Jack B. Fanshawe, Thomas Hughes, Karen Briggs, Raveen Sandher, Yacoub Khalaf, Tet Yap, Julia Kopeika, Majid Shabbir
ObjectiveTo determine the success rate of oncological microdissection testicular sperm extraction (onco‐microTESE) in patients with testicular cancer (TC) with azoospermia and severe oligoasthenoteratozoospermia (OAT; <1 million/mL sperm) and to explore any factors that may predict success.Patients and MethodsCase series of outcomes from all consecutive patients (42 testes in 38 patients) that presented or were referred to a single specialist tertiary referral centre for fertility management in the context of TC with severe OAT or azoospermia between August 2015 and August 2022. Biochemical, radiological, and histological parameters were collected for all patients. All patients underwent onco‐microTESE (simultaneous radical inguinal orchidectomy with ex vivo microTESE of the affected testis). Those with unsuccessful surgical sperm retrieval (SSR) from the affected testis underwent contemporaneous contralateral microTESE, if no contraindication was present. The primary outcome was successful SSR from the affected testicle sufficient for assisted reproductive techniques. Secondary outcomes included contralateral microTESE success, the time from referral to procedure, and the total successful fertility preservation rate.ResultsInitial onco‐microTESE was successful in 19 of 31 patients (61%) with azoospermia. Contralateral microTESE was successful in a further two of eight patients with azoospermia with failed onco‐microTESE. Overall, 22/31 patients with azoospermia (71%) had successful fertility preservation in this series. In addition, six of seven patients with severe OAT had further sperm harvested by onco‐microTESE to maximise their fertility preservation. All surgery was performed within median (interquartile range) of 7 (5–13) days from presentation.ConclusionsOnco‐microTESE represents an effective method of fertility preservation for sub‐fertile patients with TC without delaying oncological treatment. Knowledge of the fertility status at first presentation is essential to allow for such additional options for optimal fertility preservation in TC.
{"title":"Oncological microdissection testicular sperm extraction (Onco‐microTESE) outcomes for fertility preservation of patients with testicular cancer with azoospermia or severe oligoasthenoteratozoospermia","authors":"Jack B. Fanshawe, Thomas Hughes, Karen Briggs, Raveen Sandher, Yacoub Khalaf, Tet Yap, Julia Kopeika, Majid Shabbir","doi":"10.1111/bju.16553","DOIUrl":"https://doi.org/10.1111/bju.16553","url":null,"abstract":"ObjectiveTo determine the success rate of oncological microdissection testicular sperm extraction (onco‐microTESE) in patients with testicular cancer (TC) with azoospermia and severe oligoasthenoteratozoospermia (OAT; <1 million/mL sperm) and to explore any factors that may predict success.Patients and MethodsCase series of outcomes from all consecutive patients (42 testes in 38 patients) that presented or were referred to a single specialist tertiary referral centre for fertility management in the context of TC with severe OAT or azoospermia between August 2015 and August 2022. Biochemical, radiological, and histological parameters were collected for all patients. All patients underwent onco‐microTESE (simultaneous radical inguinal orchidectomy with <jats:italic>ex vivo</jats:italic> microTESE of the affected testis). Those with unsuccessful surgical sperm retrieval (SSR) from the affected testis underwent contemporaneous contralateral microTESE, if no contraindication was present. The primary outcome was successful SSR from the affected testicle sufficient for assisted reproductive techniques. Secondary outcomes included contralateral microTESE success, the time from referral to procedure, and the total successful fertility preservation rate.ResultsInitial onco‐microTESE was successful in 19 of 31 patients (61%) with azoospermia. Contralateral microTESE was successful in a further two of eight patients with azoospermia with failed onco‐microTESE. Overall, 22/31 patients with azoospermia (71%) had successful fertility preservation in this series. In addition, six of seven patients with severe OAT had further sperm harvested by onco‐microTESE to maximise their fertility preservation. All surgery was performed within median (interquartile range) of 7 (5–13) days from presentation.ConclusionsOnco‐microTESE represents an effective method of fertility preservation for sub‐fertile patients with TC without delaying oncological treatment. Knowledge of the fertility status at first presentation is essential to allow for such additional options for optimal fertility preservation in TC.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643219","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}
