BMC Urology最新文献

Objective: This randomized controlled trial evaluated the clinical efficacy of super-lubricous Foley catheters in reducing urethral complications during indwelling catheterization. Focusing on addressing friction-induced injuries, the study assessed four outcomes: 1) urethral adverse reactions; 2) urethral trauma and inflammatory responses; 3) patient comfort; and 4) post-removal voiding symptoms.

Methods: A total of 114 patients from a tertiary hospital (December 2023-June 2024) were randomly allocated into two arms: 57 individuals in the experimental arm were treated with super-lubricous Foley catheters, whereas the same number in the control arm received conventional catheters. Primary outcomes included bladder irritation and urethral pain. Secondary outcomes encompassed urethral injury (red blood cells and epithelial cells), inflammation (white blood cells), comfort metrics (activity restriction, sleep disturbance, anxiety), and voiding parameters (dysuria, urinary hesitation, incomplete bladder emptying and lower abdominal pain).

Results: The baseline data revealed no statistically meaningful differences between the two groups. (all P > 0.05). The experimental group demonstrated significantly lower overall rates of bladder irritation (31.6% vs. 50.9%, P < 0.05) and urethral pain during catheterization (14.0% vs. 31.6%, P < 0.05). Notably, urinary epithelial cells (median 6 vs. 13.5/HP) and leukocytes (31 vs. 81/μL) were reduced in the experimental group (P < 0.05). Activity restriction rates decreased significantly (42.1% vs. 68.4%, P < 0.05), and first void volume improved (200 vs. 150 mL, P < 0.05). There were no meaningful differences between groups in the occurrence of the four urination-related symptoms-including dysuria, urinary hesitation, incomplete bladder emptying, and lower abdominal pain (all P > 0.05).

Conclusion: Super-lubricous Foley catheters effectively mitigate bladder irritation, urethral trauma, and inflammation while enhancing patient mobility. However, they show limited efficacy in alleviating post-removal voiding dysfunction. These findings support the clinical adoption of super-lubricous Foley catheters for reducing catheterization-related complications.

Trial registration: This study was a randomized controlled trial registered at Chinese Clinical Trial Registry (ChiCTR2300078483, https://www.chictr.org.cn/ ) on 11 December 2023.

Background: This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with medium-sized (10-20 mm) renal pelvic stones.

Methods: This retrospective cohort study, data of 718 patients who underwent SWL for urinary tract stones were analyzed and single, unilateral, radio-opaque renal pelvic stones were included in the study. Patient age, sex, stone side, shape (round/non-round), size, surface area (SA), and presence of hydronephrosis were recorded. Patients were divided into two groups depending on the presence of steinstrasse: Group 1 (with steinstrasse) and Group 2 (without). Demographic, clinical, and radiological parameters were compared between the groups.

Results: The mean age of the patients was 50.8 ± 11.2 years. The average number of SWL sessions was 2 (range 1-4). Group 1 included 12 patients (23.1%), while Group 2 comprised 40 patients (76.9%). The mean SA in Group 1 was significantly higher than in Group 2 (145.43 vs. 111.69 mm²; p = 0.044). Round stones were more frequently observed in Group 1, whereas non-round stones predominated in Group 2 (83.3% vs. 62.5%, respectively; p = 0.008). The overall SWL success rate was determined as 76.9%. Logistic regression analysis revealed that round stones increased the risk of steinstrasse by 8.333 times (OR = 8.333, 95% CI = 1.604-43.288, p = 0.012).

Conclusions: SA was higher in patients who developed steinstrasse. Since the likelihood of steinstrasse formation is elevated in medium-sized round renal pelvic stones, pre-stenting may be appropriate.

Background: Mortality remains high among patients with end-stage renal disease (ESRD) on maintenance hemodialysis despite advances in dialysis technology. This study aimed to investigate the causes of death and identify factors associated with survival in a Chinese hemodialysis population.

Methods: We conducted a single-center retrospective cohort of deceased maintenance hemodialysis patients. Eligible patients had received thrice-weekly hemodialysis for ≥ 3 months prior to death; peritoneal dialysis, transplant during follow-up, and incomplete records were excluded. Subgroup analyses compared survival by age (< 60, 60-70, 70-80, > 80 years), dialysis duration (< 1, 1-5, 5-10, > 10 years), and sex using Kaplan-Meier curves with log-rank tests. Cox models assessed factors associated with all-cause mortality; logistic regression evaluated correlates of cardiovascular death.

