Therapeutic Advances in Urology最新文献

{"title":"Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes","authors":"A. Bove, A. Brassetti, Mario Ochoa, U. Anceschi, M. Ferriero, G. Tuderti, L. Misuraca, R. Mastroianni, Silvia Cartolano, S. D'annunzio, Giulia Torreggiani, G. Simone","doi":"10.1177/17562872221147104","DOIUrl":"https://doi.org/10.1177/17562872221147104","url":null,"abstract":"Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p < 0.01). RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"1 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48599730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of use of medications used to treat urinary incontinence and potentially inappropriate prescriptions.","authors":"Luis Fernando Valladales-Restrepo,&nbsp;Hugo Alejandro Bedoya-Arias,&nbsp;Brayan Stiven Aristizábal-Carmona,&nbsp;Jorge Enrique Machado-Alba","doi":"10.1177/17562872231179104","DOIUrl":"https://doi.org/10.1177/17562872231179104","url":null,"abstract":"<p><strong>Background: </strong>The pharmacological treatment of urinary incontinence (UI) may involve bladder antimuscarinics, which can generate risks in the elderly.</p><p><strong>Objective: </strong>The aim was to determine the treatment patterns of a group of patients with UI and possible potentially inappropriate prescriptions.</p><p><strong>Design and methods: </strong>This was a cross-sectional study that identified prescription patterns of medications for outpatient use in patients with UI between December 2020 and November 2021 based on a population database of members of the Colombian Health System. Patients were identified based on the codes of the international classification of diseases, version-10. Sociodemographic and pharmacological variables were considered.</p><p><strong>Results: </strong>A total of 9855 patients with UI were identified, with a median age of 72 years, and 74.6% were women. Unspecified UI was the most frequent form (83.2%), followed by specified UI (7.9%), stress UI (6.7%), and UI associated with an overactive bladder (2.2%). A total of 37.2% received pharmacological treatment, mainly with bladder antimuscarinics (22.6%), mirabegron (15.6%), and topical estrogens (7.9%). Pharmacological management predominated in UI associated with overactive bladder, in women and in patients between 50 and 79 years of age. Of the patients who received bladder antimuscarinics, 54.5% were 65 years old or older, and 21.5% also had benign prostatic hyperplasia, sicca syndrome, glaucoma, constipation, or dementia. A total of 2.0% of women had been prescribed systemic estrogens and 1.7% had been prescribed peripheral α-adrenergic antagonists.</p><p><strong>Conclusion: </strong>Differences in the prescriptions were found according to the type of UI, sex, and age group. Potentially inappropriate or risky prescriptions were common.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231179104"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/69/fa/10.1177_17562872231179104.PMC10278437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9709973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under pressure: irrigation practice patterns during flexible ureteroscopy.","authors":"Bassel Salka,&nbsp;Jamsheed Bahaee,&nbsp;Jeff Plott,&nbsp;Khurshid R Ghani","doi":"10.1177/17562872231179009","DOIUrl":"https://doi.org/10.1177/17562872231179009","url":null,"abstract":"<p><strong>Introduction: </strong>Irrigation parameters during flexible ureteroscopy (fURS) may impact patient outcomes, yet there are limited data on current practice patterns of irrigation methods and parameter selection. We assessed the common irrigation methods, pressure settings, and situations that present the most problems with irrigation among worldwide endourologists.</p><p><strong>Methods: </strong>A questionnaire on fURS practice patterns was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Surgeons were from North America (the United States and Canada), Latin America, Europe, Asia, Africa, and Oceania.</p><p><strong>Results: </strong>Questionnaires were answered by 208 surgeons (response rate 14%). North American surgeons accounted for 36% of respondents; 29% Europe, 18% Asia, and 14% Latin America. In North America, the most common irrigation method was the pressurized saline bag using a manual inflatable cuff (55%). Saline bag (gravity) with a bulb or syringe injection system was the most common method in Europe (45%). Automated systems were the most common method in Asia (30%). For pressures used during fURS, the majority of respondents used 75-150 mmHg. The clinical scenario which had the greatest issue with adequate irrigation was during biopsy of urothelial tumor.</p><p><strong>Conclusion: </strong>There is variation in irrigation practices and parameter selection during fURS. North American surgeons primarily used a pressurized saline bag, in contrast to European surgeons who preferred a gravity bag with a bulb/syringe system. Overall, automated irrigation systems were not commonly used.