Minerva Urology and Nephrology最新文献

{"title":"Urinary tract infection as a leading cause of morbidity after radical cystectomy: unveiling microbiological patterns and risk factors.","authors":"Alberto Artiles Medina, José D Subiela Henríquez, Alfonso Muriel García, César Mínguez Ojeda, Álvaro Sánchez González, Irene DE LA Parra Sánchez, David López Curtis, Victoria Gómez Dos Santos, Miguel Á Jiménez Cidre, Francisco J Burgos Revilla","doi":"10.23736/S2724-6051.24.06171-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06171-8","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774626","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 the influence of smoking on inflammatory markers in bacillus Calmette Guérin response among bladder cancer patients: a novel machine-learning approach.","authors":"Matteo Ferro, Octavian S Tataru, Giuseppe Fallara, Cristian Fiori, Matteo Manfredi, Francesco Claps, Rodolfo Hurle, Nicolò M Buffi, Giovanni Lughezzani, Massimo Lazzeri, Achille Aveta, Savio D Pandolfo, Biagio Barone, Felice Crocetto, Pasquale Ditonno, Giuseppe Lucarelli, Francesco Lasorsa, Giuseppe Carrieri, Gian M Busetto, Ugo G Falagario, Francesco Del Giudice, Martina Maggi, Francesco Cantiello, Marco Borghesi, Carlo Terrone, Pierluigi Bove, Alessandro Antonelli, Alessandro Veccia, Andrea Mari, Stefano Luzzago, Raul Gherasim, Ciprian Todea-Moga, Andrea Minervini, Gennaro Musi, Francesco A Mistretta, Roberto Bianchi, Marco Tozzi, Francesco Soria, Paolo Gontero, Michele Marchioni, Letizia M Janello, Daniela Terracciano, Giorgio I Russo, Luigi Schips, Sisto Perdonà, Riccardo Autorino, Michele Catellani, Chiara Sighinolfi, Emanuele Montanari, Savino M DI Stasi, Francesco Porpiglia, Bernardo Rocco, Ottavio de Cobelli, Roberto Contieri","doi":"10.23736/S2724-6051.24.05876-2","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05876-2","url":null,"abstract":"<p><strong>Background: </strong>Approximately 70% of bladder cancer is diagnosed as non-muscle invasive (NMIBC) and inflammation is known to impact the oncological outcomes. Adjuvant intravesical BCG in intermediate/high risk can lower recurrence and progression. The efficacy of intravesical BCG can be impacted by smoking effects on systemic inflammation.</p><p><strong>Methods: </strong>Our retrospective, multicenter study with data from 1.313 NMIBC patients aimed to assess the impact of smoking and the systemic inflammatory status on BCG response in T1G3 bladder cancer, using a machine-learning CART based algorithm.</p><p><strong>Results: </strong>In a median of 50-month follow-up (IQR 41-75), 344 patients experienced progression to muscle invasive or metastatic disease and 65 died due to bladder cancer. A CART algorithm has been employed to stratify patients in three prognostic clusters using smoking status, LMR (lymphocytes to monocytes ratio), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) as variables. Cox regression models revealed a 1.5-fold (HR 1.66, 95%, CI 1.20-2.29, P=0.002) and three-fold (HR 2.99, 95% CI 2.08-4.30, P<0.001) risk of progression, in intermediate and high risk NMIBC respectively, compared to the low-risk group. The model's concordance index was 0.66.</p><p><strong>Conclusions: </strong>Our study provides an insight into the influence of smoking on inflammatory markers and BCG response in NMIBC patients. Our machine-learning approach provides clinicians a valuable tool for risk stratification, treatment, and decision-making. Future research in larger prospective cohorts is required for validating these findings.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774689","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":"Comparative analysis of the long-term efficacy and safety of minimally invasive simple prostatectomy and endoscopic enucleation of the prostate for large benign prostatic hyperplasia (>80 mL).","authors":"Jia Luo, Pengjun Xu, Hui Shuai, Tao Cai, Shu Cui, Lin Zhou, Qian Xu, Yuxin Zhao, Tao Chen, Tao Wu","doi":"10.23736/S2724-6051.24.05940-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05940-8","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive simple prostatectomy (MISP) and endoscopic enucleation of the prostate (EEP) are appropriate candidates for the large prostate. However, their comparative effectiveness and safety remain unclear. This study aims to conduct a comprehensive analysis comparing the efficacy and safety of MISP and EEP.</p><p><strong>Evidence acquisition: </strong>We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases to identify eligible studies comparing MISP and EEP. Data analysis was performed using Review Manager 5.3. Risk of bias was assessed with the ROBINS-I and the ROB2.0 assessment tool.