Active stone removal is a safe option for ocotogenarians and nonagenarians with nephrolithiasis.

PURPOSE: To assess the contemporary in-hospital management of octogenarians and nonagenarians with renal calculi. MATERIAL AND METHODS: A multicentric retrospective evaluation of patients aged ≥ 80 years hospitalized with kidney stones between 01/2000 and 12/2019. Stone and patient related data were collected, including stone size and location, geriatric status and comorbidities. Surgical treatment patterns and outcome were assessed. RESULTS: A total of 299 patients (57% female) with kidney stones were analyzed. Mean age was 84.7 years. Patients were largely multimorbid (ASA ≥ 3 in 70%) and about 25% were classified as frail. Active stone treatment was performed in 65% and 35% were treated with urinary diversion (stent or nephrostomy). Prognostic factors for receiving an active stone treatment were age < 90 years, male sex, stone size and quantity, and performance status. Mean overall survival was 23.7 months and when stratified to treatment mean survival were 21 months after urinary diversion, 28 months after URS, 29 months after PCNL and 45 months after SWL. CONCLUSION: Age, frailty and performance-status as well as stone size and quantity are predictors for active stone treatment. Octogenarians and nonagenarians, who are considered fit for surgery, tend to live long enough to profit from active stone treatment.

Ureteral calculi in octogenarians and nonagenarians: Contemporary in-hospital management-A joint study by the endourological section of the Austrian Association of Urology.

AIM: To assess contemporary in-hospital management of octogenarians and nonagenarians with ureteral calculi. MATERIALS AND METHODS: Review of patients aged ≥80 years hospitalized due to ureteral calculi. Data was extracted from eight Austrian centers of urology. Stone and patient related data were recorded. Treatment patterns in acute and elective settings were assessed. RESULTS: A total of 759 patients hospitalized with ureteral calculi were analyzed. Out of them, 643 were octogenarians (80-89years) and 116 nonagenarians (90-99 years). In an acute setting, simple de-obstruction with urinary diversions outnumbered active stone treatments like URS and SWL (62.6% vs. 26.9% vs. 10.5%). Decision making whether patients underwent active stone treatment was driven by stone location (OR = 0.28, p<0.0001), impaired renal function (OR = 0.28, p = 0.01) and indwelling urethral catheters (OR = 0.23, p = 0.01) but not by age or extend of mobility (all p>0.05). In elective settings, 81.5% of procedures were active stone treatments-mainly URS (76.9%), while DJ stent or nephrostomy replacements were noted in 14.2% and 4.3%. Octogenarians (OR = 14, p<0.0001) and patients capable of walking (OR = 4.51, p = 0.01) had significantly higher odds of receiving active stone. Stone free rates and complications rates with URS were similar between octogenarians and nonagenarians (p = 0.98 and p = 0.58). CONCLUSION: In acute settings, age and extend of mobility were not found to be independent predictors for active stone treatment. In elective settings, after having received urinary diversions, reduced mobility and nonagenarians were less likely to undergo stone removal treatments. Safety and efficacy of URS seems to be similar in octogenarians and nonagenarians.

Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study.

PURPOSE: To determine the safety and efficacy of transurethral resection of the prostate (TUR-P) in patients 85 years or older. METHODS: In this retrospective, multicentre study, patients equal or older than 85 years at the time of surgery (2015-2020) were included. Several pre-, peri- and postoperative parameters were collected. The main outcome criterion was spontaneous voiding with a post-void residual (PVR) volume < 100 ml at dismission and at 12 months after surgery. RESULTS: One hundred sixty-eight patients (median age: 87 years, interquartile range [IQR]: 86-89) were recruited. The patients took on average 5.2 permanent medications (3-8), 107 (64%) were anticoagulated preoperatively and neurological co-morbidities were present in 29 (17%). The indication for surgery was recurrent urinary retention in 66.3% (n = 110) with a mean retention volume of 849 ml. The mean PVR volume of the remaining 35% was 146 ml. Surgery was successfully completed in all patients. A perioperative surgical revision had to be performed in 3% and 13 patients (7.7%) required blood transfusion. After catheter removal, 85% of patients were able to void spontaneously with a PVR < 100 ml, and 14.3% were dismissed with a catheter. Twelve months data were available for 93 patients (55%). Of this cohort, 78 (83.9%) were able to void spontaneously with a PVR < 100 ml, 12 (12.9%) were on permanent catheterization. One patient (0.6%) died perioperatively. The only significant factor associated with an unsuccessful outcome was the number of permanent medications (6.8 vs. 5.0, p = 0.005). CONCLUSION: This retrospective multicentre study documents the safety and efficacy of TURP (monopolar and bipolar) in the old-old cohort.

