World Journal of Urology最新文献

{"title":"Impact of neurovascular bundle preservation on biochemical recurrence after robot-assisted radical prostatectomy for high-risk prostate cancer.","authors":"Hiroki Hagimoto, Masashi Kubota, Yoshiyuki Matsui, Takayuki Sumiyoshi, Ryoichi Saito, Takehiko Segawa, Shigeki Fukuzawa, Kenji Mitsumori, Toru Yoshida, Toshiya Akao, Yuya Sekine, Hiromitsu Negoro, Ryoma Kurahashi, Kimihiro Shimatani, Atsuro Sawada, Shusuke Akamatsu, Takashi Kobayashi, Takayuki Goto, The Daimonji Clinical Application Database Dai-Cad","doi":"10.1007/s00345-024-05363-w","DOIUrl":"https://doi.org/10.1007/s00345-024-05363-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate functional and oncological outcomes in patients who underwent unilateral or bilateral nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer.</p><p><strong>Methods: </strong>The cohort comprised 2683 patients with clinical stage T1-4, N0M0 high-risk prostate cancer who underwent RARP in Japanese tertiary care centers from August 2011 to April 2023. High risk was defined using the European Association of Urology risk stratification criteria. Patients were classified as high risk if they had clinical stage T2c-T4, a serum prostate-specific antigen concentration (PSA) of > 20 ng/dL, or an International Society of Urological Pathology (ISUP) grade of 4-5. Patients were grouped into NS and non-NS surgery groups. Propensity score matching was performed (1:1 ratio) to reduce confounding bias. The primary outcome was biochemical recurrence (BCR)-free survival (BCR-FS). The impact of NS surgery on BCR-FS was examined in the propensity score-matched cohort using Cox proportional hazards regression.</p><p><strong>Results: </strong>The propensity score-matched cohort comprised 1722 patients. In the matched cohort, median follow-up was 31.9 months. The 5-year BCR-FS was 70.2% in the NS group and 71.9% in the non-NS group (HR 1.05; 95% confidence interval, 0.85-1.29). NS surgery did not increase the risk of BCR in subgroups of patients stratified according to ISUP grade, T stage, percent cancer core involvement, and PSA.</p><p><strong>Conclusion: </strong>Neurovascular bundle preservation during RARP for high-risk prostate cancer appears feasible without increasing the BCR rate. However, the retrospective study design carries the potential influence of selection bias.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"43"},"PeriodicalIF":2.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor for the article \"Hyper-realistic rendering-assisted laparoscopic adrenalectomy for giant adrenal tumors: a pilot study\".","authors":"Haixia Ren, Jianghua Yang","doi":"10.1007/s00345-024-05405-3","DOIUrl":"https://doi.org/10.1007/s00345-024-05405-3","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"42"},"PeriodicalIF":2.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing flexible ureteroscopy outcomes for lower Pole versus non lower Pole stones using the flexible and navigable suction ureteric access sheath: a prospective multicenter study by EAU Endourology and PEARLS group.","authors":"Anil Shrestha, Olivier Traxer, Christian Seitz, Mariela Corrales, Daniele Castellani, Ben Hall Chew, Deepak Ragoori, Udita Mishra, Saeed Bin Hamri, Karl Marvin Tan, Steffi Kar Kei Yuen, Akash Chitrakar, Etienne Xavier Keller, Bhaskar Kumar Somani, Vineet Gauhar","doi":"10.1007/s00345-024-05384-5","DOIUrl":"https://doi.org/10.1007/s00345-024-05384-5","url":null,"abstract":"<p><strong>Purpose: </strong>Use of suction in flexible ureteroscopy is increasing lately. The introduction of flexible and navigable suction access sheath (FANS) has shown improved stone free rate (SFR). However, its efficacy in lower pole stone (LPS) in terms of SFR and complications is yet to be studied.</p><p><strong>Methods: </strong>We collected data from 25 centers that included 394 adult patients undergoing ureteroscopy using FANS. Non contrast CT (NCCT) scan was done within first 30 days post operatively to access the SFR. Residual fragments were graded as A: 100% SFR; B: single fragment ≤ 2 mm; C: single fragment 2.1-4 mm; D: Single or multiple fragments > 4 mm. Post operative complications were recorded.