Archive for category: Latest Articles

Managing prolonged ischaemic priapism

Objectives

To undertake a prospective multicentre national audit of penile prosthesis practice in the UK over a 3‐year period.

Patients and Methods

Data were submitted by urological surgeons as part of the British Association of Urological Surgeons Penile Prosthesis National Audit. Patients receiving a penile prosthesis (inflatable or malleable) were included as part of a prospective registry over a 3‐year period. Data were validated and then analysed using a software package (Tableau).

Results

A total of 1071 penile prosthesis procedures were included from 22 centres. The three commonest aetiological factors for erectile dysfunction were diabetes, prostate surgery and Peyronie’s disease. Of the recorded data, inflatable penile prostheses were the commonest devices implanted, with 665 devices used (62.1%), whereas malleable prostheses accounted for 14.2% of the implants. Recorded intra‐operative complications included urethral injury (0.7%, n = 7), corporal perforation (1.1%, n = 12) and cross‐over (0.6%, n = 6). Known postoperative complications were recorded in 9.8% of patients (74/752), with the two most frequently reported being postoperative penile pain (n = 11) and scrotal haematoma (n = 14).

Conclusion

This baseline analysis is the largest prospective registry of penile prostheses procedures to date. The data show that, over the 3‐year collection period in the UK, there are now fewer surgeons performing the procedure, together with a reduction in the number of centres. Peri‐operative complications were infrequent, and the rate of implant abortion (e.g. as a result of urethral injury) was very low. Further follow‐up data will be required to publish long‐term outcomes and patient satisfaction.

Welcome to the October issue of Trainees’ Corner

Objectives

To undertake a prospective multicentre national audit of penile prosthesis practice in the UK over a 3‐year period.

Patients and Methods

Data were submitted by urological surgeons as part of the British Association of Urological Surgeons Penile Prosthesis National Audit. Patients receiving a penile prosthesis (inflatable or malleable) were included as part of a prospective registry over a 3‐year period. Data were validated and then analysed using a software package (Tableau).

Results

A total of 1071 penile prosthesis procedures were included from 22 centres. The three commonest aetiological factors for erectile dysfunction were diabetes, prostate surgery and Peyronie’s disease. Of the recorded data, inflatable penile prostheses were the commonest devices implanted, with 665 devices used (62.1%), whereas malleable prostheses accounted for 14.2% of the implants. Recorded intra‐operative complications included urethral injury (0.7%, n = 7), corporal perforation (1.1%, n = 12) and cross‐over (0.6%, n = 6). Known postoperative complications were recorded in 9.8% of patients (74/752), with the two most frequently reported being postoperative penile pain (n = 11) and scrotal haematoma (n = 14).

Conclusion

This baseline analysis is the largest prospective registry of penile prostheses procedures to date. The data show that, over the 3‐year collection period in the UK, there are now fewer surgeons performing the procedure, together with a reduction in the number of centres. Peri‐operative complications were infrequent, and the rate of implant abortion (e.g. as a result of urethral injury) was very low. Further follow‐up data will be required to publish long‐term outcomes and patient satisfaction.

Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism

Abstract

Objective

To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage ureteropelvic junction obstruction (UPJO) through a meta‐analysis of comparative studies.

Methods

A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were extrapolated. Subgroup analyses were performed according to study design and techniques. PROSPERO REGISTRATION (CRD42020163303).

Results

Eighteen studies describing 2,007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR=0.99; 95%CI 0.97, 1.01), complications (RR=1.09, 95%CI 0.82, 1.45), OT (SMD=0.61, 95%CI ‐0.04, 1.26), LOS (SMD=‐0.30, 95%CI ‐0.63, 0.04), EBL (SMD=‐0.53, 95%CI ‐1.26, 0.21), or analgesic requirements (SMD=‐0.51, 95%CI ‐1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal laparoscopy likely had a higher conversion rate (RR=2.40; 95%CI 1.23, 4.66); however, patients resumed diets earlier (SMD=‐2.49, 95%CI ‐4.17, ‐0.82) and had shorter drain duration (SMD=‐0.31, 95%CI ‐0.57, ‐0.05).

Conclusion

The evidence suggests that there are no significant differences in success rate, operative time and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher in the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Abstract

Objective

To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage ureteropelvic junction obstruction (UPJO) through a meta‐analysis of comparative studies.

Methods

A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were extrapolated. Subgroup analyses were performed according to study design and techniques. PROSPERO REGISTRATION (CRD42020163303).

