Central European Journal of Urology最新文献

英文中文

LETTERS TO THE EDITOR. 给编辑的信。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 Epub Date: 2023-04-21 DOI: 10.5173/ceju.2023.L1

Sabine Uguzova, Christian Beisland, Patrick Juliebø-Jones

We read with interest the systematic review published by Riveros et al., which has succinctly evaluated the available evidence on Holmium Moses mode. [1]. Their efforts are timely given the continued interest in Moses technology as a means to improve stone lithotripsy. As the authors rightly say, the initial findings from pre-clinical studies were extremely promising. Indeed, many will be familiar with the impressive video demonstrations of Moses technology from benchside models. Combined with the biblical nomenclature, which gives a suggestion of superhuman powers, impressive outcomes in the patient setting were eagerly anticipated. However, Riveros et al. have demonstrated that the reality has not lived up to those expectations. For while Moses mode does appear to hold technical advantages in terms of ablation speed and lasing time, these do not translate to benefits in terms of stonefree status or complication rate. The latter are of course what are most important to the patient, namely, to be free of their stone and to get through their operation without problems. Even operation time was found to have no significant difference in this systematic review [1]. In contrast, other areas of laser technology, such as Thulium fiber laser (TFL) do seem to be able to deliver actual clinical benefit [2]. We would therefore argue that Moses technology has had sufficient time to prove its clinical worth and warrant further research attention. Instead, our focus should be aimed at investigating other areas including TFL, high versus lower power settings, temperature control and single-use ureteroscopes among other key topics where clinically meaningful results can be achieved [3, 4].

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引用次数: 0

Robotic revision of vesicourethral stricture after robot-assisted radical prostatectomy. 机器人辅助根治性前列腺切除术后膀胱尿道狭窄的修复。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2023.38

Alessandro Princiotta, Davide Brusa, Damiano D'Aietti, Emanuele Serafin, Riccardo Rizzetto, Maria Angela Cerruto, Alessandro Veccia, Alessandro Antonelli

cm before anastomosis. During the urethrocystography, no micturition occurred, so it was necessary to position an epicystostomy. A standard transperitoneal robotic approach was planned to correct the vesicourethral anastomotic stenosis. After removing the suprapubic catheter, the first step was the dissection of the bladder from the walls of the pelvis, anteriorly and laterally, trying to identify the levator ani muscle and the correct anatomy, which was very difficult due to fibro - sis and adhesions. We opened the cystotomy site close to the bladder neck to highlight the anatomy of the bladder neck and the bladder more clearly regarding the position of the urethral orifice.

引用次数: 0

Diagnostic accuracy and clinical utility of micro-ultrasound guided biopsies in patients with suspected prostate cancer. 微超声引导下前列腺癌活检的诊断准确性及临床应用。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2023.198

Nuno Dias, Gianmarco Colandrea, Francisco Botelho, Lara Rodriguez-Sanchez, Camille Lanz, Petr Macek, Xavier Cathelineau

Introduction: New technologies to improve quality of prostate biopsies are appearing in clinical practice.We evaluate the performance of a micro-ultrasound device and the Prostate Risk Identification using MicroUltraSound (PRI-MUS) score in detecting clinically significant prostate cancer (csPCa).

Material and methods: We retrospectively reviewed data of 139 biopsy- naïve patients with suspicion of prostate cancer, who underwent diagnostic MRI and micro-ultrasonography (microUS), followed by transrectal prostatic biopsy (systematic ±targeted) under local anesthetic. The main objective was to evaluate the performance of the Prostate Risk Identification using MicroUltraSound (PRI-MUS) score in detecting csPCa, defined as International Society of Urological Pathology (ISUP) ≥2.

Results: Of all patients, 97 (70%) were found to have PCa, and 62 (45%) having csPCa.Among 100 patients with positive microUS (PRI-MUS score ≥3), 23 (23%) had ncsPCa and 57 (57%) were diagnosed with csPCa (ISUP ≥2); and in 39 patients with negative microUS, 12 (31%) were diagnosed with ncsPCa and 5 (13%) with csPCa.A PRI-MUS score ≥3 presented a sensitivity, specificity, positive predictive value and negative predictive value of 92%, 44%, 57% and 95%, respectively, for the detection of csPCa.The PRI-MUS score had higher areas under the curve than Prostate Imaging Reporting & Data System (PI-RADS) both for targeted (AUC 0.801 vs 0.733) and systematic + targeted (AUC 0.776 vs 0.694) biopsies for csPCa detection.

