Urologia Internationalis最新文献

{"title":"Efficacy of cetirizine, tamsulosin and their combination as medical expulsive therapy for distal ureteral stones: a prospective randomized study.","authors":"Ahmed Mahmoud Hasan, Amr Alameldeen Ahmed, Reham Farouk Sayed, Mostafa AbdelRazek","doi":"10.1159/uin/aewag046","DOIUrl":"https://doi.org/10.1159/uin/aewag046","url":null,"abstract":"<p><p>Background The management of ureteral stones, particularly those measuring less than 10 mm, has garnered considerable attention in urological research, with the goal of enhancing non-invasive treatment methods. Medical expulsive therapy is notable for its low invasiveness and cost.</p><p><strong>Objectives: </strong>To assess the efficacy and safety of tamsulosin alone, cetirizine alone, as well as their combination in treating distal ureteric stones sized 5-10 mm.</p><p><strong>Methods: </strong>Between March 2021 and March 2024, patients presented with lower ureteral stones 5-10 mm were randomly assigned to four groups: group A (121 patients) took tamsulosin 0.4 mg; group B (120 patients) took cetirizine 5 mg; group C (119 patients) took a combination of tamsulosin 0.4 mg and cetirizine 5 mg; and group D (120 patients) received analgesics on demand as a control group. We evaluated stone passage rates, time required for stone expulsion, total analgesic dosage, and any recorded side effects. All outcomes were recorded and analyzed accordingly.</p><p><strong>Results: </strong>Group C exhibited the highest rate of stone expulsion among all groups (85.8% vs. 67%, 55%, and 25% in groups A, B, and D respectively, p = 0.0001). Group C had a substantially shorter time required for stone expulsion in comparison with groups A, B, and D (13.15 ± 5.3 days vs. 14.95 ± 6.95, 17.57 ± 6.21, and 20.94 ± 5.58 days respectively, p < 0.0001). A statistically significant reduction in the total analgesic requirements was demonstrated in group C (p < 0.0001). Except for retrograde ejaculation which was evident in groups A and C (40 %, 37.7 % respectively versus 0% in the other groups, p < 0.0001), no substantial variations regarding the side effects were observed among the groups.</p><p><strong>Conclusions: </strong>Combined therapy with tamsulosin and cetirizine significantly improves stone expulsion rate, shortens expulsion time, and reduces analgesic requirements compared with either therapy alone.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228698","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 urologic emergency visits and hospital admissions: experience of a tertiary care center.","authors":"Carolin Siech, Clara Humke, Suel Ibrahimzadeh, Quynh Chi Le, Julius Dislich, Miriam I Traumann, Mike Wenzel, Philipp Mandel, Marianne Leitsmann, Felix K H Chun, Luis A Kluth","doi":"10.1159/uin/aewag043","DOIUrl":"https://doi.org/10.1159/uin/aewag043","url":null,"abstract":"<p><strong>Purpose: </strong>Based on steady increase in the number of visits in German emergency departments, the present study examined patterns of urologic emergency visits and inpatient hospital admissions at a tertiary care center in Germany.</p><p><strong>Methods: </strong>Urologic visits in two selected years (2018 and 2022) to the emergency department were identified. Patient characteristics, time, type and reason for presentation, diagnostic and therapeutic measures were tabulated.</p><p><strong>Results: </strong>Overall, 2,223 urologic emergency visits were recorded in 2022, and 2,795 in 2018. In 2022 vs. 2018, median age was 54 vs. 50 years, 74 vs. 70% were male, 73 vs. 69% self-referrals, and 16 vs. 19% repeat visits. The majority of visits (55 vs. 60%) took place during on-call time. The most common reasons for presentation were lower-acuity infections (18 vs. 19%), followed by urolithiasis (13 vs. 16%) and displacement or loss of catheters (12 vs. 11%). Inpatient hospital admission rates were 22% in 2022 and 26% in 2018. In 2022 multivariable adjusted subgroup analyses, older age and referral by ambulance services, external hospitals, office-based urologists, and general practitioner were associated with inpatient hospital admission, unlike referral by on-call medical services.