Central European Journal of Urology最新文献

Introduction: Sacral neuromodulation and posterior tibial nerve stimulation for lower urinary tract dysfunction (LUTD) and overactive bladder yield good and reliable results. However, neuromodulation research is continuously evolving because there is still need for more patient-friendly treatment options in the therapeutic management of LUTD. Pudendal neuromodulation (PNM) has been emerging as a promising alternative treatment option for the last few decades. The aim of this study is to review the current state of the art of PNM.

Material and methods: A wide literature search was conducted in the field of PNM using Medline through the PubMed database and Elsevier using the Scopus database; a critical review of the results was then carried out. PNM has been studied in its various possible aspects: percutaneous PNM, transrectal/transvaginal PNM, and both percutaneous and transcutaneous dorsal genital nerve stimulation.

Results: Each technique was found to result in promising improvements in different clinical outcomes, with some trials reporting even better results than sacral neuromodulation.

Conclusions: As a result of a comparison between the various PNM techniques with both sacral neuromodulation and posterior tibial nerve stimulation, we think that PNM should be seen as seriously promising, and we believe it will expand the treatment options for overactive bladder. Even though several studies accordingly showed PNM to be safe and effective, a systematic review and meta-analysis were not feasible. PNM in its various techniques is a promising treatment for LUTD. Nevertheless, further research is needed to include it in treatment algorithms.

Introduction: This publication provides a summary of national guidelines developed in response to the regional characteristics of aetiological factors, resistance patterns, and the availability of antibacterial drugs in Poland.

Material and methods: After reviewing the epidemiological evidence, case-control studies, randomised control trials, and current international guidelines and statements, a Polish multidisciplinary group prepared the final recommendations. These recommendations cover diagnosis and management of community-acquired lower urinary tract infections in both genders, pregnant and breastfeeding women, recurrent lower urinary tract infections, and asymptomatic bacteriuria.

Results: The regional choice of antimicrobial agents for first-line therapy of uncomplicated cystitis in women includes fosfomycin trometamol, pivmecillinam, furazidin (furagin), and nitroxoline. For men, co-trimoxazole or fluoroquinolone therapy is recommended. Pivmecillinam and fosfomycin are recommended for the treatment of pregnant and breastfeeding women. For continuous prophylaxis of recurrent urinary tract infections in women, the following antimicrobial agents can be used: fosfomycin trometamol, trimethoprim, furazidin (furagin), and cefaclor. The significance of behavioural management and the use of vaginal hormonal therapy, vaginal probiotics, and immunoprophylaxis is emphasised. Asymptomatic bacteriuria should be treated in pregnant women and in patients prior to surgical intervention in the urinary tract.

Conclusions: New national guidelines based on locally available therapeutic resources should contribute to a more rational choice of therapy in patients with lower urinary tract infection and asymptomatic bacteriuria in Poland.

Introduction: Thermal injury to kidney tissue during holmium laser lithotripsy represents a significant complication. This issue is often unavoidable due to the variability of renal conditions and the absence of techniques for real-time intrarenal temperature monitoring. The objective of this research was to evaluate influence of manual hand pump irrigation on temperature of the fluid within a pelvicalyceal model during holmium laser lithotripsy.

Material and methods: Laser lithotripsy of artificial stones was carried out in a 3D-printed model of the renal pelvicalyceal system. The irrigation system employed a continuous gravity approach (P = 60 cmH₂O), augmented by manual pumping as required. A 9.2 Fr ureteroscope was inserted into the model via a ureteral access sheath (UAS), with sizes of either 10/12 Fr or 12/14 Fr.The power settings for the lithotripsy varied between 12 and 25 W. Temperature monitoring during the procedure was conducted using thermographic methods.

Results: For all laser power settings, the temperatures recorded under gravity irrigation alone were significantly higher compared to those achieved when gravity was combined with a manual hand pump, regardless of the ureteral access sheath size. When using the hand pump system and a 12/14Fr UAS, the median temperatures in none of the laser settings exceeded 30°C. However, using a 10/12Fr UAS, the median temperatures did not exceed 35°C in any of the settings and were significantly lower compared to the use of the gravity flow system alone.

Conclusions: The employment of gravity irrigation supplemented by a manually on-demand pump in retrograde intrarenal surgery is a critical component in mitigating the risk of significant temperature elevations, leading to thermal injury to the adjacent kidney tissues. Moreover, the interquartile ranges of temperatures indicating that gravity system enhanced by an on-demand pump irrigation not only reduce the median temperature but also promote a more consistent thermal environment.

