Pub Date : 2024-01-01Epub Date: 2024-01-06DOI: 10.5173/ceju.2023.254
Jacopo Durante, Michele Santarsieri, Francesca Manassero, Girolamo Fiorini, Claudia Cariello, Piero Lippolis, Andrea Colli, Giorgio Pomara
{"title":"Robotic left nephrectomy with level IV inferior vena cava thrombectomy using the AngioVac system.","authors":"Jacopo Durante, Michele Santarsieri, Francesca Manassero, Girolamo Fiorini, Claudia Cariello, Piero Lippolis, Andrea Colli, Giorgio Pomara","doi":"10.5173/ceju.2023.254","DOIUrl":"https://doi.org/10.5173/ceju.2023.254","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/PMC11032026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847415","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 : 2023-01-01Epub Date: 2023-04-17DOI: 10.5173/ceju.2023.204
Alfredo Maria Bove, Aldo Brassetti, Mario Ochoa, Umberto Anceschi, Simone D'Annunzio, Marilia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Riccardo Mastroianni, Silvia Cartolano, Giulia Torregiani, Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Simone
Introduction: The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other.
Material and methods: The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement.
Results: We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016).
Conclusions: At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP.
{"title":"Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison.","authors":"Alfredo Maria Bove, Aldo Brassetti, Mario Ochoa, Umberto Anceschi, Simone D'Annunzio, Marilia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Riccardo Mastroianni, Silvia Cartolano, Giulia Torregiani, Riccardo Lombardo, Cosimo De Nunzio, Giuseppe Simone","doi":"10.5173/ceju.2023.204","DOIUrl":"10.5173/ceju.2023.204","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other.</p><p><strong>Material and methods: </strong>The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ<sup>2</sup> and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement.</p><p><strong>Results: </strong>We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016).</p><p><strong>Conclusions: </strong>At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/a6/CEJU-76-204.PMC10357823.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860923","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}
Introduction Renal colic pain is considered one of the most excruciating pains ever experienced and ranks as one of the most common urological emergencies. Despite existing established recommendations, new therapies and their combinations are continuously being tested. The aim of this systematic review is to analyze and compare studies involving pharmacologic and non-pharmacologic interventions used in the treatment of renal colic pain. Material and methods This systematic review was conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Scopus, Cochrane Library, and Google Scholar were searched for relevant randomized controlled trials (RCTs) involving adult patients. The quality and results of the included studies were assessed and discussed. Results This review provides an extensive analysis of 71 identified RCTs. Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and dipyrone/metamizole have demonstrated effectiveness as single medications. Some evidence points to opioids having a potential disadvantage compared to others when used as a first-line single medication. Among the 63 studies exploring pharmacological therapy, 51 reported opioids utilization for rescue therapy in significant proportion of patients. Promising combination therapies involve the administration of an NSAID alongside opioids, ketamine, desmopressin, steroids, or nitric oxide. Conversely, spasmolytics, magnesium, and lidocaine exhibited limited or no additional effect. Noteworthy methodological shortcomings encompass a low pain threshold during participant recruitment and the reliance on pain reduction rather than complete pain elimination as an endpoint. Conclusions Frequent use of opioids as rescue medications in RCTs undermine their conclusions on effectiness of other therapeutics. Combination therapies should be considered as first choice in renal colic pain management. RCTs should define success of therapy as achieving complete or near-complete pain relief rather than pain reduction.
