Central European Journal of Urology最新文献

Introduction: Ureteral double-J stent length is an important factor affecting stent-related symptoms. Multiple techniques exist to determine ideal stent length for a given patient, however, little is known about what techniques urologists rely on. Our objective was to identify how urologists determine optimal stent length.

Material and methods: An online survey was e-mailed in 2019 to all members of the Endourology Society. The survey sought to assess what methods are commonly used to determine choice of stent length, along with frequency of stent placement post ureteroscopy, duration of stenting, availability of different stent lengths and the use of stent tether.

Results: 301 urologists (15.1%) responded to our survey. Following ureteroscopy, 84.5% of respondents would stent at least 50% of the time. Following uncomplicated ureteroscopy, most respondents (52.0%) would leave a stent for 2-7 days. Patient height was most commonly ranked first as the method of choice in determining stent length (47.0%), followed by estimation based on experience only (20.6%) and intra-operative direct measurement of ureteric length (19.1%). Most respondents utilized multiple methods in determination of optimal stent length. Most respondents (66.5%) were interested in a simple intra-operative technique utilizing a special ureteral catheter that would help choose the most appropriate stent length.

Conclusions: Post-ureteroscopy stent insertion is common and patient height is the most common method of choice used in determining optimal stent length. Most respondents were interested in using a simple, novel ureteral catheter device that would allow them to more accurately select optimal stent length.

Introduction: The aim of this study was to evaluate the possible histopathological alterations that occur in the kidneys due to a continuous temperature increase above 43°C for one hour of lithotripsy using a newly introduced thulium fiber laser (TFL).

Material and methods: Two female pigs were used. After the insertion of a 9.5/11.5 ureteral access sheath, flexible ureteroscopy and laser lithotripsy for one hour were conducted. A TFL laser with a 200-μm fiber was used. The power setting used was 8 W (0.5 J × 16 Hz). A K-type thermocouple was inserted and fixed in the upper calyx of the right porcine kidney to record the temperature in the pelvicalyceal system during the laser activation. Second-look flexible nephroscopy followed by nephrectomy and pathohistological evaluation of the operated kidney was performed one week after the procedure in the first pig and 2 weeks after the surgery in the second pig.

Results: Flexible nephroscopy did not reveal significant differences between the 2 porcine kidneys. Nevertheless, the histopathological report demonstrated severe alterations in the kidney of the first pig. Mild changes were reported in the kidney of the second pig. A significant improvement in inflammation and haemorrhagic lesions was demonstrated when comparing the 2 kidneys.

Conclusions: The difference demonstrated between the 2 kidneys based on the histopathological report shows that the healing process is capable of improving severe to mild alterations within a one-week time frame. Two weeks after the surgery, only minor changes were observed, suggesting that even temperature increases above the threshold can be tolerated regarding renal damage.

The aim of this report is to underline proper differential diagnosis of scrotal enlargement and to highlight feasibility of minimally invasive robotic-assisted treatment of giant urinary bladder containing inguinoscrotal hernia. A 48-year-old patient was referred to the outpatient urology clinic with diagnosis of hydrocele. During the diagnostic procedures, it was confirmed that the scrotal enlargement is a giant inguinal hernia containing most of the urinary bladder. Robotic-assisted laparoscopic transabdominal preperitoneal hernia repair (TAPP) has been performed. The patient remains asymptomatic after 18 months of observation. Minimally invasive repair should always be considered due to better perioperative and postoperative outcomes.

Introduction: Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy.

Material and methods: A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy.

Results: Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications.

Conclusions: Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.

Introduction: Pelvic floor muscle training (PFMT) is suggested for women with stress urinary incontinence (SUI). The aim of our study is to examine the effectiveness of PFMT on urodynamic (UDS) parameters.

Material and methods: This is a prospective observational study enrolling women with SUI. Pelvic surgery, prolapse, body mass index >30, and cognitive disability were exclusion criteria. Patients had baseline UDS, then PFMT only (Group A) or PFMT plus biofeedback (BFD) (Group B) for 6 months and UDS 3 months after treatment. The primary investigated parameters were the number of pads used per day and Valsalva leak point pressure (VLPP).

Results: Forty-six women completed the study, 22 in Group A and 24 in Group B. At baseline, all patients documented SUI with 3 median pads used per day. Urodynamic SUI was documented with a median Valsalva leak point pressure (mVLPP) of 45 cmH₂O. At the re-evaluation, 12 women (26.1%) had SUI in BDs with median number pads per day of 1, which was statistically different to baseline (p = 0.02). Urodynamic SUI was reported in 8 (17.4%) women with a mVLPP of 88 cmH₂O.Six patients were from Group A and 6 from Group B. In Group A, the median number of pads per day was 1, and urodynamic SUI was found in 3 women. In Group B, the median number of pads per day was 1, and urodynamic SUI was found in 5 women. Thirty-four women (73.9%) were dry - 16 (47.1%) from Group A and 18 (52.9%) from Group B.