Introduction: To compare the mineral content of commercially available water (tap and bottled) in the Netherlands and to evaluate which type of water should be recommended for kidney stone patients.

Material and methods: All Dutch water supply companies were contacted to request water analysis reports of tap water. Bottled still and sparkling water available in the 5 main supermarket chains in the Netherlands were also included. Information regarding the mineral composition of bottled waters was read from the manufacturers' ingredient label on the bottles. Data regarding sodium, potassium, bicarbonate, calcium, magnesium, and sulphate content were evaluated.

Results: All Dutch water supply companies, consisting of 179 production locations, were included. Twenty-one bottled still waters and 25 bottled sparkling waters were included. There was a wide range of results for the evaluated minerals. Sodium levels were highest in tap water (134.0 mg/l), whereas potassium concentrations were highest in bottled water (18.0 mg/l). Bicarbonate, calcium, and sulphate concentrations were highest in bottled still water (432.0 mg/l, 240.0 mg/l, and 400.0 mg/l, respectively). Magnesium levels were highest in bottled sparkling water (51.4 mg/l).

Conclusions: Commercially available water (bottled and tap) in the Netherlands is safe to use for KSD patients. However, specific bottled waters can be described as calcium and magnesium rich. Therefore, it remains important for KSD patients and their physicians to realise that the mineral composition of drinking water may vary, and its consumption might require alterations of their diet.

Introduction: Nationwide data on urological hospitalizations may improve the quality of care. This study aimed to evaluate the epidemiological characteristics of all registered hospital admissions to adult urological departments in Poland in 2022.

Material and methods: This epidemiological retrospective analysis is based on the national registry on hospital admissions managed by the National Institute of Public Health - National Research Institute. All adult patients admitted to urological departments were included in the analysis.

Results: In 2022, 214,063 hospital admissions were recorded in Polish urological departments, 72% of the patients were male. Emergency admissions accounted for 17.6% of these admissions. There were significant differences in hospitalization rate per 100,000 population between the administrative regions (voivodeships), with extreme values recorded in the Opolskie (411.5) and Podkarpackie (987.9) voivodeships. The major causes of admission were genitourinary diseases (ICD-10: N00-N99) at 59% and cancers (ICD-10: C00-C97; D00-D48) at 36%. In general, kidney and ureteral stones (19.9%), bladder cancer (15.2%), and prostate hyperplasia (10%) were the most common causes of hospital admissions. The highest hospitalization rate per 100,000 inhabitants was observed among adults aged 60-69 and 70-79 years. A quarter of hospitalizations were one-day hospitalizations, and the mean duration of hospitalization was 2.93 days for all hospitalizations, and when excluding one-day hospitalizations 3.89 days. Epidemiological characteristics of patients and duration of hospitalization differed by cause of admission.

Conclusions: Findings from this study provide precise epidemiological data on inpatient urological care in Poland. Physicians and policymakers may use this study to evaluate and improve inpatient urological care in Poland.

Introduction: After radical nephroureterectomy (RNU), adjuvant chemotherapy (AC) is recommended in either muscle invasive or lymph node positive upper urinary tract urothelial carcinoma (UTUC). However, optimal patient selection remains to be studied. We propose a risk-adapted scoring model for selecting patients for AC in localised UTUC with ≤pT2.

Material and methods: The model was based on 7 risk factors modified from the risk stratification system in the European Association of Urology guideline for localised UTUC. Each risk factor indicated one point; total scores were used to categorise patients as at low or high risk for disease recurrence. We applied our model to 135 patients with localised UTUC with ≤pT2, who underwent RNU without AC. Recurrence-free survival and cancer-specific survival were analysed based on risk group.

Results: A risk score of ≥4 points indicated high risk (33/135 patients [24.4%]). The accuracy of predicting recurrence was 82.9% (95% confidence interval [CI]: 75.5-88.9%) with a negative predictive value of 93.1% (95% CI: 87.9-96.2%). Disease recurred in 51.5% of high-risk patients and 6.9% of low-risk patients. Multivariate analysis indicated that high-risk was independently associated with recurrence and cancer-specific death (hazard ratio [HR] = 10.20, 95% CI: 3.94-26.44%, HR = 8.72, 95% CI: 2.47-30.73%, all p <0.001, respectively).

