Central European Journal of Urology最新文献

Introduction: The objective of this study is to compare the safety and efficacy, through the stone-free rate (SFR), as well as the costs, between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), for 2-4 cm kidney stones.

Material and methods: We analysed the data relating to RIRS and PCNL performed in 3 reference centres for kidney stones, in the period between 1/2019 and 12/2021. The total number of procedures was 130 (63 RIRS and 67 PCNL). We defined SFR as the absence of lithiasic fragments or stones <3 mm. Results were compared between 2 groups depending on the stone size: 2-3 cm stones (group 1) and >3 cm stones (group 2).

Results: The duration of RIRS was 90 minutes for group 1 and 115 minutes for group 2, and for PCNL it was 135 minutes for group 1 and 145 minutes for group 2. RIRS had shorter duration with a significant difference in group 1 (p = 0.000014). SFR for RIRS was 78% for group 1 and 21% for group 2, and for PCNL it was 92% for group 1 and 81% for group 2. Therefore, there is a statistically significant difference, which is more evident for 3 cm and multiple stones (p = 0.0057 for group 1, p = 0.000146 for group 2). The difference in costs was estimated by calculating the expected costs for a single surgical procedure and the estimated cost per day for ordinary hospitalization.

Conclusions: 2-4 cm stones can be safely treated with both RIRS and PCNL, but RIRS should not be chosen as an option for stones >3 cm, except in selected cases. PCNL remains the gold standard for the treatment of complex stones, especially for stones >3 cm. Risk of postoperative complications is higher in PCNL, even if this difference is not great. The costs associated with RIRS, even when recalculating with the need for new treatments, remain cheaper.

Introduction: One of the main issues related to the use of high-power lasers is the associated rise in temperature. The aim of this study was to characterize temperature variations with activation of the Moses™ 2.0 laser.

Material and methods: An in vitro experimental study was designed using a high-fidelity uretero-nephroscope simulation model to assess changes in temperature during intracorporeal laser lithotripsy. Renal and ureteral temperature records were obtained from the treatment of BegoStones positioned in the renal pelvis. Different laser settings over three time periods and two possible irrigation flow speeds were evaluated. We considered 43°C as the threshold since it is associated with denaturation of proteins. The Wilcoxon-Mann-Whitney test was used to assess quantitative variables and the Kruskal-Wallis test for categorical variables.

Results: The highest increase in intrarenal temperature was reached with 30 seconds of laser activation at a laser setting of 0.5 J/100 Hz (50 W) and a flow of 10 mL/min. Only 15 seconds of activation was sufficient for most settings to exceed 43°C. The ureteral temperature did not increase significantly, regardless of the combination of laser setting, time, or irrigation flow, except when 30 W was used for a 30 second period. Multivariate analysis showed that an irrigation flow of 20 mL/min produced an intrarenal temperature decrease of 4.7-9.2°C (p <0.001).

Conclusions: Use of high-power lasers, both for the ureter and kidney, should involve consideration of temperature increases evidenced in this study, due to the potential biological risk entailed.

Intravesical Bacillus Calmette-Guérin (BCG) therapy is a standard treatment for non-muscle invasive bladder cancer, but some patients experience side effects that lead to treatment discontinuation. Local side effects are typically mild, while systemic side effects can be severe and life-threatening. BCG therapy has immunotherapy effects on bladder cancer, but the mechanism is not fully understood. Due to its effect on the immune system, patients may also develop rare autoimmune complications, such as neuropathy. This case report suggests a potential association between BCG therapy and Guillain-Barré Syndrome (GBS), as a patient developed GBS after receiving intravesical BCG therapy for invasive bladder cancer.

Introduction: Collecting duct, or Bellini duct, renal cell carcinoma (CDRCC) is a rare tumour, comprising only 0.4-2% of all renal cell carcinoma. The goal of this study was to evaluate the cases in our institution and look at current available literature.

