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If not now, then when? The need for new evidence in the robotic management of upper tract urothelial carcinoma. 此时不做,更待何时?上尿路尿道癌机器人治疗需要新证据。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.23736/S2724-6051.24.05795-1
Fabrizio DI Maida, Carlo A Bravi, Ruben DE Groote, Federico Piramide, Filippo Turri, Mike Wenzel, Gopal Sharma, Christoph Würnschimmel, Iulia Andras, Edward Lambert, Paolo Dell'oglio, Marcio Covas Moschovas, Riccardo Campi, Nikolaos Liakos, Antonio A Grosso, Francesco Montorsi, Alberto Briganti, Alexandre Mottrie, Andrea Minervini, Alessandro Larcher

Current guidelines recommend radical nephroureterectomy with bladder cuff excision as the standard surgical treatment for high-risk upper tract urothelial carcinoma (UTUC). While large evidence is available regarding open and laparoscopic nephroureterectomy, data focusing on robotic nephroureterectomy (RNU) in UTUC are mostly limited with mixed results, especially in locally advanced disease. In light of the recent introduction of new robotic platforms, it is of utmost importance to further investigate oncologic outcomes associated with RNU. Moreover, stronger data exploring different operative settings (i.e. robotic arms and trocars placement) for the new robotic systems are eagerly warranted. To give an answer to such open clinical questions, the Junior ERUS/Young Academic Urologist Working Group on Robot-assisted Surgery designed a multicentric project involving different high-volume centers across the world. The aim of the study will be exploring surgical and oncologic outcomes of RNU, specifically focusing on several clinical unmet needs, such as best operative setting for new robotic platforms, lymph node dissection (LDN) template and robotic bladder cuff management.

现行指南建议将根治性肾切除术和膀胱袖带切除术作为高风险上尿路上皮癌(UTUC)的标准手术治疗方法。开腹和腹腔镜肾切除术有大量证据可循,但机器人肾切除术(RNU)治疗UTUC的数据却十分有限,结果也不尽相同,尤其是在局部晚期疾病中。鉴于近期新机器人平台的引入,进一步研究与 RNU 相关的肿瘤治疗效果至关重要。此外,我们还急需更多的数据来探讨新型机器人系统的不同手术设置(即机器人手臂和套管放置)。为了回答这些临床问题,Junior ERUS/青年泌尿科医师机器人辅助手术工作组设计了一个多中心项目,涉及全球不同的高容量中心。该研究的目的是探索 RNU 的手术和肿瘤治疗效果,尤其关注一些尚未满足的临床需求,如新型机器人平台的最佳手术环境、淋巴结清扫(LDN)模板和机器人膀胱袖带管理。
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引用次数: 0
Embracing innovation while preserving tradition: single-port robotics landing in Europe. 拥抱创新,传承传统:单端口机器人技术在欧洲的落地。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.23736/S2724-6051.24.06037-3
Riccardo Bertolo, Alessandro Veccia, Alessandro Antonelli
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引用次数: 0
Effect of irrigation solution temperature on complications of percutaneous nephrolithotomy: a systematic review of the literature, meta-analysis and trial sequential analysis of randomized clinical trials. 冲洗液温度对经皮肾镜碎石术并发症的影响:文献系统回顾、荟萃分析和随机临床试验的试验序列分析。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-31 DOI: 10.23736/S2724-6051.24.05731-8
Henrique L Lepine, Fernanda M Llata, Breno C Porto, Nathalie C Hobaica, Carlo C Passerotti, Rodrigo A Sanderberg, Everson L Artifon, Jose P Otoch, Jose A da Cruz

Introduction: The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time.

Evidence acquisition: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data.

Evidence synthesis: The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I2=33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I2=0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I2=82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid.

Conclusions: There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.

