BMC Urology最新文献

Purpose: To describe a novel single-position intraperitoneal laparoscopic surgery (SP-ILS) technique for radical nephroureterectomy (RNU) and bladder cuff excision (BCE) in the supine position.

Methods: Between January 2019 and June 2023, 40 patients with UTUC underwent laparoscopic RNU and BCE using the SP-ILS technique. Clinical, perioperative, and pathological data were retrospectively analyzed.

Results: All procedures were performed laparoscopically without patient repositioning. No intraoperative or postoperative complications occurred. The mean operative time was 101.0 ± 24.5 minutes, and mean estimated blood loss was 53 ± 27.0 mL. The median postoperative hospital stay was 4.2 ± 1.1 days. Postoperative pathology revealed Ta in 14 patients, T1 in 21 patients, and T2 in 5 patients. During a mean follow-up of 12.9 months (range, 2-24), one patient developed bladder recurrence.

Conclusions: The SP-ILS technique offers direct visualization, reproducible bladder cuff excision, and efficient single-position workflow during both LRNU and BCE.

Background: Malignancies of the adrenal gland account for a minority of adrenal incidentalomas, with metastases being more common than primary tumors. Cholangiocarcinoma, an aggressive malignancy of the bile ducts, rarely metastasizes to the adrenal gland, and to date, no cases of primary cholangiocarcinoma originating in the adrenal gland have been reported. This case presents a novel and unprecedented tumor origin, offering valuable insights into diagnostic challenges and the utility of molecular profiling in rare adrenal neoplasms.

Case presentation: A 44-year-old female with a history of hypertension, obstructive sleep apnea, and bariatric surgery presented with progressive voiding dysfunction. Imaging revealed a right adrenal mass with radiologic features suspicious of adrenocortical carcinoma. Biochemical evaluation for a functional tumor was unremarkable. She underwent laparoscopic adrenalectomy. Histopathology revealed metastatic adenocarcinoma with an immunoprofile initially suggestive of a pancreatic primary. However, further molecular analysis using AI-driven genomic profiling indicated a 91% probability of cholangiocarcinoma. Despite comprehensive post-operative imaging, including PET-CT and MRCP, no primary hepatic, pancreatic, or biliary tumor was identified, supporting the diagnosis of a primary adrenal cholangiocarcinoma. The patient was treated with six cycles of gemcitabine, cisplatin, and durvalumab, which was later discontinued due to thyroiditis. Follow-up imaging revealed no residual or metastatic disease.

Conclusions: This case represents the first known report of cholangiocarcinoma arising in the adrenal gland, broadening the differential diagnosis for adrenal incidentalomas. It underscores the critical role of advanced histopathologic and genomic profiling in evaluating atypical adrenal lesions, especially in patients without a known primary malignancy. Comprehensive diagnostic workup and a multidisciplinary approach are essential for accurate diagnosis and appropriate management of rare adrenal tumors.

Background: Laparoscopic ureterolithotomy (LU) is an effective option for managing large or impacted ureteral stones when other minimally invasive treatments are not feasible. However, data on outcomes and predictors of recovery after LU remain limited.

Methods: We retrospectively reviewed 40 patients who underwent LU at a single center. Clinical features, perioperative parameters, and outcomes were analyzed to identify predictors of prolonged hospitalization and postoperative pain.

Results: All patients achieved stone-free status, and no major intraoperative complications occurred. The mean hospital stay was 4.6 ± 3.5 days. Multivariate analysis showed that postoperative fever (p = 0.002), prior percutaneous nephrostomy drainage (PCND) (p = 0.009), and longer operative time (p = 0.048) independently predicted prolonged hospitalization. Severe postoperative pain was more likely in patients with preoperative acute kidney injury (AKI) (p = 0.015) and in those treated with the transperitoneal approach compared with the retroperitoneal approach (p = 0.022).

Conclusions: LU provides excellent stone clearance with minimal complications. Preoperative factors such as PCND and AKI, along with intraoperative choices like surgical approach, influence recovery outcomes. Identifying these predictors may guide perioperative management in LU.

Trial registration: Not applicable.

Purpose: To evaluate the efficacy and safety of flexible ureteroscopy (FURL) combined with flexible and navigable suction ureteral access sheaths (FANS) compared to conventional FURL for treating 1-2 cm complex lower calyceal stones.

Methods: A retrospective single-center study was conducted at the Affiliated Hospital of Shandong Second Medical University, analyzing patients treated between July 2023 and February 2025. Inclusion criteria were: (i) preoperative CT diagnosis of 1-2 cm single lower calyceal stones; (ii) preoperative intravenous urography (IVU) identifying direct insertion of minor calyces into the renal pelvis or branched fusion forming major calyceal openings; and (iii) surgeries performed by one fellowship-trained endourologist for procedural standardization. Exclusion criteria included: (i) uncontrolled preoperative urinary tract infections; (ii) significant ureteral strictures; (iii) severe cardiopulmonary dysfunction or coagulation disorders; (iv) unforeseen postoperative events unrelated to the procedure; and (v) incomplete perioperative data. Patients were divided into an intervention group (FURL with FANS) and a control group (standard FURL with conventional ureteral access sheath). Baseline characteristics, stone-free rates, operative time, hospital stay, and postoperative complications were compared using weighted t-tests, Chi-square tests, or Fisher's exact test.

