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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Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting.

World Journal of Diabetes

To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting.

We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. bulbar urethroplasty with grafts, penile urethroplasty with/without grafts/flaps, Johanson, de novo or revision perineostomy, end-to-end anastomosis, meatoplasty and/or meatotomy) at our tertiary care institution. Complications were graded with Clavien-Dindo score and Comprehensive Complication Index (CCI). Complications were classified in: bleeding no gastrointestinal, cardiac, gastrointestinal, genitourinary, infectious, neurological, oral, wound, miscellaneous, and pulmonary. Logistic regression tested for predictors of in-hospital complications and prolonged hospitalization (> 75th percentile). Kaplan-Meier and Cox regression investigated the effect of complications on failure after urethroplasty.

Overall, 161 (34.3%) patients experienced at least one complication. Of those, 47 (10%) experienced two or more complications and 59 (12.6%) experienced at least one Clavien-Dindo ≥ II complication. Only two patients had Clavien-Dindo III complications. Infectious was the most frequent complication, and de novo or revision perineostomy was associated with the highest rate of complications. The occurrence of any complications, as well as complication with Clavien-Dindo ≥ II were associated with prolonged hospitalizations, but not with higher rates of post-urethroplasty failure.

Complications after urethroplasty were common events, but rarely with severe sequelae. Infectious were the most common complications and perineostomy was the type of urethroplasty with the highest rate of complications. The application of the EAU recommendations allowed the identifications of a higher number of complications after urethroplasty if compared with previous reports based on unsupervised chart review.

Safe transition to opioid-free pathway after robotic-assisted laparoscopic prostatectomy.

Journal of Robotic Surgery

To determine whether local anesthetic infiltration and non-narcotic pain medications can safely reduce or eliminate opioid use following robotic-as...

''Comparison of Two Surgical Techniques for the Treatment of Transverse Olecranon Fractures: A Finite Element Study''.

Int J Med

In this study, we aimed to compare the stability of traditional tension band wiring (TBW) and screw combined TBW (SC-TBW) fixation methods performed for a transverse olecranon osteotomy-fracture during different degrees of elbow movement by using finite element analysis (FEA).

Three-dimensional solid modeling of the olecranon was obtained by computed tomography (CT) images. Transverse olecranon fracture was created and fixed by TBW and SC-TBW with respect to triceps muscle force. Open-angle, twisting angle and interplanar translation occurring on the fracture line were evaluated at 45° and 90° elbow flexion.

Open-Angle: 0.71°, 0.87° at 45° and 0.64°, 0.67° at 90° elbow flexion for TBW and SC-TBW respectively. Twisting-Angle: -0.01°, -0,19° at 45° flexion and 0.19°, 0.30° at 90° flexion for TBW and SC-TBW respectively. Interplanar Translation: 1.93 mm, 4.65 mm at 45° flexion and 1,78 mm, 3,95 mm at 90° flexion for TBW and SC-TBW respectively.

TBW fixation provides more stability than SC-TBW fixation model. This article is protected by copyright. All rights reserved.

A new robotically assisted system for total knee arthroplasty: A sheep model study.

Int J Med

We investigated the accuracy and safety of a new HURWA robotic-assisted total knee arthroplasty (TKA) system in a sheep model.

Ten male Small-tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in 3 dimensions were measured .

The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93±1.02° and 1.93±1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26±1.04 and 1.68±0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer, and posterior cut on the medial side were 0.47±0.35 mm, 0.41±0.37 mm, 0.12±0.26 mm, 0.41±0.44 mm, and 0.12±0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred CONCLUSION: This new HURWA robotic-assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model. This article is protected by copyright. All rights reserved.

Pattern, timing and predictors of recurrence after surgical resection of chromophobe renal cell carcinoma.

World Journal of Diabetes

Currently there are no specific guidelines for the post-operative follow-up of chromophobe renal cell carcinoma (chRCC). We aimed to evaluate the pattern, location and timing of recurrence after surgery for non-metastatic chRCC and establish predictors of recurrence and cancer-specific death.

