Central European Journal of Urology最新文献

Introduction: Over the last few years, trends in managing benign prostatic hyperplasia (BPH) have improved, advancing from reliance on surgery to satisfactory medical therapies. However, the efficacy and safety of combination therapies, including silodosin and tadalafil, are not well established compared to monotherapy for treating lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO).

Material and methods: A systematic search was conducted in PubMed, ScienceDirect, Cochrane Library, and Scopus up to April 1, 2024. The quality of the studies was assessed using The Cochrane Risk of Bias (RoB) Tools 2 and Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E). Meta-analysis was conducted using RevMan 5.4.

Results: A total of 1,300 records were screened, resulting in 7 final studies. Our meta-analyses showed that international prostate symptom score (IPSS), maximum urine flow rate (Q_max), and post-void residual volume (PVR) led to considerably greater improvements with the combination of silodosin and tadalafil compared to using either as monotherapy. However, combination therapy notably exhibited higher rates of adverse events (AE). On the other hand, as monotherapy, silodosin demonstrated a statistically significant improvement in Q_max (p = 0.006) and PVR (p = 0.02) over tadalafil but with higher rates of total AE, discontinuation, and risk of retrograde ejaculation.

Conclusions: Silodosin and tadalafil are effective for treating LUTS in men due to BPO, especially when used in combination. However, with concerns about safety, tadalafil as monotherapy offers an advantage for patients with fertility desires due to its favorable side effect profile.

Introduction: Aim of the study was to evaluate and illustratively depict the aspiration properties of a single-use 7.5 Fr flexible ureteroscope with direct-in-scope suction (DISS) in a specifically designed in vitro setting.

Material and methods: An experimental in vitro study using a 6.5 size sterile glove, natural stone fragments and part of a porcine ureter was performed. A single use 7.5 Fr digital flexible ureteroscope with integrated direct-in-scope suction (PU3033AH, Zhuhai Pusheng Medical Technology Co., Ltd., Zhuhai China) was used for all trials. Five stone fragments ranging from 3 to 5 mm in maximal diameter were used. For each stone, three trials were performed; stones placed in the upper, middle and lower calyx. The experimental trial was defined as partially successful if stone relocation using suction (SRS) was present and successful when subsequent evacuation was reported.

Results: Relocation of stone fragments (partial success) was observed for all stones in different locations. Easy evacuation of the 3 mm stone fragment occurred from all calyces. Complete success was also reported for all 4 mm stones. Complete success was documented with the 5 mm stone positioned in the upper and middle calyces, whereas evacuation of the stone from the lower calyx was not achieved after 5 attempts.

Conclusions: With the 7.5 Fr Pusen DISS integrated scope, stone fragments 3-5 mm in all calyces were successfully relocated. Whilst evacuation from any calyx was successfully done in 3-4 mm fragments, this was only possible for 5 mm fragments located in upper calyx or interpolar region. The lower pole and greater fragment size need further evaluation for optimal management by DISS.

Introduction: Nocturnal enuresis (NE) is defined as the involuntary passage of urine during sleep in children over the age of five. Although the precise mechanisms of NE are unclear, factors like delayed development, genetic influences, excessive nighttime urine production, disrupted sleep, and bladder dysfunction play a role. This study aims to evaluate the role of comorbidities in NE and develop a scoring system to predict treatment response, with clinical applications.

Material and methods: We recruited 374 patients aged 5-18 years undergoing pharmacological treatment (single or combined) for NE. Demographic and clinical data were collected through parent interviews. Statistical analyses included descriptive statistics and categorical analysis using χ² tests, followed by logistic regression.

Results: Statistical associations were found between recurrence and learning disorders (χ² = 4.862, p = 0.027), and between treatment response and learning disorders, encopresis, polythelia, language delay, and snoring. Logistic regression identified learning disorders (OR = 3.023), encopresis (OR = 2.156), polythelia (OR = 2.196), language delay (OR = 2.137), and snoring (OR = 1.560) as predictors of poor treatment response. We propose the PiFe score, a clinical tool to predict treatment outcomes in children with NE. This score integrates factors such as comorbidities, age, and symptom severity, helping to guide multidisciplinary interventions.

