Central European Journal of Urology最新文献

Introduction: This study aims to evaluate the feasibility of stone fragmentation and aspiration of dust and small stone particles via a direct-in-scope suction (DISS) system using a novel single-use flexible cystoscope (PC200, Pusen Medical Technology, Guangdon, China) in a straight position and with extreme bending.

Material and methods: An ex vivo experimental study was performed on freshly harvested porcine lower urinary systems (bladder and urethra) with natural urinary stones (calcium oxalate dihydrate 70%, urate 30%). In the first set of trials (3 trials) the stones were placed in the bladder and lithotripsy was performed with a scope in a straight position. For the second set of trials, porcine gallbladder was additionally used, circumferentially sutured to the anterior wall of the porcine bladder, and the stone was positioned in the gallbladder (imaginary diverticulum). In the latter trials, lithotripsy was achieved with the scope at an almost 180° bend.

Results: Laser lithotripsy was successfully completed in all trials. Stone fragmentation and aspiration were faster in the first set of trials with the cystoscope in a straight position. In the second set, to access the anterior-wall "diverticulum", continuous suction and irrigation were employed. After lithotripsy, the stone fragments were effectively flushed from the simulated diverticulum into the main bladder cavity.

Conclusions: Bladder stone lithotripsy using a flexible cystoscope with DISS is feasible. The DISS system offers several advantages, including improved visibility through simultaneous fluid and dust aspiration, as well as enhanced maneuverability of the scope due to suction-assisted positioning.

Introduction: Perioperative blood transfusion (BT) is often required in radical cystectomy (RC) due to significant blood loss. Tranexamic acid (TXA), an antifibrinolytic agent, reduces bleeding, but concerns about thromboembolic risks persist. This systematic review and meta-analysis evaluate TXA's efficacy and safety in RC.

Material and methods: A systematic search was conducted in PubMed, Embase, and Cochrane Central databases. Randomized controlled trials (RCTs) and retrospective studies comparing TXA versus controls in RC were included. Primary outcomes were perioperative, intraoperative, and postoperative BT rates. Secondary outcomes included estimated blood loss (EBL) and thromboembolic events (PROSPERO; CRD420251013502).

Results: Four studies totaling 1,656 patients were included. TXA significantly reduced perioperative transfusion rates (OR = 0.40; 95% CI: 0.30-0.51; p < 0.00001). However, intraoperative (OR = 0.87; 95% CI: 0.50-1.52; p = 0.63) and postoperative transfusion rates (OR = 0.51; 95% CI: 0.21-1.23; p = 0.13) were not significantly different. No significant difference was found in EBL (MD = -9.31; 95% CI: from -82.50 to 63.87; p = 0.80). Safety analysis showed no increased risk of deep vein thrombosis (OR = 1.14; 95% CI: 0.54-2.41; p = 0.72) or pulmonary embolism (OR = 1.49; 95% CI: 0.69-3.24; p = 0.31).

Conclusions: TXA reduces perioperative transfusion needs in RC without significantly affecting intraoperative or postoperative transfusion rates, EBL, or thromboembolic risk. Further RCTs are needed to optimize TXA use in RC.

Introduction: We aimed to assess and compare the feasibility and perioperative outcomes using low-power thulium laser enucleation of the prostate (ThuLEP) compared to standard holmium laser enucleation of the prostate (HoLEP) in the management of BPO-related symptoms due to prostates volume exceeding 80 ml.

Material and methods: One hundred and fifty patients with large prostates indicated for prostate enucleation were prospectively randomized into two groups: HoLEP group (74 patients), and the low-power ThuLEP group (76 patients). Preoperative assessment included digital rectal examination, serum prostate-specific antigen, transrectal ultrasonography, uroflowmetry, postvoid residual urine (PVR) measurement, and International Prostate Symptom Score (IPSS) and QoL scoring systems.

Results: The mean age for the HoLEP group was 68 ±5.0 years and 69 ±4.8 years for the low-power ThuLEP group. The mean prostate volume was 87 ±11.5 cc for HoLEP and 90 ±12.0 cc for ThuLEP, with no statistically significant differences between both groups (p = 0.1079). There was a statistically significant difference between both groups with regard the mean total operative time, which was 72 ±10.5 minutes for HoLEP and 92 ±11.5 minutes for ThuLEP, and the mean enucleation time, which was 50 ±8.5 minutes for HoLEP and 70 ±7.0 minutes for ThuLEP (p <0.001). No significant differences between the groups regarding catheterization time, hospital stay, or haemoglobin drop. Subjective and objective voiding parameters as IPSS and Qol scores, Q_max, and PVR improved significantly after treatment with both techniques with no statistically significant difference between both groups. The complication rate was low.