Conclusions: In our cohort, microUS performed well as a diagnostic tool through an easily implementable scale. MicroUS presented similar sensitivity and higher specificity than MRI in detecting csPCa. Further multicenter prospective studies may clarify its role in prostate cancer diagnosis.

前言:提高前列腺活检质量的新技术正在临床实践中出现。我们评估了微超声设备的性能和使用微超声(PRI-MUS)评分检测临床显著性前列腺癌(csPCa)的前列腺风险识别。材料和方法:我们回顾性分析139例怀疑前列腺癌的活检- naïve患者的资料，这些患者接受了诊断性MRI和微超声检查(microUS)，然后在局麻下进行了经直肠前列腺活检(系统±靶向)。主要目的是评估使用微超声(PRI-MUS)评分检测csPCa的前列腺风险识别的性能，csPCa的定义为国际泌尿病理学学会(ISUP)≥2。结果:在所有患者中，发现97例(70%)患有PCa, 62例(45%)患有csPCa。100例microUS阳性(PRI-MUS评分≥3)患者中，23例(23%)为ncsPCa, 57例(57%)诊断为csPCa (ISUP≥2);在39例microUS阴性患者中，12例(31%)诊断为ncsPCa, 5例(13%)诊断为csPCa。PRI-MUS评分≥3时，csPCa检测的敏感性为92%，特异性为44%，阳性预测值为57%，阴性预测值为95%。在csPCa检测的靶向活检(AUC 0.801 vs 0.733)和系统+靶向活检(AUC 0.776 vs 0.694)中，PRI-MUS评分曲线下面积均高于前列腺成像报告和数据系统(PI-RADS)。结论:在我们的队列中，microUS作为一种易于实施的诊断工具表现良好。MicroUS检测csPCa的灵敏度与MRI相近，特异度更高。进一步的多中心前瞻性研究可能阐明其在前列腺癌诊断中的作用。

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引用次数: 1

Impact of outcomes and costs for implementation of robotic radical cystectomy with full intracorporeal urinary diversion. 实施机器人根治性膀胱切除术并进行完全体外尿路转流对疗效和成本的影响。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 Epub Date: 2023-11-15 DOI: 10.5173/ceju.2023.203

Razvan George Rahota, Jean-Baptiste Beauval, Jean-Romain Gautier, Christophe Almeras, Valerie Garnault, Guillaume Loison, Ambroise Salin, Christophe Tollon, Guillaume Ploussard

Introduction: Radical cystectomy (RC) remains a surgery with important morbidity despite technical advances. Our aim was to determine the impact on outcomes and costs of robot-assisted radical cystectomy (RARC) with full intracorporeal diversion.

Material and methods: We retrospectively included 196 consecutive patients undergone RC for bladder cancer between 2017 and 2022. Comparisons were done between the open radical cystectomy (ORC; n = 166) and RARC with full intracorporeal diversion (n = 30) in the overall cohort and after matched pair analysis.

Results: More neobladders were performed in the RARC group (40% vs 18.7%, p = 0.011). Peri-operative parameters continuously improved over time in the RARC cohort despite an increased proportion of elderly patients with higher comorbidity index. RARC patients had lower prolonged stay (33.3% vs 68.3%, p = 0.002), lower grade 1 complication rates (26.7% vs 53.3%, p = 0.016) and blood loss (185 vs 611 ml, p <0.001) than ORC patients. RARC was an independent favorable predictor for prolonged stay (OR 0.199) and complication (OR 0.334). Cost balance favored ORC, with an increase of hospitalization cost at 816 euros for RARC.

Conclusions: After matching, RARC with full intracorporeal diversion was associated with improved outcomes and a moderated increase of post-operative costs mainly due to the use of robotic devices.

导言：尽管技术不断进步，根治性膀胱切除术（RC）仍然是一种发病率很高的手术。我们的目的是确定完全体腔内转流的机器人辅助根治性膀胱切除术（RARC）对预后和成本的影响：我们回顾性纳入了 2017 年至 2022 年间接受膀胱癌根治术的 196 例连续患者。在总体队列和配对分析后，比较了开放根治性膀胱切除术（ORC；n = 166）和全体外转流 RARC（n = 30）：结果：RARC组进行新膀胱术的比例更高（40% vs 18.7%，p = 0.011）。尽管合并症指数较高的老年患者比例增加，但随着时间的推移，RARC 组患者的围手术期参数持续改善。经过匹配后，采用完全体腔内转流的 RARC 可改善疗效，但术后费用的增加有限，这主要是由于使用了机器人设备。

