Central European Journal of Urology最新文献

Introduction: This study aimed to evaluate the clinical impact of implementing routine emergency computed tomography (eCT) for all patients presenting with suspected acute renal colic at the emergency department (ED).

Material and methods: We did a retrospective observational study of all patients who underwent eCT for suspected acute renal colic at the ED in Helsingborg between May 9, 2023 and May 8, 2024 and compared with a 2019/2020 cohort not using routine eCT.

Results: Of 66,540 ED visits during the study period, 1,566 patients underwent eCT for suspected acute renal colic; 1,261 were included in the analysis after exclusions. In 57% of patients, no symptomatic stone was identified; nevertheless, one fifth required hospital admission for alternative diagnoses. A radiologically proven stone explaining their symptoms was found in 43% of patients. Compared with the 2019/2020 cohort, the 2023/2024 cohort had more treatments (33% vs 21%), and significantly shorter time to both treatment (p = 0.01) and clinical closure (p <0.001). Stone size, location, type of treatment and number of visits to the ED were comparable between the two cohorts.

Conclusions: Acute renal colic in its clinical presentation appeared to be less diagnostically reliable than previously assumed. The use of eCT ensured accurate diagnosis of urolithiasis, significantly shortened time to treatment, and to a stone-free patient as well as reduced the use of stents. We propose that eCT should be implemented as a routine procedure in the management of acute renal colic.

Introduction: Platelets store numerous growth factors that are released upon activation at sites of tissue injury. These factors support the wound healing process by enhancing chemotaxis, angiogenesis, cellular proliferation, extracellular matrix synthesis, and tissue remodeling.The aim of the study was to evaluate the therapeutic effect of intralesional lyophilized platelet-derived growth factors (PDGF) in men with Peyronie's disease (PD).

Material and methods: This prospective study included 42 patients diagnosed with PD between June 2022 and October 2023; four were lost to follow-up. After providing informed consent, all participants underwent clinical evaluation, including medical history, physical examination, Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), Peyronie's Disease Questionnaire (PDQ), intracavernosal injection test, and penile duplex ultrasonography. Patients received six biweekly intralesional injections of lyophilized PDGF (one vial every two weeks over 12 weeks).

Results: A significant reduction in penile curvature was observed, with the mean angle decreasing from 34.62 ±16.37° to 11.40 ±8.84° (mean reduction of 23.22°). Plaque size was also significantly reduced, from a mean of 2.70 ±0.87 cm to 1.43 ±0.44 cm. PDQ scores improved in all domains: Domain 1 by 9.18 points, Domain 2 by 14.74 points, and Domain 3 by 8.3 points. Additionally, erectile function improved, with no patients reporting an EHS grade of E1 or E2 after treatment.

Conclusions: Intralesional injection of lyophilized PDGF appears to be a promising non-surgical option for improving curvature, plaque size, and sexual function in patients with Peyronie's disease. Further studies are recommended to validate these findings.

Introduction: Nocturnal enuresis (NE) is defined as the involuntary passage of urine during sleep in children over the age of five. Although the precise mechanisms of NE are unclear, factors like delayed development, genetic influences, excessive nighttime urine production, disrupted sleep, and bladder dysfunction play a role. This study aims to evaluate the role of comorbidities in NE and develop a scoring system to predict treatment response, with clinical applications.

Material and methods: We recruited 374 patients aged 5-18 years undergoing pharmacological treatment (single or combined) for NE. Demographic and clinical data were collected through parent interviews. Statistical analyses included descriptive statistics and categorical analysis using χ² tests, followed by logistic regression.

Results: Statistical associations were found between recurrence and learning disorders (χ² = 4.862, p = 0.027), and between treatment response and learning disorders, encopresis, polythelia, language delay, and snoring. Logistic regression identified learning disorders (OR = 3.023), encopresis (OR = 2.156), polythelia (OR = 2.196), language delay (OR = 2.137), and snoring (OR = 1.560) as predictors of poor treatment response. We propose the PiFe score, a clinical tool to predict treatment outcomes in children with NE. This score integrates factors such as comorbidities, age, and symptom severity, helping to guide multidisciplinary interventions.

Conclusions: This study emphasizes the importance of a holistic approach to managing NE. The PiFe score could be a useful tool for predicting treatment outcomes and guiding interventions. Further research is needed to validate and refine the scoring system.

Introduction: Immunonutrition plays a major role in the prehabilitation of patients undergoing radical cystectomy for bladder cancer. The aim of this study was to familiarize practitioners familiarize current clinical research on the nutritional preconditioning of patients prior to surgery.

Material and methods: A systematic literature review was conducted in PubMed database. Out of 25 records identified, 7 studies were included. Only 1 of these was a randomized controlled trial.

Results: Immunonutrition has been associated with a reduction in postoperative complications and hospital length of stay, as well as improvements in postoperative bowel function. It may also contribute to modulating the inflammatory response.

Conclusions: Nutritional prehabilitation may positively influence postoperative outcomes following radical cystectomy. However, further randomized controlled trials are necessary to provide more robust and reliable evidence in this field.