</p><p><strong>Conclusion: </strong>Most urologic visits in the two selected years were self-referrals, occurred outside of regular working hours, and did not require hospital admission. The present findings suggest that expanding office-based urologic emergency consultation hours and providing targeted urologic training for on-call medical staff may represent potential strategies for optimizing emergency care pathways. However, the effectiveness and appropriateness of these measures warrant prospective evaluation.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224906","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":"Comparative study of flexible navigable suction access sheaths versus conventional ureteral access sheaths in retrograde intrarenal surgery: A prospective single-center evaluation of efficiency and safety.","authors":"Laura Isabel Althöfer, Friedrich Otto Hartung, Simon Filmar, Christopher Netsch, Louisa Charlotte Bormann, Sophia Hook, Benedikt Becker","doi":"10.1159/uin/aewag039","DOIUrl":"https://doi.org/10.1159/uin/aewag039","url":null,"abstract":"<p><p>Purpose The use of suction-enabled ureteral access sheaths during flexible ureteroscopy (fURS) has been proposed to improve procedural efficiency and clinical outcomes of stone management. This study compared novel flexible and navigable suction ureteral access sheaths (FANS-UAS) with conventional ureteral access sheaths (CUAS), focusing on operative parameters, stone-free rates (SFR), and length of hospital stay. Methods In this prospective single-center study, 150 consecutive adult patients undergoing retrograde intrarenal surgery (RIRS) for renal stones in 2024 and 2025 were included. Patients were treated using either FANS-UAS (n = 75) or CUAS (n = 75). Primary endpoints included intraoperative parameters (basket use, operative time, ureteroscopy time, and laser-on time) and SFR. Secondary endpoints included length of hospital stay, re-intervention rate, and 30-day postoperative complications. Statistical analyses were performed using Welch's t-test, chi-square or Fisher's exact test. Results Baseline characteristics were comparable between groups. The FANS-UAS group demonstrated significantly shorter operative time (56.4 ± 20.7 vs. 64.4 ± 22.8 min; p = p < 0.05), ureteroscopy time (43.2 ± 19.6 vs. 51.8 ± 21.8 min; p < 0.05), and laser-on time (21.6 ± 9.8 vs. 25.9 ± 10.9 min; p < 0.05). Basket use was significantly reduced (6.7% vs. 89.3%; p < 0.001). SFR were high and comparable. Hospital stay was shorter with FANS-UAS (1.25 ± 0.82 vs. 1.72 ± 0.83 days; p < 0.001). Complication rates were low and similar. Conclusions FANS-UAS improves operative efficiency and reduces hospitalization without compromising SFR or safety, supporting its use in modern endourological stone management.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216782","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":"Perioperative Outcomes of Vacuum-Assisted Versus Standard Mini-Percutaneous Nephrolithotomy: A Propensity Score Overlap Weighting Analysis.","authors":"Cemil Bayraktar, Salim Tozan, Yavuz Güler","doi":"10.1159/uin/aewag044","DOIUrl":"https://doi.org/10.1159/uin/aewag044","url":null,"abstract":"<p><p>Background Vacuum-assisted mini-percutaneous nephrolithotomy (mini-PCNL) improves stone fragment evacuation and surgical efficiency. However, comparative evidence remains limited and susceptible to selection bias. We compared perioperative outcomes of standard and vacuum-assisted mini-PCNL using propensity score overlap weighting. Methods This retrospective study included 80 patients undergoing mini-PCNL between January 2022 and December 2025. Forty patients underwent standard mini-PCNL and 40 underwent vacuum-assisted mini-PCNL. Propensity score overlap weighting was performed using demographic and stone-related characteristics, including age, sex, ASA score, comorbidity status, stone size, stone multiplicity, and Guy's Stone Score. Stone-free status