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.
导言:本研究旨在评估有症状的前盆腔器官脱垂(POP)女性的逼尿肌活动不足(DUA)患病率,并评估DUA与POP分期之间的关系:这是一项前瞻性研究,招募了患有症状性前盆腔器官脱垂的女性。纳入了在2018年1月至2021年4月期间接受尿动力学检查(UD)的无症状2-4期POP定量系统(POP-Q)患者:共纳入了 330 名阴道前壁缺损妇女(平均年龄为 63.7 ± 18.4 岁)的数据。38名妇女(11.5%)被诊断出合并需要手术矫正的顶端缺损(子宫/阴道穹窿)。166名女性(50.3%)被发现患有阴道前壁缺损。在 DUA 女性中,发现 POP-Q 2 期的占 45.2%,3 期的占 50.9%,4 期的占 76.5%。只有 POP-Q 第 4 阶段在 DUA 和非 DUA 女性中显示出显著的统计学差异(P 0.006):结论:在有症状的 POP 女性中,无论 POP-Q 分期如何,发生 DUA 的几率都很高。约有一半因有症状的 POP 而接受 UD 的女性被诊断出 DUA,而在 POP-Q 4 期的病例中,DUA 的发生率要高出三倍。由于 POP-Q 4 期的 DUA 发生率很高,因此在进展到 4 期之前发现并治疗脱垂可能是有利的。
{"title":"Detrusor underactivity in symptomatic anterior pelvic organ prolapse.","authors":"Emanuele Rubilotta, Marilena Gubbiotti, Achim Herms, Howard Goldman, Alessandro Antonelli, Matteo Balzarro","doi":"10.5173/ceju.2023.246","DOIUrl":"https://doi.org/10.5173/ceju.2023.246","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-12DOI: 10.5173/ceju.2023.147
Emanuele Rubilotta, Francesco Ditonno, Marilena Gubbiotti, Alessandro Antonelli, Matteo Balzarro
Introduction: It is still uncertain whether detrusor underactivity (DUA) influences the outcomes of women undergoing surgery for stress urinary incontinence (SUI). Even less evidence is available about women with complicated stress urinary incontinence (C-SUI). The aim of the study was to assess outcomes of middle urethral sling (MUS) placement according to the type of SUI, and the impact of DUA on uncomplicated SUI (U-SUI) and C-SUI functional and surgical results.
Material and methods: The study was conducted among patients undergoing MUS. The population was divided into 4 groups: 1: C-SUI with DUA; 2: C-SUI without DUA; 3: U-SUI with DUA; and 4: U-SUI without DUA. Women were qualified for the DUA group if they met one of the Jeong, Abarbanel and Marcus, BVE, and PIP1 Griffiths criteria. Post-operative functional outcomes and differences in POUR rate, de novo overactive bladder syndrome (OAB), and SUI recurrence were examined.
Results: 142 women took part in the study, of whom 97 completed the 2-year follow-up. DUA was found in 54.6% (53/97) of patients. C-SUI was prevalent also in the no-DUA group (59.1%). Post-operative ICIQ-FLUTS improved more in the no-DUA patients compared to the DUA women. Post-operative Qmax was statistically significant higher the in no-DUA than in the DUA population. After surgery, neither the PVR nor the PVR ratio differed in the DUA and the no-DUA patients. C-SUI and U-SUI patients showed a POUR rate of 15.6%-12.1%, de novo OAB 12.5%-3%, tape incision 3.1%-3%, and SUI recurrence 4.6%-3%, respectively.
Conclusions: The impact of pre-operative DUA on the outcomes of patients undergoing MUS was negligible, even in C-SUI cases. DUA women with SUI, even if complicated, should not be excluded from this kind of surgery.
