BMC Urology最新文献

Purpose: To evaluate the safety and feasibility of intraperitoneal laparoscopic surgery in Trendelenburg position (ILSTP) for pyelolithotomy, pyeloplasty, and heminephrectomy in patients with horseshoe kidneys (HSKs).

Methods: Between March 2021 and March 2024, three patients with HSKs underwent ILSSP. Of these three patients, two with pelvi-ureteric junction obstruction with recurrent kidney stones underwent pyelolithotomy and pyeloplasty, one with symptomatic nonfunctioning left moiety of a HSK was managed with heminephrectomy.

Results: Mean operating time was 114 ± 64.8 (44-172) min, and estimated blood loss was 63.3 ± 51.3 (20-120) ml. The mean hospital stay was 3.3 ± 1.5 (2-5) days. There were no major intra- or post-operative complications.

Conclusions: ILSTP is a feasible and effective technique for performing pyelolithotomy, pyeloplasty, and heminephrectomy in patients with HSKs.

Objective: To investigate the feasibility of transvaginal posterior levatorplasty combined with perineoplasty (TPLP) for women with primary stress urinary incontinence and demonstrate the surgical technique with step-by-step procedures.

Methods: A prospective, non-randomised study was conducted using technique of TPLP to treat female primary SUI from January 2019 to December 2021. Patient follow-up was performed at 3 and 12 months posteroperatively. A series of validated questionnaires were used to evaluate the improvement of symptom severity, sexual function and quality of life. In addition, 4-D ultrasonography was used to measure the anatomic changes of pelvic structures.

Results: A total of 47 patients were enrolled in this study with a mean age of 43.6 years. Mean operative time was 78.7 min. Median estimated intraoperative blood loss was 80.2 ml. Objective cure and subjective cure rates were 87.2% and 91.5%, respectively. Compared with baseline, scores of quality of life, symptom severity and sexual function improved after surgery. Meanwhile, mobility of the urethra and bladder neck and areas of levator hiatus were decreased after surgery. Mild coitus pain was reported in 15.4% (6/39) patients at the initial several times of intercourse after resuming sexual activity.

Conclusions: This study shows that transvaginal posterior levatorplasty combined with perineoplasty appears to be an effective surgical method for selected women with primary stress urinary incontinence.

Background: To explore the feasibility and safety of aflexible ureteroscopy with intelligent control of renal pelvic pressure(FUS-ICP) without a post-operative indwelling urinary catheter .

Methods: In this retrospective study, we assessed patients with upper urinary tract stones who were treated with FUS-ICP at the Ganzhou People's Hospital from February 2022 to December 2023. Patients were divided into the non-urinary catheter (non-UC) and urinary catheter (UC) groups according to whether an indwelling catheter was used after surgery.

Results: In total, 142 patients were included in the study. There was no significant difference in the preoperative general data between the two groups. Patients in the non-UC group performed better than those in the UC group in terms of catheter-related bladder irritation (P = 0.001), the Sedation-Agitation Scale score (P = 0.012), and the numerical rating scale (P = 0.003). The incidences of urinary retention (P = 0.620), urinary tract infection (P = 0.529), and replacement of urethral catheter s (P = 0.438) in the UC group were inferior to those in the non-UC group, but there was no statistical significance.

Conclusions: It is feasible and safe to perform FUS-ICP without a post-procedure indwelling urinary catheter.

Background: To evaluate accuracy of MRI-based radiomics in diagnosing prostate cancer (PCa) in patients with PSA levels between 4 and 10 ng/mL and compare it with the latest Prostate Imaging Reporting and Data System (PI-RADS v2.1) score.

Methods: 221 patients with prostate lesions and PSA levels in 4-10 ng/mL, including 154 and 67 cases in the training and validation groups. Pathological confirmation of all patients was accomplished by the use of MRI-TRUS fusion targeted biopsy or systematic transrectal ultrasound (TRUS) guided biopsy. 851 radiomic features were extracted from each lesion of ADC and T2WI images. The least absolute shrinkage and selection operator (LASSO) regression algorithm and logistic regression were employed to select features and build the ADC and T2WI model. The combined model was obtained based on the ADC and T2WI features. The clinical benefit and diagnostic accuracy of the three radiomics models and PI-RADS v2.1 score were evaluated.

