Current Urology最新文献

{"title":"Holmium laser enucleation of the prostate versus transurethral resection of the prostate in treatment of benign prostatic hyperplasia: A meta-analysis of 13 randomized control trials.","authors":"Besut Daryanto, Wisnu Syahputra Suryanullah, Probo Yudha Pratama Putra","doi":"10.1097/CU9.0000000000000257","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000257","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of benign prostatic hyperplasia (BPH) in older men increases with age, beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years. Surgical procedures such as holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the preferred treatments for BPH. Nevertheless, there is disagreement regarding the most efficient and safe treatment for BPH. The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.</p><p><strong>Materials and methods: </strong>This meta-analysis was performed in accordance with the PRISMA guidelines. In February 2023, a literature review was conducted using PubMed, ScienceDirect, and the Cochrane Library, and the meta-analysis was performed using RevMan V.5.4.</p><p><strong>Results: </strong>A total of 656 patients underwent HoLEP, and 653 patients underwent TURP. There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3, 6, 18, 24, and 36 months; the HoLEP group showed a significant difference at 12 months. The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings, but the TURP group showed significant results at 24 months. Meanwhile, the HoLEP group showed significant postvoid residual results. There was no significant difference in the quality of life between the groups. Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop. The operating time was shorter in the TURP group. The difference in specimen weight between the 2 groups was not statistically significant. The overall complications were similar in both groups, but the HoLEP group received significantly fewer blood transfusions.</p><p><strong>Conclusions: </strong>Holmium laser enucleation of the prostate demonstrated excellent efficacy and safety, with fewer hematological changes and complications; however, TURP had a shorter operating time.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"19 1","pages":"6-16"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040388","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":"Ability of clock drawing errors on Mini-Cog test to predict development of delirium after major urological cancer surgery.","authors":"Shugo Yajima, Yasukazu Nakanishi, Shunya Matsumoto, Naoya Okubo, Kenji Tanabe, Madoka Kataoka, Hitoshi Masuda","doi":"10.1097/CU9.0000000000000177","DOIUrl":"10.1097/CU9.0000000000000177","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the impact of the clock drawing test (CDT) on postoperative delirium and compare the abilities of the mini-cognitive (Mini-Cog) test and the CDT for predicting postoperative delirium after major urological cancer surgery.</p><p><strong>Materials and methods: </strong>In this single-center retrospective observational study, we collected the medical records of patients who underwent major urologic cancer surgery and preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and the 3-word recall task at our department in 2020-2021 (n = 387). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for postoperative delirium. We also compared the ability of the CDT alone and the Mini-Cog test consisting of the CDT and 3-word recall task to predict postoperative delirium.</p><p><strong>Results: </strong>A total of 117 patients (30%) had abnormal CDT results. Postoperative delirium occurred in 29 patients (7%). On multivariate analysis, American Society of Anesthesiologists physical status ≥3 (odds ratio [OR], 5.0; <i>p</i> = 0.01), abnormal CDT (OR, 4.8; <i>p</i> < 0.001), preoperative benzodiazepine use (OR, 4.9; <i>p</i> < 0.001), and operative time ≥237 minutes (OR, 3.0; <i>p</i> = 0.01) were independent risk factors for postoperative delirium. The area under the curve for predicting postoperative delirium was 0.709 for CDT alone and 0.743 for the Mini-Cog test. No significant intergroup difference was observed (<i>p</i> = 0.43).</p><p><strong>Conclusions: </strong>The CDT served as a formal but simple tool with adequate predictive power to identify the risk of postoperative delirium among patients undergoing major urological cancer surgery. Effective screening using the CDT might help provide optimal urological care for older patients.