoms in patients undergoing ureteroscopy and stone lithotripsy.

Methods: After receiving institutional ethical committee approval (SMC 0119-23), we conducted a prospective, randomized, single-blinded trial between 2023-2024. Patients undergoing ureteroscopy and stone lithotripsy were randomized into two groups: those receiving a soft polymer stent (Universa^®, Cook Medical, Bloomington, IN, USA) or a firm polymer stent (Percuflex^®, Boston Scientific, Marlborough, MA, USA). Symptoms were assessed using the Ureteral Stent Symptoms questionnaire (USSQ), completed upon stent removal, 14 days postoperatively. The primary outcome was the USSQ index score, with secondary outcomes including individual USSQ domain scores.

Results: A total of 120 patients completed the questionnaire. The soft-stent group (N.=60) demonstrated significantly lower USSQ index scores (26 vs. 73, P<0.001) and improved outcomes across all USSQ sub-domains (P<0.001) compared to the firm-stent group. A multiple regression model confirmed that using firm stent material independently resulted in higher USSQ index scores (P<0.001) relative to soft stent. Intraoperative and postoperative complication rates were similar between groups.

Conclusions: Using soft ureteral stents results in fewer stent-related symptoms compared to firm stents, offering superior quality of life while maintaining a comparable safety profile. Based on these findings, when placing a ureteral stent following ureteroscopy and stone lithotripsy, a soft stent is recommended.

Background: The role of surgical exploration and frozen sections (FSs) in monorchid patients with testicular nodules is still not well defined. We tested the role of surgical exploration and FSs in monorchid patients and the impact on the chance of testis sparing surgery (TSS).

Methods: We identified 81 consecutive monorchid patients with testicular nodules between 2008 and 2024 candidates to surgical exploration and FSs. The statistical significance of differences in medians and proportions was tested with the Wilcoxon rank sum and chi-square tests. Multivariable logistic regression models (MLRMs) were used.

Results: Testicular lesions number was available in 61 patients and was one in 35 (57.4%) of those, two in 15 (24.6%), three in 7 (11.5%) and more than three in 4 (6.5%). Median larger lesion size was 12 mm (IQR 9-20 mm). FSs were performed in 59 (73%) patients and showed germ-cell tumor (GCT) in 53 (65.4%). Orchidectomy was performed in 68 patients (84%). In 55 of 56 patients (98.3%) definitive histology confirmed FSs. Thirteen (16%) had TSS including 7 patients with seminomatous GCT, of those none had disease relapse at follow-up. At MLRMs older age was associated with lower probability of GCT (Odds Ratio 0.91, Confidence Interval 0.84-0.99, P value 0.03).

Conclusions: FSs are feasible and reliable in monorchid patients following a history of GCT. Nonetheless, TSS is rarely performed, as most of these patients actually have GCT. The few ones who had TSS had excellent oncological results.

Introduction: To provide an updated and detailed overview of the current use of platelet-rich plasma (PRP) penile injections in men affected by Peyronie's disease (PD).

Evidence acquisition: A comprehensive search in PubMed, Scopus, and Web of Science, was performed for prospective and retrospective, single cohort or comparative studies published in form of full-text articles or conference abstracts, evaluating safety and efficacy of PRP for PD treatment. Primary outcome consisted in the reduction of penile curvature. Sexual function and adverse/side effects were also investigated. Qualitative and quantitative data syntheses were provided.

Evidence synthesis: Overall, 15 records were included: four studies focused on PRP alone, two randomized clinical trials tested PRP versus placebo, and the remainder assessed the combination of PRP with external shock wave therapy, manual penile modelling, vacuum erection device therapy, percutaneous needle tunneling, phosphodiesterase type-5 inhibitors or hyaluronic acid. Patient numbers ranged between 10 and 159 according to studies, with 685 patients receiving PRP alone or in combination (median age 56.2 years). Despite the heterogeneity in study design, protocol of administration, dose of PRP, and follow-up duration, all studies independently reported a statistically significant improvement in penile curvature and sexual outcomes, without major adverse/side effects. A linear mixed-effects model was fitted to estimate the change in penile curvature over time across studies, with results suggesting that the effect of PRP on reducing penile curvature tends to improve over time, was enhanced by greater initial treatment intensity, and negatively influenced by patient age.

