Central European Journal of Urology最新文献

Introduction: Ureteral stenting is not routinely recommended, but it may be performed before or after retrograde intrarenal surgery (RIRS). We aimed to investigate the effect of preoperative ureteral stenting on the success rate and intraoperative, postoperative, and infectious complications in RIRS.

Material and methods: We retrospectively analysed the data of 581 patients who underwent RIRS. Demographic data, stone characteristics, presence of hydronephrosis, presence of congenital kidney anomaly and solitary kidney, duration of operation, and duration of hospitalisation were analysed. Intraoperative, postoperative, and infectious complications and the success rate of all operations were recorded. The patients were divided into 2 groups as prestented and non-prestented and matched in terms of age, sex, stone size, and number of stones. Ninety-four patients in the prestented group were matched with 282 patients in the non-prestented group with respect to age, sex, stone size, and number of stones (matched 1:3).

Results: The 2 groups were similar in terms of matching parameters and all other characteristics. After matching, the success rate was 77.7% (73/94) in the prestented group and 78% (220/282) in the non--prestented group, and there was no statistically significant difference between the 2 groups (p = 0.943). The intraoperative complication rate was statistically significantly higher in the non-prestented group (19.2% vs 28.7%, p = 0.046). Postoperative complications occurred in 22.3% of patients in the prestented group and 20.7% of patients in the non-prestented group (p = 0.429).

Conclusions: Preoperative ureteral stenting in RIRS was not associated with the success rate or postoperative and infectious complications. However, preoperative stenting was effective in decreasing only grade 1 intraoperative complications.

Introduction: In this study we aimed to compare the efficacy of mirabegron and silodosin as medical expulsive therapy (MET) for distal ureteric calculus ≤10 mm.

Material and methods: A total of 114 patients who met the inclusion criteria were prospectively randomised into 2 groups, 58 patients in the silodosin group and 56 patients in the mirabegron group. The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and secondary endpoints were stone expulsion time and number of pain episodes.

Results: There were no statistically significant differences between the two groups in terms of mean age, gender, mean stone size, side, or hydronephrosis. Both groups exhibited similar rates of stone expulsion and expulsion time. Regarding pain management, the frequency of renal colic episodes was significantly lower with mirabegron compared to silodosin (2.3 ±0.2 vs 1.9 ±0.2, P <0.0001). Six patients were excluded from the study due to adverse drug reactions: 4 (6.15%) in the silodosin group (retrograde ejaculation, hypotension) and 2 (3.27%) in the mirabegron group (hypertension).

Conclusions: In among patients with distal ureteric stones measuring 5-10 mm, mirabegron did not demonstrate superiority in stone expulsion rate or expulsion time compared to silodosin. However, mirabegron significantly reduced the frequency of renal colic episodes. Therefore, mirabegron may be considered a preferable option for medical expulsive therapy for distal ureter stones over silodosin.

Introduction: This study was aimed to evaluate the feasibility, safety, and advantages of the use of transurethral intraprostatic anesthesia (TUIA) using Schelin Catheter^TM (SC) in patients undergoing holmium laser enucleation of the prostate (HoLEP).

Material and methods: TUIA was performed using SC, a catheter equipped with an operative channel with a retractile needle, a standard drainage outlet, and a balloon port. After inserting the SC into the patient's urethra and filling the balloon to anchor it in the bladder neck, four target injections with local anesthetic were performed, one in each quadrant in the base area of the prostate. After injections, the catheter was removed and the HoLEP procedure started. During the procedure, patients also received moderate sedation/analgesia.

Results: We selected two 63-year-old patients with good performance status. Prostate volume was 40 ml for the first patient and 31 ml for the second. TUIA and HoLEP operative times were 68 minutes in the first patient and 42 minutes in the second.During the procedure, patients complained of only minimal discomfort, and during hospitalization patients' numeric rating scale (NRS) pain score ranging from 1 to 0, with no need for additional analgesics. No complications were reported perioperatively and 15 days after the procedure.

Conclusions: This is the first report on TUIA via SC in patients undergoing HoLEP. In our preliminary experience, TUIA via SC was safe and feasible, showing complete perioperative pain control. Further studies are needed to confirm these promising results and better define the category of patients eligible for this type of treatment.

Introduction: Ureteroscopic lithotripsy (URSL) is an approved, minimally invasive, low-risk procedure for urolithiasis treatment. However, some patients may develop urinary tract infection (UTI) post-procedure, eventually leading to urosepsis. Determining the predictors of infection after URSL would help identify patients at a high risk of urosepsis, thereby enabling the early implementation of effective treatment. Therefore, we aimed to establish the incidence and predictors of urosepsis after URSL.

Material and methods: We assessed 231 patients who underwent URSL using a holmium laser. The incidence of urosepsis during the 30-day post-treatment period was analysed, and potential predictors of urosepsis, including patient characteristics and individual clinical factors, were examined.