导言:对于接受压力性尿失禁(SUI)手术的女性而言,目前尚不确定逼尿肌活动不足(DUA)是否会影响手术效果。关于复杂性压力性尿失禁(C-SUI)的证据则更少。该研究旨在根据 SUI 的类型评估中段尿道吊带(MUS)置入术的效果,以及 DUA 对无并发症 SUI(U-SUI)和 C-SUI 功能和手术效果的影响:研究对象为接受 MUS 手术的患者。研究对象分为四组:1: 有 DUA 的 C-SUI;2: 无 DUA 的 C-SUI;3: 有 DUA 的 U-SUI;4: 无 DUA 的 U-SUI。符合 Jeong、Abarbanel 和 Marcus、BVE 和 PIP1 Griffiths 标准之一的妇女可被纳入 DUA 组。对术后功能结果以及POUR率、新发膀胱过度活动综合征(OAB)和SUI复发率的差异进行了研究:结果:142 名妇女参加了研究,其中 97 人完成了为期 2 年的随访。54.6%的患者(53/97)发现了膀胱过度活动症。在无 DUA 组中,C-SUI 也很普遍(59.1%)。与 DUA 女性患者相比,无 DUA 患者术后 ICIQ-FLUTS 改善程度更高。无 DUA 组术后 Qmax 在统计学上明显高于 DUA 组。术后,DUA 和无 DUA 患者的 PVR 和 PVR 比率均无差异。C-SUI和U-SUI患者的POUR率分别为15.6%-12.1%,新发OAB率为12.5%-3%,胶带切口率为3.1%-3%,SUI复发率为4.6%-3%:术前DUA对接受MUS手术的患者的预后影响微乎其微,即使在C-SUI病例中也是如此。有 SUI 的 DUA 妇女,即使病情复杂,也不应被排除在此类手术之外。
{"title":"Detrusor underactivity and complicated stress urinary incontinence: a cross-data study.","authors":"Emanuele Rubilotta, Francesco Ditonno, Marilena Gubbiotti, Alessandro Antonelli, Matteo Balzarro","doi":"10.5173/ceju.2023.147","DOIUrl":"https://doi.org/10.5173/ceju.2023.147","url":null,"abstract":"<p><strong>Introduction: </strong>It is still uncertain whether detrusor underactivity (DUA) influences the outcomes of women undergoing surgery for stress urinary incontinence (SUI). Even less evidence is available about women with complicated stress urinary incontinence (C-SUI). The aim of the study was to assess outcomes of middle urethral sling (MUS) placement according to the type of SUI, and the impact of DUA on uncomplicated SUI (U-SUI) and C-SUI functional and surgical results.</p><p><strong>Material and methods: </strong>The study was conducted among patients undergoing MUS. The population was divided into 4 groups: 1: C-SUI with DUA; 2: C-SUI without DUA; 3: U-SUI with DUA; and 4: U-SUI without DUA. Women were qualified for the DUA group if they met one of the Jeong, Abarbanel and Marcus, BVE, and PIP1 Griffiths criteria. Post-operative functional outcomes and differences in POUR rate, de novo overactive bladder syndrome (OAB), and SUI recurrence were examined.</p><p><strong>Results: </strong>142 women took part in the study, of whom 97 completed the 2-year follow-up. DUA was found in 54.6% (53/97) of patients. C-SUI was prevalent also in the no-DUA group (59.1%). Post-operative ICIQ-FLUTS improved more in the no-DUA patients compared to the DUA women. Post-operative Qmax was statistically significant higher the in no-DUA than in the DUA population. After surgery, neither the PVR nor the PVR ratio differed in the DUA and the no-DUA patients. C-SUI and U-SUI patients showed a POUR rate of 15.6%-12.1%, de novo OAB 12.5%-3%, tape incision 3.1%-3%, and SUI recurrence 4.6%-3%, respectively.</p><p><strong>Conclusions: </strong>The impact of pre-operative DUA on the outcomes of patients undergoing MUS was negligible, even in C-SUI cases. DUA women with SUI, even if complicated, should not be excluded from this kind of surgery.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-12DOI: 10.5173/ceju.2023.183
Pietro Ferrara, Ignazio Cammisa, Margherita Zona, Antonio Gatto, Roberto Sacco, Alberto Verrotti Di Pianella
Introduction: Enuresis (NE) is a socially stigmatising and stressful condition affecting children's and parent's quality of life. The aim of this review was to evaluate and summarize the current knowledge about the pharmacological and non-pharmacological traditional and innovative treatments in children with NE.
