Central European Journal of Urology最新文献

Introduction: Thermal injury to kidney tissue during holmium laser lithotripsy represents a significant complication. This issue is often unavoidable due to the variability of renal conditions and the absence of techniques for real-time intrarenal temperature monitoring. The objective of this research was to evaluate influence of manual hand pump irrigation on temperature of the fluid within a pelvicalyceal model during holmium laser lithotripsy.

Material and methods: Laser lithotripsy of artificial stones was carried out in a 3D-printed model of the renal pelvicalyceal system. The irrigation system employed a continuous gravity approach (P = 60 cmH₂O), augmented by manual pumping as required. A 9.2 Fr ureteroscope was inserted into the model via a ureteral access sheath (UAS), with sizes of either 10/12 Fr or 12/14 Fr.The power settings for the lithotripsy varied between 12 and 25 W. Temperature monitoring during the procedure was conducted using thermographic methods.

Results: For all laser power settings, the temperatures recorded under gravity irrigation alone were significantly higher compared to those achieved when gravity was combined with a manual hand pump, regardless of the ureteral access sheath size. When using the hand pump system and a 12/14Fr UAS, the median temperatures in none of the laser settings exceeded 30°C. However, using a 10/12Fr UAS, the median temperatures did not exceed 35°C in any of the settings and were significantly lower compared to the use of the gravity flow system alone.

Conclusions: The employment of gravity irrigation supplemented by a manually on-demand pump in retrograde intrarenal surgery is a critical component in mitigating the risk of significant temperature elevations, leading to thermal injury to the adjacent kidney tissues. Moreover, the interquartile ranges of temperatures indicating that gravity system enhanced by an on-demand pump irrigation not only reduce the median temperature but also promote a more consistent thermal environment.

Introduction: Olaparib, rucaparib, niraparib, and talazoparib are poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) targeted at recombination. To gain a comprehensive understanding of the mechanism of action of PARPi, scientists conducted research involving numerous studies that provided evidence regarding their efficacy and safety.

Material and methods: A literature review was performed using the PubMed^® and Google Scholar databases. Articles were reviewed and categorized based on the most crucial and current information regarding the pharmacological properties and use of PARPi in treating metastatic castration-resistant prostate cancer (mCRPC), while also indicating the future therapeutic direction toward which these pharmaceuticals are progressing. Data were extracted, analyzed and summarized.

Results: PARP inhibitors like olaparib, rucaparib, niraparib, and talazoparib show promise in mCRPC, particularly for patients with specific genetic mutations (BRCA1/2, ATM). While they extend PFS and sometimes OS, side effects - especially anemia - are prevalent and impact treatment continuation.

Conclusions: Despite PARPi already being recognized as the standard treatment for mCRPC, further research is crucial to optimize their efficacy and safety, particularly in the context of combination therapies and use in the early stages of the disease.

Introduction: We assessed the association of genitourinary microbiomes with prostate cancer (PCa) tumorigeneses and cancer characteristics.

Material and methods: A systematic search and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoints were the association between relative abundance of genitourinary microbiomes and PCa compared to non-cancerous men/prostate specimen, high grade disease, and disease progression. The odds ratio (OR) was used as the summary statistic, and results were reported with 95% confidence intervals (CI).

Results: Seventeen studies, comprising 2,195 patients were eligible for review and meta-analysis. The specific microbiomes in urine, prostate tissue, and prostate (or seminal) secretions were significantly more abundant in patients with PCa compared to men in the control groups in individual studies. Certain bacterial phyla, genuses, and species were significantly associated with PCa aggressiveness and disease progression in individual studies. The relative abundance meta-analysis of five urine microbiomes revealed no statistically significant differences between PCa patients and control groups (pooled OR, 1.35; 95% CI: 0.70-2.59).

Conclusions: Our systematic review indicates that specific genitourinary microbiomes are more abundant in PCa and have a potential to predict/prognosticate disease aggressiveness and clinical outcomes. Nevertheless, these findings should be interpreted with caution owing to the significant heterogeneity among studies in terms of microbiome analysis method, assessed sample's characteristics, and individual biological behavior of microbiomes for analysis. Further studies are needed to validate these observations and shed more light on the role of the microbiome across the development and natural history of PCa.

