OBJECTIVE: This study was conducted to evaluate the body image perception, pain, fatigue and anxiety levels of individuals with kidney transplantation and undergoing hemodialysis and waiting for kidney transplantation. M...OBJECTIVE: This study was conducted to evaluate the body image perception, pain, fatigue and anxiety levels of individuals with kidney transplantation and undergoing hemodialysis and waiting for kidney transplantation. MATERIALS AND METHODS: This cross-sectional study was conducted with 240 individuals who applied to the nephrology outpatient clinic and dialysis unit between 29 August 2021 and 20 May 2022. Data in the study were collected using Patient Information Form, LANSS Pain Scale, Visual Similarity Scale for Fatigue, Beck Anxiety Scale and Body Image Scale. RESULTS: The Body Image Scale total score average of individuals undergoing hemodialysis is 104.8 ± 15.4, the LANSS Pain Scale total score average is 18.7 ± 5.4, the Visual Similarity Scale total score average for Fatigue is 29.5 ± 1.2, and the Beck Anxiety Scale total score average is 104.8 ± 15.4. The total score average is 47.6 ± 6.8. The LANSS Pain Scale total mean score of individuals with kidney transplantation is 8.2 ± 2.0, the Body Image Scale total score mean is 75.6 ± 3.5, the Visual Similarity Scale total score mean for Fatigue is 24.3 ± 1, and the Beck Anxiety Scale total score mean is 24.3 ± 1. The mean total score of the scale was found to be 25.6 ± 4.1. CONCLUSION: It has been determined that hemodialysis patients waiting for a kidney transplant are not satisfied with their body image, experience more pain, and have higher levels of fatigue and anxiety than patients who have had a kidney transplant.
OBJECTIVES: To assess the impact of cTURBT on pathologic response. Secondary endpoints involved survival and oncologic outcomes. METHODS: Tertiary centre data from patients with MIBC submitted to NAC and radical cystecto...OBJECTIVES: To assess the impact of cTURBT on pathologic response. Secondary endpoints involved survival and oncologic outcomes. METHODS: Tertiary centre data from patients with MIBC submitted to NAC and radical cystectomy between March 2010 and November 2022 was retrospectively analysed. Patients with complete resection (cTURBT) before NAC were compared to those with incomplete (iTURBT). RESULTS: Thirty-seven patients were included in this study. NAC regime was identical between groups. cTURBT group demonstrated a higher rate of downstaging than the iTURBT group (50% vs 20%, p = 0.022). During the mean 49-month follow-up period, overall survival (86.4% vs. 40%, p=0.005), relapse-free survival (81.8% vs. 46.7% p=0.036), and cancer-specific survival (90.9% vs 60%, p=0.042) were higher in the cTURBT group. Furthermore, we observed significantly fewer relapses, higher survival rates, and lower oncological-related deaths in patients who exhibited downstaging. CONCLUSION: cTURBT demonstrated a favourable impact on patients with MIBC undergoing NAC, enhancing pathologic downstaging and improving survival outcomes. Our results can be confounded by cTURBT being a proxy for less aggressive disease.
