Central European Journal of Urology最新文献

Introduction: The aim of this review was to assess the outcomes of partial nephrectomy using indocyanine green (ICG) regarding ischemia time, positive surgical margins (PSM), estimated blood loss (EBL) and estimated GFR reduction while also suggesting the optimal dosage scheme.

Material and methods: A systematic review was performed using Medline (PubMed), ClinicalTrials.gov, and Cochrane Library (CENTRAL) databases, in concordance with the PRISMA statement. Studies in English regarding the use of indocyanine green in partial nephrectomy were reviewed. Reviews and meta-analyses, editorials, perspectives, and letters to the editors were excluded.

Results: Individual ICG dose was 5 mg in most of the studies. The mean warm ischemia time (WIT) on each study ranged from 11.6 minutes to 27.2 minutes. The reported eGFR reduction ranged from 0% to 15.47%. Lowest mean EBL rate was 48.2 ml and the highest was 347 ml. Positive surgical margin rates were between 0.3% to 11%.

Conclusions: Indocyanine green seems to be a useful tool in partial nephrectomy as it can assist surgeons in identifying tumor and its related vasculature. Thereby, warm ischemia time can be reduced and, in some cases, selective ischemia can be implemented leading to better renal functional preservation.

Introduction: To investigate the role of trans-labial ultrasound study in detection of female urethral stenosis (FUS) compared to former cysto-urethroscopy as the currently available definitive diagnostic modality.

Material and methods: In this cross-sectional study, 60 consecutive patients with bladder outlet obstruction diagnosed by clinical symptoms and urodynamic study, were included from 2019 to 2022. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF).

Results: In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra. GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002).

Conclusions: GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The location and the length of the stricture and probable peri-urethral fibrosis can be identified by this method. However, in meatal or pure short-length distal urethral strictures, this method should be used with caution.

Introduction: The study presents the initial outcomes of robot-assisted radical prostatectomies (RARPs) using the Versius robotic system in a urological centre with no prior robotic surgery experience.

Material and methods: A retrospective analysis of 58 RARPs was conducted, including patients' parameters as well as Versius system performance.

Results: The study involved 58 patients (average age 66.9 years). Median preoperative prostate specific antigen (PSA) was 9.8 ng/ml, with 48% having ISUP grade group ≥ 3 on biopsy and 25.8% showing extraprostatic extension on MRI. Median blood loss was 437 ml, with complications (10.3% Clavien-Dindo grade II and 4 grade III cases). One conversion to open surgery occurred (0.58%). Final pathology revealed 46.5% extraprostatic disease, and 25.8% had positive margins. Post-surgery, 96.5% had undetectable PSA at 6 weeks. Continence rates were 89.7% at 6 weeks, increasing to 91.3% at 12 months. Median catheter duration was 7.9 days, and the hospital stay was 4.5 days. Console time averaged 150.9 minutes, with a median operative time of 213 minutes. The Versius system reported medium priority alarms in 24.1% of operations, including 1266 alarms related to robotic arm clashes and 43 instrument swaps. One bedside unit exchange occurred with no console or robotic system failures.

Conclusions: The Versius robotic system can be successfully introduced in a urological centre without prior robotic surgery experience. Our setup and operating room positioning are effective, safe, and reproducible. We encountered and resolved surgical and technical challenges. Further follow-up studies are needed to assess the system's performance.

Introduction: This study aimed to compare the safety and efficacy of treatment using simple prostatectomy (SP) and using photoselective vaporization of the prostate (PVP) with a 180W GreenLight XPS laser in patients with high-volume prostate hypertrophy.

Material and methods: The study included 120 patients with LUTS symptoms caused by prostatic enlargement of more than 80 ml; 79 patients were treated with SP, while 41 were treated with PVP. The analysis included subjective the International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and objective (Qmax), (Qave), and post-void residual volume (PVR) parameters before treatment and at an average of 38 months after surgical treatment. Early and late adverse effects and length of hospitalisation were assessed. Complication reports were performed according to the modified Clavien-Dindo system.

Results: The analysis independently showed the effectiveness of both methods. Subjective parameters (IPSS, QoL), showed no significant differences. Patients treated with SP scored slightly better on objective parameters (Qmax, Qave, and PVR). Analysis of adverse effects and hospitalisation time were more favourable after PVP.

Conclusions: SP and PVP were found to be comparable and highly effective in treating benign prostatic hyperplasia in terms of IPSS and QoL. Patients treated with the SP method obtained slightly better results of objective parameters such as Qmax, Qave, and PVR. Compared with SP, PVP has a more favourable safety profile.

