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Preoperative double J stent indwelling contributes to recurrent stricture in patients after ureteral reconstruction surgery. 输尿管重建手术后患者术前留置双 J 支架会导致狭窄复发。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-04-01 Epub Date: 2024-02-29 DOI: 10.23736/S2724-6051.24.05761-6
Wei Zuo, Xinfei Li, Zihao Tao, Zhihua Li, Kunlin Yang, Qi Tang, Hongjian Zhu, Peng Zhang, Bing Wang, Yaming Gu, Yingzhi Diao, Liqun Zhou, Xuesong Li
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引用次数: 0
Thermal ablation for T1b renal cancer: an "I wish I could, but I cannot?" 热消融治疗 T1b 肾癌:"我希望我能,但我不能?
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05842-7
Riccardo Bertolo, Daniele Amparore, Stijn Muselaers, Michele Marchioni, Zhenjie Wu, Riccardo Campi, Alessandro Antonelli
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引用次数: 0
The safety and efficacy of Sotn ureteroscopy for renal and upper ureteral calculi: a prospective multicenter randomized controlled trial. Sotn输尿管镜检查治疗肾结石和输尿管上段结石的安全性和有效性:一项前瞻性多中心随机对照试验。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05595-2
Zhenlang Guo, Zhichao Wang, Xiangtao Weng, Yanquan Tang, Deneng Wu, Fan Cheng, Bin Chen, Huilong Tang, Jinsheng Cui, Chiming Gu, Qianming Zou, Yuan Li, Shu Gan, Songtao Xiang, Shusheng Wang

Background: Sotn ureteroscopy is a new lithotripsy procedure developed on the basis of ureteroscopy and includes a rigid ureteral access sheath, standard mirror, lithotripsy mirror, and Sotn perfusion aspirator. Thus, we performed a prospective multicenter randomized controlled trial comparing the safety and efficacy of Sotn ureteroscopy in the treatment of renal and upper ureteral calculi.

Methods: In this study, 224 patients with renal and upper ureteral calculi were randomly divided equally into study and control groups from March 2018 to March 2022. All the patients were approved by the hospital ethics committee (proof number: ZF-2018-164-01 and ZF-2018-165-01) of the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and month after treatment and operation duration. The secondary outcome was postoperative complication rate.

Results: In total, for upper ureteral calculi, the SFR of 1 day after operation of the Sotn ureteroscopy group was significantly higher than the rigid ureteroscopy group (83.6% vs. 60%, P=0.006). Moreover, operative time (33.7±1.80 vs. 52.9±2.73 min, P<0.005) of the Sotn ureteroscopy group was significantly lower than the rigid ureteroscopy group. Additionally, the SFR of 1 day after operation and operative time for the study group (Sotn ureteroscopy combined with flexible ureteroscopy) and the control group (flexible ureteroscopy alone) were 63.2% and 36.8% (P=0.005), 65.6±4.06 and 80.3±4.91 (P=0.023), respectively. However, there were no significant differences in the SFR of 1 month after operation, success rate of ureteral access sheath placement, and postoperative complications between the two groups (P>0.05). In subgroups with stone diameters ≥1.5 cm and stone CT values ≥1000 Hounsfield units, Sotn ureteroscopy showed more advantages in terms of the SFR of 1 day after operation. Importantly, complications such as ureteral injury, sepsis, fever, and severe hematuria were not statistically different between the two groups (P>0.05).

Conclusions: For renal and upper ureteral calculi, Sotn ureteroscopy has the advantage of a higher SFR of 1 day after the operation and a shorter operative time, suggesting that the Sotn ureteroscopy may have further potential applications in clinics.