{"title":"Response to Tang et al. ‘Evaluating the efficacy of physiotherapy in post‐prostatectomy continence and pelvic muscle function’","authors":"Mifuka Ouchi, Takeya Kitta","doi":"10.1111/bju.16592","DOIUrl":"https://doi.org/10.1111/bju.16592","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"107 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601207","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}
ObjectivesTo investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath‐assisted flexible cystoscopy (eFC). EndoSheaths are single‐use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time‐consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced.Patients and MethodsAll adult patients undergoing eFC over a 26‐month period at a single institution were evaluated prospectively. Post‐eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2–4 = mild, 5–7 = moderate, 8–10 = severe). The diagnosis of UTI was broad and based on any one of patient self‐report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi‐squared testing (P < 0.05, two‐tailed).ResultsOf the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post‐eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis.ConclusionThis large, prospective, unselected, real‐world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.
{"title":"EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases","authors":"Lara Ratcliffe, Brian Birch","doi":"10.1111/bju.16578","DOIUrl":"https://doi.org/10.1111/bju.16578","url":null,"abstract":"ObjectivesTo investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath‐assisted flexible cystoscopy (eFC). EndoSheaths are single‐use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time‐consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced.Patients and MethodsAll adult patients undergoing eFC over a 26‐month period at a single institution were evaluated prospectively. Post‐eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2–4 = mild, 5–7 = moderate, 8–10 = severe). The diagnosis of UTI was broad and based on any one of patient self‐report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi‐squared testing (<jats:italic>P</jats:italic> < 0.05, two‐tailed).ResultsOf the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post‐eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis.ConclusionThis large, prospective, unselected, real‐world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"35 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601210","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}
Erik Thimansson, Elin Axén, Fredrik Jäderling, Johan Styrke, Maria Nyberg, Nina Hageman, Johan Ivarsson, Gert Malmberg, Viktoria Gaspar, Magnus Törnblom
<p>In the diagnostic pathway for early detection of prostate cancer, MRI, biopsies, and pathology are included. The shift towards ‘MRI first’ avoids unnecessary biopsies and reduces overdiagnosis [<span>1</span>] but demands high standards for Prostate Imaging-Reporting and Data System (PI-RADS) [<span>2</span>] grading and accuracy in targeted biopsies. Formulating a comprehensive assessment for optimal patient management is challenging for today's urologists as the volume and complexity of data grow. Quality registers are crucial for evaluating, comparing, and improving patient care. The Swedish National Prostate Cancer Register (NPCR) encompasses over 240 000 patients and is routinely used to monitor and evaluate care quality, aiming to optimise patient outcomes through transparent comparisons [<span>3</span>].</p> <p>Traditionally, reporting to quality registries relies on manual post-registration, which has disadvantages including time consumption, registration errors, and incomplete data. A multi-professional group within the Swedish NPCR developed a nationally endorsed novel model for integrated prostate cancer diagnostics, tested in routine care in autumn 2023. The model (Figs 1, S1 and S2) is based on ‘single entry’ per specialist and comprises six key components: complete data registration, real-time data registration, structured MRI and pathology review and reporting, structured biopsy sampling and referral, individualised automated feedback from biopsy to radiologist, and summarised outcomes from MRI, biopsy, and pathology in an interactive format.