González Enguita C, López Martín L, Herranz Fernández LM
… +16 more, Sinues Ojas B, Barrera Rodríguez C, Extramiana Cameno J, Campá Bortoló J, Oscá García JM, Perán Teruel M, Gimeno Argente V, Navarro Beltrán A, López Alcina E, Povo Martín I, Salvador Pallás Costa Y, Budía Alba A, Ortiz Salvador J, Salgado Plonski JJ, Suárez Sal P, Fernández Arjona M
INTRODUCTION AND OBJECTIVES: UroLift® is a minimally invasive treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The primary objective was to evaluate the impact of UroLif...INTRODUCTION AND OBJECTIVES: UroLift® is a minimally invasive treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The primary objective was to evaluate the impact of UroLift® system treatment on quality of life. Secondary objectives assessed the impact on urinary symptoms and sexual function. PATIENTS AND METHODS: Patients at 7 Spanish hospitals undergoing pharmacological treatment were offered the choice to continue this treatment or accept surgical intervention. The primary outcome, impact on quality of life, was assessed using the EuroQol-5D-5L questionnaire. Secondary outcomes, including impact on symptoms, erectile function, and ejaculatory function, were evaluated using the IPSS, SHIM-5, and MSHQ-EjD-SF questionnaires, respectively. Outcomes were compared between groups. RESULTS: 91 patients chose UroLift® and 45 continued with pharmacotherapy. At 6 months, a positive impact on quality of life was estimated with UroLift® (0.046; SD: 0.02; p = 0.067), being significant in subgroups of patients aged >65 years (diff.: 0.034), PSA > 2.2 (diff.: 0.108), diabetes mellitus (diff.: 0.023), hypertension (diff.: 0.011) or hypercholesterolemia (diff.: 0.016). The impact on symptomatology was superior with UroLift® (-10.07; SD: 1.65; p < 0.001), being significant in subgroups aged >65 (diff.: 1.37), prostate >40 cc (diff.: 0.74), PSA > 2.2 (diff.: 2.63), and diabetes mellitus (diff.: 1.66), hypertension (diff.: 1.23). Erectile function was not affected (-0.33; SD: 1.99; p = 0.868) while ejaculatory function showed a favorable impact (2.98; SD: 1.26; p = 0.019). CONCLUSIONS: Minimally invasive Urolift® system treatment is associated with a positive impact on quality of life and urinary symptoms without adversely affecting sexual function.
Rosino Sánchez A, García Torralba E, Girela Baena E
… +6 more, Macías Cerrolaza JA, Tudela Pallares J, Zafra Povés M, Barceló Bayonas I, Muñoz Guillermo V, Fernández Aparicio T
INTRODUCTION: Men with mutations in DNA damage response (DDR) pathways have a higher risk of developing prostate neoplasia compared to the general population. The best studied alterations are mutations in BRCA1/2, ATM an...INTRODUCTION: Men with mutations in DNA damage response (DDR) pathways have a higher risk of developing prostate neoplasia compared to the general population. The best studied alterations are mutations in BRCA1/2, ATM and MMR-Lynch syndrome. MATERIAL AND METHODS: A review of the clinical and prognostic implications of mutations in DDR pathways, as well as an evaluation of the different screening strategies available for affected patients. OBJECTIVE: To propose an early diagnostic strategy for men with mutations in DDR pathways. RESULTS: Current guidelines do not provide clear, specific recommendations for this subgroup of men. Among mutations in the MMR pathway, the germline MSH2 mutation is most strongly associated with prostate cancer. Men with germline mutations in BRCA1/2, ATM, and MSH2 have a higher incidence of prostate neoplasia, tend to develop the disease at a younger age, and are more likely to have aggressive forms of the disease. Furthermore, men with BRCA1/2 mutations have a lower cancer-specific survival rate compared to the general population. In these patients, PSA levels have important limitations in detecting prostate cancer. Multiparametric MRI of the prostate may be more effective than periodic PSA testing. CONCLUSIONS: Patients with mutations in DDR pathways are at increased risk for aggressive prostate neoplasms and require earlier and more intensive screening. PSA-based screening has notable limitations. A screening strategy incorporating multiparametric MRI could offer a more effective strategy for this patient group.
