Central European Journal of Urology最新文献

Introduction: Urolithiasis is a prevalent condition with several etiological factors, affecting up to 20% of the population and exhibiting high recurrence rates. Its strain on healthcare systems, exacerbated by high incidence and recurrence, often results in insufficient time for thorough diagnostics and counselling. Consequently, many patients seek easily accessible online sources of information. This study aimed to assess the readability and availability of online urolithiasis materials across 24 official European languages to compare readability across different source types.

Material and methods: The phrase "kidney stones" was translated into all official European languages, and the first 50 search results for each language were retrieved. Non-functional websites, those requiring accounts or payments, and duplicates were excluded. Relevance was assessed using Google Translate to filter out results lacking medical information. Only patient-oriented materials were included for analysis. Obtained results were then classified by source category, and their readability was assessed using LIX formula.

Results: A total of 723 articles were analysed. The English term yielded the highest number of results, followed by Spanish and Portuguese. Overall, the English articles performed best, being the only language with a mean LIX score below 40, which marks the threshold between "somewhat hard" and "hard" to read. Finnish, Lithuanian, and Hungarian materials had LIX scores significantly exceeding the threshold of 50, classifying them as "very hard to read" and among the most difficult to comprehend.A subgroup analysis revealed no statistically significant differences across the source classification.

Conclusions: Online materials on kidney stones are generally too complex for patients, limiting their understanding and treatment adherence. Simplification of patient-oriented materials along with artificial intelligence utilisation could enhance comprehension. Improved awareness may promote adherence to preventive measures and help reduce the incidence and economic burden of urolithiasis.

Introduction: Cancer, next to cardiovascular diseases, remains the primary concern of modern medicine in developed countries. Despite the unprecedented progress in targeted therapies and personalised medicine, including immunotherapy and gene therapy, we are still unable to efficiently treat many malignancies. One of the major obstacles to treating cancer is its ability to metastasise. Hence, a better understanding of cancer biology with emphasis on the metastasis formation may hold the key to further ameliorating cancer treatment. Nowadays, there is a growing body of evidence for the common denominator of neoplasia, which seems to be universal - cancer stem cells which are being found in a growing number of cancers.

Material and methods: We conducted a Web of Science and Medline database search using the terms "cancer stem cells", "carcinogenesis", and "stem cells" in conjunction with "metastasis", without setting time limits.

Results: The existence of cancer stem cells was proven both in animal models and in humans. We know beyond doubt that cancer stem cells may be found in bladder cancer, breast cancer, and colon cancer, among others. The cancer stem cells in the aforementioned cancers may initiate tumour formation ex vivo and thus theoretically lead to tumour recurrence. Their role in the formation of metastases, however, is still under investigation.

Conclusions: Although their exact role is yet to be identified, it is now obvious that cancer stem cells give rise to primary mass in solid tumours and differentiated cancer cells in leukaemias. However, the role of cancer stem cells in metastasis is still obscure.

Introduction: The combination of magnetic resonance imaging (MRI) and ultrasound (US) allows for better lesion targeting and diagnostic probability compared to random prostate biopsies. The Artemis Fusion Biopsy system and ExactVu micro-US technology capitalize on this advantage and provide higher-resolution imaging of the prostate during biopsy. Their accuracy in measuring prostate volume and resulting implications on prostate specific antigen (PSA) density and risk stratification, however, has not been evaluated. We hypothesized that PSA densities as measured by these modalities will demonstrate clinically insignificant differences compared to standard measurement.

Material and methods: We retrospectively reviewed all prostate fusion biopsy cases performed at our health system with Artemis or ExactVu systems from April 2021 to July 2023 and compared the PSA density calculated from the volume obtained with these systems to standard measurement with ellipsoid calculation from MRI. Change in National Comprehensive Cancer Network (NCCN) prostate cancer risk stratification was analyzed for each system.

Results: Artemis MRI segmentation (0.179 ng/ml, p = 0.04) and US (0.181 ng/ml, p = 0.067) underestimated and ExactVu micro-US (0.247 ng/ml, p <0.001) overestimated PSA density. Risk stratification changed in 1.2% of Artemis MRI segmentation cases, 1.6% of Artemis US cases, and 1.2% of ExactVu micro-US cases.

