Central European Journal of Urology最新文献

Introduction: Promising studies have shown a high stone-free rate achieved with the pulsed solid-state thulium YAG laser. However, studies on its safety concerning temperature effects during activation remain limited. The aim of this study was to characterize temperature variations during laser activation.

Material and methods: This in vitro experimental study utilized a high-fidelity uretero-renal simulation model to assess temperature changes during intracorporeal laser lithotripsy. Temperatures reached after laser activation at 15, 20, and 30 seconds were recorded. The flow rates used were 10 ml/min and 20 ml/min. The maximum allowed temperature was set at 43°C, given its association with thermal tissue damage. A linear logistic regression model was used to analyze variations and project temperature behavior over time.

Results: In the renal model, temperature increases were correlated with the applied energy. With a 10 ml/min flow rate, no laser configuration exceeded 43°C at 15 seconds; at 20 seconds, only the 30 W (2.5 J/20 Hz) configuration exceeded this temperature. By 30 seconds, all 30 W configurations exceeded 43°C, except for 0.4 J/75 Hz. With a 20 ml/min flow rate, no laser configuration exceeded 43°C. The 20 ml/min flow rate decreased renal temperature by 1.96°C (p = 0.01). In the ureteral model, the temperature increase was not proportional to the applied energy, but in no scenario the temperatures reach the 43°C.

Conclusions: The temperature variations observed in this study with the use of the pulsed solid-state thulium YAG laser should be considered to avoid potential renal and ureteral thermal damage.

Introduction: Prostate cancer is typically diagnosed following prostate biopsy. In low-risk and selected favourable intermediate-risk disease, active surveillance is the treatment strategy of choice. In these men, a confirmatory biopsy performed. We report on the rates of risk upgrading at biopsy confirmatory that may represent a need to pursue further treatment in lieu of active surveillance.

Material and methods: We performed a systematic review and meta-analysis of pooled reclassification rates of men on active surveillance at first confirmatory biopsy, in line with PRISMA recommendations. PubMed, EMBASE, and Cochrane central registry for clinical trials were searched until June 2024. Stata was used to pool reclassification rates at first confirmatory biopsy.

Results: Seventeen studies from 9 countries comprising 6,039 patients were included. Transrectal biopsy was the most common biopsy method for confirmatory biopsy. Weighted pooled rates of upgrading on first confirmatory biopsy were 20% with a 95% confidence interval of 19-21%.

Conclusions: Approximately 20% of men undergoing active surveillance were upgraded at confirmatory biopsy. This may alter the management of these patients, and it highlights the importance of a confirmatory biopsy.

Introduction: Ureteral stents are generally used after ureterorenoscopy (URS) procedures, even in uncomplicated ones. We aimed to compare the safety and tolerability of single-J (SJ) stents and double-J (DJ) stents in patients submitted to flexible URS for renal stones.

Material and methods: This prospective, randomized, unblinded, single-center study was conducted between July 2022 and May 2024, involving patients undergoing flexible URS with holmium laser lithotripsy for renal stones. Patients were randomized to either SJ stents (removed within 24 hours) or DJ stents (removed 2-4 weeks post-surgery). Primary endpoints included emergency department admissions, postoperative complications, and reintervention rates. Secondary endpoints included stent tolerability and surgery efficacy. A symptom questionnaire was applied at postoperative weeks 1 (W1) and 4 (W4).

Results: We included 125 patients (60 in group SJ and 65 in group DJ), with comparable baseline characteristics. Emergency department admissions were similar (18.3% vs 16.9%, p = 0.84), as were complications (18.3% vs 21.5%, p = 0.65) and reintervention rates (1.7% vs 3.1%, p = 1.0). SJ stents showed better tolerability, with lower scores for lower urinary tract symptoms (LUTS) and pain at both time points.

Conclusions: SJ stents placed for less than 24 hours after complete flexible URS are comparable to DJ stents regarding safety and are better tolerated, particularly 4 weeks after the surgery. SJ stents should be prioritized, reducing costs and hospital visits for stent removal.

Urinary bladder leiomyosarcoma is an extremely rare malignancy of the urogenital system. We present the case of a 59-year-old Caucasian male with a gigantic bladder leiomyosarcoma. The patient was subdued to the surgical excision of the urinary bladder - laparoscopic radical cystectomy with extended pelvic lymphadenectomy, with urinary diversion by bilateral ureterocutaneostomy. The excision was complete both macroscopically and microscopically. No additional adjuvant therapy was administered. In the 6-month follow-up, the patient remained in radiological remission. Surgical excision with extended pelvic lymphadenectomy seems to be sufficient in the treatment of urinary bladder leiomyosarcoma.