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引用次数: 0

Pushing the boundaries: Emerging role of radical prostatectomy as part of multimodal treatment for oligometastatic prostate cancer 突破界限:根治性前列腺切除术作为少转移性前列腺癌多模式治疗的一部分的新作用

Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2023.001e

引用次数: 0

Worldwide trends of practice and intervention in Paediatric Endourology: Comparison of European versus Non-European responses 全球趋势的实践和干预在儿科泌尿道:比较欧洲和非欧洲的反应

Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2023.79

Introduction The area of paediatric endourology is unique and is recognised to be challenging, and it requires a certain level of focused training and expertise. Our aim was to conduct a worldwide survey in order to gain an overview regarding the current practice patterns for minimally invasive treatments of paediatric upper urinary tract stone patients. Material and methods The survey was distributed between December 2021 and April 2022 through urology sections and societies in United Kingdom, Latin America and Asia. The survey was made up of 20 questions and it was distributed online using the free online Google Forms (TM). Results 221 urologists answered the survey with 56 responses each from India, South America and UK and 53 responses from the rest of Europe (15 countries). In total, 163 responders (73.7%) managed paediatric stone patients in their daily practice. Of the responders, 60.2% were adult urologists and 39.8% were paediatric urologists. 12.9% adult urologists and 20.4% paediatric urologists run independent clinics while some run combined adult and paediatric clinics sometimes with the support of the nephrologists. Only 33.9% urologists offered all surgical treatments [extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS) and retrograde intrarenal surgery (RIRS)]. Conclusions Treatment of paediatric stones can vary according to country and legislations. Based on the results of this survey, minimally invasive methods such as URS and mini PCNL seem to have become more popular. In most institutions a collaboration exists between adult and paediatric urologists, which is the key for a tailored decision making, counselling and treatment success.

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引用次数: 0

Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single centre. 非钳式机器人辅助部分肾切除术:来自单一中心的手术经验。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2023.261

Matteo Zanoni, Fabio Grizzi, Paolo Vota, Giovanni Toia, Cinzia Mazzieri, Maria Chiara Clementi, Edoardo Beatrici, Gianluigi Taverna

Introduction: Robot-assisted partial nephrectomy (RAPN) is a minimally invasive treatment for localized renal tumours, which can sometimes result in extended warm ischaemic time and serious complications. This study reports on surgical outcomes including feasibility, positive margins, and complications during and after surgery.

Material and methods: From January 2011 to November 2022, a single centre performed off-clamp sutureless RAPN on 287 patients. The study recorded preoperative patient characteristics, estimated glomerular filtration rate, and tumour features according to the preoperative aspects and dimensions used for an anatomical (PADUA) classification, and utilized the RENAL nephrometry scoring system. Intraoperative details and complications were documented. Postoperative complications within 30 days were classified according to the Clavien-Dindo system. Follow-up appointments were scheduled at 1, 3, and 6 months in the first year, followed by subsequent appointments every 6 months, and then annually.

Results: The study included 145 males and 142 females, with a mean age of 58.9 years and a mean body mass index of 26.7 kg/m². The mean PADUA score was 8.3, the average console time was 83 minutes, and the estimated blood loss was 280 mL. The average hospital stay was 3 days, and no intraoperative complications were observed. However, 4 patients (1.4%) experienced post-operative haemorrhage that required laparotomy (Clavien-Dindo stage IIIB), and 4 patients (1.4%) had positive surgical margins.

Conclusions: Off-clamp selective arterial clamping during minimally invasive partial nephrectomy is a safe and feasible approach for small renal tumours. Further randomized prospective studies are required to confirm if RAPN without clamping offers any renal functional benefits and reduces perioperative bleeding complications.

机器人辅助部分肾切除术(RAPN)是一种局部肾肿瘤的微创治疗方法，有时会导致热缺血时间延长和严重的并发症。本研究报告了手术结果，包括可行性、阳性切缘、手术中和术后并发症。材料与方法:2011年1月至2022年11月，某中心对287例患者进行了无钳外缝合RAPN。该研究记录了术前患者的特征，估计肾小球滤过率，根据术前的方面和尺寸进行解剖(PADUA)分类，并使用肾肾测量评分系统。记录术中细节及并发症。术后30天内的并发症按照Clavien-Dindo系统进行分类。随访预约安排在第一年的第1、3和6个月，随后每6个月随访一次，然后每年随访一次。结果:研究对象男性145人，女性142人，平均年龄58.9岁，平均体重指数26.7 kg/m2。平均PADUA评分8.3分，平均控制台时间83分钟，估计失血量280 mL，平均住院时间3天，无术中并发症。然而，4例(1.4%)患者出现术后出血，需要开腹手术(Clavien-Dindo IIIB期)，4例(1.4%)患者手术切缘阳性。结论:在微创肾部分切除术中，非钳形选择性动脉夹持是一种安全可行的治疗小肿瘤的方法。需要进一步的随机前瞻性研究来证实不夹持的RAPN是否能提供任何肾功能益处并减少围手术期出血并发症。