</p><p><strong>Results: </strong>Out of 394 patients, non LPS (group1) comprised of 268 patients, rest 126 patients had LPS (group 2). Single stage zero fragment SFR was seen in 58.6% (group 1) vs. 54.8% (group 2) (P = 0.619). Single stage grade A + B SFR was achieved in 96.6% vs. 98.4% in groups 1 and 2 respectively. On multivariate analysis Thulium fiber laser use was significantly associated with higher odds of being grade A stone-free, while stone volume with lower odds. In LPS group only two patients needed reintervention. The highest grade of complication was Clavien 2, which was seen in 3.2% LPS group.</p><p><strong>Conclusion: </strong>Use of flexible and navigable suction ureteric access sheath for lower pole stones is effective and safe. The stone free rate of lower pole stones is comparable to non-lower pole locations with very low reintervention rate in both groups.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"41"},"PeriodicalIF":2.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential benefits of neoadjuvant radiotherapy prior to \"en bloc\" compartmental resection of pure retroperitoneal liposarcomas.","authors":"Jérémy Mercier, Élisa Bréhat, Laurent Ghouti, Anne Ducassou, Justine Attal Khalifa, Thomas Prudhomme, Mathieu Roumiguié, Xavier Game, Michel Soulie, Matthieu Thoulouzan, Anne-Sophie Bajeot","doi":"10.1007/s00345-024-05389-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05389-0","url":null,"abstract":"<p><p>Retroperitoneal liposarcomas(RPL) are rare malignant tumors, accounting for approximately 15% of soft tissue sarcomas and 0.07-0.2% of all cancers. The annual incidence is 0.5 to 1 per 100,000 individuals. Surgical resection is the only curative option, but recurrence rates are high, and the role of neoadjuvant radiotherapy(NRT) remains uncertain. This study aimed to assess the impact of preoperative NRT on overall survival(OS) and recurrence-free survival(RFS) in RPL patients undergoing compartmental resection, while identifying prognostic factors. A retrospective monocentric review of 94 patients with confirmed RPL treated between 2008 and 2022 was conducted. Forty-six patients received NRT, while 48 underwent surgery alone. Data on preoperative, intraoperative, and postoperative variables, including complications, recurrence, and survival, were analyzed. Kaplan-Meier analysis evaluated OS and RFS, and multivariate Cox regression identified independent prognostic factors. With a median follow-up of 46.5 months, OS did not significantly differ between the NRT and surgery-only groups (HR = 0.8; 95% CI [0.4-1.54], p = 0.48). However, RFS was significantly improved in the NRT group (HR = 0.41; 95% CI [0.21-0.83], p = 0.001), particularly in patients with dedifferentiated RPL (HR = 0.38; 95% CI [0.18-0.83], p = 0.015). Tumor rupture (HR = 5.5; p < 0.001) was a strong risk factor for recurrence, while NRT was a protective factor (HR = 0.3; p = 0.002). NRT did not improve OS but significantly enhanced RFS, particularly in dedifferentiated RPL cases. These results warrant further prospective studies to better define NRT's role in RPL management.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"40"},"PeriodicalIF":2.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel pressure- and temperature-controlled flexible ureteroscope system with a suction ureteral access sheath: a multicenter retrospective feasibility study.","authors":"Jianghua Yang, Zhikai Wu, Mingzhou Dai, Changbao Xu, Tiejun Pan, Guangmin Yin, Zhuohang Li, Kewei Xu","doi":"10.1007/s00345-024-05400-8","DOIUrl":"10.1007/s00345-024-05400-8","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the feasibility of a pressure-controlled and temperature-controlled flexible ureteroscope system (PT Scope™) during flexible ureteroscopy.</p><p><strong>Materials and methods: </strong>We developed the PT Scope™, a novel ureteroscope system with capabilities for monitoring and controlling intrarenal pressure and temperature to maintain them within set parameters. Data were retrospectively collected from 48 consecutive patients diagnosed with upper urinary tract stones who underwent flexible ureteroscopic lithotripsy using the PT Scope™ across five centers in China. Analyses focused on 24-h postoperative stone-free rates, intrarenal pressure and temperature measurements, and other procedural data.