Results: 10 radiomic features were ultimately selected from the ADC images, 13 from the T2WI images and 7 from the combined models. The ADC, T2WI and combined models achieved satisfactory diagnostic accuracy in the training [AUC:0.945 (ADC), 0.939 (T2WI), 0.979 (combined)] and validation groups [AUC: 0.942 (ADC), 0.943 (T2WI), 0.959 (combined)], which was significantly higher than those in PI-RADS v2.1 model (0.825 for training cohort and 0.853 for validation cohort). Compared with the PI-RADS v2.1 score, the three radiomics models generated superior PCa diagnostic performance in both the training (p = 0.002, p = 0.005, p < 0.001) and validation groups (p = 0.045, p = 0.035, p = 0.015).

Conclusion: Radiomics based on ADC and T2WI images can better identify PCa in patients with PSA 4-10 ng/mL, and MRI-based radiomics significantly outperforms the PI-RADS v2.1 score.

Clinical trial number: Not applicable.

Objective: The primary objective of this clinical trial is to investigate the effect of low-intensity pulsed ultrasound (LIPUS) on patients suffering from comorbid erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).

Methods: The clinical trial was conducted in the andrology outpatient treatment room of the Department of Urology, Xiangya Hospital, Central South University from August to November 2022 A total of 60 patients who met the research criteria for comorbid ED combined with CP/CPPS were recruited and randomly assigned to three treatment groups. They were treated with LIPUS (Group A), drug therapy(Group B), and LIPUS combined with drug therapy (Group C), respectively. Each group comprised 20 patients. Statistical analysis was performed on the five-item version of International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the incidence of adverse events to comprehensively evaluate the efficacy and safety of LIPUS.

Results: The positive response rate of ED and CP/CPPS treatment in Group A is 40%(8/20) and 45%(9/20), while those in Group B is 55%(11/20) and 60%(12/20), and those in Group C is 85%(17/20) and 85%(17/20). A notable increase in IIEF-5 scores was observed across the three groups post-treatment (10.45 ± 2.50 vs. 13.65 ± 3.03, P = 0.008; 11.80 ± 3.21 vs. 16.40 ± 3.20, P = 0.011; 12.90 ± 3.92 vs. 19.40 ± 2.35, P = 0.042) with a concomitant significant decrease in NIH-CPSI scores (16.75 ± 4.53 vs. 14.65 ± 4.51, P = 0.016; 16.35 ± 4.32 vs. 12.20 ± 4.74, P = 0.007; 16.00 ± 4.40 vs. 8.15 ± 4.28, P = 0.021). Notably, the most pronounced changes were seen in the group receiving LIPUS combined with tadalafil and doxazosin. Additionally, all groups exhibited marked improvements in anxiety and depression symptoms post-treatment. No adverse events were observed during treatment.

Conclusion: LIPUS can improve erectile function and CP/CPPS symptoms with good safety, and LIPUS combined with tadalafil and doxazosin is more effective during the treatment. However, its long-term efficacy remains to be seen.

Trial registration: Chinese Clinical Trial Registry; approval number: ChiCTR2200063038 ( https://www.chictr.org.cn/ ) on August 29, 2022.

Background: Laparoscopic surgery is associated with a lower morbidity than open surgery. No recent data compared kidney cancer surgery in the French population using the National Health Insurance database (PMSI-MCO).

Aims: We explore and compare the surgical morbidity rates between laparoscopic and open laparotomy for kidney cancer.

Methods: The initial length of stay and complications parameters during the three postoperative months were described for renal cancer in every French center in 2018. We compared Relative Risks (RR [95% CI]) between laparoscopic and open surgery for both radical and partial nephrectomy.

Results: Among 8,162 patients, 3,525 had a radical nephrectomy, 978 open, 2,547 laparoscopic surgeries; 4,637 patients had partial nephrectomies, 1,778 open 2,859 laparoscopic surgeries. For radical surgery, the most common complications were urinary infections (7.8%), acute renal failure (8.9%), sepsis (8.4%), bleeding (9.3%), and postoperative anemia (5.9%); the RR for laparoscopic versus open surgery were respectively 0.68 [0.54;0.86], 0.71 [0.57;0.88], 0.69 [0.55;0.86], 0.83 [0.66;1.03], 0.56 [0.43;0.73]. For partial nephrectomies, the most common complications were urinary infections (7.7%), bleeding (11.6%), and postoperative anemia (5.8%), with RR of 0.71 [0.58;0.87], 0.61 [0.52;0.71], and 0.64 [0.51;0.81]. The mean length of stay was 7.7 for open radical nephrectomy, 6.3 for laparoscopic radical nephrectomy, 7.5 for open partial nephrectomy, and 5 for laparoscopic partial nephrectomy.

