World Journal of Urology最新文献

{"title":"Postoperative pain evaluation in laparoscopic radical prostatectomy surgery using tranexamic acid: analgesia?, hyperalgesia??","authors":"Gülten Arslan, Nihan Yaman Mammadov, Ceren Önal, Fırat Mavi, Fatih Doğu Geyik, Banu Eler Çevik","doi":"10.1007/s00345-025-05581-w","DOIUrl":"10.1007/s00345-025-05581-w","url":null,"abstract":"<p><strong>Purpose: </strong>Tranexamic acid(TXA), an antifibrinolytic agent, is widely used to reduce bleeding, but its effect on pain is not clear.The purpose of this study was to evaluate the effectiveness of intravenous TXA on postoperative pain and bleeding in patients undergoing laparoscopic radical prostatectomy(LRP).</p><p><strong>Methods: </strong>Our study was conducted as a prospective, observational study. Seventy patients aged 18-75years, ASA II-III, who would undergo LRP surgery under general anesthesia were included in the study.After anaesthesia induction, maintenance was provided with desflurane and 0.1-0.5mcg/kg/min remifentanil infusion with BIS monitoring.The control group(Group C) (n = 35) received 100 ml of saline and the study group(Group TXA) (n = 35) received TXA 15 mg/kg bolus 10 min before the incision and then 100 mg/hour infusion until skin closure. Demographic, hemodynamic data, ASA, education level, duration of operation and anesthesia, bleeding, administered fluid and remifentanil amounts, hemoglobin values(at the beginning of the operation, 2nd hours, end of the operation, postoperative 12th, 24th hours), Visual Analog Scale (VAS) (at 0th, 6th, 12th, 24th hours postoperatively), time to first rescue analgesia requirement, number of rescue analgesia used within 24h and side effects were recorded.</p><p><strong>Results: </strong>It was observed that VAS scores were statistically higher in TXA group at postoperative 0th and 6th hours, postoperative rescue analgesia requirement was higher and first rescue analgesia requirement time was shorter. No difference was determined between the groups in terms of other parameters.</p><p><strong>Conclusion: </strong>In our study, we concluded that there was no significant difference in terms of bleeding in patients who were administered TXA, but this agent may cause hyperalgesia and a special approach to analgesia should be taken in cases where it is decided to be used.</p><p><strong>Clinical trials: </strong>GOV : (NCT06040853).</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"300"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective multicenter real-world outcomes of Suction Technology Utility in Mini-PCNL Study (STUMPS) in modern-day practice: formulation of the global STUMPS registry on behalf of the endourology section of the European Association of Urology and the suction mini-PCNL collaborative study group.","authors":"Vineet Gauhar, Daniele Castellani, Jaisukh Kalathia, Amish Mehta, Nariman Gadzhiev, Vigen Malkhasyan, Nitesh Kumar, Rajiv H Kalbit, Ivan Gorgotsky, Mehmet Ilker Gokce, Mahmoud Laymon, Takaaki Inoue, Gopal Ramdas Tak, Abu Baker, Pankaj Dholaria, Arun Chawla, Edgar Beltrán-Suárez, Abhay Mahajan, Khi Yung Fong, Steffi Kar-Kei Yuen, Karl Tan, Mohamed Omar, Kremena Petkova, Kazumi Taguchi, Chinnakhet Ketsuwan, Mohamed Amine Lakmichi, Sundaram Palaniappan, Yiloren Tanidir, Nebil Akdogan, Marcos Cepeda, Alexey Martov, Zelimkhan Tokhtiyev, Lazaros Tzelves, Andreas Skolarikos, Esteban Acuña, Marek Zawadzki, Wissam Kamal, Leonardo Gomes Lopes, Dmitriy Gorelov, Madhu Sudan Agrawal, Chandra Mohan Vaddi, Bhaskar K Somani, Thomas R W Herrmann","doi":"10.1007/s00345-025-05656-8","DOIUrl":"https://doi.org/10.1007/s00345-025-05656-8","url":null,"abstract":"<p><strong>Purpose: </strong>To present outcomes of a registry to understand the practice patterns, resource utilization, and nuances of suction mini-percutaneous nephron lithotripsy (SM-PCNL).</p><p><strong>Methods: </strong>Data from 30 centers in 21 countries were prospectively collected (March-November 2024). SM-PCNL was defined as PCNL using a suction nephrostomy sheath of size 14-22 Fr. with any lithotripsy device. There were no instructions on how to perform the surgical procedure. Stone features and stone-free status were assessed using an unenhanced CT scan. Data are presented as median/interquartile range and frequency/proportion.