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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A Novel Manipulator with Needle Insertion Forces Feedback for Robot-Assisted Lumbar Puncture.

Int J Med

The use of lumbar puncture for pediatric diagnosis and treatment, such as cerebrospinal fluid sampling and intracranial pressure measurements, is s...

Implementation of robot-assisted total mesorectal excision by multiple surgeons in a large teaching hospital: morbidity, long-term oncological and functional outcome.

Int J Med

Robot-assisted total mesorectal excision (TME) might offer benefits in less morbidity, better functional and long-term outcome over laparoscopic TME. However its implementation is often described by large single surgeon series using surrogate short-term outcome.

All consecutive patients undergoing robot-assisted TME for rectal cancer during implementation between May 2015 and December 2019 performed by five surgeons in a single centre were included. Outcomes included local recurrence rate at 3 years, conversion rate, circumferential resection margin (CRM) positivity rate, 30-day postoperative morbidity, and outcomes of low anterior resection syndrome (LARS) questionnaires.

In 105 robot-assisted TME, local recurrence rate at 3 years was 7.4%, conversion to open surgery rate was 8.6%, CRM positivity rate was 5.7% and, 73.3% had good quality specimen, postoperative morbidity rate was 47.6% and anastomotic leakage rate was 9.0%. Incidence of major low anterior resection syndrome (LARS) was 55.3%.

Results of this study described acceptable morbidity, functional and long-term outcome during implementation of robotic TME for rectal cancer by multiple surgeons in a single centre. This article is protected by copyright. All rights reserved.

Robot-assisted percutaneous vertebroplasty under local anesthesia for osteoporotic vertebral compression fractures: a retrospective, clinical, nonrandomized, controlled study.

Int J Med

A retrospective, clinical, nonrandomized, controlled study.

To evaluate the application of a new spinal navigation robot on percutaneous vertebroplasty under local anesthesia.

The result of inserting the puncture needle into the simulated pedicle was observed in vitro. 30 patients with thoracolumbar fractures were enrolled. The basic data, operation-related data, and clinical effect scores were recorded. The learning curve of robot-guided surgery was analyzed.

The maximum yaw angle of the puncture needle implanting into the simulated pedicle is 0.5 °. The operation time (33.93 ± 5.97 min vs 53.75 ± 14.08 min, P = 0.000) and the average X-ray exposure time (31.43 ± 4.93 s vs 54.69 ± 2.15 s, P = 0.000) was significantly less in the robot group. The surgeons quickly mastered the technique of robot-guided pedicle puncture after three surgeries.

Robot-assisted percutaneous vertebroplasty could performed under local anesthesia with the new robot. This article is protected by copyright. All rights reserved.

Available active surveillance follow-up protocols for small renal mass: a systematic review.

World Journal of Diabetes

To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data.

We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included.

Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS.

The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.

The efficacy and safety of Serenoa repens extract for the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome: a multicenter, randomized, double-blind, placebo-controlled trial.

World Journal of Diabetes

To perform a placebo-controlled trial to evaluate the efficacy and safety of Serenoa repens extract (SRE) for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

We conducted a double-blind, randomized, placebo-controlled, multicenter, clinical phase 4 study of 221 patients with CP/CPPS across 11 centers. Participants were randomly assigned in a 2:1 ratio to receive SRE or placebo for 12 weeks. The primary efficacy endpoint was the change in total score on the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). Secondary efficacy endpoints included improvements within each domain of NIH-CPSI, clinical response rate, and International Index of Erectile Function 5 items (IIEF-5).

In total, 226 patients were enrolled and randomized between January 2017 and June 2018. Of these 221 patients were included in the intent-to-treat analysis: 148 in the SRE group and 73 patients in the placebo group. Compared to the placebo, SRE led to statistically significant improvements in the NIH-CPSI total score and sub-scores. The significant improvements of NIH-CPSI scores were established after 2 weeks from the first dose, and continued to the end of the treatment. Furthermore, a significantly higher rate of patients achieved a clinical response in the SRE group compared with that in the placebo group (73.0% vs 32.9%, P < 0.0001). Only minor adverse events were observed across the entire study population.

