REVIEW


Purpose: To compare the risk of complications between laparoscopic peritoneal dialysis (PD) catheter placement and open PD catheter placement.


Methods: We searched numerous databases, including SinoMed, CNKI, cqVIP, WanFang, Pubmed, Web of Science, OVID,  Cochrane and Scopus, for published randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) .


Results: Ten studies were included(n=1341). The overall statistical results showed that patients receiving laparoscopic insertion of the PD catheter had a lower risk of catheter migration, inadequate drainage and blockage. The risk of leakage was higher in the laparoscopic group in studies performed prior to 2015; in studies performed after 2015, the risk of leakage was lower than in the conventional open-placement group. For the risk of developing pain, the risk was lower in the subgroup of laparoscopic patients starting PD within 1 day after catheter insertion; however, there was no significant difference between the subgroups starting PD 1 week or 2 weeks after catheter insertion. The risk outcome for abdominal bleeding was similar to that for pain, with a lower risk in the subgroup of laparoscopic patients starting PD within 1 day. The overall research quality was moderate.


Conclusion: Laparoscopic placement of the PD catheter has unique advantages over conventional open surgical placement, especially in special conditions such as emergency initiation. In addition, we found that some factors that were previously considered irrelevant may have an impact on the results for Asians. However, this conclusion still needs to be substantiated by further large samples in multicenter, high quality Randomized Controlled Trials (RCTs).


 


 

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose: To investigate temperature changes around the fibres of the super pulse thulium fibre laser (SP-TFL) during in vitro lithotripsy.


Materials and Methods: Stones were placed in the in vitro model. The laser was continuously excited for 180 s; the probe was positioned 5 mm around the fibre; the laser power was set at 10, 15, 20, 25, and 30 W; and the irrigation rate was set at 0, 15, 25, 35 ml/min, using a domestic SP-TFL. The temperature variations around the fibre under different power settings and different irrigation rates were compared.


Results: Without irrigation, the temperature around the fibre rapidly reached the safety threshold of 43℃ at 24 s. At irrigation rate 15 ml/min and laser power <15 W, the temperature around the fibre was <43℃. Once the laser power increased to ≥20 W, the temperature around the fibre increased to >43℃ at its lowest plateau. At irrigation rate 25 ml/min and laser power ≤25 W, the temperature around the fibre was <43℃. At irrigation rate 35 ml/min and laser power <30 W, the fibre temperature was <43℃. When laser power was ≥30 W, the fibre temperature was >43℃. Conclusion: In extracorporeal ureteroscope SP-TFL lithotripsy, when the laser power is ≤15 W, ≤25 W, and ≤30 W, the irrigation rate should be maintained at ≥15 ml/min, ≥25 ml/min, and ≥35 ml/min, respectively.

Does the Prone Position During the Shockwave Lithotripsy of Kidney Stones Improve the Stone-Free Rate? Results from a Randomized Clinical Trial

Abdolreza Mohammadi, Leonardo Oliveira Reis, Alireza Khajavi, Leila Zareian Baghdadabad, Seyed Mohammad Kazem Aghamir

Urology Journal, Vol. 20 (2023), , Page 7418
https://doi.org/10.22037/uj.v20i.7418

Objective: This study aimed to evaluate the impact of the skin-to-stone distance in the supine and prone positions on the outcome of shockwave lithotripsy of kidney stones.


Methods: In a prospective randomized clinical trial study, 81 patients that candidates for shockwave lithotripsy (SWL) of kidney stones were randomly divided into two groups to perform SWL in the prone position (40 patients) or conventional supine position (41 patients). Demographic data, stone characteristics, skin–to–stone distances (SSD) in CT, SSD during SWL with an ultrasound probe in prone and supine positions, total shock wave rate, total energy (kilovolt), visual analog scale (VAS), complications (Clavien-Dindo scale system), and SWL success rate evaluated in two intervention and control groups. All statistical analysis was performed by independent T-test, Chi-Square test, Fisher exact test, paired T-test, and SPSS 22.0 software for windows.


 


Results: There were no significant differences between demographic characteristics, SWL sessions, the median number of SWLs, the median SWL time, median total energy, VAS, and complications in the two groups. The SFR was numerically higher in the prone SWL group than in the supine SWL group (80% vs. 73.2%) but was not significantly different (p-value: 0.468).


Also, the inline ultrasound (US) measuring of the SSD in the prone position was significantly different from US SSD measures in the supine position in the two groups (p-values=0.001 and 0.024). The mean SSD was lower in the US measurement during the SWL process that measured in supine and prone position than the CT measurement (73.5 vs. 101.1), which means the routine SSD measured by CT scan is higher than SSD in the US probe measurement during SWL.