Giulioni C, De Stefano V, Traxer O
… +25 more, Ragoori D, Gadzhiev N, Tanidir Y, Inoue T, Emiliani E, Bin Hamri S, Amine Lakmichi M, Mohan Vaddi C, Tiong Heng C, Soebhali B, More S, Sridharan V, Gökce MI, Tursunkulov AN, Ganpule A, Pirola GM, Naselli A, Aydin C, de Fata Chillón FR, Solano Mendoza C, Candela L, Hall Chew B, Kumar Somani B, Gauhar V, Castellani D
OBJECTIVE: To evaluate outcomes of same sitting Bilateral Retrograde IntraRenal Surgery (SSB-RISRS) for kidney stone in patients aged ≥70 years. METHODS: We retrospectively reviewed patients with bilateral kidney stones...OBJECTIVE: To evaluate outcomes of same sitting Bilateral Retrograde IntraRenal Surgery (SSB-RISRS) for kidney stone in patients aged ≥70 years. METHODS: We retrospectively reviewed patients with bilateral kidney stones who underwent SSB-RISRS in 21 centers (January 2015-June 2022). INCLUSION CRITERIA: patients aged ≥70 years, bilateral kidney stones diagnosed due to either unilateral or bilateral symptomatic presentation. Patients were divided into 2 groups. Group 1: patients aged 70-74 years, Group 2: patients aged ≥75 years. RESULTS: There were 86 patients in Group 1 and 60 patients in Group 2. There was no difference between the groups for gender, ASA score, BMI, comorbidities, presenting symptoms, and positive preoperative urine culture. Group 2 had a significantly higher proportion of recurrent stone formers (54.7% vs 35.0%, p=0.03). A higher proportion of bilaterally pre-stented patients were present in group 2 (37.9% vs 18.6%). There was no difference in total operation time and rate of post-operative uni- and bilateral stent positioning. Surgery was discontinued in 15.1% and 18.3% of cases in groups 1 and 2, respectively (p=0.773). Median length of postoperative stay was 2 days in both groups. The most frequent complication was fever requiring antibiotics and prolonged admission (10.5% in group 1 and 11.7% in group 2, p>0.99). Sepsis rate was 2.3% patients in group 1 and none in group 2. 1.2% in group 1 required a blood transfusion due to hematuria. Bilateral SFR was similar (60.0% vs 47.7%, p=0.194). CONCLUSIONS: SSB-RISRS in elderly patients demonstrated an acceptable safety profile with good bilateral SFR.
OBJECTIVES: To evaluate health-related quality of life (HRQOL) six years post-radical cystectomy in patients with muscle-invasive bladder cancer, comparing orthotopic ileal neobladder (ONB) and ileal conduit (IC). Theref...OBJECTIVES: To evaluate health-related quality of life (HRQOL) six years post-radical cystectomy in patients with muscle-invasive bladder cancer, comparing orthotopic ileal neobladder (ONB) and ileal conduit (IC). Therefore, the study aims to analyze the under-investigated long-term impact of standard bladder cancer treatments on HRQOL and provide insights into the HRQOL differences associated with these two common urinary diversion methods. PATIENTS AND METHODS: This prospective study included 39 patients with urothelial carcinoma treated with ONB or IC at our center between 03/2013 and 01/2023. Patients with variant histology, metastasis, neoadjuvant chemotherapy, or benign indications for cystectomy were excluded. HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire preoperatively, at four and six years postoperatively. Statistical analyses included Chi-square tests, T-tests, and logistic regression models. RESULTS: Of the patients, 64% (25/39) underwent ONB, and 76.9% (30/39) were male, with an average age of 69 years. No significant differences in overall good HRQOL (GHS > 70) were observed between ONB and IC at six years (IC: 60 ± 22; ONB: 69 ± 23, p = 0.2). Patients with IC reported higher insomnia at both follow-ups (4 years: p = 0.01; 6 years: p = 0.03). Emotional function remained stable in ONB patients but declined in IC patients from the fourth to sixth years (p = 0.04). CONCLUSION: Long-term HRQOL did not significantly differ between ONB and IC up to six years post-radical cystectomy. Both urinary diversion methods can be offered to patients, with tailored discussions in terms of HRQOL.
