Canadian Journal of Urology最新文献

Introduction: To determine the prevalence of hypogonadism in men undergoing partial nephrectomy (PN) and whether hypogonadism and frailty are associated with adverse postoperative outcomes.

Materials and methods: We identified men undergoing PN between 2012-2021 using the Merative Marketscan database. Patients were considered to have hypogonadism if diagnosed within 5 years prior to PN. Frailty was determined using the Hospital Frailty Risk Score (HFRS). Length of stay (LOS), complications, ED visits, and inpatient readmissions were compared. Sub-group analysis of men with hypogonadism was performed to determine if testosterone replacement therapy (TRT) improved clinical outcomes.

Results: Among 9,105 men who underwent PN, 809 (8.9%) were hypogonadal prior to PN. Hypogonadal men were significantly more frail compared to eugonadal men (HFRS score: median 6.7, IQR 4.1-10.1 vs. median 5.6, IQR 3.3-8.8, p < 0.001). However, there was no significant difference in LOS following PN nor in 90-day postoperative complications, ED visits, or inpatient readmission between men with and without hypogonadism. However, intermediate- and high-risk frailty were associated with increased risk of 90-day ED visits and 90-day inpatient readmission compared to low-risk patients. Among high-risk men with hypogonadism, TRT was associated with decreased risk of 90-day ED visits (p = 0.04).

Conclusions: Frailty was associated with postoperative outcomes following PN. Hypogonadism was associated with frailty, and treatment of hypogonadal men with TRT was associated with reduction in post-operative risk. These findings suggest a role for frailty assessment, and possibly testosterone screening, in men undergoing PN.

Introduction: Benign prostatic hyperplasia (BPH) is a prevalent condition affecting a significant portion of the male population, leading to secondary lower urinary tract symptoms (LUTS). Alternative therapies such as phytotherapy using Lipidosterolic extract of Serenoa repens (LSESR USPlus) are commonly used. However, the efficacy of LSESr remains controversial due to conflicting data. We sought to determine the effect of a standardized USP-verified Saw Palmetto extract on male LUTS secondary to BPH.

Materials and methods: In this prospective single-arm trial, we investigated the efficacy of a standardized USP-verified Saw Palmetto extract in treating male LUTS secondary to BPH. We utilized the ProudP mobile application for home uroflowmetry and symptom assessment.

Results: Results from 46 patients using 320 mg daily of USP-verified Saw Palmetto extract revealed significant improvements in IPSS and QoL scores at 12 weeks compared to baseline, particularly in patients with moderate symptoms. Uroflowmetry parameters also improved with increased flow rates, primarily in patients with mild symptoms.

Conclusion: Our findings support the efficacy of USP-verified Saw Palmetto extract in alleviating LUTS in men with BPH. Further studies are warranted in larger, diverse cohorts over longer follow up periods.

Introduction: It is unclear whether laterality has prognostic implications for patients with renal cell carcinoma (RCC). Some suggest that left sided tumors may have worse survival outcomes. The purpose of this study is to associate tumor characteristics and clinical outcomes with laterality in patients with RCC.

Materials and methods: Patients with RCC were identified in the National Cancer Database between 2004-2020. Patients were categorized as having either localized, regional or metastatic disease. Time-series charts were generated to demonstrate laterality differences and variance over time. Multivariable Cox proportional hazards regression was utilized to associate laterality with overall survival, stratified by clinical stage. Kaplan-Meier estimates were utilized to visualize survival functions.

Results: A total of 306,196 patients were included, 156,450 (51.1%) had right sided tumors and 283,282 (92.5%) had localized RCC. Localized tumors were more likely to be right sided (0.51 [95% CI 0.50-0.52], p < 0.001). Metastatic and regional tumors (cN+M0) were more likely to be left sided (0.48 [0.47-0.49], p < 0.001; and 0.43 [0.41-0.45], p < 0.001; respectively). For localized disease, smaller tumors were more likely to be right sided (< 2 cm: 0.52 [0.51-0.52], p < 0.001), while tumors > 7cm showed no significant site association (0.49 [0.49-0.50], p = 0.07). When stratified by staging, there were no significant associations between laterality and OS (localized RCC: HR 1.01 [0.99-1.02], p = 0.50; metastatic RCC: 1.03 [1.00-1.07], p = 0.7; cN+M0 RCC: 0.96 [0.86-1.07], p = 0.50).

Conclusions: Left-sided RCC tumors are associated with larger tumor size and a higher propensity for regional nodal involvement and distant metastases. However, they do not demonstrate more aggressive behavior leading to meaningful survival differences.

Introduction: We report the first scoping review of the clinical urologic literature for photodynamic therapy (PDT) among multiple urologic malignancies.