背景:Sotn输尿管镜检查是在输尿管镜检查基础上发展起来的一种新型碎石术,包括硬质输尿管入路鞘、标准镜、碎石镜和Sotn灌注吸引器。因此,我们进行了一项前瞻性多中心随机对照试验,比较 Sotn 输尿管镜治疗肾结石和输尿管上段结石的安全性和有效性:在这项研究中,从2018年3月至2022年3月,将224例肾结石和输尿管上段结石患者随机平均分为研究组和对照组。所有患者均经中国广州中医药大学第二附属医院医院伦理委员会批准(证明编号:ZF-2018-164-01、ZF-2018-165-01)。主要研究结果为治疗后第1天和第1个月通过计算机断层扫描评估的无结石率(SFR)以及手术持续时间。次要结果为术后并发症发生率:总之,对于输尿管上段结石,索氏输尿管镜组术后 1 天的无结石率(SFR)明显高于硬性输尿管镜组(83.6% 对 60%,P=0.006)。此外,手术时间(33.7±1.80 vs. 52.9±2.73分钟,P0.05)。在结石直径≥1.5 cm、结石 CT 值≥1000 Hounsfield 单位的亚组中,Sotn 输尿管镜在术后 1 天的 SFR 方面显示出更大的优势。重要的是,输尿管损伤、败血症、发热和严重血尿等并发症在两组间无统计学差异(P>0.05):结论:对于肾结石和输尿管上段结石,Sotn输尿管镜具有术后1天SFR较高和手术时间较短的优势,这表明Sotn输尿管镜可能在临床上有进一步应用的潜力。
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引用次数: 0
Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project). 肥胖患者的微创经腹腔肾部分切除术与根治性肾切除术:大型透视当代系列研究的围手术期和长期功能性结果(RECORd2 项目)。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05692-1
Luca Lambertini, Andrea Mari, Alessandro Sandulli, Daniele Amparore, Alessandro Antonelli, Maurizio Barale, Pierluigi Bove, Eugenio Brunocilla, Umberto Capitanio, Luigi F DA Pozzo, Fabrizio DI Maida, Antonio Andrea Grosso, Cristian Fiori, Paolo Gontero, Vincenzo Li Marzi, Riccardo Campi, Nicola Longo, Michele Marchioni, Emanuele Montanari, Francesco Montorsi, Francesco Porpiglia, Angelo Porreca, Riccardo Schiavina, Claudio Simeone, Salvatore Siracusano, Carlo Terrone, Vincenzo Ficarra, Andrea Minervini

Background: The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma.

Methods: Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m2, clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined.

Results: Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01).

Conclusions: In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.

研究背景本研究的目的是评估腹腔镜(LPN)和机器人辅助肾部分切除术(RAPN)与腹腔镜肾根治术(LRN)相比,对确诊为肾细胞癌的肥胖患者的围手术期和长期功能结果:收集了意大利肾皮质肿瘤保守根治术(RECORD 2 项目)4325 名连续患者的临床数据。只有体质指数(BMI)≥30 kg/m2、临床肾肿瘤为 T1 且术前估计肾小球滤过率(eGFR)≥60 mL/min 的经腹膜 LPN、RAPN 或 LRN 治疗患者才被纳入。对围手术期和长期功能结果进行了研究:共纳入 388 例患者,其中 123 例(31.7%)、120 例(30.9%)和 145 例(37.4%)患者分别接受了 LRN、LPN 和 RAPN 治疗。术前特征无明显差异。总体而言,各组的术中和术后并发症发生率相当。与 LPN 和 RAPN 相比,LRN 组的急性肾损伤(AKI)发生率明显增加(40.6% vs. 15.3% vs. 7.6%,P=0.001)。与LPN和RAPN相比,腹腔镜RN患者在60个月的随访评估中肾功能下降的比例明显更高。30.1%接受腹腔镜RN治疗的患者肾功能明显下降,而接受LPN和RAPN治疗的患者分别为16.7%和10.3%(P=0.01):在肥胖患者中,LPN 和 RAPN 的并发症发生率相当,肾功能保存率高于 LRN。这些研究结果凸显了在肥胖患者中,微创肾盂成形术比根治性手术的潜在优势。
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引用次数: 0
Single-layer versus double-layer renorrhaphy technique during robot-assisted partial nephrectomy: impact on perioperative outcomes, complications, and functional outcomes. 机器人辅助肾部分切除术中的单层肾切除术与双层肾切除术:对围手术期结果、并发症和功能性结果的影响。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05700-8
Riccardo Bertolo, Francesco Ditonno, Alessandro Veccia, Vincenzo DE Marco, Filippo Migliorini, Antonio B Porcaro, Riccardo Rizzetto, Maria A Cerruto, Riccardo Autorino, Alessandro Antonelli

Background: The debate between single-layer and double-layer renorrhaphy techniques during robot-assisted partial nephrectomy (RPN) represents a subject of ongoing discourse. The present analysis aims to compare the perioperative and functional outcomes of single- versus double-layer renorrhaphy during RPN.

