Postoperative Hematuria Research Articles

A Single-Center Study of the Efficacy of Transvesicoscopic Ureterovesical Reimplantation: With or Without Ureteral Tailoring in Children with Congenital Megaureter.

Objective: To investigate the efficacy of ureteral tailoring with or without ureteral bladder reimplantation in the treatment of primary megaureter (MGU) in children by transvesicoscopic ureteral reimplantation. Methods: Clinical data from 21 children with primary MGU who were treated with pneumo-bladder ureterovesical reimplantation in Anhui Children's Hospital from January 2019 to August 2022 were retrospectively analyzed. Thereafter, children were divided into two groups according to whether intraoperative ureteral tailoring was performed, including 9 in the trimmed group and 12 in the nontrimmed group. In the meantime, there were 16 males and 5 females, with the age of 4.7 ± 2.12 years. Furthermore, there were 17 obstructive MGU cases, 2 reflux MGU cases, and 2 obstructive with reflux MGU cases, with 16 cases on the left side (including 1 case of Y-shaped ureter in the left duplicated kidney), whereas 5 on the right side. All children underwent transvesicoscopic ureteral reimplantation (the Cohen procedure). Thereafter, changes in operation time, duration of retained catheterization, hematuria time, renal pelvis and ureteral dilatation, and tortuosity between two groups were compared 3 months after Double-J tube removal. Results: All children were effectively treated with transvesicoscopic ureteral reimplantation, the operation time (p = 0.02, p < 0.05), postoperative hematuria time (p = 0.00, p < 0.05), and retained urinary catheter time (p = 0.00, p < 0.05) were shorter in the nontrimmed group, and the mean postoperative follow-up time was 27.6 (3-22) months. Moreover, the postoperative anteroposterior diameters of the affected renal pelvis in both groups were 0.31 ± 0.39 cm and 0.27 ± 0.29 cm, respectively, whereas the postoperative maximum ureteral diameters were 0.33 ± 0.31 cm and 0.27 ± 0.36 cm, separately, which were significantly reduced compared with the preoperative counterparts. All children recovered well, with no postoperative complications. Conclusion: Whether intraoperative ureteral clipping is performed or not does not significantly affect the outcome of transvesicoscopic laparoscopic ureteral bladder reimplantation for primary MGU in children. Both groups of children improved with satisfactory surgical results, but the nontrimmed group has shorter operation time, simpler operation, and less trauma.

A comparison of suprapubic percutaneous versus transurethral approach for the treatment of vesical stone in male patients: prospective clinical trial

Abstract Background: Urolithiasis can affect all parts of the urinary tract (kidneys, ureter, urinary bladder, urethra, and even the prostate). The disease is usually symptomatic; however, a symptomatic disease can occur in some cases; vesical stones account for approximately 5% of urinary tract calculi. Objectives: In the present study, we try to compare two different techniques for endoscopic surgical treatment of vesical stone (transurethral versus percutaneous). Materials and Methods: This work involved 37 male patients with vesical stones; those patients split into two groups, the first treated by transurethral vesicolithotripsy while Group 2 (G2) treated by suprapubic vesicolithotripsy using pneumatic lithoclast system in both groups. Patients in both groups have been compared regarding operative time, stone clearance, postoperative hematuria, hospital stay, and some other parameters. Results: There was no clinical significance regarding the sizes and the number of vesical stones between the two groups of patients. The study showed the operative time was significantly shorter in G2 than in Group (G1); in addition to that postoperative hematuria was little in G2 than in G1. Stone clearance was also significantly higher in G2 than G1. Conclusion: We conclude that the suprapubic approach is better than transurethral approach for the treatment of vesical stones in male patients due to its higher efficacy and shorter operative time.

Effect of Sanjin Paishi Decoction combined with lithotripsy on clinical symptoms and renal function of patients with nephrolithiasis