Introduction: Leiomyosarcoma (LMS) of the lower urinary tract (LUT) is a rare and aggressive malignancy derived from smooth muscle cells. It most commonly arises in the bladder, is less frequent in the prostate, and exceptionally rare in the urethra. The disease typically affects adults around the sixth decade of life with a slight male predominance. Etiology remains unclear, although previous radiotherapy or exposure to specific chemotherapeutic agents has been implicated. Clinical presentation is often nonspecific and may resemble more prevalent urinary tract diseases, contributing to delayed or inaccurate diagnosis.

Material and methods: This narrative review summarizes current knowledge on LUT LMS based on available case reports and small case series. The literature was analyzed with focus on epidemiology, clinical features, diagnostic methods, and treatment strategies to highlight challenges in management and areas requiring further investigation.

Results: Diagnosis of LUT LMS relies on histopathological assessment supported by immunohistochemistry, typically demonstrating positivity for smooth muscle markers such as smooth muscle actin, desmin, h-caldesmon, and vimentin. Surgery remains the cornerstone of treatment. Radical cystectomy is the most common approach for bladder tumors, while prostatic and urethral involvement often necessitates extensive surgical resection. The effectiveness of chemotherapy and radiotherapy is uncertain, and their use is tailored to individual tumor characteristics and patient condition. Regardless of location, prognosis is generally poor due to biological aggressiveness and frequent late presentation.

Conclusions: LUT LMS is an extremely rare malignancy with limited evidence available to guide management. Further research, including multicenter databases and prospective studies, is needed to establish prognostic factors and optimize treatment. Multidisciplinary collaboration is essential to ensure timely diagnosis, appropriate therapeutic planning, and improved patient outcomes.

We present a case of a 44-year-old male with gross hematuria and lower urinary tract symptoms (LUTS). Ultrasonography revealed a 3 cm lesion, initially non-indicative of bladder cancer. Magnetic resonance imaging (MRI) identified a 26 mm posterior bladder wall mass, suggesting muscle invasive bladder cancer (MIBC). Transurethral resection of the bladder tumor (TURBT) was performed. Histopathology and immunohistochemistry confirmed an inflammatory myofibroblastic tumor (IMT). No neuro- or angioinvasion was present. Follow-up clinical evaluation revealed no evidence of recurrence, and the patient remained asymptomatic with complete resolution of urinary symptoms.

Introduction: Over the last few years, trends in managing benign prostatic hyperplasia (BPH) have improved, advancing from reliance on surgery to satisfactory medical therapies. However, the efficacy and safety of combination therapies, including silodosin and tadalafil, are not well established compared to monotherapy for treating lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO).

Material and methods: A systematic search was conducted in PubMed, ScienceDirect, Cochrane Library, and Scopus up to April 1, 2024. The quality of the studies was assessed using The Cochrane Risk of Bias (RoB) Tools 2 and Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E). Meta-analysis was conducted using RevMan 5.4.

Results: A total of 1,300 records were screened, resulting in 7 final studies. Our meta-analyses showed that international prostate symptom score (IPSS), maximum urine flow rate (Q_max), and post-void residual volume (PVR) led to considerably greater improvements with the combination of silodosin and tadalafil compared to using either as monotherapy. However, combination therapy notably exhibited higher rates of adverse events (AE). On the other hand, as monotherapy, silodosin demonstrated a statistically significant improvement in Q_max (p = 0.006) and PVR (p = 0.02) over tadalafil but with higher rates of total AE, discontinuation, and risk of retrograde ejaculation.

Conclusions: Silodosin and tadalafil are effective for treating LUTS in men due to BPO, especially when used in combination. However, with concerns about safety, tadalafil as monotherapy offers an advantage for patients with fertility desires due to its favorable side effect profile.

Introduction: Aim of the study was to evaluate and illustratively depict the aspiration properties of a single-use 7.5 Fr flexible ureteroscope with direct-in-scope suction (DISS) in a specifically designed in vitro setting.

Material and methods: An experimental in vitro study using a 6.5 size sterile glove, natural stone fragments and part of a porcine ureter was performed. A single use 7.5 Fr digital flexible ureteroscope with integrated direct-in-scope suction (PU3033AH, Zhuhai Pusheng Medical Technology Co., Ltd., Zhuhai China) was used for all trials. Five stone fragments ranging from 3 to 5 mm in maximal diameter were used. For each stone, three trials were performed; stones placed in the upper, middle and lower calyx. The experimental trial was defined as partially successful if stone relocation using suction (SRS) was present and successful when subsequent evacuation was reported.

Results: Relocation of stone fragments (partial success) was observed for all stones in different locations. Easy evacuation of the 3 mm stone fragment occurred from all calyces. Complete success was also reported for all 4 mm stones. Complete success was documented with the 5 mm stone positioned in the upper and middle calyces, whereas evacuation of the stone from the lower calyx was not achieved after 5 attempts.

Conclusions: With the 7.5 Fr Pusen DISS integrated scope, stone fragments 3-5 mm in all calyces were successfully relocated. Whilst evacuation from any calyx was successfully done in 3-4 mm fragments, this was only possible for 5 mm fragments located in upper calyx or interpolar region. The lower pole and greater fragment size need further evaluation for optimal management by DISS.