导言:接受 PCNL 手术的患者冲洗液的最佳温度尚不明确。因此,本研究旨在探讨不同冲洗液温度(冷/室温冲洗液与温/体温冲洗液)的影响。我们的主要终点是低体温率。次要结果为颤抖率、平均体温下降率、患者最终平均体温、失血量和手术时间:本系统综述按照 PRISMA 指南进行。2023 年 11 月对多个数据库进行了检索。在筛选出的 299 项研究中,有 8 项被选中进行全文综述,最终有 4 项随机临床试验符合纳入标准和预期结果。研究选择和数据提取由多名审稿人共同完成,并采用随机效应模型对数据进行汇总:主要结果--低体温发生率在组间存在显著统计学差异,实验组(35-37 ºC)的发生率低于低温/室温灌注组(RR 0.64;95%CI 0.46, 0.89; P2=33%)。次要结果如哆嗦率(RR 0.46;95%CI 0.31,0.67;P2=0%)和最终平均温度(MD 0.43;95%CI 0.12,0.75;I2=82%)也显示组间存在显著统计学差异,使用加热液体灌洗更有利:结论:使用温水冲洗 PCNL 的患者体温过低和颤抖的发生率较低。结论:使用温热灌流液进行 PCNL 的患者体温过低和颤抖的发生率较低,实验组的最终平均温度也较高。至于失血量,各组间的平均血红蛋白下降率差异无统计学意义,这促使人们进一步研究灌流液温度对失血量的影响。
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引用次数: 0
The single port robotic surgical "toolbox": a primer for beginners. 单孔机器人手术 "工具箱":初学者入门指南。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.05766-5
Francesco Ditonno, Antony A Pellegrino, Antonio Franco, Luca Morgantini, Celeste Manfredi, Eugenio Bologna, Leslie Claire Licari, Francesco Porpiglia, Alessandro Antonelli, Simone Crivellaro, Riccardo Autorino

Background: The aim of this study is to provide a comprehensive overview of the da Vinci Single Port robotic platform, including instruments and tools that can aid in implementing the use of this novel platform.

Methods: Footage recorded during various Single port robotic urologic procedures and dry labs performed at two US institutions was used as video material. A step-by-step guide illustrating key points on OR set-up, platform, instruments, trocar configurations, intraoperative suctioning, bedside assistance were discussed and highlighted.

Results: The Single port surgeon console resembles the Xi console but includes upgraded software. The 6-mm biarticulated instruments incorporate an elbow and a wrist flexible joint. These instruments are deployed through the Access port. Access port kit includes the Access port, and a 25-mm multichannel trocar accommodating an 8-mm flexible scope, and three 6-mm robotic instruments. The 0° endoscope has two sets of articulation: a fixed one, and a distal one, allowing for three movements, selected with a hand command, the "Camera Adjust", the "Camera Control" and the "Relocation." The "Cobra mode," is an extra setting that allows the camera to wing out and move laterally relative to the working instruments. Suction is preferably performed with the Remotely Operated Suction Irrigation system.

Conclusions: Herein we provide a detailed guide to the main technical nuances of the Single port platform and a practical overview of the instrumentation that is used during Single port robotic procedures. Knowledge of the toolbox that is used during Single port robotic surgery is key for those approaching for the first time this novel technology.

背景:本研究旨在全面介绍达芬奇单孔机器人平台,包括有助于使用这一新型平台的仪器和工具:方法:使用在美国两家机构进行的各种单孔机器人泌尿外科手术和干实验室的录像作为视频材料。讨论并强调了手术室设置、平台、器械、套管配置、术中抽吸、床旁协助等要点的分步指南:单孔外科医生控制台与Xi控制台相似,但包括升级软件。6 毫米生物关节器械包含一个肘关节和一个腕关节。这些器械通过接入端口展开。接入端口套件包括接入端口、一个可容纳 8 毫米柔性内窥镜的 25 毫米多通道套管和三个 6 毫米机器人器械。0° 内窥镜有两套铰接装置:一套是固定的,另一套是远端铰接的,可进行三种运动,用手指令选择 "摄像头调整"、"摄像头控制 "和 "重新定位"。眼镜蛇模式 "是一种额外的设置,可使摄像头相对于工作器械向外和横向移动。抽吸最好使用遥控抽吸灌溉系统:在此,我们详细介绍了单孔平台的主要技术细节,并对单孔机器人手术中使用的器械进行了实际概述。了解单孔机器人手术中使用的工具箱对于初次接触这项新技术的人来说至关重要。
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引用次数: 0
Unveiling the impact of opioid-free postoperative regimens in ureteroscopy: a comprehensive systematic review and meta-analysis. 揭示无阿片类药物术后方案对输尿管镜检查的影响:一项全面的系统回顾和荟萃分析。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.05824-5
Bruno D Terada, Felipe G Gonçalves, Breno C Porto, Bruno Duarte Silva, Carlo C Passerotti, Rodrigo A Sanderberg, Everson L Artifon, Jose P Otoch, Jose A da Cruz