Introduction: To assess the impact of preoperative pelvic floor muscle (PFM) strength on urinary incontinence (UI) after radical prostatectomy (RP).

Material and methods: A total of 127 men who underwent surgical treatment for clinically localized prostate cancer in a tertiary university hospital were included in a sub-analysis. PFM strength (cmH₂O) and endurance (s) were measured using a perineometer on the day before and at 1, 3, and 6 months after surgery. UI volume was measured using an 8-hour pad test. The primary outcome was continence, defined as 0-5 grams of urine during the 8-hour pad test at 6 months post-RP. The association between baseline PFM strength and continence was analyzed using Spearman's correlation coefficient, receiver-operating characteristic analysis, and logistic regression analysis.

Results: At 6 months post-RP, 45 of 127 (35.4%) men were continent. UI showed a strong negative (r = -0.7; p <0.001) association with preoperative PFM strength and a medium negative (r = -0.55; p <0.001) association with PFM endurance. PFM strength (odds ratio [OR] = 1.16, p <0.0001), PFM endurance (OR 1.6, p <0.0001), and preoperative prostate-specific antigen (OR = 0.87, p = 0.03) were the most significant predictors of continence in the univariate regression analysis. In the multivariate analysis, only PFM strength remained a significant predictor (OR = 1.13, p <0.001) of UI. The thresholds for PFM endurance and strength were 9.6 seconds and 98.9 cmH₂O, respectively.

Conclusions: Preoperative PFM strength and endurance demonstrated significant associations with postoperative UI. Objectively measured preoperative PFM conditions could help identify patients at increased risk of UI after RP.

Introduction: The aim of this study was to evaluate the surgical efficacy and safety of microscopic cluster ligation of the spermatic vein (MCLSV), and to compare the similarities and differences between MCLSV and microscopic traditional branch ligation of the spermatic vein (MTBLSV).

Material and methods: A prospective matched case-control study of 91 patients with bilateral varicocele was conducted. Participants underwent microscopic bilateral spermatic vein ligation and were randomly assigned by computer to undergo MCLSV on one side and MTBLSV on the other. The operative outcomes of the two techniques were compared.

Results: The operative time of MCLSV was significantly lower than that of MTBLSV (p <0.001). Postoperative day 1 VAS scores at the operative site in MCLSV were significantly lower than MTBLSV (p <0.05). There was no significant difference between the two groups in the number of spermatic vein ligations, the number of internal spermatic arteries and lymphatics, complications, occurrence of foreign body sensation of wire knots, improvement of scrotal pain and distant recurrence (p >0.05).

Conclusions: Compared with MTBLSV, MCLSV can significantly shorten surgical time, improve surgical efficiency, and alleviate postoperative perineal pain and discomfort in patients while ensuring surgical safety and effectiveness.

Introduction: Stress urinary incontinence (SUI) is a common complication following radical prostatectomy, affecting up to 60.0% of men. The artificial urinary sphincter (AUS) has been the gold standard for treating severe SUI since its introduction in 1973. Despite its efficacy, long-term complications such as device failure and recurrent incontinence are relatively common, often necessitating revision surgeries. This review focuses on cuff downsizing as a revision strategy for non-mechanical AUS failure.

Material and methods: A literature review was conducted using PubMed/Medline, covering studies published between January 2000 and December 2023. Key words included: "artificial urinary sphincter", "cuff downsizing", "urethral atrophy", "non-mechanical failure" and "male urinary incontinence revision". Inclusion criteria were studies addressing cuff downsizing as a primary revision for non-mechanical failures. Only English-language studies were reviewed. We analyzed the timing of revisions, follow-up duration, and outcomes such as continence rates, complication rates, and device survival.

Results: Six retrospective studies involving 206 patients were included in the present review. Cuff downsizing was performed as the sole intervention in 3 studies and in combination with other approaches in the remaining 3 studies. The median cuff size decreased from 4.5 cm preoperatively to 4.0 cm postoperatively, with 8.0-12.0% of patients receiving a cuff downsized by more than 1.0 cm. Across all studies, continence rates after revision surgery ranged from 52.0% to 90.0% based on patient-reported outcome measures (PROMs). Device survival rates varied from 64.0% to 95.0%, with infection and urethral erosion being the leading causes of device explantation.

Conclusions: Cuff downsizing is a reasonable revision strategy for non-mechanical AUS failure, offering similar continence outcomes and complication rates compared to alternative techniques.

Introduction: This review aims to determine whether the use of ureteral stents with extraction strings in adult patients undergoing upper urinary tract endoscopic procedures results in a higher incidence of urinary tract infections (UTIs) compared to stents without strings.