</p> <figure><picture> <source media="(min-width: 1650px)" srcset="/cms/asset/1f94090a-0f84-4957-ab19-cc62cd2b3587/bju16582-fig-0001-m.jpg"/><img alt="Details are in the caption following the image" data-lg-src="/cms/asset/1f94090a-0f84-4957-ab19-cc62cd2b3587/bju16582-fig-0001-m.jpg" loading="lazy" src="/cms/asset/22efa2b7-ee21-4345-b792-beb0f388a95c/bju16582-fig-0001-m.png" title="Details are in the caption following the image"/></picture><figcaption> <div><strong>Fig. 1<span style="font-weight:normal"></span></strong><div>Open in figure viewer<i aria-hidden="true"></i><span>PowerPoint</span></div> </div> <div>An overview of the model with the workflow from MRI to pathology, feedback loop (top) and registry data (bottom). MDT, multidisciplinary team meeting.</div> </figcaption> </figure> <p>The workgroup included urologists, radiologists, pathologist, urology nurse, patient representative, product owner from the Swedish Information Network for Cancer (INCA), and a project manager. The model was evaluated by a national reference group that included key opinion leaders holding leadership positions for the National Clinical Care guidelines for prostate cancer and the organised prostate cancer testing from urology, pathology, and radiology. Data management occurs within the Swedish INCA, with designated personnel ensuring adaptation to a national model with modular data collection for quality r
{"title":"A novel approach to integrated prostate cancer diagnostics: insights from MRI, prostate biopsy, and pathology reports in a pilot study","authors":"Erik Thimansson, Elin Axén, Fredrik Jäderling, Johan Styrke, Maria Nyberg, Nina Hageman, Johan Ivarsson, Gert Malmberg, Viktoria Gaspar, Magnus Törnblom","doi":"10.1111/bju.16582","DOIUrl":"https://doi.org/10.1111/bju.16582","url":null,"abstract":"<p>In the diagnostic pathway for early detection of prostate cancer, MRI, biopsies, and pathology are included. The shift towards ‘MRI first’ avoids unnecessary biopsies and reduces overdiagnosis [<span>1</span>] but demands high standards for Prostate Imaging-Reporting and Data System (PI-RADS) [<span>2</span>] grading and accuracy in targeted biopsies. Formulating a comprehensive assessment for optimal patient management is challenging for today's urologists as the volume and complexity of data grow. Quality registers are crucial for evaluating, comparing, and improving patient care. The Swedish National Prostate Cancer Register (NPCR) encompasses over 240 000 patients and is routinely used to monitor and evaluate care quality, aiming to optimise patient outcomes through transparent comparisons [<span>3</span>].</p>\u0000<p>Traditionally, reporting to quality registries relies on manual post-registration, which has disadvantages including time consumption, registration errors, and incomplete data. A multi-professional group within the Swedish NPCR developed a nationally endorsed novel model for integrated prostate cancer diagnostics, tested in routine care in autumn 2023. The model (Figs 1, S1 and S2) is based on ‘single entry’ per specialist and comprises six key components: complete data registration, real-time data registration, structured MRI and pathology review and reporting, structured biopsy sampling and referral, individualised automated feedback from biopsy to radiologist, and summarised outcomes from MRI, biopsy, and pathology in an interactive format.</p>\u0000<figure><picture>\u0000<source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/1f94090a-0f84-4957-ab19-cc62cd2b3587/bju16582-fig-0001-m.jpg\"/><img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/1f94090a-0f84-4957-ab19-cc62cd2b3587/bju16582-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/22efa2b7-ee21-4345-b792-beb0f388a95c/bju16582-fig-0001-m.png\" title=\"Details are in the caption following the image\"/></picture><figcaption>\u0000<div><strong>Fig. 1<span style=\"font-weight:normal\"></span></strong><div>Open in figure viewer<i aria-hidden=\"true\"></i><span>PowerPoint</span></div>\u0000</div>\u0000<div>An overview of the model with the workflow from MRI to pathology, feedback loop (top) and registry data (bottom). MDT, multidisciplinary team meeting.</div>\u0000</figcaption>\u0000</figure>\u0000<p>The workgroup included urologists, radiologists, pathologist, urology nurse, patient representative, product owner from the Swedish Information Network for Cancer (INCA), and a project manager. The model was evaluated by a national reference group that included key opinion leaders holding leadership positions for the National Clinical Care guidelines for prostate cancer and the organised prostate cancer testing from urology, pathology, and radiology. Data management occurs within the Swedish INCA, with designated personnel ensuring adaptation to a national model with modular data collection for quality r","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"109 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601977","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}