Retrospective analysis of consecutive surgically treated non-metastatic chRCC cases from the Royal Free London NHS Foundation Trust (UK, 2015-2019) and the international collaborative database RECUR (15 institutes, 2006-2011). Kaplan-Meier curves were plotted. The association between variables of interest and outcomes were analysed using univariate and multivariate Cox proportional hazards regression models with shared frailty for data source.

295 patients were identified. Median follow-up was 58 months. The five and ten-year recurrence-free survival rates were 94.3% and 89.2%. Seventeen patients (5.7%) developed recurrent disease, 13 (76.5%) with distant metastases. 54% of metastatic disease diagnoses involved a single organ, most commonly the bone. Early recurrence (< 24 months) was observed in 8 cases, all staged ≥ pT2b. 30 deaths occurred, of which 11 were attributed to chRCC. Sarcomatoid differentiation was rare (n = 4) but associated with recurrence and cancer-specific death on univariate analysis. On multivariate analysis, UICC/AJCC T-stage ≥ pT2b, presence of coagulative necrosis, and positive surgical margins were predictors of recurrence and cancer-specific death.

Recurrence and death after surgically resected chRCC are rare. For completely excised lesions ≤ pT2a without coagulative necrosis or sarcomatoid features, prognosis is excellent. These patients should be reassured and follow-up intensity curtailed.

A cross-sectional study on gut microbiota in prostate cancer patients with prostatectomy or androgen deprivation therapy.

Prostate Cancer and Prostatic Diseases

Androgen deprivation therapy (ADT), either by medical or surgical castration, is the backbone for standard treatment of locally advanced or metastatic prostate cancer, yet it is also associated with various metabolic and cardiovascular complications. Recent evidence have shown that obesity, insulin resistance, or metabolic disturbances can be associated with changes in the gut microbiome, while animal studies also show that castration is associated with changes in the gut microbiome. This study aims to investigate whether the fecal microbiota in prostate cancer patients who had undergone prostatectomy or ADT are different, and explore changes in phylogeny and pathways that may lead to side effects from ADT.

A total of 86 prostate cancer patients (56 patients on ADT and 30 patients with prostatectomy) were recruited. The fecal microbiota was analyzed by the 16S rRNA gene for alpha- and beta-diversities by QIIME2, as well as the predicted metabolic pathways by Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2.

The alpha-diversity was significantly lower in the ADT group. The beta-diversity was significantly different between the groups, in which Ruminococcus gnavus and Bacteroides spp were having higher relative abundance in the ADT group, whereas Lachnospira and Roseburia were reduced. The Firmicutes-to-Bacteroidetes ratio is noted to be lower in the ADT group as well. The functional pathway prediction showed that the biosynthesis of lipopolysaccharide (endotoxin) and propanoate was enriched in the ADT as well as the energy cycle pathways. This study is limited by the cross-sectional design and the clinical heterogeneity.

There is a significant difference in gut microbiome between prostate cancer patients on ADT and prostatectomy. We theorize that this difference may contribute to the development of metabolic complications from ADT. Further longitudinal studies are awaited.

Comparative study of neuroendocrine acquisition and biomarker expression between neuroendocrine and usual prostatic carcinoma.

Prostate

Neuroendocrine prostatic carcinoma (NEPC) is uncommon. The pathogenesis, clinical association, and clinical implications of this disease are still evolving.

Clinicopathologic, immunohistochemical and genomic studies were used to investigate the incidence of NEPC in various clinicopathologic settings and the expression of various biomarkers in NEPC and non-NEPC as well as small cell NEPC. The study included 45 treatment-naïve Gleason pattern (GP) 3 and 94 GP 4/5, 43 post-radiation, 60 post-androgen deprivation therapy (ADT), 38 lymph node metastatic and 9 small cell prostatic adenocarcinomas (PCs).