was assessed on postoperative non-contrast computed tomography (NCCT) with 3-mm slice thickness and classified as Grade A (no residual fragments), Grade B (residual fragments ≤2 mm), and Grade C (residual fragments 2.1-4 mm). Perioperative outcomes were compared using weighted regression models. Results After overlap weighting, excellent covariate balance was achieved across baseline variables. Vacuum-assisted mini-PCNL was associated with shorter operative time (53.8 ± 10.9 vs. 74.1 ± 3.8 min, p<0.001), shorter laser fragmentation time (p<0.001), shorter stone extraction time (p<0.001), lower postoperative hemoglobin decrease (p=0.041), reduced estimated blood loss (p=0.043), and shorter hospital stay (p=0.023). Needle puncture and fluoroscopy times were comparable between groups (p=0.540 and p=0.844, respectively). Grade A stone-free status was achieved in 32/40 (80.0%) patients in the vacuum-assisted group and 27/40 (67.5%) in the standard group, whereas Grade B status was observed in 3/40 (7.5%) and 2/40 (5.0%), respectively, and Grade C status in one patient (2.5%) in each group. Although Grade A stone-free status and postoperative complication rates favored the vacuum-assisted group, these differences were not statistically significant. Regression analysis confirmed an independent reduction in operative time (β = -20.28, 95% CI -24.60 to -15.96; p<0.001) and postoperative hemoglobin decrease (β = 2.39, 95% CI 0.10-4.67; p=0.041). Conclusions After propensity score overlap weighting, vacuum-assisted mini-PCNL demonstrated superior operative efficiency and reduced perioperative morbidity compared with standard mini-PCNL. NCCT-based stone-free assessment demonstrated a higher Grade A stone-free rate in the vacuum-assisted group, although this difference was not statistically significant. Larger prospective multicenter studies are warranted to validate these findings.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216805","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":"Efficacy of adjuvant nivolumab versus adjuvant gemcitabine plus cisplatin/carboplatin after radical nephroureterectomy for upper tract urothelial carcinoma: a real-world analysis using a Japanese large-scale claims database.","authors":"Akihito Hashizume, Takashi Kawahara, Masanobu Yamazaki, Daiki Ueno, Shinnosuke Kuroda, Teppei Takeshima, Daiji Takamoto, Takeaki Noguchi, Yasushi Yumura, Hiroji Uemura, Kazuhide Makiyama, Jun-Ichi Teranishi","doi":"10.1159/uin/aewag029","DOIUrl":"https://doi.org/10.1159/uin/aewag029","url":null,"abstract":"<p><strong>Background: </strong>Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy with a poor prognosis. Although adjuvant platinum-based chemotherapy is a standard treatment after radical nephroureterectomy (RNU), the efficacy of adjuvant nivolumab in UTUC remains unclear, especially in real clinical practice. We examined this using a large Japanese real-world database.</p><p><strong>Methods: </strong>Using the Medical Data Vision database, we identified UTUC patients who underwent RNU and received adjuvant therapy. The adjuvant GC/GCarbo group and the adjuvant nivolumab group were defined by distinct treatment eras to reduce treatment selection bias. Event-free survival (EFS) was compared using Kaplan-Meier curves and the log-rank test, with a sensitivity analysis truncating follow-up at 300 days.</p><p><strong>Results: </strong>A total of 1,058 patients were analyzed (240 nivolumab, 818 GC/GCarbo). In the whole cohort, EFS was significantly longer in the nivolumab group (HR = 0.6365, P = 0.0076). This benefit was consistent in patients with neoadjuvant chemotherapy (HR = 0.4053, P = 0.001) and in those without it (HR = 0.6765, P = 0.0462).</p><p><strong>Conclusion: </strong>In Japanese UTUC patients, adjuvant nivolumab may be at least not inferior to GC/GCarbo, suggesting the usefulness of an immunotherapy-after-chemotherapy sequence.