Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study

Background We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study. Methods Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho). Results Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P = 0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P = 0.025), but pain scores of the two groups were similar before discharge (P = 0.560). There were no differences in the changes of serum creatinine level (P = 0.792) and changes of estimated glomerular filtration rate (P = 0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3 months (P = 0.014). Maneuverability and accessibility were better in SA with sedation than GA (P < 0.001). Conclusions RIRS under SA showed advantages in renal function change using renogram at postoperative 3 months and in lower pain score on the first postoperative morning. Performance of operator under SA was worse than that under GA and significantly improved with sedation. RIRS under SA showed advantages in lower pain score at postoperative first day. Trial registration Clinicaltrials.gov ID is NCT03957109, and registration date is 17th May 2019. This study was retrospectively registered.This study was supported by grant no. 04–2015-0680 from the SNUH Research Fund

Free combination of dutasteride plus tamsulosin for the treatment of benign prostatic hyperplasia in South Korea: analysis of drug utilization and adverse events using the National Health Insurance Review and Assessment Service database

Abstract Objective To assess the use and safety of free combination therapy (dutasteride and tamsulosin), dutasteride monotherapy, or tamsulosin monotherapy in patients with benign prostatic hyperplasia (BPH). Methods This non-interventional retrospective cohort study used claims data from the Korea Health Insurance Review and Assessment-National Patient Sample database. Patients with BPH ≥ 40years of age receiving combination therapy (dutasteride 0.5mg and tamsulosin 0.4mg daily) or dutasteride 0.5mg, or tamsulosin 0.4mg daily dose between 2012 and 2017 were included. The frequency, duration of treatment and risk of any adverse event (AE) or serious AE (SAE) was compared for combination therapy versus each monotherapy using non-inferiority testing. Results Of 14,755 eligible patients, 1529 (10.4%) received combination therapy, 6660 (45.1%) dutasteride monotherapy, and 6566 (44.5%) tamsulosin monotherapy. The proportion of patients treated with combination therapy exceeded the pre-specified 3% threshold for frequent use. Safety results indicated a similar risk of any AE and SAE irrespective of treatment group. The adjusted relative risk for any AE over the treatment observation period comparing combination therapy with dutasteride monotherapy was 1.07 (95% confidence interval [CI] 1.03, 1.12), and with tamsulosin monotherapy was 0.98 (95% CI 0.95, 1.02) demonstrating non-inferiority. The adjusted relative risk for any SAE was 1.07 (95% CI 0.66, 1.74) and 0.90 (95% CI 0.56, 1.45), compared with dutasteride and tamsulosin monotherapy, respectively. Although the SAE results did not statistically demonstrate non-inferiority of combination therapy based on pre-specified margins, the 95% CI for the risk ratio estimates included the null with a lower limit below the non-inferiority margins, indicating no meaningful differences in SAE risk between groups. Absolute SAE risks were low. Conclusion Combination therapy with dutasteride and tamsulosin is frequently used in real-world practice in South Korea for treatment of BPH and demonstrates a safety profile similar to either monotherapy

A Prospective Multi-center Trial of Escherichia coli Extract for the Prophylactic Treatment of Patients with Chronically Recurrent Cystitis

We have assessed the efficacy and safety of Escherichia coli extract (ECE; UroVaxom (R)) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2 +/- 5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.Ha US, 2008, INT J ANTIMICROB AG, V31, pS63, DOI 10.1016/j.ijantimicag.2007.07.018LEE SJ, 2008, KOREAN J UROL, V48, P428Krieger JN, 2002, J UROLOGY, V168, P2351, DOI 10.1097/01.ju.0000037620.30988.b2Barnett BJ, 1997, AM J MED SCI, V314, P245Nicolle LE, 1997, INFECT DIS CLIN N AM, V11, P647Baier W, 1997, ARZNEIMITTEL-FORSCH, V47, P980Lettgen B, 1996, CURR THER RES CLIN E, V57, P464AVORN J, 1994, JAMA-J AM MED ASSOC, V271, P751MAGASI P, 1994, EUR UROL, V26, P137SCHULMAN CC, 1993, J UROLOGY, V150, P917JACOBY GA, 1991, NEW ENGL J MED, V324, P601NAUCK M, 1991, INT J EXP CLIN CHEMO, V4, P1SOTOLONGO JR, 1990, J UROLOGY, V143, P979VANPHAM T, 1990, J BIOL RESP MODIF, V9, P231TAMMEN H, 1990, BRIT J UROL, V65, P6HANSSON S, 1989, BRIT MED J, V298, P856HANSSON S, 1989, BRIT MED J, V298, P853WYBRAN J, 1989, IMMUNOPHARM IMMUNOT, V11, P17BOSCH A, 1988, IMMUNOPHARM IMMUNOT, V10, P333TAMMEN H, 1988, UROLOGE, V28, P294BOTTEX C, 1988, INT J IMMUNOTHER, V4, P203FREY C, 1986, UROL INT, V41, P444HAUSER WE, 1982, AM J MED, V72, P711