Methods: Study data were retrieved from prospectively maintained institutional database (Jan2018-May2023). Study population was divided into two groups according to the number of layers (single vs. double) used for renorrhaphy. Baseline and perioperative data were compared. Postoperative surgical outcomes included type and grade of complications as classified according to Clavien-Dindo. Serum creatinine and estimated glomerular filtration rate were used to measure renal function.

Results: Three hundred seventeen patients were included in the analysis: 209 received single-layer closure, while 108 underwent double-layer renorrhaphy. Baseline characteristics were not statistically different between the groups. Comparable low incidence of intraoperative complications was observed between the cohorts (P=0.5). No difference was found in terms of mean (95% CI) Hb level drop postoperation (single-layer: 1.6 g/dL [1.5-1.7] vs. double-layer: 1.4 g/dL [1.2-1.5], P=0.3). Overall and "major" rate of complications were 16% and 3%, respectively, with no difference observed in terms of any grade (P=0.2) and major complications (P=0.7). Postoperative renal function was not statistically different between the treatment modalities. At logistic regression analyses, no difference in terms of probability of overall (OR 0.82 [0.63-1.88]) and major (OR 0.94 [0.77-6.44]) complications for the number of suture layers was observed.

Conclusions: Single-layer and double-layer renorrhaphy demonstrated comparable perioperative and functional outcomes within the setting of the present study.

背景:机器人辅助肾部分切除术(RPN)中单层肾切除术和双层肾切除术之间的争论是一个持续的话题。本分析旨在比较机器人辅助肾部分切除术中单层肾切除术与双层肾切除术的围手术期和功能结果:研究数据取自前瞻性维护的机构数据库(2018 年 1 月至 2023 年 5 月)。根据肾盂成形术的层数(单层与双层)将研究对象分为两组。比较了基线和围手术期数据。术后手术结果包括根据 Clavien-Dindo 分类的并发症类型和等级。血清肌酐和估计肾小球滤过率用于测量肾功能:共有 317 名患者参与分析:其中 209 人接受了单层肾盂闭合术,108 人接受了双层肾盂成形术。两组患者的基线特征无统计学差异。两组患者的术中并发症发生率相当低(P=0.5)。在术后平均(95% CI)血红蛋白水平下降方面没有发现差异(单层:1.6 g/dL [1.6 g/dL] ;双层:1.6 g/dL [1.6 g/dL] ):单层:1.6 g/dL [1.5-1.7] vs. 双层:1.4 g/dL [1.5-1.7] :1.4 g/dL [1.2-1.5],P=0.3)。总并发症发生率和 "主要 "并发症发生率分别为16%和3%,在任何级别并发症(P=0.2)和主要并发症(P=0.7)方面未观察到差异。两种治疗方法的术后肾功能无统计学差异。在逻辑回归分析中,未观察到缝合层数对总体(OR 0.82 [0.63-1.88] )和主要(OR 0.94 [0.77-6.44])并发症发生概率的影响:结论:在本研究中,单层和双层肾造瘘术的围手术期和功能效果相当。
{"title":"Single-layer versus double-layer renorrhaphy technique during robot-assisted partial nephrectomy: impact on perioperative outcomes, complications, and functional outcomes.","authors":"Riccardo Bertolo, Francesco Ditonno, Alessandro Veccia, Vincenzo DE Marco, Filippo Migliorini, Antonio B Porcaro, Riccardo Rizzetto, Maria A Cerruto, Riccardo Autorino, Alessandro Antonelli","doi":"10.23736/S2724-6051.24.05700-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05700-8","url":null,"abstract":"<p><strong>Background: </strong>The debate between single-layer and double-layer renorrhaphy techniques during robot-assisted partial nephrectomy (RPN) represents a subject of ongoing discourse. The present analysis aims to compare the perioperative and functional outcomes of single- versus double-layer renorrhaphy during RPN.</p><p><strong>Methods: </strong>Study data were retrieved from prospectively maintained institutional database (Jan2018-May2023). Study population was divided into two groups according to the number of layers (single vs. double) used for renorrhaphy. Baseline and perioperative data were compared. Postoperative surgical outcomes included type and grade of complications as classified according to Clavien-Dindo. Serum creatinine and estimated glomerular filtration rate were used to measure renal function.</p><p><strong>Results: </strong>Three hundred seventeen patients were included in the analysis: 209 received single-layer closure, while 108 underwent double-layer renorrhaphy. Baseline characteristics were not statistically different between the groups. Comparable low incidence of intraoperative complications was observed between the cohorts (P=0.5). No difference was found in terms of mean (95% CI) Hb level drop postoperation (single-layer: 1.6 g/dL [1.5-1.7] vs. double-layer: 1.4 g/dL [1.2-1.5], P=0.3). Overall and \"major\" rate of complications were 16% and 3%, respectively, with no difference observed in terms of any grade (P=0.2) and major complications (P=0.7). Postoperative renal function was not statistically different between the treatment modalities. At logistic regression analyses, no difference in terms of probability of overall (OR 0.82 [0.63-1.88]) and major (OR 0.94 [0.77-6.44]) complications for the number of suture layers was observed.</p><p><strong>Conclusions: </strong>Single-layer and double-layer renorrhaphy demonstrated comparable perioperative and functional outcomes within the setting of the present study.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923769","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
Feasibility and safety of dual-console telesurgery with the KangDuo Surgical Robot-1500 System using fifth-generation and wired networks: an animal experiment and sea-spanning clinical study. 使用第五代和有线网络的康多手术机器人-1500系统双控制台远程手术的可行性和安全性:动物实验和跨海临床研究。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05808-7
Liqing Xu, Cheng Shen, Xinfei Li, Fangzhou Zhao, Wei Huang, Kunlin Yang, Peng Zhang, Yicong DU, Shubo Fan, Liang Cui, Liqun Zhou, Xuesong Li

