RESUMEN
This study aimed to compare the efficacy of percutaneous microwave ablation therapy (MWAT) and laparoscopic partial nephrectomy (LPN) in early-stage renal cell carcinoma (RCC) classified as T1a; a retrospective analysis was conducted on patients treated between January 2017 and November 2023. Oncological outcomes, radiological recurrence, length of stay (LOS), and costs were evaluated. The study included 110 patients, with no significant differences between the two groups regarding residual tumors, local tumor progression, and disease-free survival rates (p > 0.05). The LPN group showed significantly lower pre/postoperative serum urea and creatinine and higher estimated glomerular filtration rate values, whereas the MWA group experienced significantly lower mean costs, complication rates, LOS in the hospital, and procedure durations (p ≤ 0.05). However, post-procedure residual tumors and local tumor progression rates did not differ significantly between the LPN and MWAT groups (p > 0.05). MWAT is as effective as LPN for T1a RCC lesions. In addition, MWAT has lower costs than LPN and is a cost-effective treatment method. Therefore, MWAT minimizes hospital stay and complications and since the oncological results are similar to LPN, it might be considered as the first choice of treatment in young patients.
RESUMEN
BACKGROUND AND OBJECTIVE: The widespread adoption and rapid integration of new technologies and techniques in endoscopic and laser bladder interventions, particularly endoscopic enucleation, have led to new types of bladder injuries. This underscores the need for an intraoperative injury classification system. This study aims to develop and validate the Bladder Injury Classification System for Endoscopic Procedures (BICEP), which standardizes the classification of complications and intervention requirements. METHODS: This mixed-methods study involved experts from the European Association of Urology Section of Urotechnology to standardize and validate the BICEP classification system. An iterative process involving focus groups, expert surveys, and revisions assessed clarity, relevance, comprehensiveness, and practicality. Validity was confirmed through expert surveys conducted in two rounds for face and content validity, using a 5-point Likert scale to correlate ratings with expected outcomes. KEY FINDINGS AND LIMITATIONS: The novel BICEP classification system categorizes bladder injuries into ten subcategories with scores ranging from 0 to 4, reflecting injury severity and management requirements. Face validity was demonstrated by a 95% consensus on the system's clarity, relevance, and comprehensiveness. Content validity was supported by high acceptance rates in expert surveys, with average scores of 4.53 and 4.58 in the first and second rounds, respectively. This demonstrates strong support for its applicability in clinical practice. However, the primary limitation is the lack of external validation. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study demonstrates that the BICEP system is a robust and comprehensive classification system, with strong support for its face and content validity. The BICEP system is a proposal based on expert opinion, and additional studies are necessary to ensure its widespread adoption and efficacy. PATIENT SUMMARY: Our study addressed the critical need for standardized classification in the increasingly widespread context of urology endoscopic technologies by focusing on intraoperative evaluation, reporting, and standardization of bladder injuries. This study provides a globally standardized basis for the classification and treatment of bladder injuries in urology endoscopic procedures.
RESUMEN
The prevalence of penile calcification in the population remains uncertain. This retrospective multicenter study aimed to determine the prevalence and characteristics of penile calcification in a large cohort of male patients undergoing non-contrast pelvic tomography. A total of 14 545 scans obtained from 19 participating centers between 2016 and 2022 were retrospectively analyzed within a 3-months period. Eligible scans (n = 12 709) were included in the analysis. Patient age, penile imaging status, presence of calcified plaque, and plaque measurements were recorded. Statistical analysis was performed to assess the relationships between calcified plaque, patient age, plaque characteristics, and plaque location. Among the analyzed scans, 767 (6.04%) patients were found to have at least one calcified plaque. Patients with calcified plaque had a significantly higher median age (64 years (IQR 56-72)) compared to those with normal penile evaluation (49 years (IQR 36-60) (p < 0.001). Of the patients with calcified plaque, 46.4% had only one plaque, while 53.6% had multiple plaques. There was a positive correlation between age and the number of plaques (r = 0.31, p < 0.001). The average dimensions of the calcified plaques were as follows: width: 3.9 ± 5 mm, length: 5.3 ± 5.2 mm, height: 3.5 ± 3.2 mm, with an average plaque area of 29 ± 165 mm² and mean plaque volume of 269 ± 3187 mm³. Plaques were predominantly located in the proximal and mid-penile regions (44.1% and 40.5%, respectively), with 77.7% located on the dorsal side of the penis. The hardness level of plaques, assessed by Hounsfield units, median of 362 (IQR 250-487) (range: 100-1400). Patients with multiple plaques had significantly higher Hounsfield unit values compared to those with a single plaque (p = 0.003). Our study revealed that patients with calcified plaques are older and have multiple plaques predominantly located on the dorsal and proximal side of the penis.