Catheterization Time Research Articles

PD41-12 PERIOPERATIVE COMPLICATIONS AND OUTCOMES OF PATIENTS UNDERGOING AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA: A SINGLE TERTIARY REFERRAL CENTER EXPERIENCE IN 146 PATIENTS

You have accessJournal of UrologyCME1 Apr 2023PD41-12 PERIOPERATIVE COMPLICATIONS AND OUTCOMES OF PATIENTS UNDERGOING AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA: A SINGLE TERTIARY REFERRAL CENTER EXPERIENCE IN 146 PATIENTS Alireza Ghoreifi, David Ortega Herrera, Michael Eppler, Randall Lee, Maria Lizana, Abhisek Venkat, Marissa Maas, Andre Abreu, Rene Sotelo, Mike Nguyen, Inderbir Gill, Leo Doumanian, Giovanni E. Cacciamani, and Mihir Desai Alireza GhoreifiAlireza Ghoreifi More articles by this author , David Ortega HerreraDavid Ortega Herrera More articles by this author , Michael EpplerMichael Eppler More articles by this author , Randall LeeRandall Lee More articles by this author , Maria LizanaMaria Lizana More articles by this author , Abhisek VenkatAbhisek Venkat More articles by this author , Marissa MaasMarissa Maas More articles by this author , Andre AbreuAndre Abreu More articles by this author , Rene SoteloRene Sotelo More articles by this author , Mike NguyenMike Nguyen More articles by this author , Inderbir GillInderbir Gill More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most published data with Aquablation, a recently introduced minimally-invasive technology for management of patients with benign prostatic hyperplasia (BPH), is from 2 large multicenter trials. The aim of this study is to report post-commercialization perioperative complications and outcomes of Aquablation from a single institution. METHODS: Using our IRB-approved database, we retrospectively reviewed the records of consecutive patients who underwent Aquablation for BPH in our institution between August 2020 and June 2022. Those with no available 90-day data were excluded. Primary and secondary outcomes were 90-day complications (graded by Clavien-Dindo classification) and 90-day readmission, respectively. Specific focus was placed on hemorrhagic complications. Univariate and multivariable logistic regression were performed to assess the factors affecting the 90-day complications. RESULTS: Among 146 patients who received Aquablation during the study timeframe, 133 patients with a median (IQR) age of 69 (64 – 73) years and median (IQR) prostate size of 85 (65 – 109) mL were included in the analysis. Baseline and clinical features of the patients are presented in Table 1. Median operative time was 64 minutes, and no intraoperative complication/blood transfusion was recorded. Median length of hospital stay and catheter time were 1 and 3 days, respectively. 90-day complications were recorded in 36 patients (27%) with a Clavien 3 in 11 patients (8%). A bleeding event was recorded in 5 patients (4%) of whom 4 required cystoscopic fulguration (Table 2). Average drop in postoperative hemoglobin was 1.5 gm/dL, yet no patient required peri-operative blood transfusions. The readmission rate was 4.5% (6/133). Two patients underwent re-treatment (transurethral resection of the prostate). On multivariable analysis, prostate size was not independently associated with 90-day complications (OR 1.02, 95% CI 0.99 – 1.03, p=0.07). CONCLUSIONS: Aquablation is safe with a 27% overall complication rate that is independent of patient or prostate factors. Bleeding rate with incorporation of selective cautery hemostasis has dropped compared to the Water and Water 2 trial data. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1063 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author David Ortega Herrera More articles by this author Michael Eppler More articles by this author Randall Lee More articles by this author Maria Lizana More articles by this author Abhisek Venkat More articles by this author Marissa Maas More articles by this author Andre Abreu More articles by this author Rene Sotelo More articles by this author Mike Nguyen More articles by this author Inderbir Gill More articles by this author Leo Doumanian More articles by this author Giovanni E. Cacciamani More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-09 SCHELIN CATHETER TM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS

You have accessJournal of UrologyCME1 Apr 2023MP76-09 SCHELIN CATHETERTM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS Giampaolo Siena, Francesco Sessa, Paolo Polverino, Lorenzo Viola, Anna Rivetti, Pietro Spatafora, Riccardo Campi, and Luca Cindolo Giampaolo SienaGiampaolo Siena More articles by this author , Francesco SessaFrancesco Sessa More articles by this author , Paolo PolverinoPaolo Polverino More articles by this author , Lorenzo ViolaLorenzo Viola More articles by this author , Anna RivettiAnna Rivetti More articles by this author , Pietro SpataforaPietro Spatafora More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , and Luca CindoloLuca Cindolo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Among minimally invasive surgical techniques (MISTs) for moderate lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), RezūmTM water vapor treatment (Boston Scientific Corporation, Marlborough, USA) (RT) has been accepted as one of the most effective and versatile, with a very good sexual safety profile. To further enhance the minimal invasiveness of RT, we sought to evaluate potential advantages and feasibility of pure local transurethral intraprostatic anesthesia (TUIA) via the Schelin CatheterTM (ProstaLund AB, Lund, Sweden) (SC), a 3 ways device designed with an operational channel equipped with a retractile needle and the standard drainage and ballon ports (Figure 1). METHODS: After Ethical Commitee approval, included and collected data from 20 patients with moderate LUTS due to BPO, undergone RT procedure using TUIA by SC, from 2 centers. To rate their pain, patients were asked to use a numeric rating scale (NSR; numbered 0–10; 0 “No pain”/10 “Worst pain”) at 9-time points: 1-Preoperatively; 2-Schelin catheter insertion; 3-anestethic infiltration; 4-Rezum probe insertion; 5-Water Vapor Treatment (WVT); 6-Catheter insertion; 7-Day 1; 8-Day 7 catheter removal; 9-Day 30 follow-up visit. RESULTS: All 20 patients safely received TUIA prior RT. None required further anesthesiologic treatment. Median prostate size, Qmax, IPSS and QoL were 7 5ml, 9 mL/sec, 23 and 4, respectively. Median TUIA time was 3 minutes. Median catheterization time was 7 days. No need of re-catheterization or urinary tract infections at 30 days post-operatively were reported. Median NRS reported was 1.5 at each time point except at point 1, 2, 3 and 5. At preoperative stage NRS of pain was 0 in all cases. During catheter insertion (point 2) median NRS of pain was 2; during LA infiltration (point 3) was 2.5, and during WVT was 2 (point 5). One out of 10 patients reported a NRS of 6 during WVT (point 5). No perioperative anesthesiologic and procedure-related complications were recorded. CONCLUSIONS: Our data report for the first time in literature the feasibility and safeness of TUIA during RT using SC that showed full operative and post-operative pain control and reduced operative time and patient discomfort. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1094 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giampaolo Siena More articles by this author Francesco Sessa More articles by this author Paolo Polverino More articles by this author Lorenzo Viola More articles by this author Anna Rivetti More articles by this author Pietro Spatafora More articles by this author Riccardo Campi More articles by this author Luca Cindolo More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-07 A NOVEL OUTCOMES CATEGORIZATION FOR CURRENT MINIMALLY INVASIVE EJACULATION-SPARING TREATMENTS OF BENIGN PROSTATIC HYPERPLASIA: RESULTS OF A MULTICENTRIC SERIES

PD41-07 A NOVEL OUTCOMES CATEGORIZATION FOR CURRENT MINIMALLY INVASIVE EJACULATION-SPARING TREATMENTS OF BENIGN PROSTATIC HYPERPLASIA: RESULTS OF A MULTICENTRIC SERIES

MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY Antonio Luigi Pastore, Yazan Al salhi, Andrea Fuschi, Alessia Martoccia, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Paolo Pietro Suraci, Onofrio Antonio Rera, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al salhiYazan Al salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Paolo Pietro SuraciPaolo Pietro Suraci More articles by this author , Onofrio Antonio ReraOnofrio Antonio Rera More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last years minimally invasive endoscopic approaches have been proposed and introduced with the aim to reduce the morbidity related to TURP, such as: convective water vapor energy (Rezum) and heat free water-jet ablation (Aquablation).The aim of this prospective randomized study is to compare the perioperative and functional outcomes between gold standard surgery (TransUrethral Resection of Prostate, TURP) and these two new minimally invasive approaches (Rezum and Aquablation). METHODS: Patients with benign prostatic obstruction were prospectively enrolled and randomized for the three surgical approaches between January 2021 and September 2022. All patients were preoperatively evaluated with digital rectal examination, PSA value and abdominal ultrasound for prostate volume measurement. Preoperatively and 6 months after surgery, patients were studied as follows: Uroflowmetry (Qmax and Qave) with postvoid residual (PVR), International Prostatic Symptoms Score (IPSS), Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-5). All patients were also investigated by urodynamics. Operating time, days of hospital stay, intraoperative and postoperative bleeding, postoperative catheterization time were evaluated for each procedure. RESULTS: 252 patients with mean age of 64.6 years old were included in the study. Patients were prospectively randomized to the following treatment groups: 61 subjects underwent Rezum (group A), 92 patients Aquablation (group B), and 99 patients bipolar TURP (group C). Postoperative IPSS resulted lower in patients underwent TURP and AQUABEAM than Rezum (p<0.001). Postoperative IIEF5 mean scores significantly increased in groups A and B (25 and 24, respectively) than in group C (18, p<0.001). The antegrade ejaculation was spared in all Rezum and Aquablation subjects, whereas all TURP patients reported retrograde ejaculation. The TURP group reported mean flowmetry parameters significantly better when compared to Aquabeam and Rezum groups (p<.005). Operating time and length of hospital stay were longer after TURP (respectively 75 min, 3 days) when compared to the other two groups (8 min, 0.6 days; 5.2 min, 1 day, in group A and B, respectively). The mean estimated blood loss (evaluated as postoperative drop in Hb) was significantly higher in group C (DHb 1.2 mg/dl) than in the other two groups (DHb 0.1 mg/dl observed in both groups, p<.005). CONCLUSIONS: This prospective randomized study is the first to compare new endoscopic approaches to gold standard surgery in the treatment of non-neurogenic LUTS secondary to BPH for prostate volumes 30-80 ml. Our results condrm that Rezum and Aquablation are safe and effective. Postoperative outcomes are better in new approaches in terms of sexual function and overall satisfaction, especially related to the preservation of the antegrade ejaculation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e700 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan Al salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Paolo Pietro Suraci More articles by this author Onofrio Antonio Rera More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-19 FACTORS ASSOCIATED WITH THE USE OF LOWER ENERGY DENSITY IN GREEN LASER PROSTATE PHOTO-VAPORIZATION

