Central European Journal of Urology最新文献

Introduction: Blood urea nitrogen (BUN)/creatinine (Cr) and BUN/albumin ratios are used in the evaluation of many diseases that can be associated with ED. The aim of this study was to examine the relationship between ED and BUN/Cr and BUN/albumin ratios and compare them to healthy peers.

Material and methods: Total of 1,664 patients diagnosed with ED between January 2020 and August 2024 were accessed and retrospectively examined. Six hundred and seventy-two male patients with IIEF-5 score below 22 and complaining of ED were included in the study. Ninety-six patients without ED complaints were selected as the control group. Control and ED groups were compared in terms of BUN/Cr and BUN/Albumin ratio values and other biochemical and hormonal parameters.

Results: BUN/Cr value was calculated as 27.63 ±12.3 in the ED group and 17.52 ±5.1 in the control group (p <0.001). The AUC value of this ratio was calculated as 0.745 and its sensitivity was found to be 32% and specificity was found to be 98%. BUN/albumin ratio was calculated as 6.03 ±5.8 in the ED group and 3.54 ±1.2 in the control group (p <0.001). The AUC value of this ratio was found to be 0.718, its sensitivity was 43% and its specificity was 98%. The BUN/Cr ratio of all ED subgroups was significantly higher than control group, and BUN/albumin value was significantly higher in mild, moderate and severe groups.

Conclusions: In this study, it was calculated that the risk of ED was higher in patients with BUN/Cr ratio >33.92 and BUN/albumin ratio >5.80, and both values had high specificity.

Introduction: Urolithiasis is a highly prevalent disease influenced by a wide range of factors multifactorial etiology results in the formation of urinary stones with diverse mineral compositions. Accurate identification of stone constituents is crucial for effective prevention of recurrence. Gold-standard methods for stone analysis are not always readily available in clinical practice. To address this, Daudon proposed a morphological classification system aimed at identifying stone types based on their surface characteristics. However, existing literature reports suboptimal accuracy of this method, largely due to technical limitations of endoscopic equipment. The primary objective of this study was to evaluate the reliability of morphological assessment in predicting stone mineral composition. Secondary aims included the identification of factors contributing to the consistently poor accuracy reported in previous studies.

Material and methods: An online quiz consisting of 20 single-choice questions was developed, each accompanied by a high-resolution image of a urinary stone and five predefined answer options. The reference stone composition for each image was determined using Fourier-transform infrared spectroscopy. Participants' performance was evaluated based on the percentage of correct responses per individual and per question. The results of specialists and residents were compared using the two-proportion Z-test, with statistical significance set at p <0.05.

Results: A total of 779 responses were collected, with an overall accuracy rate of 33.7%. The most commonly selected answers were respectively oxalates, phosphates, uric acid, cystine, and infectious stones. Subgroup analysis revealed accuracy rates of 36% among attending physicians and 32% among residents, with no statistically significant difference. Notably, two participants achieved a perfect score (100%), supporting the internal validity of the test.

Conclusions: Detailed analysis revealed a wide distribution of scores, ranging from participants with only one correct response to those who completed the quiz with full accuracy. These results suggest that the consistently low diagnostic accuracy reported in the literature is more likely due to limited familiarity and lack of experience with the morphological classification, rather than inherent shortcomings of the system itself. The findings highlight the need for comprehensive endourology training programs focused on improving stone morphology recognition skills.

Introduction: To evaluate the intrarenal pressure parameters of the 9.2 Fr (5.1 Fr working channel) and 7.5 Fr (3.6 Fr working channel) flexible ureteroscopes with direct-in-scope suction (DISS) in an ex vivo experimental setting.

Material and methods: We performed an experimental study using an ex vivo porcine model using two DISS single-use digital videoureteroscopes: a 7.5 Fr PU3033AH and 9.2 Fr PU400A (Pusen, Zhuhai, China). Intrarenal pressures (IRPs) were measured with an automated irrigation pump set at 40, 60, 80, 100 mmHg, manual hand pumping and gravity fed-irrigation, with suction applied continuously and intermittently at 3-second intervals.

Results: Higher IRPs were documented when the 9.2 Fr flexible ureteroscope was used compared to the 7.5 Fr scope, regardless of the irrigation setup. The highest IRP (45 mmHg) was documented with the 9.2 Fr scope, using manual pump irrigation and intermittent pumping with no suction. In contrast, the lowest IRP was reported with the 7.5 Fr scope and the automated pump at 40 mmHg. The pressure difference following 1second of suctioning was more pronounced with 9.2 Fr compared to 7.5 Fr. The 9.2 Fr ureteroscope with the 5.1 Fr working channel resulted in significantly shorter time to regain the initial IRP.