Conclusions: Although HoLEP offers shorter operative time, low-power ThuLEP is a feasible choice for surgical management of benign prostatic obstruction as it offers similar clinical outcomes.

Introduction: Late relapse (LR) of testicular germ cell tumor (TGCT) is a relatively rare event with limited data to help refine evidence-based decision-making. This individual patient data meta-analysis aims to analyze disease characteristics, treatment modalities, and factors affecting oncological outcomes of TGCT patients suffering from LR.

Material and methods: A systematic search and individual patient data gathering was performed. The primary end points were disease-free survival (DFS) and cancer-specific survival (CSS).

Results: A total of 12 studies, comprising 240 patients, were selected for review. In multivariable analysis, surveillance as primary management of TGCT was associated with a higher risk of retroperitoneal LR (OR = 10.08, 95% CI: 2.34-43.31). On univariable analyses, longer time to LR, LR multiplicity, and chemotherapy (as the sole treatment of LR) were significantly associated with worse DFS and CSS, while pure teratoma at LR, teratoma element at LR, surgery (as the sole treatment of LR), and surgery-based combination treatment of LR were significantly associated with better DFS and CSS. Salvage chemotherapy for LR was associated with worse DFS and CSS compared to first-line chemotherapy in multivariable cox regression analysis (HR = 13.03, 95% CI: 1.13-150.25). Two decision-tree models are proposed to help shared decision making regarding chemotherapy-based vs surgery-only and surgery-based versus combination treatments; the accuracies of these models were 0.94 and 0.88.

Conclusions: Available data suggest a benefits to surgery alone or surgery-based combination therapy compared to chemotherapy alone for LR of TGCT. We propose decision-tree models to help clinical decision-making in TGCT patients with LR.

Introduction: The aim of this study was to determine population-level treatment patterns for urolithiasis and renal colic-like pain symptoms in Poland.

Material and methods: We used data from POLSTONE, a survey representative of the entire Polish population stratified by age, sex, and place of residence. We identified and evaluated non-surgical and surgical treatment patterns for urolithiasis and renal colic-like pain symptoms.

Results: In this nationally representative survey of 10,029 Polish adults, the lifetime prevalence of urolithiasis was 12.85% (n = 1,289) and 43.05% (n = 4,317) reported renal colic-like pain symptoms. Ultrasound was the most used diagnostic method for urolithiasis (73.78%; n = 951), followed by computed tomography (22.11%; n = 285). Conservative treatment predominated in the management of urolithiasis, with 58.73% (n = 757) of patients receiving prescription drugs and 29.87% (n = 385) using over-the-counter medications. Among surgical interventions, transurethral procedures were most frequent (13.42%; n = 173), followed by shockwave lithotripsy (11.48%; n = 148), laparoscopic or open surgery (6.75%; n = 87), and percutaneous nephrolithotripsy (6.05%; n = 78). Physicians gave preventive advice to 88.98% (n = 1,147) of respondents who had urolithiasis, most often recommending increased fluid intake (58.65%; n = 756). For renal colic-like pain, medications were the mainstay of treatment, with nearly 90% of patients reporting satisfaction. Some treatment patterns varied by age, sex, and/or residence, highlighting the influence of sociodemographic factors on care.

Conclusions: This study offers the first in-depth, population-level evaluation of how urolithiasis and renal colic-like pain symptoms are treated in Poland. The results can guide healthcare policy, support cost-effectiveness studies, and inform targeted strategies for management of urolithiasis and renal colic-like pain symptoms.

Introduction: Biopsy of the upper tract urothelial carcinoma (UTUC) often provides low-quality or non-diagnostic material. Cryobiopsy may improve the quality of UTUC samples. Our aim was to assess the feasibility of in vivo endoscopic cryobiopsy of UTUC and bladder cancer (BC).

