Central European Journal of Urology最新文献

Introduction: Post-radiation cystitis is a complication of external beam radiation therapy, for the radical treatment of pelvic malignancies as radical treatment for pelvic malignancies. Chronic, refractory, post-radiation cystitis is problematic in its management, mainly when a conservative approach is preferred. Conservative methods are the first line of treatment, especially since the area has been irradiated, making surgical treatment more challenging.The objective of this systematic review is to evaluate the effectiveness and safety of conservative methods for the management of post-radiation cystitis. All non-invasive methods were included in the research, in patients over 18 years of age undergoing pelvic radiation therapy.

Material and methods: We conducted a systematic search for comparable studies on the conservative treatment of chronic post-radiation cystitis, analysing the efficacy and safety of these techniques, based on a specific protocol. The PubMed, Scopus, and CENTRAL databases and the grey literature were searched. Risk control of the individual papers was carried out using the RoB2 and ROBINS-I tools.

Results: A total of 282 papers were reviewed, of which 6 were included in the review: 3 randomised clinical trials and 3 non-randomised studies. Each of these studies investigated a different treatment, using a different population as control group, so it was not possible to conduct a meta-analysis of the studies.

Conclusions: Although most conservative measures appear to be successful in the management of post-radiation cystitis, more studies, especially randomised clinical trials, are needed before an algorithm of conservative methods can be created.

Introduction: Obesity represents a worldwide epidemic disorder, increasing the overall morbidity and mortality rate. In this study we assessed the impact of obesity on perioperative and long-term functional outcomes of robotic-assisted simple prostatectomy (RASP).

Material and methods: Baseline measurements of uroflowmetry and validated questionnaire responses were prospectively recorded, which were repeated at follow-up. Composite outcomes (trifecta) were defined as combination of post-operative Q-max >15 ml/s, IPSS score <8, and absence of complications. Pentafecta included 2 additional criteria, namely post-operative ejaculation persistence (MSHQ score >0) and erectile function maintenance (ΔIEEF <6). Data analysis was stratified by BMI (<30 or ≥30).

Results: Eighty-one patients underwent RASP in our institution. Baseline demographic and clinical features, questionnaire scores, and baseline uroflowmetry results showed no significant differences between obese and non-obese cohorts. However, during follow-up, obese patients reported less improvement in IPSS (p = 0.02) and OABQ scores (p <0.001), along with a higher incidence of stress incontinence requiring duloxetine (p <0.001). Uroflowmetry outcomes were also lower in the obesity group (p = 0.02 and p = 0.03 for Qmax [ml/s] and post-void residual [ml], respectively). However, when considering assessment of comprehensive outcomes, obese patients demonstrated similar rates of achieving trifecta (67% vs 54%, p = 0.39) and pentafecta (p = 0.76) compared to non-obese patients.

Conclusions: Our results show that obesity is associated with poorer functional outcomes. Specifically concerning storage LUTS and incontinence rates following RASP. However, no impact of obesity on the achievement rates of trifecta and pentafecta outcomes was observed.

[This corrects the article DOI: 10.5173/ceju.2023.273.].

Introduction: Guidelines for transition from paediatric to adult care are being introduced around the world. There are tools available in the English-language literature to assess a patient's readiness to transition. The aim of the study was to adapt the English-language version of the Transition Readiness Assessment Questionnaire for patients with spina bifida (TRAQ-SB).

Material and methods: The questionnaire was translated into Polish following the established procedure. Two native Polish speakers who declared a very good command of English translated the TRAQ-SB into Polish. Then, 2 native English speakers who declared fluency in Polish and who did not know the content of the original questionnaire, independently translated it back into English. The outcome was assessed and the discrepancies related to different healthcare systems were corrected and approved with the author of the TRAQ-SB. The TRAQ-SB-PL scale was also checked for reliability, construct validity, and internal consistency in a pilot study. Fifty-two spina bifida patients aged 13 to 18 years were recruited.

Results: Static analysis revealed a 3-domain structure of the 26-item version of the TRAQ-SB-PL: "Autonomy", "Health literacy", and "Adherence". The internal consistency of the total score was good (0.734). Age had a significant effect on the TRAQ-SB-PL-26 score. There was no statistically significant difference between girls and boys.

Conclusions: The TRAQ-SB-PL-26 is a reliable tool that can also be used in the Polish population. It will help to identify teenagers who need more attention during the transition process. The survey will raise awareness of the transition and may be used for educational purposes.