</p><p><strong>Results: </strong>1707 patients were included and 42.4% of them were males. Most were first-time stone formers. Median age was 50 years. Median stone volume was 1700 mm³. Surgery was commonly performed using a single access tract (92.9%) and in supine position (56.5%). The fluoroscopy-only puncture was used as the most common access (70.7%), followed by the combination of fluoroscopy and ultrasound (25.1%). Median operation time was 45 min. The most common sheath was Clearpetra (27.8%). Thulium fiber laser was the most frequent energy used (26.2%). A tubeless procedure with a stent was employed in 47.0% of cases. Most common complications were fever managed by observation (7.3%), fever requiring antibiotics (3.3%), blood transfusion (1.1%), and sepsis (0.2%). Median hospitalization was 3 days. 30-day CT scan showed zero fragments in 82.4% of patients. Reintervention was performed in 2.6% of cases.</p><p><strong>Conclusions: </strong>This registry outlines the various equipment, peri-operative strategies, complications, and outcomes of SM-PCNL performed in real-world practice, providing valuable data on the nuances of performing such surgery.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"298"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013586","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":"Integration of brain-computer interfaces with sacral nerve stimulation: a vision for closed-loop, volitional control of bladder function in neurogenic patients through real-time cortical signal modulation and peripheral neuro-stimulation.","authors":"Ali Aamir, Munaim Siddiqui","doi":"10.1007/s00345-025-05683-5","DOIUrl":"https://doi.org/10.1007/s00345-025-05683-5","url":null,"abstract":"<p><p>Sacral nerve stimulation (SNS) and brain-computer interfaces (BCI) are emerging neuromodulation therapies that offer innovative solutions for chronic neurological disorders. SNS, primarily used in the management of conditions such as urinary incontinence and chronic pelvic pain, demonstrates significant therapeutic potential. In contrast, BCIs are rapidly advancing in their ability to restore lost motor functions and improve the quality of life of patients with severe neurological impairments, such as spinal cord injury and stroke. The integration of SNS and BCI technologies presents a promising avenue for enhancing neuromodulation outcomes by leveraging the potential of both systems. This article explores the combined operation of SNS and BCI, addressing current challenges, future directions, and the potential for these combined therapies to revolutionise the field of functional neuromodulation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"301"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050807","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":"A comparative study of mirabegron versus doxazosin in improving ureteral stent-related dysfunction.","authors":"Bo Tao, Enyan Jiang, Yuan Zhao, Zhangxiao Xu, Juan Yang, Lijun Wang","doi":"10.1007/s00345-025-05663-9","DOIUrl":"10.1007/s00345-025-05663-9","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of mirabegron and doxazosin in alleviating ureteral stent-related symptoms and sexual dysfunction.</p><p><strong>Method: </strong>This study included 107 patients who provided informed consent and underwent transurethral ureteral lithotripsy with ureteral stent placement between January 2023 and December 2023. Patients were randomized into two groups receiving either mirabegron (50 mg/day) or doxazosin (4 mg/day). The Ureteral Stent Symptom Questionnaire (USSQ) scores and adverse drug reactions were recorded at baseline (ureteral stent placement), 2 weeks (ureteral stent removal), and 4 weeks (2 weeks after stent removal). The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2500095161).</p><p><strong>Results: </strong>At 2 weeks, the mirabegron group showed a greater improvement in pain during intercourse compared to the doxazosin group (0.379 ± 0.186; p = 0.043). This improvement persisted at 4 weeks (0.363 ± 0.186). No significant differences were observed in sexual satisfaction scores between the groups at either time point (2 weeks: 0.175 ± 0.186, p = 0.350; 4 weeks: 0.157 ± 0.186, p = 0.401). Subgroup analysis revealed that mirabegron provided greater relief of pain during intercourse in women compared to doxazosin (OR = 14.40, 95% CI 1.53-135.51, p = 0.020). Additionally, women in the doxazosin group reported significantly lower sexual satisfaction compared to the mirabegron group (OR = 42.00, 95% CI 2.41-825.71, p = 0.014).</p><p><strong>Conclusions: </strong>Mirabegron and doxazosin demonstrated similar efficacy in relieving ureteral stent-related symptoms. However, mirabegron offered a clear advantage in improving female sexual function, particularly regarding pain during intercourse and overall satisfaction.