Lars Boesen, Nis Nørgaard, Rasmus Bisbjerg, Vibeke Løgager
ObjectivesTo evaluate the additional prostate cancer detection yield and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious magnetic resonance imaging (MRI) findings undergoing MRI‐guided transperineal (TP) biopsies in an outpatient clinic.Patients and MethodsA prospective study of 655 consecutive men with unilateral MRI suspicious findings undergoing office‐based MRI‐guided TP biopsies between May 2022 and December 2023. All men had pre‐biopsy MRI followed by MRI‐guided TP fusion biopsies with at least four targeted cores per lesion plus five contralateral systematic biopsies. The primary objective was the clinically significant prostate cancer (csPCa) detection rate of contralateral systematic biopsies in men with no or insignificant PCa on targeted biopsies. Secondary objectives included the impact of contralateral biopsies on PCa grade upgrading, additional insignificant PCa diagnoses, and the clinical implications of multifocal csPCa detected on both targeted and contralateral cores.ResultsAny and csPCa (Gleason Grade Group [GG] ≥2) was detected in 564/655 (85%) and 471/655 (71%) men with a median age of 66 years and PSA level of 7.6 ng/mL. Overall, seven of 655 (1%) men had csPCa detected by contralateral systematic biopsies missed on MRI‐targeted biopsy, all of whom had low‐volume Gleason GG 2 PCa eligible for active surveillance. Furthermore, 70/464 (15%) men with csPCa on MRI‐targeted biopsy had matching Gleason GG 2–5 PCa on contralateral biopsy, and another seven had higher Gleason GG. However, the additional information from contralateral biopsies did not seem to influence whole‐gland treatment allocation and nerve‐sparing during surgery.ConclusionContralateral systematic biopsies in men with unilateral MRI findings undergoing MRI‐guided TP targeted biopsies have limited value for csPCa detection and risk assessment for whole‐gland treatment but may be important for determining PCa multifocality considering focal therapy eligibility.
{"title":"Clinical value of contralateral biopsies in men with unilateral MRI foci undergoing targeted biopsy","authors":"Lars Boesen, Nis Nørgaard, Rasmus Bisbjerg, Vibeke Løgager","doi":"10.1111/bju.16579","DOIUrl":"https://doi.org/10.1111/bju.16579","url":null,"abstract":"ObjectivesTo evaluate the additional prostate cancer detection yield and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious magnetic resonance imaging (MRI) findings undergoing MRI‐guided transperineal (TP) biopsies in an outpatient clinic.Patients and MethodsA prospective study of 655 consecutive men with unilateral MRI suspicious findings undergoing office‐based MRI‐guided TP biopsies between May 2022 and December 2023. All men had pre‐biopsy MRI followed by MRI‐guided TP fusion biopsies with at least four targeted cores per lesion plus five contralateral systematic biopsies. The primary objective was the clinically significant prostate cancer (csPCa) detection rate of contralateral systematic biopsies in men with no or insignificant PCa on targeted biopsies. Secondary objectives included the impact of contralateral biopsies on PCa grade upgrading, additional insignificant PCa diagnoses, and the clinical implications of multifocal csPCa detected on both targeted and contralateral cores.ResultsAny and csPCa (Gleason Grade Group [GG] ≥2) was detected in 564/655 (85%) and 471/655 (71%) men with a median age of 66 years and PSA level of 7.6 ng/mL. Overall, seven of 655 (1%) men had csPCa detected by contralateral systematic biopsies missed on MRI‐targeted biopsy, all of whom had low‐volume Gleason GG 2 PCa eligible for active surveillance. Furthermore, 70/464 (15%) men with csPCa on MRI‐targeted biopsy had matching Gleason GG 2–5 PCa on contralateral biopsy, and another seven had higher Gleason GG. However, the additional information from contralateral biopsies did not seem to influence whole‐gland treatment allocation and nerve‐sparing during surgery.ConclusionContralateral systematic biopsies in men with unilateral MRI findings undergoing MRI‐guided TP targeted biopsies have limited value for csPCa detection and risk assessment for whole‐gland treatment but may be important for determining PCa multifocality considering focal therapy eligibility.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"39 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599402","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}
Amit D. Raval, Stephanie Chen, Natasha Littleton, Niculae Constantinovici, Peter J. Goebell
To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC). While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade.