You have accessJournal of UrologyCME1 Apr 2023MP59-19 FACTORS ASSOCIATED WITH THE USE OF LOWER ENERGY DENSITY IN GREEN LASER PROSTATE PHOTO-VAPORIZATION Laura Zuluaga, Mauricio Plata, Carlos Gustavo Trujillo, Jessica Santander, Maria Paula Mogollon, Juan Ignacio Caicedo, Julian Azuero, Cesar Diaz Ritter, Claudia Colmenares, and Martin Rondón Laura ZuluagaLaura Zuluaga More articles by this author , Mauricio PlataMauricio Plata More articles by this author , Carlos Gustavo TrujilloCarlos Gustavo Trujillo More articles by this author , Jessica SantanderJessica Santander More articles by this author , Maria Paula MogollonMaria Paula Mogollon More articles by this author , Juan Ignacio CaicedoJuan Ignacio Caicedo More articles by this author , Julian AzueroJulian Azuero More articles by this author , Cesar Diaz RitterCesar Diaz Ritter More articles by this author , Claudia ColmenaresClaudia Colmenares More articles by this author , and Martin RondónMartin Rondón More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Energy density (ED) (kJ/mL) measures the amount of Joules used in relation to prostate volume (PV). ED appears to be related to adequate tissue removal and probably improved mid-term outcomes in patients treated with photo-vaporization (PVP) of the prostate with GreenLight laser. We aim to assess associated factors with a lesser ED delivery in prostate photo-vaporization. METHODS: Data was retrospectively collected from a single center database with 748 patients who underwent surgery between 2012 and 2019. Groups were divided according to intra-operative energy delivered to the prostate. Group 1: < 4.0 and group 2: ≥4.0 kJ/mL. Peri and postoperative outcomes were assessed. Bivariate and multivariate analyses were performed to determine the statistically significant variables associated with the use of low ED. RESULTS: General characteristics are shown in Table 1. Group 1 had a total of 36% (n=268), and Group 2 had 64% (n=480) patients. Bivariate analysis was performed, and statistically significant association was observed for higher PV (OR=1.02 [1.02-1.01] IC 95% p-value <0.01), history of combination therapy (OR=1.5 [2-1.1] IC95% p-value=0.01) and postoperative longer bladder catheterization time. After controlling by confounding variables, the multivariate analysis showed that for patients with lower ED delivered acute urinary retention (AUR) appeared to be a protective factor (OR=0.6 [0.9-0.4] IC95% p-value=0.01), and a larger prostate volume (OR=1.02 [1.3-1.02] IC95% p-value <0.01) was associated with lesser ED. CONCLUSIONS: After analyzing factors like surgeons' expertise and comorbidity, we found that PV is shown to be associated with lower energy density delivery and potentially associated with worse functional outcomes. Source of Funding: No funding was received © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e816 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Zuluaga More articles by this author Mauricio Plata More articles by this author Carlos Gustavo Trujillo More articles by this author Jessica Santander More articles by this author Maria Paula Mogollon More articles by this author Juan Ignacio Caicedo More articles by this author Julian Azuero More articles by this author Cesar Diaz Ritter More articles by this author Claudia Colmenares More articles by this author Martin Rondón More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA Javier Romero Otero, Juan Justo Quintas, Raquel Sopeña Sutil, Borja García Gómez, Ricardo Brime Menendez, Javier Amalio Feltes Ochoa, David Saenz Calzada, Gino Marcelo Espinales Catro, Laura Avilleira García, Elena Peña Vallejo, Cristina Calzas Montalvo, Alfredo Rodríguez Antolín, and Esther Garcia Rojo Javier Romero OteroJavier Romero Otero More articles by this author , Juan Justo QuintasJuan Justo Quintas More articles by this author , Raquel Sopeña SutilRaquel Sopeña Sutil More articles by this author , Borja García GómezBorja García Gómez More articles by this author , Ricardo Brime MenendezRicardo Brime Menendez More articles by this author , Javier Amalio Feltes OchoaJavier Amalio Feltes Ochoa More articles by this author , David Saenz CalzadaDavid Saenz Calzada More articles by this author , Gino Marcelo Espinales CatroGino Marcelo Espinales Catro More articles by this author , Laura Avilleira GarcíaLaura Avilleira García More articles by this author , Elena Peña VallejoElena Peña Vallejo More articles by this author , Cristina Calzas MontalvoCristina Calzas Montalvo More articles by this author , Alfredo Rodríguez AntolínAlfredo Rodríguez Antolín More articles by this author , and Esther Garcia RojoEsther Garcia Rojo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic enucleation is considered the gold standard for the surgical treatment of benign prostatic hyperplasia(BPH). Emerging minimally invasive technologies aim to maintain functional results whilst decreasing adverseevents. Aquablation is a novel heat-free therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for removal of prostate tissue. Our objective is to compare for the first time the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and Aquablation for the surgical treatment of BPH. METHODS: Prospective comparative non-randomized multicenter study of 100 consecutive patients treated with HoLEP or Aquabeam system. HoLEP was performed by 3 expert surgeons and a standard Aquablation was performed with the AquaBeam system by 2 surgeons. Inclusion criteria: patients with moderate/severe symptoms due to BPH. Exclusion criteria: previous surgical treatment for BPH, concomitant urethral stenosis, bladder tumor, or lithiasis and prostates >120cc. The data were prospectively collected. A descriptive analysis was performed and data onthe efficacy and safety of both techniques were compared. RESULTS: The groups are comparable (p>0.05) in prostate size; mean HoLEP vs Aquabeam; 78.95 vs 77.10cc, preoperative IPSS (24.26 vs 22.68), Q max (8.44 vs 9.83) and IIEF15 (41.10 vs 58.15), as well as in the rest preoperative variables (age, personal history, PSA, ASA risk and ejaculation function). Treatment time was longer in the HoLEP group with a mean of 23 minutes for enucleation vs. 5.99 minutes in the Aquabeam group (p<0.05). However, no statistically significant differences in total operating theatre time (53 vs 60 minutes). No intraoperative complications. More significant haematic loss (haemoglobin drop) in the Aquabeam group but none of the patients required a transfusion. As for the perioperative outcomes: no differences were observed between the two groups in bladder catheterization time: 30.53 vs 46.91 hours and hospitalization time 1.4 vs 1.74 days. No differences in rehospitalization, emergency room visits, recatheterization, or infection. At the 6-month follow-up, no statistically significant differences were found in Q-max, BOO, IPSS, complication rates or incontinence. On the other hand, statistically significant differences were found in prostate volume (16.86 vs 42.43 p=0.012) and PSA(0.51 vs 4.2 p<0.01). All patients with Aquabeam retain anterograde ejaculation, while only one patient in the HoLEP group preserves it. CONCLUSIONS: The Aquabeam System appears to be a safe technique that provides comparable early functional and perioperative results to HoLEP with a similar complication rate. Advantages of this technique include reduced resection time as well as the possibility of preserving sexual function. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e806 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Romero Otero More articles by this author Juan Justo Quintas More articles by this author Raquel Sopeña Sutil More articles by this author Borja García Gómez More articles by this author Ricardo Brime Menendez More articles by this author Javier Amalio Feltes Ochoa More articles by this author David Saenz Calzada More articles by this author Gino Marcelo Espinales Catro More articles by this author Laura Avilleira García More articles by this author Elena Peña Vallejo More articles by this author Cristina Calzas Montalvo More articles by this author Alfredo Rodríguez Antolín More articles by this author Esther Garcia Rojo More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-07 IMPACT OF AGE AND FRAILTY ON SURGICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN NONAGENARIANS AND OCTOGENARIANS PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP51-07 IMPACT OF AGE AND FRAILTY ON SURGICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN NONAGENARIANS AND OCTOGENARIANS PATIENTS Mohamed Elsaqa, Yu Zhang, and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author , Yu ZhangYu Zhang More articles by this author , and Marawan M. El TayebMarawan M. El Tayeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the growing population aging, BPH burden has increased with considerable percentage of octogenarian (80-90 years) and nonagenarian (>90 years) patients requiring surgical management. We aimed to assess the difference in complication rate and functional outcome of Holmium laser enucleation of prostate (HoLEP) in these age groups. METHODS: Maintained database was reviewed for HoLEP patients with follow up of 1 year. Patients were divided into 2 groups according to age: ≥80 years (G I) and<80 years (G II). Perioperative complications and functional outcomes were compared between both groups. RESULTS: Total 1090 patients were included, 201 and 889 in GI and II respectively. Median age was 84 and 70 years in GI and GII respectively. GI had significantly higher frailty score, lower baseline hemoglobin and more anticoagulant use. GI showed significantly longer operative time, higher rate of blood transfusion, longer catheterization time and higher rates of failed 1st voiding trial, emergency room (ER) visits and readmission. Clavien-Dindo complications within 30-days were statistically higher in GI (20.8% vs 9.3%, p=0.008) although over-grade II complications were comparable in both groups (3.4% vs 1.79%, p=0.133). (Tables 1 and 2) Follow up IPSS and incontinence rates were comparable in both groups. (Figure 1) CONCLUSIONS: HoLEP is a safe and very effective option in the geriatric population of octogenarians and nonagenarians. HoLEP is associated with higher overall complication rate in octogenarians and nonagenarians, however most complications are minor with comparable over-grade II complication rate to younger age group. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e695 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Yu Zhang More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-03 EFFICACY AND SAFETY OF a NOVEL 450 NM BLUE DIODE LASER VERSUS PLASMAKINETIC ELECTROCAUTERY FOR THE TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER: THE PROTOCOL AND RESULT OF a MULTICENTRE RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP63-03 EFFICACY AND SAFETY OF a NOVEL 450 NM BLUE DIODE LASER VERSUS PLASMAKINETIC ELECTROCAUTERY FOR THE TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER: THE PROTOCOL AND RESULT OF a MULTICENTRE RANDOMIZED CONTROLLED TRIAL Kaijie Wu, Lianhua Zhang, Shuai Jiang, Tianhai Lin, YI Luo, and Dalin He Kaijie WuKaijie Wu More articles by this author , Lianhua ZhangLianhua Zhang More articles by this author , Shuai JiangShuai Jiang More articles by this author , Tianhai LinTianhai Lin More articles by this author , YI LuoYI Luo More articles by this author , and Dalin HeDalin He More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To be the first to apply a novel 450 nm blue diode laser in transurethral resection of bladder tumour (TURBt) to treat patients with non-muscle invasive bladder cancer (NMIBC) and evaluate its efficacy and safety during the preoperative period compared to the conventional plasmakinetic electrocautery. METHODS: Randomized controlled trials (RCTs) in five medical centres were conducted from October 2018 to December 2019. Patients with NMIBC were randomized to the blue laser or plasmakinetic electrocautery group for TURBt. As the first study to evaluate this novel blue laser device, the primary outcome was the effective resection rate of bladder tumours, including effective dissection and haemostasis. The secondary outcomes were the perioperative records, including operation time, postoperative indwelling catheter time, hospital stay length, blood loss, reoperation rate, wound healing and adverse events. RESULTS: A total of 174 patients were randomized to either the blue laser group (85 patients) or plasmakinetic electrocautery group (89 patients). There was no statistical significance in the clinical features of bladder tumours, including tumour site, number and maximum lesion size. Both the blue laser and plasmakinetic electrocautery could effectively dissect all visible bladder tumours. The operation time for patients in the blue laser group was longer (p=0.001), but their blood loss was less than that of patients in the control group (p=0.003). There were no differences in the postoperative indwelling catheter time, hospital stay length, reoperation rate or other adverse events. However, the patients undergoing TURBt with the blue laser showed a faster wound healing at 3 months after operation. CONCLUSIONS: The novel blue laser could be effectively and safely used for TURBt in patients with NMIBC, and this method was not inferior to plasmakinetic electrocautery during the perioperative period. However, TURBt with the blue laser may provide the benefit to reduce preoperative blood loss and accelerate postoperative wound healing. Moreover, longer follow-up to confirm recurrence-free survival benefit was required. Source of Funding: This study was fifinancially supported by the National Key Research and Development Program (2019YFC0121501) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e871 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kaijie Wu More articles by this author Lianhua Zhang More articles by this author Shuai Jiang More articles by this author Tianhai Lin More articles by this author YI Luo More articles by this author Dalin He More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis.