Results: The study included 69 patients (intervention group, n = 36; control group, n = 33). After inverse probability of treatment weighting(IPTW) adjustment, baseline characteristics, including age, sex, BMI, stone size, and stone density, showed no significant differences between groups (P > 0.05). The intervention group demonstrated a significantly higher stone-free rate (75.5% vs. 48.9%, P = 0.010), defined as residual fragments < 4 mm on CT at postoperative day 30, shorter operative time (63.02 ± 8.17 min vs. 73.92 ± 15.56 min, P < 0.001), shorter hospital stay (3.15 ± 0.46 days vs. 5.16 ± 1.35 days, P < 0.001), and lower incidence of postoperative fever (0% vs. 12.5%, P = 0.047).

Conclusions: FURL combined with FANS offers superior efficacy and safety compared to conventional FURL for managing 1-2 cm complex lower calyceal stones. This approach resulted in higher stone-free rates, reduced operative times, shorter hospital stays, and fewer postoperative complications, presenting a promising alternative for this challenging condition. Larger, multicenter studies are needed to confirm these findings.

Background: Ureteral strictures pose significant challenges in urological surgery, requiring precise localization of stenotic segments for effective resection. Traditional rigid ureteroscopy-assisted techniques involve positioning limitations and procedural inefficiencies. This study evaluates the safety and efficacy of a novel approach combining flexible ureteroscopy and laparoscopy for ureteroureterostomy, focusing on improved intraoperative navigation and reduced procedural complexity.

Methods: A retrospective analysis was conducted in 12 patients (7 males, 5 females; median age 50 years) undergoing laparoscopic ureteroureterostomy with flexible ureteroscopy between July 2023 and August 2024. All strictures were located in the upper ureter (length: 8-23 mm). Key innovations included lateral positioning, a flexible ureteroscope sheath (external/internal diameter: 12 Fr /10 Fr), and real-time ureteral light guidance. Surgical parameters (operative time, blood loss), perioperative outcomes, and follow-up data (median 10 months) were analyzed. Biochemical recovery (serum creatinine normalization) and radiological recovery (urography patency) were primary endpoints.

Results: All procedures were completed without conversion to open surgery. Median operative time was 175 min (range: 130-225), with intraoperative bleeding of 22.5 mL (range: 20-50). Flexible ureteroscopy enabled repeated lumen verification (median 6 insertions) without ureteral trauma. Postoperatively, hydronephrosis resolved in all patients, with no anastomotic leaks or restenosis. Median hospital stay was 5.5 days (range: 3-9); one patient experienced transient fever. Biochemical and radiological recovery was achieved in all cases. Follow-up imaging (median 10 months) confirmed sustained ureteral patency and improved renal function.

Conclusions: The integrated flexible ureteroscopy-laparoscopy approach enhances surgical precision and efficiency for upper ureteral strictures, mitigating positioning limitations and reducing iatrogenic injury. While initial outcomes demonstrate safety and efficacy, long-term follow-up and prospective multicenter trials are warranted to validate durability. This technique represents a promising advancement in minimally invasive ureteral reconstruction.

Purpose: Super-mini percutaneous nephrolithotomy (SMP) is a promising minimally invasive approach for upper tract stone management. However, evidence on its performance using suction sheath and pneumatic lithotripsy in resource-limited setting remains scarce. The main objective of this study is to examine the efficacy and safety of SMP done exclusively with this combination.

Methods: Prospectively collected data of all eligible SMP cases done in two centers between March 2021 and February 2025 were retrospectively processed. After de-identification of the final data, descriptive and analytical statistics were used as appropriate. Regression models were then constructed to identify risk factors for complications.

Results: Total of 324 prone SMP procedures were performed on 319 patients. The mean stone volume, operating time and fluoroscopy beam-on time were 1473 mm³, 38 min, and 145 s respectively. The mean hemoglobin drop was 1.2 ± 0.9 gm% with 2.1% of patients requiring blood transfusion. Overall, stone-free rate was 96.9% at 1-month follow-up, minor complications (Clavien-Dindo ≤ II) being 13.4%, and major complications (Clavien-Dindo > II) being 2.2%. Multinomial regression analysis revealed operating time > 40 min, positive urine culture, and access through 10th intercostal space as significant predictors of complications. Limitation includes retrospective design, lack of computerized tomography for confirming stone-free status, and lack of intra-renal pressure monitoring.