Material and methods: We searched all data on renal cell tumours in our institution between 2011 and 2021 and identified four cases with confirmed CDRCC pathology. Important features were listed and analysed. We also reviewed current available literature and compared it to our case series.

Results: All cases were men with a median age of 63.5 years. All were symptomatic at presentation. Two patients presented with flank pain and two with gross haematuria. Three patients had stage IV disease at time of presentation and one stage III disease. All cases had clear Bellini duct renal cell carcinoma appearance on microscopy with infiltrative tubular architecture and high-grade nuclear features. Immunohistochemic (IHC) staining was performed for diagnostic confirmation. Three patients underwent radical nephrectomy and received adjuvant chemotherapy. One case had kidney biopsy for diagnostic confirmation and received first line chemotherapy. Immunotherapy or tyrosine kinase inhibitor (TKI) were started for second, third or fourth line of treatment. Median overall survival after diagnosis was 11 months.

Conclusions: CDRCC is a rare subtype of renal cell carcinoma with poor prognosis, typically presenting in a more advanced or metastatic stage. Diagnosis can be challenging. Multimodality treatment should be considered using radical surgery and systemic treatment.

Introduction: Open radical nephroureterectomy (ONU) is the standard of care for treatment of upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LNU) is increasingly being used due to better perioperative outcomes. However, its oncological safety remains controversial, in particular for advanced disease.We aimed to compare perioperative and oncological outcomes between surgical approaches in locally advanced UTUC (≥pT3 and/or pN+).

Material and methods: This study was a retrospective analysis of all 48 patients submitted to radical nephroureterectomy for advanced UTUC between 2006 and 2020 in our center.Perioperative data were compared between groups. Bladder tumor-free survival (BTFS), metastasis-free survival (MFS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier curves and compared with log-rank p test. Multivariable Cox regression model was used to evaluate their association with surgical approach.

Results: Clinical and pathological characteristics were similar between groups. LNU had lower blood loss (p = 0.031), need for transfusion (p = 0.013) and length of hospital stay (p <0.001), with similar operative time (p = 0.860).LNU was associated with better MFS (hazard ratio [HR]: 0.43, 95% confidence interval [CI] 0.20-0.93, p = 0.033) and CSS (HR: 0.42, 95%CI 0.19-0.94, p = 0.036). Median time to cancer death was 41 months for LNU and 12 months for ONU (log-rank p = 0.029). BTFS was similar between groups (HR: 0.60, 95%CI 0.17-2.11, p = 0.427). On multivariable Cox regression model, surgical approach wasn't significantly associated with MFS (p = 0.202), CSS (p = 0.149) or BTFS (p = 0.586).

Conclusions: In our cohort of advanced UTUC, LNU did not result in inferior oncological control compared to ONU. The minimally invasive approach conferred an advantage in perioperative outcomes.

Introduction: The Italian Radical Cystectomy Registry (Registro Italiano Cistectomie - RIC) aimed to analyse outcomes of a multicenter series of patients treated with radical cystectomy (RC) for bladder cancer.

Material and methods: An observational, prospective, multicenter, cohort study was performed to collect data from RC and urinary diversion via open (ORC), laparoscopic (LRC), or robotic-assisted (RARC) techniques performed in 28 Italian Urological Departments. The enrolment was planned from January 2017 to June 2020 (goal: 1000 patients), with a total of 1425 patients included. Chi-square and t-tests were used for categorical and continuous variables. All tests were 2-sided, with a significance level set at p <0.05.

Results: Overall median operative-time was longer in RARCs (390 minutes, IQR 335-465) than ORCs (250, 217-309) and LRCs (292, 228-350) (p <0.001). Lymph node dissection (LND) was performed more frequently in RARCs (97.1%) and LRCs (93.5%) than ORCs (85.6%) (p <0.001), with extended-LND performed 2-fold more frequently in RARCs (61.6%) (p <0.001). The neobladder rate was significantly higher (more than one-half) in RARCs. The median estimated blood loss (EBL) rate was lower in RARCs (250 ml, 165-400) than LRCs (330, 200-600) and ORCs (400, 250-600) (p <0.001), with intraoperative blood transfusion rates of 11.4%, 21.7% and 35.6%, respectively (p <0.001). The conversion to open rate was slightly higher in RARCs (6.8%) than LRCs (4.3%). Intraoperative complications occurred in 1.3% of cases without statistically significant differences among the approaches.

