The latest medical research on Urology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about urology gathered by our medical AI research bot.

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Robot-assisted sialolithotomy with sialoendoscopy: a review of safety, efficacy and cost.

Journal of Robotic Surgery

Review the safety, efficacy and cost of robot-assisted sialolithotomy with sialoendoscopy (RASS) for large submandibular gland hilar sialoliths.

Patients ≥18 years diagnosed with submandibular hilar sialolithiasis between 1/1/2015 and 7/31/2018 who underwent RASS were identified. Procedure success, post-operative complications, procedure duration, and costs associated with the procedure were reviewed.

33 patients fit inclusion criteria. 94% of patients had successful sialolith removal. Mean sialolith size was 8.9 mm. 15.1% had transient tongue paresthesia. 0% had permanent tongue paresthesia compared to a 2% rate of lingual nerve damage cited in the literature for combined approach sialolithotomy (CAS). The average total cost was $16,921. Insurance paid 100%, 90-99%, 70-89.9%, and 40-69.9% of the expected reimbursement in 43.8%, 18.7%, 18.7% and 12.5% of patients respectively. 6% of patients self-paid. Compared to CAS, the cost of reusable robotic arms and drapes totaled $475, though these costs were included in the standardized operative cost per minute and were not forwarded to the patient. The mean procedure time was 62 minutes. Compared to published mean procedure times for CAS, the reduced operative time may account for a savings of $3332-$6069.

RASS is a safe modality for submandibular hilar sialolith removal with a high success rate, low risk for temporary tongue paresthesia, and lower rate of permeant lingual nerve damage compared to CAS. Compared with CAS, RASS may result in a net reduction of operative room costs given its shorter procedure time.

Non papillary mini-percutaneous nephrolithotomy: early experience.

World Journal of Diabetes

This study aims to evaluate the non-papillary puncture for mini-PCNL in terms of safety and efficacy.

A total number of 32 patients were subjected to mini-PCNL by the performance of non-papillary punctures over 6 months. One-step track dilation to 22 Fr took place in all cases. An 18 Fr nephroscope (Slender, Karl Storz GmbH, Germany) and an ultrasound lithotripter (Lithoclast Master, EMS S.A, Switzerland) with 9.9 Fr probe was used. Demographics and perioperative data are prospectively collected from an institutional board-approved database and the presented data were retrospectively collected.

The average cumulative stone size was 23.53 ± 6.6 mm. Mean operative time was 44.6 ± 13.44 min and primary stone-free rate after PCNL was 96% and 85.7% for single and multiple access, respectively. Second access was performed in seven cases, all of which had multiple stones. Mean hemoglobin drop was 1.23 ± 0.88 gr/dL. The patients stayed 2.56 ± 0.98 days in the hospital. Overall complication rate was 9.37%, without encountering any severe bleeding complication.

Using non-papillary access for mini-PCNL did not result in significant blood loss and need for transfusions. The respective data were directly comparable to contemporary literature and the safety of mini-PCNL by a non-papillary approach could be advocated.

Effect of information on prostate biopsy history on biopsy outcomes in the era of MRI-targeted biopsies.

World Journal of Diabetes

To describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies.

An exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016-2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS ≥ 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG ≥ 2 defined clinically significant cancer (csPCa).

Men with previous biopsies had significantly more often negative MRI (26% vs. 17%, p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%, p < 0.05) and lower rates of GG2 (17% vs. 30%, p < 0.05) and GG ≥ 3 (5% vs. 10%, p < 0.05) cancer. Biopsy-naïve men had higher proportions of highly suspicious MRI lesions (PIRADS 5; p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20-0.71).

In this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naïve men. Further, biopsy-naïve men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.

NCT02788825 (ClinicalTrials.gov). Date of registration June 2, 2016.

Comparison of operative time between robotic and laparoscopic myomectomy for removal of numerous myomas.

Int J Med

We hypothesized that the total operative time of robot myomectomy (RM) is shorter than that of laparoscopic myomectomy (LM) in cases where numerous myomas are removed, due to the faster suturing time of the robotic system. To verify this, we compared the surgical outcomes of RM vs LM for the number of myomas removed.