Material and methods: Cryobiopsies were performed using the ERBECRYO® device and ø 1.1 mm flexible cryoprobes. Adult patients with UTUC/BC undergoing diagnostic/therapeutic endoscopic procedures were included. The cryoprobes were introduced in the proximity of the tumors and activated. The tissue samples were avulsed from the tumor, extracted and placed in a fixative.

Results: Six males were included. Out of these, 4 had UTUC, while 2 had BC. The median age was 68 years. Transurethral procedures were performed in 4 patients, percutaneous in 1 and combined in 1. Cryobiopsies were conducted using cystoscopes (n = 2), rigid ureterorenoscopes (n = 2), nephroscopes (n = 1) and without endoscope, through the ureteral access sheath (n = 1). Mean obtained sample size was 6.2 × 4.7 × 3.0 mm. All the specimens allowed for a histopathologic evaluation; no crushing artifacts were reported, lamina propria was present in 4 specimens, and muscularis propria was present in 1. Bleeding from the sample bed was subjectively significantly less intense than after conventional biopsies, and the procedure was found to be less challenging than standard methods.

Conclusions: Cryobiopsy represents a promising advancement in the endoscopic diagnosis of UTUC. Our pilot study demonstrates its feasibility in human in vivo settings. Further comparative research is warranted to establish its role in routine practice.

Introduction: Prostate cancer (PC) remains a significant global health burden, necessitating accurate staging for optimal treatment planning. Conventional imaging methods, including multiparametric magnetic resonance imaging (mpMRI), computed tomography (CT), and bone scintigraphy (BS), exhibit limitations in sensitivity and specificity. Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (⁶⁸Ga PSMA-PET/CT) has emerged as a promising alternative, with potential advantages in staging accuracy.

Material and methods: A comprehensive review of current literature was conducted to assess the role of ⁶⁸Ga PSMA-PET/CT in primary PC staging. The diagnostic performance of PSMA-PET/CT was compared with conventional imaging techniques in detecting locoregional and distant metastases. Studies evaluating sensitivity, specificity, and clinical utility in treatment decision-making were analyzed.

Results: ⁶⁸Ga PSMA-PET/CT demonstrated superior sensitivity and specificity in detecting lymph node and distant metastases compared to conventional imaging. It enables earlier and more precise disease staging, potentially reducing the need for multiple imaging modalities. Emerging evidence suggests its role in guiding therapeutic strategies, particularly in high-risk and recurrent PC cases. Despite its advantages, limitations such as accessibility, cost, and occasional false-negative findings must be considered.

Conclusions: ⁶⁸Ga PSMA-PET/CT represents a transformative diagnostic tool for PC staging, offering enhanced accuracy compared to traditional imaging. Its integration into clinical practice could streamline diagnostic pathways, improve treatment selection, and potentially optimize patient outcomes. Further research and cost-effectiveness analyses are needed to establish its widespread implementation.

Introduction: Neurogenic lower urinary tract dysfunction is typically managed through a step-up approach, beginning with anticholinergic medications, progressing to Botulinum toxin injections, and surgical interventions. Gabapentin offers a less invasive option, either as an adjunct to anticholinergics or as a standalone therapy. This systematic review examines gabapentin's efficacy and safety in treating neurogenic overactive bladders (NOAB) in both paediatric and adult populations.To determine gabapentin's effect on reducing bladder pressure, increasing bladder capacity, and alleviating incontinence symptoms in NOAB patients.

Material and methods: A systematic search was conducted on PubMed, Scopus, ScienceDirect, and Cochrane to identify studies on gabapentin for NOAB. Articles were sorted according to PRISMA guidelines, and the risk of bias was assessed using the JBI clinical appraisal tool. Data from the selected articles were synthesized qualitatively.

Results: Of the 116 identified articles, 6 were selected. Two focused on paediatric patients with neural tube defects, while four studies involved adults with conditions like spinal trauma, Parkinson's disease, and multiple sclerosis. Urodynamic parameters improved in four studies, whether gabapentin was used alone or as an adjunct. All 6 studies reported significant improvements and minimal side effects.

Conclusions: While limitations in dosages and study durations hinder a definitive endorsement of gabapentin, the overall positive response across studies suggests its potential efficacy in managing NOAB. Further high-quality randomized controlled trials comparing gabapentin with other treatments and exploring factors related to non-responsiveness are warranted for conclusive insights.