{"title":"Methodology and findings of randomized clinical trials on pharmacologic and non-pharmacologic interventions to treat renal colic pain – a review","authors":"","doi":"10.5173/ceju.2023.92","DOIUrl":"https://doi.org/10.5173/ceju.2023.92","url":null,"abstract":"Introduction Renal colic pain is considered one of the most excruciating pains ever experienced and ranks as one of the most common urological emergencies. Despite existing established recommendations, new therapies and their combinations are continuously being tested. The aim of this systematic review is to analyze and compare studies involving pharmacologic and non-pharmacologic interventions used in the treatment of renal colic pain. Material and methods This systematic review was conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Scopus, Cochrane Library, and Google Scholar were searched for relevant randomized controlled trials (RCTs) involving adult patients. The quality and results of the included studies were assessed and discussed. Results This review provides an extensive analysis of 71 identified RCTs. Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and dipyrone/metamizole have demonstrated effectiveness as single medications. Some evidence points to opioids having a potential disadvantage compared to others when used as a first-line single medication. Among the 63 studies exploring pharmacological therapy, 51 reported opioids utilization for rescue therapy in significant proportion of patients. Promising combination therapies involve the administration of an NSAID alongside opioids, ketamine, desmopressin, steroids, or nitric oxide. Conversely, spasmolytics, magnesium, and lidocaine exhibited limited or no additional effect. Noteworthy methodological shortcomings encompass a low pain threshold during participant recruitment and the reliance on pain reduction rather than complete pain elimination as an endpoint. Conclusions Frequent use of opioids as rescue medications in RCTs undermine their conclusions on effectiness of other therapeutics. Combination therapies should be considered as first choice in renal colic pain management. RCTs should define success of therapy as achieving complete or near-complete pain relief rather than pain reduction.","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135602438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Umberto Anceschi, Michele Morelli, Rocco Simone Flammia, Aldo Brassetti, Paolo Dell'Oglio, Antonio Galfano, Stefano Tappero, Enrico Vecchio, Marco Martiriggiano, Lorenzo Giuseppe Luciani, Isabella Sperduti, Simone Albisinni, Gabriele Tuderti, Francesco Prata, Maria Consiglia Ferriero, Alfredo Maria Bove, Riccardo Mastroianni, Giuseppe Spadaro, Andrea Russo, Daniele Mattevi, Antonio Tufano, Costantino Leonardo, Riccardo Lombardo, Cosimo De Nunzio, Tommaso Cai, Thierry Quackels, Aldo Massimo Bocciardi, Giuseppe Simone
Introduction: The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers.
Material and methods: Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant.
Results: Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15-8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3).
Conclusions: Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes.
{"title":"Predictors of trainees' proficiency during the learning curve of robot-assisted radical prostatectomy at high- -volume institutions: results from a multicentric series.","authors":"Umberto Anceschi, Michele Morelli, Rocco Simone Flammia, Aldo Brassetti, Paolo Dell'Oglio, Antonio Galfano, Stefano Tappero, Enrico Vecchio, Marco Martiriggiano, Lorenzo Giuseppe Luciani, Isabella Sperduti, Simone Albisinni, Gabriele Tuderti, Francesco Prata, Maria Consiglia Ferriero, Alfredo Maria Bove, Riccardo Mastroianni, Giuseppe Spadaro, Andrea Russo, Daniele Mattevi, Antonio Tufano, Costantino Leonardo, Riccardo Lombardo, Cosimo De Nunzio, Tommaso Cai, Thierry Quackels, Aldo Massimo Bocciardi, Giuseppe Simone","doi":"10.5173/ceju.2023.260","DOIUrl":"https://doi.org/10.5173/ceju.2023.260","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers.</p><p><strong>Material and methods: </strong>Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant.</p><p><strong>Results: </strong>Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15-8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3).</p><p><strong>Conclusions: </strong>Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/3a/CEJU-76-260.PMC10091888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9309522","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}
Justin Kwong, R John D'A Honey, Jason Y Lee, Michael Ordon
Introduction: Ureteral double-J stent length is an important factor affecting stent-related symptoms. Multiple techniques exist to determine ideal stent length for a given patient, however, little is known about what techniques urologists rely on. Our objective was to identify how urologists determine optimal stent length.
Material and methods: An online survey was e-mailed in 2019 to all members of the Endourology Society. The survey sought to assess what methods are commonly used to determine choice of stent length, along with frequency of stent placement post ureteroscopy, duration of stenting, availability of different stent lengths and the use of stent tether.
Results: 301 urologists (15.1%) responded to our survey. Following ureteroscopy, 84.5% of respondents would stent at least 50% of the time. Following uncomplicated ureteroscopy, most respondents (52.0%) would leave a stent for 2-7 days. Patient height was most commonly ranked first as the method of choice in determining stent length (47.0%), followed by estimation based on experience only (20.6%) and intra-operative direct measurement of ureteric length (19.1%). Most respondents utilized multiple methods in determination of optimal stent length. Most respondents (66.5%) were interested in a simple intra-operative technique utilizing a special ureteral catheter that would help choose the most appropriate stent length.
Conclusions: Post-ureteroscopy stent insertion is common and patient height is the most common method of choice used in determining optimal stent length. Most respondents were interested in using a simple, novel ureteral catheter device that would allow them to more accurately select optimal stent length.
