Central European Journal of Urology最新文献

Introduction: Data on holmium laser enucleation of the prostate (HoLEP) in men ≤60 are limited. This study aimed to characterize the clinical presentation and outcomes of this population.

Material and methods: This retrospective study comprised 750 consecutive HoLEPs between 1/2020 and 11/2024. Patients were categorized by age: ≤60, 61-70, 71-80, and >80 years. The data retrieved from the medical records included age, International Prostate Symptom Scores (IPSS), uroflowmetry, preoperative prostate volume (via abdominal ultrasound), comorbidities, previous prostate surgery, presence of a preoperative indwelling urinary catheter or chronic retention, bladder stones, operative time, complications, hospital stay, and outcome.

Results: Presentation with absolute indication (indwelling catheter and/or chronic retention) was more prevalent in the ≤60 and >80 age groups (p <0.001). The youngest group had smaller prostate volume (78 vs 90 ml, p = 0.004), fewer comorbidities, shorter surgery (70 vs 90 minutes, p <0.001), lower "beach balls" rate (2% vs 15%, p = 0.008), and shorter hospitalization (1 vs 1.5 days, p <0.001). Younger patients had lower postoperative IPSS (4 vs 7 points, p = 0.036), while the quality of life scores were similar. The overall rate of incidental prostate cancer increased with age, but not significantly. The youngest group presented with only International Society of Urological Pathology (ISUP) 1, while older groups had a higher rate of ISUP grade ≥2 (0 vs 18-25%, p <0.05). Complications were similar across age groups.

Conclusions: HoLEP is an effective treatment for men of all ages. Men under 60 or over 80 were more frequently treated for absolute indications, while those aged 61-80 were more often treated for relative indications.

Introduction: The pulsed thulium:YAG (p-Tm:YAG) laser has shown encouraging results in the management of stone disease and BPH; however, its application in the endoscopic management of upper tract urothelial carcinoma (UTUC) has not yet been clinically investigated. The aim of this study is to evaluate the effectiveness and safety of the p-Tm:YAG laser in the endoscopic management of UTUC.

Material and methods: Retrospective data were collected from all patients who underwent endoscopic treatment for UTUC between January and April 2024. Eligible patients were those diagnosed with UTUC and deemed suitable for endoscopic management. Both low-grade and high-grade cases were included. All patients underwent a second-look procedure 2 months after the initial surgery, followed by endoscopic surveillance at 6 and 12 months postoperatively. The laser source used for tumor ablation and coagulation was the p-Tm:YAG laser.

Results: A total of 20 patients were included in the study. Among them, 12 patients (60%) were included in the low-risk UTUC conservative treatment group, while 8 patients (40%) were categorized into the high-risk group. At the time of the second procedure, histopathological analysis revealed no evidence of tumor in 16 cases (80%), while a tumor was identified in 4 patients (20%). No intraoperative complications were recorded. Postoperatively, 10 out of 75 procedures (13.3%) were associated with Clavien-Dindo grade I-II complications. No major complications occurred.

Conclusions: In short-term follow-up, the use of the p-Tm:YAG laser for endoscopic UTUC treatment has proven to be safe and effective.

Introduction: The use of ureteral access sheaths (UASs) is an issue of contention among urologists, with their efficacy unclear in retrograde intrarenal surgery (RIRS). Therefore, we performed a systematic review and meta-analysis to assess RIRS with laser lithotripsy for the treatment of urolithiasis with and without the use of UASs.

Material and methods: A systematic literature search was conducted in July 2023 using MEDLINE, EMBASE and the Cochrane library. The quality of the included studies was assessed using the Newcastle-Ottowa scale and Cochrane collaboration risk of bias tool. The primary outcome measures were stone-free rate (SFR), and post-operative complications. Secondary outcomes were operative time (OT), hospital length of stay (LOS) and ureteral injury rate. Effect sizes were calculated by pooled risk ratios (RRs) and mean differences (MDs) with confidence intervals (CIs).

Results: In total, 16 studies met the inclusion criteria. There were 3,123 participants who had RIRS with a UAS and 1,478 without. Pooled analysis revealed no significant difference between groups in SFR (RR = 1.03, 95% CI: 0.99-1.07), complication rate (RR = 1.31, 95% CI: 1.00-1.73), ureteral injuries (RR = 1.13, 95% CI: 0.77-1.65) or LOS (MD = -0.01, 95% CI: from -0.08 to 0.11). OT was significantly longer in the UAS group (MD = 0.35, 95% CI: 0.01-0.7).