The medical records of 144 women underwent LM and 121 women underwent RM by a single surgeon were reviewed.

The operative time did not statistically differ between the groups, even when the number of removed myomas was more than 12 (200.6 ± 48.2 vs 196.0 ± 48.4 min, P = .791). Note that in our logistic regression analysis, the operation type of operation was excluded from the independent risk factors prolonging operative time.

RM showed a similar operative time relative to LM regardless of the number of myomas removed (numerous or not). This article is protected by copyright. All rights reserved.

Grading Severity and Bother Using the IPSS and ICIQ-MLUTS Scores in Men Seeking Lower Urinary Tract Symptoms Therapy.

J Urol

To establish severity banding ranges, bother assessment and key item content in principal patient reported outcomes measures (PROMs) in men seeking therapy for lower urinary tract symptoms (LUTS).

Data for International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire Male LUTS (ICIQ-MLUTS) were derived from a study evaluating 820 men at 26 UK hospitals. Receiver operating characteristic (ROC) curves were used to establish severity bandings.

Classification tree showed that thresholds between mild-moderate and moderate-severe severity bands were 15 and 27 respectively for IPSS, 16 and 26 for ICIQ-MLUTS/severity, and 22 and 81 for ICIQ-MLUTS/bother. Highest area under ROC and lowest Akaike's information criteria of univariate logistic regression indicated that ICIQ-MLUTS/bother was more related to global quality of life (QoL) than were IPSS and ICIQ-MLUTS/severity. The symptoms affecting IPSS-QoL were only fully identified by ICIQ-MLUTS, because two key symptoms (urinary incontinence and post-micturition dribble) are not measured by IPSS. ICIQ-MLUTS demonstrated that bother of some LUTS is disproportionate to severity, and that persisting high bother levels following surgery are more likely due to storage (18-25%) and post-voiding (18-28%) LUTS than voiding LUTS (5-13%). Symptom improvement after surgery is uncertain if baseline IPSS-QoL score was <3.

The severity threshold scores were measured for the two key LUTS PROMs, and the results indicate suitable categories of symptom severity for use in men referred for urological care. The ICIQ-MLUTS measures all the LUTS affecting QoL, and includes individual symptom bother scores.

Acute Kidney Injury following Enhanced Recovery after Surgery (ERAS) in Patients Undergoing Radical Cystectomy.

J Urol

We assessed the effect of ERAS protocol-related fluid restriction on kidney function and the incidence of postoperative acute kidney injury and 3-month kidney function.

In a retrospectively collected, single-institution cohort we studied 296 consecutive patients (146 pre-ERAS patients vs. 150 ERAS patients) who underwent radical cystectomy from 2010 to 2018. The primary outcome was the incidence of postoperative acute kidney injury. Secondary outcomes were the length of hospital stay, time to bowel movements, time to tolerate regular diet, postoperative complications, and 30-day readmission rate. Study limitations include its retrospective design and relatively modest sample size.

We observed an increased rate of postoperative acute kidney injury in patients on the ERAS protocol (42.7 % vs. 30.1 % OR = 1.725, p=0.025). On multivariate analysis, ERAS protocol remained a significant predictor of acute kidney injury even when controlling for other covariates including baseline kidney functions (OR 1.8, 95% CI 1.04-3.30, p=0.036). Patients with postoperative acute kidney injury demonstrated a significantly higher odds of stage 3 chronic kidney disease at 3 months even after controlling for baseline renal function (OR 2.5, 95% CI 1.3-4.9, p=0.016).

Use of an ERAS protocol following radical cystectomy was associated with a higher risk of postoperative acute kidney injury, in patients who had baseline chronic kidney disease which could be related to the restricted perioperative fluid management mandated by ERAS. Use of the ERAS protocol did not impact the length of hospital stay or readmission rates.

Development and Validation of Symptom Score for Total Bladder-Bowel Dysfunction; Subscales for Overactive Bladder and Dysfunctional Voiding.