Conclusions: Despite differences in PSA density, choice of fusion biopsy system has minimal clinical impact on risk stratification and any of these studied systems may be used without fear of misrepresenting a patient's disease state.

Introduction: Minimally-invasive partial nephrectomy (MIPN) is the standard treatment for kidney tumors with a diameter smaller than 4 cm. It is also performed in selected cases of tumors reaching 7 cm, but it may lead to potential complications. We investigated the current literature for simulators that could be used to teach urologists alone or within the boundaries of a course or a curriculum.

Material and methods: We performed a literature search using PubMed (Ovid Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE [R] Daily, and Ovid MEDLINE [R]). Search terms included: simulation, simulation training, education, curricul*, partial nephrectomy, and nephron-sparing surgery. The primary endpoints were the efficacy of different simulators and the impact of different devices, curricula, or courses in training and trainee learning curves.

Results: We identified 16 studies evaluating simulation with 3D reconstruction, ex vivo, in vivo, synthetic models, and virtual reality simulators. Additionally, we identified one study presenting a training curriculum. The results appeared promising, although currently available studies are scarce. Regardless of the type of simulator, participants stated that, to some degree, their skills were improved and their confidence was elevated.

Conclusions: Simulation-based training can help novice surgeons familiarize themselves with complex procedure steps and reduce learning curves. A specific validated curriculum for this operation still needs to be included. Validating simulators or curricula for MIPN could be essential to enable more urologists to treat patients safely and effectively.

Introduction: The MemoKath™-051 (MK) is a thermo-expandable spiral stent for the treatment of benign or malignant ureteral obstruction. Existing studies on outcome measurements, like complication rate or time to stent exchange for MK differ significantly. In this retrospective analysis, we investigated the supposed superiority of the MK over conventional tumor ureteral stent (TUS) insertion.

Material and methods: In this monocentric retrospective analysis, 72 consecutive patients with benign or malignant extrinsic ureteral stenosis who either underwent insertion of a MK or TUS between 03/2008 and 12/2018 were analyzed. Indications for stent insertion were either chronic benign or malignant extrinsic obstruction in patients who were unsuitable for or refused definitive surgery. Patients who underwent urinary diversion were excluded. We compared the indwelling time, the complication rates and the time to occurrence of complications using Mann-Whitney-U-test and χ² test for categorical variables. Complication rates of both, the MK and the TUS were compared using Fisher´s test. Complications were classified according to Clavien-Dindo Classification (CDC).

Results: The total number of ureteral units analyzed was 171, including 89 MK stents and 82 TUSs. No significant differences between both groups regarding age, stent indications, and stricture characteristics occurred. At a median follow-up of 32 and 27 months in the MK and TUS groups, postoperative complications occurred in 82 (92%) and 19 (23%) patients, respectively (p = 0.01). Almost all complications were major (CDC grade 3b) that required stent removal or replacement, with the exception of one patient in the MK group. Median time to complications was significantly longer for the MK group, 5.6 months, compared to 3.5 months in the TUS group (p = 0.01), and median time to stent replacement was 8 months for the MK group vs 5.2 months for the TUS group (p <0.001).

Conclusions: Although the MemoKath™ is designed for a long indwelling time of up to years, it is associated with higher complication rates and premature replacement. However, compared to the TUS, the MK still has a significantly longer indwelling time. Further studies are needed to determine the predictors of failure and the best candidates for both stents.

Introduction: To compare the surgical outcomes of holmium laser enucleation of the prostate (HoLEP) and robotic single-port transvesical enucleation of the prostate (STEP) for the treatment of benign prostatic hyperplasia (BPH) during early adoption at a single center.

Material and methods: Data about consecutive BPH patients who underwent HoLEP and STEP at our Center from July 2023 to September 2024 were retrospectively analyzed. Both procedures were performed by surgeons at the beginning of their experience with the procedures.