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"299"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Modified amplatz sheath with suction versus standard sheath in percutaneous nephrolithotomy for treating large renal stones > 2 cm: a prospective randomized trial\".","authors":"Huacai Zhu, Jianhua Huang, Pengpeng Zhao, Zhanping Xu","doi":"10.1007/s00345-025-05686-2","DOIUrl":"https://doi.org/10.1007/s00345-025-05686-2","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"297"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985506","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":"Artificial intelligence for enhanced classification of intraoperative complications in urology.","authors":"Zine-Eddine Khene, Frédéric Panthier, Lucas Bento, Alexandre de La Taille","doi":"10.1007/s00345-025-05623-3","DOIUrl":"https://doi.org/10.1007/s00345-025-05623-3","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"293"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029980","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":"Comment on: \"With great power comes great risk: high ureteral stricture rate after high-power, high-frequency thulium fiber laser lithotripsy in ureteroscopy\".","authors":"Mucahit Gelmis, Ali Ayten","doi":"10.1007/s00345-025-05678-2","DOIUrl":"https://doi.org/10.1007/s00345-025-05678-2","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"296"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013103","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":"Silicone double-j stents for long-term ureteral stenting: results from a multicentric PEARLS analysis.","authors":"Mariela Corrales, Etienne Xavier Keller, Yazeed Barghouthy, Felipe Pauchard, Vincent De Coninck, Olivier Traxer","doi":"10.1007/s00345-025-05481-z","DOIUrl":"10.1007/s00345-025-05481-z","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze outcomes from long-term ureteral stenting using silicone double-j stents (maximal dwell time of 12 months).</p><p><strong>Methods: </strong>Patients undergoing first-time insertion of an ImaJin™ or ImaJin Hydro™ silicone double-j stent with a planned dwell time of a least 3 months were considered. Patients treated between 2018 and 2024 were included in this multicenter, retrospective study. Primary endpoint was stent failure, defined as unplanned premature re-intervention.</p><p><strong>Results: </strong>105 patients were available for analysis. Median age was 63 years. All stents were inserted using a hydrophilic guidewire without any complications related to stent insertion. In 11 patients (10%) the cause of ureteral obstruction was extrinsic, in 31 patients (30%) parietal and in 63 patients (60%) intra-luminal. Stent failure-free survival estimates at 1,3,6,9 and 12 months were 99%,98%,88%,82% and 69%, respectively. Estimated mean failure-free survival was 307 days (95% confidence interval 282 to 332). Among all baseline and perioperative parameters, increasing patient weight, increasing urinary leucocytes, and urinary tract infection (UTI) were found to be significant and independent predictors of stent failure (all p < 0.05). Spontaneous stent migration was noted in one patient (< 1%). Stent encrustation was documented in 13 patients (12%), with five of these cases occurring after > 365 days.</p><p><strong>Conclusion: </strong>Long-term ureteral stenting with silicone double-j stents seems to be an effective and safe treatment with low encrustation and stent migration rates. Close follow-up and screening for stent failure shall be considered in patients with high weight, high urinary leucocytes or in cases with suspected UTI.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"292"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031581","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":"Multiparametric MRI lesion dimension as a significant predictor of positive surgical margins following laparoscopic radical prostatectomy for transitional zone prostate cancer.","authors":"Xin Chen, Yanzhong Chen, Chengbo Qian, Chaozhong Wang, Yuxin Lin, Yuhua Huang, Jianquan Hou, Xuedong Wei","doi":"10.1007/s00345-025-05680-8","DOIUrl":"10.1007/s00345-025-05680-8","url":null,"abstract":"<p><strong>Background: </strong>Positive surgical margins (PSM) after laparoscopic radical prostatectomy are a critical factor influencing treatment outcomes and prognosis in prostate cancer. Optional treatment strategies (neoadjuvant therapy, surgical techniques) and intraoperative margin monitoring highlight the importance of PSM risk assessment. This study aims to evaluate the potential PSM risk in transitional zone (TZ) tumors.