J Urol

Bladder-bowel questionnaires (BBQ) are an important tool in diagnosing non-neurogenic bladder-bowel dysfunction (BBD) in children. In this study, we report the validity and reliability of a BBQ, which has been in clinical use in our institution for decades.

The BBQ contains 13 questions with answers ranging from never (0) to daily3. It was answered by 139 healthy controls and 134 children aged 3-16 years diagnosed with BBD by a pediatric urologist/urotherapist. A sub-diagnosis, of overactive bladder (OAB) or dysfunctional voiding (DV), was given each patient. BBQ scales were developed and evaluated against hypotheses of validity (known-groups/convergent/discriminating) and reliability (internal consistency/retest reliability), sensitivity and specificity. Responsiveness was tested in 80 patients who answered the BBQ after treatment.

A total BBD score scale demonstrated ability to discriminate between patients with a BBD and healthy subjects. It resulted in a ROC curve with AUC 0.96. The maximized sensitivity was 94% and specificity was 89% for a cut-off score of 7. Two subscales were identified referring to six filling-phase items and three voiding-phase items. When tested in OAB and DV patients respectively, multivariable scales performed sufficiently to discriminate between OAB vs non-OAB patients and DV vs non-DV patients. All these scales fulfilled the evaluated requirements for validity and reliability. One year after treatment, all scales scores corresponded to patients' improvement (p<0.0001), suggesting the BBQ can detect clinical change over time.

The BBQ is valid and reliable for diagnosing BBD in pediatric patients, and OAB and DV in those with BBD.

Systematic assessment of information about surgical urinary stone treatment on YouTube.

World Journal of Diabetes

To systematically assess the quality of videos on the surgical treatment of urinary stones available on YouTube using validated instruments.

A systematic search for videos on YouTube addressing treatment options of urinary stones was performed in October 2019. Assessed parameters included basic data (e.g. number of views), the grade of misinformation reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics.

A total of 100 videos with a median of 26,234 views (1020-1,720,521) were included in the analysis. Of these, only 26 videos were rated to contain no misinformation and only nine disclosed potential conflicts of interest. Overall, the median quality of the videos was low (2 out of 5 points for DISCERN question 16). Videos uploaded by healthcare professionals and medical societies/organizations offered significantly higher levels of quality. In particular, the videos provided by the EAU achieved the highest rating with a median score of 3.0.

The majority of videos concerning the surgical treatment of urinary stones have a low quality of content, are potentially subject to commercial bias and do not report on conflicts of interest. Videos provided by medical societies, such as the EAU, provide a higher level of quality. This highlights the importance of active recommendation of evidence-based patient education materials.

Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate?

World Journal of Diabetes

Radical cystectomy (RC) and urinary diversion in the treatment of muscle-invasive bladder cancer is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity often requiring secondary interventions. We sought to evaluate our experience with benign UEAS in our open ileal orthotopic neobladder (ON) population.

After Internal Review Board (IRB) approval, we performed a retrospective review of patients who had RC and ON between 2000 and 2015 at MD Anderson Cancer Center and had at least 6 months of follow-up. Baseline demographics and treatment characteristics, peri-operative and post-operative outcomes, as well as information regarding anastomosis technique and suture types were evaluated. Patients with malignant ureteral obstruction were excluded from the analysis.

418 patients had ON creation and the mean age was 59 years (SD 9.4 years) and 90% were males. The mean follow-up was 57 months (6-183 months). 37 patients (8.9%) developed UEAS in 42 renal units and the mean time to diagnosis was 15.8 months (0.85-90 months). Anastomosis and suture type were not predictive of UEAS (p = 0.594, p = 0.586). Perioperative UTI within 30 days of surgery, and recurrent UTI were predictive of UEAS, HR 2.4 p = 0.03, HR 5.1 p < 0.001, respectively.

UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following ON, but may occur as late as 7 years following surgery. Indeed, technical factors and surgeon experience contribute to the rates of UEAS, but perioperative UTI appears to herald future stricture development.