Materials and methods: A scoping review using Medline and Embase was performed for treatment of urologic malignancies with PDT.

Results: There were 84 papers included with the majority involving bladder and prostate cancer. Upper tract urothelial cancer (UTUC) only comprised three publications and there was no clinical data for renal or testicular cancer. Utilizing PDT in prostate cancer led to a negative biopsy rate of 30%-100%. Bladder cancer treatment with PDT had a 3-month complete response rate of 31.5%-100%. UTUC management with PDT reported at least 50% complete response rate.

Conclusions: Ultimately, PDT has been established as a safe and effective treatment for urologic malignancies and we provide the first comprehensive review of the literature regarding the utility of this treatment modality.

Introduction: We describe a method of robotic ureterocalicostomy (RALUC) with the Da Vinci Single Port (SP) platform and present clinical outcomes in our cohort of patients.

Materials and methods: We retrospectively reviewed all patients undergoing RALUC with the SP platform in a single-institution, IRB-approved database between 2020-2023. Demographics, preoperative, intraoperative, and postoperative outcomes were collated. Surgical success was defined as freedom from hardware, avoidance of additional surgical reconstruction, and no obstruction on follow up imaging/ureteroscopy. An incision is made 1/3rd the distance from anterior superior iliac spine to the umbilicus. The retroperitoneal space is entered and SP Access Port is placed. The psoas is identified and concomitant ureteroscopy is used to identify the ureter. The ureter is dissected to the most proximal aspect and transected. The remaining proximal ureteral stump is suture ligated. The lower pole parenchyma is removed to access the calyx. Absorbable barbed suture is used to control parenchymal bleeding and evert the mucosal edge of the calyx. Barbed suture is then used for the ureterocaliceal anastomosis over a ureteral stent.

Results: Six patients underwent RALUC. Retroperitoneal approach was used for 5/6 cases. Prior ureteral surgery had been performed in 4/6 patients. Fifty percent of cases included an additional procedure with a median operative time of 248 minutes. One patient required nephrostomy tube placement postoperatively. Median follow up was 10.35 months with surgical success rate of 67%.

Conclusions: SP RALUC is a safe and feasible option for proximal ureteral reconstruction in patients with unfavorable upper urinary tract anatomy or in salvage cases.

Nephrolithiasis is one of the most common indications for surgery in patients with a horseshoe kidney. Robotic-assisted surgery has become a staple in urologic practice, yet its application in stone management is largely undefined. We present a patient with a horseshoe kidney, who underwent a robotic-assisted laparoscopic pyelolithotomy (RPL) to treat a 3 cm stone burden. This procedure allowed for safe access that could not be obtained with percutaneous nephrolithotomy (PCNL) and stone removal without fragmentation, which would have been challenging with traditional laparoscopy. We advocate for the use of robotic-assisted laparoscopic pyelolithotomy in cases of aberrant anatomy complicating a heavy stone burden.

Radical cystectomy is a preferred treatment for muscle-invasive bladder cancer.  Despite known complications, rapid onset, severe hyperkalemia necessitating abortion of surgery has not been reported.  In this case report, a patient with end stage renal disease (ESRD) undergoing attempted cystectomy developed severe intraoperative hyperkalemia and acidosis that led to abortion of surgery and transfer to the medical intensive care unit for emergent hemodialysis.  The multifactorial etiology was related to respiratory acidosis, ESRD, patient positioning, clipping of ureters, and body habitus, as well as an idiopathic element.  Knowledge of hyperkalemia etiologies can assist in diagnosis and treatment of this serious condition.

The Hem-o-lok Weck clip is part of a polymer locking ligation system often employed for hemostasis in surgical practices. Its use is routine in a wide array of surgical subspecialties. Surgeons have limited options in removing these clips when they are aberrantly positioned. Herein, we describe a novel, cost-effective approach for removing a Hem-o-lok clip using standard robotic instruments. This simple approach will allow surgeons to remove a Hem-o-lok clip precisely and quickly if it is not adequately placed. During a routine robotic-assisted laparoscopic prostatectomy a Hem-o-lok Weck clip was noted to be in juxtaposition to the rectal wall, and it was deemed appropriate to remove it. Ultimately, the indwelling Prograsp forceps was moved from the right fourth arm position to the left arm position. This allowed the Prograsp forceps to compress the scissors in the right hand port, which was insufficient in cutting the hinge of the clip. This provided sufficient force to cut through the clip at its hinge with ease. The Hem-o-lok Weck clip is used in various surgical specialties. It is occasionally placed suboptimally and requires removal. Given the challenge of finding and using the clip removal device, surgeons should be aware of this simple and cost-effective way of removing a Hem-o-lok clip if desired.