Results: Statistical analysis revealed that 16.88% of patients had a confirmed positive urine culture before the procedure. Post-procedure urosepsis occurred in 4.76% of patients. Univariable analysis revealed that 3 factors were significantly associated with the risk of postoperative urosepsis: double-J stent insertion before URSL, pre-operative positive urine culture, and MDR pathogen found preoperatively. In multivariable analysis, only positive urine culture remained significantly associated with the risk of urosepsis after URSL.

Conclusions: Patients with positive urine culture before URSL are at significantly higher risk of urosepsis in the postoperative period. Hence, urine culture should be routinely performed before planned endoscopic urolithiasis treatment.

Introduction: Sacral neuromodulation and posterior tibial nerve stimulation for lower urinary tract dysfunction (LUTD) and overactive bladder yield good and reliable results. However, neuromodulation research is continuously evolving because there is still need for more patient-friendly treatment options in the therapeutic management of LUTD. Pudendal neuromodulation (PNM) has been emerging as a promising alternative treatment option for the last few decades. The aim of this study is to review the current state of the art of PNM.

Material and methods: A wide literature search was conducted in the field of PNM using Medline through the PubMed database and Elsevier using the Scopus database; a critical review of the results was then carried out. PNM has been studied in its various possible aspects: percutaneous PNM, transrectal/transvaginal PNM, and both percutaneous and transcutaneous dorsal genital nerve stimulation.

Results: Each technique was found to result in promising improvements in different clinical outcomes, with some trials reporting even better results than sacral neuromodulation.

Conclusions: As a result of a comparison between the various PNM techniques with both sacral neuromodulation and posterior tibial nerve stimulation, we think that PNM should be seen as seriously promising, and we believe it will expand the treatment options for overactive bladder. Even though several studies accordingly showed PNM to be safe and effective, a systematic review and meta-analysis were not feasible. PNM in its various techniques is a promising treatment for LUTD. Nevertheless, further research is needed to include it in treatment algorithms.

Introduction: To assess the value of a novel inflammatory marker involving the ratio between mean platelet volume and lymphocyte counts (MPVL) in the prediction of high-grade recurrence-free survival (HG RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC) treated with adjuvant Bacillus Calmette-Guérin (BCG) therapy.

Material and methods: In this retrospective, single tertiary centre study the medical records of 216 consecutive patients with NMIBC, who received BCG between 2010 and 2019, were reviewed. Kaplan-Meier curves and Cox proportional hazard regression were used for survival analysis.

Results: We included 194 patients who underwent transurethral resection of a bladder tumour and received at least an induction course of BCG. The majority of patients presented with high-grade T1 tumours (n = 114, 59%). Within a median follow-up of 65 months (IQR: 27-93), 35 patients (18%) experienced progression, and 69 (34.5%) had a high-grade recurrence. Kaplan-Meier analyses revealed a significant association between higher MPVL and worse PFS and HG RFS (both p <0.05). Specifically, patients with higher MPVL demonstrated decreased 5-year PFS (75% vs 90%) and HG RFS (54.5% vs 75%) compared to lower MPVL counterparts. Multivariate analyses confirmed the independent prognostic value of MPVL for HG RFS (HR = 1.7, p = 0.047) and PFS (HR = 2.37, p = 0.026).

Conclusions: In patients with NMIBC treated with adjuvant BCG, an elevated inflammatory marker comprising mean platelet volume and lymphocyte count ratio may serve as a prognostic factor associated with worse PFS and HG RFS. The role of MPVL in clinical decision-making must be validated in further multicentre prospective studies.

Introduction: Nationwide data on urological hospitalizations may improve the quality of care. This study aimed to evaluate the epidemiological characteristics of all registered hospital admissions to adult urological departments in Poland in 2022.

Material and methods: This epidemiological retrospective analysis is based on the national registry on hospital admissions managed by the National Institute of Public Health - National Research Institute. All adult patients admitted to urological departments were included in the analysis.

Results: In 2022, 214,063 hospital admissions were recorded in Polish urological departments, 72% of the patients were male. Emergency admissions accounted for 17.6% of these admissions. There were significant differences in hospitalization rate per 100,000 population between the administrative regions (voivodeships), with extreme values recorded in the Opolskie (411.5) and Podkarpackie (987.9) voivodeships. The major causes of admission were genitourinary diseases (ICD-10: N00-N99) at 59% and cancers (ICD-10: C00-C97; D00-D48) at 36%. In general, kidney and ureteral stones (19.9%), bladder cancer (15.2%), and prostate hyperplasia (10%) were the most common causes of hospital admissions. The highest hospitalization rate per 100,000 inhabitants was observed among adults aged 60-69 and 70-79 years. A quarter of hospitalizations were one-day hospitalizations, and the mean duration of hospitalization was 2.93 days for all hospitalizations, and when excluding one-day hospitalizations 3.89 days. Epidemiological characteristics of patients and duration of hospitalization differed by cause of admission.