Material and methods: We examined the following bibliographic electronic databases: PubMed and the Cochrane Library, from January 2000 until July 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (8) and was limited to English-language papers that focused on enuresis in patients under 18 years old. Each paper that met the eligibility criteria was reviewed and analyzed in full text by three authors and any discrepancies among them were solved by debate. Due to the heterogeneity of the articles examined, we focused on a qualitative analysis.
Results: Overall, we identified 560 records through database searching. As first step, we excluded 46 articles in non-English language, 6 records whose related articles were not available, 8 articles concerning ongoing trials and 210 duplicated papers. As second step, we eliminated 215 records by evaluating only title and abstract because they did not match the inclusive criteria we mentioned before. Of the remaining 75 studies, we excluded 34 through a further discussion among authors upon the reliability of data. Thus, 41 selected articles were included in the review.
Conclusions: Multiple treatment approaches, both pharmacological and non pharmacological, have been established and validated to reduce signs and symptoms of NE and improve quality of life and the social and emotional discomfort experienced by children. The aim of pediatrician is to identify the right therapy protocol for very single child, evaluating the best approach for him and the family.
{"title":"Traditional and innovative interventions in the management of enuresis.","authors":"Pietro Ferrara, Ignazio Cammisa, Margherita Zona, Antonio Gatto, Roberto Sacco, Alberto Verrotti Di Pianella","doi":"10.5173/ceju.2023.183","DOIUrl":"https://doi.org/10.5173/ceju.2023.183","url":null,"abstract":"<p><strong>Introduction: </strong>Enuresis (NE) is a socially stigmatising and stressful condition affecting children's and parent's quality of life. The aim of this review was to evaluate and summarize the current knowledge about the pharmacological and non-pharmacological traditional and innovative treatments in children with NE.</p><p><strong>Material and methods: </strong>We examined the following bibliographic electronic databases: PubMed and the Cochrane Library, from January 2000 until July 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (8) and was limited to English-language papers that focused on enuresis in patients under 18 years old. Each paper that met the eligibility criteria was reviewed and analyzed in full text by three authors and any discrepancies among them were solved by debate. Due to the heterogeneity of the articles examined, we focused on a qualitative analysis.</p><p><strong>Results: </strong>Overall, we identified 560 records through database searching. As first step, we excluded 46 articles in non-English language, 6 records whose related articles were not available, 8 articles concerning ongoing trials and 210 duplicated papers. As second step, we eliminated 215 records by evaluating only title and abstract because they did not match the inclusive criteria we mentioned before. Of the remaining 75 studies, we excluded 34 through a further discussion among authors upon the reliability of data. Thus, 41 selected articles were included in the review.</p><p><strong>Conclusions: </strong>Multiple treatment approaches, both pharmacological and non pharmacological, have been established and validated to reduce signs and symptoms of NE and improve quality of life and the social and emotional discomfort experienced by children. The aim of pediatrician is to identify the right therapy protocol for very single child, evaluating the best approach for him and the family.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-10DOI: 10.5173/ceju.2023.215
Rafal Osiecki, Mieszko Kozikowski, Łukasz Białek, Michał Pyzlak, Jakub Dobruch
Introduction: Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features.
Material and methods: In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres.
Results: 48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis.
Conclusions: The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.
