Minerva Urology and Nephrology最新文献

Background: Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms.

Methods: An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant.

Results: A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users.

Conclusions: Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

Background: Sutureless (SL) techniques have emerged as an alternative to standard renorrhaphy (RR) in robot-assisted partial nephrectomy (RAPN), aiming to reduce the potential adverse effects of parenchymal suturing on renal function, especially in off-clamp procedures. The aim of this article is to compare perioperative, functional, and oncological outcomes of sutureless versus renorrhaphy-based off-clamp RAPN in a matched cohort.

Methods: Between June 2020 and March 2024, 410 off-clamp RAPN were included in the UroCCR database. A 2:1 propensity score matching was performed based on the R.E.N.A.L. nephrometry score for comparison of SL and RR groups. The primary endpoint was trifecta achievement (negative surgical margins, no major complications (Clavien-Dindo ≥III), and preservation of ≥90% of preoperative eGFR at first follow-up).

Results: Of 410 off-clamp RAPN, 112 were sutureless and 298 with renorrhaphy. After matching, 112 SL and 224 RR cases were included. Trifecta achievement was superior in the SL group (66.1% vs. 43.3%, P<0.001), mainly due to early renal function recovery. SL patients had reduced blood loss (103 vs. 344 mL, P<0.001), shorter operative time (145 vs. 176 min, P=0.001), and fewer intraoperative complications (0.9% vs. 5.4%, P=0.04). Postoperative morbidity, long-term renal function, and oncological outcomes, including margin status, recurrence and survival, were comparable between groups.

Conclusions: In selected off-clamp RAPN cases, the omission of parenchymal and capsular renorrhaphy appears to be a safe and effective strategy that may enhance early functional outcomes and reduce operative time, without increasing perioperative morbidity or compromising oncological safety.

Background: The aim of the article is to assess perioperative and oncological features of patients with clinically positive lymph nodes treated with RARC wit intracorporeal urinary diversion in a large contemporary cohort.

Methods: Consecutive patients treated from January 2016 to January 2025 with RARC, lymph node dissection (LND) and intracorporeal reconfiguration for cT1-3 N0-N1 M0 BCa were included. Follow-up schedule included blood analysis and CT scan performed three months after surgery, then every 6 months from the first to the third postoperative year, followed by annual imaging.

Results: Overall, 324 patients treated with RARC + LND were included. Of these, the 19% was female. The median age was 69 (61-75) years while the median CCI was 3 (2-4). In terms of intraoperative features, no significant differences were recorded with a median operative time was 366 (317-396) vs. 377 (312-442) minutes while an extended LND template was performed in the 39 vs. 49% of cases in the cN0 and cN1 groups, respectively (P=0.015). Overall postoperative complications occurred in the 28% of patients and the rate of major complications was not different between the two groups (9.1 vs. 13%, P=0.9). After a median follow-up of 38 (24-45) months, disease free survival was 69 vs. 34% with a median time to recurrence of 12 vs. 9 months in the cN0 and cN1 groups (P=0.05 and P=0.04, respectively). In terms of survival analyses, the cN1 groups was associated with significantly lower rates of CSS (79 vs. 40.2%, P=0.001), and OS (65 vs. 33%, P=0.001, respectively).

Conclusions: In a cohort of cN1 patients, RARC shows worthy oncological outcomes with disease recurrence and cancer-specific mortality rates consistent to open surgical series and no evidence of atypical recurrences.

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.