Results: Thirty HoLEP and 20 STEP cases were included in the analysis. STEP patients had larger prostate volume (median 101.5 vs 78.5 cc; p = 0.003). Median operative time was longer for STEP (286 vs 124 min, p <0.001). Median catheterization time was shorter for HoLEP (3 vs 7 days, p <0.001). Transient post-operative incontinence was higher for HoLEP (31% vs 5.3%, p = 0.032). There was no difference in median length of stay (30 hours for HoLEP and 31 hours for STEP; p = 0.108).

Conclusions: Both HoLEP and STEP can be safely implemented for the minimally invasive treatment of BPH. Each of the procedures presents some appealing features that can be tailored to different subgroups of patients. HoLEP is appealing for higher surgical risk patients, while STEP allows to effectively manage larger glands even at the beginning of the surgeon's learning curve. As experience with SP robotic surgery matures, it is likely that STEP becomes a competitive alternative to the well-established HoLEP.

Introduction: To compare retrograde intrarenal surgery (RIRS) and supine mini percutaneous nephrolithotomy (smPCNL) in the management of upper ureteric stones larger than 10 mm.

Material and methods: Patients with upper ureteric stones (above L4 vertebra transverse process) larger than 10 mm at Ford Hospital and Research Centre between January 2023 and June 2024 were included in the study and were operated with either RIRS (group A) or smPCNL (group B) based on the informed consent and patients' decision. Patient demographics, stone parameters, intraoperative variables, postoperative outcomes, stone-free rates (SFR) and complications were recorded, and the two groups were compared.

Results: Over 18 months, 140 patients (70 in each group) were available for comparison. Both the groups were comparable in terms of patient's demographics and the stone parameters. For RIRS and smPCNL, the mean stone size was 13.87 ±3.69 and 14.21 ±3.47 mm (p = 0.329), mean operative duration was 42.52 ±28.37 and 30.69 ±18.55 minutes (p = 0.0001), mean drop in haemoglobin at 24 hours was 0.44 ±0.96 and 0.69 ±0.92 g/dl (p = 0.364) and postoperative hospital stay was 0.92 ±0.68 and 1.13 ±0.76 days, respectively.The SFR (at 3 months post-surgery) were 94.2% for RIRS and 98.57% for smPCNL (p = 0.084) and complications rate (Clavien-Dindo ≥II) was 2.88% for both groups. Primary access was not possible in 30% of patients in RIRS leading to staged intervention.

Conclusions: RIRS and smPCNL are safe and effective surgical alternatives for managing upper ureteric stones larger than 10 mm. smPCNL offers a single stage solution and equivalent results with RIRS for the large upper ureteric stones.

Introduction: There is minimal research on the types of complications patients experience after radical cystectomy (RC). Moreover, the impact of these complications is not well qualified. The primary purpose of this study is to qualify complications after RC and quantify rates of emergency department (ED) utilisation and readmissions to the hospital. The secondary purpose is to associate risk factors for ED visits and hospital readmission.

Material and methods: Patients were retrospectively analysed, who underwent RC for bladder cancer. ED visits within 90 days of discharge from RC and readmission at both 30 and 31-90 days of discharge were collected. Complications were graded using the Clavien-Dindo system and classified using the Memorial Sloan-Kettering Cancer Center complication system.

Results: Three hundred and eighty-six patients were included. The in-house complication rate before discharge was 36%, and the 90-day complication rate after discharge was 54.8%. 33.7% of patients had ≥1 ED visit postoperatively, 18.7% were readmitted within 30 days, and 17.3% within 31-90 days of discharge. The primary reason for ED presentation, readmission at 30 and 31-90 days was infection. Cutaneous ureterostomy (CU) was associated with greater likelihood of presentation to the ED and readmission 31-90 days postoperatively (p <0.01). Overall survival (OS) was worse in patients who presented to the ED and/or were readmitted at both the 30- and 31-90-day marks (p <0.01).

Conclusions: ED utilisation and readmission rates after RC are high. The most common complication is infection. Patients with a CU are at higher risk for healthcare utilisation. OS is worse in patients with an ED visit or readmission to the hospital, and these patients may require closer monitoring.