Purpose: To determine the effect of Sanjin Paishi decoction (SJPSD) combined with lithotripsy on the improvement of clinical symptoms and renal function in nephrolithiasis patients.&#x0D; Methods: A total of 100 patients with nephrolithiasis, who were treated in the outpatient department of the Affiliated Hospital of Jinggangshan University, Ji'an, Jiangxi, China from January 2019 to October 2021, were retrospectively analyzed and enrolled in the study. They were divided into control group (CG, n = 40) treated with holmium laser lithotripsy through flexible ureteroscope, and a study group (OG, n = 60) treated with SJPSD after holmium laser lithotripsy through flexible ureteroscope. Treatment effect and improvement in renal function indices (serum creatinine (Scr), cystatin C (CysC) and urinary N-acetyl-β-D glucosaminidase (NAG)), were compared. Postoperative clinical efficacy, time of disappearance of hematuria, postoperative extubation time, of hospital stay, Traditional Chinesemedicine (TCM) symptom score, and the incidence of complications were evaluated.&#x0D; Results: After treatment, OG showed significantly downregulated Scr, CysC, and NAG compared with CG, but the total clinical effectiveness was significantly higher than that of CG (p &lt; 0.05). Kidney stone clearance rate of OG was higher than that of CG at 4 weeks post-operation (p &lt; 0.05). The time of disappearance of postoperative hematuria, postoperative extubation time, and hospitalization time ofOG was shorter than those of CG, while TCM symptom scores were lower than those in CG (p &lt; 0.05).&#x0D; Conclusion: The combination of SJPSD and holmium laser lithotripsy in the management of patients with renal calculi results in improvement in clinical efficacy, reduction in TCM symptom scores, and speed-up postoperative recovery, without increase in the incidence of complications. Prospective studies and long-term follow-up are anticipated in the future. Furthermore, established animal or in vitro models are required to determine the specific mechanism of action.

Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability

ABSTRACT Objectives To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending. Patients and methods Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported. Results Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52–0.76). Median (range in months) time to event was 20 (1–60) for all cases and 13.5 (1–42) and 30 (18–60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively. Conclusion Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.

Complications and device failures associated with urolift: Findings from the MAUDE database.

Urolift is an established intervention for symptoms of bladder outflow obstruction caused by benign prostate enlargement. Reported advantages include its minimally invasive profile, short learning curve and feasibility as a day case procedure. Our aim was to use a national registry as a means to evaluate the nature of complications and device failures that have been documented to occur. Retrospective review was performed of the US Manufacturer and User Facility Device Experience (MAUDE) database, a prospective register, which contains voluntarily submitted adverse events associated with surgical devices. Information collected include event timing, underlying cause, procedural completion, complications and mortality status. Between 2016 and 2023, 103 device failures, 5 intra-operative complications and 165 post-operative complications (early: 151, late: 14) were registered. The commonest device problem (56%, n = 58) was failure of the implant to deploy with subsequent requirement for complete replacement. There were 50 cases of documented urosepsis. 62 patients with post operative haematuria were registered including 12 that underwent emergency embolisation. Other complications included stroke (n = 5), pulmonary embolism (n = 3) and necrotising fasciitis (n = 1). Twelve ITU admissions were registered. In the reports, 22 cases were filed that recorded a hospital stay of 7 days or more. Eleven deaths were captured in the database over the study period. While urolift is recognised as less invasive intervention compared to alternatives such as transurethral resection of the prostate, serious adverse events have been reported to occur including death. Our findings can provide learning points for surgeons and allow for improved patient counselling and treatment planning accordingly.

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). The study highlighted the positive effect of the one-day surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Effect of pneumovesicoscopic cohen surgery with adjustable suspension technique through the urethra on the treatment of primary vesicoureteral reflux disease in infants

ObjectiveThe objective of this study was to evaluate the safety and efficacy of pneumovesicoscopic Cohen surgery with an adjustable suspension technique through the urethra for the treatment of primary vesicoureteral reflux disease in infants.MethodsThis study retrospectively analysed the clinical data of 31 infants who underwent pneumovesicoscopic Cohen surgery with an adjustable suspension technique through the urethra in our hospital from January 2019 to December 2020. We also collected the clinical data of 29 infants who underwent open Cohen surgery in our hospital from January 2015 to December 2018 as a control variable. The clinical efficacy of the two groups was compared.ResultAll pneumovesicoscopic Cohen surgeries were successfully completed and no patients were converted to open surgery. The amount of bleeding, duration of postoperative analgesia, duration of postoperative haematuria, incision size and length of hospital stay in the pneumovesicoscopic surgery group were significantly lower than those in the open surgery group (P < 0.05). The operation time of the pneumovesicoscopic surgery group was significantly longer than that of the open surgery group (P < 0.05). Both groups were followed for six months after surgery. At the 6-month follow-up time, there were no significant differences in the degree of hydronephrosis, renal scarring, renal atrophy, glomerular filtration rate, or KIM-1 and MCP-1 expression between the two groups (P > 0.05).ConclusionPneumovesicoscopic Cohen surgery with an adjustable suspension technique through the urethra for the treatment of primary vesicoureteral reflux disease in infants was safe and effective. This procedure had the advantages of less trauma, quick recovery and good cosmetic effects.