Introduction: The aim of this study was to assess the detrusor underactivity (DUA) prevalence of females with symptomatic anterior pelvic organ prolapse (POP) and to evaluate the relationship between DUA and POP stage.

Material and methods: This was a prospective study recruiting women with symptomatic anterior POP. Patients with symptomatic stage 2-4 POP quantification system (POP-Q) who underwent urodynamics (UD) between January 2018 and April 2021 were included.

Results: Data on 330 women (mean age 63.7 ±18.4 years old) with anterior vaginal wall defect were enrolled. Concomitant apical defect (uterine/vaginal vault) requiring surgical correction was diagnosed in 38 women (11.5%). DUA was found in 166 females (50.3%). In DUA women, POP-Q stage 2 was found in 45.2%, stage 3 in 50.9% and stage 4 in 76.5%. Only stage POP-Q stage 4 showed a statistically significant difference between DUA and non-DUA females (p 0.006).

Conclusions: In women with symptomatic POP, regardless of the POP-Q stage, the chance of DUA occurrence was high. DUA was diagnosed in approximately half of the women undergoing UD for symptomatic POP, and it was three-fold higher in cases of POP-Q stage 4. Due to the high incidence of DUA in POP-Q 4 stage, it may be advantageous to identify and treat prolapse before they progress to stage 4.

Introduction: There are three common treatment options for kidney stones: extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL). The choice of treatment is based on stone- and patient-related characteristics. However, some stones are eligible for several approaches and the decision is made based on patient and urologist's preferences. This study evaluates which approach has the highest workload.

Material and methods: Between March and August 2022, five members of the Amsterdam Endourology Research Group collected data from 22 ESWL, 31 URS and 22 PNL procedures. After each procedure, the SURG-TLX questionnaire was completed by the surgeon to evaluate workload. Six dimensions were scored for each procedure, including: mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. The total workload, and the median for each dimension, was calculated and compared for the three treatments.

Results: ESWL scored significantly lower than URS for mental demands, physical demands, temporal demands, situational stress, distraction and total workload. However, task complexity did not differ significantly between the two techniques. Compared with PNL, ESWL scored significantly lower for all dimensions. Finally, PNL received significantly higher scores for mental demands, physical demands, temporal demands, situational stress, distractions and total workload than URS. Only task complexity showed no significant difference between both groups.

Conclusions: Urologists perceive the highest workload during PNL, followed by URS and finally ESWL. A follow-up study is needed to identify stressors that increase perceived workload with the purpose to address these variables and as final objective to improve urologists' workload, patient safety and treatment outcomes.

Introduction: Ureteral stents-related symptoms (USRs) are the common complications of ureteral stenting. Tamsulosin a selective alpha-1 blocker and Tadalafil a PDE-5 inhibitor are one of drugs have been used for USRs relief. In this study we aimed to evaluate the effectiveness and safety of combination therapy Tamsulosin+Tadalafil for treating USRs comparing it with the efficacy of either Tamsulosin or Tadalafil monotherapies.

Material and methods: 279 patients with indwelled unilateral ureteral stents were randomized to Tamsulosin 0.4 mg + Tadalafil 5 mg once a day (Group 1, n = 67), Tamsulosin 0.4 mg once a day (Group 2, n = 71), Tadalafil 5 mg once a day (Group 3, n = 69) and Placebo once a day (Group 4, n = 72). USRs severity was registered and calculated by using the Ureteral Symptoms Score Questionnaire (USSQ) at the 14^th day of treatment. Side-effects and total analgesic use were recorded and compared.

Results: At the endpoint in patients with unilateral ureteral stents the combination therapy Tamsulosin + Tadalafil led to statistically lower intensity of urinary symptoms comparing with Tamsulosin (15.2 ±4.3 vs 21.8±3.6, p = 0.0003) or Tadalafil (15.2 ±4.3 vs 20.6 ±2.8, p = 0.0004) monotherapy. All groups of treatment demonstrated significant relief of USRs comparing with Placebo mostly beneficial in the combined therapy group. Body pain and analgesic need in Group 1 was lower than in Groups 2, 3 or 4. Side-effects were registered rarely without statistical differences in frequency between groups.

