Daily Urological Practice Research Articles

Role of low-dose deflazacort with tamsulosin versus tamsulosin alone for medical expulsive therapy of ureteric stone

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as anti-inflammatory agent, there may have a potential to improve the pathology and outcome of the treatment. Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis. Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted. Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P<0.001) and less number of colic episodes (33 episodes vs. 21 episodes, P=0.026) and less analgesic requirements (65% vs. 82.5%, P=0.022) in deflazacort group. No significant side effects were noted during the study. Conclusion: Low-dose deflazacort added to tamsulosin provides a significant advantage in ureteric stone expulsion without any extra side effects. With a comparable rate of stone passage, there are more rapid stone expulsion, low analgesic requirement, and less colic episodes when low-dose deflazacort is added to tamsulosin for ureteric stone ≤10 mm.

A prospective study of surgeons’ workloads and associated factors in real-world practice

New technologies such as laparoscopic and robotic surgery are spreading, and there is a demand for physicians to keep up with novel methods. In contrast to the recent focus on healthcare professional burnout, the mental and physical costs during surgery are not well-understood. We aimed to quantify surgeons’ workloads in daily urological surgical practice and clarify potential background factors associated with such workloads. Urologists in Hokkaido, Japan, were invited to this study. Between December 2020 and December 2021, participants repeatedly reported workloads, which were assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), after each surgery in conjunction with participants’ names, patients’ backgrounds, their roles (independent operator, operator under supervision, instructor, and 1st or 2nd assistant), and surgical outcomes, via SurveyMonkey®. Because of the heterogeneity among individuals, a linear mixed-effects model was utilized to analyze factors associated with NASA-TLX, calculating the parameter estimates (PE) of regression coefficients for each factor and their 95% confidence interval (CI). Sixty-five urologists (5 women) joined the study, and 2169 data were collected within 7 days after surgeries. A linear mixed-effects model revealed that female surgeons (PE + 15.56, 95% CI 2.36–28.77), urgent/emergency surgery (PE + 6.65, 95% CI 4.59–8.70), intraoperative complications (PE + 9.26, 95% CI 6.76–11.76), and near-miss incidents (PE + 3.81, 95% CI 2.27–5.36) were associated with higher workloads. Regarding the surgeons’ role, operator under supervision (PE + 12.46, 95% CI 9.86–15.06) showed the highest workloads. Surgeons’ workloads decreased as the number of previous cases of the same procedure increased. Surgeons’ workloads were associated with various factors. Given that the highest workloads were for operators under supervision, instructors should be aware of trainees’ high workloads and devise appropriate instructional interventions.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Review of vasocutaneous fistulas and other rare complications after vasectomy.

Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy. A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy. Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications. Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.

Forgotten Double-J ureteral stent: An analysis of 25 cases in a tertiary hospital

IntroductionDouble-J (DJ) ureteral stents are considered basic and common in daily urological practice. We aim to share our experience of managing 25 cases of forgotten double-J (DJ) stents in our tertiary care center. Methods and materialsWe did a retrospective analysis of cases with forgotten DJ stent for a period of one year spanning from February 2021 to February 2022. Detailed information like age, sex, the indication for insertion of the double-J, the period of insertion, presenting symptoms, and the definite procedure performed to remove the double-J. ResultsThe total number of cases was 25. We had 60% of patients underwent previous procedure in our hospital and the rest 40% were in other centers. The mean age was 38.44 years. The mean duration of the indwelling stent was 20.36 months, and the duration ranged from 13 months to 33 months.Most common indications for stenting were URS (64%). Presenting complaints were dysuria (n = 19; 76%), hematuria (n = 13, 52%), flank pain (n = 9; 36%), storage lower urinary tract symptoms (n = 8; 32%), and recurrent urinary tract infection (n = 5; 20%).Several complications were noted during or after forgotten stent removal like stent fragmentation (20%), fever (16%), sepsis (8%), and hematuria requiring transfusion (4%). ConclusionForgotten double-J ureteral stents are a source for morbidity. Patients should be educated about the complications of the forgotten double-J. Creating a scheduled program for notifying patients with double-J stent is another good way.

