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Prostate cancer diagnostic pathway in men with lower urinary tract symptoms or performing opportunistic screening: The Italian Society of Urology (SIU) position paper. 有下尿路症状或进行机会性筛查的男性的前列腺癌诊断路径:意大利泌尿外科学会(SIU)立场文件。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.06118-4
Vincenzo Ficarra, Riccardo Bartoletti, Marco Borghesi, Cosimo DE Nunzio, Ugo G Falagario, Giorgio Gandaglia, Gianluca Giannarini, Andrea Minervini, Vincenzo Mirone, Francesco Porpiglia, Bernardo Rocco, Andrea Salonia, Paolo Verze, Giuseppe Carrieri

Background: Voluntary PCa screening frequently results in excessive use of unnecessary diagnostic tests and an increasing risk of detection of indolent PCa and unaffordable costs for the various national health systems. In this scenario, the Italian Society of Urology (Società Italiana di Urologia, SIU) proposes an organized flow chart guiding physicians to improve early diagnosis of significant PCa avoiding unnecessary diagnostic tests and prostate biopsy.

Methods: According to available evidence and international guidelines [i.e., European Association of Urology (EAU), American Association of Urology (AUA) and National Comprehensive Cancer Network (NCCN)] on PCa, a Panel of expert urologists selected by Italian Society of Urology (SIU, Società Italiana di Urologia) proposed some indications to develop a stepwise diagnostic pathway based on the diagnostic tests mainly used in the clinical practice. The final document was submitted to six expert urologists for external revision and approval. Moreover, the final document was shared with patient advocacy groups.

Results: In voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care.

Conclusions: Scientific societies must support the use of shared diagnostic pathway with the aim to increase the early detection of significant PCa reducing a delayed diagnosis of advanced PCa. Moreover, a shared diagnostic pathway can reduce the incorrect use of antibiotic, the number of unnecessary laboratory and radiologic examinations as well as of prostate biopsies.

背景:自愿性 PCa 筛查经常会导致不必要的诊断性检查使用过多,并增加检出不典型 PCa 的风险,使各国医疗系统无法承担费用。在这种情况下,意大利泌尿外科学会(Società Italiana di Urologia, SIU)提出了一个有条理的流程图,指导医生提高对重大 PCa 的早期诊断率,避免不必要的诊断检查和前列腺活检:方法:根据现有证据和有关 PCa 的国际指南(即欧洲泌尿外科协会 (EAU)、美国泌尿外科协会 (AUA) 和美国国立综合癌症网络 (NCCN)),由意大利泌尿外科学会 (SIU, Società Italiana di Urologia) 选定的泌尿外科专家组成的专家小组提出了一些适应症,以便根据临床实践中主要使用的诊断测试制定逐步诊断路径。最终文件提交给六位泌尿科专家进行外部修订和批准。此外,还与患者权益组织分享了最终文件:对于 PSA 值升高(>3 纳克/毫升)的自愿男性和无症状患者,专家小组强烈反对在没有尿培养证实尿路感染的情况下使用抗生素。DRE 仍是泌尿科体检的关键部分,有助于泌尿科医生正确解读 PSA 升高,并在出现可疑 PCa 时优先执行多参数磁共振成像 (mpMRI)。对于 mpMRI 呈阴性、临床怀疑 PSA 较低的男性(PSA 密度< 0.20 ng/mL/cc、DRE 结果阴性、无家族史),可对其进行进一步监测。对于 mpMRI 阴性且 PCa 风险较高的男性(家族史、可疑 DRE、PSAD>0.20 ng/mL/cc 或 PSA>20 ng/mL),应考虑进行系统性前列腺活检。PI-RADS 4-5 级病变是前列腺活检的强烈指征,而 PI-RADS 3 级病变则应根据 PSAD 值进一步分层,并在 PSAD 超过 0.20 时进行前列腺活检。应大力考虑对放射医师和前列腺 mpMRI 中心进行认证、鉴定和质量审核。还应在诊断路径中评估 MRI 检查的可及性和/或候诊名单。专家组建议将经会阴或经直肠靶向加系统活检作为标准治疗:科学协会必须支持使用共享诊断路径,以提高重大 PCa 的早期发现率,减少晚期 PCa 的延迟诊断。此外,共享诊断路径还能减少抗生素的错误使用、不必要的实验室和放射检查以及前列腺活检的次数。
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引用次数: 0
Balancing oncological control and renal function: the emerging role of robotic distal ureterectomy in upper tract urothelial carcinoma. 兼顾肿瘤控制和肾功能:机器人远端尿道切除术在上尿路上皮癌中的新作用。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.06159-7
Federico Piramide, Fabrizio DI Maida, Carlo A Bravi, Filippo Turri, Iulia Andras, Edward Lambert, Christoph Würnschimmel, Mike Wenzel, Marcio Covas Moschovas, Ahmed Eraky, Danny D Carbin Joseph, Nikolaos Liakos, Marco Paciotti, Gabriele Sorce, Stefano Tappero, Paolo Dell'oglio, Ruben DE Groote, Alessandro Larcher
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引用次数: 0
Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates. 美国成年人输尿管盆腔梗阻的原发性肾盂成形术,带或不带双 J 型留置输尿管支架。保险理赔数据包括当代移除时间趋势、围手术期并发症、医疗费用和再次介入率。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.05834-8
Francesco Del Giudice, Deok Hyun Han, Anas Tresh, Shufeng Li, Satvir Basran, Vincenzo Asero, Carlo Maria Scornajenghi, Dalila Carino, Roberta Corvino, Matteo Ferro, Felice Crocetto, Benjamin Pradere, Andrea Gallioli, Wojciech Krajewski, Łukasz Nowak, Jan Łaszkiewicz, Tomasz Szydełko, Bernardo Rocco, Maria Chiara Sighinolfi, Ettore De Berardinis, Jonathan Kam, Rajesh Nair, Benjamin I Chung