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196842","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":"Sex Disparity in Flexible Ureteroscopic Lithotripsy with Flexible and Navigable Suction Ureteral Access Sheath for 2- to 3-cm Upper Urinary Tract Stones: Shorter Operative Time in Female Patients.","authors":"Junkai Huang, Tong Bao, Jian Li, Qi Liu, Xuanhao Zhang, Songhao Lu, Chunyu Liu, Haijie Xie","doi":"10.1159/uin/aewag027","DOIUrl":"10.1159/uin/aewag027","url":null,"abstract":"<p><strong>Introduction: </strong>The flexible and navigable suction ureteral access sheath (FANS-UAS) has expanded the indications for flexible ureteroscopic lithotripsy (fURL) to include upper urinary tract stones (UUTSs) measuring 2-3 cm. However, the impact of patient sex on surgical efficiency with this novel technique remains unknown.</p><p><strong>Methods: </strong>This single-center retrospective study enrolled 318 consecutive patients (210 males and 108 females) who underwent fURL with FANS-UAS for a solitary UUTS measuring 2-3 cm, between December 2024 and May 2026. Exclusion criteria included anatomical abnormalities and severe organ dysfunction. Baseline parameters, operative time (total and by phase), stone-free rates (SFRs) on postoperative day (POD) 1 and POD 30, and Clavien-Dindo complications were compared between sexes. Three general linear models (GLMs) were constructed to adjust for age, stone size, hydronephrosis, and other confounders, and to dissect the effect of sex on total operative time, fragmentation time, and fragment retrieval time.</p><p><strong>Results: </strong>Total operative time was significantly shorter in females than in males (63.4 ± 15.0 vs. 79.9 ± 21.4 min, p < 0.01), driven predominantly by a marked reduction in fragment retrieval time (36.5 ± 10.4 vs. 50.9 ± 13.5 min, p < 0.01), whereas fragmentation time did not differ significantly (17.8 ± 5.7 vs. 18.4 ± 5.9 min, p = 0.341). Immediate SFR (86.1% vs. 87.6%, p = 0.704) and follow-up SFR at POD 30 (91.7% vs. 90.0%, p = 0.831) were comparable, as were overall complication rates. GLM analysis confirmed female sex as the strongest independent predictor of shorter total operative time (B = -18.5, 95% CI: -21.6 to -15.4, F = 134.9, p < 0.01) and fragment retrieval time (B = -15.6, 95% CI: -17.8 to -13.4, F = 191.1, p < 0.01).</p><p><strong>Conclusion: </strong>Female patients undergoing fURL with FANS-UAS for UUTSs measuring 2-3 cm have significantly shorter operative times than males. Patient sex should be considered in preoperative counseling and surgical planning.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196802","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":"Diagnosis and treatment of urothelial carcinoma of the upper urinary tract: Evaluation of guideline compliance 2011-2024.","authors":"Felix Pütz, Wiebke Müller, Axel Heidenreich, Pia Paffenholz","doi":"10.1159/uin/aewag033","DOIUrl":"https://doi.org/10.1159/uin/aewag033","url":null,"abstract":"<p><strong>Background: </strong>Urothelial carcinoma of the upper urinary tract (UTUC) requires a complex, multimodal treatment approach. The European Association of Urology (EAU) publishes evidence-based guidelines on the diagnosis and treatment of this rare tumour every year. However, due to the low number of cases and diagnostic challenges, their implementation in everyday clinical practice is often difficult. The objective of this retrospective analysis was to evaluate guideline-compliant care for patients diagnosed with UTUC and to investigate potential associations between non-guideline therapy decisions and overall survival and other oncological outcomes.</p><p><strong>Methods: </strong>The study included 181 patients diagnosed with UTUC who were treated at our clinic between 2011 and 2024. Treatment courses and oncological outcomes were analyzed based on EAU guidelines, and the overall course was examined in relation to treatment adherence.