NEPC was found in 7% GP3, 10% GP4/5, 9% post-radiation, 18% post-ADT, and 5% lymph node metastatic PCs, respectively. Compared with treatment-naïve PCs, post-ADT PCs showed significantly increased incidence of NEPC (p < .05) while no significant difference was noted between low- and high-grade PCs, post-radiation, and lymph node metastatic PCs. Serotonin was uniformly positive in NE cells of benign glands but negative in NEPC. Significant increase of Bcl-2 and Auro A and decrease of prostein were noted in NEPC (p < .05). No significant changes in the expression of other biomarkers were found. In addition, small cell NEPC was strongly associated with ADT (44%) and high Gleason score (≥8, 100%) and often presented with alterations of TP53/RB1 and ARID1A/B or other genes crucial to genomic fidelity.

Given that no specific treatment for NEPC is presently available, the findings in this study have significant implications in the better understanding of this often-deadly disease both clinically and pathogenetically as well as future patient management, including targeted therapy.

Clinical Outcomes in Clinical N0 (cN0) Squamous Cell Carcinoma (SCC) of the Penis according to Nodal Management: Early, Delayed or Selective (following Dynamic Sentinel Node Biopsy - DSNB) Inguinal Lymph-Node Dissection (ILND).

J Urol

We evaluated the oncologic efficacy of early inguinal lymph-node dissection (ILND), observation or dynamic sentinel node biopsy (DSNB) followed by delayed or selective ILND in cN0 patients with penile squamous cell carcinoma (peSCC).

Between 1980 and 2017 included, 296 evaluable consecutive cN0 peSCC patients underwent early ILND (16), observation (114) or DSNB (166). Median follow-up was 50 months. Tumor stage, grade, lympho-vascular invasion (LVI) and age were considered. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free and cancer specific survival (CSS) rates. Multivariable Cox Regression models (MCRMs) tested the treatment effect. Analyses were repeated after inverse probability of treatment weighting adjustment (IPTW).

The 5-year IR-free survival and CSS rates following early, observation and DSNB ILND were 100%, 87%, 89%, and 84%, 81%, 85%, respectively. The 5-year crude IR-free survival and CSS rates were 90% and 93% in low-risk patients undergoing observation. Clavien grade 3 complications were 0.6 Vs 12.5% in DSNB and early ILND group, respectively. After IPTW adjustment, 5-year IR and CSS were 90% vs 73% and 90% vs 77% following DSNB and observation, respectively. At MCRMs, patients undergoing DSNB had significantly lower IR (HR 0.4, CI 0.2-0.85, p 0.02) and CSM (HR 0.29, CI 0.11-0.77; p- 0.01) compared to those under observation. The low number of patients undergoing early ILND made a reliable comparison with this group impractical.

Selective ILND following DSNB significantly improved IR and CSM when compared with observation, providing evidence of efficacy of DSNB in clinical stage N0 peSCC patients.

A randomized trial regarding antimicrobial prophylaxis (AMP) in transurethral resection of bladder tumor (TURB).

World Journal of Diabetes

To determine whether omitting antimicrobial prophylaxis (AMP) in TURB is safe in patients undergoing TURB without an indwelling pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture.

A multi-centered randomized controlled trial (RCT) from 17-09-2017 to 31-12-2019 in 5 hospitals. Patients with a pre-operative indwelling catheter/DJ-stent or nephrostomy and a positive pre-operative urinary culture (> 104 uropathogens/mL) were excluded. Post-operative fever was defined as body temperature ≥ 38.3 °C. A non-inferiority design with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (AMP-group) - E (no AMP-group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed for AMP and post-TURB fever with covariates: tumor size and (clot-) retention. The R Project® for statistical computing was used for statistical analysis and a p value of 0.05 was considered as statistically significant.