</p><p><strong>Evidence synthesis: </strong>The results of analyzing 13 studies involving 2271 patients showed that EEP had significant lower operative time (MD [CI]: 41.59 [14.62-68.56]), catheterization time (MD [CI]: 4.35 [3.31-5.38]), length of stay (MD [CI]: 2.16 [0.70-3.61]), and Hb decreases (MD [CI]: 0.46 [0.06-0.87]). MISP demonstrated significantly better long-term (MD [CI]: -0.46 [-0.89; -0.03]) and short-term QoL (MD [CI]: -0.38 [-0.66; -0.10]) and short-term Qmax (MD [CI]: 2.04 [0.06-4.03]). Efficacy outcomes were comparable in postoperative IPSS, PVR and PSA between MISP and EEP procedures. No significant differences were observed in resection weight, overall complications, blood transfusions, or urinary incontinence between MISP and EEP.</p><p><strong>Conclusions: </strong>Overall, EEP and MISP are both effective treatment options for large-volume BPH, providing comparable efficacy outcomes and long-term maintenance. EEP, on the other hand appears to have better perioperative outcomes, but it has a higher rate of short-term postoperative incontinence.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774693","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":"Robot-assisted redo ureteral reimplantation in adults after failed primary surgery: technique and outcomes from two centers.","authors":"Liqing Xu, Xinfei Li, Fangzhou Zhao, Zhihua Li, Guanpeng Han, Wencong Han, Yaming Gu, Bing Wang, Peng Zhang, Wenzhi Gao, Liang Cui, Liqun Zhou, Kunlin Yang, Xuesong Li","doi":"10.23736/S2724-6051.24.06009-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06009-9","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report our technical experience and mid-term outcomes of robot-assisted redo ureteral reimplantation in adults following failed primary ureteral reimplantation.</p><p><strong>Methods: </strong>Twelve patients underwent robot-assisted redo ureteral reimplantation from December 2020 to May 2022 at double centers. Surgical procedures included anti-reflux dismembered submucosal tunnel reimplantation, anti-reflux dismembered nipple reimplantation, and anti-reflux non-dismembered submucosal tunnel reimplantation. The perioperative variables were prospectively collected, and the outcomes were assessed.</p><p><strong>Results: </strong>Twelve patients underwent 13 robot-assisted redo ureteral reimplantations. Anastomotic stenosis was the primary cause of redo surgery, accounting for 83.3% of cases. Additionally, 83.3% of patients had received balloon dilation, stent placement, and other urological treatments after primary surgery. All patients successfully underwent robot-assisted redo ureteral reimplantation without conversion to open or laparoscopic surgery. All patients underwent anti-reflux technique, with 9 patients undergoing submucosal tunnel reimplantation (75%) and 3 nipple reimplantation (25%). Psoas hitch was required in eight patients (66.7%). The mean operative time was 129.3±29.0 minutes. The median postoperative hospitalization time was 3.0 (IQR, 3.0, 3.0) days. At a mean follow-up of 15.7±5.9 months, all patients achieved complete success with no severe complication. Two patients (16.7%) still experienced vesicoureteral reflux related symptoms postoperatively, which improved compared to preoperatively.</p><p><strong>Conclusions: </strong>Robotic redo ureteral reimplantation is safe and effective. The success of redo surgery is attributed to preoperative nephrostomy, clearing the fibrous scar surrounding the ureter, appropriate selection of anti-reflux technique, and psoas hitch when needed.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774623","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":"Robot-assisted partial nephrectomy of multiple tumors: a multicenter analysis.","authors":"Pouriya Faraj Tabrizi, Philip Zeuschner, Olga Katzendorn, Frank Schiefelbein, Andreas Schneller, Georg Schoen, Burkhard Ubrig, Simon Gloger, Clemens G Wiesinger, Jacob Pfuner, Eva Falkensammer, Ahmed Eraky, Daniar Osmonov, Philipp Nuhn, Volker Zimmermanns, Ionna Paramythelli, Boris A Hadaschik, Jan P Radtke, Christopher Darr, Nils Gilbert, Maximilian Kriegmair, Christian Fuhrmann, Markus A Kuczyk, Nina N Harke","doi":"10.23736/S2724-6051.24.05816-6","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05816-6","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses.</p><p><strong>Methods: </strong>The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses.</p><p><strong>Results: </strong>The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WIT<inf>sum</inf>) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WIT<inf>sum</inf>, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization.</p><p><strong>Conclusions: </strong>iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WIT<inf>sum</inf> was identified as a surgery-related independent parameter.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741206","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":"Iliococcygeus fixation for the treatment of vaginal vault prolapse: a systematic review and meta-analysis.","authors":"Andrea Braga, Giulia Amato, Giorgio Caccia, Andrea Papadia, Giorgio Treglia, Chiara Scancarello, Stefano Salvatore, Marco Torella, Yoav Baruch, Maurizio Serati","doi":"10.23736/S2724-6051.24.05818-X","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05818-X","url":null,"abstract":"<p><strong>Introduction: </strong>It has been reported that approximately 80-90% of apical prolapse repair is through reconstructive or obliterative vaginal surgery. Although several procedures have been described, to date there is a lack of consensus on the best surgical procedure. The aim of this study was to perform a thorough review of the current literature on the efficacy and safety of the iliococcygeus fixation technique for the treatment of vaginal vault prolapse.