Two Cases of Strictures after Percutaneous CT-Guided Radiofrequency Ablation for Renal Cell Carcinoma.

Percutaneous radiofrequency ablation is a safe and effective minimally invasive treatment option in selected patients with T1a tumors of the kidney with a low complication rate. We describe two cases that developed the rare but severe complication of thermal injury-induced strictures of the upper urinary tract and its consecutive management.

Overactive bladder symptoms in patients undergoing rigid and flexible cystoscopy.

PURPOSE: To evaluate overactive bladder (OAB) symptoms in patients undergoing diagnostic cystoscopy. Overall changes in the entire study population were assessed, as well as broken down by various subgroups. METHODS: A prospective multi-center study among consecutive 450 adults undergoing diagnostic cystoscopy was conducted. OAB-symptoms were evaluated with the validated eight-item OAB Screening Awareness Tool (OAB-V8) immediately before and on days 1, 4, and 7 after cystoscopy. Patients were distinguished between being OAB-negative and OAB-positive (< 8 and ≥ 8 sum-score, respectively). Average sum-scores and subdomains were evaluated. RESULTS: Before cystoscopy, 44.7% of patients were screened OAB-positive and 55.3% OAB-negative. Out of those being screened negative, development of de-novo OAB was noticed in 16.8%, declining to 8.1% on day 7 (p < 0.001). In patients being OAB-positive before cystoscopy, a decline of OAB-positivity was noted during follow-up (p < 0.001). No statistically significant differences were noted when broken down by gender (p = 0.92), age (p = 0.82) and type cystoscope (rigid vs. flexible, p = 0.38). Average sum-scores declined from 8.68 before cystoscopy to 6.9 during follow-up. Flexible cystoscopy was superior over rigid in four subdomains: uncomfortable urge to urinate (p = 0.04), sudden urge to urinate with little or no warning (p = 0.02), uncontrollable urge to urinate (p = 0.03), and urine loss associated with a strong desire to void (p = 0.009). CONCLUSION: OAB-symptoms are common in patients undergoing cystoscopy. Cystoscopy itself can cause de-novo OAB-symptoms. Controversially, a decline of OAB-symptoms was noted after cystoscopy when patients were screened OAB-positive before cystoscopy. Flexible scopes were superior in some subdomains.

Renal Papillary Hyperplasia as a Cause of Persistent Asymptomatic Microhematuria.

Asymptomatic microscopic hematuria (AMH) is incidentally found during routine health screenings. In the clinical evaluation of persistent AMH imaging modalities, CT urography, MR urography, and retrograde pyelography are of diagnostic importance. In case of pathologic findings (e.g., contrast-filling defects), endoscopic evaluation is mostly performed. To our knowledge, we report the first case of a patient with persistent AMH caused by biopsy-proven renal papillary hyperplasia.

Bladder cancer in nonagenarians: a multicentre study of 123 patients.