MP59-17 DIABETES MELLITUS ASSOCIATED WITH DELAYED CONTINENCE RECOVERY AFTER HoLEP

You have accessJournal of UrologyCME1 Apr 2023MP59-17 DIABETES MELLITUS ASSOCIATED WITH DELAYED CONTINENCE RECOVERY AFTER HoLEP Parth M. Patel, Jonathan Modai, Thomas Gaither Castellanos, Woo Young Lee, Dong Ho Shin, Corinne Del Rosario, and Matthew D. Dunn Parth M. PatelParth M. Patel More articles by this author , Jonathan ModaiJonathan Modai More articles by this author , Thomas Gaither CastellanosThomas Gaither Castellanos More articles by this author , Woo Young LeeWoo Young Lee More articles by this author , Dong Ho ShinDong Ho Shin More articles by this author , Corinne Del RosarioCorinne Del Rosario More articles by this author , and Matthew D. DunnMatthew D. Dunn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rates of transient post-operative urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) are quite variable in the existing literature. Classically, post-HoLEP UI has been found to be associated with surgeon experience and surgical technique. Patients experiencing UI are typically reassured about the expected continence recovery but the timeline of this recovery remains poorly understood. We sought to evaluate whether any patient-related factors played a role in the speed of post-HoLEP continence recovery. METHODS: We performed a prospective observational cohort study of patients undergoing HoLEP with a single surgeon from 2020 to 2021. Demographic and clinical variables were collected for analysis. Patients were followed post-operatively until they regained urinary continence. Univariate and multivariable logistic regression analyses were performed to identify predictors of early (<1 month) versus delayed (>1 month) continence recovery after HoLEP. RESULTS: A total of 171 patients were included in the analysis, 35% of whom took longer than one month to regain continence. On univariate analysis, diabetes mellitus, prostate size, length of surgery, and degree of post-operative hematuria were all associated with delayed continence recovery. On multivariable logistic regression, patients with diabetes were 3.6x more likely to experience delayed continence recovery. Patients with worse post-operative hematuria were also significantly more likely to remain incontinent for a longer period of time (OR 14, 95% CI 2.4-82.) CONCLUSIONS: Surgeon experience and surgical technique may not be the only factors associated with post-operative urinary incontinence after HoLEP. Our findings indicate that patient-related factors such as diabetes mellitus can delay continence recovery as well. This understanding can inform providers’ counseling practices when setting patients’ expectations when undergoing HoLEP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e815 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parth M. Patel More articles by this author Jonathan Modai More articles by this author Thomas Gaither Castellanos More articles by this author Woo Young Lee More articles by this author Dong Ho Shin More articles by this author Corinne Del Rosario More articles by this author Matthew D. Dunn More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimally Invasive versus Open Ureteral Reimplantation in Children: A Systematic Review and Meta-Analysis.

We performed a systematic review and meta-analysis to compare the safety and efficacy of minimally invasive surgery (MIS) versus open ureteral reimplantation (OUR) in children. Literature searches were conducted to identify studies that compared MIS (laparoscopic ureteral reimplantation or robot-assisted laparoscopic ureteral replantation) and OUR in children. Parameters such as operative time, blood loss, length of hospital stay, success rate, postoperative urinary tract infection (UTI), urinary retention, postoperative hematuria, wound infection, and overall postoperative complications were pooled and compared by meta-analysis. Among the 7,882 pediatric participants in the 14 studies, 852 received MIS, and 7,030 received OUR. When compared with the OUR, the MIS approach resulted in shorter hospital stays (I 2 = 99%, weighted mean difference [WMD] -2.82, 95% confidence interval [CI] -4.22 to -1.41; p < 0.001), less blood loss (I 2 = 100%, WMD -12.65, 95% CI -24.82 to -0.48; p = 0.04), and less wound infection (I 2 = 0%, odds ratio 0.23, 95% CI 0.06-0.78; p = 0.02). However, no significant difference was found in operative time and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications. MIS is a safe, feasible, and effective surgical procedure in children when compared with OUR. Compared with OUR, MIS has a shorter hospital stay, less blood loss, and less wound infection. Furthermore, MIS is equivalent to OUR in terms of success rate and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications. We conclude that MIS should be considered an acceptable option for pediatric ureteral reimplantation.

