A Randomized Controlled Study of Robot-Assisted versus 3D Laparoscopic Radical Prostatectomy in Patients with Carcinoma ProstateRead the full article
Advances in Urology provides a forum for urologists, nephrologists, and basic scientists working in the field of urology. The journal publishes articles focusing on the male and female urinary tract and the male reproductive organs.
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Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty
Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, n = 25) and standard group (group I, n = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; ), as well as the likelihood of relapse within two years (). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; ). The FTS protocol reduced the treatment period () and decreased the severity of postoperative pain (). The use of the “fast track surgery” protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.
A Potential Protective Effect of Alcohol Consumption in Male Genital Lichen Sclerosus: A Case-Control Study
Introduction and Objectives. Lichen sclerosus (LSc) is a chronic inflammatory process of the skin characterized by its unique histological features. It affects men and women of all ages, mainly in the anogenital area. The etiologies and exact pathophysiology are not well-known; however, LSc can be considered a precursor to male genital squamous cell carcinoma. We aim, through this case-control study, to potentially associate genital LSc with risk factors and certain patient characteristics in Lebanese adult males. Materials and Methods. A nested case-control study design was chosen. Subjects enrolled were adult male patients who had a circumcision between January 2010 and December 2020 at our university hospital, with a confirmed LSc diagnosis on pathology. Cases were matched with controls by age with a ratio of 1 : 1, all of whom were circumcised and had a negative pathology report. Data collection consisted of sociodemographic, behavioral, and past medical and familial history characteristics. Results. A total of 94 patients were enrolled. The mean age was 49.81 (±22.92) in the group of men with LSc. No significant differences in sociodemographic characteristics (age and BMI) were found between the two compared groups. Smoking cannot predict LSc as opposed to alcohol consumption, which we found to be a protective factor against the appearance of LSc (). Men with LSc had significantly higher rates of diabetes () and hypertension (). No associations were found between LSc and the presenting chief complaints, family history of LSc, and past penile trauma. Conclusion. In this study, we were able to compare multiple variables between 47 circumcised patients diagnosed with LSc and a control group. We found that LSc patients showed higher rates of diabetes and hypertension. A potential protective effect of alcohol consumption is to be explored in future projects with bigger sample sizes and higher statistical powers.
Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett’s Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study
Background. Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett’s procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett’s procedure. Results. No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett’s repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions. The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.
Outcomes of Top-Down Holmium Laser Enucleation of Prostate for Recurrent/Residual Benign Prostatic Hyperplasia: One-Year Follow-Up
Introduction and Objective. We aimed to evaluate urinary functional outcomes of top-down holmium laser enucleation of the prostate (HoLEP) in patients who underwent transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH) compared to patients with primary BPH. Materials and Methods. We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (Qmax), postvoid residual urine test (PVR), and continence status. Results. Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25–200)) was not significantly longer than that for group II (60 min (19–165) ()). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months’ follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI. Conclusions. For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.
The Effects of Pelvic Floor Muscle Exercise Combined with Core Stability Exercise on Women with Stress Urinary Incontinence following the Treatment of Nonspecific Chronic Low Back Pain
Aim. To compare the combined effects of core stability exercise and pelvic floor muscle exercise (PFME) with the effects of PFME alone on women with stress urinary incontinence (SUI) who experience nonspecific chronic low back pain (NSCLBP). Methods. A stratified randomized controlled trial study (RCT) was conducted with 50 women with SUI who experienced LBP, aged 18–60 years and with pad weight ≥2 grams for the one-hour pad test. The respondents were divided into two groups: the intervention group (PFME + core stability exercise) and the control group (PFME). The primary outcomes were the amount and frequency of urine leakage, which were measured using the one-hour pad test and the Bengali-ISI subjective questionnaire. A secondary outcome was quality of life (QoL), which was measured using King’s Health Questionnaire (KHQ). An ITT analysis was conducted using repeated measures ANOVA (2 × 2) with Bonferroni’s post-hoc analysis. Results/Preliminary Findings. The findings illustrated that 72% (n = 18) of the intervention and 28% (n = 7) of the control group participants showed improvement in UI after 12 weeks of intervention. In addition, the amount and frequency of urine leakage significantly decreased in the intervention group compared to the control group (). Conclusion. The RCT-illustrated improvement of SUI in women with nonspecific chronic low back pain, reduction of frequency, and improvement of the QoL were more evident from PFME with core stability exercise than from PFME alone.
Diagnosing Oncocytoma by Core Needle Biopsy: A Single-Center Experience
Background. Oncocytoma is one of the most common benign kidney tumors, accounting for 3–7% of all solid renal masses. Diagnosing oncocytomas using renal biopsy remains a controversy in the uro-pathologic community. With the increasing use of biopsies for assessment of renal lesions, reaching this pathologically benign diagnosis may prevent further surgical measures and have significant clinical benefit. Objective. To demonstrate our center’s results using renal biopsy to diagnose oncocytomas and to suggest that this diagnosis can be made with high success rates. Design, Setting, and Participants. From our center’s database, we retrospectively identified and retrieved all cases of oncocytoma diagnosed between the years 2011 and 2020 by renal biopsy. Medical records of those patients were then reviewed to view follow-up meetings and imaging of the lesions biopsied. Outcome Measurements and Statistical Analysis. In 21 biopsies performed on 19 patients, diagnosis was supported by subsequent follow-up averaging at 3.44 years per patient. Results and Limitations. The lesions exhibited benign behavior during follow-up after biopsy, consistent with the diagnosis of oncocytoma. Conclusions. Our study demonstrates that with good patient selection and proficient cooperation between urologists, radiologists and dedicated uro-pathologists, correctly diagnosing oncocytomas using RCB is a viable task. Patient Summary. Oncocytomas are benign lesions of the kidney. In our study, we reviewed all cases of oncocytomas pathologically diagnosed using renal biopsy from our center’s database. We found that in subsequent follow-up later to biopsy, the lesions displayed benign behavior consistent with oncocytoma. The use of percutaneous biopsies to reach this diagnosis could save patients more extensive surgeries.