{"title":"The presence of cribriform pattern in prostate biopsy and radical prostatectomy is associated with negative postoperative pathological features.","authors":"Rafal Osiecki, Mieszko Kozikowski, Łukasz Białek, Michał Pyzlak, Jakub Dobruch","doi":"10.5173/ceju.2023.215","DOIUrl":"https://doi.org/10.5173/ceju.2023.215","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features.</p><p><strong>Material and methods: </strong>In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres.</p><p><strong>Results: </strong>48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis.</p><p><strong>Conclusions: </strong>The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-05DOI: 10.5173/ceju.2023.255
Carlotta Nedbal, Ewa Bres-Niewada, Bartosz Dybowski, Bhaskar K Somani
{"title":"The impact of artificial intelligence in revolutionizing all aspects of urological care: a glimpse in the future.","authors":"Carlotta Nedbal, Ewa Bres-Niewada, Bartosz Dybowski, Bhaskar K Somani","doi":"10.5173/ceju.2023.255","DOIUrl":"https://doi.org/10.5173/ceju.2023.255","url":null,"abstract":"","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-22DOI: 10.5173/ceju.2023.228
Jan Łaszkiewicz, Wojciech Krajewski, Łukasz Nowak, Joanna Chorbińska, Francesco Del Giudice, Aleksandra Sójka, Małgorzata Mazur, Szymon Pisarski, Wojciech Tomczak, Bartosz Małkiewicz, Tomasz Szydełko
Introduction: The ILY robotic flexible ureteroscope has been introduced in order to improve intraoperative ergonomics, reduce operator distance from radiation and shorten the learning curve. In this study we aimed to assess the clinical performance and feasibility of the ILY robot during retrograde intrarenal surgery (RIRS) and combined endoscopic procedures (miniECIRS).
Material and methods: The RIRS procedures were performed using the ILY robotic arm in 57 adult patients (46 RIRS and 11 miniECIRS) from 2022 to 2023. All procedures were performed in the supine position. Pre-stenting was not the standard of care.
Results: Turning on and calibration of the device took approximately 100 s. Average draping time was 93 s using original ILY drapes and 47 s using classic drapes designed for C-arm covering. Mean docking time was 73 s in procedures with ureteral access sheath (UAS) and 61 s in procedures without it. The undocking took less than 60 s in every case. Average procedure time was 63 min for RIRS and 55 min for miniECIRS. Endoscopically proven stone-free rate was achieved in 37 (80.4%) RIRS and 10 (90.9%) miniECIRS patients. A total of 17 (36.9%) RIRS and 8 (72.7%) miniECIRS procedures required conversion in order to perform basketing and stone fragments retrieval/transposition.
Conclusions: The use of ILY robot during endourological procedures is feasible and urologists that are familiar with the device controller do not require extensive training. The time needed for device draping, docking and undocking was approximately 4 minutes. Moreover, use of the robot resulted in satisfactory stone-free rates.
{"title":"Retrograde intrarenal surgery using the ILY robotic flexible ureteroscope: a single centre experience.","authors":"Jan Łaszkiewicz, Wojciech Krajewski, Łukasz Nowak, Joanna Chorbińska, Francesco Del Giudice, Aleksandra Sójka, Małgorzata Mazur, Szymon Pisarski, Wojciech Tomczak, Bartosz Małkiewicz, Tomasz Szydełko","doi":"10.5173/ceju.2023.228","DOIUrl":"https://doi.org/10.5173/ceju.2023.228","url":null,"abstract":"<p><strong>Introduction: </strong>The ILY robotic flexible ureteroscope has been introduced in order to improve intraoperative ergonomics, reduce operator distance from radiation and shorten the learning curve. In this study we aimed to assess the clinical performance and feasibility of the ILY robot during retrograde intrarenal surgery (RIRS) and combined endoscopic procedures (miniECIRS).</p><p><strong>Material and methods: </strong>The RIRS procedures were performed using the ILY robotic arm in 57 adult patients (46 RIRS and 11 miniECIRS) from 2022 to 2023. All procedures were performed in the supine position. Pre-stenting was not the standard of care.</p><p><strong>Results: </strong>Turning on and calibration of the device took approximately 100 s. Average draping time was 93 s using original ILY drapes and 47 s using classic drapes designed for C-arm covering. Mean docking time was 73 s in procedures with ureteral access sheath (UAS) and 61 s in procedures without it. The undocking took less than 60 s in every case. Average procedure time was 63 min for RIRS and 55 min for miniECIRS. Endoscopically proven stone-free rate was achieved in 37 (80.4%) RIRS and 10 (90.9%) miniECIRS patients. A total of 17 (36.9%) RIRS and 8 (72.7%) miniECIRS procedures required conversion in order to perform basketing and stone fragments retrieval/transposition.</p><p><strong>Conclusions: </strong>The use of ILY robot during endourological procedures is feasible and urologists that are familiar with the device controller do not require extensive training. The time needed for device draping, docking and undocking was approximately 4 minutes. Moreover, use of the robot resulted in satisfactory stone-free rates.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-31DOI: 10.5173/ceju.2023.233
Mohammed Shahait, Tuan Thanh Nguyen, Nguyen Xuong Duong, Philip Mucksavage, Bhaskar K Somani
Introduction: Several studies have compared the safety and effectiveness of general and regional anaesthesia in percutaneous nephrolithotomy (PCNL). This study aimed to compare the perioperative and postoperative outcomes of general anaesthesia and regional anaesthesia for patients undergoing PCNL.