Effectiveness of Extracorporeal Shockwave Lithotripsy and Percutaneous Nephrolithotripsy for the Management of Moderate Size Kidney Stone

Aim: To provide a specific guidance in managing renal stones. Study Design: Place and Duration of Study: Pakistan Atomic Energy Commission, General Hospital Islamabad from 1st 2018 to 30th November 2018. Methodology: Eighty two patients were included and divided into two groups. Patients in group A underwent ESWL, while those in group B underwent PCNL. All of the participants underwent thorough diagnostic and therapeutic procedures. As per inclusion and exclusion criteria, patients with renal stones (10-20 mm), detected by CT scan were selected for either ESWL or PCNL. Results: Thirty four patients in the PCNL group and 21 patients in the ESWL group, had post-operative hematuria at the time of presentation (p=0.072). There is a substantial difference between patients between 18-38 years and those in the 60+ years. According to the stone-free rate, 76 individuals had favourable results whereas only 6 had negative ones (p=0.756 and p=0.050). Conclusion: Extracorporeal shockwave lithotripsy and pecutaneous nepthrolithotripsy are both effective technique options for kidney stones. However, since ESWL is non-invasive and has fewer adverse effects than PCNL treatment option, it is more successful in treating medium-sized kidney stones (20 mm or smaller). Keywords: Extracorporeal shockwave lithotripsy, Percutaneous nephrolithotripsy, Kidney stone

A Comparative Study of the Efficacy of Thulium Fiber Laser Enucleation and Transurethral Resection for Medium- to Large-Size Prostate

Abstract Purpose: The objective of this study was to evaluate the efficacy and safety of the newer, thulium fiber laser enucleation of the prostate (ThuFLEP) versus the transurethral resection of the prostate (TURP) for medium- to large-volume benign prostatic hyperplasia (BPH). Materials and Methods: We performed a single-center retrospective study between May 2020 and June 2021. Among these, we included patients &gt;50 years of age, with prostate size &gt;80 cc, International Prostate Symptom Score (IPSS) &gt;19, and maximum urine flow rate (Qmax) &lt;15 mL/s. All patients underwent either TURP or ThuFLEP. Preoperative parameters such as IPSS score, quality of life (QoL) score, Qmax, and residual urine were assessed. Results: Of the total of 101 patients, 29 underwent ThuFLEP and 72 TURP. The mean prostate volume was significantly higher in the ThuFLEP group compared to the TURP (P = 0.01). The mean operative time was longer for ThuFLEP compared to TURP (P &lt; 0.0001). No significant difference was noted in the postoperative hematuria (P = 0.29) and mean postoperative hemoglobin (P = 0.37). The QoL scores were significantly improved with ThuFLEP than TURP (P = 0.0006). Compared to a day after catheter removal, the proportion of patients with stress, urge, and total incontinence was significantly reduced at the end of 1 month in the ThuFLEP group (P &lt; 0.00001); however, it was significantly greater than with TURP (P &lt; 0.05). At 3 months, no significant difference was found between IPSS (P = 0.37) and Qmax (P = 0.98) scores between the groups; however, the decrease from baseline was significant for IPSS (P &lt; 0.0001). The Clavien–Dindo Grade I and II complications were 31% and 13.8%, respectively, for ThuFLEP and 8.3% and 1.4% for TURP. There was no significant difference of patients with late complications. Conclusion: ThuFLEP demonstrated efficacy similar to TURP in medium- to larger-size BPH in terms of IPSS and Qmax but had significant improvement in QoL scores. The overall complications with ThuFLEP were higher as compared to TURP.