Conclusions: For the first time in experimental studies we noted that irrigation through a wider 5.1 Fr working channel raises the baseline IRP faster than the classic 3.6 Fr working channel. Although these findings should be further investigated in a clinical setting, they should be taken into consideration to select the optimal strategy, to keep IRP at safe levels, and avoid complications.

Robotic-assisted surgery is gaining popularity for the implantation of artificial urinary sphincters (AUS) in female patients. We present a case of a 76-year-old woman with refractory stress urinary incontinence. She underwent an uncomplicated robotic-assisted AUS implant. Post activation of the system, she experienced right-sided flank pain and developed urosepsis shortly thereafter. On imaging with an activated system, grade 3 hydro-ureteronephrosis (HUN) was seen. Robotic-assisted revision showed a right-sided ectopic ureter draining towards the bladder neck, which was compressed on activation of the system. A new cuff was successfully placed distal to the orifice with complete continence 3 months after the procedure.

Introduction: Ureteropelvic junction obstruction (UPJO) hinders urine flow from the renal pelvis to the ureter, causing renal dysfunction. Treatment focuses on relieving obstruction to restore urinary drainage and preserve renal function. Robotic-assisted laparoscopic pyeloplasty (RALP) offers enhanced precision compared to laparoscopic pyeloplasty (LP), but limited comparative data exist for adult patients. This study compares RALP and LP outcomes in an adult cohort from a tertiary care centre.

Material and methods: A retrospective cohort analysis was conducted on adult patients who underwent RALP or LP between March 2018 and May 2024. Primary outcome measures included operative time, with secondary outcomes such as estimated blood loss (EBL), hospital length of stay (LOS), complication rates, and success (defined by symptom relief and diuretic renogram improvement). Statistical analysis included Mann-Whitney, χ², and Fisher's exact tests, with a significance threshold of p <0.05.

Results: The study included 128 patients (87 RALP, 41 LP). Operative time was significantly longer for RALP (200.92 ±59.26 minutes) vs LP (161.92 ±55.21 minutes, p <0.001), largely due to robotic docking. Both groups had similar EBL (47.87 ml for RALP vs 45 ml for LP, p = 0.45) and success rates (97.7% for RALP vs 97.4% for LP). However, RALP patients experienced a longer LOS (3.91 days vs 3.41 days, p = 0.001).

Conclusions: RALP demonstrates technical advantages but does not reduce operative time and incurs increased resource utilisation compared to LP. Both techniques achieve high success rates, though further research is needed to assess RALP's cost-effectiveness.

Introduction: Anatomical endoscopic enucleation of the prostate (AEEP) is a guideline-recommended treatment for benign prostatic hyperplasia (BPH). We aimed to analyze postoperative complications and outcomes within a large real-world database.

Material and methods: The Refinement in Endoscopic Anatomical enucleation of Prostate (REAP) registry includes patients who received AEEP for BPH in 8 centers worldwide from January 2020 to January 2022. Exclusion criteria included previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, and concomitant lower urinary tract surgery (internal urethrotomy, cystolithotripsy, or transurethral resection of bladder tumor). The primary outcome was postoperative incontinence; secondary outcomes included early complications (<30 days) and late complications (>30 days).

Results: We analyzed 6,193 patients; the mean age was 68 years. Thulium laser was used in 37% and high-power holmium laser in 32%. Median operation time was 67 min [IQR 50-95 min]. The 2-lobe enucleation technique was utilized in 49%, and en-bloc resection was utilized in 39%. Early postoperative complications included urinary tract infection (4.7%), acute urinary retention (4.1%), post-operative bleeding requiring additional intervention (0.9%), and sepsis requiring intensive care admission (0.1%). The incidence of postoperative incontinence was 14.8%, of which 54% were stress incontinence; 84% cases resolved by 3 months. On univariate and multivariate analysis, prostate volume >100 ml was a significant predictor of postoperative incontinence. Late complications such as bulbar urethral stricture, bladder neck sclerosis, and need for redo BPH surgery each occurred in <1% of patients.

Conclusions: Analysis of the real-world REAP database shows favorable safety outcomes for AEEP, with a low incidence of serious complications and postoperative incontinence beyond 3 months.

Introduction: To evaluate intrarenal pressures (IRP) and suction performance of two novel flexible ureteroscopes equipped with a direct-in-scope suction (DISS) feature - the 7.5 Fr PU3033AH and the 9.2 Fr PU400A - both with an empty working channel and with various working instruments inserted.

