Minerva Urology and Nephrology最新文献

Background: Organ sparing radical cystoprostatectomy in males is being considered with skepticism due to fear of compromising oncological safety; however, sacrifice of erectile nerves can lead to quality of life deterioration due to erectile dysfunction.

Methods: Data from men with muscle-invasive bladder cancer (MIBC) who were potent and wish to preserve potency were collected prospectively. Both nerve-sparing and capsule-sparing approach (with or without seminal vesicle preservation) was performed in a high-volume center. Baseline characteristics, oncological and sexual outcomes were collected. International Index for Erectile Function-5 (IIEF-5) was used both preoperatively and at last follow-up. Potency was defined as a score ≥3 in question 2.

Results: Twenty-five patients were included in capsule-sparing and 15 in nerve-sparing group. Patients in the former group were younger (55 vs. 66 years old) but no other significant difference in baseline characteristics was noted. Perioperative outcomes were similar among groups, whilst no difference was found regarding overall survival, recurrence rate, incidental prostate cancer and positive surgical margins. Postoperative IIEF-5 score was higher in capsule-sparing group (14 vs. 7, P=0.016) and more patients were potent (18 vs. 3, P=0.004). In regression analysis, the only significant predictor of potency was capsule-sparing surgery (odds ratio: 8.58, 95% CI: 1.30-81.5, P=0.034).

Conclusions: Capsule-sparing and nerve-sparing approaches during robotic radical cystectomy are feasible techniques among carefully selected patients, with improved sexual and non-inferior oncological outcomes compared with standard approach.

Introduction: Urolithiasis is a highly prevalent condition and its definitive treatment with endourological procedures exposes patients and medical staff to ionizing radiation. The efficacy and safety of fluoroscopy-free ureteroscopy (FF-URS) over conventional ureteroscopy (CV-URS) are controversial.

Evidence acquisition: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) data comparing FF-URS to CV-URS in patients undergoing treatment for ureteral or kidney stones.

Evidence synthesis: Eight randomized controlled trials (RCTs) were included in the meta-analysis, comprising 873 patients. Of these, 440 (50.4%) patients underwent FF-URS. The meta-analysis revealed no statistically significant difference in stone-free rate (SFR) between the two groups (RR=0.99; 95% CI 0.94-1.04; P=0.65; I²=0%). Similarly, there was no difference in the overall complication rates (8.4% vs. 9.7%; RR 0.87; 95% CI 0.57-1.31; P=0.50; I²=0%), Clavien-Dindo I/II (RR=0.68; 95% CI 0.42, 1.10; P=0.12; I²=0%) and operative time (MD 1.58 min; 95% CI -0.02-3.18; P=0.05; I²=16%). Clavien-Dindo III occurred only in one patient (0.2%) in the FF-URS group.

Conclusions: FF-URS is effective and safe compared to CV-URS and can reduce radiation exposure for both patients and medical staff without compromising treatment outcomes.

Background: We performed a comparison between the Wolf^® Piranha^™ and the Quanta System^® Cyber Blade^™ morcellators for the Thulium laser enucleation of the prostate (ThuLEP).

Methods: Overall, 205 patients underwent ThuLEP in three urologic departments (Como, Bordeaux, Madrid). Patients were randomized to Piranha morcellator with disposable blades (100 cases, Group A) or Cyber Blade morcellator (105 cases, Group B). Morcellation efficiency was related to prostate volume (PV) using the cut-off of 100 mL. Complication rate and device malfunctions were reported. The chi-square test was used for the comparison of the study groups. All statistical tests were two-sided with a level of significance at P<0.05.

Results: Mean PV was 82.5 vs. 91.9 mL (P=0.21) in Group A vs. B. Mean morcellation time was 9.7 vs. 10.1 min in Group A vs. B when PV was ≤100 mL (P=0.34), it was significantly lower in Group B when PV was >100 mL (12.7 vs. 10.1 min, P=0.04). Similarly, morcellation efficiency was comparable when PV was ≤100 mL (8.5 vs. 9.1 g/min, P=0.08), while it was significantly higher with the Cyber Blade when PV was >100 mL (10.0 vs. 12.3 g/min, P=0.04). Bladder injury occurred in three and two cases in Group A and B. Complication rate was comparable.

Conclusions: Piranha and Cyber Blade morcellators showed a comparable efficacy when PV was ≤100 mL, while efficacy was significantly higher with the Cyber Blade when PV was >100 ml. Both instruments are safe and reliable according to the risk of bladder injury and the occurrence of mechanical problems.

