Central European Journal of Urology最新文献

Introduction: The aim of this review was to assess the outcomes of partial nephrectomy using indocyanine green (ICG) regarding ischemia time, positive surgical margins (PSM), estimated blood loss (EBL) and estimated GFR reduction while also suggesting the optimal dosage scheme.

Material and methods: A systematic review was performed using Medline (PubMed), ClinicalTrials.gov, and Cochrane Library (CENTRAL) databases, in concordance with the PRISMA statement. Studies in English regarding the use of indocyanine green in partial nephrectomy were reviewed. Reviews and meta-analyses, editorials, perspectives, and letters to the editors were excluded.

Results: Individual ICG dose was 5 mg in most of the studies. The mean warm ischemia time (WIT) on each study ranged from 11.6 minutes to 27.2 minutes. The reported eGFR reduction ranged from 0% to 15.47%. Lowest mean EBL rate was 48.2 ml and the highest was 347 ml. Positive surgical margin rates were between 0.3% to 11%.

Conclusions: Indocyanine green seems to be a useful tool in partial nephrectomy as it can assist surgeons in identifying tumor and its related vasculature. Thereby, warm ischemia time can be reduced and, in some cases, selective ischemia can be implemented leading to better renal functional preservation.

Introduction: The research aim was to determine the role of clinical, laboratory, immunological and sonographic parameters in the development of an assessment tool for the symptomatic manifestations of prostate calcifications in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Material and methods: All men underwent a transabdominal ultrasonographic examination using a grayscale B-mode and color Doppler mapping, the evaluation of the National Institutes of Health-Chronic Prostatitis Symptom Index and the Patient Health Questionnaire-9, spermogram. Vascular endothelial growth factor (VEGF), serotonin and gamma-aminobutyrate (GABA), interleukins 1β and 10 were determined in blood serum and ejaculate.

Results: This study included 102 men aged 18-45 years. Group 1 (n = 34) consisted of patients with CP/CPPS. Group 2 included patients (n = 34) with asymptomatic prostatitis. Group 3 consisted of healthy volunteers (n = 34). More severe symptoms of prostatitis and depression, as well as frequent exacerbations in patients with CP/CPPS, were associated with ultrasound evidence of prostate calcifications, and especially the twinkling artifact (Spearman's r = 0.481; р <0.001; Spearman's r = 0.437; р <0.001, respectively).The presence of prostate calcifications in both CP/CPPS and asymptomatic prostatitis was accompanied by a significantly higher concentration of pro-inflammatory cytokine IL-1β and a lower concentration of anti-inflammatory cytokine IL-10 in the ejaculate (p < 0.05 in both cases, Kolmogorov-Smirnov test). The clinical manifestations observed in patients with CP/CPPS and asymptomatic prostatitis were not correlated with the leukocyte count in the ejaculate or the levels of VEGF, GABA, and serotonin in both blood and ejaculate.

Conclusions: Twinkling artifact potentially could serve as a valuable tool for evaluating the condition of patients with CP/CPPS and prostate calcifications.

Introduction: The aim of this study was to retrospectively evaluate the etiology of urethral stricture disease (USD) in a large series of patients undergoing urethroplasty.

Material and methods: The multicenter retrospective cohort study was conducted at two reconstructive urology referral centers in years 2015-2022. Prior to the surgical intervention, all patients underwent diagnostic procedures including retrograde urethrography and voiding cystourethrography. We collected comprehensive demographic and medical data including the length and location of the stricture. We paid particular attention to identifying the underlying causes of USD in the medical records.

Results: The study included 949 patients meeting criteria, with a mean age of 53. The primary cause of USD was identified as iatrogenic (404 cases, 42.6%), followed by trauma (210, 22.1%), previous hypospadias repair (122, 12.9%), lichen sclerosus (32, 3.4%), and infections (12, 1.3%). Notably, 169 patients (17.8%) did not have a discernible cause for their USD and were thus classified as idiopathic. Furthermore, it was observed that 66% of idiopathic USD cases were localized in the bulbar urethra. The etiology of USD varied significantly based on its localization (p <0.01). The mean stricture length differed among different causes, with the longest in patients with USD due to lichen sclerosus (41 mm), followed by previous hypospadias repair (35 mm), and iatrogenic causes (29 mm), p <0.001.

Conclusions: Careful medical history-taking can identify the etiology of urethral stricture in over 80% of patients undergoing urethroplasty. The etiology of the USD impacts its location and length and thus can affect surgical treatment strategy and outcomes.

Introduction: To investigate the role of trans-labial ultrasound study in detection of female urethral stenosis (FUS) compared to former cysto-urethroscopy as the currently available definitive diagnostic modality.

Material and methods: In this cross-sectional study, 60 consecutive patients with bladder outlet obstruction diagnosed by clinical symptoms and urodynamic study, were included from 2019 to 2022. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF).

Results: In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra. GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002).

Conclusions: GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The location and the length of the stricture and probable peri-urethral fibrosis can be identified by this method. However, in meatal or pure short-length distal urethral strictures, this method should be used with caution.

Introduction: The study presents the initial outcomes of robot-assisted radical prostatectomies (RARPs) using the Versius robotic system in a urological centre with no prior robotic surgery experience.

Material and methods: A retrospective analysis of 58 RARPs was conducted, including patients' parameters as well as Versius system performance.