Introduction: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are minimally invasive urologic procedures that are commonly used to treat kidney stones. However, they often result in significant postoperative pain. Historically, patients undergoing these surgeries have predominantly been managed with opioids, which has contributed to the escalating global complications associated with these drugs, including abuse and addiction. As a result, over the recent years, many healthcare centers have made efforts to minimize opioid use, opting instead for safer alternative medications. In this study, we aim to compare the efficacy of both opioid and opioid-free pain management regimens following URS or RIRS procedures.

Evidence acquisition: A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies that compared opioid-based and opioid-free postoperative care for managing pain in patients who underwent URS or RIRS for lithotripsy. Our primary outcome of interest was the frequency of postoperative emergency department (ED) visits. Secondary outcomes included pain-related phone calls, postoperative unexpected encounters, need for opioids at discharge, and patients with opioid refills.

Evidence synthesis: We retrieved 10 articles, encompassing 6786 patients in the opioid group and 5276 patients in the opioid-free group. Overall, our findings lean towards favoring the opioid-free regimen, revealing notable differences between the groups. Opioid-free regimen was associated with less ED visits (OR=0.67; 95% CI: 0.58, 0.77; P=0.00001; I2=0%) and required less opioids at discharge (OR=0.11; 95% CI 0.02, 0.64; P=0.01; I2=89%).

Conclusions: Through statistically superior results, our meta-analysis suggests that an opioid-free regimen outperforms the use of opioids after URS or RIRS, particularly in terms of pain management.

导言:输尿管镜检查(URS)和逆行肾内手术(RIRS)是微创泌尿外科手术,常用于治疗肾结石。然而,这两种手术通常会导致明显的术后疼痛。一直以来,接受此类手术的患者主要使用阿片类药物,这导致与此类药物相关的全球并发症不断增加,包括滥用和成瘾。因此,近年来许多医疗中心都在努力减少阿片类药物的使用,转而使用更安全的替代药物。在本研究中,我们旨在比较 URS 或 RIRS 手术后阿片类药物和无阿片类药物疼痛治疗方案的疗效:在 MEDLINE、Embase、Scopus、Cochrane、LILACS 和 Google Scholar 中进行了系统检索。我们纳入的研究比较了基于阿片类药物和不含阿片类药物的术后护理对接受 URS 或 RIRS 碎石术患者疼痛的控制效果。我们关注的主要结果是术后急诊科(ED)就诊频率。次要结果包括与疼痛相关的电话、术后意外情况、出院时对阿片类药物的需求以及阿片类药物续药患者:我们检索了 10 篇文章,包括阿片类药物组的 6786 名患者和无阿片类药物组的 5276 名患者。总体而言,我们的研究结果倾向于无阿片治疗方案,并揭示了两组之间的显著差异。无阿片方案与较少的急诊就诊相关(OR=0.67;95% CI:0.58,0.77;P=0.00001;I2=0%),出院时所需阿片类药物较少(OR=0.11;95% CI 0.02,0.64;P=0.01;I2=89%):我们的荟萃分析结果表明,不使用阿片类药物的治疗方案优于 URS 或 RIRS 后使用阿片类药物的治疗方案,尤其是在疼痛治疗方面。
{"title":"Unveiling the impact of opioid-free postoperative regimens in ureteroscopy: a comprehensive systematic review and meta-analysis.","authors":"Bruno D Terada, Felipe G Gonçalves, Breno C Porto, Bruno Duarte Silva, Carlo C Passerotti, Rodrigo A Sanderberg, Everson L Artifon, Jose P Otoch, Jose A da Cruz","doi":"10.23736/S2724-6051.24.05824-5","DOIUrl":"10.23736/S2724-6051.24.05824-5","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are minimally invasive urologic procedures that are commonly used to treat kidney stones. However, they often result in significant postoperative pain. Historically, patients undergoing these surgeries have predominantly been managed with opioids, which has contributed to the escalating global complications associated with these drugs, including abuse and addiction. As a result, over the recent years, many healthcare centers have made efforts to minimize opioid use, opting instead for safer alternative medications. In this study, we aim to compare the efficacy of both opioid and opioid-free pain management regimens following URS or RIRS procedures.</p><p><strong>Evidence acquisition: </strong>A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies that compared opioid-based and opioid-free postoperative care for managing pain in patients who underwent URS or RIRS for lithotripsy. Our primary outcome of interest was the frequency of postoperative emergency department (ED) visits. Secondary outcomes included pain-related phone calls, postoperative unexpected encounters, need for opioids at discharge, and patients with opioid refills.</p><p><strong>Evidence synthesis: </strong>We retrieved 10 articles, encompassing 6786 patients in the opioid group and 5276 patients in the opioid-free group. Overall, our findings lean towards favoring the opioid-free regimen, revealing notable differences between the groups. Opioid-free regimen was associated with less ED visits (OR=0.67; 95% CI: 0.58, 0.77; P=0.00001; I<sup>2</sup>=0%) and required less opioids at discharge (OR=0.11; 95% CI 0.02, 0.64; P=0.01; I<sup>2</sup>=89%).</p><p><strong>Conclusions: </strong>Through statistically superior results, our meta-analysis suggests that an opioid-free regimen outperforms the use of opioids after URS or RIRS, particularly in terms of pain management.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis. 良性前列腺增生症(BPH)手术后尿失禁:来自全国综合数据库分析的启示。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.05802-6
Leslie C Licari, Eugenio Bologna, Celeste Manfredi, Antonio Franco, Francesco Ditonno, Cosimo DE Nunzio, Giorgio Franco, Luca Cindolo, Costantino Leonardo, Sarah A Adelstein, Cristian Fiori, Edward E Cherullo, Ephrem O Olweny, Riccardo Autorino