Conclusions: Findings from this study provide precise epidemiological data on inpatient urological care in Poland. Physicians and policymakers may use this study to evaluate and improve inpatient urological care in Poland.

Introduction: To compare the mineral content of commercially available water (tap and bottled) in the Netherlands and to evaluate which type of water should be recommended for kidney stone patients.

Material and methods: All Dutch water supply companies were contacted to request water analysis reports of tap water. Bottled still and sparkling water available in the 5 main supermarket chains in the Netherlands were also included. Information regarding the mineral composition of bottled waters was read from the manufacturers' ingredient label on the bottles. Data regarding sodium, potassium, bicarbonate, calcium, magnesium, and sulphate content were evaluated.

Results: All Dutch water supply companies, consisting of 179 production locations, were included. Twenty-one bottled still waters and 25 bottled sparkling waters were included. There was a wide range of results for the evaluated minerals. Sodium levels were highest in tap water (134.0 mg/l), whereas potassium concentrations were highest in bottled water (18.0 mg/l). Bicarbonate, calcium, and sulphate concentrations were highest in bottled still water (432.0 mg/l, 240.0 mg/l, and 400.0 mg/l, respectively). Magnesium levels were highest in bottled sparkling water (51.4 mg/l).

Conclusions: Commercially available water (bottled and tap) in the Netherlands is safe to use for KSD patients. However, specific bottled waters can be described as calcium and magnesium rich. Therefore, it remains important for KSD patients and their physicians to realise that the mineral composition of drinking water may vary, and its consumption might require alterations of their diet.

Introduction: After radical nephroureterectomy (RNU), adjuvant chemotherapy (AC) is recommended in either muscle invasive or lymph node positive upper urinary tract urothelial carcinoma (UTUC). However, optimal patient selection remains to be studied. We propose a risk-adapted scoring model for selecting patients for AC in localised UTUC with ≤pT2.

Material and methods: The model was based on 7 risk factors modified from the risk stratification system in the European Association of Urology guideline for localised UTUC. Each risk factor indicated one point; total scores were used to categorise patients as at low or high risk for disease recurrence. We applied our model to 135 patients with localised UTUC with ≤pT2, who underwent RNU without AC. Recurrence-free survival and cancer-specific survival were analysed based on risk group.

Results: A risk score of ≥4 points indicated high risk (33/135 patients [24.4%]). The accuracy of predicting recurrence was 82.9% (95% confidence interval [CI]: 75.5-88.9%) with a negative predictive value of 93.1% (95% CI: 87.9-96.2%). Disease recurred in 51.5% of high-risk patients and 6.9% of low-risk patients. Multivariate analysis indicated that high-risk was independently associated with recurrence and cancer-specific death (hazard ratio [HR] = 10.20, 95% CI: 3.94-26.44%, HR = 8.72, 95% CI: 2.47-30.73%, all p <0.001, respectively).

Conclusions: The risk-adapted scoring model might be an effective way for selecting patients who may benefit from AC after RNU in nonmetastatic UTUC with ≤pT2. These results should be validated in a larger, prospective study.

Introduction: This publication provides a summary of national guidelines developed in response to the regional characteristics of aetiological factors, resistance patterns, and the availability of antibacterial drugs in Poland.

Material and methods: After reviewing the epidemiological evidence, case-control studies, randomised control trials, and current international guidelines and statements, a Polish multidisciplinary group prepared the final recommendations. These recommendations cover diagnosis and management of community-acquired lower urinary tract infections in both genders, pregnant and breastfeeding women, recurrent lower urinary tract infections, and asymptomatic bacteriuria.

Results: The regional choice of antimicrobial agents for first-line therapy of uncomplicated cystitis in women includes fosfomycin trometamol, pivmecillinam, furazidin (furagin), and nitroxoline. For men, co-trimoxazole or fluoroquinolone therapy is recommended. Pivmecillinam and fosfomycin are recommended for the treatment of pregnant and breastfeeding women. For continuous prophylaxis of recurrent urinary tract infections in women, the following antimicrobial agents can be used: fosfomycin trometamol, trimethoprim, furazidin (furagin), and cefaclor. The significance of behavioural management and the use of vaginal hormonal therapy, vaginal probiotics, and immunoprophylaxis is emphasised. Asymptomatic bacteriuria should be treated in pregnant women and in patients prior to surgical intervention in the urinary tract.

Conclusions: New national guidelines based on locally available therapeutic resources should contribute to a more rational choice of therapy in patients with lower urinary tract infection and asymptomatic bacteriuria in Poland.