</p><p><strong>Results: </strong>Among the 48 patients treated with the PT Scope™ system, a significant stone-free rate of 89.6% was achieved within 24 h postoperation, without any instances of intraoperative complications such as perforation or mucosal hemorrhage. Only two patients reported mild postoperative pain and were managed with NSAIDs, and there were no cases of postoperative fever or sepsis. The average maximum intrarenal pressure and temperature were recorded at 30.2 ± 4.20 mmHg and 36.6 ± 4.27 °C, respectively. Notably, during lithotripsy, both the pressure and temperature were maintained below 30 mmHg and 43 °C for 99% of the procedure duration, respectively.</p><p><strong>Conclusion: </strong>This preliminary investigation indicates that the PT Scope™ is a safe and effective tool for the treatment of upper urinary tract stones, offering the benefit of regulating intrarenal pressure and temperature within predetermined limits. These findings support the feasibility of the system for clinical application.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"38"},"PeriodicalIF":2.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation and quantitative evaluation of three surgical techniques of endoscopic enucleation of prostate on a realistic phantom model.","authors":"Senol Tonyali, Maximilian Ferry Von Bargen, Maximilian Glienke, Mazhar Ortac, August Sigle","doi":"10.1007/s00345-024-05404-4","DOIUrl":"https://doi.org/10.1007/s00345-024-05404-4","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of three different AEEP techniques on the training performance of novices using a realistic hydrogel prostate phantom model.</p><p><strong>Material and methods: </strong>The experimental setup utilized realistic prostate phantom model provided by the Max Planck Institute for Intelligent Systems, Germany. For the enucleation, we utilized a new solid-state pulsed thulium laser (Thulio®, Dornier MedTech, Weßling, Germany). We explored three different AEEP techniques-bilobar, trilobar, and en-bloc-repeated ten times each, totaling 30 procedures.</p><p><strong>Results: </strong>Median enucleation time was 9.5 min (range: 6-16), median laser time was 4.29 min (3.21-6.34), median total energy used was 25.8 kJ (19.4-38.1), and median number of laser pulses was 12.8 thousand (9.7-17). There were no significant differences in operation time, laser time, pulses, or joules among the en-bloc, two-lobe, and three-lobe techniques (p = 0.113, 0.143, 0.148, 0.141 respectively). Ultrasound evaluations showed the one-lobe technique to be superior in accuracy, smoothness, and circularity (p = 0.0002, 0.012, 0.00005 respectively) (Figs. 9, 10, 11), despite having the highest perforation rate, which was not statistically significant compared to other techniques (p = 1.4). The one-lobe technique's higher accuracy may increase the risk of perforation. In contrast, the three-lobe technique had the lowest perforation rate and removal efficiency due to its lower accuracy.</p><p><strong>Conclusion: </strong>The en-bloc, bilobar, and trilobar enucleation techniques exhibited comparable operation times. The one-lobe method emerged as superior in terms of accuracy, smoothness, and circularity. However, it also presented the highest rate of perforation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"39"},"PeriodicalIF":2.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using three-dimensional virtual imaging of renal masses to improve prediction of robotic-assisted partial nephrectomy Tetrafecta with SPARE score.","authors":"HaoXiang Huang, Bohong Chen, Cong Feng, Wei Chen, Dapeng Wu","doi":"10.1007/s00345-024-05344-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05344-z","url":null,"abstract":"<p><strong>Objective: </strong>To improve the predictability of outcomes in robotic-assisted partial nephrectomy, we utilized three-dimensional virtual imaging for SPARE nephrometry scoring. We compared this method with a conventional two-dimensional scoring system to determine whether 3D virtual images offer enhanced predictive accuracy for Tetrafecta outcomes.</p><p><strong>Methods: </strong>We retrospectively collected basic information, demographic data, and perioperative indices from patients who underwent robot-assisted partial nephrectomy for renal masses at the Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University. A three-dimensional visualization system (IPS system, Yorktal) was employed to reconstruct the patients' imaging data using AI-based automatic segmentation, resulting in a three-dimensional visualization model (3DVM). This model was then imported into the virtual surgical planning software (Touch Viewer System, Yorktal) for automatic measurement of the SPARE score. Tetrafecta was defined as a warm ischemic time (WIT) of less than 25 min, negative surgical margins, absence of major perioperative complications, and no decline in postoperative renal function. The receiver operating characteristic (ROC) curve was utilized to evaluate the sensitivity and specificity of the SPARE score.