Objectives: To provide current peri-operative outcomes and short-term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications.
Patients and methods: Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018-2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi-squared, Fisher's exact and unpaired t-tests in our analyses.
Results: A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m2. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m2; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30-day period. The study was limited by its retrospective design and short-term follow-up.
Conclusions: We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.
{"title":"Contemporary short-term peri-operative outcomes of open primary retroperitoneal lymph node dissection.","authors":"Jacob D McFadden, Timothy A Masterson, Clint Cary","doi":"10.1111/bju.16506","DOIUrl":"https://doi.org/10.1111/bju.16506","url":null,"abstract":"<p><strong>Objectives: </strong>To provide current peri-operative outcomes and short-term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications.</p><p><strong>Patients and methods: </strong>Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018-2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi-squared, Fisher's exact and unpaired t-tests in our analyses.</p><p><strong>Results: </strong>A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m<sup>2</sup>. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m<sup>2</sup>; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30-day period. The study was limited by its retrospective design and short-term follow-up.</p><p><strong>Conclusions: </strong>We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118941","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}
Annaleena Anttila, Tuija Lahdes-Vasama, Niklas Pakkasjärvi, Seppo Taskinen
Objective: To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre.
Patients and methods: Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan-Meier methods were used to evaluate the re-operation data.
Results: The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards.
Conclusion: There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.
{"title":"Cumulative re-operation rates during follow-up after hypospadias repair.","authors":"Annaleena Anttila, Tuija Lahdes-Vasama, Niklas Pakkasjärvi, Seppo Taskinen","doi":"10.1111/bju.16519","DOIUrl":"https://doi.org/10.1111/bju.16519","url":null,"abstract":"<p><strong>Objective: </strong>To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre.</p><p><strong>Patients and methods: </strong>Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan-Meier methods were used to evaluate the re-operation data.</p><p><strong>Results: </strong>The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards.</p><p><strong>Conclusion: </strong>There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118942","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}
Wietse Claeys, Dylan T. Wolff, Alexandra Zachou, Piet Hoebeke, Nicolaas Lumen, Anne‐Françoise Spinoit
ObjectiveTo review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.MethodsA systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.ResultsIn total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.ConclusionThis review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.
目的综述有关变异生殖器性别确认手术（GGAS）的现有文献，包括实施手术的原因、手术本身及其结果。方法对变异生殖器性别确认手术的实施情况进行系统综述（系统综述国际前瞻性注册[PROSPERO]标识符：CRD42022306684）：对 PubMed、Embase、Web of Science 和 Cochrane 数据库进行了研究（国际前瞻性系统综述注册[PROSPERO]标识符：CRD42022306684），研究时间从开始至 2023 年 12 月 31 日。研究遵循了系统综述和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，并使用五项标准质量评估清单对每项研究的偏倚风险进行了评估。患者选择这些手术主要是出于个人意愿，以避免并发症的风险，或者是因为他们对自己生殖器的某些部位没有恐惧感。男性化手术的并发症主要来自尿道的延长，这可以通过初级会阴尿道前列腺切除术来缓解。在保留阴道的情况下，阴茎成形术和阴道成形术出现尿道并发症的风险较高。在女性化手术中，如果外阴成形术不创建阴道管，则可避免内脏损伤和终生自行扩张的风险。结论本综述强调了变性 GGAS 的重要性，并承认了变性者和性别多样化者的偏好。患者应了解这些手术每个步骤的风险和益处。
{"title":"Variant genital gender‐affirming surgery: a systematic review","authors":"Wietse Claeys, Dylan T. Wolff, Alexandra Zachou, Piet Hoebeke, Nicolaas Lumen, Anne‐Françoise Spinoit","doi":"10.1111/bju.16513","DOIUrl":"https://doi.org/10.1111/bju.16513","url":null,"abstract":"ObjectiveTo review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.MethodsA systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.ResultsIn total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.ConclusionThis review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100806","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}
Zhuo Tony Su, Isabella S. Florissi, Katherine M. Mahon, Taibo Li, Michael E. Rezaee, Nirmish Singla, Sunil H. Patel, Jeffrey P. Townsend, Max R. Kates
ObjectivesTo compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).Patients and MethodsWe performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.ResultsThe guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.ConclusionIn microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients.