Conclusion: SMP using a combination of suction sheath and pneumatic lithotripsy is a safe and effective treatment option for selected cases with upper tract lithiasis in resource-limited settings, with high stone clearance and acceptable complication rates.

Objective: Through the investigation of the current situation of bladder cancer secondary electrotomy performed by urologists in China, it provides reference for further improvement and improvement of diagnosis and treatment norms.

Methods: From September 3, 2023 to October 7, 2023, questionnaires compiled by researchers were distributed and collected from urologists across the country in the form of electronic questionnaires through the questionnaire Star platform; The questionnaire data were exported online using SPSS 26.0 software (SPSS Inc, Chicago, IL, USA) and R language (R Foundation for Statistical Computing, Vienna, Austria, Austria). Version 4.2.1) for data analysis. Count data were described by percentages, and comparisons between groups were made by chi-square test or Fisher's exact test. Logistic regression was used to screen out the influencing factors related to the status of secondary electrotomy for bladder cancer performed by Chinese urologists and to construct a predictive model for the column-line diagram. ROC curves, calibration curves, and DCA curves were plotted to evaluate the model and validate its efficacy.

Results: A total of 514 valid questionnaires were returned. 77.2% (397/514) of the physicians interviewed were from tertiary care hospitals. 21.2% (109/514) were from secondary care hospitals. The acceptance rate of secondary electrosurgical resection of bladder cancer among Chinese urologists was 87.74%, with 12.26% still opposed to the procedure.The majority of respondents believed that secondary electroresection could be performed if the indications recommended by the guidelines were met (75%), while a significant number felt that the initial electroresection was complete and did not require a second (37.74%), or they decided whether to perform a secondary electroresection based on their clinical experience (40.27%).

Conclusion: Survey results indicate that secondary transurethral resection enhances staging accuracy, eliminates residual lesions, and decreases recurrence and progression rates. However, it serves as a means to compensate for shortcomings in the initial resection. Advances in NMIBC treatment techniques assist in reducing or avoiding the need for secondary transurethral resection in bladder cancer cases. This study is the first to develop a predictive model for Chinese urologists' acceptance of secondary transurethral resection for bladder cancer and analyzes their perspectives on the procedure, offering a reference for future research.

Background: As one of the most common malignant tumors in men, prostate cancer (PCa) has garnered substantial research investment from the medical community. However, due to multiple challenges in diagnostic techniques and clinical practice, cases of missed diagnosis and misdiagnosis still persist.

Case presentation: This article presents a case of a 36-year-old male renal transplant recipient (RTR) who was initially misdiagnosed with prostatic abscess (PA) due to perineal discomfort, but was later confirmed to have PCa through surgery.

Conclusion: This case highlights the similarities in symptoms and imaging manifestations between PCa and PA, as well as the complexity involved in diagnosing PCa. Furthermore, the article particularly underscores the significance of being vigilant about the increased risk of PCa following kidney transplantation, employing clinical examination methods judiciously, and enhancing the ability to differentiate PCa.

Objective: To determine impact factors affecting intraoperative blood loss and fluid absorption by utilizing a novel endoscopic surgical monitoring system (ESMS) for objective quantification in high-risk benign prostatic hyperplasia (BPH) patients undergoing transurethral plasmakinetic resection of the prostate (PK-TURP).

Methods: This prospective cohort study enrolled 512 high-risk BPH patients undergoing PK-TURP. The ESMS was employed to monitor blood loss and fluid absorption in real-time and non-invasively during the surgery. Univariable and multivariable linear and logistic regression analyses were used to identify factors associated with blood loss (and > 300 ml) and fluid absorption (and > 1000 ml).

Results: Multivariable analyses showed prostate volume, operation time, resected tissue weight, venous sinus opening and present smoking (10-20cigs/d, > 20cigs/d) were independent risk factors of blood loss and fluid absorption (all P < 0.05). Surgical capsule perforation was a significant risk factor for fluid absorption (and > 1000 ml) (B:100.47, P=0.008; OR:2.917, P=0.015). Preoperative finasteride treatment (7days-3months, >3months) and surgeon's experience (50-250 procedures, 250-500 procedures, > 500 procedures) were factors associated with lower odds of blood loss and fluid absorption (all P < 0.05).

Conclusion: Prostate volume, operation time, resected tissue weight, venous sinus opening, and present smoking (10-20cigs/d, > 20cigs/d) increase the risk of blood loss and fluid absorption during PK-TURP in high-risk patients. Preoperative finasteride treatment (7days-3months, >3months) and surgeon's experience (50-250 procedures, 250-500 procedures, > 500 procedures) reduce these risks, while surgical capsule perforation significantly increases fluid absorption risk. The ESMS represents an innovative tool for real-time blood loss and fluid absorption monitoring, enabling precision identification of impact factors and enhancing perioperative decision-making.