Conclusions: PFMT improves urodynamic parameters among women with SUI.

Introduction: Inversion of the patient, forced diuresis after hydration, and mechanical percussion technique was developed for lower renal pole (LRP) stones with extracorporeal shock wave (ESWL). In this study, we aimed to analyze the effect of percussion, diuresis and inversion (PDI) therapy on the success rates of retrograde intrarenal surgery (RIRS) for the LRP stones.

Material and methods: 114 patients who underwent RIRS for LRP stones <2cm were included in this study. Patients' demographic, clinical, radiological and anatomical features and success status were recorded prospectively. The patients were divided into two groups. One group received RIRS procedure only (non-PDI group) and the other group received PDI therapy after the RIRS procedure (PDI group).

Results: PDI was performed to 60 (52.6%) patients, and not performed to 54 (47.4%) patients. The success rate (58.3%) for the PDI group was higher than the non-PDI group (25.9%), and this difference was statistically significant (p <0.001). In multivariate logistic regression analysis, stone size (OR = 1.306; 95% CI = 1.019-1.674; p <0.001), IU (OR = 1.702; 95% CI = 1.383-2.096; p <0.001) and not performing PDI therapy (p <0.001) OR = 9.455; 95% Cl = 2.426-10.853; p = 0.001) were revealed to be independent risk factors for failure.

Conclusions: PDI therapy increases the success rates of RIRS performed for the LRP stones.

Introduction: This study aimed to evaluate cancer-specific (CSM) and other-cause mortality (OCM) in elderly patients with prostate cancer treated with radical prostatectomy (RP) and postoperative radiotherapy (RT).

Material and methods: The Surveillance, Epidemiology, and End Results (SEER) database was searched for clinically non-metastatic prostate cancer (PCa) treated with RT after RP between 2010 and 2015. Patients were stratified according to age groups and underwent propensity score (PS) matching. The Kaplan-Meier method and competing-risk Cox regression (CRR) were used for survival analysis.

Results: In total, 5385 patients were analysed, including 738 (13.7%) elderly patients (≥70 years old) and 4647 (86.29%) younger individuals. A total of 54 (7.32%) and 69 (9.35%) patients aged ≥70 years died due to PCa and competing reasons, respectively. Among younger patients these included 275 (5.92%) and 208 (4.48%) deaths, respectively. At a median follow-up of 80 months, patients ≥70 years old had significantly shorter OCM (p <0.0001) than PS-matched younger controls without significant impairment of cancer-specific survival when compared to controls (p = 0.19). In CRR analysis older patients were at significantly higher risk of OCM (HR = 2.24, p = 0.0002 and HR = 3.3, p = 0.011 for patients aged ≥70 and ≥75 years, respectively). Simultaneously, the CRR revealed no increased risk of CSM for patients older than 70 and 75 years (HR = 1.2, p = 0.33 and HR = 1.53, p = 0.29, respectively).

Conclusions: Elderly patients with PCa are at high risk of dying due to competing reasons, which might prevent the survival benefit of RT after RP. Selection for salvage and adjuvant RT in these individuals should be cautious.

Introduction: Radiomics in uro-oncology is a rapidly evolving science proving to be a novel approach for optimizing the analysis of massive data from medical images to provide auxiliary guidance in clinical issues. This scoping review aimed to identify key aspects wherein radiomics can potentially improve the accuracy of diagnosis, staging, and grading of renal and bladder cancer.

Material and methods: A literature search was performed in June 2022 using PubMed, Embase, and Cochrane Central Controlled Register of Trials. Studies were included if radiomics were compared with radiological reports only.

Results: Twenty-two papers were included, 4 were pertinent to bladder cancer, and 18 to renal cancer. Radiomics outperforms the visual assessment by radiologists in contrast-enhanced computed tomography (CECT) to predict muscle invasion but are equivalent to CT reporting by radiologists in predicting lymph node metastasis. Magnetic resonance imaging (MRI) radiomics outperforms radiological reporting for lymph node metastasis. Radiomics perform better than radiologists reporting the probability of renal cell carcinoma, improving interreader concordance and performance. Radiomics also helps to determine differences in types of renal pathology and between malignant lesions from their benign counterparts. Radiomics can be helpful to establish a model for differentiating low-grade from high-grade clear cell renal cancer with high accuracy just from contrast-enhanced CT scans.

Conclusions: Our review shows that radiomic models outperform individual reports by radiologists by their ability to incorporate many more complex radiological features.