Appropriate management reduces radiation exposure in daily urological practice.

To identify and raise awareness of the radiation exposure of urologists due to X-ray fluoroscopic procedures in daily practice. This was a single-center, cohort study of 30 consecutive patients who underwent periodic percutaneous or transurethral replacements of urinary tract catheters. A total of 55 replacements every 3 months with cases aligned were performed by a single urologist. The urologist's radiation exposure and the incident dose to patients per case were measured with thermoluminescent dosimeters. In the latter 3-month period, the pulse fluoroscopy condition was changed from 15 to 7.5 pulses per second, and collimation was added to the field of view. In the analysis of all patients, the use of a modified pulse rate and collimation did not affect the fluoroscopy time, but it did significantly reduce the air kerma and dose area product; in addition, with respect to the medical exposure dose during percutaneous catheter replacement, fluoroscopy time was longer, but air kerma and dose area product showed significant decreases. As with decreases in medical exposure of patients, the equivalent dose for eye lenses of the urologist decreased from 1.2 mSv in the first 3-month period to 0.2 mSv in the second 3-month period. Similarly, the exposure dose for the extremities also decreased significantly, from 33.9 mSv to 8.1 mSv. Urologists are exposed to non-negligible amounts of radiation due to fluoroscopy. Appropriate management such as modified pulse fluoroscopy condition and precautions are required.

Silicone vs. Polyurethane Stent: The Final Countdown.

Ureteric stents are conventionally used in daily urological practice. There is ongoing debate on the superiority of different stent materials, particularly in terms of patient tolerance. We conducted a literature review to compare silicone stents and stents made of other materials from a patient tolerability perspective. We conclude that silicone stents are better tolerated but further research is required.

Unplanned Hospital Visit After Urinary Stone Procedure

Background: Urinary stone is a multifactorial disease which is common in daily urological practice, and is also a substantial public health problem. Surgical management of urinary calculi has changed enormously during the past 20 years. Nowadays, the trend among urologists involved in the management of patients with urinary tract stones is to choose the less invasive and more effective option. Objective: We evaluate the causes of the unplanned hospital visit following shock wave lithotripsy (ESWL), URS (Uretrorenoscope), and PCNL (percutaneous nephrolithotomy)surgical procedures for stone disease and determine the predictors affecting on the visit and readmission. Patients and Methods: This study is a cross-sectional study carried out in Ghazi Al-Hariri hospital for subspecialized surgery in Medical City Complex in Baghdad city-Iraq. The duration of the study was 18 months throughout the period from January, 2019 till June 2020. The majority of SWL techniques were as an outpatient procedure. The patients received analgesia and in each SWL session, 3000 shocks were delivered at a rate of 60 to 90 shocks/min. For URS the patients were performed under general or spinal anesthesia. In cases where ureteral access was not possible, insertion of a ureteric stent was the option followed by ureteroscopy after 14 days. In PCNL the surgical procedure was fluoroscopic guided , prone position used .This procedure was performed under general anesthesia. Results: A 362 patients with urinary stones; 41 unplanned visits were recorded within one month of surgical operation. The incidence of unplanned visits after management of urinary stone in Medical City Complex was (11.3%) and rate of unplanned visits according to management types( 26.6%, 18.8% and 4.6% for PNL, URS and ESWL) . Conclusion: The rate of unintended visits within 30 days after treatment of urinary tract was treated at Martyr Ghazi Hariri Specialized Surgery at the Medical City Complex in the world, and the rate of unplanned visits within 30 days after the removal of the kidneys The percutaneous route is the highest, followed by ureteroscopy and the lowest level after extracorporeal lithotripsy.Factors influenced by unintended visits such as hospital exit, and not given cafés after exit, insufficient follow-up and therapeutic mistakes that are still large. Reservation therapy is the perfect treatment method for treating illegal visits special after the ureter end. Keywords:Shock wave lithotripsy, percutaneous nephrolithotomy, Uretrorenoscope

Hemorrhagic renal angiomyolipoma: An analysis of 6 cases with review of the literature