INTRODUCTION: Varicocele, defined as abnormal convoluted enlargement of the pampiniform plexus veins, is the most common cause of correctable male infertility. This study aimed to investigate the effect of blood drainage...INTRODUCTION: Varicocele, defined as abnormal convoluted enlargement of the pampiniform plexus veins, is the most common cause of correctable male infertility. This study aimed to investigate the effect of blood drainage in varicose veins on spermiogram parameters, postoperative pain, cosmetic appearance, and patient satisfaction in patients undergoing subinguinal microscopic varicocelectomy. METHODS: Patients diagnosed with clinical varicocele and admitted to our urology outpatient clinic between January 2020 and January 2024 were evaluated. Those with a venous vessel diameter ≥ 2.5 mm underwent subinguinal microscopic varicocelectomy. In 75 patients, a small incision was made in the thickest varicose vein, and the veins were ligated after venous blood was drained by hand patting. In another 75 patients, vessels were cut and ligated by the classical method without venous blood drainage. Exclusion criteria included patients younger than 18, those with secondary varicocelectomy history, undescended testis, testicular trauma or tumors, and prior infertility treatment. Preoperative and postoperative spermiogram values, pain scores, cosmetic appearance, and patient satisfaction were recorded and compared. RESULTS: The pain rate was significantly lower (p < 0.05) in the blood-milking varicocelectomy group during postoperative controls (7-10 days) compared to the classical method group. The blood-milking group also showed significantly higher (p < 0.05) sperm count and motility at the 3rd postoperative month. Cosmetic satisfaction was significantly higher (p < 0.05) in the blood-milking group. CONCLUSIONS: Blood drainage during subinguinal microscopic varicocelectomy significantly reduces postoperative pain and enhances sperm values, cosmetic outcomes, and patient satisfaction. These findings suggest that vein-milking techniques during varicocelectomy can optimize postoperative outcomes.
Ortega Polledo LE, García Rico E, Sánchez Pellejero A
… +8 more, Bianchini Hernández GFJ, Sanchís Bonet A, Gómez Rivas J, Galante Romo I, Moreno Sierra J, Miñana B, Ahyai S, Alonso Y Gregorio S
OBJECTIVE: The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate (HoLEP) in 125 consecutive cases. MATERIALS AND METHODS: Preoperative basel...OBJECTIVE: The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate (HoLEP) in 125 consecutive cases. MATERIALS AND METHODS: Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by HoLEP were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test. RESULTS: Surgical time decreased progressively: 92 min. (Q1), 65 min. (Q2), 54 min. (Q3), 45 min. (Q4) and 50 min. (Q5) (p < 0.001). Enucleation rate gradually increased: 1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min (Q4) and 2.74 g/min (Q5) (p < 0.001). There were no differences in enucleated weight (Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g) (p = 0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p > 0.05). Time to continence recovery was similar in quintiles 1-4 (23, 27, 21, 20 days) and shorter in quintile 5 (3.5 days) (p < 0.001). CONCLUSION: The initiation of a HoLEP program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.
INTRODUCTION AND OBJECTIVES: Suture renorrhaphy remains as time-consuming in partial nephrectomy (PN) and carries the risk of renal arterial damage and renal functional loss. This study aims to compare the functional and...INTRODUCTION AND OBJECTIVES: Suture renorrhaphy remains as time-consuming in partial nephrectomy (PN) and carries the risk of renal arterial damage and renal functional loss. This study aims to compare the functional and oncological outcomes of the clampless and sutureless robotic PN (sRPN) with clampless conventional suture renorrhaphy RPN (cRPN). PATIENTS: A total of 173 consecutive patients who underwent RPN between January 2019 and December 2023 were identified from our center's database and reviewed. Seventy-six clampless (sutureless: 23, conventional suture renorrhaphy: 53) RPN were identified. A propensity score-matchedpair analysis (PSM) was performed to homogenize the characteristics of the groups. Comprehensive evaluations of perioperative variables, functional and oncological results were performed before and after the PSM between the sRPN and cRPN. RESULTS: Before the PSM, median console time was 10 min shorter in the sRPN group but was not statistically significant. Estimated median blood loss was significantly lower in the sRPN group (p < 0.05). After PSM, 22 patients were matched in each group and all of the preoperative baseline characteristics were similar. Ratio of interpolar lines located tumors was higher in sRPN group (68.2% vs. 31.2%) (p < 0.05). Median tumor diameter was 3 (1.5-7) cm in each group. The trifecta achievement rates were 90.9% and 77.2% for the sRPN and cRPN groups, respectively (p > 0.05). There were no differences in terms of median console times, estimated blood loss, drain removal times or eGFR changes. CONCLUSIONS: In the treatment of small renal masses with clampless RPN, the sutureless technique can be applied with similar complication rates and functional, oncological outcomes as conventional sutured renorrhaphy.