Conclusions: PRP penile injections for PD treatment have shown encouraging results in preliminary studies. Patient numbers and the short-term follow-up may limit the generalizability of these observations. High-quality, large-scale, and standardized controlled trials are needed before starting to recommend its use in clinical practice.

Background: Guy's Stone Score (GSS) has proven to be the most reliable and valuable tool for predicting the success rate and potential complications after percutaneous nephrolithotomy (PCNL) This study aims to assess the impact of GSS on perioperative outcomes, complications and stone-free rates (SFR) in adult patients undergoing suction mini-percutaneous (SM)-PCNL for kidney stone(s).

Methods: Data from 1527 adult patients with normal renal anatomy who underwent prone or supine SM-PCNL across 21 countries were analyzed. Patients were stratified by GSS (1-4) based on preoperative CT imaging. The primary outcome was 30-day SFR, assessed by non-contrast CT, defined as zero fragment. Secondary outcomes included peri- and postoperative complications. Multivariate analysis identified predictors of SFR and complications.

Results: Despite increased complexity, SM-PCNL was frequently utilized for GSS 3 and 4 cases, often requiring multiple tracts and advanced access techniques. Complication rates, including bleeding and infectious events, were low but significantly higher in GSS 3 and 4 groups. SFR decreased with increasing GSS, with GSS 1 achieving the highest rates and GSS 4 the lowest. Multivariate analysis identified stone volume (OR 0.96), and GSS 2 (OR 0.53), 3 (OR 0.27) and 4 (OR 0.46) as independent predictors of lower odds of zero residual fragment compared to GSS 1, while sheath size 16-18 Fr (OR 1.72) and <18 Fr (OR 4.48) with higher odds compared to sheath size <16 Fr. GSS 2 (OR 2.22), 3 (OR 4.97) and 4 (OR 4.01) compared to GSS 1 and mechanical lithotripsy (OR 1.65) were associated with higher odds of all complications compared to laser lithotripsy.

Conclusions: GSS effectively predicts perioperative outcomes following suction mini-PCNL. Increasing stone complexity is associated with reduced SFR and higher complication rates, underscoring the importance of preoperative risk stratification, tailored surgical planning and a proper informed consent for the patient in complex cases.

Background: Combined transrectal mpMRI-TRUS targeted (TB) and systematic biopsy (SB) is widely used to diagnose prostate cancer (PCa). However, SB may be omitted in a subset of patients with minimal risk of missing clinically significant prostate cancer (csPCa) in TB alone. We aimed to identify clinical characteristics predicting the need for SB in men undergoing TB.

Methods: In this retrospective cohort study, 879 patients underwent combined TB and SB. Cases where csPCa was missed by TB but detected by SB were identified. Logistic regression analysis was used to identify clinical predictors for SB necessity, including digital rectal examination, prior negative biopsy, age, prostate-specific antigen (PSA), prostate volume, PSA density, mpMRI tumor volume (MTV), number of mpMRI lesions, PI-RADS score, and mpMRI tesla.

Results: In 80 (9.1%) cases csPCa was missed by TB and detected by SB only. Median MTV was 0.75 cm³ (IQR 0.43-1.41 cm³). Multivariable logistic regression analysis revealed MTV as the only significant predictor of csPCa missed by TB alone (OR=0.52, 95% CI 0.36, 0.75, P<0.001). A larger MTV was inversely associated with the risk of missing csPCa in TB alone. In patients with an MTV greater than 1.36 cm³, the rate of missing csPCa with TB alone was ≤5%.

Conclusions: MTV is a promising predictor to identify patients who may not require a concomitant SB when undergoing TB. However, this finding needs to be validated in external cohorts before being applied in clinical practice.