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":" ","pages":"64-69"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44309131","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":"Beyond size: A comprehensive overview of small-volume benign prostatic hyperplasia.","authors":"Junhao Xu, Bangmin Han, Shujie Xia, Yifeng Jing","doi":"10.1097/CU9.0000000000000261","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000261","url":null,"abstract":"<p><p>Benign prostatic hyperplasia (BPH) is one of the most frequently diagnosed benign disorders that cause dysuria in middle-aged and elderly men. Some patients with BPH have relatively small prostates (referred to as small-volume BPH) but still experience the lower urinary tract infection. Medication treatment is typically not successful in these patients. In addition, their pathophysiologic pathways deviate from those previously observed. Furthermore, as there is no accepted protocol for the diagnosis and treatment of small-volume BPH, patients can experience great difficulties in managing surgical complications such as bladder neck contracture. Thus, we reviewed the features of small-volume prostates, preoperative assessment, surgical technique, and management of complications.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"19 1","pages":"1-5"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054364","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":"A randomized comparative study of flexible ureterorenoscopy versus mini-percutaneous nephrolithotomy for treatment of renal stones 2 cm or less.","authors":"Amr E Darwish, Alaa E Abdel Moneim, Abdelfatah I Ahmed, Seif M Hamdy, Hassan A Abolella, Ahmed Reda","doi":"10.1097/CU9.0000000000000215","DOIUrl":"10.1097/CU9.0000000000000215","url":null,"abstract":"<p><strong>Background: </strong>Flexible ureterorenoscopy (fURS) and mini-percutaneous nephrolithotomy (mPCNL) have been increasingly used for the treatment of renal stones. However, current guidelines do not recommend one modality over the other. The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.</p><p><strong>Materials and methods: </strong>A prospective, randomized, comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers. Inclusion criteria were adult patients with renal stone(s) ≤ 2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy. Subjects were assigned to 1 of 2 treatment groups, either mPCNL or fURS. Two primary outcomes were assessed: (1) initial success rate, defined as the absence of clinically significant residual fragments (>2 mm) on kidney ureter bladder X-ray and ultrasound on the first postoperative day; and (2) complications, which were reported according to the Modified Clavien-Dindo classification system. Secondary outcomes included final success rate, defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day; operative time; auxiliary procedures and blood transfusion rates; hemoglobin drop; and length of hospital stay.</p><p><strong>Results: </strong>One hundred and eighteen procedures were analyzed (59 in each group). The initial success rate of the mPCNL group (93%) was significantly higher than that of the fURS group (70%). Complications occurred more frequently with mPCNL than fURS (44.1% vs. 18.6%, respectively). Final success rate, operative time, and length of hospital stay were comparable between the 2 groups.</p><p><strong>Conclusions: </strong>Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones <2 cm because of its higher initial success rate and lower auxiliary procedure rate. However, mPCNL results in significantly higher complication rates than fURS.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":" ","pages":"273-277"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45386070","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":"A contemporary step-by-step guide to performing flexible ureterorenoscopy for renal calculi.","authors":"Thomas Fonseka, Alberto Melchionna, Nicolo De Luyk, Vimoshan Arumuham, Simon Choong","doi":"10.1097/CU9.0000000000000252","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000252","url":null,"abstract":"<p><p>With advancements in laser technology and urological techniques, flexible ureterorenoscopy has emerged as a vital surgical approach for managing stone disease. Various techniques can be employed to customize endourological stone treatments. Despite the continuous evolution of equipment, it remains crucial to comprehend the fundamental steps of the procedure. This paper offers a comprehensive step-by-step guide that integrates the latest advancements in both scopes and lasers. Additionally, it outlines potential pitfalls and strategies to circumvent them, aiming to achieve optimal stone clearance and deliver individualized patient care safely and efficiently.