Background: To evaluate the feasibility and safety of dual-console telesurgery with the new KangDuo system in an animal experiment and clinical study.

Methods: Six canine models were performed radical prostatectomy with dual-console KanDuo surgical robot-1500 (KD-SR-1500-RARP). The perioperative outcomes, physical and mental workload of the surgeon were collected. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with NASA-TLX. After conducting animal experiments to verify safety of dual-console KD-SR-1500-RARP, we conducted the clinical trial using 5G and wired networks.

Results: In the animal experiment, all surgeries were performed successfully. The operative time was 80.2±32.1 min. The docking time was 2.4±0.5 min. The console time was 49.7±25.3 min. There were no perioperative complications or equipment related adverse events. All dogs can micturate after catheter removal at one week postoperatively. The mental workload was at a low level (a scale ranging from 0 to 60), which scored 15.7±6.9. Among the eight recorded muscles, the fatigue degree of the right radial flexor and left biceps was the highest two (iEMG, resection, 299.8±344 uV, 109.9±16.9 uV; suture, 849.4±1252.5 uV, 423.1±621.3 uV, respectively). In the clinical study, the console time was 136 min. The mean latency time was ≤200 ms. The data pocket loss was <1%. The operation was successfully completed without malfunctions occurring throughout the entire process.

Conclusions: Dual-console telesurgery with the KD-SR-1500 system was shown to be feasible and safe in radical prostatectomy using 5G and wired networks.