Background: Predicting whether recurrence will occur during follow-up in bladder cancer cases confined to the mucosa (Ta-stage) is one of the crucial aspects of management. In this study, we aimed to compare the models obtained by conventional statistical methods and machine learning (ML) methods in order to predict the development of recurrence in the 2-year postoperative period in Ta stage Non-Muscle Invasive Bladder Cancers.

Methods: The data of patients who underwent complete transurethral resection of the bladder and were found to have Ta pathologies due to primary bladder cancer between 2018-2021 was retrospectively screened. Patients with no recurrence during the two-year follow-up were classified as Group 1 (N.=107, 58.2%), and those with recurrence were classified as Group 2 (N.=77, 41.8%). The demographic, clinical, imaging and pathological data were recorded. These parameters were analyzed using a conventional statistical method and ML methods to construct prediction models.

Results: Body Mass Index, American Society of Anesthesiologists (ASA) score, and the presence of macroscopic hematuria were found to be significant variables to predict early recurrence (P<0.05). The prediction model created by Cox-regression analysis was determined to have a sensitivity of 65%, specificity of 63.6%, and an area under the curve (AUC) value of 66%, while the AUC values achieved by the ML methods, namely random forest, logistic regression, and k-nearest neighbors, were calculated to be 0.75, 0.87 and 0.74, respectively.

Conclusions: Models developed using ML can provide more accurate predictions than conventional statistical methods in predicting the recurrence of Ta bladder cancer.

Background: Peyronie's disease (PD) is a progressive fibrotic disorder of the tunica albuginea that impairs penile anatomy, sexual function, and quality of life. With no approved pharmacological treatments in Europe after the withdrawal of collagenase Clostridium histolyticum (CCH), intralesional hyaluronic acid (HA) has emerged as a potential option. This study aims to assess the clinical effectiveness of HA in PD, focusing on patient-reported outcomes via the Peyronie's Disease Questionnaire (PDQ).

Methods: This prospective observational study included patients treated with weekly intralesional HA injections for 8 weeks, combined with penile modeling and daily tadalafil. Inclusion required a penile curvature >30° and at least one episode of penetrative intercourse within the past 3 months. Penile curvature, IIEF-5, and PDQ scores were assessed at baseline and after 3 months.

Results: Sixty-six patients were included. Total PDQ scores improved from 61.5 (50.0-67.0) to 40.0 (26.8-49.0; P<0.001), with a mean reduction of -19.9±9.7. Specifically, all three domains of the PDQ questionnaire (Penile Pain, Penile Deformity, and Symptom Bother) showed a significant improvement (P<0.001). No adverse events were recorded.

Conclusions: Intralesional HA injections are safe and effective in improving patient's reported symptoms and subsequently quality of life in PD patients. This therapy may represent a valuable alternative in real-world clinical practice, especially in Europe where other pharmacological options are lacking.

Prostate biopsy is often perceived as an invasive and painful procedure, frequently associated with significant emotional distress. Despite the use of local anesthesia, a considerable proportion of patients still report pain and anxiety. Hypnosis has been demonstrated to reduce procedural discomfort; however, its clinical use is limited by the requirement of trained professionals and time constraints. This preliminary study evaluates the feasibility and potential benefits of digital sedation using immersive virtual reality (VR) with the HypnoVR system in five patients undergoing prostate biopsy. Patients selected their preferred virtual environment and started wearing the device four minutes before the procedure. Anxiety and pain were assessed using Visual Analog Scales (VAS), and vital signs were monitored as physiological surrogates. Results revealed low pre-procedural anxiety (median 1/10 ±1) and moderate pain during (median 5.6/10 ±1.1) and immediately after biopsy (median 3/10 ±2.2), with no pain reported at 24 hours. All patients reported high satisfaction and no complications occurred. Transrectal biopsies were performed without anesthesia, while the transperineal ones were carried out using subcutaneous anesthesia only, with no significant differences in tolerability. Although limited by its small sample size, this initial experience supports the potential role of VR-based hypnosis as a non-pharmacological, patient-centered approach to enhance comfort and reduce invasiveness during prostate biopsy.