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"18 4","pages":"265-267"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044674","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":"Erratum.","authors":"","doi":"10.1097/CU9.0000000000000258","DOIUrl":"https://doi.org/10.1097/CU9.0000000000000258","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/CU9.0000000000000224.].</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"18 4","pages":"350"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023439","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":"Relevance of Guy's stone score in evaluation and outcome of percutaneous nephrolithotomy.","authors":"Rohit Kapoor, Deepak Mane, Siddharth Jai Singh, Vikram Satav, Vilas Sabale, Pratyush Ranjan","doi":"10.1097/CU9.0000000000000165","DOIUrl":"10.1097/CU9.0000000000000165","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to ascertain the relevance of the Guy's stone score in the evaluation and outcome of percutaneous nephrolithotomy (PCNL).</p><p><strong>Materials and methods: </strong>This 2-year hospital-based, prospective clinical study enrolled 100 patients who were indicated for PCNL. All patients were allocated into groups according to the Guy's stone score and were compared for factors associated with stone-free rate (SFR) and complication risk. The data were statistically analyzed using SPSS version 20.</p><p><strong>Results: </strong>The median patient age was 40 years (range, 5-70 years). A greater portion of the patients were aged 31-40 years. A majority of the stones were solitary, found in 83% of the kidneys. Overall, 49% were grouped as Guy's stone score 1, 26% as 2, 11% as 3, and 14% as 4. The overall SFR was 97%. Furthermore, SFR was found to be 100% for Guy's stone score 1, 100% for 2, 90.91% for 3, and 85.7% for 4. Intraoperative and postoperative complication rates were found in 6% and 38% of the patients, respectively. Among postoperative complications, pain (26%) was the most frequent, followed by fever (8%), bleeding (3%), and puncture site abscess (1%).</p><p><strong>Conclusions: </strong>Based on the study findings, Guy's stone score was efficient in predicting PCNL outcomes.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":" ","pages":"287-290"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48862492","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":"Visual guidelines and tutoring in pediatric urological surgery.","authors":"Stanislav Kotcherov, Shahar Rotem, Jawdat Jaber, Galit Avraham, Gennady Lev, Michal Darmon, Yudith Gabay, Boris Chertin","doi":"10.1097/CU9.0000000000000066","DOIUrl":"10.1097/CU9.0000000000000066","url":null,"abstract":"<p><strong>Background: </strong>The aim of this prospective randomized study was to evaluate the impact of visual guidelines (picture book) and parents tutoring on pediatric urological surgery on parent's stress and anxiety, the number of postoperative contacts, and complications.</p><p><strong>Materials and methods: </strong>Following institutional ethical committee approval, a special picture book reflecting different stages of the convalescent period following multiple types of pediatric urological surgery was developed. Parents were randomly divided into 2 groups in which 33 parents in Group 1 received the picture book in addition to routine instructions prior to the surgery and 31 in Group 2 received only routine postoperative instructions. The parents were asked to answer a questionnaire (Amsterdam Preoperative Anxiety and Information Scale) regarding the level of anxiety before surgery and immediately after surgery in the recovery room. The number of postoperative parent's calls, nonplaned emergency room visits, and complications were recorded.</p><p><strong>Results: </strong>No statistically significant difference in perioperative parental anxiety was found <i>(p</i> = 0.88). The visual tutoring group had a significantly lower rate of emergency room admissions (6.6% vs. 18.6%, <i>p</i> = 0.0433), however parents from this group made a higher number of postoperative calls (9.9% vs. 3.1%, <i>p</i> = 0.38). Two (6.6%) from the tutoring group expressed their desire to omit visual counseling in future surgical preparation and 4 (13.2%) did not have an opinion. Overall satisfaction with regards to the preoperative counseling and information and the number of postoperative complications was similar in both groups.</p><p><strong>Conclusions: </strong>Visual tutoring does not add any value to parental anxiety but seems helpful in reducing postoperative emergency room visits. Some parents preferred to exclude visual information from future preoperative counseling.