Renal angiomyolipoma is the most common benign solid tumor of the kidney. It can occur sporadically or in association with tuberous sclerosis, which is an autosomal dominant inherited disease. Hemorrhagic rupture of renal angiomyolipoma with retroperitoneal hematoma is the most serious complication that can be life-threatening and requires urgent management. The aim of this study is to review, through 6 cases and by means of a review of the literature, the diagnostic criteria of renal angiomyolipoma and the particularities of management of hemorrhagic renal angiomyolipoma. We carried out a retrospective study which concerned 6 patients with hemorrhagic renal angiomyolipoma, unilateral or bilateral, during the period between January 2019 and August 2021, in the Urology Department of the Hassan II University Hospital in Fez. The average age of our patients was 53 years with an F/M sex ratio of 2. Bourneville's tuberous sclerosis was diagnosed in 3 patients. The circumstances of discovery of renal angiomyolipoma were: acute flank pain associated with anemic syndrome in 3 patients, incidental discovery in 1 patient, clot hematuria in 1 patient and abdominal mass in 1 patient. Clinical examination revealed hemodynamic instability in 1 patient, flank defense in 2 patients, lumbar mass in 1 patient and lumbar tenderness in 1 patient. The abdominal CT angiogram allowed us to retain the diagnosis of renal angiomyolipoma in all the patients, with a bilateral form in the 3 patients with tuberous sclerosis of Bourneville. Renal embolization was performed in 5 patients, while total nephrectomy was performed in 1 patient. Renal angiomyolipoma is a rare tumor in daily urological practice. Its hemorrhagic risk requires a good knowledge of diagnostic, therapeutic and monitoring methods.

Health-Related Quality of Life Assessment in Daily Urologic Practice: A Survey of Greek Urologists.

PurposeHealth-related quality of life (HRQoL) assessment has become an integral part of clinical research across different disciplines. However, the degree of incorporation of QoL standardized questionnaires in daily routine is variable. This survey study examined how HRQoL is perceived and utilized among urologists from the Hellenic Urological Association (HUA) in their daily practice.MethodsA nationwide survey of Greek urologists registered with the HUA was conducted. Participants were asked to complete a questionnaire sent via email. The survey questionnaire consisted of demographic data including sex, age, working position and working environment and 11 Likert-scale questions regarding perception and use of HRQoL in clinical practice.ResultsA total of 1000 Greek urologists were contacted, of whom 400 (40%) responded. Participants were predominantly male (94.8%) with a mean age of 43.7 years and a mean working experience of 12.5 years. Most participants considered HRQoL assessment to be important in their clinical practice (95.3%) and valuable in both patient consultation (95.8%) and treatment follow-up (91.8%). Half of urologists (51%) agreed with the statement that there is limited time for HRQoL assessment in daily practice. Validated questionnaires were rated as useful by 75.5% of participants. Overall, only 26.7% of participants stated they have incorporated HRQoL questionnaires in their daily practice. A subgroup analysis of participants showed that experienced physicians (>10 years) were less likely to utilize HRQoL (OR 0.38, p=0.008, 95% CI 0.19–0.77) and experienced difficulty in distinguishing between HRQoL assessment and symptom-rating (OR 0.32, p<0.001, 95% CI 0.17–0.61). Lack of time for HRQoL assessment was a main concern for urologists in-training (OR 0.7, p<0.001, 95% CI 0.57–0.85).ConclusionHRQoL assessment is well-perceived by Greek urologists, although it has yet to achieve a substantial degree of integration in their daily practice.

Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey

Introduction: Guideline recommendations are meant to help minimize morbidity and to improve the care of nonmuscle invasive bladder cancer (NMIBC) patients but studies have suggested an underuse of guideline-recommended care. The aim of this study was to evaluate the level of adherence of German and Austrian urologists to German guideline recommendations. Methods: A survey of 27 items evaluating diagnostic and therapeutic recommendations (15 cases of strong consensus and 6 cases of consensus) for NMIBC was administered among 14 urologic training courses. Survey construction and realization followed the checklist for reporting results of internet e-surveys and was approved by an internal review board. Results: Between January 2018 and June 2019, a total of 307 urologists responded to the questionnaire, with a mean response rate of 71%. The data showed a weak role of urine cytology (54%) for initial diagnostics although it is strongly recommended by the guideline. The most frequently used supporting diagnostic tool during transurethral resection of the bladder was hexaminolevulinate (95%). Contrary to the guideline recommendation, 38% of the participants performed a second resection in the case of pTa low-grade NMIBC. Correct monitoring of Bacille Calmette-Guérin (BCG) response with cystoscopy and cytology was performed by only 34% of the urologists. Conclusions: We found a discrepancy between certain guideline recommendations and daily routine practice concerning the use of urine cytology for initial diagnostics, instillation therapy with a low monitoring rate of BCG response, and follow-up care with unnecessary second resection after pTa low-grade NMIBC in particular. Our survey showed a moderate overall adherence rate of 73%. These results demonstrate the need for sharpening awareness of German guideline recommendations by promoting more intense education of urologists to optimize NMIBC care thus decreasing morbidity and mortality rates.

Renoprotective effect of direct renin inhibitor (aliskiren) during partial ureteral obstruction

Partial ureteral obstruction (PUO) is a major clinical problem in the daily urologic practice that is treatable and often reversible. Renin-angiotensin system (RAS) is implicated in the pathophysiology of PUO as angiotensin II induces alterations in renal hemodynamics, apoptosis, inflammation and fibrosis

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from İstanbul

Background/aimThe aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey.Materials and methodsWe retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in İstanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed.Results There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively. ConclusionThis novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

The effect of the first wave of COVID-19 pandemic on urology practice and anxiety scores of patients awaiting surgery.

ObjectiveWe aimed to determine the effect COVID‐19 pandemic on the daily urology practice of the level 3 centre located in one of the most affected regions in Turkey. We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID‐19‐related restrictions.MethodsThe number of patients admitted to the outpatient clinic, outpatient procedures, emergency consultation requests, hospitalised patients and the total number of surgeries between March 10, 2020 and June 15, 2020 were evaluated. These numbers were compared with the same period of 2019. Subsequently, patients who could not be operated or whose elective surgeries were postponed between March 10, 2020 and June 15, 2020 were determined(n:96). These patients were asked to fill out Beck Depression Inventory(BDI) and State‐Trait Anxiety Inventory(STAI). The presence of difference between the baseline anxiety levels and the anxiety levels during the COVID‐19 pandemic was investigated. Afterwards, these patients were divided into two groups based on planned procedures as oncological group (group1) and non‐oncological group (group2). The presence of a difference between the anxiety and depression levels between the groups was investigated.ResultsThere was a drastic decline in number of patients in all assessed parameters. The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI‐S and STAI‐T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively)(P < .001). STAI‐S scores of the patients were found to be compatible with severe anxiety. The patients’ mean BDI score was found to be 15 ± 8.9, which indicated mild depression. However, the age and STAI‐S values were significantly higher in group1.ConclusionWe noted that anxiety and depression levels increased in patients whose operations were delayed because of pandemic‐related restrictions, especially in oncological patients. We believe that an important contribution can be made to the protection of public health by planning advance psychosocial interventions for high‐risk groups during pandemics.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey.

ObjectiveTo present a nation‐wide analysis of the workload of urology departments in Turkey week‐by‐week during Covid‐19 pandemic.MethodologyThe centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9‐March‐2020 and 31‐May‐2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019.ResultsA total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid‐19 pandemic compared with normal life.ConclusionsCovid‐19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non‐deferrable surgeries by urologists in concordance with published clinical guidelines.

Comparison of before and after COVID-19 urology practices of a pandemic hospital.