The association between plant-based content in diet and testosterone levels in US adults.

World Journal of Diabetes

To evaluate the association between the plant-based content of diet and serum testosterone levels in men from the national health and nutrition examination survey (NHANES) database.

Data on demographics, diet, and testosterone levels was acquired from the NHANES database. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) was developed. A higher score on PDI and hPDI indicates higher consumption of plant foods.

A total of 191 participants were included, average age was 45 (30-60) years and average total testosterone level was 546.7 ± 254.7 ng/dL. The mean PDI and hPDI were 50.4 ± 6 and 50.8 ± 7.2, respectively. On multiple linear regression analysis, BMI and age significantly contribute to testosterone levels (p < 0.05); however, neither of the diet indexes significantly predicted serum testosterone levels (PDI: p = 0.446; and hPDI: p = 0.056).

In a well characterized national database, the plant-based diet index is unable to predict testosterone levels. Plant-based food content in diet is not associated with serum testosterone levels.

Characterization of intracalyceal pressure during ureteroscopy.

World Journal of Diabetes

To provide the first report of measuring intracalyceal pressures during ureteroscopy (URS).

A prospective single-center clinical study using a cardiac pressure guidewire to measure intracalyceal pressure during flexible URS was performed. Eight patients (45 calyces) undergoing URS for nephrolithiasis were included. A Verrata® pressure guide wire was passed through the working channel of a dual lumen flexible ureteroscope and into the calyces while irrigation was maintained at 150 mmHg. Pressure was measured in the renal pelvis, upper pole, interpolar, and lower pole calyces both with and without a ureteral access sheath (UAS). The pressure in each location with and without a UAS was compared. The correlation between calyceal pressure and infundibular dimensions (width, length) was determined.

Intracalyceal pressure was significantly lower in each region when a UAS was used. Compared to patients with a 12/14Fr UAS, those with a 14/16Fr UAS had significantly lower pressure in the interpolar (25.3 ± 13.1 vs. 44.0 ± 27.5 mmHg, p = 0.03) and lower pole (16.2 ± 3.5 vs. 49.2 ± 40.3 mmHg, p = 0.004) calyces. Interpolar calyceal pressure in the presence of a UAS was significantly higher than the renal pelvis pressure (RPP) (30.8 ± 19.6 vs. 17.9 ± 11.0 mmHg, p = 0.004).

During flexible URS, RPP strongly correlates with, but does not uniformly represent, the intracalyceal pressure. With a 14/16Fr UAS and an inflow pressure of 150 mmHg, RPP and intracalyceal pressure never exceed the threshold for renal backflow.

Bipolar versus monopolar transurethral resection of non-muscle-invasive bladder cancer: a systematic review and meta-analysis of randomized controlled trials.

World Journal of Diabetes

To compare the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumors (TURBT) in non-muscle invasive bladder cancer (NMIBC) treatment.

A systematic search of all Randomized Controlled Trials (RCTs), which compared bipolar TURBT (bTURBT) and monopolar TURBT (mTURBT) in NMIBC treatment, were performed in PubMed, Web of Science, Cochrane Library and Embase up to February 1, 2019. We evaluated their efficacy by operative time, hospitalization time, catheterization time, and recurrence rate. While obturator jerk, bladder perforation, thermal damage, and overall complications were used to evaluate their safety.

A total of 13 RCTs, involving 2379 patients, were included. There were no statistically significant differences in efficacy between bTURBT and mTURBT in NMIBC treatment, such as operative time (p = 0.12), hospitalization time (p = 0.13), catheterization time (p = 0.50), and recurrence rate (p = 0.88). Compared to the safety in mTURBT in NMIBC treatment, no significant advantages were observed in that in bTURBT as well, such as obturator jerk (p = 0.12), bladder perforation (p = 0.11), thermal damage (p = 0.24), and overall complications (p = 0.65).

Our analysis demonstrated that bTURBT has no significant advantages in efficacy and safety in NMIBC treatment compared to that in mTURBT. Thus, bTURBT could not completely replace mTURBT as a safer and more effective NMIBC treatment.