Material and methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until March 2023. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI).
Results: The final cohort analysis, comprised 3871 cases of PCNL, (2154 regional anaesthesia and 1717 general anaesthesia). Compared to general anaesthesia, the regional anaesthesia group had a significantly shorter length of stay (MD = -0.34 days, 95% CI -0.56 to -0.12, p = 0.002), lower postoperative nausea and vomiting rates (RR = 0.16, 95% CI 0.03 to 0.80, p = 0.026), lower complications grade III-V rates (RR = 0.68, 95% CI 0.53 to 0.88, p = 0.004), and lower postoperative visual analogue pain score (VAS) at 1 hour (MD = -3.5, 95% CI -4.1 to -2.9, p <0.001). There were no significant differences in other outcomes between the two groups.
Conclusions: Our results show that PCNL under regional anaesthesia is safe and feasible, with comparable results to those done under general anaesthesia. While patient selection is important, counselling and decision-making for these procedures must go hand in hand to achieve the best clinical outcome.
简介:多项研究比较了经皮肾镜碎石术(PCNL)中全身麻醉和区域麻醉的安全性和有效性。本研究旨在比较全身麻醉和区域麻醉对 PCNL 患者的围手术期和术后效果:对三个电子数据库(包括 PubMed、Scopus 和 Web of Science)中的相关文章进行了检索,检索时间从开始到 2023 年 3 月。根据 PRISMA 2020 和 AMSTAR 指南报告了一项荟萃分析。采用风险比(RR)和平均差(MD)对二分变量和连续变量进行比较,并得出 95% 的置信区间(CI):最终的队列分析包括 3871 例 PCNL(区域麻醉 2154 例,全身麻醉 1717 例)。与全身麻醉相比,区域麻醉组的住院时间明显更短(MD = -0.34 天,95% CI -0.56 至 -0.12,p = 0.002),术后恶心和呕吐率更低(RR = 0.16,95% CI 0.03至0.80,p = 0.026),并发症III-V级发生率较低(RR = 0.68,95% CI 0.53至0.88,p = 0.004),术后1小时视觉模拟疼痛评分(VAS)较低(MD = -3.5,95% CI -4.1至-2.9,p 结论:我们的研究结果表明,在区域麻醉下进行 PCNL 是安全可行的,其结果与在全身麻醉下进行 PCNL 的结果相当。选择患者固然重要,但这些手术的咨询和决策必须齐头并进,才能取得最佳临床效果。
{"title":"Regional versus general anaesthesia in percutaneous nephrolithotomy: a systematic review and meta-analysis.","authors":"Mohammed Shahait, Tuan Thanh Nguyen, Nguyen Xuong Duong, Philip Mucksavage, Bhaskar K Somani","doi":"10.5173/ceju.2023.233","DOIUrl":"https://doi.org/10.5173/ceju.2023.233","url":null,"abstract":"<p><strong>Introduction: </strong>Several studies have compared the safety and effectiveness of general and regional anaesthesia in percutaneous nephrolithotomy (PCNL). This study aimed to compare the perioperative and postoperative outcomes of general anaesthesia and regional anaesthesia for patients undergoing PCNL.</p><p><strong>Material and methods: </strong>For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until March 2023. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI).</p><p><strong>Results: </strong>The final cohort analysis, comprised 3871 cases of PCNL, (2154 regional anaesthesia and 1717 general anaesthesia). Compared to general anaesthesia, the regional anaesthesia group had a significantly shorter length of stay (MD = -0.34 days, 95% CI -0.56 to -0.12, p = 0.002), lower postoperative nausea and vomiting rates (RR = 0.16, 95% CI 0.03 to 0.80, p = 0.026), lower complications grade III-V rates (RR = 0.68, 95% CI 0.53 to 0.88, p = 0.004), and lower postoperative visual analogue pain score (VAS) at 1 hour (MD = -3.5, 95% CI -4.1 to -2.9, p <0.001). There were no significant differences in other outcomes between the two groups.</p><p><strong>Conclusions: </strong>Our results show that PCNL under regional anaesthesia is safe and feasible, with comparable results to those done under general anaesthesia. While patient selection is important, counselling and decision-making for these procedures must go hand in hand to achieve the best clinical outcome.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-31DOI: 10.5173/ceju.2023.110
Muhammed Emin Polat, Mustafa Karaaslan, Mehmet Yilmaz, Erkan Olcucuoglu, Mehmet Emin Sirin
Introduction: Despite the developments in the material of the double J (DJ) stents and the production of thinner ones of desired sizes, patients continue to experience troublesome DJ stent-related symptoms in their lives. This study aimed to determine how DJ stenting affects patients' work performance after endoscopic stone surgery.
Material and methods: A total of 107 patients underwent placement of a ureteral stent after ureterorenoscopy (URS)/retrograde intrarenal surgery (RIRS), and only active and full-time working patients were included. All patients were asked to complete the validated Turkish version of the work performance score (WPS) questionnaire in the Ureteral Stent Symptom Questionnaire (USSQ) the day before stent removal and again one month after stent removal.
Results: Of the participants, 32.7% (n = 35) were female and 67.3% (n = 72) were male; the mean age was 41 (19-80) years. The workday loss had no statistically significant correlation with patient BMI, stone size, or stent indwelling time (p >0.005); however, a statistically significant negative correlation was detected with patient age (r = -0.335, p <0.001). The medians of WPSs with the stent and without the stent were 6 (3-15) and 3 (3-12), respectively (p <0.001).
Conclusions: Although DJ catheterization is a crucial tool for urological practice, it may increase the social and economic burden of patients due to reduced work performance and lost workdays. Therefore, limiting the duration of the DJ stent's stay and providing treatments to minimize patient symptoms will positively impact their professional lives. It would be beneficial to avoid DJ stenting in routine practice unless medically necessary.