</p><p><strong>Evidence acquisition: </strong>A systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. was conducted using the PubMed/MEDLINE and Cochrane CENTRAL databases. Our analysis included randomized control trials and observational prospective or retrospective cohort studies that assessed the Iliococcygeus fixation, in terms of overall cure rate, failure rate, reoperation rate, and complications rate.</p><p><strong>Evidence synthesis: </strong>The overall cure rate ranged from 74.4% to 98% in the considered studies with a pooled value of 84.9% (95% CI: 73.3% to 96.4%). The overall failure rate ranged from 4.8% to 23% with a pooled value of 13.6% (95% CI: 5.5% to 21.7%) while the pooled value of overall re-operation rate was 3.3% (95% CI: 0.6% to 6%), ranging from 0% to 6.8. The overall complication rate ranged from 0% to 33% with a pooled value of 10.4% (95% CI: 1.4% to 19.3%).</p><p><strong>Conclusions: </strong>Despite limitations due to the heterogeneity of study designs, our review, for the first time in the literature, demonstrated that fixation of the iliococcygeus appears to be an effective and safe option for the treatment of vaginal vault prolapse. However, future randomized controlled trials with rigorous methodological protocols are needed.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741141","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":"Impact of antibiotic treatment duration for preoperative asymptomatic bacteriuria, during urological surgery, on postoperative infectious complications: results from the multicentric TOCUS cohort.","authors":"Humphrey Robin, Stessy Kutchukian, Pierre Bigot, Marc Françot, Stéphane de Vergie, Jérôme Rigaud, Mathilde Chapuis, Laurent Brureau, Camille Jousseaume, Omar Karray, Fares T Kosseifi, Aurélien Descazeaud, Harrison-Junior Asare, Maxime Gaullier, Baptiste Poussot, Thibault Tricard, Shahed Borojeni, Bastien Gondran-Tellier, Michael Baboudjian, Éric Lechevallier, Pierre-Olivier Delpech, Elias Ayoub, Héloïse Ducousso, Simon Bernardeau, Aurélien Dinh, Franck Bruyère, Maxime Vallée","doi":"10.23736/S2724-6051.24.05725-2","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05725-2","url":null,"abstract":"<p><strong>Background: </strong>According to the European guidelines, any urological surgery breaching the mucosa requires preoperative screening and antibiotic treatment of any asymptomatic bacteriuria (ABU).</p><p><strong>Methods: </strong>The aim of this study was to determine whether the preoperative antibiotic treatment duration of ABU in urological surgery impact postoperative infectious complications. National multicenter, retrospective study including all consecutive patients screened for ABU before urologic surgery in 10 centers from 1^st April 2019 to April 2023. The primary endpoint was all postoperative infectious complications occurring within 30 days after surgery. Short antibiotic treatment (SAT) of ABU was defined by 5- day regimen or less. Long antibiotic treatment (LAT) was defined by duration longer than 5 days.</p><p><strong>Results: </strong>Among the 2389 patients included, 839 (35.1%) patients had positive urine culture (UC), of whom 546 (65%) had positive mono or bimicrobial UC and 292 (34.8%) polymicrobial UC. There were 106 (4.4%) postoperative infectious complications occurring within 30 days including 62 (58.5%) in the positive UC group. In the positive UC group, 336 (40%) had received SAT, 261 (31.1%) LAT and 231 (27.5%) had not received any treatment. The 30-day surgery-related infection rates were 8.3%, 6.1% and 7.36% respectively. There was no statistical difference between SAT versus LAT in the univariate analysis (P=0.6) or in the multivariate analysis OR 1.97 [0.37, 1.86] (P=0.06).</p><p><strong>Conclusions: </strong>Our results found no association between antibiotic treatment duration and urinary infectious complication among patients with preoperative ABU who undergo urological surgery. These results need a RCT to be confirmed.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741155","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":"Conversions in robot-assisted partial nephrectomy: a multicentric analysis of 2549 cases.","authors":"Olga Katzendorn, Frank Schiefelbein, Georg Schoen, Clemens Wiesinger, Jacob Pfuner, Burkhard Ubrig, Simon Gloger, Daniar Osmonov, Ahmed Eraky, Christian Wagner, Abdirahman Ayanle, Mulham Al-Nadar, Claudia Kesch, Boris A Hadaschik, Pouriya Faraj Tabrizi, Mathias Wolters, Markus A Kuczyk, Stefan Siemer, Michael Stoeckle, Philip Zeuschner, Nina N Harke","doi":"10.23736/S2724-6051.24.06018-X","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06018-X","url":null,"abstract":"<p><strong>Background: </strong>Conversion in partial nephrectomy to radical nephrectomy occurs in 1-5%. This analysis assessed predictors for conversions in robot-assisted partial nephrectomies.