Conclusions: The results of this meta-analysis demonstrate that the use of UASs during RIRS does not improve post-operative outcomes and is associated with a longer OT. While there are still times where the use of UASs may be beneficial, their routine use for patients undergoing RIRS is not currently indicated.

Introduction: Our experimental in vitro study aimed to evaluate the impact of four power settings with different energy and frequency combinations on the irrigation fluid temperature using the thulium fiber laser (TFL). In addition, we aimed to identify the differences between the Ho: YAG laser and TFL by direct comparison of the same power settings.

Material and methods: All measurements were performed with a fluid volume fixed at 10 ml and an outflow rate at 10 ml/min. The laser was fired continuously for 30 seconds with total power settings of 10 W, 20 W, 40 W, and 60 W with different power settings (energy × frequency) and various pulse combinations using TFL and Ho: YAG laser (Quanta System, Samarate, Italy).

Results: Higher temperatures were recorded when the power was increased from 10 W, 20 W, 40 W, to 60 W. The temperature exceeded the threshold of 43°C when power settings of ≥40 W were applied regardless of frequency (15-120 Hz) and energy (0.5-4 J). Similar temperature increase patterns were reported with different peak power settings. No major differences were found when the same power settings were applied using TFL and Ho: YAG lasers.

Conclusions: Based on our results temperatures >43°C were recorded for power settings ≥40 W after continuous laser firing of 30 seconds using TFL. Modifying the frequency and energy settings, as well as firing with Ho:YAG laser under the same power setting did not affect the patterns of temperature increase. Generally, the TFL shows more regular thermal behavior in comparison with the Ho:YAG laser.

Introduction: The aim of this study was to evaluate the prognostic impact of favourable prostate cancer (PCa) pathology patterns through Briganti's 2012 nomogram and beyond EAU risk classes in patients treated with robotic surgery.

Material and methods: We analysed 757 patients from January 2013 to December 2021 with favourable pathology features (ISUP 1-3, pT2/pT3a, and pN0/x) and available follow-up. Pathologic features were scored from zero (ISUP 1 + pT2) to three (ISUP 3 + pT3a). Associations with Briganti's 2012 nomogram by EAU risk class were evaluated to determine the prognostic impact on PCa progression, defined as biochemical persistence/recurrence or loco-regional/metastatic recurrence.

Results: Favourable pathology risk scores were most commonly grades one (49%) and two (30.95%), followed by zero (15.2%) and three (4.9%). After adjusting for EAU prognostic groups, higher nomogram scores were associated with increased risk scores of two and three. PCa progression occurred in 12.7% of cases after a mean follow-up of 92.1 months. Patients with recurrence had a worse prognosis as risk scores increased from one to three, even after adjustment for Briganti's 2012 nomogram by EAU class.

Conclusions: Favourable pathology risk scores, grouped by Briganti's 2012 and EAU nomograms, impact prognosis. As scores increase, the likelihood of disease progression rises, potentially influencing treatment strategies.

We present the case of a 42-year-old man with a palpable, painless, slow-growing mass, growing over a period of 12 years. The mass was completely extirpated in June 2017 with relative ease from the adjacent structures sparing the penis, testes, and epididymis. The patient's successive postoperative course of care was uneventful, and he was discharged 24 days after the operation. Microscopic examination revealed fibrolipoma. At a 12-month follow-up - and thus one year after the operation - it was determined that the patient was healthy and free from local tumor recurrence. His body mass had diminished to 140 kilograms (before the operation he weighed 167 kilograms). The patient died on January 6, 2022 due to cardiovascular and pulmonary complications after COVID-19 infection without any signs of scrotal tumor recurrence.

Introduction: The aim of this study was to systematically review the available evidence on the feasibility and safety of robot-assisted radical prostatectomy (RARP) in patients with prostate cancer following laser enucleation of the prostate (LEP).