OBJECTIVE: To investigate the oncological outcome of nonagenarians with bladder cancer, as a substantial rise in bladder cancer in the old-old age group in the upcoming decades is expected, due to demographic changes and the peak incidence around the age of 85 years. The paucity of data of nonagenarians prompted us to investigate the outcomes of such patients. PATIENTS AND METHODS: A retrospective, multicentre study was designed to assess patient demographics, tumour patterns, treatment strategies and outcome in patients aged ≥90 years treated at participating centres. Patients entered either as de novo or as recurrent cancer. The study period ranged from 01.01.2006 to 31.12.2016. RESULTS: A total of 123 patients with a mean (range) age of 91 (90-99) years were recruited. The American Society of Anesthesiologists Physical Status Classification (ASA-score) distribution was as follows: II, 38%; III, 50%; IV, 12%; and the male to female ratio 2.4:1. The median (range) follow-up was 8 (1-132) months. In all, 60% of patients had a de novo cancer diagnosis. Histological findings revealed: pTa 39% (n = 48), pT1 28.5% (n = 35), and ≥pT2 33% (n = 40). Overall, 67.5% patients had no recurrence, 25.2% one and 7.5% two or more. pTa tumours (n = 48) recurred in 20 patients (42%), pT1 tumours (n = 35) in 12 (34%), and ≥pT2 tumours (n = 40) in six (15%). The median overall survival (OS) was 30.0 months for patients with pTa tumours, 14.0 months for pT1 tumours, and 6.0 months for ≥pT2 tumours. The overall mortality rate of patients with pTa tumours was 40%, with pT1 tumours at 60%, and ≥pT2 tumours 75%. The ASA-score also had a strong influence on median OS after stratification by ASA-score (II, 30 months; III, 12 months; IV, 4 months). CONCLUSIONS: In nonagenarians with bladder tumours, pTa/pT1/≥pT2 stages are almost evenly distributed and two-thirds of patients had no recurrence after transurethral resection of the bladder. The mean OS was 1.3 years, and 6 months for ≥pT2 tumours. Further case-series of patients in this specific age-group are required to identify the best management of this increasing proportion of patients with bladder tumours.

A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal.

OBJECTIVE: To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS: A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS: Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION: Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.

Anxiety and depression analyses of patients undergoing diagnostic cystoscopy.

PURPOSE: To prospectively assess anxiety and depression in patients undergoing diagnostic cystoscopy. METHODS: Patients presenting for outpatient diagnostic cystoscopy were recruited from four European urological departments. Anxiety and depression were assessed with the 'Hospital Anxiety and Depression Scale' (HADS) before cystoscopy and after 1 week. Statistical analyses, including the Chi-square test, univariate, and multivariate logistic regression analyses, were carried out with SPSS v. 21 (IBM Corp., Armonk, NY). RESULTS: Prior to cystoscopy, 30.2 % of patients were anxious and 24.8 % depressive (n = 442). In the post-examination period, anxiety declined to 24.5 %, while depression was unchanged (24.4 %). Pre-cystoscopy anxiety was significantly more common in women (41.8 vs. 24.5 %, p < 0.0001), patients aged <65 years (34.9 vs. 25.9 %, p = 0.04), and in those being examined with rigid cystoscopes (35.7 vs. 23.9 %, p = 0.007). In multivariate regression analyses, female gender (OR 2.6, p < 0.0001), <65 years of age (OR 1.7, p = 0.03), and coexistence of depression (OR 7.8, p < 0.0001) were independently associated with elevated pre-cystoscopy anxiety. Anxious (OR 2.1, p = 0.03) and depressive (OR 2.1, p = 0.01) patients had higher odds of experiencing moderate or severe pain during cystoscopy. Bladder cancer diagnosis did not significantly change patient's anxiety (p = 0.23) or depression (p = 0.7) during the 1 week of follow-up. CONCLUSIONS: Women, patients aged <65 years, depressive patients and those being examined with rigid devices had higher rates of anxiety prior to cystoscopy. Anxious and depressive patients experienced more pain during cystoscopy. Bladder cancer diagnosis seems to have a minor effect on anxiety and depression during the first week after diagnosis.

Impact of hours worked by a urologist prior to performing ureteroscopy on its safety and efficacy.

OBJECTIVE: The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy. MATERIALS AND METHODS: Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses. RESULTS: In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (< 6 h 4.4%, 6-12 h 3.2%, > 12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28). CONCLUSION: Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.

