ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy(T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients of renal calculi with a maximum diameter of 2-3 cm treated between January 2022 to July 2024. Of these, 146 cases were treated with single use ureteroscopic lithotripsy through a FV-UAS while 124 cases were treated by tubeless PCNL (T-PCNL group) through 16F amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFR) were compared.

Results: There was no significant difference in the stone free rates(SFRs) between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI): 0.56-2.28, odds ratio (OR) = 1.13, P = .724; the SFRs at 1 month postoperatively were compared: 95% CI: 0.417-2.60, OR = 1.041, P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% CI: 0.355-1.055, OR = 0.612, P = .076; the SFRs at 1 month postoperatively were compared: 95% CI: 0.374-1.320, OR =.703, P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P=0.813, P=0.839, respectively). The surgical duration in the FV-UAS group was significantly longer (P<0.001). The decrease in postoperative hemoglobin(Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (P<0.001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: To evaluate urodynamic parameters that may serve as predictors of treatment efficacy with Onabotulinumtoxin-A (onaBoNT-A) in patients with neurogenic lower urinary tract dysfunction (NLUTD).

Materials and Methods:: Patients with NLUTD who received 200 IU onaBont-A injections were included in the study. Urodynamic parameters and the correlations between these parameters and treatment outcomes were analyzed. The primary endpoints were changes in the daily pad usage, and the secondary endpoint was to demonstrate the relationship between duration of treatment efficacy of onabotulinumtoxin-A with preoperative urodynamic parameters in patients with NLUTD.

Results: The data of 74 patients were analyzed retrospectively, and 66 (89%) patients benefited from onaBoNT-A treatment. A negative correlation was observed between the number of pads changed per day and maximum cystometric capacity (MCC) (p=0.024, r=-0.277). A positive correlation existed between the duration of treatment efficacy of onaBoNT-A and change in detrusor pressure during filling cystometry (ΔPdet) (p=0.018, r=0.291), whereas a negative correlation was noted with bladder compliance (p=0.035, r=-0.260). Any additional indicator of its urodynamic efficacy showing a correlation with the number of pads changed per day has not been identified yet.

Conclusion: OnaBoNT-A injections effectively manage NLUTD, with MCC being a potential predictor of treatment response. Other urodynamic parameters showed limited predictive value. Patients with lower MCC experienced greater improvements in reducing the number of pads used following treatment. High ΔPdet and low bladder compliance were associated with treatment benefits persisting for longer periods of time.

ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


Improved Graft Function and Decreased Post-transplantation Urinary Tract Infection After Azithromycin Dosing to Donors: A Pilot Study

Mojtaba Teimoori, Gholamreza Mokhtari, Siavash Falahatkar , Masoud Khosravi , Majid Momeni Moghaddam, Zahra Taheri

Urology Journal, Vol. 22 (2025), 5 January 2025, Page 7988
https://doi.org/10.22037/uj.v22i.7988

Introduction: The rising trend of End-stage Renal Disease (ESRD) patients requiring dialysis or transplantation needs a more therapeutic plan. As the best strategy for ESRD patients, kidney transplantation still needs outcome improvement. Macrolide drugs display antimicrobial and anti-inflammatory properties in chronic disease and intraoperatively and can concentrate in tissues for extended periods. Hence, theoretically, the drug prescription to the donor and accumulation in the kidney can cause graft immunomodulation and improve kidney transplantation outcomes.

Methods and Analysis: This double-blinded randomized clinical trial was conducted on 62 eligible kidney donors randomly allocated to the azithromycin or placebo group and treated with a single dose (one gram) one day before surgery. The primary outcome was kidney graft function, and secondary outcomes included rejection rate, urinary tract infections in graft recipients, pain and systemic inflammatory response syndrome in live donors, and complications in donors and recipients. Outcomes were measured at baseline and every day in the first week after transplantation in both live donors and recipients and 30 and 90 days after transplantation. The adverse events were recorded as well.

Result: The mean age was 39 (SD, 13) years; 40% were women, and 11.6% were diabetic. Mean creatinine was 6.11 mL/min/1.73m2. Most patients in both arms were male (61.3%) and in early middle age. Hypertension was the most common cause of ESRD. Azithromycin could reduce the rejection rate in the first few days after kidney transplantation. Inflammatory mediators were lower in the azithromycin group, and fewer cases of urinary tract infection were found in the azithromycin group (p<0.05).

Conclusion: Azithromycin reduces adverse outcomes and enhances graft function. It would offer an intervention that is easy to use and economical, lowering post-transplant risks.

UNCLASSIFIED


Purpose: Benign prostatic hyperplasia (BPH) is a condition commonly observed in elderly males, leading to lower urinary tract symptoms and potential complications. Surgical procedures primarily include transurethral resection of the prostate (TURP) and plasmakinetic resection, with their effectiveness under active research and clinical interest.

Materials and Methods: This retrospective cohort study compared the impacts of plasmakinetic resection and conventional TURP on clinical symptoms and quality of life in patients with benign prostatic hyperplasia. It encompassed surgical duration, postoperative complications, urodynamic parameters, quality of life scores, sexual function, and long-term outcomes.

Results: Postoperative symptom improvements, including International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, were significantly higher in the plasmakinetic resection group (P = 0.033 and P = 0.003, respectively). Urodynamic parameters such as peak flow rate (P = 0.008), post-void residual volume (P = 0.044), and Qmax (P = 0.012) also showedsignificant improvements. Quality of life assessments, including (EuroQol-5 Dimensions)EQ-5D scores (P = 0.003), general health perception (P = 0.009), sexual function (P = 0.011), and overall satisfaction (P = 0.004) favored plasmakinetic resection. Plasmakinetic resection resulted in better outcomes for continence and sexual function. Long-term outcomes at 1 year post-operation, including IPSS scores (P = 0.006) and overall satisfaction (P = 0.002), were significantly better in the plasmakinetic resection group. No significant differences were observed in health care resource utilization.

Conclusion: The study suggests that plasmakinetic resection offer advantages over conventional TURP in symptom relief, quality of life, continence, sexual function, and long-term results for patients with BPH.

REVIEW


Laparoscopic stone surgery was historically recommended only for cases involving concomitant ureteropelvic junction obstruction (UPJO), congenital abnormalities, or when other endourological procedures had failed as an alternative to open surgery. However, recent randomized clinical trials and meta-analyses involving patients with normal anatomy and large renal stones have shown that laparoscopic pyelolithotomy (LPL) has a higher success rate and lower complication rates compared to the gold standard, percutaneous nephrolithotomy (PCNL). Furthermore, stone recurrence appears to be lower following LPL compared to PCNL. Therefore, we suggest that current guidelines for stone treatment reconsider laparoscopy as an effective primary treatment for large kidney stones, rather than simply viewing it as an alternative option. Nonetheless, careful case selection and the surgeon's experience are critical for the success of this treatment.