Conclusions: The laparoscopic approach had fewer postoperative complications and a shorter length of stay than open surgery for partial and radical nephrectomy. The PMSI analysis provided an exhaustive description of surgical practice for kidney cancer and surgical complications in France.

Clinical trial number: Not applicable.

Background: Nephroureterectomy with bladder cuff excision is the standard treatment for high-risk upper urinary tract urothelial carcinoma (UTUC). The role of minimally invasive surgery in treating locally advanced UTUC remains controversial. This study aimed to compare the outcomes of open, laparoscopic, and robotic surgeries for managing locally advanced UTUC.

Methods: We retrospectively reviewed 705 patients with locally advanced UTUC from multiple institutions throughout Taiwan. Perioperative outcomes and oncological outcomes, such as cancer-specific survival, overall survival, disease-free survival and bladder-free survival, were compared between the open, laparoscopic and robotic groups.

Results: The minimally invasive group had better overall and cancer-specific survival (CSS) rates. The 2-year CSS rates of the open, laparoscopic and robotic groups were 71%, 83%, and 77% respectively (p < 0.001). The robotic group had similar outcomes to the laparoscopic group. (p = 0.061, 0.825, 0.341 for OS, CSS, DFS respectively.) More lymph node dissections were performed and more lymph nodes were harvested in the robotic group (p = 0.009).

Conclusions: Our results demonstrated that minimally invasive surgery, including laparoscopic and robotic surgery, for locally advanced UTUC resulted in oncological outcomes that are non-inferior to those of open surgery.

Background: This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones.

Methods: The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared.

Results: PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p < 0.05).

Conclusions: The application of navigation system based on deep learning and mixed reality in PNL for kidney stones allows for real-time intraoperative navigation, with acceptable accuracy and safety. Most importantly, this technique is easily mastered, particularly by novice surgeons in the field of PNL.

Polyorchidism is an uncommon congenital condition often discovered incidentally, which may significantly impact male fertility. We present a case of a 34-year-old man with unilateral polyorchidism and associated severe asthenozoospermia and teratozoospermia. Despite normal hormonal levels and no detected genetic anomalies, the patient's sperm showed mitochondrial damage, and his fertility remained compromised after conservative management and assisted reproductive attempts. This case underscores the intricate relationship between polyorchidism and male infertility, highlighting the need for personalized management strategies and further research into its etiology and impact.

Background: For renal hilar angiomyolipoma, general surgical resection is often quite challenging. The aim of this study is to evaluate the safety and efficacy of an innovative robot-assisted laparoscopic strategy that combines tumor enucleation with tumor aspiration in the treatment of renal hilar angiomyolipoma.

Methods: The clinical data of 38 patients with renal hilar angiomyolipoma who went through robotic tumor enucleation combined with tumor aspiration in the Department of Urology, the Affiliated Hospital of Nanjing University Medical School, from December 2019 to December 2022 were retrospectively analyzed. The basic characteristics, the perioperative variables, intraoperative procedures, and postoperative complications were all recorded. Patients were followed up to evaluate the angiomyolipoma recurrence and the renal function by urologic CT or ultrasound and renal function tests.

Results: All surgeries were successfully completed without conversion to radical nephrectomy or open surgery. One patient developed urinary extravasation 10 days after surgery, and was readmitted to the hospital for transurethral ureteral stenting considering the injury of the renal collecting system. The median operative time was 181.5 (123.8-206.3) min, the warm ischemia time was 20.0 (17.3-24.0) min, the blood loss was 125 (100.0-262.5) ml, and no patients received blood transfusion during and after surgery. The median hospitalization time was 7.0 (6.0-9.0) days, and the duration of indwelling drainage tube was 2.0 (2.0-3.0) days. The serum creatinine (Scr) on the first day, 3 months, and 6 months after surgery were 55.5 (50.8-62.8) µmol/L, 55.5 (48.0-62.0) µmol/L and 54.0 (51.8-63.5) µmol/L, respectively, and there was no significant difference compared with the preoperative level 56.0 (47.8-60.3) µmol/L. All patients were followed up after surgery, and the urinary CT scan or renal color doppler ultrasound, and renal function were reexamined. The median follow-up time of all patients was 19.0 (14.75-33.0) months, and no local recurrence of angiomyolipoma was seen in all patients.

Conclusions: The surgical strategy of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration is safe and effective in the treatment of renal hilar angiomyolipoma.