Central European Journal of Urology最新文献

Introduction: Obesity represents a worldwide epidemic disorder, increasing the overall morbidity and mortality rate. In this study we assessed the impact of obesity on perioperative and long-term functional outcomes of robotic-assisted simple prostatectomy (RASP).

Material and methods: Baseline measurements of uroflowmetry and validated questionnaire responses were prospectively recorded, which were repeated at follow-up. Composite outcomes (trifecta) were defined as combination of post-operative Q-max >15 ml/s, IPSS score <8, and absence of complications. Pentafecta included 2 additional criteria, namely post-operative ejaculation persistence (MSHQ score >0) and erectile function maintenance (ΔIEEF <6). Data analysis was stratified by BMI (<30 or ≥30).

Results: Eighty-one patients underwent RASP in our institution. Baseline demographic and clinical features, questionnaire scores, and baseline uroflowmetry results showed no significant differences between obese and non-obese cohorts. However, during follow-up, obese patients reported less improvement in IPSS (p = 0.02) and OABQ scores (p <0.001), along with a higher incidence of stress incontinence requiring duloxetine (p <0.001). Uroflowmetry outcomes were also lower in the obesity group (p = 0.02 and p = 0.03 for Qmax [ml/s] and post-void residual [ml], respectively). However, when considering assessment of comprehensive outcomes, obese patients demonstrated similar rates of achieving trifecta (67% vs 54%, p = 0.39) and pentafecta (p = 0.76) compared to non-obese patients.

Conclusions: Our results show that obesity is associated with poorer functional outcomes. Specifically concerning storage LUTS and incontinence rates following RASP. However, no impact of obesity on the achievement rates of trifecta and pentafecta outcomes was observed.

[This corrects the article DOI: 10.5173/ceju.2023.273.].

Introduction: Post-radiation cystitis is a complication of external beam radiation therapy, for the radical treatment of pelvic malignancies as radical treatment for pelvic malignancies. Chronic, refractory, post-radiation cystitis is problematic in its management, mainly when a conservative approach is preferred. Conservative methods are the first line of treatment, especially since the area has been irradiated, making surgical treatment more challenging.The objective of this systematic review is to evaluate the effectiveness and safety of conservative methods for the management of post-radiation cystitis. All non-invasive methods were included in the research, in patients over 18 years of age undergoing pelvic radiation therapy.

Material and methods: We conducted a systematic search for comparable studies on the conservative treatment of chronic post-radiation cystitis, analysing the efficacy and safety of these techniques, based on a specific protocol. The PubMed, Scopus, and CENTRAL databases and the grey literature were searched. Risk control of the individual papers was carried out using the RoB2 and ROBINS-I tools.

Results: A total of 282 papers were reviewed, of which 6 were included in the review: 3 randomised clinical trials and 3 non-randomised studies. Each of these studies investigated a different treatment, using a different population as control group, so it was not possible to conduct a meta-analysis of the studies.

Conclusions: Although most conservative measures appear to be successful in the management of post-radiation cystitis, more studies, especially randomised clinical trials, are needed before an algorithm of conservative methods can be created.

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.

Introduction: Gaining insight into patient characteristics to predict the success of procedures is crucial for improving outcomes and for preoperative counselling. We identified predictors of achieving a minimal clinically important difference (MCID) in lower urinary tract symptoms (LUTS) 3 months after Rezūm.

Material and methods: A retrospective study was conducted on patients treated with Rezūm. Patients with moderate or severe LUTS and a recorded International Prostate Symptom Score (IPSS) at 3 months were included and categorised into 2 cohorts based on experiencing a MCID at 3 months (≥ 25% improvement in IPSS). Predictors were identified through multivariate logistic regression analysis.

Results: Out of 174 patients, 134 (77%) achieved a MCID at 3 months, and those who did had a higher median baseline IPSS (20 [16-26] vs 15 [10-21], P <0.001) and were more likely to have severe LUTS at baseline (53.0% vs 35.0%, P = 0.046) when compared to those who did not experience a MCID at 3 months. Higher baseline IPSS (OR: 1.10, 95% CI 1.04-1.17) and larger baseline prostate volumes (OR: 1.03, 95% CI 1.0-1.05) were predictors of achieving a MCID at 3 months. More specifically, a significantly greater proportion of patients with severe LUTS (83.5 vs 70.8%, P = 0.046) and prostate volume ≥60 cc (94.6 vs 71.4%, P = 0.003) achieved MCID at 3 months when compared to patients with moderate LUTS and prostate volumes <60 cc, respectively.