Introduction: Gaining insight into patient characteristics to predict the success of procedures is crucial for improving outcomes and for preoperative counselling. We identified predictors of achieving a minimal clinically important difference (MCID) in lower urinary tract symptoms (LUTS) 3 months after Rezūm.

Material and methods: A retrospective study was conducted on patients treated with Rezūm. Patients with moderate or severe LUTS and a recorded International Prostate Symptom Score (IPSS) at 3 months were included and categorised into 2 cohorts based on experiencing a MCID at 3 months (≥ 25% improvement in IPSS). Predictors were identified through multivariate logistic regression analysis.

Results: Out of 174 patients, 134 (77%) achieved a MCID at 3 months, and those who did had a higher median baseline IPSS (20 [16-26] vs 15 [10-21], P <0.001) and were more likely to have severe LUTS at baseline (53.0% vs 35.0%, P = 0.046) when compared to those who did not experience a MCID at 3 months. Higher baseline IPSS (OR: 1.10, 95% CI 1.04-1.17) and larger baseline prostate volumes (OR: 1.03, 95% CI 1.0-1.05) were predictors of achieving a MCID at 3 months. More specifically, a significantly greater proportion of patients with severe LUTS (83.5 vs 70.8%, P = 0.046) and prostate volume ≥60 cc (94.6 vs 71.4%, P = 0.003) achieved MCID at 3 months when compared to patients with moderate LUTS and prostate volumes <60 cc, respectively.

Conclusions: More than three-quarters of patients treated with Rezūm achieved a MCID at 3 months. Patients with severe LUTS and prostate volumes ≥ 60 cc may be optimal candidates for experiencing early relief in LUTS following Rezūm.

Introduction: Although pediatric urolithiasis remains relatively uncommon, its global prevalence is on the rise. Technological advances have led to miniaturization of instruments especially in the form of single use scopes. As the evidence on the use of small single use ureteroscopes in children is scarce, we have conducted a pilot two-center study to analyze the outcomes of pediatric patients treated with the Pusen 7.5 Fr single use scopes at our institutions.

Material and methods: This study included consecutive pediatric patients with urinary stones treated with the small Pusen 7.5 Fr single use ureteroscope. The study was conducted at two large European tertiary endourology centers that specialize in pediatric kidney stone management. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone free rate (SFR), operating time, and complications.

Results: In this pilot study, 26 patients were included with a median age of 12 years (7.0-16.0) and a male to female ratio of 14:12. The mean cumulative stone size was 15.15 mm (SD ±11.1) and multiple stones were present in 9 (34.6%) patients. Pre-operative stent, access sheath and post-operative stent usage was done in 12 (46.2%), 23 (88.5%) and 13 (50%) patients respectively. The median operative time was 47 minutes (IQR: 40.0-63.8). Following the initial procedure 24 (92.3%) patients were stone free, while no intra or postoperative complications were observed.

Conclusions: Our study demonstrates that the use of the small 7.5 single use ureteroscope is safe and efficient for the treatment of urinary stones in pediatric patients with high stone-free rates and no complications noted in our series. While this might become a standard of care in future, to confirm and validate our findings further studies with larger cohorts are warranted.

Introduction: Bacillus Calmette-Guerin (BCG) Moreau is under-represented in literature and comparisons with other BCG strains are rare.

Material and methods: We conducted a retrospective data analysis in patients with intermediate or high-risk non-muscle invasive bladder cancer (NMIBC) to assess effectiveness and safety of BCG Moreau Polish substrain to BCG RIVM. The primary objective was to describe the real-world effectiveness of BCG Moreau in the treatment of patients with NMIBC in terms of recurrence free survival (RFS) 2 years post-treatment initiation compared to BCG RIVM.

Results: The database to be analysed comprised of 967 patients with NMIBC. The primary endpoint was met since BCG Moreau was non-inferior to BCG RIVM in terms of RFS [HR: 0.920 (95%CI: 0.725; 1.168)]. There was no statistically significant difference in all secondary endpoints including time to recurrence, progression-free survival, time to progression, and overall survival. The safety profile of BCG Moreau Polish substrain was consistent with side effects and frequency of complications observed with BCG RIVM and study reports in the literature.

Conclusions: BCG Moreau was effective and safe in the treatment of patients with intermediate- or high-risk non-muscle invasive bladder cancer. There was no statistically significant difference in treatment outcome between BCG Moreau and BCG RIVM strains based on real-world data.