Conclusion : The prone position SWL modification could be effective in obese patients with a BMI of more than 30 and increase the stone-free rate (p-value=0.039) with a similar safety profile and comparable VAS score. It seems the SSD measured by the ultrasound is a more accurate dynamic measurement during the SWL and needs to define the SSD according to the SSD calculation by the US probe of the therapy head. SFR was numerically higher in the prone compared with the supine treatment groups

National Lifetime Prevalence and Demographic Factors of Urolithiasis in Iran

Abbas Basiri, Amir Hossein Kashi, Hossein Salehi Omran, Nasrin Borumandnia, Shabnam Golshan, Behzad Narouie, Sakineh Hajebrahimi, Hayat Mombeini

Urology Journal, Vol. 20 (2023), , Page 7576
https://doi.org/10.22037/uj.v20i.7576

Purpose: To estimate the current lifetime prevalence of urolithiasis at the national level in Iran and investigate the potential influential demographic factors in different geographical areas.


 


Materials and methods: An epidemiological study was conducted between October 2020 and November 2022 in 31 provinces of Iran at the national level. Data was obtained through telephone interviews with households. Items in the interview included questions about the current and past episodes of urolithiasis, family history of urolithiasis, and demographic and environmental variables of potential interest in urolithiasis.


 


Results: A total of 44186 participants were investigated from 31 provinces of Iran. The overall percentage of those with lifetime prevalence of urolithiasis was 6.6%, including 7.9% for males and 5.3% for females (P<.001). In addition, with regard to the residential location, men were 53% (7.9% vs. 5.2%) more susceptible than women to urinary stones in urban areas and 36% (7.8% vs. 5.7%) more susceptible in rural areas. Out of 31 provinces, the Sistan-baluchistan province had the highest lifetime prevalence (15.6%) and the Golestan province had the lowest (2.1%). The lifetime prevalence of urolithiasis in the rural areas was 6.8% versus 6.5% in the urban areas (P=.29). Regarding age differentiation, the lifetime urolithiasis prevalence has increased up to the age of 70 years. In addition, the most prominent increase in the lifetime prevalence was observed in the age range of 20 to 60 years (from 0.9% to 11.8%). The ethnicity with the highest lifetime prevalence rate of urolithiasis was the Baluch ethnicity (18%).


 


Conclusion: generally, 6.6% of Iranian population suffers from urinary stones during their lifetime. Urolithiasis prevalence has increased 0.06% annually compared to the latest national study that took place 15 years ago. This increasing trend seems to be less prominent than other countries. According to our findings, urinary stones are more prevalent in men than in women and in the third to sixth decade of life regardless of gender. Baluch ethnicity is associated with the highest lifetime prevalence rate of urolithiasis and there is no significant difference between rural and urban areas. However, the ratio of male to female risk of urolithiasis is higher in urban areas compared to rural areas.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Purpose: The aim of this retrospective study is to assess the long-term outcomes and safety of laparoscopic simple prostatectomy.


Material and Methods: Between 2012 and 2019 80 patients with prostates volumes ≥ 80 mL were treated with laparoscopic simple prostatectomy at our department. Uroflowmetry, post void residual volume and standardized questionnaires were assessed pre- and postoperatively.


Perioperative complications were categorized using the Clavien-Dindo classification.


Results: The mean specimen weight was 83 grams, and the mean operation time was 156 minutes. At a mean follow-up time of 40 months patients showed a significant improvement of Qmax (P = .002), IPSS (P < .001) and QoL (P < .001). Post void residual volumes decreased significantly.


Complications occurred in 11 patients (13.8%), nine had mild (grade 1 - 2) and two had severe (grade 3b - 4a) complications. One conversion to open surgery due to massive prostatic adherence from previous abscess formation was recorded and one patient needed blood transfusion intraoperatively.


Conclusion: laparoscopic simple prostatectomy is an effective and safe procedure for large volume prostate glands with a significant and stable long term symptoms improvement.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: To investigate the direct and indirect effects of demographic characteristics, relationship satisfaction, and psychological factors on female sexual distress (FSD) using path analysis.


Materials and Methods: This study was conducted in two stages. Initially we obtained the FSD predictor factor's conceptual model through a literature review and expert panel. In the Second stage, a population-based cross-sectional study on 207 non-pregnant and married women (without any age restriction) in Zanjan, Iran was conducted. FSDs-R, FSFI-6, DASS-21, and GEMREL Standard questionnaires and the demographic researcher-made questionnaire were used in this study. The data undergone path analysis based on the initial conceptual model.


Results: Sexual function (SF) had the strongest relationship with FSD from the direct path (β = -.49) and overall effect (β = -.58). The highest indirect effect belonged to depression-anxiety-stress level (β = .284) mediated by SF (β = -.42) and relationships satisfaction with spouse (β = -.20). Age difference (β = -.13) and relationships satisfaction with spouse (β = -.19) had only a direct effect on FSD. Marriage Duration had only indirect effect on FSD through mediating role on SF (β = -.26) and depression-anxiety-stress level (β = -.15).


Conclusion:  Among the predictor factors investigated in this study, sexual dysfunction is the most important predictor of FSD. In addition; men older than their spouses, longer marriage duration, relationship dissatisfaction with the spouse and higher rate of depression-anxiety-stress have positive correlation with SD. Therefore, we should offer a combination of the mentioned factors in providing care for women with SD.

