BJU International最新文献

Objectives: To evaluate Urologists' perception regarding stone volume (SV) to assess the stone burden in current practice. Whilst SV might be considered as the most accurate measure of stone burden, international guidelines are to date based on maximum stone diameter (MSD).

Subjects and methods: An on-line survey (four parts, 22 multiple choice questions) designed by international Endourology experts was submitted to the urological community between December 2023 and January 2024. In addition to questions on clinical practice, stone burden reporting and lithotripsy methods, participants were asked to intuitively estimate the spherical SV equivalent of several stone sizes and situations. Interest in SV overall, including knowledge about SV measurement tools were also investigated.

Results: A total of 218 participants completed the survey, of whom 83% were male and 43% were aged 30-40 years. Approximately two thirds were European (63%), consultant Urologists (66%) and worked in a university hospital (66%). In all, 79% had specialist Endourology training and 44% declared more than half of their surgical activity was dedicated to Endourology. Although MSD was preferred to SV (67% vs 3%) for preoperative stone burden estimation, 64% of respondents were 'very keen' to have a tool to provide SV in future. The rate of correct intuitive SV estimations decreased with case complexity (from 40% to 20%). Endourology experts and academic Urologists were keener to adopt SV in practice but their ability to estimate SV was similar to those who were not Endourology trained or in non-academic posts.

Conclusions: Urologists agree that SV provides a better estimation for stone burden than MSD. However, intuitive SV estimation based on stone diameters seems insufficient, hence readily accessible SV estimation tools are warranted for using SV in routine practice.

Objectives: To evaluate long-term outcomes and predictive factors of urinary continence (UC) and fecal continence (FC) after surgery for classic bladder exstrophy (CBE) using validated questionnaires.

Patients and methods: This study is part of the QUALEXSTRO study, a retrospective, observational, single-centre cohort study assessing through questionnaires UC, FC, sexuality, fertility, and quality of life in patients treated for CBE, who were aged of at least 15 years at evaluation. Herein, UC and FC were assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Fecal Incontinence Quality of Life Scale (FIQL), respectively.

Results: Of the 63 eligible patients, 42 patients responded to the study  (response rate 66.7%). Most patients were treated using the modern staged repair exstrophy technique (88.1%) with pelvic osteotomy (95.2%). A total of 69% of patients underwent continent urinary diversion, 61.9% underwent augmentation enterocystoplasty (AEC), and 7.1% underwent bladder neck closure. Additional endourological procedures were performed in 45.2% of patients. The median (interquartile range [IQR]) age and follow-up were 26 (18-35) years and 22 (17-32) years, respectively. Regarding the voiding mode, 21.4% of patients were able to void spontaneously per urethra without intermittent catheterisation, while 76.2% performed clean intermittent self-catheterisation (CISC). All patients who underwent AEC performed intermittent catheterisation. The median (IQR) ICIQ-UI SF score was 8 (0-13) and was significantly better in women (P = 0.002). A total of 13 patients (30.9%) were continent (ICIQ-UI SF score = 0). Of these, three were able to void spontaneously per urethra, 10 used CISC, and seven underwent AEC. Most patients (66.7%) did not respond to the FIQL questionnaire since they had no concerns regarding FC.

Conclusions: Achieving UC depends on both initial and subsequent surgeries, with few patients able to void per urethra during adulthood. Women have better urinary outcomes than men.