Current Laser Treatments for Benign Prostatic Hyperplasia

The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient

The current role of the artificial urinary sphincter in male and female urinary incontinence

The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59∼ 97% in males vs. 60∼92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence

Restoring erectile function by combined treatment with JNK inhibitor and HDAC inhibitor in a rat model of cavernous nerve injury

© 2022 American Society of Andrology and European Academy of AndrologyBackground: The main pathophysiologic conditions of erectile dysfunction (ED) after radical prostatectomy are considered to be corporal fibrosis and apoptosis induced by cavernosal nerve (CN) injury. Objectives: In a rat model of CN crush injury (CNCI), we investigated whether combination treatment with JNK inhibitor (JNKi), SP600125, and HDAC inhibitor (HDACi), suberoylanilide-hydroxamic-7 acid (SAHA), for 2 weeks after CNCI would restore erectile function by suppressing fibrosis and apoptosis through normalization of JNK and HDAC pathways. Materials and methods: Seventy 12-week-old rats were randomly divided into five groups: Sham surgery, CNCI alone, CNCI treated with daily intraperitoneal injection of 10 mg/kg JNKi, CNCI treated with daily oral administration of 25.0 mg/kg HDACi, and CNCI daily treated with a combination. Two weeks after CNCI, we investigated the erectile response to electrostimulation and conducted histological staining, caspase-3 activity assay, and western blot analysis. Results: CNCI alone resulted in significantly reduced intracavernosal pressure/mean arterial pressure (MAP) and area under the curve/MAP, decreased smooth muscle (SM)/collagen ratio and SM content, higher caspase-3 activity, and increased protein levels of total HDAC3, transforming growth factor (TGF)-β, fibronectin, and c-Jun phosphorylation, compared with the Sham surgery. The CNCI groups exposed to JNKi, HDACi or both showed improvements in erectile-responses and SM/collagen ratio, compared to the CNCI alone. The combined treatment showed additional improvement in erectile responses at 1.0V stimulation and in SM/collagen ratio compared to the single agent treatment. SM content, caspase-3 activity, and c-Jun phosphorylation improved in the two CNCI groups exposed to JNKi. The two CNCI groups exposed to HDACi showed normalization of protein levels of HDAC3, fibronectin, and TGF-β. Discussion and conclusions: The combined administration of JNKi and HDACi during the acute phase after CNCI in rats can preserve ED by suppressing cavernosal fibrosis and apoptosis by normalizing the HDAC/TGF-β and JNK pathways.N

Patients' experience with ambulatory urodynamics. A prospective study

OBJECTIVE: To assess emotional variables in patients who underwent ambulatory urodynamic monitoring (AUM). MATERIAL AND METHODS: A total of 33 females and 7 males aged 23-72 years with an overactive bladder who had undergone three consecutive AUM sessions were included in the study on a prospective basis. Patients completed a self-administered questionnaire before and immediately after each procedure. Answers were given using a visual analog scale. RESULTS: The pre-procedural level of anxiety did not differ significantly with respect to sex, age, education level or income. The degree of bother experienced by patients aged > or = 50 years was higher than for those aged 0.05). Only the subjective bother score influenced the examiner-rated degree of intolerance during AUM (p = 0.007). A total of 34 patients (85.0%) indicated that they would be willing to return for a further session of AUM. The degree of intolerance decreased at the second (p = 0.006) and third (p = 0.049) AUM sessions, whereas other parameters were not significantly different. CONCLUSION: Our results demonstrate that AUM is acceptable and well tolerated by patients with bladder dysfunction