Minerva Urology and Nephrology最新文献

{"title":"Prediction models for postoperative renal function after living donor nephrectomy: a systematic review.","authors":"Alicia López-Abad, Alessio Pecoraro, Romain Boissier, Alberto Piana, Thomas Prudhomme, Vital Hevia, Claudia L Catucci, Muhammet I Dönmez, Alberto Breda, Sergio Serni, Angelo Territo, Riccardo Campi","doi":"10.23736/S2724-6051.24.05556-3","DOIUrl":"10.23736/S2724-6051.24.05556-3","url":null,"abstract":"<p><strong>Introduction: </strong>Living-donor nephrectomy (LDN) is the most valuable source of organs for kidney transplantation worldwide. The current preoperative evaluation of a potential living donor candidate does not take into account formal estimation of postoperative renal function decline after surgery using validated prediction models. The aim of this study was to summarize the available models to predict the mid- to long-term renal function following LDN, aiming to support both clinicians and patients during the decision-making process.</p><p><strong>Evidence acquisition: </strong>A systematic review of the English-language literature was conducted following the principles highlighted by the European Association of Urology (EAU) guidelines and following the PRISMA 2020 recommendations. The protocol was registered in PROSPERO on December 10, 2022 (registration ID: CRD42022380198). In the qualitative analysis we selected the models including only preoperative variables.</p><p><strong>Evidence synthesis: </strong>After screening and eligibility assessment, six models from six studies met the inclusion criteria. All of them relied on retrospective patient cohorts. According to PROBAST, all studies were evaluated as high risk of bias. The models included different combinations of variables (ranging between two to four), including donor-/kidney-related factors, and preoperative laboratory tests. Donor age was the variable more often included in the models (83%), followed by history of hypertension (17%), Body Mass Index (33%), renal volume adjusted by body weight (33%) and body surface area (33%). There was significant heterogeneity in the model building strategy, the main outcome measures and the model's performance metrics. Three models were externally validated.</p><p><strong>Conclusions: </strong>Few models using preoperative variables have been developed and externally validated to predict renal function after LDN. As such, the evidence is premature to recommend their use in routine clinical practice. Future research should be focused on the development and validation of user-friendly, robust prediction models, relying on granular large multicenter datasets, to support clinicians and patients during the decision-making process.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 2","pages":"148-156"},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923852","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":"Thulium fiber laser enucleation of the prostate: a systematic review of the current outcomes.","authors":"Theodoros Spinos, Vasileios Tatanis, Angelis Peteinaris, Bhaskar Somani, Ioannis Kartalas Goumas, Evangelos Liatsikos, Panagiotis Kallidonis","doi":"10.23736/S2724-6051.24.05654-4","DOIUrl":"10.23736/S2724-6051.24.05654-4","url":null,"abstract":"<p><strong>Introduction: </strong>One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP).</p><p><strong>Evidence acquisition: </strong>PubMed^®, Scopus^® and Cochrane^® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported.</p><p><strong>Evidence synthesis: </strong>Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches.</p><p><strong>Conclusions: </strong>ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSES^TM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 2","pages":"157-165"},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923880","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":"The role of androgen deprivation therapy prior to radical prostatectomy in high-risk prostate cancer: a systematic review.","authors":"Yenny Arroyo-Rojas, Lara Rodriguez-Sanchez, Gianmarco Colandrea, Hugo Otaola Arca, Camille Lanz, Eric Barret, Rafael Sanchez-Salas, Petr Macek, Xavier Cathelineau","doi":"10.23736/S2724-6051.24.05630-1","DOIUrl":"10.23736/S2724-6051.24.05630-1","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with high-risk prostate cancer (HRPCa) are prone to have worse pathological features, resulting in early biochemical recurrence after radical prostatectomy (RP). There is an urgent need to develop novel treatment strategies for this group of patients to optimize their outcomes. The purpose of this study is to perform a systematic review of the role of neoadjuvant hormonal therapy (NHT) followed by RP in HRPCa patients.</p><p><strong>Evidence acquisition: </strong>We performed a systematic review of the following databases, MEDLINE (PubMed), EMBASE, Cochrane Library, and clinical Trial.gov; between January 2007 and August 2023, following the PRISMA guidelines.