Conclusions: This study emphasizes the importance of a holistic approach to managing NE. The PiFe score could be a useful tool for predicting treatment outcomes and guiding interventions. Further research is needed to validate and refine the scoring system.

Introduction: Immunonutrition plays a major role in the prehabilitation of patients undergoing radical cystectomy for bladder cancer. The aim of this study was to familiarize practitioners familiarize current clinical research on the nutritional preconditioning of patients prior to surgery.

Material and methods: A systematic literature review was conducted in PubMed database. Out of 25 records identified, 7 studies were included. Only 1 of these was a randomized controlled trial.

Results: Immunonutrition has been associated with a reduction in postoperative complications and hospital length of stay, as well as improvements in postoperative bowel function. It may also contribute to modulating the inflammatory response.

Conclusions: Nutritional prehabilitation may positively influence postoperative outcomes following radical cystectomy. However, further randomized controlled trials are necessary to provide more robust and reliable evidence in this field.

Introduction: The use of ureteral access sheaths (UASs) is an issue of contention among urologists, with their efficacy unclear in retrograde intrarenal surgery (RIRS). Therefore, we performed a systematic review and meta-analysis to assess RIRS with laser lithotripsy for the treatment of urolithiasis with and without the use of UASs.

Material and methods: A systematic literature search was conducted in July 2023 using MEDLINE, EMBASE and the Cochrane library. The quality of the included studies was assessed using the Newcastle-Ottowa scale and Cochrane collaboration risk of bias tool. The primary outcome measures were stone-free rate (SFR), and post-operative complications. Secondary outcomes were operative time (OT), hospital length of stay (LOS) and ureteral injury rate. Effect sizes were calculated by pooled risk ratios (RRs) and mean differences (MDs) with confidence intervals (CIs).

Results: In total, 16 studies met the inclusion criteria. There were 3,123 participants who had RIRS with a UAS and 1,478 without. Pooled analysis revealed no significant difference between groups in SFR (RR = 1.03, 95% CI: 0.99-1.07), complication rate (RR = 1.31, 95% CI: 1.00-1.73), ureteral injuries (RR = 1.13, 95% CI: 0.77-1.65) or LOS (MD = -0.01, 95% CI: from -0.08 to 0.11). OT was significantly longer in the UAS group (MD = 0.35, 95% CI: 0.01-0.7).

Conclusions: The results of this meta-analysis demonstrate that the use of UASs during RIRS does not improve post-operative outcomes and is associated with a longer OT. While there are still times where the use of UASs may be beneficial, their routine use for patients undergoing RIRS is not currently indicated.

Introduction: Our experimental in vitro study aimed to evaluate the impact of four power settings with different energy and frequency combinations on the irrigation fluid temperature using the thulium fiber laser (TFL). In addition, we aimed to identify the differences between the Ho: YAG laser and TFL by direct comparison of the same power settings.

Material and methods: All measurements were performed with a fluid volume fixed at 10 ml and an outflow rate at 10 ml/min. The laser was fired continuously for 30 seconds with total power settings of 10 W, 20 W, 40 W, and 60 W with different power settings (energy × frequency) and various pulse combinations using TFL and Ho: YAG laser (Quanta System, Samarate, Italy).

Results: Higher temperatures were recorded when the power was increased from 10 W, 20 W, 40 W, to 60 W. The temperature exceeded the threshold of 43°C when power settings of ≥40 W were applied regardless of frequency (15-120 Hz) and energy (0.5-4 J). Similar temperature increase patterns were reported with different peak power settings. No major differences were found when the same power settings were applied using TFL and Ho: YAG lasers.

Conclusions: Based on our results temperatures >43°C were recorded for power settings ≥40 W after continuous laser firing of 30 seconds using TFL. Modifying the frequency and energy settings, as well as firing with Ho:YAG laser under the same power setting did not affect the patterns of temperature increase. Generally, the TFL shows more regular thermal behavior in comparison with the Ho:YAG laser.

Introduction: The aim of this study was to evaluate the prognostic impact of favourable prostate cancer (PCa) pathology patterns through Briganti's 2012 nomogram and beyond EAU risk classes in patients treated with robotic surgery.

