Animal model assessment of a new design for a coated mitomycin-eluting biodegradable ureteral stent for intracavitary instillation as an adjuvant therapy in upper urothelial carcinoma.

BACKGROUND: A major limitation in the treatment of upper urinary tract urothelial carcinoma is the limited use of adjuvant therapy due to the drawbacks of current techniques for intracavitary instillation. The aim was to assess, in a large animal model, a biodegradable ureteral stent coated with silk fibroin for mitomycin release, i.e. BraidStent-SF-MMC. METHODS: A total of 14 female pigs with a solitary kidney underwent initial urinalysis, blood chemistry, nephrosonographic, and contrast fluoroscopy assessment of the urinary tract. Later, the BraidStent-SF-MMC was placed retrogradely to assess the mitomycin urine concentration from 0-48 hours. Follow-up was performed weekly until complete stent degradation to assess the macroscopic and microscopic changes in the urinary tract, stent complications. RESULTS: The drug eluting stent released mitomycin for the first 12 h. The main complication was the release of obstructive ureteral coating fragments during the first to third week in 28.5 and 7.1% of animals, respectively, related to urinary pH<7.0, which destabilized the stent coating. Another complication was ureteral strictures between the fourth and sixth week in 21%. The stents were completely degraded by 6-7 weeks. There were no stent-related systemic toxic effects. The success rate was 67.5% and the complication rate was 25.7%. CONCLUSIONS: For the first time, we have shown that a biodegradable anti-cancer drug eluting stent, BraidStent-SF-MMC, provides controlled and well-tolerated release of mitomycin into the upper urinary tract in an animal model. Mitomycin release from a silk fibroin coating could be a compelling approach for adjuvant chemotherapy instillation in upper tract urothelial carcinoma management.

Willingness to Pay and Preferences Among Patients Undergoing Cystoscopies: Results from a Large Survey-Based Study in Spain.

Purpose: Cystoscopy procedures can cause distress among patients. Patient perspectives on health services are essential inputs in decision-making. This study investigated the patient preferences in Spain regarding single-use cystoscopes (SUC) compared to reusable cystoscopes and their willingness to pay (WTP) for cystoscopy procedures. Patients and Methods: Between May and June 2021, an anonymous survey was distributed to Spanish patients who had previously undergone a cystoscopy. The survey included patient preference measures on reusable cystoscopes compared to SUCs and a discrete choice experiment. The survey was distributed through a human data science company (IQVIA), collected using an online survey tool (QuestionPro®), and analyzed using Stata/MP, StataCorp. Results: Of 300 respondents, 148 (49.33%) were female and 150 (50%) were male, and mainly between 18-49 years (247, 82.33%). Most (265, 88%) preferred to have their procedure performed with a SUC rather than a reusable cystoscope. Among these patients, 215 (80%) could imagine asking their doctor to use a SUC. A total of 231 (77%) respondents indicated an increased level of concern about the risk of exposure to contamination related to their cystoscopy following the COVID-19 pandemic. Patients would pay 62 EUR to have their initial consultation and cystoscopy procedure on the same day (p < 0.001), 59 EUR to reduce the environmental impact, and 57 EUR to reduce the risk of contamination (p < 0.001). Conclusion: Patients prefer to undergo cystoscopy using an SUC on the same day as their initial consultation. The increased contamination concerns due to the COVID-19 pandemic and WTP to reduce the risk of cystoscope contamination may explain patients' preferences for SUCs. The most important attributes related to their cystoscopy procedure are the ability to have their procedure performed on the same day as their initial consultation, the reduction of the environmental impact, and the reduction of the contamination risk.

Iatrogenic Ureteral Injury Treatment with Biodegradable Antireflux Heparin-Coated Ureteral Stent-Animal Model Comparative Study.