Background: Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal.

Methods: Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed.

Results: Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal.

Conclusions: Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

背景:我们利用一个基于人口的大型数据集,主要目的是比较输尿管盆腔交界处梗阻(UPJO)患者接受支架与非支架肾盂成形术的术后并发症、医疗支出和再次介入率。次要目标是调查影响DJ支架取出时机的因素:方法:使用 Merative™ Marketscan® 数据库对 2007-2021 年间接受初级开放式或微创肾盂成形术治疗的≥18 岁 UPJO 患者进行识别。采用多变量模型研究了双J(DJ)支架置入与肾盂成形术后并发症、住院费用和再次介入率之间的关系,以及围手术期预测因素对DJ支架移除时间的作用。此外,还根据输尿管支架植入时间进行了分组分析:在4872名接受初级肾盂成形术的患者中,4154人(85.3%)植入了DJ支架。术后并发症很少(218 例,4.47%),且与输尿管支架置入无关(几率比 [OR]:0.78,95% 置信区间 [CI]:0.55-1.12)。住院费用的中位数为21,775美元,DJ支架置入可独立增加中位数总额(OR:1.29,95% CI:1.09-1.53)。总体而言,21.18%的患者接受了再次干预,DJ支架置入具有保护作用(OR:0.79,95% CI:0.66-0.96)。较高的夏尔森综合指数、较长的住院时间和开放手术方式是DJ支架取出时间延长的独立预测因素:我们的研究表明,与接受有支架手术的患者相比,接受无支架肾盂成形术的患者确实有更高的二次手术率,但并发症并不高。同时,尽管二次手术率增加,但无支架方法可降低医疗支出。
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引用次数: 0
YAU Renal Cancer spotlight - Hugo RAS platform for robotic partial nephrectomy: more evidence needed. YAU肾癌聚焦--用于机器人肾部分切除术的雨果RAS平台:需要更多证据。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.23736/S2724-6051.24.06113-5
Riccardo Bertolo, Riccardo Campi, Daniele Amparore
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引用次数: 0
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。
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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":"76 5","pages":"618-624"},"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}
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Minerva Urology and Nephrology
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