{"title":"Varying the intensity of cystoscopic surveillance for high‐risk non‐muscle‐invasive bladder cancer","authors":"Zhuo Tony Su, Isabella S. Florissi, Katherine M. Mahon, Taibo Li, Michael E. Rezaee, Nirmish Singla, Sunil H. Patel, Jeffrey P. Townsend, Max R. Kates","doi":"10.1111/bju.16521","DOIUrl":"https://doi.org/10.1111/bju.16521","url":null,"abstract":"ObjectivesTo compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).Patients and MethodsWe performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.ResultsThe guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.ConclusionIn microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100807","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":"Observational study on screen‐detected prostate cancer: case series of empirical clinical practice","authors":"Takeshi Takahashi","doi":"10.1111/bju.16525","DOIUrl":"https://doi.org/10.1111/bju.16525","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100766","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}
Lu Yu Kuo, Jenny Kuo, Joshua Silverman, Jason Jae Yeun Kim, Caitlin Letch, Scott McClintock
ObjectivesTo evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP).Patients and MethodsThis was a single‐centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no‐AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic‐related morbidity were captured within a 3‐month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no‐AC, and DOAC groups were analysed with two‐sided t‐test, and chi‐square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability‐weighted treatment effect analysis to evaluate bleeding risk.ResultsThere were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no‐AC vs AC: 0.4% vs 2.7%, P = 0.01).ConclusionThis is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding‐related complications than rivaroxaban.
目的评估接受经尿道前列腺切除术（TURP）的患者使用直接口服抗凝药（DOAC）和华法林的围术期发病率和死亡率。患者和方法这是一项单中心回顾性队列分析，分析对象是2019年4月至2023年12月期间因良性前列腺增生接受TURP手术的患者。主要目的是评估抗凝（AC）与无抗凝患者的围手术期出血和血栓栓塞风险。次要目标是评估不同配方 DOACs 的围手术期出血和血栓栓塞风险。研究人员收集了患者的人口统计学资料、既往治疗情况、前列腺大小、基线出血风险和手术细节。采集了术后 3 个月内出血和血栓栓塞相关的发病率。记录了AC治疗的围手术期管理情况，所有患者都暂停了AC治疗。使用双侧 t 检验和卡方检验分析了 AC 组与无 AC 组和 DOAC 组之间的队列特征。还进行了进一步的逻辑回归分析，以确定组间的重要变量。结果队列中有 629 名患者，其中 113 名（18%）患者接受了 AC 治疗。据统计，接受阿昔单抗治疗的患者发生急性出血的风险增加了1.6倍，血尿时间延长14天的风险增加了11倍。与阿哌沙班相比，接受利伐沙班治疗的患者急性出血的风险在统计学上显著增加了2.21倍。接受 AC 治疗的患者在围手术期发生中风的风险有统计学意义的显著增加（无 AC vs AC：0.4% vs 2.7%，P = 0.01）。尽管暂停了治疗，但接受 AC 治疗的患者在围手术期更有可能出现血尿和中风。阿哌沙班引起的出血相关并发症似乎少于利伐沙班。
{"title":"Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate","authors":"Lu Yu Kuo, Jenny Kuo, Joshua Silverman, Jason Jae Yeun Kim, Caitlin Letch, Scott McClintock","doi":"10.1111/bju.16478","DOIUrl":"https://doi.org/10.1111/bju.16478","url":null,"abstract":"ObjectivesTo evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP).Patients and MethodsThis was a single‐centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no‐AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic‐related morbidity were captured within a 3‐month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no‐AC, and DOAC groups were analysed with two‐sided <jats:italic>t</jats:italic>‐test, and chi‐square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability‐weighted treatment effect analysis to evaluate bleeding risk.ResultsThere were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no‐AC vs AC: 0.4% vs 2.7%, <jats:italic>P</jats:italic> = 0.01).ConclusionThis is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding‐related complications than rivaroxaban.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100767","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>In this issue of the <i>BJUI</i>, Torricelli et al. [<span>1</span>] report results from a randomised trial of participants who underwent treatment for large proximal ureteric stones with flexible ureteroscopy (URS) and holmium:yttrium-aluminium-garnet (Ho:YAG) lithotripsy or retroperitoneal laparoscopic ureterolithotomy (RLU). In total, 64 patients were included and randomised. Stone-free rates (SFRs) were 84.3% for URS and 93.7% for RLU (<i>P</i> = 0.23). There were no differences in complication rates, operative time or hospital stay. The authors conclude that both URS and RLU demonstrate high efficiency and low morbidity in the treatment of large proximal ureteric stones.</p><p>Since the reporting of the first experiences in the early 1980s, the evolution in URS has been extraordinary. High SFRs and few minor complications have made URS for ureteric stones the preferred treatment option [<span>2</span>]. SFRs of 100% after day-case surgery procedures have been reported in randomised trials using either Ho:YAG or thulium fibre lasers [<span>3, 4</span>]. In special circumstances with large, impacted stones or challenging anatomy, other treatment options may still be an alternative. However, European Association of Urology guidelines state laparoscopic or open stone surgery to be a valid option in complicated cases only when multiple endourological approaches have failed [<span>2</span>].