Objective: The aim is to assess the effectiveness of a biodegradable antireflux ureteral stent with heparin coating in a comparative study (BraidStent®-H) in an animal model for the treatment of iatrogenic ureteral perforation. Materials and Methods: A total of 24 female pigs underwent initial endoscopic, nephrosonographic, and contrast fluoroscopy assessment of the urinary tract. Afterward, unilateral iatrogenic perforation in proximal ureter model was performed. Then the animals were randomly assigned to Group-I, in which a double-pigtail stent was placed for 6 weeks, or Group-II, in which a BraidStent-H a biodegradable heparin-coated stent was placed. Follow-up assessments were performed at 1 and 6 weeks and 5 months. Results: In terms of therapeutic effectiveness, complete resolution was observed in 95.8% of Group-I animals and 87.5% in Group-II. No animals in Group-II showed vesicoureteral reflux (VUR) during the study; statistical significance was observed at 1 and 6 weeks versus Group-I. All stents in Group-II degraded without producing obstructive fragments and allowed distal ureteral peristalsis. Heparin coating was not efficient to reduce asymptomatic bacteriuria between groups. Pathologic assessment did not show any significance in the global score, but did in the "fibrosis in muscular layer" parameter, at the ureteral perforation healing area; Group-II showed higher healing quality. Conclusions: The biodegradable intraureteral BraidStent®-H is highly effective for the minimally invasive treatment of ureteral perforation, since it displays controlled and predictable degradation, avoiding the development of VUR as well as irritation of the bladder trigone. Unfortunately, heparin coating was not effective in avoiding stent-associated bacteriuria.

Bacterial spectrum and antibiotic resistance of urinary tract infections in patients treated for upper urinary tract calculi: a multicenter analysis.

The purpose of this study is to collect information on the bacterial resistance to antibiotics of bacteria isolated from urine cultures of patients treated for upper urinary tract calculi. Data of patients with urinary tract infection and urolithiasis were retrospectively reviewed to collect information on age, gender, stone size, location, hydronephrosis, procedure of stone removal and antibiotic treatment, identification and susceptibility of pathogens, symptoms, and infectious complications. A total of 912 patients from 11 centers in 7 countries (Bulgaria, Greece, Italy, North Macedonia, Spain, and Turkey) were studied. Mean age was 54 ± 16 years and M/F ratio 322/590. Out of 946 microbial isolates, the most common were E. coli, Gram-positive, KES group (Klebsiella, Enterobacter, Serratia), Proteus spp., and P. aeruginosa. Carbapenems, piperacillin/tazobactam and amikacin showed low resistance rates to E. coli (2.5%, 7%, and 3.6%) and Proteus spp. (7.7%, 16%, and 7.4%), but higher rates were observed with Klebsiella spp., P. aeruginosa, and Gram-positive. Fosfomycin had resistance rates less than 10% to E. coli, 23% to KES group, and 19% to Gram-positive. Amoxicillin/clavulanate, cephalosporins, quinolones, and TMP/SMX showed high resistance rates to most bacterial strains. High rates of antibiotic resistance were observed in patients candidate to stone treatment from South-Eastern Europe. The empirical use of antibiotics with low resistance rates should be reserved to the most serious cases to avoid the increase of multidrug resistant bacteria. Basing on our results, carbapenems, piperacillin/tazobactam, and amikacin may be a possible option for empiric treatment of urinary stone patients showing systemic symptoms.

[Strategies and recommendations for urolithiasis treatment and follow-up in COVID-19 pandemia.] / Estrategias y recomendaciones para el tratamiento y seguimiento de la patología litiásica en el periodo de la pandemia COVID-19.

