Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study

BackgroundTo investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml.Materials and methods100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml.Results17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed.ConclusionsThis is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE

Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy – the controversy continues

BACKGROUND: To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi ≤ 20 mm, in patients aged ≥ 14 years, were included in the study. Intravenous urograms (IVU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size. RESULTS: At three months follow up the clearance for stone size ≤ 10 mm, 11–15 mm and 16–20 mm were 95, 96 and 90% respectively. Patients with acute LPC (<90°) and obtuse angle (>90°) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 kg/m(2), the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (≤ 20 mm) and BMI has no relation with stone clearance. With modern lithotripter, stones up to 20 mm could primarily be treated by ESWL, irrespective of an un-favorable lower polar calyceal anatomy and body habitus

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma

Introduction The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group. Methods The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report. Results There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy. Conclusions Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC

Re: indwelling ureteral stents and sexual health: a prospective multivariate analysis . MC Sighinolfi et al. J.Urol 2007, 178 229-31

We read with interest the article by Sighinolfi et al. who prospectively assessed the impact of indwelling ureteral stents on sexual function using the IIEF-5 and Female SFI. At 45 and 60 days after stent insertion 83% of men reported some grade of sexual dysfunction, and 30% of women reported no sexual activity due to stent related anxiety. In recent years there has been an increasing awareness of the need for validated tools to measure objectively the considerable morbidity associated with ureteral stenting, and to address its influence on daily activities. These tools have remained elusive. In this respect the present study significantly adds to the existing literature. Nevertheless we would like to address some issues that we believe deserve scrutiny. Although the authors recognize the robustness of the USSQ developed by Joshi et al. they failed to use it in their study. The USSQ is a validated self-administered instrument with good evaluative and discriminant properties, which explores stent related morbility in 6 areas. The questionnaire has been adopted in several clinical trials and has recently been validated by our group in Italian in a prospective cohort of 66 patients of box sexes with indwelling stents. In the USSQ sexual function for both sexes is investigated with 3 questions evaluating transient but complete sexual dysfunction , pain during intercourse and overall satisfaction for those subjects with a pre-stent active sex life. The 2 specific questionnaires on sexual dysfunction were chosen by Sighinolfi et al. for a more thorough assessment. However one has to recognize that they have not been formally validated in Italian and thus a bias may have been introduced. Moreover with the IEEF-5 the evaluation of pain during intercourse, commonly reported complaint (64% and 45% of men at 1 and 4 weeks after stent insertion, respectively in our series) remains unexplored. Finally a single multidimensional questionnaire with a separate index score for each domain such as the USSQ, would have allowed an easier and more reliable correlation between sexual dysfunction and all other symptoms. Within the same cohort used for our validation study we perform a multivariate analysis to identify predictors of stent related morbidity, including patient age, gender and BMI and stent length, size and location of distal extremity with respect to the midline has determined on abdominal X-ray. Stent distal loop crossing the midline, which was previously shown to impact symptoms negatively , proved to be an independent predictor of morbidity for all USSQ domains including sexual matters. In particular 82% and 100% of original active male and female patients with this condition, respectively reported impaired sexual function at 1 week, compared to 43%and 80% respectively with the stent not crossing the midline (p<0,01). This easily determinable parameter was not investigated by the authors