Material and methods: A systematic literature search was conducted using PubMed, Scopus, and Google Scholar. Studies evaluating differences in UTI rates among adult patients with ureteral stents with or without extraction strings were included. Data on UTI rates, antibiotic prophylaxis protocols, and stent dwell time were extracted.

Results: The review included 11 trials published between 2015 and 2023. One multicenter retrospective study involving 4,392 patients reported a significantly higher UTI rate in patients with extraction strings (2.1% vs 1.1%, p = 0.006). In the remaining 10 studies, including four randomized controlled trials, the differences were not statistically significant. Antibiotic prophylaxis was described in five studies. In two studies, a single perioperative antibiotic dose was administered, with a total UTI rate of 6.8% (28/410). In contrast, three studies using prolonged prophylactic antibiotic regimens reported a total UTI rate of 3.2% (13/403). The impact of stent dwell time on UTI risk could not be determined. The risk of bias was high in 10 studies and moderate in one retrospective study.

Conclusions: Based on low-quality evidence, the difference in UTI risk between ureteral stents with and without extraction strings appears to be minimal and statistically insignificant. Well-designed studies with standardized methodologies are needed to clarify these findings.

Introduction: Pre-stenting remains a subject of debate, and its influence on FANS assisted ureteroscopy is unclear. The global FANS collaborative group aims to address the influence of pre-stenting on FANS-assisted ureterorenoscopy (URS).

Material and methods: This prospective multicentre study assesses the outcomes of 394 patients undergoing FANS-assisted ureteroscopy for renal stones. Patients were stratified into a non-pre-stented (group 1, n = 163) and pre-stented group (group 2, n = 231). Data on demographics, stone characteristics, operative parameters, and postoperative 30-day outcomes were analysed. Statistical analyses, including multivariate regression, were performed for stone-free rates (SFR) and complications. SFR was defined by bone window on non-contrast computed tomography (CT).

Results: Pre-stented patients had a higher prevalence of positive urine culture treated with preoperative antibiotics (23.8% vs 12.3%, p = 0.006). Larger stone volumes were noted (1,306 mm³ vs 1,200 mm³, p = 0.027) in group 1. Postoperative complications were minor. Sepsis was not reported in either group. Group 1 had a higher incidence of low-grade Traxer grade 1 ureteric injuries (4.3% vs 0.4%, p = 0.021). FANS resulted in high overall SFRs of 97.5% and 97.0% in groups 1 and group 2. Multivariate analysis showed no statistical difference in SFR between the groups (63.2% vs 53.2%, p = 0.063). Only thulium fibre laser (TFL) and stone volume were significant predictors of residual fragments (RF).

Conclusions: Pre-stenting for FANS is not mandatory irrespective of stone location and volume. The use of TFL and stone volume significantly influenced SFR, while FANS itself proved highly effective in achieving high SFR.

Introduction: The study aimed to retrospectively assess the safety and efficacy of Rezum, a promising minimally invasive treatment method for BPH, in patients treated at our clinic.

Material and methods: From January 1, 2022, to December 31, 2022, a cohort of 71 patients presenting with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) were enrolled in the study. These individuals opted for Rezum therapy as their treatment approach. Primary outcome measures included the International Prostate Symptom Score (IPSS), maximum flow rate (Q_max), post-void residual volume (PVR), Quality of Life (QoL), prostate volume (PV), prostate-specific antigen (PSA), and the International Index of Erectile Function (IIEF) questionnaire.

Results: The median age of the 71 patients was 62.1 ±9.3 years, with a median PV of 60.4 ±16.6 ml. Preoperatively, IPSS was 21.9 ±5.2, Q_max was 9.67 ±3.2, QoL was 3.35 ±0.61, IIEF-5 was 23.9 ±5.4, total PSA was 2.43 ±1.27 ng/ml, and PVR was 177.4 ±216.5 ml. At the 3-month follow-up, IPSS improved to 10.1 ±5.6, Q_max to 24.5 ±3.7, QoL to 1.2±0.51, IIEF-5 to 24.5 ±5.4, total PSA to 1.8 ±0.9 ng/ml, and PVR remained at 177.4 ±216.5 ml. At the 12-month follow-up, IPSS was 6.0 ±3.1, Q_max was 18.12 ±3.7, QoL was 1.2 ±0.51, IIEF-5 was 24.5 ±5.4, total PSA was 1.8 ±0.9 ng/ml, and PVR was 24.9 ±25.2 ml.

Conclusions: Rezum therapy is a safe, effective, and minimally invasive option for the treatment of men with moderate to severe lower urinary tract symptoms (LUTS).