{"title":"Determination of optimal stent length: a survey of urologic surgeons.","authors":"Justin Kwong, R John D'A Honey, Jason Y Lee, Michael Ordon","doi":"10.5173/ceju.2023.83","DOIUrl":"https://doi.org/10.5173/ceju.2023.83","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteral double-J stent length is an important factor affecting stent-related symptoms. Multiple techniques exist to determine ideal stent length for a given patient, however, little is known about what techniques urologists rely on. Our objective was to identify how urologists determine optimal stent length.</p><p><strong>Material and methods: </strong>An online survey was e-mailed in 2019 to all members of the Endourology Society. The survey sought to assess what methods are commonly used to determine choice of stent length, along with frequency of stent placement post ureteroscopy, duration of stenting, availability of different stent lengths and the use of stent tether.</p><p><strong>Results: </strong>301 urologists (15.1%) responded to our survey. Following ureteroscopy, 84.5% of respondents would stent at least 50% of the time. Following uncomplicated ureteroscopy, most respondents (52.0%) would leave a stent for 2-7 days. Patient height was most commonly ranked first as the method of choice in determining stent length (47.0%), followed by estimation based on experience only (20.6%) and intra-operative direct measurement of ureteric length (19.1%). Most respondents utilized multiple methods in determination of optimal stent length. Most respondents (66.5%) were interested in a simple intra-operative technique utilizing a special ureteral catheter that would help choose the most appropriate stent length.</p><p><strong>Conclusions: </strong>Post-ureteroscopy stent insertion is common and patient height is the most common method of choice used in determining optimal stent length. Most respondents were interested in using a simple, novel ureteral catheter device that would allow them to more accurately select optimal stent length.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/ee/CEJU-76-83.PMC10091891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9309524","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}
Introduction: The aim of this study was to evaluate the possible histopathological alterations that occur in the kidneys due to a continuous temperature increase above 43°C for one hour of lithotripsy using a newly introduced thulium fiber laser (TFL).
Material and methods: Two female pigs were used. After the insertion of a 9.5/11.5 ureteral access sheath, flexible ureteroscopy and laser lithotripsy for one hour were conducted. A TFL laser with a 200-μm fiber was used. The power setting used was 8 W (0.5 J × 16 Hz). A K-type thermocouple was inserted and fixed in the upper calyx of the right porcine kidney to record the temperature in the pelvicalyceal system during the laser activation. Second-look flexible nephroscopy followed by nephrectomy and pathohistological evaluation of the operated kidney was performed one week after the procedure in the first pig and 2 weeks after the surgery in the second pig.
Results: Flexible nephroscopy did not reveal significant differences between the 2 porcine kidneys. Nevertheless, the histopathological report demonstrated severe alterations in the kidney of the first pig. Mild changes were reported in the kidney of the second pig. A significant improvement in inflammation and haemorrhagic lesions was demonstrated when comparing the 2 kidneys.
Conclusions: The difference demonstrated between the 2 kidneys based on the histopathological report shows that the healing process is capable of improving severe to mild alterations within a one-week time frame. Two weeks after the surgery, only minor changes were observed, suggesting that even temperature increases above the threshold can be tolerated regarding renal damage.