Current treatment for non-muscle invasive bladder cancer (NMIBC) is the conventional transurethral resection of bladder tumor (CTURBT), but the en bloc transurethral resection of bladder tumor (ERBT) has been gaining more attraction in recent years considering better specimen integrity. Thus, we conducted this meta-analysis to compare the safety and efficacy of ERBT versus CTURBT. Trials were collected from an online database. The primary outcomes included identification of detrusor muscle in specimen, residual tumor, 3, 12, and 24-month recurrence rates and same-site recurrence rate. A total of 31 trials were included. The ERBT group had a higher rate of identification of detrusor muscle in specimens (p = 0.003) and lower residual tumor (p < 0.001). Other than that, lower rates of 3-month (p = 0.005) and 24-month recurrence rate (p < 0.001), same-site recurrence rate (p < 0.001) and complications were also observed. For perioperative outcomes, shorter hospitalization time (HT) (p < 0.001), and catheterization time (CT) (p < 0.001) were also revealed in the ERBT group. No significant difference was found in operative time (OT) (p = 0.93). The use of ERBT showed better pathological outcomes and fewer complications, so it could be considered a more effective treatment option for NMIBC.

Left atrial strain analysis improves left ventricular filling pressures non-invasive estimation in the acute phase of Takotsubo syndrome.

The aim of our study is to assess the ability of left atrial (LA) strain values to improve left ventricular and diastolic pressure (LVEDP) non-invasive estimation as compared with traditional echocardiographic indexes in the acute phase of Takotsubo syndrome (TTS) and to predict adverse in-hospital outcomes in this population. Consecutive TTS patients were prospectively enrolled. Left ventricular and diastolic pressure was measured at the time of catheterization. Transthoracic echocardiography was performed within 48 h from hospital admission. In-hospital complications (acute heart failure, death from any cause, and life-threatening arrhythmias) were collected. A total of 62 patients were analysed (72.2 ± 10.1 years, female 80%) and in-hospital complications occurred in 25 (40.3%). Left ventricular and diastolic pressure mean value was 24.53 ± 7.92 mmHg. Left atrial reservoir and pump strain values presented higher correlation with LVEDP (r -0.859, P < 0.001 and r -0.848, P < 0.001, respectively) in comparison with E/e ' ratio, left atrial volume index (LAVi), and tricuspid regurgitation (TR) peak velocity. In addition, at receiver-operating characteristic curve analysis, LA reservoir and pump strain resulted to be better predictors of LVEDP above the mean of our population [0.909 (95% CI 0.818-0.999, P < 0.001) and 0.889 (95% CI 0.789-0.988, P < 0.001)], respectively] as compared with E/e' ratio, LAVi, and TR peak velocity.Finally, LA reservoir strain resulted to be an independent predictor of worse in-hospital outcomes, together with LVEDP and left ventricular ejection fraction (all P < 0.001). In our study, lower LA reservoir and pump strain values were better predictors of LVEDP as compared with traditional echocardiographic indexes in the acute phase of TTS syndrome. Moreover, LA reservoir strain was an independent predictor of adverse in-hospital outcomes.

Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience.

To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones. A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group (n = 56) and traditional group (n = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up. The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group (P < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) (P = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) (P = 0.037). The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.

Effect of Sodium Bicarbonate Ringer's Solution on Intraoperative Blood Gas Analysis and Postoperative Recovery Time in Liver Transplantation: A Single-Center Retrospective Study.

BACKGROUND Sodium bicarbonate Ringer's solution (BRS) is the latest generation of balanced crystal solutions. BRS does not increase the liver burden, but its impact in liver transplantation is unclear. The aim of this study was to investigate the effect of BRS as a fluid therapy on intraoperative blood gas analysis and postoperative recovery time in orthotopic liver transplantation (LT) patients. MATERIAL AND METHODS The study included 101 patients who received classical in situ liver transplantation at the Second Affiliated Hospital of Guangxi Medical University from November 2019 to January 2022. The patients were divided into 2 groups according to the intraoperative fluid infusion: the BRS group and the sodium lactate Ringer's solution group (LRS group). Intraoperative blood gas analysis, including pH, base excess (BE), bicarbonate, and lactic acid levels of radial artery blood, were collected after induction (T0), 30 min before opening (T1), 30 min after no liver period (T2), 30 min after opening (T3), and at the end of the operation (T4). Postoperative ICU catheter time, ICU stay time, and total hospitalization days were also recorded and compared between the 2 groups. RESULTS Lactic acid levels were decreased significantly at T3 in the BRS group (P<0.05). ICU catheter time, ICU hospitalization days, and total hospitalization days were significantly shorter in the BRS group (P<0.05). CONCLUSIONS BRS can decrease the lactic acid level at 30 min after opening, reducing the postoperative recovery time. BRS is more effective than LRS in liver transplantation.

Perioperative, functional, and oncologic outcomes in patients undergoing robot-assisted radical prostatectomy previous transurethral resection of prostate: a systematic review and meta-analysis of comparative trials.

The influence of robot-assisted radical prostatectomy (RARP) on patients who have previously undergone transurethral resection of the prostate (TURP) versus TURP-naive patients is still debatable. The present study aimed to compare perioperative, functional, and oncologic outcomes of RARP between TURP and Non-TURP groups. We systematically searched the databases such as Science, PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies published in English up to August 2022. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022378126). Eight comparative trials with a total of 4186 participants were conducted. The TURP group had a longer operative time (WMD 22.22min, 95% CI 8.48, 35.95; p = 0.002), a longer catheterization time (WMD 1.32day, 95% CI 0.37, 2.26; p = 0.006), a higher estimated blood loss (WMD 23.86mL, 95% CI 2.81, 44.90; p = 0.03), and higher bladder neck reconstruction rate (OR 8.02, 95% CI 3.07, 20.93; p < 0.0001). Moreover, the positive surgical margin (PSM) was higher in the TURP group (OR 1.49, 95% CI 1.12, 1.98 p = 0.007). However, there was no difference between the two groups regarding the length of hospital stay, transfusion rates, nerve-sparing status, complication rates, long-term continence, potency rates and biochemical recurrence (BCR). Performing RARP on patients who have previously undergone TURP is a safe procedure. Furthermore, the current findings demonstrated that the TURP group had comparable oncologic and long-term functional outcomes to the Non-TURP group.

Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes

ABSTRACT Periurethral and anterior vaginal masses are relatively common with an estimated prevalence of 3% to 4% and 1%, respectively. These masses often cause diagnostic challenges due to nonspecific and overlapping symptoms. Urinary symptoms include frequency, urgency, and dysuria; vaginal discharge, urinary tract infection (UTI), dyspareunia, bleeding, postvoid dribbling, pelvic and urethral pain, and palpable mass can also present. Familiarity with differentiation of masses is important to make timely diagnoses and to expedite treatment without delays. This study aimed to describe the etiology of periurethral and anterior vaginal wall masses in a large series, as well as report the clinical presentations to determine whether the differential diagnosis can be narrowed based on presenting symptoms. The study consisted of a retrospective chart review, based on charts of patients from November 2001 to July 2021 at a tertiary referral center. Analyzed data included age, body mass index, operative findings, operative time, concomitant procedures, pathologic diagnosis, catheterization time, complications, length of stay, symptoms on follow-up, and follow-up duration. Describing the etiology of periurethral and anterior vaginal wall masses was the primary objective of the study (including underlying etiology distribution), followed by the secondary objective of describing rates of other clinical characteristics. A systematic search of literature was performed using various databases: MEDLINE (Ovid), Cochran Central Register of Controlled Trials (Wiley Online Library), EMBASE (Elsevier), and Scopus. The study included a total of 126 patients, all with at least 1 symptom exhibited. The most common presenting symptoms were palpable mass, dyspareunia, and urinary tract symptoms (dysuria, stress urinary incontinence [SUI], and UTI). There was an infection rate of 21.4% and a malignancy rate of 1.6%. Each patient underwent surgical treatment, including urethral repair, periurethral cyst excision, urethral diverticulectomy, and lesion excision. A total of 29.4% of patients reported SUI preoperatively. Postoperatively, 105 patients reported no incontinence (83.3%), 15 reported SUI (11.9%), 5 reported mixed urinary incontinence (4%), and 1 presented with overflow incontinence (0.8%). Limitations of the study include the prospective collection of data but its retrospective analysis, thereby limiting findings according to the accuracy and completeness of the medical records. In addition, there was an absence of patient-reported outcome measures when SUI or other symptoms were assessed, and the authors recognize a need for future prospective studies to include such outcome measures. This large series evaluation of periurethral and anterior vaginal wall masses is the largest of its kind, as the previous study included only 79 patients with periurethral masses, 96% of whom had definitive pathological diagnoses and surgical treatment. This study provides a broad view into the etiological spectrum underlying periurethral and anterior vaginal masses. Malignancy is rare. Infectious pathology is common and found in 21.4% of patients, whereas urethral diverticulum was the most common pathology (40% of cases). Finally, this study indicated high success rates for surgical excisions, as there were no recurrences among diverticula patients in the study. For Skene’s gland cyst excisions, a recurrence rate of less than 1% was noted.

Clinical efficacy and complications of transurethral resection of the prostate versus plasmakinetic enucleation of the prostate

BackgroundBenign prostatic hyperplasia (BPH) is a common disease in elderly males, and many kinds of minimally invasive procedures can be used for the treatment of BPH. However, various procedures have caused some controversies regarding clinical outcomes, so more studies are needed to validate these controversial topics.AimsThis study aimed to explore differences of clinical efficacy, surgical features, and complications between transurethral resection of the prostate (TURP) and plasmakinetic enucleation of the prostate (PKEP) for BPH.MethodsA total of eligible 850 cases of BPH underwent TURP (the TURP group, 320 cases) or PKEP (the PKEP group, 530 cases) in the urology department of our hospital from March 2015 to 2018 were involved in this study. Then, the baseline data, surgical characteristics, IPSS, QoL, PVR, Qmax, IIEF-5, and documented complications were compared between the two groups.ResultsThe operative time, intraoperative irrigation volume, postoperative hemoglobin, decrease in hemoglobin, postoperative irrigation time and volume, catheterization time, and hospital stay of the PKEP group were significantly less than those of the TURP group (all P < 0.05). At 3 months, 1, 2, and 3 years after operation, no significant differences were observed in IPSS, QoL, PVR, but the results of Qmax and IIEF-5 in the PKEP group were significantly higher than those parameters in the TURP group (all P < 0.05). The incidences of massive blood loss, postoperative secondary bleeding, blood transfusion, capsular perforation, urinary tract irritation, bladder spasm, clot retention, urinary tract infection, transient incontinence, erectile dysfunction, and the incidences of II, III grade of Clavien–Dindo classification in the PKEP group were significantly lower than those of the TURP group (all P < 0.05).ConclusionThe clinical efficacy of PKEP is compared favorably with TURP during midterm follow-up. Given the merits such as less blood loss and hospital stay, lower complications, PKEP should be given a priority for BPH.

Prevalence and Risk Factors of Urinary Retention in Patients With Cervical Cancer: A Meta-analysis and Systematic Review.

The literature is inconsistent on the prevalence and risk factors of urinary retention in patients with cervical cancer. The aim of this study was to review the literature on the prevalence of urinary retention in patients with cervical cancer and consolidate the risk factors. For this meta-analysis, eligible articles published in English or Chinese by December 10, 2021, were systematically searched for and retrieved from PubMed, Cochrane Library, Ovid-Embase Medline, Web of Science, PsycINFO, CINAHL, and Scopus. Prevalence, odds ratios (ORs), and 95% confidence intervals (CIs) were used for meta-analysis. Twenty-five studies were included in the analysis. The pooled overall prevalence was 0.26 (95% CI, 0.21-0.30, I2 = 95.0%). The identified risk factors were age (OR, 1.13; 95% CI, 1.08-1.19), urinary tract infection (UTI) (OR, 3.33; 95% CI, 1.48-7.49), surgical extent (OR, 2.95; 95% CI, 1.27-6.85), and catheter indwelling time (OR, 3.44; 95% CI, 2.43-3.87). The prevalence of urinary retention in patients with cervical cancer is 0.26. Older age, UTI, longer catheter indwelling time, and a larger surgical extent may increase the risk of urinary retention. Clinicians should identify patients at risk and adopt interventions such as individualized catheter care. Nursing staff should assess the risk of urinary retention in a patient with cervical cancer according to her age, presence of UTI, surgical extent, and catheterization time. A carefully chosen surgical procedure and interventions such as individualized education, timely catheter removal, treatment of UTI, and rehabilitation should be offered.

Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women

PurposeTo evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. Materials and MethodsEighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. ResultsA total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19–85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). ConclusionsImaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.

Preliminary comparison of the modified extraperitoneal free-PORT single incision technique and transabdominal multi-incision robot-assisted laparoscopic radical prostatectomy

To compare the clinical efficacy of an innovative modified single-incision technique without special extraperitoneal PORT with that of transperitoneal multi-incision robot-assisted laparoscopic radical prostatectomy and to explore the feasibility and safety of the former. A retrospective analysis was performed on 259 patients who received robot-assisted laparoscopic radical prostatectomy in the Robot Minimally Invasive Center of Sichuan Provincial People's Hospital between September 2018 and August 2021. Among them were 147 cases involving extraperitoneal single incision with no special PORT (Group A) and 112 cases involving multiple incisions by the transperitoneal method (Group B). Differences in age, PSA level, Gleason score, prostate volume, body mass index, clinical stage, lower abdominal operation history, and lymph node dissection ratio between the two groups were not statistically significant (P > 0.05). All operations were performed by the same operator. In this study, all 259 operations were completed successfully, and there was no conversion. There was no significant difference in transperitoneal blood loss, postoperative hospital stay, positive rate of incision margin, indwelling time of urinary catheter, satisfaction rate of immediate urine control, satisfaction rate of urine control 3 months after operation, positive rate of postoperative lymph node pathology or postoperative pathological stage between the two groups (P > 0.05). There were significant differences in operation time, postoperative exhaust time and incision length (P < 0.05). The modified extraperitoneal nonspecial PORT single-incision technique is safe and feasible for robot-assisted laparoscopic radical prostatectomy, and its curative effect is similar to that of transperitoneal multi-incision RARP. It has the advantages of a short operation time, less impact on the gastrointestinal tract and a more beautiful incision. The long-term effect of treatment needs to be further confirmed by prospective studies.

Retrospective analysis of 1470-/980-nm dual-wavelength laser en bloc resection versus transurethral resection of bladder tumor for primary non-muscle-invasive bladder cancer.

To compare the safety and efficacy of en bloc resection of non-muscle-invasive bladder cancer (NMIBC) using a 1470-/980-nm dual-wavelength laser (DwLRBT) compared to the gold standard, transurethral resection (TURBT). The study group included 251 patients with a confirmed diagnosis of NMIBC, 97 in the DwLRBT group and 154 in the TURBT group. Clinical characteristics, complications, and recurrence-free survival were compared between the two groups. There were no differences between the two groups with regard to age, sex, mean tumor size, mean tumor number, tumor location, risk, fever, and reoperation. Compared to TURBT, DwLRBT was associated with a shorter hospitalization time (mean±standard deviation: 5.81±1.48 days vs. 4.96±1.32, respectively, p=0.001), shorter catheterization time (4.98±1.47 vs. 4.20±1.48 days, respectively; p=0.035), and smaller volume of intraoperative bleeding (8.43±6.21 ml vs. 6.15±5.08, respectively; p=0.003). Recurrence-free survival (RFS) was better for DwLRBT than TURBT in the overall cohort (hazard ratio [HR], 0.4323; 95% confidence interval [CI], 0.2852-0.6554; p=0.0004) and for the following subgroups and tumor types: intermediate-risk (HR, 0.2654; 95%CI, 0.1020-0.6904; p=0.0245) and high-risk (HR, 0.4461; 95% CI, 0.2778-0.7162; p=0.0027) groups; and for pedunculate bladder tumors (HR, 0.4158; 95%CI, 0.2401-0.7202; p=0.0063), single bladder tumors (HR, 0.4136; 95%CI, 0.2376-0.7293; p=0.0072), and multiple bladder tumors (HR, 0.2727; 95%CI, 0.1408-0.5282; p=0.0014). DwLRBT is associated with better operative and postoperative outcomes, including, importantly, a longer RFS, compared to TURBT.

Application of the ultrasound-guided double-screen contrast method in the standardized teaching and training of resident doctors in femoral vein puncture.

The aim of this study was to investigate the advantages of the double-screen contrast method compared with the short-axis ultrasound display method for teaching ultrasound-guided femoral vein puncture during the standardized training of resident doctors. Sixty resident doctors undergoing standardized training were randomly divided into a test group (short-long axis switching double-screen contrast, n = 30) and a control group (n = 30). These two groups of physicians underwent teaching and training of ultrasound-guided femoral vein puncture, and the success rate of the first puncture attempt, the total catheterization time, and any accidental femoral artery punctures were recorded and compared between the two groups. The success rate of the first puncture attempt in the test group was significantly higher than that in the control group (P < 0.05). In the control group, two doctors accidentally punctured the artery, while in the test group, no arterial punctures occurred. The puncture time for the test group was longer than for the control group (P < 0.05). In the standardized training of ultrasound-guided femoral vein puncture for resident doctors, the double-screen contrast method has significant advantages. It enables resident doctors to quickly understand and apply the technique, so it is worth making this the method of choice.