To evaluate in a systematic review the outcomes, benefits, and limitations of robot-assisted surgeries for paediatric neurogenic lower urinary tract dysfunction (LUTD), as robot-assisted techniques have emerged as a potential alternative, offering enhanced precision, dexterity, and visualisation.
This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier CRD42023464849) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies of paediatric patients (aged <18 years) with neurogenic LUTD undergoing robot-assisted continence surgery, assessing safety and efficacy. Literature searches in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Scopus were conducted until 12 July 2024. Data extraction included surgical procedures, complications, operative times, lengths of stay, and bladder function outcomes.
A total of 42 studies (20 case reports, 10 case series, six cohort studies, six comparative cohort studies) were included. Robotic procedures for continent catherisable channel construction, augmentation cystoplasty, and bladder neck reconstruction showed comparable peri- and postoperative outcomes. Meta-analysis of five studies comparing robotic vs open appendicovesicostomy indicated a significant reduction in length of stay for robotic groups, while operative time, complications, and re-intervention rates were not significantly different. Conversions to open surgery were rare, indicated by adhesions or small appendices during channel constructions.
Robot-assisted surgeries for paediatric neurogenic LUTD demonstrate potential benefits, including reduced hospital stays and comparable complication rates to open surgery in certain contexts. However, the available evidence is limited by heterogeneity in study designs, small sample sizes, and single-centre experiences, which constrain generalisability. Standardised reporting of complications and outcomes, alongside multicentre studies, is essential to clarify the long-term efficacy and broader applicability of these techniques.
To compare postoperative complication rates of patients with metabolic syndrome (MetS) with patients without MetS after holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH).
We retrospectively reviewed patients aged >40 years who underwent HoLEP at our institution from 2007 to 2022. Criteria for MetS were diagnoses of at least three of the following: diabetes mellitus, hypertension, hyperlipidaemia, or obesity (body mass index ≥30 kg/m2). Uni- and multivariable logistic regression were used to compare the likelihood of immediate, 30-day, and 90-day complications between groups.
A total of 1500 patients were included with a median (interquartile range) age of 70 (65–76) years. Patients with MetS were more likely to develop complications at both 30 and 90 days, including urinary incontinence, irritative voiding symptoms, and bleeding (P < 0.001). After adjusting for potential confounders, patients with MetS had a greater than three times odds of both 30- and 90-day complications compared to patients without MetS (30-day adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 2.21–5.01, P < 0.001; and 90-day aOR 3.64, 95% CI 2.49–5.31, P < 0.001).
Metabolic syndrome was associated with a three-fold likelihood of 30- and 90-day complications after HoLEP. This could be an important factor to consider in preoperative counselling and patient selection.
To conduct the first meta-analysis using only prospective studies to evaluate whether video endoscopic inguinal lymphadenectomy (VEIL) offers advantages in perioperative outcomes compared to open IL (OIL) in patients with penile cancer.
A systematic review with meta-analysis was conducted across multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Latin America and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, and several trial registries up to June 2024. Only randomised controlled trials (RCTs) and prospective cohort studies were included. Data extraction focused on operative time, perioperative complications, drainage time, hospital stay, number of nodes retrieved and oncological outcomes.
Four prospective studies, including three RCTs and one non-randomised study, were included in the analysis, totalling 95 patients and 174 operated limbs. VEIL demonstrated significantly fewer wound infections (P < 0.001; 95% confidence interval [CI] 0.01–0.18; I2 = 0), skin necrosis (P = 0.002; 95% CI 0.04–0.49; I2 = 0), and lymphoedema (P = 0.05; 95% CI 0.09–0.99; I2 = 27%) compared to OIL. The VEIL group also had a shorter drainage period (P = 0.001; mean difference [MD] –1.94, 95% CI −3.15 to −0.74) and hospital stay (P < 0.01; MD –5.48, 95% CI −6.34 to −4.62). Pain intensity and operative time were lower in the VEIL group, contributing to fewer postoperative complications overall. Oncological outcomes showed no significant differences between the groups.
The meta-analysis indicates that VEIL offers significant advantages over OIL in terms of reducing wound infections, skin necrosis, and lymphoedema, leading to shorter hospital stays and overall improved perioperative outcomes. However, the limited sample of 95 patients across four studies underscores the need for further randomised trials and a cautious interpretation of the results, which currently support the use of VEIL in managing patients with penile cancer.
To identify associations between 24-h urine abnormalities and clinical risk factors for recurrent stone formers.
The Registry for Stones of the Kidney and Ureter was queried for all patients who underwent 24-h urine studies. Patients were categorised by the number of clinical risk factors for recurrent stone disease. Stone recurrence was calculated by stone events per person-year. We utilised a novel method to calculate an overall severity score for 24-h urine parameters. The stone recurrence and 24-h urinary analyte values were then compared using Student's t-tests, chi-square analysis and negative binomial regression.
A total of 614 stone patients met our inclusion criteria and were categorised by the number of clinical stone risk factors. On adjusted and unadjusted analysis, an escalating number of clinical risk factors predicted increased stone recurrence risk. However, there were no differences in mean 24-h urine analyte values amongst these groups aside from higher urinary calcium. However, after calculation of a 24-h urine severity score there was a significantly higher mean severity as the number of clinical risk factors increased. This severity score also independently predicted stone recurrence on adjusted negative binomial regression.
Utilising a novel 24-h urine scoring system, we showed that higher-risk stone patients have more severe 24-h urine characteristics, which was not apparent using conventional analysis. Both the severity score and clinical characteristics independently identified those at risk of stone recurrence.
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