Material and methods: An ex vivo experimental study was conducted using a freshly harvested porcine kidney. Measurements were performed under the following conditions: empty working channel, with a 200 µm laser fiber, a 272 µm laser fiber, and a 2.2 Fr nitinol basket. The evaluated parameters included: irrigation flow rates with gravity irrigation and an automated pump, maximum IRP without suctioning, time to collapse of the pelvicalyceal system, and time to regain baseline IRP after suctioning.

Results: The highest IRP of 34 mmHg was recorded with the 9.2 Fr scope under 100 mmHg irrigation pressure. Irrespective of the irrigation system used, the introduction of working instruments significantly reduced the IRP for both 7.5 Fr and 9.2 Fr DISS scopes. A longer time was required to collapse the pelvicalyceal system and regain the basal intrarenal pressure when working instruments were used. The thicker the diameter of the instrument, the greater the impact on flowrate, IRP, collapse of the system, and regain of the pressure was observed. The latter trends were less pronounced with the 9.2 Fr scope with a wider 5.1 Fr working channel.

Conclusions: The 9.2 Fr DISS ureteroscope demonstrated higher irrigation flow rates and IRP, and shorter times to system collapse and recovery compared to the 7.5 Fr scope. However, the insertion of working instruments negatively affected all measured parameters, with a greater impact observed in the 7.5 Fr scope due to its narrower channel.

Introduction: Percutaneous nephrolithotomy (PCNL) is efficacious for the management of bigger or complex renal calculi. This study assesses the safety and efficacy of single-shot dilation (one-shot - OD) against gradual dilation (multiple - MD) in fluoroscopy-guided PCNL, with the objective of enhancing stone management techniques.

Material and methods: A comprehensive study adhering to PRISMA criteria concentrated on adult patients receiving conventional percutaneous nephrolithotomy for nephrolithiasis. Included were clinical trials and cohort studies comparing OD and MD approaches, but omitting ultrasound-guided, mini, and micro-PCNL methods. Investigations were performed in PubMed, Scopus, EMBASE, Cochrane Library, and Medline from 2008 onwards. Two reviewers independently evaluated and extracted data, employing the Cochrane ROB2 and ROBINS-I instruments for quality evaluation. Statistical analyses utilizing Review Manager 5.4 employed fixed and random-effects models contingent upon heterogeneity (I²).

Results: Sixteen studies (14 randomized controlled trials and 2 cohort studies) including 572 individuals with OD and 581 patients with MD were examined. The meta-analysis indicated a markedly reduced complication rate in the OD group (RR = 0.77; 95% CI: 0.63-0.94; p = 0.01), with no statistically significant difference in stone-free rates (RR = 1.02; 95% CI: 0.97-1.08; p = 0.49). Variations in hemoglobin reduction, duration of hospitalization, fluoroscopy exposure, and surgical time were noted. However, the significant variability requires cautious interpretation.

Conclusions: The single-shot dilation approach showed a markedly reduced complication rate, indicating it as a safer option for adult patients having conventional PCNL. Additional research is required to corroborate these results across various clinical environments.

Introduction: It is believed that bacteria can be involved in the formation of all types of stones. The aim of study was to assess the urinary microbiome in patients with urolithiasis.

Material and methods: The study group included 50 patients qualified for endoscopic treatment of urinary tract stones using: ureteroscopic lithotripsy (URSL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PCNL), endoscopic combined intrarenal surgery (ECIRS). Before the procedure, patients were asked to collect urine and stool for analysis. Urine from the upper urinary tract and stone fragments were collected intraoperatively. The research material was subjected to 16S rRNA sequencing. The chemical composition of stones was assessed using Raman spectroscopy.

Results: In the urinary bladder, upper urinary tract, and kidney stone microbiomes of patients with urolithiasis the predominant bacteria identified were: Acinetobacter, Bifidobacterium, Corynebacterium, Cutibacterium, Paracoccus, Pseudomonas, Staphylococcus and Streptococcus. Further analysis showed the relative similarity of the urinary bladder and upper urinary tract microbiomes and the dissimilarity of the kidney stone microbiome. A comparison of the upper urinary tract microbiome based on the method of urine collection and a comparison of urinary bladder and upper urinary tract microbiomes based on the presence of a DJ stent prior to the procedure showed no statistically significant differences.

Conclusions: The microbiome of stones differs from the microbiome of urine, which may play a role in the pathogenesis of urolithiasis. Bladder urine and upper urinary tract urine microbiomes do not differ. Therefore, bladder urine can replace upper urinary tract urine in microbiome studies.