Material and methods: We analysed 757 patients from January 2013 to December 2021 with favourable pathology features (ISUP 1-3, pT2/pT3a, and pN0/x) and available follow-up. Pathologic features were scored from zero (ISUP 1 + pT2) to three (ISUP 3 + pT3a). Associations with Briganti's 2012 nomogram by EAU risk class were evaluated to determine the prognostic impact on PCa progression, defined as biochemical persistence/recurrence or loco-regional/metastatic recurrence.

Results: Favourable pathology risk scores were most commonly grades one (49%) and two (30.95%), followed by zero (15.2%) and three (4.9%). After adjusting for EAU prognostic groups, higher nomogram scores were associated with increased risk scores of two and three. PCa progression occurred in 12.7% of cases after a mean follow-up of 92.1 months. Patients with recurrence had a worse prognosis as risk scores increased from one to three, even after adjustment for Briganti's 2012 nomogram by EAU class.

Conclusions: Favourable pathology risk scores, grouped by Briganti's 2012 and EAU nomograms, impact prognosis. As scores increase, the likelihood of disease progression rises, potentially influencing treatment strategies.

Introduction: Data on holmium laser enucleation of the prostate (HoLEP) in men ≤60 are limited. This study aimed to characterize the clinical presentation and outcomes of this population.

Material and methods: This retrospective study comprised 750 consecutive HoLEPs between 1/2020 and 11/2024. Patients were categorized by age: ≤60, 61-70, 71-80, and >80 years. The data retrieved from the medical records included age, International Prostate Symptom Scores (IPSS), uroflowmetry, preoperative prostate volume (via abdominal ultrasound), comorbidities, previous prostate surgery, presence of a preoperative indwelling urinary catheter or chronic retention, bladder stones, operative time, complications, hospital stay, and outcome.

Results: Presentation with absolute indication (indwelling catheter and/or chronic retention) was more prevalent in the ≤60 and >80 age groups (p <0.001). The youngest group had smaller prostate volume (78 vs 90 ml, p = 0.004), fewer comorbidities, shorter surgery (70 vs 90 minutes, p <0.001), lower "beach balls" rate (2% vs 15%, p = 0.008), and shorter hospitalization (1 vs 1.5 days, p <0.001). Younger patients had lower postoperative IPSS (4 vs 7 points, p = 0.036), while the quality of life scores were similar. The overall rate of incidental prostate cancer increased with age, but not significantly. The youngest group presented with only International Society of Urological Pathology (ISUP) 1, while older groups had a higher rate of ISUP grade ≥2 (0 vs 18-25%, p <0.05). Complications were similar across age groups.

Conclusions: HoLEP is an effective treatment for men of all ages. Men under 60 or over 80 were more frequently treated for absolute indications, while those aged 61-80 were more often treated for relative indications.

Introduction: The pulsed thulium:YAG (p-Tm:YAG) laser has shown encouraging results in the management of stone disease and BPH; however, its application in the endoscopic management of upper tract urothelial carcinoma (UTUC) has not yet been clinically investigated. The aim of this study is to evaluate the effectiveness and safety of the p-Tm:YAG laser in the endoscopic management of UTUC.

Material and methods: Retrospective data were collected from all patients who underwent endoscopic treatment for UTUC between January and April 2024. Eligible patients were those diagnosed with UTUC and deemed suitable for endoscopic management. Both low-grade and high-grade cases were included. All patients underwent a second-look procedure 2 months after the initial surgery, followed by endoscopic surveillance at 6 and 12 months postoperatively. The laser source used for tumor ablation and coagulation was the p-Tm:YAG laser.

Results: A total of 20 patients were included in the study. Among them, 12 patients (60%) were included in the low-risk UTUC conservative treatment group, while 8 patients (40%) were categorized into the high-risk group. At the time of the second procedure, histopathological analysis revealed no evidence of tumor in 16 cases (80%), while a tumor was identified in 4 patients (20%). No intraoperative complications were recorded. Postoperatively, 10 out of 75 procedures (13.3%) were associated with Clavien-Dindo grade I-II complications. No major complications occurred.

Conclusions: In short-term follow-up, the use of the p-Tm:YAG laser for endoscopic UTUC treatment has proven to be safe and effective.