{"title":"High-power laser lithotripsy - do we treat or harm? Histological evaluation of temperature effects in an in vivo study with thulium fiber laser.","authors":"Angelis Peteinaris, Arman Tsaturyan, Vasiliki Bravou, Vasileios Tatanis, Gabriel Faria-Costa, Konstantinos Pagonis, Solon Faitatziadis, Athanasios Vagionis, Evangelos Liatsikos, Panagiotis Kallidonis","doi":"10.5173/ceju.2023.24","DOIUrl":"https://doi.org/10.5173/ceju.2023.24","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the possible histopathological alterations that occur in the kidneys due to a continuous temperature increase above 43°C for one hour of lithotripsy using a newly introduced thulium fiber laser (TFL).</p><p><strong>Material and methods: </strong>Two female pigs were used. After the insertion of a 9.5/11.5 ureteral access sheath, flexible ureteroscopy and laser lithotripsy for one hour were conducted. A TFL laser with a 200-μm fiber was used. The power setting used was 8 W (0.5 J × 16 Hz). A K-type thermocouple was inserted and fixed in the upper calyx of the right porcine kidney to record the temperature in the pelvicalyceal system during the laser activation. Second-look flexible nephroscopy followed by nephrectomy and pathohistological evaluation of the operated kidney was performed one week after the procedure in the first pig and 2 weeks after the surgery in the second pig.</p><p><strong>Results: </strong>Flexible nephroscopy did not reveal significant differences between the 2 porcine kidneys. Nevertheless, the histopathological report demonstrated severe alterations in the kidney of the first pig. Mild changes were reported in the kidney of the second pig. A significant improvement in inflammation and haemorrhagic lesions was demonstrated when comparing the 2 kidneys.</p><p><strong>Conclusions: </strong>The difference demonstrated between the 2 kidneys based on the histopathological report shows that the healing process is capable of improving severe to mild alterations within a one-week time frame. Two weeks after the surgery, only minor changes were observed, suggesting that even temperature increases above the threshold can be tolerated regarding renal damage.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/0e/CEJU-76-24.PMC10091897.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316745","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}
Introduction: The aim of this study was to compare the long-term oncological results of patients with the diagnosis of prostate cancer who underwent open radical retropubic prostatectomy (RRP) and subsequent adjuvant (ART) or salvage radiotherapy (SRT).
Material and methods: A total of 145 patients underwent open RRP for prostate cancer and subsequent ART or SRT postoperatively between 2010 and 2019. ART (n = 56) is defined as the group of patients with prostate-specific antigen (PSA) <0.2 ng/mL or with positive lymph nodes without PSA increase who received radiotherapy within the first 6 months of urinary continence. SRT (n = 89) is defined as the group of patients with PSA >0.2 ng/mL who received RT before PSA amounted to 0.5 ng/mL.
Results: Statistically no significant difference was found between groups in terms of age, prostate volume, final pathology Gleason scores, lymphadenectomy, duration of androgen deprivation therapy (ADT), time to relapse after radiotherapy, development of biochemical recurrence and disease progression. Extraprostatic extension, seminal vesicle invasion and surgical margin positivity were significantly higher in the ART group. No difference was found between the groups in terms of biochemical recurrence-free survival, while cancer-specific survival and overall survival rates were significantly higher in the SRT group.
Conclusions: It was found that cancer-specific and overall survival was better in the SRT group. It will be more appropriate to follow-up until the recurrence and then to perform SRT after the relapse in the postoperative period.
{"title":"Oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer.","authors":"Furkan Şendoğan, Turgay Turan, Ferhat Keser, Tayfun Hancilar, Gokhan Atis, Asif Yildirim","doi":"10.5173/ceju.2023.190","DOIUrl":"https://doi.org/10.5173/ceju.2023.190","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to compare the long-term oncological results of patients with the diagnosis of prostate cancer who underwent open radical retropubic prostatectomy (RRP) and subsequent adjuvant (ART) or salvage radiotherapy (SRT).</p><p><strong>Material and methods: </strong>A total of 145 patients underwent open RRP for prostate cancer and subsequent ART or SRT postoperatively between 2010 and 2019. ART (n = 56) is defined as the group of patients with prostate-specific antigen (PSA) <0.2 ng/mL or with positive lymph nodes without PSA increase who received radiotherapy within the first 6 months of urinary continence. SRT (n = 89) is defined as the group of patients with PSA >0.2 ng/mL who received RT before PSA amounted to 0.5 ng/mL.</p><p><strong>Results: </strong>Statistically no significant difference was found between groups in terms of age, prostate volume, final pathology Gleason scores, lymphadenectomy, duration of androgen deprivation therapy (ADT), time to relapse after radiotherapy, development of biochemical recurrence and disease progression. Extraprostatic extension, seminal vesicle invasion and surgical margin positivity were significantly higher in the ART group. No difference was found between the groups in terms of biochemical recurrence-free survival, while cancer-specific survival and overall survival rates were significantly higher in the SRT group.</p><p><strong>Conclusions: </strong>It was found that cancer-specific and overall survival was better in the SRT group. It will be more appropriate to follow-up until the recurrence and then to perform SRT after the relapse in the postoperative period.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/55/CEJU-76-190.PMC10357821.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864198","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}
The aim of this report is to underline proper differential diagnosis of scrotal enlargement and to highlight feasibility of minimally invasive robotic-assisted treatment of giant urinary bladder containing inguinoscrotal hernia. A 48-year-old patient was referred to the outpatient urology clinic with diagnosis of hydrocele. During the diagnostic procedures, it was confirmed that the scrotal enlargement is a giant inguinal hernia containing most of the urinary bladder. Robotic-assisted laparoscopic transabdominal preperitoneal hernia repair (TAPP) has been performed. The patient remains asymptomatic after 18 months of observation. Minimally invasive repair should always be considered due to better perioperative and postoperative outcomes.