Conclusions: Data from the RIC confirmed the need to collect as much data as possible in a multicenter manner. RARCs proves to be feasible with perioperative complication rates that do not differ from the other approaches.

Introduction: Non-urothelial variant histology (VH), non-muscle invasive bladder cancer (NMIBC) has received little attention in contemporary urologic literature. Specifically, the effect of female sex on stage at presentation, as well as on cancer-specific mortality (CSM) have not been previously examined in VH NMIBC. Our aim was to test the effect of female sex on stage at presentation and CSM in VH NMIBC.

Material and methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified patients aged ≥18 years, with histologically confirmed VH NMIBC. Logistic regression models addressed T1 stage at diagnosis after multivariable adjustments for tumor grade, age and race/ethnicity. Before Kaplan-Meier plots and Cox regression analyses, propensity score matched adjusting for histological variants, T-stage, tumor grade, age and race/ethnicity was performed.

Results: Overall, 2,205 VH NMIBC patients were identified. Of those, 28% (n = 607) were female. Females were older (77 vs 74 years, p <0.001) and more frequently harbored T1 stage (55 vs 45%, p <0.001). Female sex independently predicted T1 stage (odds ratio [OR] = 1.66, 95% Confidence Interval [CI] = 1.35-2.03, p <0.001). Female sex also exhibited higher CSM, after matching for all assessable variables, including stage (hazard ratio [HR] = 1.91, 95% CI = 1.45-2.54, p <0.001).

Conclusions: In VH NMIBC, female sex is an indicator of higher rate of T1 stage and, fully independently of stage, female sex also results in higher CSM.

Introduction: The aim of this article was to evaluate the oncological results and safety of cryotherapy for the treatment of renal tumors.

Material and methods: This study was a prospective review and follow-up of patients who underwent cryotherapy from January 2008 to May 2021. Cryotherapy was offered to patients with bilateral tumors, tumors in solitary kidneys, or comorbid patients. Follow-up consisted of a computed tomography (CT) scan and contrast-enhanced ultrasound (CEUS), with analysis of concordance (kappa index). Overall survival and kidney survival were analyzed (Kaplan-Meier).

Results: Cryotherapy was performed 71 times in 67 patients. A total of 74.6% of patients were men. The mean age of patients was 69.7 years (standard deviation (SD) 11.3]. Mean follow-up was 52.7 months (SD 36.2). Mean tumor size was 26.2 mm (SD 7.6). 90% were cT1a, 10% cT1b stage. Type of access was open in 1 patient, laparoscopic in 8, percutaneous US-guided in 8 and percutaneous CT-guided in 54 patients. Biopsy was taken in 60 patients (84.5%) and consisted of renal cell carcinoma (22), oncocytoma (9), papillary carcinoma (4), angiomyolipoma (1), sarcoma (1), and non-conclusive (23).There were 22 complications such as pain in 2 patients, hematoma in 8 and 2 cases of bleeding, all resolved conservatively except for one case of bleeding which required embolization.Recurrences occurred in 16 cases (22.5%). Management was cryotherapy in 25%, radical nephrectomy in 31.3% and surveillance in 43.8%. Concordance between contrast-enhanced ultrasound and CT was 0.8 (excellent).Mean glomerular filtration did not change. One patient developed metastasis.No cancer-specific mortality was found. Overall survival at 12, 24 and 48 months was 98.5%, 96.8% and 76.9% respectively. Kidney survival at 12, 24 and 48 months was 97%, 93.5% and 93.5% respectively.

Conclusions: Cryotherapy for renal tumors is a safe treatment for comorbid or solitary kidney patients, with rare major complications and good oncological outcome.