Background: Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH.

Methods: A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation®), Water Vapor Thermal Therapy (WVTT - Rezum®) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of "persistent" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery.

Results: Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI.

Conclusions: UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.

背景:术后尿失禁(UI)是良性前列腺增生症手术的一种常见并发症。我们的研究旨在调查接受不同良性前列腺增生手术的患者中尿失禁的发生率:我们使用一个大型国家数据库进行了回顾性分析,该数据库包含 2011 年至 2022 年间的患者记录。考虑了前列腺增生症最常用的手术方法,包括经尿道前列腺电切术(TURP)、经尿道前列腺切开术(TUIP)、钬/铥激光前列腺去核术(HoLEP/ThuLEP)、开放式单纯前列腺切除术(OSP)、微创单纯前列腺切除术(Lap/Rob SP)、前列腺光选择性汽化术(PVP)、前列腺尿道提升术(PUL)、机器人水刀治疗(RWT - Aquablation®)、水蒸气热疗(WVTT - Rezum®)和前列腺动脉栓塞术(PAE)。对任何类型的尿失禁率进行了评估,包括压力性尿失禁(SUI)、急迫性尿失禁(UUI)和混合性尿失禁(MUI)。多变量回归分析用于确定术后 "持续性 "尿失禁的预测因素,即术后 12 个月内出现活动性尿失禁诊断:在接受良性前列腺增生手术的 274,808 名患者中,有 11,017 人(4.01%)出现持续性尿频。UUI率介于0.62%(PAE)和2.71%(PVP)之间,SUI介于0.04%(PAE)和2.75%(Lap/Rob SP)之间,而MUI介于0.11%(PAE)和1.17%(HoLEP/ThuLEP)之间。在多变量分析中,HoLEP/ThuLEP(OR 1.612;95% CI:1.508-1.721;PC结论:尿失禁仍然是良性前列腺增生症手术后的一种令人担忧的并发症,但这种并发症并不常见,会影响患者的生活质量。
{"title":"Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis.","authors":"Leslie C Licari, Eugenio Bologna, Celeste Manfredi, Antonio Franco, Francesco Ditonno, Cosimo DE Nunzio, Giorgio Franco, Luca Cindolo, Costantino Leonardo, Sarah A Adelstein, Cristian Fiori, Edward E Cherullo, Ephrem O Olweny, Riccardo Autorino","doi":"10.23736/S2724-6051.24.05802-6","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05802-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation<sup>®</sup>), Water Vapor Thermal Therapy (WVTT - Rezum<sup>®</sup>) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of \"persistent\" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery.</p><p><strong>Results: </strong>Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI.</p><p><strong>Conclusions: </strong>UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of da Vinci® versus Hugo RAS® radical prostatectomy: focus on postoperative course, pathological findings, and patients' health-related quality of life after 100 consecutive cases (the COMPAR-P prospective trial). 达芬奇®前列腺癌根治术与雨果RAS®前列腺癌根治术的疗效:100例连续病例的术后过程、病理结果以及患者与健康相关的生活质量(COMPAR-P前瞻性试验)。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.05928-7
Alessandro Antonelli, Alessandro Veccia, Sarah Malandra, Riccardo Rizzetto, Francesco Artoni, Piero Fracasso, Francesca Fumanelli, Iolanda Palumbo, Antonio Raiti, Luca Roggero, Lorenzo P Treccani, Vincenzo Vetro, Vincenzo DE Marco, Antonio B Porcaro, Maria A Cerruto, Matteo Brunelli, Riccardo Bertolo