The aim of this study is to compare the effects of COVID-19 on urology practice using pre- and post-pandemic data of a pandemic hospital. March 11 is considered as the beginning of COVID-19 and, changes in the number of the outpatient clinic examinations, non-surgical procedures, and surgery in the 8-week period before and during the pandemic were evaluated by weeks. Age, gender, and comorbid diseases of the operated patients were compared statistically. The symptoms, complaints, mortality, and morbidity conditions of the patients were recorded by contacting them. Descriptive data and chi-square test were used. The number of COVID-19 cases has been reported as 8,916 for the hospital, 88,412 for the city and 150,593 for the country. The mean age of the operated patients before and after 11 March was 51 and 47, and comorbidities were 79 and 40, respectively, and there was no statistically significant difference(p<0.05). The number of patients examined was 2,309 and 868, the number of operated patients 173 and 94, the number of patients undergoing non-surgical procedures were 371 and 174, respectively. The names and numbers of surgical and non-surgical procedures are listed according to European Association of Urology (EAU) priority classification. In follow-up, no complication because of COVID-19 was observed in any patient. Our study showed that, although the numbers have decreased, similar operations can be performed in daily urology practice without any contamination and mortality during the pandemic compared to the prepandemic period, by taking precautions and following the algorithms.

Современные подходы к диагностике острого цистита и оценке качества его лечения

Lower urinary tract infections are common infectious diseases. Although there are international valid questionnaires for evaluating a number of urological diseases (prostatitis, BPH, erectile dysfunction), a unified questionnaire for cystitis was absent until recently. Our aim was to evaluate the efficiency and ease of use of the Acute Cystitis Symptom Score (ACSS) in the daily urological practice. A total of 47 women aged 24 to 46 years with typical complaints for acute cystitis were included into multicenter open, non-comparative prospective population-based study. All of them completed the ACSS questionnaire during the first consultation and after 7-10 days at the follow-up visit. The diagnosis of acute cystitis was valid with a total score of 6 or more points. Clinical and laboratory studies were used to diagnose the cystitis. Self-completion of the questionnaire by the patient and its analysis by the physician took about four minutes. The average baseline score for the "typical" domain was 9.8+/-1.3, while a score for the differential diagnostic domain was 1.2+/-0.4. The mean baseline quality of life was 6.4+/-0.8 points. The total score averaged 17.4+/-1.9. All 47 patients had leukocyturia, and 12 (25.5%) had hematuria. A microbiological study was done in 36 (76.7%) patients and revealed an increased concentration of uropathogens in all cases. Thus, acute cystitis diagnosed on the ACSS scale was confirmed, and 41 (87.2%) patients had acute uncomplicated cystitis, and in 6 cases (12.8%) various complications developed. The specificity of the ACSS questionnaire was 100%. The questionnaire can be considered as a necessary tool for studies on LUTS in order to standardize obtained data and ensure their comparability.

The impact of COVID-19 pandemic on urological emergencies: a single-center experience.

PurposeCOVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies.Methodswe retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models.ResultsThe final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096–6.757, p = 0.0297) was a significant predictor of admission.ConclusionsUrgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.Electronic supplementary materialThe online version of this article (10.1007/s00345-020-03264-2) contains supplementary material, which is available to authorized users.

Benign prostatic hyperplasia : New and treatment-relevant aspects from the DGU guidelines

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, atargeted and resource-saving approach is essential. Arational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as atimed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as areference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As aresult, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

New aspects in the treatment of localized renal cell carcinoma

Localized renal cell carcinoma is increasingly relevant in daily urological practice due to earlier diagnosis and higher life expectancy. To analyze and compare current treatment evidence for localized renal cell carcinoma regarding new aspects of nephron-sparing surgery, the different surgical approaches and focal therapy. Asystematic search was performed to identify relevant publications from 2018 and 2019. Prospective randomized trials comparing nephrectomy with partial nephrectomy, the three different surgical approaches with each other, and focal therapy with surgery are still lacking. Positive effects on survival by partial nephrectomy could be demonstrated, even though partial nephrectomy has ahigher morbidity than radical nephrectomy. Older patients (>75years) with advanced localized renal cell carcinoma did not appear to benefit from partial nephrectomy so far, but minimally invasive surgical approaches are underrepresented in such studies. Minimally invasive partial nephrectomy is superior to the open approach, and robot-assisted partial nephrectomy has better results than laparoscopy. Focal therapy of kidney tumors is technically safe and feasible, but relevant comparisons with partial nephrectomy are still lacking. Partial nephrectomy is still the gold standard treatment for localized renal cell carcinoma, it should be preferably performed by arobot-assisted approach. Focal therapy can serve as an alternative in highly selected cases.