INTRODUCTION: The health crisis caused by COVID-19 pandemic has led to a restructuring of urological activity in order not to delay priority situations. An important part to prioritize within Urologyis Urolithiasis. The objective of this article is to establish strategies and recommendations for the treatment and follow-up in COVID-19 pandemic in phases I, II and III, based on available scientific evidence and the consensus of a group of experts in these pathologies. MATERIAL AND METHODS: The document is based on the evidence available in the literature so far on SARSCoV-2 and the experience of the authors in the management of COVID-19 in their institutions. A narrative review of the literature was conducted, and a modified nominal group technique was used due to the extraordinary restrictions of assembly and mobility during the pandemic. RESULTS: Recommendations are made regarding the epidemiological evaluation of patients before surgery ,the management of positive patients, the epidemiological measures for healthcare personnel, the management of renal colic, the type of anesthesia, endourological surgery, shockwave lithotripsy, hospitalization, clinicalt ests, out-patient service and priorities on the surgical waiting list. CONCLUSION: Treatment of Urolithiasis in COVID-19 pandemic calls for prioritization of patients, maximum efficiency in treatments, adequate protection of healthcare personnel, and the implementation of telemedicine as a measure to reduce patient attendance to the hospital.

INTRODUCCIÓN: La crisis sanitaria provocada por la pandemia COVID-19 ha obligado a reestructurar la actividad urológica para no demorar situaciones que requieran preferencia. Una parte importante para priorizar dentro de la Urología es la patología litiásica. El objetivo de este artículo es establecer estrategias y recomendaciones para el tratamiento y seguimiento de esta en el periodo de pandemia COVID-19 en las fases I II y III, basadas en la evidencia científica publicada y el consenso de un grupo de expertos en esta patología. MATERIAL Y MÉTODOS: El documento se basa en la escasa evidencia en la literatura sobre SARS-CoV-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones. Se realizó una revisión narrativa de la literatura y se utilizó una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia. RESULTADOS: Se establecen recomendaciones sobre la evaluación epidemiológica de los pacientes antes de la cirugía, el manejo de los pacientes positivos, las medidas epidemiológicas para los profesionales, el manejo del cólico renal, el tipo de anestesia, la cirugía endourológica, la litotricia extracorpórea por ondas de choque, la hospitalización, las pruebas complementarias, la consulta y las prioridades en la lista de espera quirúrgica. CONCLUSIÓN: El tratamiento de la patología litiásica durante la pandemia COVID-19 hace necesaria la priorización de pacientes, la máxima eficiencia en los tratamientos, una protección adecuada del personal sanitario y la implementación de la telemedicina como medida para reducir la asistencia de los pacientes al medio hospitalario.

[MicroPerc: Fashion or reality.] / Microperc: moda o realidad.

Miniaturization in percutaneous surgery has seen its zenith in microperc. Technological advances have enabled us to treat renal lithiasis through a 4.8 Ch. caliper percutaneous access. According to published literature, the technique is reproducible and when applied to small and medium size renal lithiasis has a high success rate keepin a low complication rate. Its main advantage is the absence of tract dilatation, diminishing the bleeding risk inherent to percutaneous access, postoperative pain and hospital stay. Nevertheless, it presents a series of technical limitations: low maneuverability and versatility, impossible extraction of significant fragments, limited vision and high intrarenal pressure. Does microperc have a place among proven techniques such as SWL, flexible ureteroscopy or minipercutaneous surgery? In our article we try to answer this question by reviewing the available literature, and review all technical features, advantages and limitations of the procedure at the same time.

Prostate-specific antigen relapse-free survival and side-effects in 734 patients with up to 10 years of follow-up with localized prostate cancer treated by permanent iodine implants.

STUDY TYPE: Therapy (case series) Level of Evidence 4. OBJECTIVE: To report our analysis of the oncological outcome, side-effects and complications after (125)I-brachytherapy, based on 10 years of experience, as low dose-rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer. PATIENTS AND METHODS: Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow-up of >or=30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3-4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the 'Phoenix consensus'. RESULTS: The median follow-up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10-year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low-, intermediate- and high-risk groups. Multivariate Cox regression analyses identified Gleason score and prostate-specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of 7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of 20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy. CONCLUSIONS: The excellent long-term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ-confined prostate cancer.