ISSN: 1735-1308

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose:  To evaluate the stone-free rates, quality of life, complications, use of fluoroscopy, analgesic requirements, a hospital stay following the management of lower calyceal with two different techniques (Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery) in a prospective manner.


Material and Methods: 50 patients with a diagnosis lower pole 1-2 cm stone were included into the study and were randomized into two groups.(Mini PCNL n: 25) ( RIRS n: 25). Safety and efficacy of both methods along with some other certain related factors were comparatively evaluated in both groups.


Results: There was no significant difference between preoperative stone size, stone to skin distance, hemogram and creatinine values, need for analgesic drug, patients' replies to visual analog scale (VAS). The duration of both the hospital stay and the exposure to fluoroscopy, hematocrit decrease due to hemorrhage, complication rates were significantly higher in cases undergoing mini PCNL when compared to RIRS. Additionally, any significant difference was not observed with respect to the stone-free rates. Despite an increase in quality of life following the both type operations was noted; there was no significant difference in the quality of life between the patients in both groups.


Conclusion: Our findings demonstrated that both surgical techniques are the feasible alternatives in the minimal invasive treatment of lower pole stones. Although there was no meaningful difference in stone-free rates between two groups; complications, use of fluoroscopy, bleeding and duration of hospital stay were noted to be significantly higher in cases treated with mini PCNL.

Purpose: The cumulative effect of measurable parameters on proximal ureteral stone clearance followed by the shock wave lithotripsy was assessed via the application of an artificial neural network.


Methods and patients: From January 2015 to January 2020, 1182 patients with upper ureteral stone underwent extracorporeal shock wave lithotripsy (ESWL) with supine position. The corresponding significance of each variable inputted in this network was determined by means of Wilk’s generalized likelihood ratio test. If the connection weight of a given variable can be set to zero while maximizing the accuracy of the network classification, the variable is not considered an important predictor of stone removal.


Results: A total of 1174 cases (excluding 8 cases) were randomly assigned into a training group (813 cases), testing group (270 cases), and keeping group (91 cases). We evaluated artificial neural network analysis to the stone clearance rate of the training group, with a predictive accuracy of 93.2% (482/517 cases). While the predictive accuracy of the stone clearance rate of the training group was 75.3% (223 cases/296 cases). The order of importance of independent variables was stone length > course (d) > patient’s age > Stone Width > PH value.


Conclusion: The neural network possess a huge prediction potential for the invalidation of ESWL.

Purpose: The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR.


Methods: This study was a systematic review and meta-analysis. A systematic literature review was conducted using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract.


Results: In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P<.00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P<.00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23).


Conclusions: The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.

ORIGINAL PAPER (FEMALE UROLOGY)


Role of Urodynamics Study in the Management of Pelvic Organ Prolapse in Women

Azar Daneshpajooh, Mahbube Mirzaie, Tania Dehesh

Urology Journal, , 23 February 2021 , Page 6408
https://doi.org/10.22037/uj.v18i.6408

Objectives: Pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) usually coexist and are common among women. Since the efficacy of urodynamic studies (UDS) in evaluating these conditions is subject to controversy, this study aimed to assess the accordance between urodynamic findings and LUTS and to determine the importance of UDS in women with POP.


Methods: This cross-sectional study was conducted on women over 18 years with symptomatic POP referred to the female urology clinic of Kerman University of Medical Sciences, Kerman, Iran, during 2017-2018. Patients who met the inclusion criteria were included in the study with informed consent. The Pelvic Floor Disability Index (PFDI-20) was completed for each patient. Pelvic examination was performed using the Pelvic Organ Prolapse Quantification System (POPQ). Subsequently, multi-channel UDS was performed, and the findings were analyzed in SPSS 20, using Chi-square or Fisher’s test.


Results: A total of 200 women with symptomatic POP were included in the study. Stress, urge, and mixed urinary incontinence showed significant accordance with the urodynamic findings (urodynamic stress incontinence and/or detrusor overactivity). However, there was no significant relationship between urinary voiding LUTS and urodynamic findings.


Conclusion: UDS should be performed for selective patients with POP. According to the results of the present study, UDS can help us provide consultation for POP patients with voiding LUTS. However, in POP patients with urinary incontinence, this test cannot provide further information and should be performed based on the patient’s condition.