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231179009"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/f8/10.1177_17562872231179009.PMC10285609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary treatment (MDT) perspectives in renal cell carcinoma.","authors":"Jeanny B Aragon-Ching,&nbsp;Robert Uzzo","doi":"10.1177/17562872231182216","DOIUrl":"https://doi.org/10.1177/17562872231182216","url":null,"abstract":"able to achieve complete metastasectomy. 14 Metastasectomy can be achieved either with surgery or radiation. The use of stereotactic ablative radiation therapy (SABR) for oligometastatic renal cell carcinoma (ORCA) was evaluated in a meta-analysis of 28 studies, 15 which included 1602 mutually exclusive patients involving 3892 lesions with the potential benefit of effective delivery in lieu of systemic therapy, 16 potential delay of subsequent line of systemic treatment in true oligoprogressive disease or perhaps in combination with systemic therapy. The feasibility of a combination approach","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231182216"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/81/10.1177_17562872231182216.PMC10286529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay.","authors":"Umberto Carbonara,&nbsp;Daniele Amparore,&nbsp;Leonardo D Borregales,&nbsp;Anna Caliò,&nbsp;Chiara Ciccarese,&nbsp;Pietro Diana,&nbsp;Selcuk Erdem,&nbsp;Laura Marandino,&nbsp;Michele Marchioni,&nbsp;Constantijn H J Muselaers,&nbsp;Carlotta Palumbo,&nbsp;Nicola Pavan,&nbsp;Angela Pecoraro,&nbsp;Eduard Roussel,&nbsp;Hannah Warren,&nbsp;Zhen-Jie Wu,&nbsp;Riccardo Campi,&nbsp;Riccardo Bertolo","doi":"10.1177/17562872231172834","DOIUrl":"https://doi.org/10.1177/17562872231172834","url":null,"abstract":"<p><p>Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both <i>via</i> a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic <i>versus</i> multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231172834"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/f7/10.1177_17562872231172834.PMC10265377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10030402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate.","authors":"Christian Habib Ayoub,&nbsp;Viviane Chalhoub,&nbsp;Adnan El-Achkar,&nbsp;Nassib Abou Heidar,&nbsp;Hani Tamim,&nbsp;Marie Maroun-Aouad,&nbsp;Albert El Hajj","doi":"10.1177/17562872221150217","DOIUrl":"https://doi.org/10.1177/17562872221150217","url":null,"abstract":"<p><strong>Background: </strong>Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients.</p><p><strong>Objectives: </strong>The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques.</p><p><strong>Design and methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis.</p><p><strong>Results: </strong>A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP (<i>p</i> < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (<i>p</i> = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (<i>p</i> = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP.</p><p><strong>Conclusion: </strong>MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872221150217"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/07/10.1177_17562872221150217.PMC9869224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9178525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the urological tract in children with anorectal malformations - a contemporary review.","authors":"Kelly T Harris,&nbsp;Duncan T Wilcox","doi":"10.1177/17562872231161468","DOIUrl":"https://doi.org/10.1177/17562872231161468","url":null,"abstract":"<p><p>Anorectal malformations (ARMs) consist of a broad spectrum of congenital anomalies that are associated with an equally wide variety of urological abnormalities, often with increasing incidence as the severity of the ARM increases. The importance of urologic involvement in the care of ARM patients has been noted for decades and is critical from birth to adulthood. Urology must be involved in the initial evaluation and operative care of the child as well as in monitoring and managing issues such as neurogenic bladder, renal disease, and eventually sexual function and fertility. Care of the ARM patient must be done through a multidisciplinary lens, with the urologist as a key player. This review will serve as an update on the management of the urologic tract in children with ARM.