</p><p>Torricelli et al. [<span>1</span>] should be commended for performing a randomised trial comparing URS and RLU treating large proximal stones. However, a randomised design alone is no guarantee for scientific quality, and the authors are correct in their suspicion of the study being underpowered. The power analysis made prior to study start returned a sample size of 49 patients in each group to detect a significant difference between the treatment arms. Despite this, only 64 patients were included in total. The authors advocate a lower sample size than calculated pointing out the SFR for RLU may be higher than anticipated. On the other hand, the authors’ assumption of SFR for URS being 75% is probably too low and in contrast to reports in other randomised studies [<span>3, 4</span>]. A higher and more realistic estimate for SFR in the URS group would in fact return a need for an even larger sample size. Lack of patients prevent detection of potential differences between the treatment groups as demonstrated in the present study. It is therefore still not known which treatment is better. On the other hand, given the reported results in the Torricelli et al. study [<span>1</span>], the differences between the two treatments may not be as large as anticipated after all.</p><p>Interesting to note, one in three of the patients had persistent hydronephrosis on CT scan at 3 months after surgery, and ureteric stricture was detected in one. The authors suggest longstanding obstruction prior to surgery as an explanation. This might well be true, but the signific
{"title":"Ureteroscopy vs laparoscopic ureterolithotomy: equal treatments?","authors":"Øyvind Ulvik","doi":"10.1111/bju.16522","DOIUrl":"10.1111/bju.16522","url":null,"abstract":"<p>In this issue of the <i>BJUI</i>, Torricelli et al. [<span>1</span>] report results from a randomised trial of participants who underwent treatment for large proximal ureteric stones with flexible ureteroscopy (URS) and holmium:yttrium-aluminium-garnet (Ho:YAG) lithotripsy or retroperitoneal laparoscopic ureterolithotomy (RLU). In total, 64 patients were included and randomised. Stone-free rates (SFRs) were 84.3% for URS and 93.7% for RLU (<i>P</i> = 0.23). There were no differences in complication rates, operative time or hospital stay. The authors conclude that both URS and RLU demonstrate high efficiency and low morbidity in the treatment of large proximal ureteric stones.</p><p>Since the reporting of the first experiences in the early 1980s, the evolution in URS has been extraordinary. High SFRs and few minor complications have made URS for ureteric stones the preferred treatment option [<span>2</span>]. SFRs of 100% after day-case surgery procedures have been reported in randomised trials using either Ho:YAG or thulium fibre lasers [<span>3, 4</span>]. In special circumstances with large, impacted stones or challenging anatomy, other treatment options may still be an alternative. However, European Association of Urology guidelines state laparoscopic or open stone surgery to be a valid option in complicated cases only when multiple endourological approaches have failed [<span>2</span>].</p><p>Torricelli et al. [<span>1</span>] should be commended for performing a randomised trial comparing URS and RLU treating large proximal stones. However, a randomised design alone is no guarantee for scientific quality, and the authors are correct in their suspicion of the study being underpowered. The power analysis made prior to study start returned a sample size of 49 patients in each group to detect a significant difference between the treatment arms. Despite this, only 64 patients were included in total. The authors advocate a lower sample size than calculated pointing out the SFR for RLU may be higher than anticipated. On the other hand, the authors’ assumption of SFR for URS being 75% is probably too low and in contrast to reports in other randomised studies [<span>3, 4</span>]. A higher and more realistic estimate for SFR in the URS group would in fact return a need for an even larger sample size. Lack of patients prevent detection of potential differences between the treatment groups as demonstrated in the present study. It is therefore still not known which treatment is better. On the other hand, given the reported results in the Torricelli et al. study [<span>1</span>], the differences between the two treatments may not be as large as anticipated after all.</p><p>Interesting to note, one in three of the patients had persistent hydronephrosis on CT scan at 3 months after surgery, and ureteric stricture was detected in one. The authors suggest longstanding obstruction prior to surgery as an explanation. This might well be true, but the signific","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.16522","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Holly A Roy, Christopher Roy, Heidi Tempest, Alexander L Green, Ricarda A L Menke
{"title":"Urinary continence networks in Parkinson's disease: a resting state functional MRI study.","authors":"Holly A Roy, Christopher Roy, Heidi Tempest, Alexander L Green, Ricarda A L Menke","doi":"10.1111/bju.16518","DOIUrl":"https://doi.org/10.1111/bju.16518","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079084","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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