</p><p><strong>Results: </strong>13% (n=25) of patients received diagnostics or therapy that did not comply with guidelines. The main causes were a lack of resection of the bladder cuff (n=13; 52%), the absence of adjuvant chemotherapy (n=8, 32% 2020 - 2024), the absence of an interdisciplinary case discussion in the form of a tumour board (n=3; 17%), and inadequate surgical treatment (n=1; 5%). In unadjusted analyses, omission of bladder cuff resection was associated with poorer overall survival (p=0.047) and a higher recurrence rate (p=0.038), while the association with overall survival was no longer statistically significant in an exploratory analysis adjusted for age and pathological tumour stage (HR 0.57, 95% CI 0.25-1.30; p=0.183). In addition, diagnostics, the interpretation of CT, cytology and URS biopsy results for the correct classification of low-risk and high-risk patients, and the administration of adjuvant chemotherapy repeatedly showed deviations from the guideline-based criteria for risk stratification.</p><p><strong>Conclusion: </strong>Despite clear recommendations from the EAU, consistent implementation in everyday clinical practice remains a challenge. In addition to the rarity of the condition, challenging diagnostic pathways contribute to its limited use. However, guideline-compliant care may be of clinical importance, as deviations could be associated with poorer oncological outcomes.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196825","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":"Post-circumcision penile and glans necrosis successfully treated with acellular fish-skin xenograft.","authors":"Fabrizio Perucchini, Miriam Partilla, Siamak Sharafi","doi":"10.1159/uin/aewag040","DOIUrl":"https://doi.org/10.1159/uin/aewag040","url":null,"abstract":"<p><strong>Background: </strong>Penile ischemia and necrosis following adult circumcision are rare but potentially devastating complications without standardized treatment guidelines. Acellular fish-skin xenografts have demonstrated regenerative benefits in complex wounds but have not previously been reported for penile necrosis.</p><p><strong>Case presentation: </strong>An 85-year-old polymorbid man underwent therapeutic circumcision for severe phimosis. On postoperative day two, he presented with penile pain, edema, urinary retention, and progressive ischemic discoloration of the glans and distal shaft. Despite catheterization, antibiotics, and conservative wound care, healing stagnated with persistent ischemic tissue. Surgical necrosectomy was performed, leaving a substantial soft-tissue defect. Given the patient's advanced age and significant vascular comorbidities, and to avoid more invasive procedures such as partial penectomy or flap reconstruction, an acellular fish-skin xenograft was applied under local anesthesia in an outpatient setting. The graft integrated successfully, resulting in rapid granulation, progressive epithelialization, and complete anatomical and functional recovery within twelve weeks.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first reported use of acellular fish-skin xenografting for post-circumcision penile necrosis. This case highlights its potential role as a minimally invasive, tissue-sparing option within stepwise treatment strategies, particularly in elderly or polymorbid patients at increased surgical risk.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184298","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":"The Role of Phosphodiesterase Inhibitors in Acute Renal Colic: A Systematic Review and Meta-analysis.","authors":"Alhasan Altayf, Hashem Altabbaa, Mohamed R Ezz, Abed Alawna, Hussein AlAli, Muhammed Elhadi","doi":"10.1159/uin/aewag041","DOIUrl":"https://doi.org/10.1159/uin/aewag041","url":null,"abstract":"<p><strong>Introduction: </strong>Acute renal colic is a common and intensely painful condition, primarily managed with non-steroidal anti-inflammatory drugs (NSAIDs). However, NSAIDs carry risks of gastrointestinal, renal, and cardiovascular adverse events. Phosphodiesterase (PDE) inhibitors, which promote ureteral smooth muscle relaxation, may offer an alternative for selected patients. This systematic review and meta-analysis assessed the efficacy and safety of PDE inhibitors compared with NSAIDs or placebo in acute renal colic.