</p><p><strong>Evidence synthesis: </strong>After screening and deduplication, we included ten studies from an initial pool of 1275. The risk of bias was low in observational studies but ranged from moderate to low in controlled trials. Five studies utilized traditional androgen deprivation treatments (ADT), revealing favorable pathological outcomes but inconsistency in evaluating oncological results. Additionally, four studies focused on RP combined with androgen receptor pathway inhibitors (ARPIs) in the NHT setting, all showing primarily positive pathological outcome, with no clear evidence of an oncological benefit. Limited long-term follow-up data and a shortage of randomized controlled trials were evident among all the studies included in this review, regardless of the type of hormonal treatment used.</p><p><strong>Conclusions: </strong>Different hormonal treatments, including traditional ADT and ARPIs, yield positive pathology outcomes. Oncological evidence remains limited, echoing older findings predating ARPIs. Definitive conclusions require longer follow-ups and precise patient selection. Currently, insufficient evidence support ARPIs' superiority over conventional therapy before RP.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 2","pages":"141-147"},"PeriodicalIF":4.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923771","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":"Is imaging accurate enough to detect index lesion in prostate cancer? Analysis of the performance of MRI and other imaging modalities.","authors":"Vito Lorusso, Michele Talso, Franco Palmisano, Nicolas Branger, Antonio M Granata, Cristian Fiori, Andrea Gregori, Geraldine Pignot, Jochen Walz","doi":"10.23736/S2724-6051.23.05285-0","DOIUrl":"10.23736/S2724-6051.23.05285-0","url":null,"abstract":"<p><p>Prostate imaging techniques have progressed across the years allowing for a better detection and characterization of prostate cancer (PCa) lesions. These advancements have led to the possibility to also improve and tailor the treatments on the most aggressive lesion, defined as Index Lesion (IL), to reduce morbidity. The IL is, indeed, considered as the entity which encompass the most aggressive features in prostate cancer disease. Multiparametric magnetic resonance imaging (mpMRI) has emerged as the suggested tool to detect the disease and plan treatments, including those under investigation such as focal therapy (FT). Our review aimed to query the literature on the ability of mpMRI in IL detection and to explore the future perspectives in PCa IL diagnosis. A review of the literature was performed from January 2010 to July 2023. All studies investigating the performance of mpMRI and other main imaging techniques able to detect the IL were assessed and evaluated. mpMRI performs well in the detection of IL with a sensitivity which reaches 71% to 94% among the different studies. However, mpMRI seems to have limited sensitivity in the detection of small tumours (<0.5 mL) and low-grade histology lesions. To overcome these limitations other diagnostic imaging techniques have been proposed. Multiparametric Ultrasound has shown results comparable to mpMRI while detecting 4.3% fewer clinically significant PCa (P=0.042). Positron emission tomography-based modalities using PSMA seems to have higher sensitivity than mpMRI, being able to yield from 13.5% to 18.2% additional cancers. MRI has emerged as the recommended tool since most of the IL can be easily identified, and is the imaging of choice while selecting patients for FT. Other imaging modalities has been proposed to improve PCa lesions detection, but results need to be confirmed by ongoing randomized controlled trial.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"22-30"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41219992","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":"Meticulous initial clinical and pathological staging with standardized long-term follow-up after radical cystectomy is required to validate and improve overall prognostic performance in patients undergoing neoadjuvant chemotherapy for bladder cancer.","authors":"Marc A Furrer, Christopher Soliman, Patrick Y Wuethrich","doi":"10.23736/S2724-6051.23.05563-5","DOIUrl":"10.23736/S2724-6051.23.05563-5","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"124-126"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405204","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":"New robotic systems: first head-to-head comparison between Hugo RAS and Versius CMR in the pre-clinical setting.","authors":"Maria C Sighinolfi, Bernardo Rocco, Stefano Terzoni, Alessandro Morandi, Margarita Afonina, Simone Assumma, Tommaso Calcagnile, Filippo Turri, Mattia Sangalli, Enrico Panio, Luca Sarchi, Angelica Grasso, Paolo Dell'orto, Efrem Pozzi, Augusto Ramondo, Emanuela Santangelo, Michele Petix, Giorgia Gaia","doi":"10.23736/S2724-6051.23.05568-4","DOIUrl":"10.23736/S2724-6051.23.05568-4","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 1","pages":"1-4"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998281","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":"PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis.","authors":"Beatriz T Constantinou, Bianca C Benedicto, Breno C Porto, Mikhael Belkovsky, Carlo C Passerotti, Everson L Artifon, Jose P Otoch, Jose A da Cruz","doi":"10.23736/S2724-6051.23.05577-5","DOIUrl":"10.23736/S2724-6051.23.05577-5","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS.</p><p><strong>Evidence acquisition: </strong>We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome.</p><p><strong>Evidence synthesis: </strong>We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I²=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I²=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I²-98%). No difference was observed regarding operative time.</p><p><strong>Conclusions: </strong>RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 1","pages":"31-41"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998284","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":"Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes.","authors":"Chen Huang, Kunlin Yang, Wenzhi Gao, Yaming Gu, Hong J Zhu, Xuesong Li","doi":"10.23736/S2724-6051.23.05492-7","DOIUrl":"10.23736/S2724-6051.23.05492-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture.</p><p><strong>Methods: </strong>A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported.</p><p><strong>Results: </strong>The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 μmol/L, postoperative day 1 creatinine level was 90.7±12.93μmol/L, postoperative 3-month creatinine level was 93.77±33.34 μmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89μmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery.</p><p><strong>Conclusions: </strong>Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 1","pages":"97-109"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998278","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":"JJ stent dislodgement in the distal ureter: how to recover it in preschool children?","authors":"Marcello Della Corte, Elisa Cerchia, Cristian Fiori, Martina Mandaletti, Elena Ruggiero, Francesco Porpiglia, Massimo Catti, Simona Gerocarni Nappo","doi":"10.23736/S2724-6051.23.05550-7","DOIUrl":"10.23736/S2724-6051.23.05550-7","url":null,"abstract":"<p><p>Double-J ureteral stents are usually placed after various urological procedures. The dislodgement of their distal ringlet is a rare complication, whose retrieval is arduous in younger children, due to the small ureteral caliber. We propose our innovative endoscopic approach to recover the dislodged JJ stent. Under 8-9.8 Ch cystoscopy, the ureteral meatus is gently cannulated with a 00.18″ guidewire, then a balloon catheter Passeo 18 3-4 mm (Biotronik, Lake Oswego, OR, USA) is coaxially inserted. A pneumatic dilatation of the vesical-ureteral junction is performed up to 8 atmospheres for 5 minutes under direct vision. Consequently, the ureteral meatus allows the cystoscope passage, and the JJ-stent can be recovered thanks to endoscopic grasping forceps. A mono-J stent is then left in place for 24 hours. Four patients aged 8 months - 4 years have been successfully treated with this approach after that JJ migration was found intraoperatively or during ultrasonography. No intra- or postoperative complications occurred. Postoperative hospital stay was prolonged for one day. During 29.5 medium follow-up no clinical or ultrasonographic signs of vesical-ureteral reflux ensued. Our cystoscopic approach is effective and safe to ensure a prompt endoscopic JJ retrieval without changing neither surgical approach nor the anesthesiological support. We believe that all the pediatric urology centers should know the procedure and have small size balloon catheter available.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"116-119"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447027","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":"Statins may increase the risk of being diagnosed with prostate cancer.","authors":"Aldo Brassetti, Francesco Tedesco, Loris Cacciatore, Francesco Prata, Alberto Ragusa, Andrea Iannuzzi, Riccardo Lombardo, Giorgia Tema, Antonio Cicione, Andrea Tubaro, Giuseppe Simone, Cosimo DE Nunzio","doi":"10.23736/S2724-6051.23.05454-X","DOIUrl":"10.23736/S2724-6051.23.05454-X","url":null,"abstract":"<p><strong>Background: </strong>Although statins are known to protect against cardiovascular accidents, their anti-inflammatory features could play a role in preventing tumorigenesis. We investigated the association between statin intake and prostate cancer (PCa) diagnosis and aggressiveness.</p><p><strong>Methods: </strong>A retrospective analysis was performed. Our dataset on patients undergone systematic prostate biopsy from December 2008 to December 2022 was searched for histopathologic and clinical data. Prognostic Grade Group ≥3 tumors were defined as high-grade (HG). The association between Metabolic Syndrome (MetS), statin use and PCa diagnosis and HG disease was assessed using logistic regression analyses.</p><p><strong>Results: </strong>Data on 1685 patients were collected; MetS affected 344 (20.4%) men and 138 (36.5%) were taking statins at least for 6 months at the time of biopsy. Among the 671 (39.8%) men diagnosed with PCa, 327 (48.7%) presented with a HG disease. Tumor incidence was higher among men taking statins, compared to controls (46.8% vs. 37.8%; P=0.002); also, high grade diseases were more common in the former group, but the difference did not reach statistical significance (49.1% vs. 48.6%; P=0.89). Statin intake (OR 1.44; 95% CI [1.05-1.98]; P=0.02) independently predicted PCa diagnosis but not high-grade disease (P=0.8).</p><p><strong>Conclusions: </strong>Statin use may be associated with an increased risk of PCa diagnosis.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"74-80"},"PeriodicalIF":4.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172148","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}