</p><p><strong>Materials and methods: </strong>This retrospective study included 434 patients who underwent laparoscopic radical prostatectomy after multiparametric magnetic resonance imaging at our center between 2019 and 2023.</p><p><strong>Results: </strong>The PSM rate was significantly higher in patients with TZ lesions compared to those with peripheral zone lesions (47%, n = 175 vs. 28%, n = 226, p < 0.01). Lesion location in TZ (OR: 4.29, 97.5% CI: 2.60-7.23, p < 0.01) was identified as independent risk factors for PSM. Further analysis identified largest dimension of lesions (OR: 1.27, 97.5% CI: 1.09-1.50, p < 0.01) and the number of positive biopsy cores (OR: 1.39, 97.5% CI: 1.16-1.70, p < 0.01) as independent risk factors for PSM in patients with TZ tumors. LASSO regression identified four significant variables (largest dimension of lesions-the most important variable, number of positive biopsy cores, prostate-specific antigen density, and International Society of Urological Pathology grade). These variables were used to construct three PSM risk prediction models, each demonstrating favorable predictive accuracy and clinical benefit.</p><p><strong>Conclusions: </strong>Certain TZ prostate cancer patients demonstrate a higher predisposition to PSM occurrence. Lesion dimension as a significant predictor of PSM for TZ patients. Separate PSM risk assessments for subgroups, like TZ prostate cancer patients, may enhance predictive accuracy and clinical utility.</p><p><strong>Clinical trial registration: </strong>China Clinical Trial Registry (ChiCTR2300075944, 2023).</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"295"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel predictive method for URS and laser lithotripsy using machine learning and explainable AI: results from the FLEXOR international database.","authors":"Carlotta Nedbal, Vineet Gauhar, Sairam Adithya, Pietro Tramanzoli, Nithesh Naik, Shilpa Gite, Het Sevalia, Daniele Castellani, Frédéric Panthier, Jeremy Y C Teoh, Ben H Chew, Khi Yung Fong, Mohammed Boulmani, Nariman Gadzhiev, Abhishek Gajendra Singh, Thomas R W Herrmann, Olivier Traxer, Bhaskar K Somani","doi":"10.1007/s00345-025-05551-2","DOIUrl":"10.1007/s00345-025-05551-2","url":null,"abstract":"<p><strong>Purpose: </strong>We developed Machine learning (ML) algorithms to predict ureteroscopy (URS) outcomes, offering insights into diagnosis and treatment planning, personalised care and improved clinical decision-making.</p><p><strong>Methods: </strong>FLEXOR is a large international multicentric database including 6669 patients treated with URS for urolithiasis from 2015 to 2023. Preoperative and postoperative(PO) correlations were investigated through 15 ML-trained algorithms. Outcomes included stone free status (SFS, at 3-month imaging follow up), intraoperative (PCS bleeding, ureteric/PCS injury, need for postoperative drainage) and PO complications (fever, sepsis, need for reintervention). ML was applied for the prediction, correlation and logistic regression analysis. Explainable AI emphasizes key features and their contributions to the output.</p><p><strong>Results: </strong>Extra Tree Classifier achieved the best accuracy (81%) in predicting SFS. PCS bleed was negatively linked with 'positive urine culture'(-0.08), 'tamsulosin'(-0.08), 'stone location'(-0.10), 'fibre optic scope'(-0.19), 'Moses Fibre'(-0.09), and 'TFL'(-0.09), and positively with 'elevated creatine'(0.25), 'fever'(0.11), and 'stone diameter'(0.21). 'PCS injury' and 'ureteric injury' both showed moderate correlation with 'elevated creatinine'(0.11), 'fever'(0.10), and 'lower pole stone'(0.09). 'Tamsulosin'(0.23) use, presence of 'multiple'(0.25) or 'lower pole'(0.25) stones, 'reusable scope'(0.17) and 'Moses Fibre'(0.2546) increased the risk for PO stent, while 'digital scope'(-0.13) or 'TFL'(-0.29) reduced it. 'Preoperative fever'(0.10), 'positive urine culture'(0.16), and 'stone diameter'(0.10) may play a role in 'PO fever' and 'sepsis'. SFS was mainly influenced by 'age'(0.12), 'preoperative fever'(0.09), 'multiple stones'(0.15), 'stone diameter'(0.17), 'Moses Fibre\"(0.15) and 'TFL'(-0.28).</p><p><strong>Conclusion: </strong>ML is valuable tool for accurately predicting outcomes by analysing pre-existing datasets. Our model demonstrated strong performance in outcomes and risks prediction, laying the groundwork for development of accessible predictive models.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"294"},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}