{"title":"A giant inguinoscrotal hernia containing urinary bladder repaired with use of robotic-assisted laparoscopy: a case report.","authors":"Piotr Kania, Paweł Marczuk, Jakub Biedrzycki","doi":"10.5173/ceju.2023.211","DOIUrl":"https://doi.org/10.5173/ceju.2023.211","url":null,"abstract":"<p><p>The aim of this report is to underline proper differential diagnosis of scrotal enlargement and to highlight feasibility of minimally invasive robotic-assisted treatment of giant urinary bladder containing inguinoscrotal hernia. A 48-year-old patient was referred to the outpatient urology clinic with diagnosis of hydrocele. During the diagnostic procedures, it was confirmed that the scrotal enlargement is a giant inguinal hernia containing most of the urinary bladder. Robotic-assisted laparoscopic transabdominal preperitoneal hernia repair (TAPP) has been performed. The patient remains asymptomatic after 18 months of observation. Minimally invasive repair should always be considered due to better perioperative and postoperative outcomes.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/8e/CEJU-76-211.PMC10091887.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9309521","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 : 2023-01-01Epub Date: 2023-04-30DOI: 10.5173/ceju.2023.04
Robby P A Lamoury, Jasper Pauwels, Stefan De Wachter, Tim Brits
Introduction: Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy.
Material and methods: A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy.
Results: Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications.
Conclusions: Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.
导语:输精管切除术是一种男性绝育手术。这是一种在日常泌尿外科实践中非常常见的手术,并发症发生率低。血肿形成、伤口感染、慢性阴囊疼痛和自发性再通是众所周知的并发症。输精管切除术后瘘管形成和睾丸梗死不太常见。在这篇文章中,我们提供了一篇关于输精管切除术后罕见并发症的文献综述。材料和方法:在2022年9月30日之前,对PubMed Medline和Web of Science核心收藏数据库进行了手动电子搜索,包括所有纳入的报告,以确定评估输精管切除术后患者并发症的研究。结果:尿道-血管皮瘘是迄今为止最常见的,而血管皮瘘、血管静脉瘘和动静脉瘘很少报道。在排出瘘管时,可以进行流体分析以区分不同类型。所有病例都进行了阴囊探查和瘘管结扎。如果存在潜在的膀胱出口梗阻,应进行治疗。阴囊梗死是输精管切除术的另一种罕见并发症。诊断是通过阴囊超声和彩色多普勒。治疗通常是保守的,但在较大的梗死中应考虑睾丸切除术。输精管切除术后患者常见单纯伤口感染。更复杂的感染是罕见的,但可能导致严重甚至致命的并发症。结论:输精管切除术后常见并发症是众所周知的,通常与患者进行充分讨论。然而,可能会出现罕见的并发症,临床医生必须认识到这些并发症。
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Pub Date : 2023-01-01Epub Date: 2023-11-13DOI: 10.5173/ceju.2023.148
Ioannis Tsikopoulos, Lazaros Lazarou, Lazaros Tzelves, Vasileios Sakalis, Christina Papathanasiou, Michael Samarinas
Introduction: Pelvic floor muscle training (PFMT) is suggested for women with stress urinary incontinence (SUI). The aim of our study is to examine the effectiveness of PFMT on urodynamic (UDS) parameters.
Material and methods: This is a prospective observational study enrolling women with SUI. Pelvic surgery, prolapse, body mass index >30, and cognitive disability were exclusion criteria. Patients had baseline UDS, then PFMT only (Group A) or PFMT plus biofeedback (BFD) (Group B) for 6 months and UDS 3 months after treatment. The primary investigated parameters were the number of pads used per day and Valsalva leak point pressure (VLPP).