Marcq G, Kassouf W, Roumiguié M
… +18 more, Pradere B, Mertens LS, Albisinni S, Cimadamore A, Yuen-Chun Teoh J, Moschini M, Laukhtina E, Mari A, Soria F, Gallioli A, Del Giudice F, d'Andrea D, Krajewski W, Beauval JB, Xylinas E, Pouessel D, Sargos P, Ploussard G
INTRODUCTION: Until recently there was no recommended adjuvant therapy for patients with lymph nodes metastasis (ypN+) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder canc...INTRODUCTION: Until recently there was no recommended adjuvant therapy for patients with lymph nodes metastasis (ypN+) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). The aim of the study was to describe the oncological outcomes of ypN+ patients following NAC and RC for MIBC. METHODS: This collaborative retrospective study included 195 patients with ypN+ disease after NAC followed by RC and bilateral pelvic lymph node dissection for MIBC between 2000 and 2019 in seven centers. Patients' demographics, clinical and pathological features were collected. Survival analyses were carried out with Kaplan-Meier estimates and a Cox model was generated. RESULTS: A total of 120 patients (62%) were pN1, 51 pN2 (26%) and 24 pN3 (12%). Adjuvant radiation therapy was performed in 18 (9%), adjuvant chemotherapy in 40 (21%) and the remaining 137 (70%) patients were observed. The median follow-up time was 51 months (95%CI 44-62). Median times for recurrence-free survival, cancer-specific survival and overall survival (OS) were 18 months (95%CI 16-21), 47 months (95%CI 31-70) and 28 months (95%CI 22-34) respectively. On multivariable analysis, female gender (HR = 1.5, 95%CI 1.002-2.21, p = 0.049) and positive surgical margins (HR = 1.6, 95%CI 1.06-2.38, p = 0.026) were the only independent predictor of OS. The type of adjuvant therapy did not impact OS (adjuvant chemotherapy, p = 0.44; adjuvant radiotherapy p = 0.40). CONCLUSION: MIBC patients with residual node positive disease following NAC and RC have poor survival outcomes. Females and patients with positive margin status at RC carry a poorer prognosis. These results may be beneficial for clinical trial design.
INTRODUCTION: Radical cystectomy (RC) is a preferred treatment for muscle-invasive bladder cancer (T2-T4) and certain non-muscle-invasive tumors. Post-cystectomy, urinary diversions often utilize intestinal segments, whi...INTRODUCTION: Radical cystectomy (RC) is a preferred treatment for muscle-invasive bladder cancer (T2-T4) and certain non-muscle-invasive tumors. Post-cystectomy, urinary diversions often utilize intestinal segments, which are prone to complications, notably urinary tract infections (UTIs). OBJECTIVE: To estimate the association between intraoperative cultures of the isolated intestinal loop and urine cultures during UTI episodes in RC patients with urinary diversion. Additionally, to compare urinary cultures from catheters at discharge with UTI cultures and calculate UTI prevalence and readmission rates within three months postoperatively. MATERIALS AND METHODS: This prospective, observational cohort study included patients who underwent RC with ileal segment diversion our center between April 2021 and January 2024. Intraoperative cultures were obtained by washing the isolated ileal loop, and urine cultures were taken during postoperative UTI episodes. Patients were followed for 90 days post-surgery, and new cultures were performed if UTI symptoms appeared. RESULTS: Among 118 cystectomies, 82 patients were included, with a mean age of 67.8 years. UTI prevalence within the first three months was 43.9%. The kappa concordance index for bacteria between intraoperative and UTI cultures was 0.033 (poor), and for cultures from discharge catheters and UTI episodes, it was 0.251 (fair). UTI readmission rate was 28.9%, with no significant predictors identified. CONCLUSION: There is no significant association between germs in intraoperative intestinal cultures or discharge catheters and those in UTI cultures in RC patients with urinary diversion. The three-month UTI prevalence is 43.9%, with a 28.9% readmission rate. Continuous epidemiological surveillance is recommended for appropriate antibiotic therapy.