</p><p><strong>Results: </strong>A total of 141 patients were included in this study, with a mean age of 55.6 ± 11.14 years and a mean tumor size of 3.5 ± 1.2 cm. All variables, except for estimated blood loss (EBL) (Coefficient = 0.056, 0.035; P = 0.514, 0.685), showed significant correlation with the SPARE score when comparing CT and 3D virtual models (Tetrafecta: Coefficient = 0.408, 0.56; P < 0.001, < 0.001; WIT: Coefficient = 0.340, 0.237; P < 0.001, 0.007; ΔeGFR: Coefficient = 0.212, 0.257; P = 0.012, 0.002). The area under the curve (AUC) values from the ROC curves indicated that the 3D virtual model group had significantly better performance than the 2D image group for the SPARE score. However, there was no significant difference in the ROC curves for the SPARE complexity category between the two imaging modalities (AUC for SPARE category with 3DVM = 0.658 vs. AUC for SPARE category with CT = 0.643, P = 0.59; AUC for SPARE score with 3DVM = 0.854 vs. AUC for SPARE score with CT = 0.755, P < 0.001).</p><p><strong>Conclusions: </strong>The SPARE score combined with 3DVM has a more accurate predictive ability for Tetrafecta of RAPN compared to the traditional 2D SPARE score.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"37"},"PeriodicalIF":2.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy and inflammaging: the influence of prostate cancer radiotherapy on systemic inflammation.","authors":"Katarzyna Paal, Bettina Stranz, Eva-Maria Thurner, Tobias Niedrist, Wilfried Renner, Tanja Langsenlehner","doi":"10.1007/s00345-024-05409-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05409-z","url":null,"abstract":"<p><strong>Purpose: </strong>The present study was performed to investigate the association of prostate cancer radiotherapy with inflammaging, a condition characterized by the elevation of inflammatory blood parameters that significantly increases the susceptibility to the occurrence or progression of age-related conditions.</p><p><strong>Patients and methods: </strong>A total of 306 patients treated with curative radiotherapy (RT) for prostate cancer were enrolled into the prospective study. Aging-related inflammatory parameters including C-reactive protein (CRP), albumin, fibrinogen, cholesterol, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were analyzed before and at the end of RT, and 3 and 15 months after completion of the RT. Statistical analysis was performed using non-parametric variance analysis.</p><p><strong>Results: </strong>Overall variance analysis showed a significant influence of RT on all inflammatory parameters (p < 0.001) with the exception of CRP (p = 0.498). Pairwise analysis revealed a significant elevation of fibrinogen (p = 0.041), NLR (p < 0.001), and PLR levels (p < 0.001) as well as a significant decrease of albumin (p < 0.001) and cholesterol levels (p < 0.001) during the RT course. After completion of RT, a significant recovery was detected for NLR, PLR, albumin and cholesterol. However, 15 months after RT, PLR, fibrinogen, and cholesterol remained significantly lower when compared to the baseline (p < 0.001).</p><p><strong>Conclusion: </strong>Our results indicate that radiation therapy triggers chronic inflammatory processes that could contribute to the development, acceleration or worsening of age-related alterations and conditions. Further investigations to estimate the long-term consequences of curative radiation therapy on clinical manifestations of aging are warranted.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"35"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urethral instrumentation in men with artificial urinary sphincter: a national survey among Brazilian urologists.","authors":"Vicktor Bruno Pereira Pinto, Jose de Bessa, José Antonio Penedo Prezotti, Karin Marise Jaeger Anzolch, Jose Ailton Fernandes, Cristiano Mendes Gomes","doi":"10.1007/s00345-024-05407-1","DOIUrl":"https://doi.org/10.1007/s00345-024-05407-1","url":null,"abstract":"<p><strong>Purpose: </strong>Urethral instrumentation (UI) in patients with an artificial urinary sphincter (AUS) demands technical considerations and poses a risk of urethral erosion, leading to serious clinical and legal consequences. We conducted a national survey to evaluate the knowledge and experience of Brazilian urologists with UI in these patients.