Postoperative complications remain a significant challenge in surgical care. This study assessed the ability of the BETTY score, a novel user-friendly scoring system, to predict postoperative outcomes in a large multicenter cohort of urological surgeries. We conducted a post-hoc analysis of a prospective, nonrandomized multicenter trial including 415 patients undergoing elective urological surgeries in six French hospitals. The BETTY score, part of a smartphone app, incorporates pre- and intraoperative data to classify patients into risk categories. We evaluated multiple endpoints, including 90-day postoperative overall and major complications, length of stay, prolonged care after discharge, unplanned readmission, reoperation, and days alive and out of hospital. Of the 415 patients, 22% experienced postoperative complications, with 3.9% major complications. Unplanned readmissions, prolonged care after discharge, and reoperation occurred in 8%, 20%, and 2.4% of cases, respectively. We found significant correlations between the BETTY score and all endpoints analyzed. In multivariate analysis, the BETTY score was significantly associated with all postoperative events studied. These findings demonstrate the reliability of the BETTY score in predicting various postoperative outcomes in urological surgery patients, especially for patients undergoing major surgeries. This tool may help optimize perioperative care and improve patient outcomes, potentially contributing to more personalized surgical care.

Background: Despite a large amount of literature focused on pharmacologic and surgical therapy for benign prostate hyperplasia (BPH), little is known about clinical presentation and management of outpatient clinic patients. We aimed to conduct a tailored analysis of BPH-affected patients, comparing men with known BPH versus newly diagnosed. The analysis was made through International Prostate Symptom Score (IPSS) and BPH Impact index (BII).

Methods: "Intensive prostate benefit" project working group designed a questionnaire prospectively administered by urologists to patients affected by lower urinary tract symptoms (LUTS) related to BPH.

Results: Overall, 3198 (64%) patients were previously diagnosed with BPH versus 1800 (36%) received a first diagnosis. Patients previously diagnosed with BPH were older (median 69 vs. 66 years) and more comorbid (P<0.001). Moreover, median IPSS score was higher in these patients (16 vs. 14), who also experienced a higher rate of severe symptoms (32.0% vs 21.5%, P<0.0001). At BII, concerns for one's health and time lost due to urinary problems were higher in patients previously diagnosed with BPH (P<0.0001). In these patients, a BPH-specific therapy was already established (88.5% vs. 75.1%) and a higher rate of therapy adherence (55.0% vs. 27.0%, P<0.0001) was observed. Roughly 90% of patients already taking BPH therapy changed their therapy after urological examination. In these patients, supplements/phytotherapeutics, alpha blockers, 5-alfa-reductase inhibitors, were prescribed in 32.8%, 37.4%, 17.4%, respectively.

Conclusions: Patients with prior BPH diagnosis have severe LUTS that worsen over time, affecting quality of life despite treatment. LUTS management in primary care is crucial, emphasizing counseling for a healthy lifestyle, cardiovascular risk control, and medication adherence.

Background: The aim of the current study was to identify predictors of erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS) in male participants at Italian web-survey.

Methods: A cross-sectional web-based survey was administered via Google Forms between July 17 and October 31, 2022, among Italian participants. The erectile function and the excessive daytime sleepiness were measured through the International Index of Erectile Function - 5 (IIEF5) and Epworth Sleepiness Scale (ESS), respectively. Two separate and independent multivariable logistic regression models (mLRMs) were fitted to predict ED and OSAS, respectively, in men answering to the survey.

Results: A total of 238 patients were identified. Of those, 58 (24%) reported to be affected by OSAS disease. Higher proportion of mild (21 vs. 6%), mild-to-moderate (9 vs. 5%), and severe (16 vs. 7%) ED were recorded in OSAS vs. non-OSAS patients (P<0.001). In mLRMs predicting ED (IIEF5≤7), age (OR: 1.04, 95% confidence interval [CI]: 1.01-1.06; P=0.002), and IPSS total score (OR:1.08, 95% CI: 1.02-1.15; P=0.006) were independent predictors. In mLRMs predicting OSAS, age (OR: 1.08, 95% CI: 1.05-1.12; P<0.001), Body Mass Index (BMI; OR: 1.12, 95% CI: 1.05-1.21; P<0.001), and ESS score (OR:1.14, 95% CI: 1.05-1.24; P=0.001) were independent predictors. In the subgroup analyses predicting severe ED, ESS and age or BMI or IPSS resulted as independent predictors (OR from 0.7 to 0.8; all P<0.05).

Conclusions: The ESS score independently predicted severe ED in males. As a result, the OSAS disease should be explored in patients who harbored severe ED to address those patients for a prompt ear, nose and throat evaluation.