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231161468"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/34/10.1177_17562872231161468.PMC10034273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9245940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus haemorrhagic cystitis in a pregnant patient with AIDS.","authors":"Bernard Marais,&nbsp;Veena John,&nbsp;Mariëtte Du Toit,&nbsp;Jeanne Mbambo,&nbsp;Jeff John","doi":"10.1177/17562872231159531","DOIUrl":"https://doi.org/10.1177/17562872231159531","url":null,"abstract":"<p><p>Cytomegalovirus (CMV), an AIDS defining disease, has a high seroprevalence in the general population, while symptomatic infections occur mostly in immunocompromised individuals. Symptomatic CMV infections commonly include pneumonia, encephalitis, retinitis and colitis, while urinary tract involvement is a rare entity. We present a rare case of massive macroscopic haematuria due to CMV haemorrhagic cystitis in a 29-year-old woman in her second trimester of pregnancy. She was treated with intravenous Ganciclovir after initial resuscitation, and her symptoms promptly resolved. Timely diagnosis and treatment of symptomatic CMV infection is necessary to prevent associated morbidity, and this is especially significant during pregnancy in order to prevent foetal transmission. Both our patient and her baby remained symptom free at the 6-month follow-up post-delivery. Clinicians should have a high index of suspicion to biopsy the bladder urothelium of at-risk patients who present with haemorrhagic cystitis and have non-specific cystoscopy findings as histopathological analysis is the mainstay of diagnosing CMV-cystitis.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231159531"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/5c/10.1177_17562872231159531.PMC10034270.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9245935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: a historically controlled study.","authors":"Marco Carilli,&nbsp;Patrizio Pacini,&nbsp;Maurizio Serati,&nbsp;Valerio Iacovelli,&nbsp;Daniele Bianchi,&nbsp;Filomena Petta,&nbsp;Serena Pastore,&nbsp;Ivana Amato,&nbsp;Claudia Fede Spicchiale,&nbsp;Giulia D'Ippolito,&nbsp;Simone Pletto,&nbsp;Yuri Cavaleri,&nbsp;Andrea D'Amico,&nbsp;Isabella Parisi,&nbsp;Enrico Finazzi Agrò","doi":"10.1177/17562872231177779","DOIUrl":"https://doi.org/10.1177/17562872231177779","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking.<b>Objective::</b> To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies.</p><p><strong>Methods: </strong>MS patients with NDO were enrolled. Inclusion criteria were NDO not responding to pharmacological and behavioural therapies. Exclusion criteria were the presence of relevant comorbidities and urinary tract infections. Patients were evaluated using 3-day bladder diaries and validated questionnaires at baseline, after 4 weeks of educational therapy and after 12 PTNS sessions. The primary outcome measure was the percentage of patients considered responders after the behavioural therapy and after the PTNS in a historical controlled fashion (definition of 'responder' was reduction ⩾50% of urgency episodes).</p><p><strong>Results: </strong>A total of 33 patients (26 women, 7 men) were enrolled. Two patients dropped out for reasons not related to the protocol. Two out of 31 patients (6.5%) and 21/29 (72.4%) were considered responders at visits 1 and 2, respectively. In PTNS responders, a statistically significant improvement in both bladder diary results and standardized questionnaire scores was recorded, compared with that obtained with behavioural therapy alone. No serious adverse events were reported.</p><p><strong>Conclusion: </strong>This historically controlled study suggests that PTNS may be effective in improving NDO in MS patients.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231177779"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/dd/10.1177_17562872231177779.PMC10233582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9637357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group.","authors":"Vineet Gauhar,&nbsp;Daniele Castellani,&nbsp;Ben Hall Chew,&nbsp;Daron Smith,&nbsp;Chu Ann Chai,&nbsp;Khi Yung Fong,&nbsp;Jeremy Yuen-Chun Teoh,&nbsp;Olivier Traxer,&nbsp;Bhaskar Kumar Somani,&nbsp;Thomas Tailly","doi":"10.1177/17562872231198629","DOIUrl":"https://doi.org/10.1177/17562872231198629","url":null,"abstract":"<p><strong>Background: </strong>Assessment of residual fragments (RFs) is a key step after treatment of kidney stones.</p><p><strong>Objective: </strong>To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) <i>versus</i> X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones.</p><p><strong>Design: </strong>A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021).</p><p><strong>Methods: </strong>Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs.</p><p><strong>Results: </strong>A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% <i>versus</i> 13.9%, <i>p</i> < 0.001) and after matching (43.1% <i>versus</i> 23.9%, <i>p</i> < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% <i>versus</i> 47.6%, <i>p</i> < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, <i>p</i> < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, <i>p</i> < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, <i>p</i> = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, <i>p</i> < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, <i>p</i> < 0.001) had significantly higher odds of having CSRFs.</p><p><strong>Conclusions: </strong>CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231198629"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/ce/10.1177_17562872231198629.PMC10493056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}