</p><p><strong>Methods: </strong>This study used an electronic survey distributed to members of the Brazilian Society of Urology. The survey included 19 multiple-choice questions assessing sociodemographic characteristics, practice patterns, AUS training, knowledge of AUS components and functionality, experience with UI in AUS patients, and interest in further training. Urologists were classified as 'competent' in AUS manipulation if they had prior experience and confidence in performing UI.</p><p><strong>Results: </strong>Among 536 participants (median age 47 years [39-55]), 72.8% reported involvement in urological emergencies, with 89.9% indicating inadequate AUS training during residency. Only 29.7% had occasional or regular involvement with AUS surgeries. Of the participants, 53.4% had performed UI in men with an AUS. Prior UI had been attempted by healthcare staff in 36.2% of cases. Only 46.8% reported knowledge of AUS components and 45.1% felt competent in deactivating it. Regarding urethral catheterization, 47.2% knew the safe catheter diameter, and 20.9% identified safe catheterization duration. Overall, 45.1% self-declared competence in UI, yet many gave incorrect answers on catheter size and duration. Competence strongly correlated with knowledge of AUS components, regular implant involvement, and prior experience. Most (89.3%) expressed interest in additional training for UI.</p><p><strong>Conclusion: </strong>This study highlights significant gaps in training and knowledge among Brazilian urologists regarding UI in AUS patients. These deficiencies underscore the potential for enhanced education to improve patient outcomes and reduce AUS-associated complications in Brazil and possibly broader international contexts.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"36"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-power versus low-power laser settings during endoscopic stone disease management: a systematic review from the EAU endourology section.","authors":"Theodoros Spinos, Bhaskar K Somani, Vasileios Tatanis, Andreas Skolarikos, Theodoros Tokas, Thomas Knoll, Angelis Peteinaris, Athanasios Vagionis, Evangelos Liatsikos, Panagiotis Kallidonis","doi":"10.1007/s00345-024-05408-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05408-0","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal laser settings during endoscopic stone disease management still represents a debatable issue. The aim of this systematic review is to summarize all existing evidence regarding the comparison of high-power (HP) versus low-power (LP) laser settings during different endoscopic lithotripsy procedures.</p><p><strong>Methods: </strong>PubMed, Scopus and Cochrane databases were systematically screened, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All endoscopic laser lithotripsy surgical approaches were included, including ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and transurethral lithotripsy for bladder stones. Pediatric patients were also included.</p><p><strong>Results: </strong>In total, 10 studies met the inclusion criteria and were included in final qualitative synthesis. In most studies total operative time (OT) was shorter for the HP group. Mean fragmentation time was homogenously significantly shorter in the HP group. Stone-free rates (SFR) ranged from 59.0% to 100% for the LP group and from 78.9% to 100% for the HP group. Total complication rates were higher for the LP group in six studies, equivalent between the two groups in one study and higher in the HP group in one study.</p><p><strong>Conclusion: </strong>HP laser lithotripsy is a safe and efficient approach for URS, RIRS, PCNL and cystolithotripsy. HP laser settings were associated with significantly shorter total operative time, while some studies reported also better SFR in the HP groups. The implementation of more Randomized Controlled Trials comparing HP and LP laser lithotripsy in different stone settings is of outmost importance, so that better conclusions can be drawn.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"34"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}