Material and methods: A systematic search was conducted using PubMed (MEDLINE) and Web of Science online databases until 31 July 2025 with the search terms ("HoLEP" OR "endoscopic enucleation" OR "laser enucleation of the prostate" OR "ThuLEP" OR "ThuFLEP" OR "EEP" OR "LEP") AND ("robot assisted radical prostatectomy" OR "robotic assisted radical prostatectomy" OR "RARP") by incorporating the PICO formula (population, intervention, comparison, outcome).

Results: Three studies were identified. Continence rates and recovery times differed between patients with prior LEP and those who were LEP-naïve. In one study, postoperative incontinence rates were significantly different between the prior HoLEP and HoLEP-naïve groups (74.0% vs 22.0%, p <0.001), whereas in the other two studies there was no significant difference between groups. Erectile function was documented in 2 studies, which exhibited no statistically significant differences between the prior-LEP group and LEP-naïve group. Complication rates across the studies remained relatively low (7.0-9.0%). Biochemical recurrence and positive surgical margins between the previous LEP and LEP naïve groups were comparable.

Conclusions: In patients undergoing RARP after LEP, complications are low and the oncological outcomes are promising, similar to patients who are LEP-naïve. It is essential for surgeons to counsel patients on the potential for prolonged recovery, particularly in regard to continence and sexual function.

Introduction: This study aims to evaluate the feasibility of stone fragmentation and aspiration of dust and small stone particles via a direct-in-scope suction (DISS) system using a novel single-use flexible cystoscope (PC200, Pusen Medical Technology, Guangdon, China) in a straight position and with extreme bending.

Material and methods: An ex vivo experimental study was performed on freshly harvested porcine lower urinary systems (bladder and urethra) with natural urinary stones (calcium oxalate dihydrate 70%, urate 30%). In the first set of trials (3 trials) the stones were placed in the bladder and lithotripsy was performed with a scope in a straight position. For the second set of trials, porcine gallbladder was additionally used, circumferentially sutured to the anterior wall of the porcine bladder, and the stone was positioned in the gallbladder (imaginary diverticulum). In the latter trials, lithotripsy was achieved with the scope at an almost 180° bend.

Results: Laser lithotripsy was successfully completed in all trials. Stone fragmentation and aspiration were faster in the first set of trials with the cystoscope in a straight position. In the second set, to access the anterior-wall "diverticulum", continuous suction and irrigation were employed. After lithotripsy, the stone fragments were effectively flushed from the simulated diverticulum into the main bladder cavity.

Conclusions: Bladder stone lithotripsy using a flexible cystoscope with DISS is feasible. The DISS system offers several advantages, including improved visibility through simultaneous fluid and dust aspiration, as well as enhanced maneuverability of the scope due to suction-assisted positioning.

Introduction: Perioperative blood transfusion (BT) is often required in radical cystectomy (RC) due to significant blood loss. Tranexamic acid (TXA), an antifibrinolytic agent, reduces bleeding, but concerns about thromboembolic risks persist. This systematic review and meta-analysis evaluate TXA's efficacy and safety in RC.

Material and methods: A systematic search was conducted in PubMed, Embase, and Cochrane Central databases. Randomized controlled trials (RCTs) and retrospective studies comparing TXA versus controls in RC were included. Primary outcomes were perioperative, intraoperative, and postoperative BT rates. Secondary outcomes included estimated blood loss (EBL) and thromboembolic events (PROSPERO; CRD420251013502).

Results: Four studies totaling 1,656 patients were included. TXA significantly reduced perioperative transfusion rates (OR = 0.40; 95% CI: 0.30-0.51; p < 0.00001). However, intraoperative (OR = 0.87; 95% CI: 0.50-1.52; p = 0.63) and postoperative transfusion rates (OR = 0.51; 95% CI: 0.21-1.23; p = 0.13) were not significantly different. No significant difference was found in EBL (MD = -9.31; 95% CI: from -82.50 to 63.87; p = 0.80). Safety analysis showed no increased risk of deep vein thrombosis (OR = 1.14; 95% CI: 0.54-2.41; p = 0.72) or pulmonary embolism (OR = 1.49; 95% CI: 0.69-3.24; p = 0.31).

Conclusions: TXA reduces perioperative transfusion needs in RC without significantly affecting intraoperative or postoperative transfusion rates, EBL, or thromboembolic risk. Further RCTs are needed to optimize TXA use in RC.