A systematic review and network meta-analysis comparing Rezum with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate.

Objectives: We aim to compare efficacy and safety of water vapour therapy (Rezum), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials: PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included. Results: At 12 months, Rezum showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezum versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezum versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezum versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezum (QoE: Low) and Rezum versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezum was similar, or inferior to other techniques at 12 months - Rezum versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezum versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezum also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rezum RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezum showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezum had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezum with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezum with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions: Moderate to weak evidence suggests that Rezum is not superior to TUNA and TUMT in all domains studied.

Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review.

PURPOSE: Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS: We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS: Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION: The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.

The Influence of the Microbiome on Urological Malignancies: A Systematic Review.

The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding.

Percutaneous nephrolithotomy (PCNL) a critical review.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. APPROACH: Approach might be by either supine or prone and the access is made with the help of either fluoroscopy or ultrasound. Recently endoscopy guided puncture has also been described. MINIATURIZATION: Traditionally the tract size for PCNL used to be 30Fr. Even though the stone clearance rate was good there were complications such as bleeding With the advent of excellent optics and advances in stone fragmentation the tract size has reduced to a great extent which has reduced the complications without compromising the stone clearance. COMPLICATIONS: The complications related to access might be injury to pleura, and other visceral organs. The other complications are bleeding, infection and incomplete stone clearance. CONCLUSION: PCNL has emerged as most efficient procedure among these approaches to stone removal, though not devoid of complications and requirement for skills. The drive for minimal invasive approach should not compromise stone clearance, latter being the core principle of endourology. In skilled hands PCNL is the answer to stone questions we as urologist face day to day. though which form of PCNL is to be chosen depends on surgeons skill level and discretion.