Results: A total of 194 patients were included. The mean age was 71.35 ± 13.05 years, with males accounting for 60.8%. Leading causes of death were cardiovascular (29.9%), cerebrovascular (19.6%), and infection (16.5%). Female sex and longer dialysis vintage showed better survival (log-rank p = 0.048 and p < 0.0001, respectively). The 60-70 years age group demonstrated the best survival profile (p = 0.023). Among patients with documented comorbidity data, hypertension was present in 73/73 (100%) and diabetes mellitus in 82/82 (100%). Higher LDL-C and pre-dialysis hyperkalemia were associated with cardiovascular death (OR 1.37, 95% CI 1.10-1.72, p = 0.005 and OR 2.19, 95% CI 1.08-4.45, p = 0.031, respectively), while lower albumin and higher CRP were associated with infection-related death (p = 0.037 and p = 0.024, respectively).

Conclusions: Cardiovascular and cerebrovascular diseases remain the leading causes of death in hemodialysis patients. Sex, age, serum albumin, LDL-C, and inflammatory markers were associated with survival outcomes. Understanding these associations may help develop targeted interventions to improve survival in hemodialysis patients.

Background: To explore the possible impact of real-time ultrasound screen visualization on pain perception, anxiety levels, and overall patient experience during transperineal prostate biopsy (TPBx) performed under local anesthesia.

Materials and methods: The prospective observational study was conducted at two medical centers. Patients were allocated into two groups: a control group (n = 59), which did not receive visual feedback, and a display group (n = 63), which observed the ultrasound screen with concurrent procedural explanations. Pain was assessed using the Visual Analog Scale (VAS), while anxiety levels were measured with the Spielberger State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI). Patient satisfaction and willingness to undergo repeat biopsies were also evaluated.

Results: A total of 122 patients were included. The display group reported significantly lower overall procedural pain (VAS: 2.46 ± 1.28 vs. 3.08 ± 1.49, p = 0.005) and reduced post-procedure anxiety (STAI-1: 44.6 ± 8.8 vs. 49.5 ± 9.2, p = 0.001). Additionally, patient satisfaction scores were significantly higher in the display group (8.00 [6-9] vs. 5.00 [4-7], p < 0.001), along with an increased willingness to undergo repeat biopsy (8.00 [4-10] vs. 5.00 [2-8], p = 0.002).

Conclusion: Real-time ultrasound screen viewing during TPBx under local anesthesia was associated with statistically significant reductions in pain and anxiety scores. However, considering the study's non-randomized design and the modest magnitude of VAS change, the clinical relevance of this difference should be interpreted with caution. This simple and low-cost approach may help improve patient comfort and procedural compliance, but further randomized studies are needed to confirm its effectiveness.

Purpose: Horseshoe kidney (HSK) with ureteropelvic junction obstruction (UPJO) is a rare clinical condition. For successful pyeloplasty in these patients, preoperative anatomic mapping is crucial. Therefore, we investigated the utility of three-dimensional (3D) image reconstruction technology for accurate preoperative and intraoperative procedure planning.

Methods: We retrospectively investigated the surgical outcomes of 6 patients who underwent laparoscopic pyeloplasty (LP) for HSK-associated UPJO at our hospital between October 2017 and October 2019. Next, we examined the concordance between intraoperative findings and 3D images reconstructed with SYNAPSE VINCENT^® software.

Results: Preoperative 3D-CT imaging clearly visualized the unique anatomy of HSK, including arteries and veins, and the vessels crossing the UPJ anteriorly could be detected before surgery in 5 of 6 patients. Importantly, these images completely coincided with intraoperative findings. In fact, no intraoperative complications or conversions to open surgery were needed. Moreover, all patients are currently asymptomatic and have no major sequelae at a mean follow-up of 29.9 months (range 15.4 to 39.7).

Conclusions: The present study suggests the potential utility of 3D image reconstruction technology in performing LP through detailed preoperative mapping of complex renal anatomies, such as in HSK.