SRE was effective, safe, and clinically superior to placebo for the treatment of CP/CPPS. ChiCTR-IPR-16010196, December 21, 2016 retrospectively registered.

Evaluating the risks and benefits of ketorolac in transoral robotic surgery.

Journal of Robotic Surgery

Transoral Robotic Surgery (TORS) is increasingly used for oropharyngeal neoplasms and obstructive sleep apnea. Post-operative pain and bleeding rem...

Clinical implications of genomic alterations in metastatic prostate cancer.

Prostate Cancer and Prostatic Diseases

There has been a rapid expansion in treatment options for the management of metastatic prostate cancer, but individual patient outcomes can be vari...

Fine needle insertion method for minimising deflection in lower abdomen: In vivo evaluation.

Int J Med

Fine needle insertion in the lower abdomen is difficult because of complex deflections and few image feedbacks. We aim to develop an approach for generating a straight insertion path by minimizing the needle deflection robustly based on a preoperative computer tomography (CT) image.

This study presents two approaches: an insertion control strategy that performs both vibration and rotation-assisted needle insertions and a preoperative insertion path planning for determining an optimal insertion path based on insertion angles at each tissue boundary. Those proposed approaches were evaluated through an in vivo experiment with a Landrace mini-pig. We compered the following: (1) the deflection with and without the insertion control strategy in different 10 insertion paths and (2) the score calculated by the path planning and the actual deflection in the 10 insertion paths.

The result shows that the deflection can be reduced significantly by applying the insertion control strategy in the optimal insertion path calculated by the path planning.

The proposed method can decrease fine needle deflections in the lower abdomen, which has the potential for accurate and safety procedures without real-time CT imaging.

DaPeCa-7: comparative assessment of fluorodeoxyglucose positron emission tomography/computed tomography (CT) and conventional diagnostic CT in diagnosis of lymph node metastases, distant metastases and incidental findings in patients with invasive penile cancer.

BJU International

To evaluate diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) compared to contrast-enhanced CT in assessment of inguinal lymph node (ILN) metastases, distant metastases and synchronous cancers in patients with penile squamous cell carcinoma (pSCC).

During a 4-year period, patients with pSCC were scheduled for FDG PET/CT prior to surgical treatment at two referral centres that manage all penile cancers in Denmark. The primary endpoint was diagnostic accuracy of FDG PET/CT and of CT alone with histopathology or Response Evaluation Criteria In Solid Tumors (RECIST) as reference.

We evaluated 171 patients for distant metastases and synchronous incident cancers and examined 286 groins in 143 patients for LN metastases by FDG PET/CT. Six groins disclosed false negatives. FDG PET/CT sensitivity was 85.4% per patient. In 135 patients (270 groins), CT images were evaluated separately and 22 groins disclosed false negatives. CT sensitivity was 47.5% per patient. FDG PET/CT detected pSCC distant metastases in seven patients. Distant metastases from other cancers were newly detected in three patients. In eight patients, an incidental synchronous cancer was detected. Seven out of the 18 distant malignancies detected depended on FDG PET information.

This study underlines the increased diagnostic accuracy of FDG PET/CT compared to CT alone in the evaluation of ILN status. In patients with palpable LNs, the advantage of FDG PET/CT over CT is less pronounced. FDG PET/CT may play a role in penile cancer evaluation.

Local Anaesthetic Transperineal Prostate (LATP) biopsy using a probe-mounted transperineal access system: A multi-centre prospective outcome analysis.

BJU International

To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal access device, and report initial prostate cancer (PCa) detection, infection rates and tolerability.

Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: 1) first biopsy in suspected PCa, 2) confirmatory biopsies for active surveillance and 3) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive MRI targeted biopsies when needed using the Precision PointTM transperineal access device. Procedure related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient reported outcomes (PROMs).

Some 1218 patients underwent LATP biopsies at ten centres: 55%, 24% and 21% for each of the three settings respectively. Any-grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients with a 56% response rate (n=234). In these men, pain during the biopsy was described as either "not at all" or "a little" painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be "not a problem" and in contrast 8.1% would consider it a "major problem". Most of the patients (81%) described the biopsy as a "minor or moderate procedure tolerable under local anaesthesia", while 5.6% perceived it as a "major procedure that requires general anaesthesia".

Our data suggest that LATP biopsy using a transperineal access system mounted to the ultrasound probe achieves excellent PCa detection with very-low sepsis rate and is safe and well tolerated. We believe a randomized controlled trial comparing LATP with TRUS to investigate the relative trade-offs between each biopsy technique would be helpful.

What influences adherence to guidance for post-operative instillation of intravesical chemotherapy to bladder cancer patients?

BJU International

To understand the barriers and facilitators to single instillation of intravesical chemotherapy (SI-IVC) use following resection of non-muscle-invasive bladder cancer (NMIBC) in Scotland and England using a behavioural theory-informed approach.

In a cross-sectional descriptive study of practices at seven hospitals, we investigated care pathways, policies, and interviewed 30 urology staff responsible for SI-IVC. We used the Theoretical Domains Framework (TDF) to organise our investigation and conducted deductive thematic analyses, while inductively coding emergent beliefs.

Barriers to SI-IVC were present at different organisational levels and professional roles. In four hospitals there was a policy to not instil SI-IVC in theatre. Six hospitals' staff reported delays in MMC ordering and/or local storage. Lack of training, skills and perceived workload affected motivation. Facilitators included access to modern instilling devices (four hospitals) and incorporating reminders operation pro-forma (four hospitals). Performance targets (with audit and feedback) within a national governance framework was present in Scotland but not England. Differences in coordinated leadership, sharing best practices, and disliking being perceived as underperforming, were evident in Scotland.

High-certainty evidence shows that SI-IVC such as Mitomycin C (MMC), following NMIBC resection reduces recurrences. This evidence underpins international guidance. Numbers of eligible patients receiving SI-IVC is variable indicating suboptimal practice. Improving SI-IVC adherence requires modifications to theatre instilling policies, delivery and storage of MMC, staff training, and documentation. Centralising care with bladder cancer expert leadership and best practices sharing, with performance targets, likely led to improvements in Scotland. National quality improvement, incorporating audit and feedback, with additional implementation strategies targeted to professional role could improve adherence and patient outcomes elsewhere. This process should be controlled to clarify implementation intervention effectiveness.

Surgical Outcomes of Conventional Laparoscopic and Robotic-Assisted Hysterectomy.

Int J Med

The aim of the present study was to compare surgical outcomes of total laparoscopic hysterectomy with those of the robotic approach using the Da-Vinci-Xi system.

Patients who underwent hysterectomy with Da-Vinci-Xi for early endometrial cancer or benign indications from 2018 to 2019 were selected. The control group consisted of patients who underwent conventional laparoscopy.

Of 300 patients included in the study. The mean duration of surgery differed significantly (p=0.025) between those who underwent laparoscopy (125.01±76.168) and robotic-assisted surgery (142.96±82.657 minutes). Blood loss, median hospital stay, intraoperative and postoperative complications were similar in both groups. No statistical difference was observed in the subgroups with a BMI > 30 kg/m2 or > 40 kg/m2 concerning the duration of surgery or the surgical outcome.

The Da-Vinci-Xi did not improve surgical outcomes in patients who underwent hysterectomy by trained laparoscopists and takes more time than robotic-assisted surgery when performed in patients of normal weight. This article is protected by copyright. All rights reserved.