Conclusions: Combination therapy with Tamsulosin + Tadalafil is an effective and safe option that achieves the statistically more significant relief of USRs comparing with Tadalafil or Tamsulosin monotherapies.

Introduction: Ureteroscopic lithotripsy is amongst the most performed surgeries in urology practice. To achieve better results and lower complications, several approaches have been proposed. Using isothermic irrigation fluid in ureteroscopy is a novel method.The aim of this study was to show the advantages of body temperature irrigation fluid in ureteroscopy compared to room temperature fluid.

Material and methods: A total of 94 patients with a single ureteral stone scheduled for semirigid ureteroscopy were enrolled into this study. Patients were randomised into 2 groups: group 1, ureteroscopy with room temperature (20-22°C) irrigation fluid and group 2, ureteroscopy with body temperature (37°C) irrigation fluid. Patient characteristics, stone characteristics (stone side, stone location, stone burden, Hounsfield unit), operation outcomes (operation time, ureteral JJ stenting, complications, stone free rate after 4 weeks, auxiliary intervention, Visual Analogue Scale) were analysed.

Results: There was no statistically significant difference between two groups regarding patient and stone characteristics. Operation time was found to be shorter in group 2 compared to group 1 (p = 0.02). Post-operative pain was also less common in group 2 compared to group 1 (p <0.001). Complication rates were 17% in group 1 and 8% in group 2 but no statistically significant difference was found.

Conclusions: Isothermic irrigation fluid in ureteroscopy is beneficial because: it facilitates easier ureteral access by decreasing ureteral spasms, shortens operation times, lowers post-operative pain and lowers the complications rates. This method can be used in semirigid ureteroscopy because it is an easily applicable method with no known associated complications.

Introduction: There is a significant gap in the literature for cases of positive urinary cytology in the absence of macroscopically detectable disease for urothelial carcinoma. This condition, which we might define as not macroscopically detectable urothelial carcinoma (NMDUC), may be relatively rare but presents significant challenges in management and patient information. This review aims to search the literature for information useful for managing this condition.

Material and methods: We structured the review as a scoping review given the desire to have a qualitative definition of NMDUC, without restrictions on study design or demographic characteristics. The review was structured around 5 domains: definition, diagnostic criteria, population, management, and time of disease progression. The review was conducted following the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines.

Results: We found a total of 411 studies and selected 16 for inclusion in the review. Notably, no studies adequately addressed the definition of NMDUC directly. Our findings highlight the diagnostic challenges posed by NMDUC, especially the reliability of positive urinary cytology. The literature indicates a significant gap in the standardisation of diagnostic criteria and management for NMDUC.

Conclusions: NMDUC represents a critical area of urological research requiring further investigation and clearer diagnostic guidelines. We propose the initiation of an international registry to better understand the prevalence, impact, and progression of NMDUC, aiming to standardise the definition and enhance management strategies. This work lays the groundwork for future research that could lead to significant improvements in the diagnosis and treatment of this challenging condition.

Introduction: Stress urinary incontinence is a significant adverse effect following radical prostatectomy for prostate cancer. Various factors, including surgical technique and patient characteristics, influence the incidence of incontinence. Early artificial urinary sphincter implantation prior to salvage radiotherapy may improve functional outcomes and quality of life for these patients. The objective of our study is to address the current gap in research regarding the effects of radiotherapy on tissues surrounding the artificial urethral sphincter, particularly when the artificial urethral sphincter (AUS) is implanted before, rather than after, radiotherapy.

Material and methods: This pilot study analysed the impact of early AUS implantation in 2 prostate cancer patients who underwent radical prostatectomy (RP) and subsequently received salvage radiotherapy (SRT) due to biochemical recurrence. Radiation dose distribution and functional outcomes, including continence rates and complications, were evaluated.

Results: Both patients experienced significant improvements in continence post-AUS implantation, using fewer pads daily. However, a slight deterioration in AUS effectiveness was observed post-radiotherapy, with an increase in pad usage. Radiation doses at the cuff site were relatively low, but mild tissue reactions were noted.

Conclusions: Early AUS implantation before SRT shows promise in enhancing urinary continence and overall quality of life in prostate cancer patients. Despite mild complications, the approach appears feasible and beneficial. Further studies are needed to confirm these findings and optimise treatment sequencing.