Background: This study aims to prospectively compare the outcomes of robot-assisted radical prostatectomy (RARP) performed using the Hugo RAS and da Vinci Xi systems, focusing on the postoperative course, pathological findings, and health-related quality of life.

Methods: The COMPAR-P trial, a prospective post-market study (clinical-trials.org NCT05766163), commenced in March 2023, enrolling patients for RARP performed with either da Vinci or Hugo RAS without selection criteria for up to 50 consecutive cases per system. Two experienced console surgeons performed the procedures according to a standardized technique. The study evaluated differences between da Vinci and Hugo RAS regarding the postoperative course, pathology findings, 30-day PSA value, functional metrics, and health-related quality of life using SF-36 and University of California Los Angeles Prostate Cancer Index questionnaires.

Results: Fifty patients underwent DV-RARP and H-RARP each. Postoperative complications, pathological data, and quality of life metrics did not significantly differ between the groups. Noteworthy limitations include the comparison between the first 50 H-RARP and last 50 DV-RARP cases, as well as the potential influence of surgeons' specialized expertise on the generalizability of findings.

Conclusions: This prospective study of 100 unselected patients undergoing RARP with either da Vinci or Hugo RAS systems reveals comparable outcomes in postoperative course, pathology, functional metrics, and health-related quality of life. However, further research with larger sample sizes, longer follow-up periods, and diverse surgical expertise is essential to validate these findings and better understand the implications for clinical practice.

研究背景本研究旨在前瞻性比较使用Hugo RAS和达芬奇Xi系统进行机器人辅助前列腺癌根治术(RARP)的疗效,重点关注术后过程、病理结果以及与健康相关的生活质量:COMPAR-P试验是一项上市后前瞻性研究(clinical-trials.org NCT05766163),于2023年3月开始,招募使用达芬奇或Hugo RAS进行RARP手术的患者,不设选择标准,每个系统最多可连续进行50例手术。两名经验丰富的控制台外科医生按照标准化技术进行手术。研究使用 SF-36 和加州大学洛杉矶分校前列腺癌指数问卷评估了达芬奇和雨果 RAS 在术后过程、病理结果、30 天 PSA 值、功能指标和健康相关生活质量方面的差异:结果:50名患者分别接受了DV-RARP和H-RARP手术。两组患者的术后并发症、病理数据和生活质量指标无明显差异。值得注意的局限性包括前50例H-RARP和后50例DV-RARP之间的比较,以及外科医生的专业知识对研究结果普遍性的潜在影响:这项前瞻性研究选取了100名未经筛选的患者,通过达芬奇或雨果RAS系统进行了RARP手术,结果显示,他们在术后病程、病理、功能指标和健康相关生活质量方面都具有可比性。不过,要验证这些发现并更好地理解其对临床实践的影响,还必须进行样本量更大、随访时间更长、手术专家更多样化的进一步研究。
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引用次数: 0
Gaps in urinary incontinence rehabilitation after radical prostatectomy. 根治性前列腺切除术后尿失禁康复方面的差距。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.06115-9
Laura Pelizzari, Riccardo Lombardo, Sabrina DE Cillis, Alessandro Giammo, Vincenzo Li Marzi, Cosimo DE Nunzio
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引用次数: 0
Bulbar urethroplasty techniques and stricture recurrence: differences between end-to-end urethroplasty versus the use of graft. 球部尿道成形术技术与狭窄复发:端对端尿道成形术与使用移植物的区别。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.23736/S2724-6051.24.05812-9
Fernando Alberca-Del Arco, Rocío Santos-Pérez DE LA Blanca, Carmen Amores Vergara, Bernardo Herrera-Imbroda, Felipe Sáez-Barranquero