背景:在动物实验和临床研究中评估使用新型康导系统进行双控制台远程手术的可行性和安全性:在动物实验和临床研究中评估使用新型康多系统进行双控制台远程手术的可行性和安全性:方法:使用双控制台KanDuo手术机器人-1500(KD-SR-1500-RARP)对6只犬模型进行前列腺癌根治术。收集了围手术期的结果、外科医生的体力和脑力工作量。体力工作量通过表面肌电图进行评估。精神工作量通过 NASA-TLX 进行评估。在进行动物实验验证双控制台 KD-SR-1500-RARP 的安全性后,我们使用 5G 和有线网络进行了临床试验:结果:在动物实验中,所有手术均顺利完成。手术时间为(80.2±32.1)分钟。对接时间为 2.4±0.5 分钟。控制台时间为 49.7±25.3 分钟。没有围手术期并发症或与设备相关的不良事件。术后一周拔除导管后,所有狗都能吸吮。精神工作量处于较低水平(0 到 60 分),为(15.7±6.9)分。在记录的八块肌肉中,右桡侧屈肌和左肱二头肌的疲劳程度最高(iEMG,切除,299.8±344 uV,109.9±16.9 uV;缝合,849.4±1252.5 uV,423.1±621.3 uV)。在临床研究中,控制台时间为 136 分钟。平均潜伏时间≤200 ms。数据袋损失为结论:使用 KD-SR-1500 系统的双控制台远程手术在使用 5G 和有线网络进行根治性前列腺切除术中是可行且安全的。
{"title":"Feasibility and safety of dual-console telesurgery with the KangDuo Surgical Robot-1500 System using fifth-generation and wired networks: an animal experiment and sea-spanning clinical study.","authors":"Liqing Xu, Cheng Shen, Xinfei Li, Fangzhou Zhao, Wei Huang, Kunlin Yang, Peng Zhang, Yicong DU, Shubo Fan, Liang Cui, Liqun Zhou, Xuesong Li","doi":"10.23736/S2724-6051.24.05808-7","DOIUrl":"10.23736/S2724-6051.24.05808-7","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the feasibility and safety of dual-console telesurgery with the new KangDuo system in an animal experiment and clinical study.</p><p><strong>Methods: </strong>Six canine models were performed radical prostatectomy with dual-console KanDuo surgical robot-1500 (KD-SR-1500-RARP). The perioperative outcomes, physical and mental workload of the surgeon were collected. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with NASA-TLX. After conducting animal experiments to verify safety of dual-console KD-SR-1500-RARP, we conducted the clinical trial using 5G and wired networks.</p><p><strong>Results: </strong>In the animal experiment, all surgeries were performed successfully. The operative time was 80.2±32.1 min. The docking time was 2.4±0.5 min. The console time was 49.7±25.3 min. There were no perioperative complications or equipment related adverse events. All dogs can micturate after catheter removal at one week postoperatively. The mental workload was at a low level (a scale ranging from 0 to 60), which scored 15.7±6.9. Among the eight recorded muscles, the fatigue degree of the right radial flexor and left biceps was the highest two (iEMG, resection, 299.8±344 uV, 109.9±16.9 uV; suture, 849.4±1252.5 uV, 423.1±621.3 uV, respectively). In the clinical study, the console time was 136 min. The mean latency time was ≤200 ms. The data pocket loss was <1%. The operation was successfully completed without malfunctions occurring throughout the entire process.</p><p><strong>Conclusions: </strong>Dual-console telesurgery with the KD-SR-1500 system was shown to be feasible and safe in radical prostatectomy using 5G and wired networks.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923840","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
Mirrored port placement for robotic radical prostatectomy with the Hugo RAS™ System: initial experience. 使用 Hugo RAS™ 系统进行机器人根治性前列腺切除术的镜像端口放置:初步经验。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2024-01-25 DOI: 10.23736/S2724-6051.23.05597-0
Alessandro Veccia, Sarah Malandra, Francesca Montanaro, Greta Pettenuzzo, Vincenzo DE Marco, Alessandro Antonelli

Herein we report our first experience with Hugo RAS™ proposing a mirrored approach with different angles. Two experienced surgeons performed 10 prostatectomies (six with the standard approach and four with the mirrored one). The median docking time was 12.5 (IQR 12-15) vs. 13.5 (IQR 12-20) minutes. The median console time was 229 (174-245) vs. 172 (IQR 164-191) minutes. None of the procedures required conversion to open surgery. The study proves the versatility of the Hugo RAS™ to perform robot-assisted radical prostatectomy with two different docking angles and might be useful for novel users to adopt the preferred approach.

在此,我们报告了 Hugo RAS™ 首次采用不同角度镜像方法的经验。两名经验丰富的外科医生进行了 10 例前列腺切除术(6 例采用标准方法,4 例采用镜像方法)。对接时间中位数为 12.5 分钟(IQR 12-15 分钟),而镜像法为 13.5 分钟(IQR 12-20 分钟)。控制台时间的中位数为 229 (174-245) 分钟 vs. 172 (IQR 164-191) 分钟。没有一项手术需要转为开放手术。这项研究证明了Hugo RAS™在两种不同对接角度下进行机器人辅助前列腺癌根治术的多功能性,可能有助于新用户采用首选方法。
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引用次数: 0
Stone centers: a national survey on surgical techniques performed in Italy. 结石中心:意大利全国手术技术调查。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05778-1
Stefano DI Bari, Giuseppe Stella, Mattia Benedetti, Michele Talso, Alberto Saita, Carlo Zaraca, Riccardo Ferrari, Pietro Acquati, Riccardo Lombardo, Stefania Ferretti, Stefano Puliatti, Luigi Cormio, Salvatore Micali

Background: Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones.

Methods: A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL.

Results: Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center.

Conclusions: Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.