Neuromuscular Paralysis is not a Barrier to Same Day Catheter Removal After HoLEP

To determine if same day catheter removal is feasible in a population of holmium laser enucleation of the prostate patients who received paralysis and if bladder pressure monitoring could predict successful catheter removal. From February 2021 to February 2022, we evaluated same day catheter removal for patients undergoing holmium laser enucleation of the prostate. Criteria for proceeding with same day catheter removal included: an uncomplicated procedure, continuous bladder irrigation weaned within 120 minutes of arrival to PACU, minimal postoperative hematuria and a bladder pressure over 30 cmH20 as measured using the VP Test device (SRS Medical). One hundred and eight patients were enrolled, with a median age of 68 years (IQR: 62.0-73.0) and prostate volume 80.8cc (IQR: 64.8-112.3). Criteria for catheter removal was met by 83/108 (76.9%) patients. Of those that attempted a trial of void, 69/83 passed for an effective pass rate of 83.1%. Median maximum detrusor pressure for those that passed and failed were 51.0 cmH20 (IQR: 40.5 -68.0) and 48.0 cmH20 (IQR: 38.8-61.8) [P=.53], respectively. Intraoperative Lasix administration was associated with a higher rate of trial of void (TOV) success and preoperative PVR was associated with lower TOV success, with OR (95%CI) of 5.8 (1.4, 29.5) [P=.02] and 0.6 (0.4, 0.9) [P=.01], respectively. Same day catheter removal is feasible in those who receive neuromuscular paralysis, with a success rate >80%. Bladder pressure monitoring did not assist with differentiating which patients will pass or fail a trial of void. Intraoperative Lasix administration may be helpful in increasing success for same day catheter removal while elevated preoperative PVR was associated with TOV failure.

Clinical Value of Ureteral Catheterization before Trans-abdominal Radical Hysterectomy and Pelvic Lymphadenectomy

Introduction: Being in the close vicinity, chances of ureteral injury is high while doing radical operation for cervical cancer. Although the incidence is low, if it is not found during the operation, it can lead to serious complications such as urinary fistula. Timely detection and repair of ureteral injury can reduce the occurrence of serious complications.The placement of ureteral catheter before radical hysterectomy can be a good method to identify the ureter during operation to prevent injury.The objective of the study was to explore the advantages and disadvantages of the placement of ureteral catheter in radical operation of cervical cancer. Methods: 103 patients who were diagnosed as cervical cancer and underwent operation in the department of Obstetrics and Gynecology, Jinling Hospital from January 2019 to April 2020 were analyzed in this study. The clinical stage ranges from IA to IIA. Among them, 23 cases were placed with double J stent before operation (observation group), 80 cases were operated without stent (control group). The intra-operative condition, operation and postoperative complications were analyzed retrospectively. Results: There was a significant difference in the operation time and intra-operative blood loss between the two groups (P&lt; 0.05), and there was no significant difference in blood transfusion between the two groups (P&gt; 0.05). There was no significant difference in the incidence of urinary tract infection and urinary retention between the two groups (P&gt; 0.05). The incidence of postoperative hematuria (including microscopic hematuria) was significant in two groups（P&lt; 0.05). Ureteric injury occurred in the 9 patients in the control group (11.25%). Conclusion: Ureteral catheter inserted before radical operation of cervical cancer can help to identify the ureter easily, decrease urinary tract injury, shorten operation time and reduce intra-operative blood loss, and will not increase urinary retention and urinary tract infection. It is safe and effective method especially for young gynecologists.

Extravesical verses intravesical ureteral reimplantation in paediatric patients suffering from vesicoureteric reflux.

Objective: To compare two different techniques for ureteric reimplantation for management of Vesicoureteric reflux in children. Study Design: Comparative study. Setting: Department of Pediatric surgery at D. G Khan Medical College Dera Ghazi Khan. Period: January 2010 to April 2021. Material &amp; Methods: Seventy four patients with vesicoureteric reflux were included. Extravesical reimplantation technique was performed in 35 children labeled as Group A , while intravesical reimplantation was performed in 39 children labeled as Group B. Parameters compared between two groups were length of the surgical procedure, average duration of hospital stay, postoperative bladder spasms, significant hematuria &gt;72 h, and long-term complications. Results: The mean age at operation was 6.5 years in Group A and 6.35years in Group B. The mean duration of surgery was significantly less in Group A .i.e 104 min with SD 18 min compared to Group B where mean duration was 128 min; SD 15 min. The mean postoperative stay was significantly lower (P value =0.032) at 4.5 (1.5) days in Group A compared to 6.5 (0.5) days in Group B. Postoperative bladder spasms were significantly lower (P = 0.003) at 1/35 in Group A compared to 35/39 in Group B. Postoperative hematuria was significantly lower (P =0.001) in Group A compared to Group B. Conclusion: Extravesical reimplantation technique has lower operative time, less postoperative discomfort and shorter hospital stay compared to intravesical reimplantation. Both techniques are equally effective in treating reflux.