{"title":"Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review","authors":"Amit D. Raval, Stephanie Chen, Natasha Littleton, Niculae Constantinovici, Peter J. Goebell","doi":"10.1111/bju.16577","DOIUrl":"https://doi.org/10.1111/bju.16577","url":null,"abstract":"To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC). While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"196 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599922","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}
{"title":"Evaluating the efficacy of physiotherapy in post-prostatectomy continence and pelvic muscle function","authors":"Wei-Zhen Tang, Wei-Ze Xu, Tai-Hang Liu","doi":"10.1111/bju.16591","DOIUrl":"https://doi.org/10.1111/bju.16591","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"158 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601969","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}
William C. Gibcus, Anne Hong, David C. Chen, Henry C.X. Yao, Anthony Ta, Marlon Perera, Joseph J. Ischia, Damien M. Bolton
{"title":"Urogeriatrics: a critical perspective for future urologists","authors":"William C. Gibcus, Anne Hong, David C. Chen, Henry C.X. Yao, Anthony Ta, Marlon Perera, Joseph J. Ischia, Damien M. Bolton","doi":"10.1111/bju.16587","DOIUrl":"https://doi.org/10.1111/bju.16587","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"31 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599411","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}
<p>Lower-pole renal stones might represent a challenge in endoscopic treatment, especially for intermediate sizes (1–2 cm), that come with no strong indication or contraindication for one technique over the other [<span>1</span>]. The sharp infundibulopelvic angle, together with the infudibulopelvic width and length, often determine treatment choices, along with the available expertise, cost and patient choice. On the other hand, some might argue that it would be excessive to perform a percutaneous nephrolithotomy (PCNL) for intermediate stone sizes, when other technologies such as flexible ureteroscopy (f-URS) allow for a lesser invasive approach. One of the most frequently applied strategies to treat intermediate-size lower-pole stones is to relocate them in the upper pole or in the renal pelvis. Despite it being a feasible and efficient technique, stone relocation might sometimes be uneasy due to the stone size or the infundibulopelvic angle, prolonging the operative times.</p> <p>In a recent prospective randomised trial, Elmansy et al. [<span>1</span>] compared the outcomes between f-URS and laser lithotripsy (f-URSL) and miniaturised PCNL (mini-PCNL) for these intermediate lower-pole stones without relocation. The most interesting finding of the study is indeed on the important difference in reported stone-free rates (SFRs). They found a 1-day SFR of 50% in the mini-PCNL group vs only 11.1% in the f-URSL group, increasing to 72.2% in the mini-PCNL and to 37.1% in the f-URSL group at 90-days follow-up. When including fragments up to 2 mm, the 3-month SFR rose in fact to 86.1% and 71.4% for mini-PCNL and f-URSL, respectively. Recent data from Brian et al. [<span>2</span>] show that over 50 months, residual fragments >4 mm have a disease progression rate of up to 88% and intervention rate of up to 47%.</p> <p>Indeed, the difference between mini-PCNL and f-URSL reported by Elmansy et al. [<span>1</span>] is significant, favouring the percutaneous treatment [<span>1</span>]. These findings are in line with the literature, reporting higher SFR for PCNL compared to classic f-URSL [<span>3</span>]. In a recent review on 1–2 cm lower-pole stones, mini-PCNL showed in fact higher efficacy in complete stone clearance, while demonstrating comparable complications rates and operative times. The difficult position and manoeuvrability of the retrograde access could be addressed as the main limitation for treating this kind of calculi, reaching lower SFRs than the ones usually reported for stones located in medium/upper renal calyces. At the same time, mini-PCNL has shown good safety profiles, at least partially overcoming the classic limitations of the percutaneous access, namely the high bleeding risk and the need for a postoperative nephrostomy. In their study, Elmansy et al. [<span>1</span>] reported a low bleeding risk during the puncture (7.4%), and good triangulation outcomes avoiding the need for multiple punctures. They also aimed for totally tub