Conclusions: More than three-quarters of patients treated with Rezūm achieved a MCID at 3 months. Patients with severe LUTS and prostate volumes ≥ 60 cc may be optimal candidates for experiencing early relief in LUTS following Rezūm.

Introduction: In this study we aimed to compare the efficacy of mirabegron and silodosin as medical expulsive therapy (MET) for distal ureteric calculus ≤10 mm.

Material and methods: A total of 114 patients who met the inclusion criteria were prospectively randomised into 2 groups, 58 patients in the silodosin group and 56 patients in the mirabegron group. The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and secondary endpoints were stone expulsion time and number of pain episodes.

Results: There were no statistically significant differences between the two groups in terms of mean age, gender, mean stone size, side, or hydronephrosis. Both groups exhibited similar rates of stone expulsion and expulsion time. Regarding pain management, the frequency of renal colic episodes was significantly lower with mirabegron compared to silodosin (2.3 ±0.2 vs 1.9 ±0.2, P <0.0001). Six patients were excluded from the study due to adverse drug reactions: 4 (6.15%) in the silodosin group (retrograde ejaculation, hypotension) and 2 (3.27%) in the mirabegron group (hypertension).

Conclusions: In among patients with distal ureteric stones measuring 5-10 mm, mirabegron did not demonstrate superiority in stone expulsion rate or expulsion time compared to silodosin. However, mirabegron significantly reduced the frequency of renal colic episodes. Therefore, mirabegron may be considered a preferable option for medical expulsive therapy for distal ureter stones over silodosin.

Introduction: This study was aimed to evaluate the feasibility, safety, and advantages of the use of transurethral intraprostatic anesthesia (TUIA) using Schelin Catheter^TM (SC) in patients undergoing holmium laser enucleation of the prostate (HoLEP).

Material and methods: TUIA was performed using SC, a catheter equipped with an operative channel with a retractile needle, a standard drainage outlet, and a balloon port. After inserting the SC into the patient's urethra and filling the balloon to anchor it in the bladder neck, four target injections with local anesthetic were performed, one in each quadrant in the base area of the prostate. After injections, the catheter was removed and the HoLEP procedure started. During the procedure, patients also received moderate sedation/analgesia.

Results: We selected two 63-year-old patients with good performance status. Prostate volume was 40 ml for the first patient and 31 ml for the second. TUIA and HoLEP operative times were 68 minutes in the first patient and 42 minutes in the second.During the procedure, patients complained of only minimal discomfort, and during hospitalization patients' numeric rating scale (NRS) pain score ranging from 1 to 0, with no need for additional analgesics. No complications were reported perioperatively and 15 days after the procedure.

Conclusions: This is the first report on TUIA via SC in patients undergoing HoLEP. In our preliminary experience, TUIA via SC was safe and feasible, showing complete perioperative pain control. Further studies are needed to confirm these promising results and better define the category of patients eligible for this type of treatment.

Introduction: Ureteroscopic lithotripsy (URSL) is an approved, minimally invasive, low-risk procedure for urolithiasis treatment. However, some patients may develop urinary tract infection (UTI) post-procedure, eventually leading to urosepsis. Determining the predictors of infection after URSL would help identify patients at a high risk of urosepsis, thereby enabling the early implementation of effective treatment. Therefore, we aimed to establish the incidence and predictors of urosepsis after URSL.

Material and methods: We assessed 231 patients who underwent URSL using a holmium laser. The incidence of urosepsis during the 30-day post-treatment period was analysed, and potential predictors of urosepsis, including patient characteristics and individual clinical factors, were examined.

Results: Statistical analysis revealed that 16.88% of patients had a confirmed positive urine culture before the procedure. Post-procedure urosepsis occurred in 4.76% of patients. Univariable analysis revealed that 3 factors were significantly associated with the risk of postoperative urosepsis: double-J stent insertion before URSL, pre-operative positive urine culture, and MDR pathogen found preoperatively. In multivariable analysis, only positive urine culture remained significantly associated with the risk of urosepsis after URSL.

Conclusions: Patients with positive urine culture before URSL are at significantly higher risk of urosepsis in the postoperative period. Hence, urine culture should be routinely performed before planned endoscopic urolithiasis treatment.