Introduction: Prostate cancer (PCa) is a major challenge in urology, with increasing incidence and mortality. Despite advances in diagnosis and treatment, certain patient groups remain poorly served. Genetic factors, particularly in hereditary prostate cancer (HPCa), are now recognized as significant contributors to disease progression. This review focuses on the role of genetic mutations in PCa, their impact on diagnosis, and management.

Material and methods: This review summarizes current literature on genetic mutations linked to PCa, including BRCA1, BRCA2, ATM, CHEK2, and others. These mutations are associated with more aggressive disease, earlier onset, and may influence treatment strategies. Guidelines from the Philadelphia Prostate Cancer Consensus Conference (PPCCC), the American National Comprehensive Cancer Network (NCCN), and the European Association of Urology (EAU) on genetic testing are also discussed.

Results: Genetic screening is increasingly recommended for high-risk individuals, such as those with a family history or aggressive PCa. Identifying mutations allows for early detection and tailored treatment, including more frequent screening and targeted therapies. Specific mutations, like those in BRCA genes, can benefit from chemotherapy in advanced stages. Genetic testing provides valuable information to guide patient management, improving early detection and patient outcomes.

Conclusions: Genetic testing plays a crucial role in PCa management, enabling personalized care for high-risk patients. As genetic research advances, incorporating genetic screening into clinical practice will enhance early diagnosis and treatment outcomes, ultimately improving patient survival and quality of life.

Introduction: The classification of patients studied for haematuria into risk groups is important for early diagnosis of urinary tract cancers and optimising healthcare resources. This study aims to evaluate the role of the IDENTIFY calculator in the initial study of these patients and its use for classifying patients into risk groups.

Material and methods: A study of patients with haematuria was performed from June 2020 to June 2022. They were classified into risk groups using the IDENTIFY calculator. Final diagnosis of bladder neoplasia between the risk groups was compared. Receiver operating characteristic (ROC) curves were calculated according to the percentage of risk obtained with the calculator and the final diagnosis of bladder neoplasia.

Results: We included 255 patients. Imaging tests were positive for bladder cancer in 39 patients (15.3%). Transurethral resection of bladder tumour was performed in 39 cases; 4 were negative, 18 cases Ta, 2 cases T1, 14 cases T2, and one case carcinoma in situ (CIS). The final diagnosis was bladder neoplasia in 35 patients (13.8%). These patients were classified as: one low risk (2.9%), 4 intermediate risk (11.4%), and 30 high risk (85.7%); p <0.001. ROC curves were calculated, with an AUC (area under curve) of 0.89; p <0.001.

Conclusions: Patients classified into the high-risk group were more frequently diagnosed with bladder cancer than other risk groups. The IDENTIFY risk calculator is a simple and easy-to-use tool with acceptable discrimination in the diagnosis of urinary tract tumours, specifically bladder cancer.

Introduction: We assessed the differential performance of imaging modalities predicting pathological response to neoadjuvant chemotherapy (NAC) in urothelial bladder cancer (UBC).

Material and methods: Literature search was conducted using the MEDLINE, SCOPUS, and Cochrane Library in December 2023 to identify eligible studies.

Results: Twenty-two studies comprising 1085 patients were selected. The pooled diagnostic odds ratio (DOR), positive likelihood ratio (LR), and negative LR of FDG positron emission tomography-computed tomography (PET/CT) for predicting bladder tumor complete pathological response (CPR) were 17.33 (95% CI: 1.65-180.99), 2.80 (95% CI: 1.04-7.57), and 0.16 (95% CI: 0.02-0.90), respectively. The pooled DOR, positive LR, and negative LR of FDG- PET/CT for predicting lymph node CPR were 5.25 (95% CI: 2.77-9.93), 1.62 (95% CI: 1.20-2.19), and 0.30 (95% CI: 0.22-0.43), respectively. The pooled DOR, positive LR, and negative LR of contrast enhanced magnetic resonance imaging (CEMRI) for predicting bladder tumor CPR were 153 (95% CI: 26.29-890.1), 16.20 (95% CI: 4.19-62.54), and 0.10 (95% CI: 0.04-0.26), respectively. The pooled DOR, positive LR, and negative LR of CEMRI for predicting lymph node CPR were 13.33 (95% CI: 1.06-166.37), 5.62 (95% CI: 0.82-38.53), and 0.42 (95% CI: 0.16-1.06), respectively.

Conclusions: We demonstrated that CEMRI (including mpMRI) helps accurate assessment of response to NAC in UBC. While CEMRI is a useful tool to detect residual tumor in lymph nodes, contrast enhanced CT scan and FDG-PET/CT are precise staging modality to identify nodal metastasis responders to NAC. Nevertheless, this differential diagnostic performance needs to be further refined with radiomics and novel tracers to help individualized clinical decision-making.