背景:复发性复杂结石病可被视为一种具有挑战性的疾病。2018 年,SIU(意大利泌尿外科学会)结石小组为自己设定了一个目标,即建立一个能够持续管理泌尿系结石病理的中心(名为结石中心)的最低要求。在本研究中,我们介绍了2019年开展的一项试点调查的结果,目的是绘制意大利泌尿外科中心处理尿路结石情况的地图:本研究共联系了260个国家的泌尿外科部门,这些部门负责处理泌尿系结石手术。向每个中心发放了一份调查表,以确定每年接受尿路结石治疗的患者人数和手术数量:1) 体外冲击波碎石 ESWL;2) 输尿管镜 URS;3) 逆行肾内手术 RIRS;4) 经皮肾镜 PCNL:在所联系的 260 个中心中,有 188 个完成了调查。结果差异很大,约 37% 的中心没有碎石机,46% 有碎石机的中心每年进行的治疗少于 100 次。在内窥镜手术方面,超过80%的受访中心开展了URS或RIRS手术;但在经皮碎石方面,这些数字大幅下降;33%的受访中心未开展PCNL手术,而在开展PCNL手术的中心中,18%的中心开展该手术的时间不足5年:结论:我们的调查显示,全国尿路结石的治疗方法各不相同。我们的目标是建立全国性的范例,以确定结石中心,让复杂性泌尿系统结石患者能够找到一个由专业人员组成的网络,并拥有适合其病理治疗的适当武器装备。
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引用次数: 0
Enhancing continence post holmium laser enucleation of the prostate: assessment of novel technique through randomized clinical trial. 增强前列腺钬激光去核术后的排尿功能:通过随机临床试验评估新技术。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05478-8
Ahmed M Elshal, Mostafa Ghazy, Fady K Ghobrial

Background: Transient urinary incontinence (UI) is distressing event following holmium laser enucleation of the prostate (HoLEP). Novel technique namely, veil sparing HoLEP (VS-HoLEP), was proposed to improve early continence outcome. In this trial (NCT03494049), VS-HoLEP was compared to standard HoLEP (St-HoLEP).

Methods: VS-HoLEP entails early apical separation with sparing of ventral apical mucosal veil proximal to the verumontanum. Eligible symptomatic BPH patients were randomly allocated to St-HoLEP (91) and VS-HoLEP (89). The primary outcome was UI as depicted by one-hour pad test at one month postoperatively. Other outcome measures include all perioperative parameters, complications, and urinary outcome measures at different follow-up points.

Results: Median preoperative prostate size was 138 (50:282) and 128 (50:228) mL in St-HoLEP and VS-HoLEP groups respectively. At one month the number of patients with positive one-hour pad test was 21 (23.1%) and 10 (11.4%) in St-HoLEP and VS-HoLEP groups respectively (P 0.047). The difference was significantly in favor of VS-HoLEP considering the number of patients reporting UI, the number of patients with positive one-hour pad test as well as the grade of UI reported at one and 4 months. The difference was not statistically significant at 12 months. The median time to patients' reported continence was 8 (1-52) and 1.5 (1-52) weeks in St-HoLEP and VS-HoLEP groups respectively (P≤0.005). The technique independently predicted positive one-hour pad test at one and four months respectively. At twelve months presence of DM (diabetes mellitus) and more percent PSA reduction independently predicted positive one-hour pad test.

Conclusions: Veil sparing HoLEP enhances significantly early postoperative urine continence both subjectively and objectively. Optimization of the surgical technique could cut short the number of leaking patients and reduce the degree as well as the duration of transient postoperative urine leak.