</p><p><strong>Methods: </strong>Two thousand five hundred forty-nine patients at eight robotic centers for robot-assisted partial nephrectomy were retrospectively analyzed. Intervention was performed by 25 surgeons with varying expertise. Conversion was defined as change from robot-assisted partial nephrectomy to open partial, open radical or robot-assisted radical nephrectomy. Comparative analyses between converted and non-converted cases and within subgroups as well as multivariate regression analyses for predictors for conversion were performed.</p><p><strong>Results: </strong>Eighty-eight (3.5%) conversions were documented (17% open nephrectomy, 53% open partial nephrectomy, 30% robot-assisted nephrectomy). In case of conversion, patients were significantly older (P<0.001) with a higher Body Mass Index (BMI; P=0.029), larger tumor size (P<0.001), multiple tumors (P<0.001) and higher PADUA scores (P<0.001). Converting surgeons had a significantly lower experience in RAPN (median EXP 64 vs. 29, P<0.001). The main reasons to convert were unfavorable anatomic features (69%). Radical nephrectomy occurred more frequently in tumors with higher PADUA Score (P<0.001). Experienced surgeons in open renal surgery performed more often open partial nephrectomy in case of open conversion (P<0.001). Patients' age, BMI, surgeon's expertise, number of tumors, tumor size and PADUA Score were independent predictors for conversion (P<0.001). Limitations are the retrospective study design and short-term follow-up.</p><p><strong>Conclusions: </strong>Conversions in robot-assisted partial nephrectomy are predominantly determined by patient- and tumor-related factors, but also surgical experience. Intensified surgical training might reduce the risk of conversions with an increased chance for nephron-sparing surgery in converted cases.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741124","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":"Robot-assisted retroperitoneoscopic kidney surgery with Versius®.","authors":"Fabrizio Dal Moro, Simonetta Fracalanza, Fabio Zattoni, Giacomo Novara, Mario Gardi","doi":"10.23736/S2724-6051.24.06122-6","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06122-6","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683439","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":"Modified robot-assisted laparoscopic dismembered pyeloplasty for adult patients with horseshoe kidney: techniques and medium-term outcomes.","authors":"Zhenyu Li, Silu Chen, Yicong DU, Zhihua Li, Shubo Fan, Shengwei Xiong, Xiang Wang, Xinfei Li, Liqun Zhou, Kunlin Yang, Xuesong Li","doi":"10.23736/S2724-6051.24.06024-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.06024-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report our technique and medium-term outcomes of modified robot-assisted laparoscopic dismembered pyeloplasty (RALDP) in the Lithotomy Trendelenburg position for treating adult ureteropelvic junction obstruction (UPJO) with horseshoe kidney (HSK).</p><p><strong>Methods: </strong>Between March 2021 and March 2023, 11 adult patients with UPJO and HSK underwent modified RALDP in the lithotomy Trendelenburg position. Patient demographic characteristics, perioperative parameters, and follow-up outcomes were collected prospectively and analyzed. A detailed description of the technique and medium-term outcomes were reported.</p><p><strong>Results: </strong>The median (range) age was 33 (23-50) years. The mean preoperative serum creatinine and preoperative estimated glomerular filtration rate (eGFR) were 74.72±16.20 μmol/L and 100.4±16.5 mL/min/1.73 m², respectively. One patient (9.1%) required an additional right pyelolithotomy. The mean operative duration was 208±70 min. The median (range) estimated blood loss was 20 (20-100) mL. The median (range) drainage-tube removal time was 3 (2-4) days postoperatively. The median (range) postoperative hospitalization period was 5 (3-6) days. No open conversions or intraoperative complications occurred. Postoperative urinary tract infections (Clavien-Dindo grade II) occurred in two patients, managed with oral antibiotics. The median (range) follow-up of 25 (12-36) months achieved an overall success rate of 100%. The mean postoperative serum creatinine and postoperative eGFR were 74.96±17.43 μmol/L and 98.14±18.39 mL/min/1.73 m², respectively.</p><p><strong>Conclusions: </strong>Our medium-term outcomes indicate that the modified RALDP in the Lithotomy Trendelenburg position was safe and feasible for adult HSK patients. Further prospective studies of larger sample sizes and randomized controlled trials are warranted.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683360","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}