MP14-11 PROPENSITY SCORE-MATCHED ANALYSIS COMPARING RETROGRADE INTRARENAL SURGERY WITH PERCUTANEOUS NEPHROLITHOTOMY IN ANOMALOUS KIDNEYS

MP14-11 PROPENSITY SCORE-MATCHED ANALYSIS COMPARING RETROGRADE INTRARENAL SURGERY WITH PERCUTANEOUS NEPHROLITHOTOMY IN ANOMALOUS KIDNEYS

Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys.

Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys. A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (horseshoe kidney [HSK], ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable. After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95% CI 1.91-7.46, P<0.001), particularly in HSK (OR=3.33, 95% CI 1.22-9.99, P=0.023), and ectopic kidneys (OR=18.10, 95% CI 3.62-147.63, P=0.002), with no significant difference in malrotated kidneys. There was no significant difference in postoperative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs. 0%, P=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias. While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in postoperative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.

Prospective study on Comparison of outcomes of mini percutaneous nephrolithotomy versus retrograde intrarenal surgery for renal stones of 1-2 cm size.

Aim and Objectives:The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate.Materials and Methods:This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi.Inclusion criteria: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020Age >15 years. Exclusion criteria: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal systemPregnant women. Results:The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance.Conclusion:The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups.

Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial.

Introduction:We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones.Methods:The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate.Results:A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%).Conclusions:The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.

Is antibiotic prophylaxis still mandatory for transperineal prostate biopsy? Results of a comparative study.

Introduction and objectivesThis study aimed to assess the incidence of urinary tract infections (UTIs) after transperineal prostate biopsy (TP-PB) comparing patients who underwent antibiotic prophylaxis (AP) with patients who had no prophylaxis.Materials and methodsThis prospective, double-center trial was conducted between August and December 2020. Patient candidates to PB were included with 1:1 allocation to case (Group A-no AP) and control group (Group B-standard AP). All TP-PBs were performed in an outpatient setting under local anesthesia. Data collected 2 weeks after the procedure included incidence of UTIs or bacteriuria, evaluated with a urine culture (UC), main symptoms, and complications related to TP-PBs.ResultsA total of 200 patients were included (100 patients in each group). The mean age was 66.2 ± 7.7 in Group A and 67.4 ± 8 years in Group B (P = 0.134). Mean prostate volume was 65.5 ± 26.7 vs. 51 ± 24.6 cc (P < 0.001), number of biopsy cores was 17.8 ± 2.4 vs. 14.9 ± 0.8 (P < 0.001), and PSA value was 15.9 ± 28.1 vs. 13.3 ± 22.3 ng/ml (P = 0.017). Overall PCa detection rate was 55% vs. 59% (P = 0.567). Postoperative UTI occurred in one patient in Group A vs. zero in Group B. Asymptomatic bacteriuria was present in 3 vs. 5 patients (P = 0.470) and was not treated with antibiotics. Postoperative hematuria was observed in 13 patients vs. 29 (P < 0.05), and acute urinary retention was observed in one patient in each group.ConclusionsThe incidence of bacteriuria and UTIs in TP-PBs is not related to AP. Therefore, AP could be discontinued in TP-PB candidates without the risk of increasing UTI-related complications.

Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement.

This study aims at exploring the effect of continuous catheterization on reducing postoperative urinary tract infection in cervical cancer patients with double J tube placement. To be specific, a retrospective analysis was performed on 120 cases of cervical cancer patients who underwent laparoscopic or open radical hysterectomy in Shengjing Hospital of China Medical University from January to December 2019. They were divided into a persistent group (n = 70) and a short-term group (n = 50) according to indwelling catheter time. The incidence of postoperative complications and the positive rate of bacterial culture in bladder urine and double J tube bacterial culture were compared between the two groups. As a result, it was found that the incidence of postoperative fever and urinary tract infection in the short-term group was significantly higher than that in the persistent group (P < 0.05). There was no significant difference in the incidence of postoperative hematuria, bladder stimulation, and urinary system injury between the two groups. The positive rate of double J tube bacterial culture in both groups was also proved to be higher than that in bladder culture, and the difference was statistically significant (P < 0.05). And in the short-term group (P < 0.05), the difference in the positive rate of bladder culture between the two groups was not statistically significant. To conclude, we found that continuous catheterization can reduce the incidence of postoperative urinary tract infection in cervical cancer patients with double J tube placement, which might be helpful for the treatment of cervical cancer.