Results: Forty-six women completed the study, 22 in Group A and 24 in Group B. At baseline, all patients documented SUI with 3 median pads used per day. Urodynamic SUI was documented with a median Valsalva leak point pressure (mVLPP) of 45 cmH2O. At the re-evaluation, 12 women (26.1%) had SUI in BDs with median number pads per day of 1, which was statistically different to baseline (p = 0.02). Urodynamic SUI was reported in 8 (17.4%) women with a mVLPP of 88 cmH2O.Six patients were from Group A and 6 from Group B. In Group A, the median number of pads per day was 1, and urodynamic SUI was found in 3 women. In Group B, the median number of pads per day was 1, and urodynamic SUI was found in 5 women. Thirty-four women (73.9%) were dry - 16 (47.1%) from Group A and 18 (52.9%) from Group B.
Conclusions: PFMT improves urodynamic parameters among women with SUI.
简介:建议患有压力性尿失禁(SUI)的女性进行盆底肌肉训练(PFMT)。我们的研究旨在探讨盆底肌训练对尿动力学(UDS)参数的影响:这是一项前瞻性观察研究,研究对象为患有 SUI 的女性。盆腔手术、脱垂、体重指数大于 30 和认知障碍是排除标准。患者进行基线 UDS,然后只进行 PFMT(A 组)或 PFMT 加生物反馈(BFD)(B 组)治疗 6 个月,并在治疗后 3 个月进行 UDS。主要研究参数为每天使用的尿垫数量和 Valsalva 漏点压力(VLPP):46 名妇女完成了研究,其中 A 组 22 人,B 组 24 人。基线时,所有患者都有 SUI 记录,每天使用的尿垫中位数为 3 个。尿动力学 SUI 的中位 Valsalva 漏点压力(mVLPP)为 45 cmH2O。在再次评估时,有 12 名女性(26.1%)在 BDs 中出现 SUI,每天使用尿垫的中位数为 1 个,与基线有统计学差异(p = 0.02)。A组有6名患者,B组有6名患者。在A组中,每天使用尿垫次数的中位数为1次,3名女性出现了尿动力性 SUI。在 B 组中,每天使用尿垫次数的中位数为 1 次,有 5 名妇女发现了尿动力 SUI。34名妇女(73.9%)为干性,其中A组16人(47.1%),B组18人(52.9%):结论:PFMT 可改善 SUI 女性的尿动力学参数。
{"title":"The effect of pelvic floor muscle training on urodynamic parameters in women with stress urinary incontinence.","authors":"Ioannis Tsikopoulos, Lazaros Lazarou, Lazaros Tzelves, Vasileios Sakalis, Christina Papathanasiou, Michael Samarinas","doi":"10.5173/ceju.2023.148","DOIUrl":"10.5173/ceju.2023.148","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic floor muscle training (PFMT) is suggested for women with stress urinary incontinence (SUI). The aim of our study is to examine the effectiveness of PFMT on urodynamic (UDS) parameters.</p><p><strong>Material and methods: </strong>This is a prospective observational study enrolling women with SUI. Pelvic surgery, prolapse, body mass index >30, and cognitive disability were exclusion criteria. Patients had baseline UDS, then PFMT only (Group A) or PFMT plus biofeedback (BFD) (Group B) for 6 months and UDS 3 months after treatment. The primary investigated parameters were the number of pads used per day and Valsalva leak point pressure (VLPP).</p><p><strong>Results: </strong>Forty-six women completed the study, 22 in Group A and 24 in Group B. At baseline, all patients documented SUI with 3 median pads used per day. Urodynamic SUI was documented with a median Valsalva leak point pressure (mVLPP) of 45 cmH<sub>2</sub>O. At the re-evaluation, 12 women (26.1%) had SUI in BDs with median number pads per day of 1, which was statistically different to baseline (p = 0.02). Urodynamic SUI was reported in 8 (17.4%) women with a mVLPP of 88 cmH<sub>2</sub>O.Six patients were from Group A and 6 from Group B. In Group A, the median number of pads per day was 1, and urodynamic SUI was found in 3 women. In Group B, the median number of pads per day was 1, and urodynamic SUI was found in 5 women. Thirty-four women (73.9%) were dry - 16 (47.1%) from Group A and 18 (52.9%) from Group B.</p><p><strong>Conclusions: </strong>PFMT improves urodynamic parameters among women with SUI.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10789280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477194","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}