Conclusions: The risk-adapted scoring model might be an effective way for selecting patients who may benefit from AC after RNU in nonmetastatic UTUC with ≤pT2. These results should be validated in a larger, prospective study.

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.

Introduction: There are three common treatment options for kidney stones: extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL). The choice of treatment is based on stone- and patient-related characteristics. However, some stones are eligible for several approaches and the decision is made based on patient and urologist's preferences. This study evaluates which approach has the highest workload.

Material and methods: Between March and August 2022, five members of the Amsterdam Endourology Research Group collected data from 22 ESWL, 31 URS and 22 PNL procedures. After each procedure, the SURG-TLX questionnaire was completed by the surgeon to evaluate workload. Six dimensions were scored for each procedure, including: mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. The total workload, and the median for each dimension, was calculated and compared for the three treatments.

Results: ESWL scored significantly lower than URS for mental demands, physical demands, temporal demands, situational stress, distraction and total workload. However, task complexity did not differ significantly between the two techniques. Compared with PNL, ESWL scored significantly lower for all dimensions. Finally, PNL received significantly higher scores for mental demands, physical demands, temporal demands, situational stress, distractions and total workload than URS. Only task complexity showed no significant difference between both groups.

Conclusions: Urologists perceive the highest workload during PNL, followed by URS and finally ESWL. A follow-up study is needed to identify stressors that increase perceived workload with the purpose to address these variables and as final objective to improve urologists' workload, patient safety and treatment outcomes.

Introduction: Ureteral stents-related symptoms (USRs) are the common complications of ureteral stenting. Tamsulosin a selective alpha-1 blocker and Tadalafil a PDE-5 inhibitor are one of drugs have been used for USRs relief. In this study we aimed to evaluate the effectiveness and safety of combination therapy Tamsulosin+Tadalafil for treating USRs comparing it with the efficacy of either Tamsulosin or Tadalafil monotherapies.

Material and methods: 279 patients with indwelled unilateral ureteral stents were randomized to Tamsulosin 0.4 mg + Tadalafil 5 mg once a day (Group 1, n = 67), Tamsulosin 0.4 mg once a day (Group 2, n = 71), Tadalafil 5 mg once a day (Group 3, n = 69) and Placebo once a day (Group 4, n = 72). USRs severity was registered and calculated by using the Ureteral Symptoms Score Questionnaire (USSQ) at the 14^th day of treatment. Side-effects and total analgesic use were recorded and compared.

Results: At the endpoint in patients with unilateral ureteral stents the combination therapy Tamsulosin + Tadalafil led to statistically lower intensity of urinary symptoms comparing with Tamsulosin (15.2 ±4.3 vs 21.8±3.6, p = 0.0003) or Tadalafil (15.2 ±4.3 vs 20.6 ±2.8, p = 0.0004) monotherapy. All groups of treatment demonstrated significant relief of USRs comparing with Placebo mostly beneficial in the combined therapy group. Body pain and analgesic need in Group 1 was lower than in Groups 2, 3 or 4. Side-effects were registered rarely without statistical differences in frequency between groups.

Conclusions: Combination therapy with Tamsulosin + Tadalafil is an effective and safe option that achieves the statistically more significant relief of USRs comparing with Tadalafil or Tamsulosin monotherapies.

Introduction: Olaparib, rucaparib, niraparib, and talazoparib are poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) targeted at recombination. To gain a comprehensive understanding of the mechanism of action of PARPi, scientists conducted research involving numerous studies that provided evidence regarding their efficacy and safety.

Material and methods: A literature review was performed using the PubMed^® and Google Scholar databases. Articles were reviewed and categorized based on the most crucial and current information regarding the pharmacological properties and use of PARPi in treating metastatic castration-resistant prostate cancer (mCRPC), while also indicating the future therapeutic direction toward which these pharmaceuticals are progressing. Data were extracted, analyzed and summarized.

Results: PARP inhibitors like olaparib, rucaparib, niraparib, and talazoparib show promise in mCRPC, particularly for patients with specific genetic mutations (BRCA1/2, ATM). While they extend PFS and sometimes OS, side effects - especially anemia - are prevalent and impact treatment continuation.

Conclusions: Despite PARPi already being recognized as the standard treatment for mCRPC, further research is crucial to optimize their efficacy and safety, particularly in the context of combination therapies and use in the early stages of the disease.