Results: The study involved 58 patients (average age 66.9 years). Median preoperative prostate specific antigen (PSA) was 9.8 ng/ml, with 48% having ISUP grade group ≥ 3 on biopsy and 25.8% showing extraprostatic extension on MRI. Median blood loss was 437 ml, with complications (10.3% Clavien-Dindo grade II and 4 grade III cases). One conversion to open surgery occurred (0.58%). Final pathology revealed 46.5% extraprostatic disease, and 25.8% had positive margins. Post-surgery, 96.5% had undetectable PSA at 6 weeks. Continence rates were 89.7% at 6 weeks, increasing to 91.3% at 12 months. Median catheter duration was 7.9 days, and the hospital stay was 4.5 days. Console time averaged 150.9 minutes, with a median operative time of 213 minutes. The Versius system reported medium priority alarms in 24.1% of operations, including 1266 alarms related to robotic arm clashes and 43 instrument swaps. One bedside unit exchange occurred with no console or robotic system failures.

Conclusions: The Versius robotic system can be successfully introduced in a urological centre without prior robotic surgery experience. Our setup and operating room positioning are effective, safe, and reproducible. We encountered and resolved surgical and technical challenges. Further follow-up studies are needed to assess the system's performance.

Introduction: This study aimed to compare the safety and efficacy of treatment using simple prostatectomy (SP) and using photoselective vaporization of the prostate (PVP) with a 180W GreenLight XPS laser in patients with high-volume prostate hypertrophy.

Material and methods: The study included 120 patients with LUTS symptoms caused by prostatic enlargement of more than 80 ml; 79 patients were treated with SP, while 41 were treated with PVP. The analysis included subjective the International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and objective (Qmax), (Qave), and post-void residual volume (PVR) parameters before treatment and at an average of 38 months after surgical treatment. Early and late adverse effects and length of hospitalisation were assessed. Complication reports were performed according to the modified Clavien-Dindo system.

Results: The analysis independently showed the effectiveness of both methods. Subjective parameters (IPSS, QoL), showed no significant differences. Patients treated with SP scored slightly better on objective parameters (Qmax, Qave, and PVR). Analysis of adverse effects and hospitalisation time were more favourable after PVP.

Conclusions: SP and PVP were found to be comparable and highly effective in treating benign prostatic hyperplasia in terms of IPSS and QoL. Patients treated with the SP method obtained slightly better results of objective parameters such as Qmax, Qave, and PVR. Compared with SP, PVP has a more favourable safety profile.

Introduction: Historically, percutaneous nephrolithotomy (PCNL) in horseshoe kidney (HSK) patients has been performed in the prone position. Nevertheless, thanks to the spread of the supine PCNL technique for patients with urinary stones and normal renal anatomy, some retrospective studies have already reported on supine PCNL and HSK, showing the effectiveness and safety of the procedure. Herein we report our experience with supine PCNL in a subset of patients with urolithiasis.

Material and methods: Prospective data were collected for all HSK patients who underwent supine PCNL at our institution from June 2016 to June 2023. Stone volume was reported as the volume of a single stone or the sum of the volumes of multiple stones on computed tomography (CT) images. Patients were reported to be stone-free if there were no stones on postoperative non-contrast CT (NCCT) exam. Peri-/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR) and the secondary endpoints were Clavien-Dindo complications Grade I or higher.

Results: A total of 35 patients met the inclusion criteria and were enrolled in the study. Forty-eight procedures were analyzed. SFR was 72.9% at 1-month follow-up. In 11 out of 48 procedures (22.9%) Clavien-Dindo Grade I-II complications were recorded. In one case Clavien-Dindo Grade IIIa complication was observed.

Conclusions: In this prospective study of 35 HSK patients who underwent 48 procedures, supine PCNL was safe and effective, with minimal morbidity.

Introduction: Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions.

Material and methods: This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications.

Results: In this pilot study, 26 patients were included with a median age of 12 years (7.0-16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0-63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed.

Conclusions: Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.

Introduction: Bacillus Calmette-Guerin (BCG) Moreau is under-represented in literature and comparisons with other BCG strains are rare.

Material and methods: We conducted a retrospective data analysis in patients with intermediate or high-risk non-muscle invasive bladder cancer (NMIBC) to assess effectiveness and safety of BCG Moreau Polish substrain to BCG RIVM. The primary objective was to describe the real-world effectiveness of BCG Moreau in the treatment of patients with NMIBC in terms of recurrence free survival (RFS) 2 years post-treatment initiation compared to BCG RIVM.

Results: The database to be analysed comprised of 967 patients with NMIBC. The primary endpoint was met since BCG Moreau was non-inferior to BCG RIVM in terms of RFS [HR: 0.920 (95%CI: 0.725; 1.168)]. There was no statistically significant difference in all secondary endpoints including time to recurrence, progression-free survival, time to progression, and overall survival. The safety profile of BCG Moreau Polish substrain was consistent with side effects and frequency of complications observed with BCG RIVM and study reports in the literature.

Conclusions: BCG Moreau was effective and safe in the treatment of patients with intermediate- or high-risk non-muscle invasive bladder cancer. There was no statistically significant difference in treatment outcome between BCG Moreau and BCG RIVM strains based on real-world data.