Frontiers in urology最新文献

Giant prostatic hyperplasia (GPH) is defined as benign prostate hyperplasia (BPH) of more than 200 ml. It is a challenging condition because transurethral resection is classically indicated for prostate volume less than 80 ml and open adenectomy remains the gold standard therapy for GPH. Herein, we present the case of a 54-years old male with giant prostatic hyperplasia (total prostate volume of 265 ml) causing lower urinary tract symptoms (LUTS) and recurrent episodes of acute urinary retention. The patient refused the surgical adenomectomy and underwent bilateral prostate arteries embolization (PAE). Post embolization period was uneventful. Total prostate volume decreased progressively and LUTS disappeared. At more than 5 years follow-up the patient remains still asymptomatic, despite the discrete regrowth of the prostate detected on imaging. This case report suggests that PEA may be a good alternative to open surgery for patients with symptomatic GPH.

Introduction: We previously presented promising results with a Burch-type colposuspension (BC) in a heterogeneous group of girls with therapy-resistant daytime incontinence (DUI). In view of our clinical observations, we expect that a small group of girls with refractory DUI based on stress-urinary incontinence (SUI) might also benefit from a BC in order to achieve continence.

Objective: To assess the (long-term) effect of BC on refractory DUI in girls with SUI, and to identify predictive factors for success.

Study design: A retrospective chart study including all girls with refractory DUI who underwent an open or laparoscopic BC at our tertiary referral center between 2003-2017 (n=34) was performed. Patients were considered refractory after having failed all non-invasive treatment methods. The main outcome measurement was continence, expressed as the percentage of children with decreased incontinence at post-surgical follow-up without any additional treatment (complete response 4-6 months after surgery). Additionally, a cross-sectional follow-up was carried out, assessing the long-term effect of BC on DUI and patient satisfaction by means of standardized questionnaires.

Results: Complete continence after surgery was achieved in 12% (4/34) and 12% (4/34) showed a decrease in frequency of incontinence episodes. Patients with an abnormal flow pattern more often failed complete continence or improved incontinence. After a mean duration of 8 years, 84% (16/19) still experienced DUI. 68% (13/19) of those patients would opt for the BC again.

Conclusion: Although 84% of children still experienced any degree DUI after a mean duration of 8 years after BC, most patients do not regret the decision of surgical treatment. Given the limited benefit and invasiveness of the procedure, however, we discourage to routinely perform BC in children with refractory DUI and SUI. Our results should be taken into account when discussing expectations and chances of success.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans, particularly affecting women, with significant clinical and socioeconomic impacts. Despite advances in medical research, the diagnostic criteria for UTI have remained practically unchanged since Kass's seminal work, emphasizing the need for a reevaluation in light of new scientific insights. Recent studies have highlighted the importance of the urobiome, a previously underappreciated community of microorganisms within the urinary tract (UT), and its role in maintaining urogenital health. The gut-bladder axis has emerged as a critical pathway in understanding UTI as a dysbiosis, where imbalances in the microbial community and its relation with the host contribute to infection susceptibility. This review explores the evolving definitions and diagnostic challenges of UTI, particularly in women, and examines the implications of recent discoveries on the urobiome and the gut-bladder axis. Additionally, we discuss the potential of novel therapeutic strategies to restore microbial balance, offering a promising avenue for the therapeutic management of UTIs.

Urinary tract diversions are a common reconstructive solution for patients with malignant, anatomic or functional pathologies of the lower urinary tract. Although urinary diversions often represent the patient's best alternative, they are not devoid of complications. Some of these complications, mainly anastomotic strictures and kidney stones, can be managed endoscopically, although upper tract access of such patients is not straightforward, requiring a fundamental understanding of the many types of diversions. In this article we will review the inherent difficulties of accessing the upper tract of patient with different diversions, the different approaches to the upper tract of diverted patients, and the equipment and techniques that can help facilitate upper tract access in diverted patients.