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"1 1","pages":"18-22"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42533932","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":"Hypoxia activates the hypoxia-inducible factor-1α/vascular endothelial growth factor pathway in a prostatic stromal cell line: A mechanism for the pathogenesis of benign prostatic hyperplasia","authors":"Tao Zhang, Changlin Mao, Yao Chang, Jia Lyu, Delong Zhao, Sentai Ding","doi":"10.1097/cu9.0000000000000233","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000233","url":null,"abstract":"\u0000 \u0000 \u0000 The development of benign prostatic hyperplasia (BPH) is closely related to hypoxia in the prostatic stroma, and the hypoxia-inducible factor-1α/vascular endothelial growth factor (HIF-1α/VEGF) pathway has been shown to significantly activate in response to hypoxia. The underlying mechanism for activation of this pathway in the pathogenesis of BPH remains unclear.\u0000 \u0000 \u0000 \u0000 We constructed HIF-1α overexpression and knockdown BPH stromal (WPMY-1) and epithelial (BPH-1) cell lines, which were cultured under different oxygen conditions (hypoxia, normoxia, and hypoxia + HIF-1α inhibitor). Quantitative real-time polymerase chain reaction (qPCR) and Western blotting were applied to detect the expression of the HIF-1α/VEGF pathway. Cell proliferation and apoptosis were analyzed by Cell Counting Kit-8 and flow cytometry. We used the miRWalk 2.0 database and Western blotting to predict the potential miRNA that selectively targets the HIF-1α/VEGF pathway, and verified the prediction by qPCR and dual-luciferase assays.\u0000 \u0000 \u0000 \u0000 In a BPH stromal cell line (WPMY-1), the expression of VEGF was in accordance with HIF-1α levels, elevated in the overexpression cells and decreased in the knockdown cells. Hypoxia-induced HIF-1α overexpression, which could be reversed by a HIF-1α inhibitor. Moreover, the HIF-1α inhibitor significantly depressed cellular proliferation and promoted apoptosis in hypoxic conditions, assessed by Cell Counting Kit-8 and flow cytometry. However, in the BPH epithelial cell line (BPH-1), the expression level of HIF-1α did not influence the expression of VEGF. Finally, a potential miRNA, miR-17-5p, regulating the HIF-1α/VEGF pathway was predicted from the miRWalk 2.0 database and Western blotting, and verified by qPCR and dual-luciferase assay.\u0000 \u0000 \u0000 \u0000 In hypoxia, activation of the HIF-1α/VEGF pathway plays a crucial role in regulating cell proliferation in a BPH stromal cell line. Regulation by miR-17-5p may be the potential mechanism for the activation of this pathway. Regulation of this pathway may be involved in the pathogenesis of BPH.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"32 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139003214","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":"Comparison of midurethral tape with autologous rectus fascial sling surgery for stress urinary incontinence: A systematic review and meta-analysis","authors":"Yavuz Güler","doi":"10.1097/cu9.0000000000000225","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000225","url":null,"abstract":"Abstract Objectives To compare the success rates of autologous fascial mesh (sling and transobturator tape [TOT]) with midurethral synthetic meshes (tension-free vaginal tape sling [TVT] and TOT) for stress urinary incontinence. Materials and methods A literature search for studies published in English was conducted from May 10, 2022, to June 1, 2022. The search included MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms{“Autologous fascial slings”}OR {“AFS”} AND{“TOT”} OR {“Transobturator tape”} OR{“TVT”} OR{“Transvaginal tape”}. A total of 20 studies, including 10 randomized controlled trials, were selected for the review. RevMan software (version 5.3) was used to calculate the pooled effect estimates for operative and postoperative variables. Results In the systemic review, 20 studies, including 10 randomized controlled trials, were assessed. In the TVT versus autologous pubovaginal sling (A-PVS) groups, the effect estimates for the surgical duration, catheter duration, success, and complication rates were more advantageous for TVT. However, in comparison to autologous transobturator tape groups, TOT provided better operative time and a shorter hospital stay. Moreover, in comparison to the A-PVS group, the TOT group was superior in terms of operating time, urethral catheterization, hospital stay, amount of residual urine, and wound complications. The A-PVS group had significantly more groin and thigh pain. Conclusions During medium- and long-term follow-ups, the use of autologous rectus fascia grafts using a A-PVS or TOT provided similar complication rates and urinary continence results as using midurethral synthetic meshes (TVT and TOT).","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135634214","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}