Introduction: The utilization of magnetic resonance imaging (MRI) in active surveillance (AS) of prostate cancer (PCa) remains a topic of debate. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system is used to evaluate the progression of MRI lesions in men undergoing AS.This study aims to evaluate the predictive capacity of the PRECISE score in monitoring PCa patients on AS.

Material and methods: A cohort of 63 men enrolled in an AS program between 2017 and 2021 was analyzed. Sequential MRIs within the AS protocol were assessed by a specialized radiologist using the PRECISE score. Data on biopsy outcomes, pathological progression, and treatment progression were documented. The relationship between progression and the PRECISE score was examined. Univariate logistic and Cox regression analyses were conducted to determine the baseline clinical and mpMRI parameters associated with disease progression.

Results: The cohort exhibited ISUP progression and biopsy progression rates of 27.6% (16/63) and 48.3% (28/63), respectively. At the second MRI, a PRECISE score exceeding 3 was observed in 31 patients (53.4%), with 25 patients (43.1%) showing new lesions. Overall, 23 patients (39.7%) underwent active treatment during a median follow-up of 117 months. The PRECISE score emerged as the sole predictor, in univariate analysis, of ISUP progression (OR: 3.2, IQR: 1.1-9.7, p = 0.04), biopsy progression (OR: 3.2, IQR: 1.1-9.7, p = 0.03), and active treatment (HR: 1.1, IQR: 1.0-1.6, p = 0.05).

Conclusions: The PRECISE scoring system facilitates the identification of patients at risk of ISUP and biopsy progression within an AS protocol utilizing mpMRI. These findings underscore the significance of mpMRI in AS.

Introduction: Exosomes contain nucleic acids and proteins inside of them. These are suggested as cell-cell communication materials and it is considered that they can modulate the status of other cells.

Material and methods: To understand the bladder cancer (BC) related exosomal microRNAs (miRNAs), we compared the 752 urine exosomal miRNAs in healthy control (n = 7), low grade (LG) BC (n = 6) and high grade (HG) BC (n = 6) by RT-qPCR.

Results: The differential expressing (DE) urine exosomal miRNAs (2 > fold regulation) were 96 and 78 in LG and HG, respectively. Our exosomal miRNAs profiles cover many miRNAs which have been reported in BC patients' tissues and other biofluids. Most DE exosomal miRNAs were up-regulated in the profiles. Seven up-regulated exosomal miRNAs in the LG group (miR-28-5p, miR-16-5p, miR-28-3p, miR-24-3p, miR-25-3p, miR-19b-3p and miR10b-5p) and 3 miRNAs in the HG group (miR-150-5p, miR-28-5p and miR28-3p) were found as directly TP53 targeting. Twenty-two and 18 PTEN targeting miRNAs were observed in up-regulated miRNAs of LG and HG. The target genes of these exosomal miRNAs and their interaction network predicted that the TP53 is the strongest hub gene in both BC groups exosomal miRNA networks. Several DE miRNAs were found that could potentially be used as biomarkers for the diagnosis of BC.

Conclusions: Profiles of urinal exosomal miRNAs derived from BC manifested potentially epigenetic regulation of the TP53 and PTEN genes as compared to other oncogenes and tumour suppressors.

Introduction: Historically, percutaneous nephrolithotomy (PCNL) in horseshoe kidney (HSK) patients has been performed in the prone position. Nevertheless, thanks to the spread of the supine PCNL technique for patients with urinary stones and normal renal anatomy, some retrospective studies have already reported on supine PCNL and HSK, showing the effectiveness and safety of the procedure. Herein we report our experience with supine PCNL in a subset of patients with urolithiasis.

Material and methods: Prospective data were collected for all HSK patients who underwent supine PCNL at our institution from June 2016 to June 2023. Stone volume was reported as the volume of a single stone or the sum of the volumes of multiple stones on computed tomography (CT) images. Patients were reported to be stone-free if there were no stones on postoperative non-contrast CT (NCCT) exam. Peri-/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR) and the secondary endpoints were Clavien-Dindo complications Grade I or higher.

Results: A total of 35 patients met the inclusion criteria and were enrolled in the study. Forty-eight procedures were analyzed. SFR was 72.9% at 1-month follow-up. In 11 out of 48 procedures (22.9%) Clavien-Dindo Grade I-II complications were recorded. In one case Clavien-Dindo Grade IIIa complication was observed.

Conclusions: In this prospective study of 35 HSK patients who underwent 48 procedures, supine PCNL was safe and effective, with minimal morbidity.