{"title":"Lower pole stones 1–2 cm: navigating treatment choices","authors":"Carlotta Nedbal, Bhaskar K. Somani","doi":"10.1111/bju.16589","DOIUrl":"https://doi.org/10.1111/bju.16589","url":null,"abstract":"<p>Lower-pole renal stones might represent a challenge in endoscopic treatment, especially for intermediate sizes (1–2 cm), that come with no strong indication or contraindication for one technique over the other [<span>1</span>]. The sharp infundibulopelvic angle, together with the infudibulopelvic width and length, often determine treatment choices, along with the available expertise, cost and patient choice. On the other hand, some might argue that it would be excessive to perform a percutaneous nephrolithotomy (PCNL) for intermediate stone sizes, when other technologies such as flexible ureteroscopy (f-URS) allow for a lesser invasive approach. One of the most frequently applied strategies to treat intermediate-size lower-pole stones is to relocate them in the upper pole or in the renal pelvis. Despite it being a feasible and efficient technique, stone relocation might sometimes be uneasy due to the stone size or the infundibulopelvic angle, prolonging the operative times.</p>\u0000<p>In a recent prospective randomised trial, Elmansy et al. [<span>1</span>] compared the outcomes between f-URS and laser lithotripsy (f-URSL) and miniaturised PCNL (mini-PCNL) for these intermediate lower-pole stones without relocation. The most interesting finding of the study is indeed on the important difference in reported stone-free rates (SFRs). They found a 1-day SFR of 50% in the mini-PCNL group vs only 11.1% in the f-URSL group, increasing to 72.2% in the mini-PCNL and to 37.1% in the f-URSL group at 90-days follow-up. When including fragments up to 2 mm, the 3-month SFR rose in fact to 86.1% and 71.4% for mini-PCNL and f-URSL, respectively. Recent data from Brian et al. [<span>2</span>] show that over 50 months, residual fragments >4 mm have a disease progression rate of up to 88% and intervention rate of up to 47%.</p>\u0000<p>Indeed, the difference between mini-PCNL and f-URSL reported by Elmansy et al. [<span>1</span>] is significant, favouring the percutaneous treatment [<span>1</span>]. These findings are in line with the literature, reporting higher SFR for PCNL compared to classic f-URSL [<span>3</span>]. In a recent review on 1–2 cm lower-pole stones, mini-PCNL showed in fact higher efficacy in complete stone clearance, while demonstrating comparable complications rates and operative times. The difficult position and manoeuvrability of the retrograde access could be addressed as the main limitation for treating this kind of calculi, reaching lower SFRs than the ones usually reported for stones located in medium/upper renal calyces. At the same time, mini-PCNL has shown good safety profiles, at least partially overcoming the classic limitations of the percutaneous access, namely the high bleeding risk and the need for a postoperative nephrostomy. In their study, Elmansy et al. [<span>1</span>] reported a low bleeding risk during the puncture (7.4%), and good triangulation outcomes avoiding the need for multiple punctures. They also aimed for totally tub","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"10 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599913","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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