Prospective, multi-institutional pain assessment of 150 women undergoing diagnostic cystoscopy.

BACKGROUND: The aim of this study was to prospectively assess women's pain during rigid and flexible diagnostic cystoscopy and afterwards during a one-week follow-up. METHODS: Prospective, multi-institutional trial analyzing numeric rating scales (NRS) of women undergoing diagnostic cystoscopy. Pain categories: no (0 points), mild (1-3), moderate (4-6) and severe pain (7-10). Assessing of pain before, during cystoscopy, and at day 1, 4 and 7 of follow-up. RESULTS: A total of 150 women undergoing rigid (N.=85) or flexible (N.=65) diagnostic cystoscopy were analyzed. Women undergoing flexible cystoscopy were more frequently pain-free (64.6% vs. 40%, P=0.003) and experienced mild pain less frequently (27.7% vs. 52.9% vs. P=0.002). No significant differences were noted among moderate (6.2% vs. 5.9%, P=0.95) and severe pain (1.5% vs. 1.2%, P=0.85). Patients undergoing their first (P=0.14) and repeat cystoscopy (P=0.08) had similar pain perception. In multivariate logistic regression analyses, women undergoing flexible cystoscopy had a 2.6 increased chance of being pain-free (OR=2.6, CI: 1.28-5.11, P=0.08) and their odds of experiencing mild pain were significantly lower (OR=0.34, CI: 0.17-0.71, P=0.004). The likelihood of experiencing moderate (OR=1.1, CI: 0.28- 4.4, P=0.83) or severe pain (OR=2.42, CI: 0.11-51.79, P=0.57) differed insignificantly. CONCLUSIONS: Rigid and flexible cystoscopies were well-tolerated by most women. However, flexible cystoscopy was associated with a higher likelihood of being pain-free and lower chances of experiencing mild pain. Patients' previous experience with cystoscopy did not influence pain perception.

Association between asymptomatic inflammatory prostatitis NIH category IV and prostatic calcification in patients with obstructive benign prostatic hyperplasia.

BACKGROUND: The aim of this study was to evaluate the incidence of prostatic calcification and prostatitis NIH category IV in patients with obstructive BPH. METHODS: Ninety-six patients with obstructive BPH who had undergone transurethral electroresection of the prostate gland were evaluated. In accordance with a preoperative transrectal ultrasound examination, patients were divided into one group with prostatic calcification (N.=31) and one without (N.=65). Prostatitis NIH category IV was classified according to the grading system by Irani. Correlations between the incidence of prostatic calcification, histological prostatitis, PSA, uric acid, cholesterol, triglycerides, CRP, IPSS, IIEF-25, and NIC-CPSI were analyzed. A stone analysis of prostatic calcification was performed using X-ray powder diffraction. RESULTS: Sixty-nine (71.9%) patients had NIH category IV prostatitis, accounting for 83.9% of those with prostatic calcification versus 66.1% of those without (P<0.04). Significant correlations were found between prostatic calcification and the severity of inflammation (P<0.02) as well as the NIH-CPSI subdomain of urinary symptoms (P<0.02). The only predictor for prostatic calcifications were elevated levels of uric acid. Such patients were 1.4times more likely of having calcifications in the prostate gland (OR=1.4, P<0.047). Stone analysis revealed the following: apatite in 41.7%, whewellite in 29.2%, weddellite and brushite in 8.7% each, whitlockite, apatite/whewellite and organic substances in 4.2%. CONCLUSIONS: On ultrasound examination, one third of patients who were treated with TURP for obstructive BPH had prostatic calcification. These were significantly more common in patients with NIH category IV prostatitis.

Tumor necrosis factor-α expression in patients with obstructive benign prostatic hyperplasia is associated with a higher incidence of asymptomatic inflammatory prostatitis NIH category IV and prostatic calcification.