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched (inception to February 11, 2025) for RCTs comparing PDE inhibitors with NSAIDs or placebo. Study selection, data extraction, and risk of bias (Cochrane RoB 2) were independently performed. Evidence certainty was assessed via GRADE. Meta-analyses were conducted using mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) under random-effects models; I² quantified heterogeneity.</p><p><strong>Results: </strong>Six RCTs (1232 participants) were included. PDE inhibitors showed no significant difference in VAS pain intensity versus NSAIDs at 20 minutes (MD: -0.02; 95% CI: -1.34 to 1.30; I² = 84%) or 60 minutes (MD: -0.33; 95% CI: -0.80 to 0.13; I² = 75%), except when combined with NSAIDs, which improved pain relief. PDE inhibitor increased rescue analgesia-free rates compared with NSAID alone, (OR: 3.06; 95% CI: 1.98-4.72; P < 0.001; I² = 0%) while PDE inhibitors were also superior to placebo for avoiding rescue analgesia (OR: 6.42; 95% CI: 3.25-12.68; P < 0.0001; I² = 25%). No overall adverse event difference was found between PDE inhibitors and NSAIDs (OR: 0.87; 95% CI: 0.48-1.60; P = 0.66; I² = 0%).PDE inhibitors had higher adverse events than placebo (OR: 9.30; 95% CI: 3.14-27.53; P < 0.0001; I² = 0%). Evidence certainty ranged from very low to moderate.</p><p><strong>Conclusion: </strong>PDE inhibitors provide analgesic efficacy comparable to NSAIDs as monotherapy and may enhance pain relief when combined with NSAIDs. Larger, high-quality RCTs are warranted to confirm these findings.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184397","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":"A retrospective analysis of modern endoscopic surgery for nephrolithiasis: ECIRS with advantages.","authors":"Vincent Scheper, Joana Bläsius, Hubert Kübler, Charis Kalogirou, Marcel Schwinger","doi":"10.1159/uin/aewag038","DOIUrl":"https://doi.org/10.1159/uin/aewag038","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the operative safety and clinical outcomes of endoscopic combined intrarenal surgery (ECIRS) compared to the established techniques (PCNL, mini-PCNL) treating kidney stones.</p><p><strong>Methods: </strong>Patients who underwent endoscopic surgery for kidney stones between 2013 and 2024 at the university hospital of Wuerzburg were divided into three (ECIRS, PCNL, mini-PCNL) groups and retrospectively analysed. Comparison was performed using t-, chi-square-tests and ANOVA.</p><p><strong>Results: </strong>A total of 185 patients were allocated to three groups and compared. Among them, 98 patients underwent standard PCNL, 48 patients were assigned to the mini-PCNL group, and 39 patients to the ECIRS group. Considering comparable characteristics regarding nephrolithiasis and postoperative complications, the ECIRS group demonstrated significantly shorter operative times (85 vs. 125 vs. 115min, p<0.001), fluoroscopy durations (3.7 vs. 7.7 vs. 5.8 min, p<0.001), and lengths of hospital stay (8.2 vs. 12.7 vs. 9.2 days, p<0.001) compared to PCNL and mini-PCNL. The stone-free rates showed a trend to be superior in the ECIRS group, while complication rates and the need for re-interventions within 30 days were comparable among the groups analysed. Additional benefits of ECIRS were identified in the subgroup analysis. In patients with multiple stones (two or more), subgroup analysis confirmed significant shorter operative and fluoroscopy times and shorter hospital stays with ECIRS, while also revealing better postoperative renal function and a trend toward higher stone-free rates compared to mini-PCNL.</p><p><strong>Conclusions: </strong>ECIRS technique is a safe and effective endoscopic option for managing complex kidney stones, offering reduced operative and fluoroscopy times as well as shorter hospital stays. Future studies with larger patient cohorts may further elucidate the advantages of the ECIRS approach and refine its indications to identify patients who would benefit most from this technique.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184315","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}