导言:尽管双 J(DJ)支架的材料不断发展,并生产出了更薄的理想尺寸的支架,但患者在生活中仍会遇到与 DJ 支架相关的麻烦症状。本研究旨在确定内镜结石手术后 DJ 支架植入对患者工作表现的影响:共有107名患者在接受输尿管造影术(URS)/逆行肾内手术(RIRS)后接受了输尿管支架置入术。所有患者均被要求在支架移除前一天完成输尿管支架症状问卷(USSQ)中经过验证的土耳其语版工作表现评分(WPS)问卷,并在支架移除一个月后再次完成该问卷:参与者中女性占 32.7%(35 人),男性占 67.3%(72 人);平均年龄为 41(19-80)岁。工作日损失与患者的体重指数、结石大小或支架留置时间没有统计学意义上的显著相关性(P >0.005);但与患者年龄存在统计学意义上的显著负相关(r = -0.335,P 结论:DJ导管术虽然是一项非常重要的手术,但也存在一些问题:尽管 DJ 导管术是泌尿外科实践中的重要工具,但它可能会因工作表现下降和工作日损失而增加患者的社会和经济负担。因此,限制 DJ 支架的停留时间并提供治疗以尽量减少患者的症状,将对他们的职业生活产生积极影响。除非医学需要,否则在常规治疗中避免使用 DJ 支架将是有益的。
{"title":"The effect of ureteral double J stent insertion on work performance in patients undergoing endoscopic stone treatment.","authors":"Muhammed Emin Polat, Mustafa Karaaslan, Mehmet Yilmaz, Erkan Olcucuoglu, Mehmet Emin Sirin","doi":"10.5173/ceju.2023.110","DOIUrl":"https://doi.org/10.5173/ceju.2023.110","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the developments in the material of the double J (DJ) stents and the production of thinner ones of desired sizes, patients continue to experience troublesome DJ stent-related symptoms in their lives. This study aimed to determine how DJ stenting affects patients' work performance after endoscopic stone surgery.</p><p><strong>Material and methods: </strong>A total of 107 patients underwent placement of a ureteral stent after ureterorenoscopy (URS)/retrograde intrarenal surgery (RIRS), and only active and full-time working patients were included. All patients were asked to complete the validated Turkish version of the work performance score (WPS) questionnaire in the Ureteral Stent Symptom Questionnaire (USSQ) the day before stent removal and again one month after stent removal.</p><p><strong>Results: </strong>Of the participants, 32.7% (n = 35) were female and 67.3% (n = 72) were male; the mean age was 41 (19-80) years. The workday loss had no statistically significant correlation with patient BMI, stone size, or stent indwelling time (p >0.005); however, a statistically significant negative correlation was detected with patient age (r = -0.335, p <0.001). The medians of WPSs with the stent and without the stent were 6 (3-15) and 3 (3-12), respectively (p <0.001).</p><p><strong>Conclusions: </strong>Although DJ catheterization is a crucial tool for urological practice, it may increase the social and economic burden of patients due to reduced work performance and lost workdays. Therefore, limiting the duration of the DJ stent's stay and providing treatments to minimize patient symptoms will positively impact their professional lives. It would be beneficial to avoid DJ stenting in routine practice unless medically necessary.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-05DOI: 10.5173/ceju.2023.158
Leonidas Karapanos, Luisa Halbe, Axel Heidenreich
{"title":"Penile urethrostomy for recurrent long-segment strictures of the penile urethra: step-by-step surgical technique.","authors":"Leonidas Karapanos, Luisa Halbe, Axel Heidenreich","doi":"10.5173/ceju.2023.158","DOIUrl":"https://doi.org/10.5173/ceju.2023.158","url":null,"abstract":"","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-11DOI: 10.5173/ceju.2023.123
Daniele Castellani, Carlo Brocca, Demetra Fuligni, Carlo Giulioni, Angelo Antezza, Angelo Cormio, Arianna Rubino, Lucia Pitoni, Virgilio De Stefano, Giulio Milanese, Luigi Cormio, Bhaskar Kumar Somani, Vineet Gauhar, Andrea Benedetto Galosi
Introduction: We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP).
Material and methods: A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted.
Results: Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients.
Conclusions: SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.
{"title":"Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review.","authors":"Daniele Castellani, Carlo Brocca, Demetra Fuligni, Carlo Giulioni, Angelo Antezza, Angelo Cormio, Arianna Rubino, Lucia Pitoni, Virgilio De Stefano, Giulio Milanese, Luigi Cormio, Bhaskar Kumar Somani, Vineet Gauhar, Andrea Benedetto Galosi","doi":"10.5173/ceju.2023.123","DOIUrl":"https://doi.org/10.5173/ceju.2023.123","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP).</p><p><strong>Material and methods: </strong>A literature search was performed on 8<sup>th</sup> March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted.</p><p><strong>Results: </strong>Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients.</p><p><strong>Conclusions: </strong>SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}