OBJECTIVE: The aim of this study was to investigate the association of the expression of tumor necrosis factor-α (TNF-α) with asymptomatic inflammatory prostatitis National Institutes of Health (NIH) category IV and prostatic calculi, in patients with obstructive benign prostatic hyperplasia (BPH) treated by transurethral electroresection of the prostate (TURP). MATERIALS AND METHODS: Ninety-six patients with obstructive BPH and TURP were evaluated in a prospective study. Based on a preoperative transrectal ultrasound examination of the prostate gland, patients were divided into two groups, one with prostatic calculi (n = 31) and one without (n = 65). Prostatitis NIH category IV was classified according to Irani's histological grading system (Irani et al. J Urol 1997;157:1301-3). Associations between the incidence of prostatic calculi, histological prostatitis, TNF-α expression, prostate-specific antigen, uric acid, cholesterol, triglycerides, C-reactive protein, International Prostate Symptom Score (IPSS), the International Index for Erectile Function (IIEF-5) and the NIH-Chronic Prostatitis Symptom Index Score (NIH-CPSI) were analyzed. RESULTS: Prostatitis was confirmed by histological investigation in 71.9% of patients: 83.9% of those with prostatic calculi versus 66.1% of those without (p < 0.04). TNF-α expression was significantly higher in patients with prostatic calculi. Association calculations yielded significant values for the severity (histological grading) of inflammation (p < 0.029), TNF-α expression (p < 0.007), uric acid (p < 0.005), cholesterol (p < 0.028) and the NIH-CPS subdomain of urinary symptoms (p < 0.044) in patients with prostatic calculi. CONCLUSIONS: In patients with obstructive BPH, prostatic calculi were found on ultrasound in one-third of the cases, and histological NIH category IV prostatitis in two-thirds of cases. The incidence of both prostatitis NIH category IV and TNF-α expression was significantly higher in patients with prostatic calculi than in those without.

Disparities in the Use of Sacral Neuromodulation among Medicare Beneficiaries.

PURPOSE: Sacral neuromodulation with the InterStim® has been done to treat urinary and bowel control. There are limited data in the literature on use trends of sacral neuromodulation. We explored disparities in use among Medicare beneficiaries. MATERIALS AND METHODS: We queried a 5% national random sample of Medicare claims for 2001, 2004, 2007 and 2010. All patients with an ICD-9 diagnosis code representing a potential urological indication for sacral neuromodulation were included. Patients who underwent device implantation were identified using CPT-4 codes. Statistical analysis was done with the chi-square and Fisher tests, and multivariate logistic regression using software. RESULTS: A total of 2,322,060 patients were identified with a diagnosis that could potentially be treated with sacral neuromodulation. During the 10-year study period the percent of these patients who ultimately underwent implantation increased from 0.03% to 0.91% (p <0.0001) for a total of 13,360 (0.58%). On logistic regression analysis women (OR 3.85, p <0.0001) and patients younger than 65 years (OR 1.00 vs 0.29 to 0.39, p <0.0001) were more likely to be treated. Minority patients (OR 0.38, p <0.0001) and those living in the western United States (OR 0.52, p <0.0001) were less likely to receive treatment. CONCLUSIONS: Sacral neuromodulation use significantly increased among Medicare beneficiaries in a 10-year period. Patients were more likely to be treated with sacral neuromodulation if they were female, white, younger (younger than 65 years) and living outside the western United States.

Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men.