459 Patients were included and 202/459 (44.1%) received AMP vs 257/459 (55.9%) without AMP. Fever occurred in 6/202 [2.9%; 95% CI (1.2-6.6%)] patients with AMP vs 8/257 [3.1%; 95% CI (1.5%-6.1%)] without AMP (p = 0.44). Multivariable, logistic regression showed no significant harm in omitting AMP when controlled for (clot-)retention and tumor size (p = 0.85) and an adjusted risk difference in developing post-TURB fever of 0.0016; 95% CI [- 0.029; 0.032].

Our data suggest the safety of omitting AMP in patients undergoing TURB without an indwelling, pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture.

Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes.

World Journal of Diabetes

To provide a systematic analysis of the comparative outcomes of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer based on the best currently available evidence.

An independent systematic review of the literature was performed up to February 2021, using MEDLINE®, EMBASE®, and Web of Science® databases. Preferred reporting items for systematic review and meta-analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle-Ottawa scale for non-randomized controlled trials. Demographics and clinical characteristics, surgical, pathological, and functional outcomes were collected.

Twenty-six studies were identified. Only 16 "high-quality" (RCTs and Newcastle-Ottawa scale 8-9) studies were included in the meta-analysis. Among the 13,752 patients included, 6135 (44.6%) and 7617 (55.4%) were RARP and LRP, respectively. There was no difference between groups in terms of demographics and clinical characteristics. Overall and major complication (Clavien-Dindo ≥ III) rates were similar in LRP than RARP group. The biochemical recurrence (BCR) rate at 12months was significantly lower for RARP (OR: 0.52; 95% CI 0.43-0.63; p < 0.00001). RARP reported lower urinary incontinence rate at 12months (OR: 0.38; 95% CI 0.18-0.8; p = 0.01). The erectile function recovery rate at 12months was higher for RARP (OR: 2.16; 95% CI 1.23-3.78; p = 0.007).

Current evidence shows that RARP offers favorable outcomes compared with LRP, including higher potency and continence rates, and less likelihood of BCR. An assessment of longer-term outcomes is lacking, and higher cost remains a concern of robotic versus laparoscopic prostate cancer surgery.

Navigation assisted total knee arthroplasty in 54,114 patients: No increased risk in acute complications and hospital utilisation.

Int J Med

The advent of navigation in total knee arthroplasty (TKA) has generated interest in attempt to improve component positioning as desired and clinical outcomes. The aim of this study was to evaluate 90-day complication and cost of navigation-assisted TKAs (NTKA) compared to conventional TKAs (CTKA) using a national database.

III. Retrospective cohort study.

NTKA was associated with a significant decrease in 90-day postoperative major and minor complications. NTKA was also associated with a decrease in 90-day hospital utilization with lower rates of emergency department visits and readmissions. The cost of hospitalization and total 90-day costs were lower in NTKA, with an average savings of $800.

The adoption of navigation in TKA is safe and efficaceous compared to CTKA.

Laparoscopic versus robotic-assisted Heller myotomy for the treatment of achalasia: A systematic review with meta-analysis.

Int J Med

Robotic-assisted laparoscopic Heller myotomy has been proposed as an alternative minimally invasive approach to traditional laparoscopy for the treatment of achalasia. This systematic review aims to compare the safety and post-operative outcomes of the two procedures.

Systematic literature search was performed in MEDLINE through Ovid, Scopus and Cochrane to identify clinical trials and retrospective analyses. Outcome measures used for meta-analysis included operative time, estimated blood loss, length of stay, 30-day readmission, intraoperative oesophageal perforation, conversion, mortality, morbidity, symptom relief beyond 1 year, re-intervention for recurrent symptoms and gastroesophageal reflux during follow-up rates.

Seven studies were selected with a total of 3214 patients. The only factor to be statistically different is intraoperative oesophageal perforation rate, which is lower in robotic-assisted Heller myotomy compared to laparoscopic (odds ratio = 0.1139; 95% confidence interval [0.0334, 0.3887]; p = 0.0005).

The results suggest a robotic approach is associated with improved patient safety.