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引用次数: 0

Laparoscopic radical nephrectomy in Trendelenburg position - technical modifications for a pelvic kidney. 腹腔镜Trendelenburg位根治性肾切除术-骨盆肾的技术改良。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2022.237

Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ana Sofia Araújo, Nuno Morais, Emanuel Carvalho-Dias

14.6 g/dl to 11.9 g/dl. The histopathologic examination revealed an 808 g surgical specimen, 8.8*8.0*6.5 cm kidney, with 7.0*6.0*4.5 cm clear cell RCC, in the middle and infe - rior pole, G3 pT3aNxR0, with focal invasion of hilar and perirenal fat. There was also vascular invasion. In conclusion, this was a challenging but success - ful surgery, using only standard laparoscopic mate-rial. Robot-assistance or CT-scan 3D reconstruction might have been helpful, if available, but we showed these are not essential

引用次数: 0

Endourological treatment of uretero-enteric benign stricture after radical cystectomy and kidney transplant. 根治性膀胱切除术及肾移植术后输尿管-肠良性狭窄的腔内治疗。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2022.238

Angelo Territo, Paolo Verri, Alessandro Uleri, Pietro Diana, Andrea Gallioli, Michael Baboudjian, Josep Maria Gaya, Francesco Sanguedolce, Julia Aumatell, Giuseppe Basile, Alejandra Bravo, Joan Palou, Alberto Breda

Endourological treatment of uretero-enteric benign stricture after radical cystectomy and kidney transplant. Cent European

引用次数: 1

The impact of antithrombotic therapy on the time of detection of bladder cancer. 抗栓治疗对膀胱癌检出时间的影响。

IF 1.2 Q3 Medicine

Central European Journal of Urology

Pub Date : 2023-01-01 DOI: 10.5173/ceju.2022.193

Dora Jakus, Marijan Šitum, Petra Čepin, Ivana Vrhovac, Josip Anđelo Borovac

Introduction: The aim of this article was to investigate the impact of chronic antithrombotic therapy (AT) use on the time of detection of bladder cancer, assuming that patients taking AT experience episodes of macroscopic hematuria earlier, and therefore have a more favorable histopathological grade and stage, as well as a smaller number and size of tumors compared to patients not taking AT.

Material and methods: A retrospective, cross-sectional study was conducted, including 247 patients who underwent bladder cancer surgery for the first time at our institution during the three-year period (2019-2021) and who experienced macroscopic hematuria.

Results: A lower frequency of high-grade bladder cancer (40.6% vs 60.1%, P = 0.006), T2 stage (7.2% vs 20.2%, P = 0.014), and a lower frequency of tumors larger than 3.5 cm (29% vs 57.9%, P <0.001) were found in patients using AT compared to patients not using them. The patients using AT had a smaller mean tumor size (2.98 vs 4.51 cm, P <0.001). A multivariable regression analysis, adjusted for age, sex, and number of comorbidities, showed a lower probability of having a high-grade cancer (OR 0.393, 95% CI 0.195-0.792, P = 0.009), T2 stage (OR 0.276, 95% CI 0.090-0.849, P = 0.025), and tumors larger than 3.5 cm (OR 0.261, 95% CI 0.125-0.542, P <0.001) in patients using AT.

Conclusions: More favorable histopathological grades, stages, and smaller tumor sizes were found in patients with bladder cancer who experienced macroscopic hematuria and were using AT compared to patients not taking AT.

前言:本文的目的是研究慢性抗血栓治疗(AT)的使用对膀胱癌发现时间的影响，假设服用AT的患者更早经历宏观血尿发作，因此具有更有利的组织病理学分级和分期，并且与未服用AT的患者相比，肿瘤的数量和大小更小。材料与方法:回顾性、横断面研究，纳入我院三年内(2019-2021年)首次行膀胱癌手术并出现宏观血尿的患者247例。结果:膀胱癌高级别(40.6% vs 60.1%， P = 0.006)、T2期(7.2% vs 20.2%， P = 0.014)、肿瘤大于3.5 cm的发生率较低(29% vs 57.9%， P)。结论:与未行AT的患者相比，有宏观血尿且行AT的膀胱癌患者有更有利的组织病理学分级、分期和更小的肿瘤大小。

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引用次数: 0

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