OBJECTIVE: To evaluate pain perception in men undergoing flexible or rigid diagnostic cystoscopy. METHODS: This is a prospective multi-institutional analysis of men undergoing cystoscopy in 4 European departments of urology. Pain perception was assessed with an 11-point numeric rating scale. Pain categories were as follows: no (0 points), mild (1-3), moderate (4-6), and severe pain (7-10). Assessment of pain was before, during cystoscopy, and at days 1, 4, and 7 of follow-up. RESULTS: A total of 300 cystoscopies were analyzed (150 rigid and 150 flexible). Men undergoing flexible cystoscopy were more frequently free of pain (58.7% vs 24%; P <.0001). Mild pain (54% vs 30.7%; P <.0001) and moderate pain (18.7% vs 9.3%; P = .02) were more common with rigid devices. No significant differences were prevalent in severe pain perception (3.3% vs 1.3%; P = .25). Patients, who had previous experience with cystoscopy reported similar pain levels as patients naïve to cystoscopy, regardless if rigid (P = .92) or flexible (P = .26) devices were used. Pain decreased to the baseline during the 1-week follow-up after both, flexible and rigid cystoscopy. In multivariate regression analyses, rigid cystoscopy was an independent predictor for not being pain free (odds ratio [OR] = 0.15; confidence interval [CI] = 0.08-0.28; P <.0001), for experiencing mild pain (OR = 2.57; CI = 1.57-4.19; P <.0001), and for moderate pain (OR = 2.39; CI = 1.13-5.07; P = .02). Severe pain was seldom with both devices, and thus, no statistical difference was found. CONCLUSION: Flexible diagnostic cystoscopy caused less pain than rigid cystoscopy in men. Patient's previous experience with cystoscopy did not influence pain sensation. The type of cystoscope itself was identified as an independent risk factor of pain perception.

Renal calculi: trends in the utilization of shockwave lithotripsy and ureteroscopy.

INTRODUCTION: To assess trends in the usage of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in the treatment of renal calculi. MATERIALS AND METHODS: An analysis of the 5% Medicare Public Use Files (years 2001, 2004, 2007 and 2010) was performed to evaluate changes in the use of SWL and URS to treat renal calculi. Patients were identified using ICD-9 (cm) and CPT codes. Statistical analyses, including the Fisher, 2 tests, and multivariate logistic regression analysis were performed using SAS 9.3 (SAS Institute Inc., Cary, NC, USA) and SPSS v20 (IBM Corp., Armonk, NY, USA). RESULTS: The absolute number of patients diagnosed with (+85.1%) and treated for (+31.5%) kidney calculi increased from 2001 to 2010. The ratio of diagnosed/treated patients declined from 15.2% in 2001 to 10.8% in 2010. Whites (OR = 1.27, p < 0.0001), patients in the South (OR = 1.16, p < 0.0001) and those ≤ 84 years of age were more likely to be treated. The utilization of SWL (84.7%) was greater than URS (15.3%), but the utilization of URS increased over time from 8.4% in 2001 to 20.6% of cases by 2010 (p < 0.0001). Treatment via URS was more likely in women (OR = 1.28, p < 0.0001), in patients living outside the South (OR = 1.29-1.45, p ≤ 0.006) and in later years of the study (OR = 2.87, p < 0.0001). CONCLUSIONS: Treatment patterns for renal calculi changed from 2001 to 2010. The usage of URS increased at the cost of SWL. Multiple sociodemographic factors correlated with the likelihood of being treated surgically as well as the choice of the surgical approach.

A meta-analysis of the performance of retropubic mid urethral slings versus transobturator mid urethral slings.

PURPOSE: We evaluate the efficacy and complications after retropubic and transobturator mid urethral slings in the treatment of female stress urinary incontinence. MATERIALS AND METHODS: A systematic literature review was performed using MEDLINE®, limited to randomized controlled trials with a minimum followup of 1 year and type 1 grafts. Statistical analyses were performed using StatsDirect Version 2.7.9 (StatsDirect Ltd, Altrincham, UK). RESULTS: Retropubic mid urethral sling procedures showed statistically significant improvements in objective cure (OR 1.35, 95% CI 1.10-1.67, p=0.005) and subjective cure (OR 1.24, 95% CI 1.04-1.49, p=0.02). Bladder perforations (OR 5.72, CI 2.94-11.12, p <0.0001) and bleeding (OR 2.65, CI 1.54-4.59, p=0.0005) were significantly more common with retropubic mid urethral slings, whereas vaginal perforations (OR 0.29, CI 0.15-0.56, p=0.0002) and neurological symptoms (OR 0.35, CI 0.25-0.5, p <0.0001) were more common with transobturator mid urethral slings. Operative time was significantly longer for retropubic mid urethral slings than transobturator mid urethral slings (OR 1.38, p <0.0001). No significant differences were noted in mesh erosions and exposure, urinary retention, infection, lower urinary tract symptoms and length of hospital stay. CONCLUSIONS: Retropubic mid urethral slings showed better objective and subjective cure rates than transobturator mid urethral slings. However, bladder perforation and bleeding were more common with retropubic mid urethral slings. Operative time was longer for retropubic mid urethral slings. Transobturator mid urethral slings were associated with more cases of neurological symptoms and vaginal perforation.

Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi?

OBJECTIVES: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. METHODS: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. RESULTS: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p=0.0001). Partial stone removal rates were similar in both groups (p=0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p=0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p=0.007) and the proximal ureter (14.5 vs. 38.6%, p=0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, p<0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22-0.61, p<0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p=0.65). CONCLUSIONS: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS.

Immunohistochemical expression of interleukin-2 receptor and interleukin-6 in patients with prostate cancer and benign prostatic hyperplasia: association with asymptomatic inflammatory prostatitis NIH category IV.

OBJECTIVE: This study prospectively investigated the immunohistochemical expression of interleukin-2 receptor (IL-2R) and interleukin-6 (IL-6) in patients with prostate cancer and benign prostatic hyperplasia (BPH), and a possible association of these conditions with asymptomatic inflammatory prostatitis National Institutes of Health (NIH) category IV. MATERIALS AND METHODS: The study included 139 consecutive patients who underwent transurethral resection of the prostate and transvesical enucleation of the prostate (n = 82) or radical prostatectomy (n = 57). To characterize inflammatory changes the criteria proposed by Irani et al. [J Urol 1997;157:1301-3] were used. IL-2R and IL-6 expression was studied by a standard immunohistochemical method. Results were correlated with tumour, node, metastasis stage, Gleason scores, total prostate-specific antigen, International Prostate Symptom Score and body mass index. RESULTS: IL-2R and IL-6 expression was significantly higher in neoplastic prostate cancer tissue than in normal tissue of prostate cancer patients (p < 0.001 and p < 0.04, respectively). Prostate cancer patients with prostatitis showed significantly higher IL-2R expression than those without inflammation (p < 0.03). In patients with BPH, expression of IL-2R as well as IL-6 was higher in patients with prostatitis than in those without (p < 0.01 and p < 0.02, respectively). CONCLUSIONS: IL-2R and IL-6 expression was significantly higher in prostate cancer tissue than in normal tissue. Patients with asymptomatic inflammatory prostatitis NIH category IV showed significantly greater activity.

Image-based simulation of urethral distensibility and flow resistance as a function of pelvic floor anatomy.

AIMS: The goal of this study is to develop an image-based model of urethral distention and resistance in women with and without SUI. METHODS: A biomechanical vector force model was created to simulate the mechanical deformation of pelvic floor structures during cough and Valsalva in order to measure urethral distension and predict flow resistance patterns. Dynamic MRI images were used to create a spatial model to construct an accurate representation of tissue thickness and location, which was combined with tissue property values (MATLAB 2011a, MathWorks, Natick, MA). Spatial profiles were created to demonstrate the effects of hypermobility and tissue property variability on distensibility and flow resistance along the urethra. Sensitivity analyses were conducted to demonstrate the relationship between flow resistance and various tissue properties. RESULTS: The average distension for incontinent cases (3.8 mm) was significantly greater than that of continent cases (2.6 mm) (t = 3.3083, df = 8, P < 0.01), corresponding to a 70% drop in average resistance to urine flow. Sensitivity analyses demonstrated that the stiffness and contractility of the vagina and urethra had the greatest effect on continence. CONCLUSIONS: We present a novel, 2-dimensional biomechanical model of female stress urinary incontinence (SUI) that relates the effects of various factors such as tissue elasticity, pelvic floor structure, and muscle activation. A better understanding of the pathophysiology underlying SUI has potential implications for the creation of novel targeted treatments.