背景:一过性尿失禁(UI)是前列腺钬激光去核术(HoLEP)后出现的令人痛苦的症状。为改善早期尿失禁的治疗效果,有人提出了一种新的技术,即前列腺钬激光剜除术(VS-HoLEP)。在这项试验(NCT03494049)中,VS-HoLEP 与标准 HoLEP(St-HoLEP)进行了比较:方法:VS-HoLEP需要进行早期根尖分离,同时保留瓣膜近端腹侧根尖粘膜纱。符合条件的有症状良性前列腺增生患者被随机分配到 St-HoLEP (91 例)和 VS-HoLEP (89 例)。主要结果是术后一个月的一小时尿垫测试显示的UI。其他结果指标包括所有围手术期参数、并发症和不同随访点的排尿结果指标:结果:St-HoLEP组和VS-HoLEP组术前前列腺大小中位数分别为138(50:282)毫升和128(50:228)毫升。一个月后,St-HoLEP 组和 VS-HoLEP 组中一小时尿垫试验呈阳性的患者人数分别为 21(23.1%)和 10(11.4%)(P 0.047)。考虑到报告尿失禁的患者人数、一小时尿垫试验呈阳性的患者人数以及在 1 个月和 4 个月时报告的尿失禁等级,差异明显有利于 VS-HoLEP 组。在 12 个月时,差异无统计学意义。St-HoLEP组和VS-HoLEP组患者报告尿失禁的中位时间分别为8周(1-52周)和1.5周(1-52周)(P≤0.005)。该技术可分别独立预测一小时和四个月后的垫试验阳性率。在12个月时,DM(糖尿病)的存在和PSA减少的百分比越多,预测一小时垫试验的阳性率越高:结论:从主观和客观角度来看,疏通静脉的HoLEP都能显著提高术后早期尿失禁率。优化手术技术可减少漏尿患者的数量,降低术后一过性漏尿的程度并缩短其持续时间。
{"title":"Enhancing continence post holmium laser enucleation of the prostate: assessment of novel technique through randomized clinical trial.","authors":"Ahmed M Elshal, Mostafa Ghazy, Fady K Ghobrial","doi":"10.23736/S2724-6051.24.05478-8","DOIUrl":"10.23736/S2724-6051.24.05478-8","url":null,"abstract":"<p><strong>Background: </strong>Transient urinary incontinence (UI) is distressing event following holmium laser enucleation of the prostate (HoLEP). Novel technique namely, veil sparing HoLEP (VS-HoLEP), was proposed to improve early continence outcome. In this trial (NCT03494049), VS-HoLEP was compared to standard HoLEP (St-HoLEP).</p><p><strong>Methods: </strong>VS-HoLEP entails early apical separation with sparing of ventral apical mucosal veil proximal to the verumontanum. Eligible symptomatic BPH patients were randomly allocated to St-HoLEP (91) and VS-HoLEP (89). The primary outcome was UI as depicted by one-hour pad test at one month postoperatively. Other outcome measures include all perioperative parameters, complications, and urinary outcome measures at different follow-up points.</p><p><strong>Results: </strong>Median preoperative prostate size was 138 (50:282) and 128 (50:228) mL in St-HoLEP and VS-HoLEP groups respectively. At one month the number of patients with positive one-hour pad test was 21 (23.1%) and 10 (11.4%) in St-HoLEP and VS-HoLEP groups respectively (P 0.047). The difference was significantly in favor of VS-HoLEP considering the number of patients reporting UI, the number of patients with positive one-hour pad test as well as the grade of UI reported at one and 4 months. The difference was not statistically significant at 12 months. The median time to patients' reported continence was 8 (1-52) and 1.5 (1-52) weeks in St-HoLEP and VS-HoLEP groups respectively (P≤0.005). The technique independently predicted positive one-hour pad test at one and four months respectively. At twelve months presence of DM (diabetes mellitus) and more percent PSA reduction independently predicted positive one-hour pad test.</p><p><strong>Conclusions: </strong>Veil sparing HoLEP enhances significantly early postoperative urine continence both subjectively and objectively. Optimization of the surgical technique could cut short the number of leaking patients and reduce the degree as well as the duration of transient postoperative urine leak.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923836","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
Fluorescence-guided laparoscopic partial adrenalectomy in adrenal medullary hyperplasia mimicking pheochromocytoma. 荧光引导下腹腔镜肾上腺部分切除术治疗嗜铬细胞瘤样肾上腺髓质增生。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-04-01 Epub Date: 2023-11-21 DOI: 10.23736/S2724-6051.23.05607-0
Ali Y Ozercan, Ozer Guzel, Narin N Imga, Oya Topaloglu, Cevdet Aydin, Aydan Kilicarslan, Nahide B Talay, Altug Tuncel
{"title":"Fluorescence-guided laparoscopic partial adrenalectomy in adrenal medullary hyperplasia mimicking pheochromocytoma.","authors":"Ali Y Ozercan, Ozer Guzel, Narin N Imga, Oya Topaloglu, Cevdet Aydin, Aydan Kilicarslan, Nahide B Talay, Altug Tuncel","doi":"10.23736/S2724-6051.23.05607-0","DOIUrl":"10.23736/S2724-6051.23.05607-0","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177971","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
期刊
Minerva Urology and Nephrology
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