Urethral stricture (US) affects most commonly the anterior portion of the urethra, concretely the bulbar, with a significant incidence in men. Open urethroplasty is the gold standard treatment. However, stricture recurrence (SR) remains a current subject of concern. The aim of the present review is to provide an updated literature summary on surgical urethroplasty techniques for bulbar US and prognostic factors for SR, comparing the different approaches. For short strictures, excision and primary anastomosis (EPA) is the preferred option, with success rates exceeding 90%. Substitution techniques are usually required for longer strictures (>2-3cm). Buccal mucosa graft (BMG) remains the first choice as it complies with ideal features, with no significant differences regarding the site of graft implantation. Stricture length, time since urethroplasty and number of previous urethral interventions are risk factors for failure. Also, surgeon's experience affects technique selection and future outcomes. There seems to be consensus on a higher SR rate following substitution techniques compared to EPA, which appears to be influenced by the stricture length, usually longer in the former group. Furthermore, there is a trend in favor of endoscopic management of SR, except for long and complex recurrences where grafts should be used. In conclusion, multiple urethroplasty techniques are available and selection must be carefully individualized, focusing on stricture characteristics, patient's history, and surgeon's experience. Well-designed studies with clear definitions and follow-up protocols are still necessary to develop standardized guidelines on the management of bulbar US.

尿道狭窄(US)最常影响尿道的前段,具体来说就是球部,男性发病率很高。开放式尿道成形术是金标准治疗方法。然而,尿道狭窄复发(SR)仍然是当前令人担忧的问题。本综述旨在提供有关球部 US 尿道成形手术技术和 SR 预后因素的最新文献摘要,并对不同方法进行比较。对于较短的狭窄,切除和原位吻合术(EPA)是首选,成功率超过 90%。对于较长的狭窄(>2-3 厘米),通常需要采用替代技术。颊粘膜移植(BMG)仍是首选,因为它符合理想的特征,而且移植部位没有明显差异。尿道狭窄的长度、尿道成形术后的时间以及之前尿道介入治疗的次数是导致失败的风险因素。此外,外科医生的经验也会影响技术选择和未来结果。与 EPA 相比,替代技术的 SR 率更高,这一点似乎已达成共识,但这似乎受狭窄长度的影响,前者的狭窄长度通常更长。此外,有一种趋势倾向于采用内窥镜治疗 SR,但对于长而复杂的复发,则应使用移植物。总之,目前有多种尿道成形术可供选择,必须根据狭窄特点、患者病史和外科医生的经验进行个体化选择。目前仍有必要开展设计合理、定义明确的研究并制定随访方案,以便为球部 US 的治疗制定标准化指南。
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引用次数: 0
Adjuvant pembrolizumab prolongs overall survival in renal cell carcinoma at high-risk of recurrence after nephrectomy. Can we do better than this? pembrolizumab可延长肾切除术后高复发风险肾细胞癌患者的总生存期。我们能做得更好吗?
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.06114-7
Chiara Ciccarese, Veronica Mollica, Laura Marandino, Carlotta Palumbo, Riccardo Campi, Daniele Amparore
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引用次数: 0
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Minerva Urology and Nephrology
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