ORIGINAL PAPER (ANDROLOGY)


Prospective Investigation on the Paternity Intention and Affecting Factors in 84 Post-treatment Testicular Cancer Patients

Serkan Yenigurbuz, Caner Ediz, Yunus Emre Kizilkan, Serkan Akan, Mehmet Pehlivanoglu, Muhammed Cihan Temel, Hasan Huseyin Tavukcu, Tuna Erturk, Omer Yilmaz

Urology Journal, Vol. 20 (2023), , Page 7337
https://doi.org/10.22037/uj.v20i.7337

Purpose: to investigate the factors affecting post-treatment paternity intention in patients followed up after the diagnosis of testicular cancer and to make recommendations for the early postoperative period based on the identified factors.


Materials and Methods: This prospective descriptive study included total 185 patients who presented to our outpatient clinic between February 2000 and July 2020 who had radical orchiectomy due to suspected testicular cancer based on physical examination and other assessments. Contact information was found for 88 of 185 patients, and accordingly, the patients were reached by one-to-one phone calls. Upon literature review, a questionnaire consisting of 10 previously validated items was developed by the researchers. The patients were compared by separating them into two groups composed of patients with (Group 1) and without (Group 2) paternity intention.


Results: A total of 84 patients participated in the study, and the participation rate was 95.5%. It was found that 19 of 32 (38%) patients with paternity intention already had children. Only 21 (40%) of 52 patients without paternity intention were married. The mean age was 26.65 (18–39) years in Group 1, while it was 28.73 (19–45) years in Group 2. Tumor volume and serum tumor markers were higher in Group 2 than in Group 1. Parameters such as testicular side in which the tumor was located, smoking status, undescended testis history, and postsurgical chemotherapy history were not statistically significant difference between the two groups.


Conclusion: The major findings included that the young aged, unmarried, and serious testicular cancer (Tumor volume and serum tumor markers were higher) can be affecting factors for testicular cancer patients’ paternity intention. Early psychological counseling about paternity may be useful for testicular cancer patients.

UNCLASSIFIED


Purpose: Urinary tract infection (UTI) is the second most common infectious disease among older adults. It is important that the treatment strategy used for older patients with UTIs in the emergency department (ED) be adequate. The effectiveness of an initial single dose of intravenous antibiotics in the ED for treating UTIs has not been extensively studied. Therefore, we investigated the clinical outcomes of single-dose intravenous antibiotic administration before discharge from the ED in elderly patients with UTIs.


Materials and Methods: This retrospective study was conducted among patients who visited two academic tertiary hospitals in Seoul, South Korea. We included all patients older than 65 years of age with UTI who visited the ED and were directly discharged between 1 January and 31 December 2019 (n = 429). The patients were divided into two groups according to whether they received a single dose of intravenous antibiotics before ED discharge.


Results: Patients who received intravenous antibiotics had a higher 72-hour revisit rate (43 [15.4%] vs 10 [6.7%], p = .009) and a longer mean duration of therapy (total days of antibiotics use) (11 [4.00 – 15.00] vs 5 [3.00 – 11.00], p < .001) than patients who received only oral antibiotics. However, the rate of admission after revisits did not differ significantly between the groups (27 [62.8%] vs 5 [50.0%], p = .492).


Conclusion: Older patients with severe UTIs were prescribed intravenous antibiotics in the ED. Decisions on admission or discharge should be made carefully for older patients with UTIs who are prescribed intravenous antibiotics in the ED.

Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP)

Carlos Ignacio Calvo de la Barra, Juan Cristobal Bravo Izurieta, Renato Navarro Capone, Rodrigo Cañas Ramirez, Felipe Pasten Alcaina, Ignacio San Francisco Reyes

Urology Journal, Vol. 20 (2023), , Page 7374
https://doi.org/10.22037/uj.v20i.7374

Purpose: Inguinal hernias and benign prostatic hyperplasia (BPH) can coexist in about one fifth of patients undergoing BPH surgery. There is scarce evidence about performing laser enucleation along with open inguinal hernia repair. Our goal is to describe the perioperative outcomes of performing both surgeries in the same operating session compared to doing HoLEP alone.


Materials and Methods: A retrospective analysis of patients undergoing HoLEP and hernioplasty with mesh in the same anesthetic time (group B) at an academic center was conducted. They were compared to a randomly picked control group of patients submitted to HoLEP alone (group A). Preoperative, operative and postoperative features were compared among both groups.


Results: 107 patients submitted to HoLEP alone were compared to 29 combined approach patients (HoLEP + hernia repair). Patients in group A were found to be older and had larger prostates. Group B showed a significant longer operative time. Length of stay and duration of catheter was comparable among groups. In multivariate analysis, the combined approach was not associated to a higher complication rate.


Conclusion: Performing benign prostatic hyperplasia surgery with HoLEP in conjunction with open inguinal hernioplasty is not related to a higher length of stay or a significantly increased risk of morbidity.