Results

Eighteen studies describing 2,007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR=0.99; 95%CI 0.97, 1.01), complications (RR=1.09, 95%CI 0.82, 1.45), OT (SMD=0.61, 95%CI ‐0.04, 1.26), LOS (SMD=‐0.30, 95%CI ‐0.63, 0.04), EBL (SMD=‐0.53, 95%CI ‐1.26, 0.21), or analgesic requirements (SMD=‐0.51, 95%CI ‐1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal laparoscopy likely had a higher conversion rate (RR=2.40; 95%CI 1.23, 4.66); however, patients resumed diets earlier (SMD=‐2.49, 95%CI ‐4.17, ‐0.82) and had shorter drain duration (SMD=‐0.31, 95%CI ‐0.57, ‐0.05).

Conclusion

The evidence suggests that there are no significant differences in success rate, operative time and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher in the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

Pod save the queen

Abstract

Objective

To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage ureteropelvic junction obstruction (UPJO) through a meta‐analysis of comparative studies.

Methods

A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were extrapolated. Subgroup analyses were performed according to study design and techniques. PROSPERO REGISTRATION (CRD42020163303).

Results

Eighteen studies describing 2,007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR=0.99; 95%CI 0.97, 1.01), complications (RR=1.09, 95%CI 0.82, 1.45), OT (SMD=0.61, 95%CI ‐0.04, 1.26), LOS (SMD=‐0.30, 95%CI ‐0.63, 0.04), EBL (SMD=‐0.53, 95%CI ‐1.26, 0.21), or analgesic requirements (SMD=‐0.51, 95%CI ‐1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal laparoscopy likely had a higher conversion rate (RR=2.40; 95%CI 1.23, 4.66); however, patients resumed diets earlier (SMD=‐2.49, 95%CI ‐4.17, ‐0.82) and had shorter drain duration (SMD=‐0.31, 95%CI ‐0.57, ‐0.05).

Conclusion

The evidence suggests that there are no significant differences in success rate, operative time and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher in the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

The clinical features and predictive factors of nocturnal enuresis in adult men

Abstract

Objective

To investigate the utility of multiparametric magnetic resonance imaging (mpMRI) in the reassessment and monitoring of patients on active surveillance (AS) for Grade Group (GG) 1 prostate cancer (PCa).

Patients and Methods

We identified, from our prospectively maintained IRB‐approved database, 181 consecutive men enrolled on AS for GG 1 PCa who underwent at least one surveillance mpMRI followed by MRI/prostate biopsy (PBx). A subset analysis was performed among 68 patients who underwent serial (at least two) mpMRI/PBx during AS. Pathological progression (PP) was defined as upgrade to GG ≥ 2 on follow up biopsy. Statistically significant if p<0.05.

Results

Baseline MRI was performed in 34 (19%) patients. In a median follow up of 2.2 years for the overall cohort, the PP was 12% (6/49) for PIRADS 1‐2 and 37% (48/129) for PIRADS≥ 3. The 2‐year PP‐free survival was 84%. Surveillance PSA density (p<0.001) and surveillance PIRADS ≥ 3 (p=0.002) were independent predictors for PP on reassessment MRI/PBx. In serial MRI cohort, the 2‐year PP‐free survival was 95% for no MRI‐progression vs 85% for MRI‐progression group (p=0.02). MRI progression was significantly higher in PP (62%) than in no‐PP (31%) group (p=0.04). If serial MRI is used for PCa surveillance and biopsy is triggered based only on MRI progression, 63% of PBx might be postponed by the cost of missing 12% of GG≥2 PCa in those with stable MRI. Conversely, this strategy would miss 38% of those with upgrading to GG≥2 PCa on biopsy. Stable serial mpMRI correlates with no reclassification to GG ≥ 3 PCa during AS.

Conclusion

PIRADS ≥ 3 on surveillance mpMRI is associated with increased risk of PCa reclassification. Surveillance biopsy based only on MRI progression may avoid large number of biopsies with the cost of missing many PCa reclassification.

A modified sequential vascular control strategy in robot‐assisted level III–IV inferior vena cava thrombectomy: initial series mimicking the open ‘milking’ technique principle

Abstract

Objective

To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage ureteropelvic junction obstruction (UPJO) through a meta‐analysis of comparative studies.

Methods

A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were extrapolated. Subgroup analyses were performed according to study design and techniques. PROSPERO REGISTRATION (CRD42020163303).

Results

Eighteen studies describing 2,007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR=0.99; 95%CI 0.97, 1.01), complications (RR=1.09, 95%CI 0.82, 1.45), OT (SMD=0.61, 95%CI ‐0.04, 1.26), LOS (SMD=‐0.30, 95%CI ‐0.63, 0.04), EBL (SMD=‐0.53, 95%CI ‐1.26, 0.21), or analgesic requirements (SMD=‐0.51, 95%CI ‐1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal laparoscopy likely had a higher conversion rate (RR=2.40; 95%CI 1.23, 4.66); however, patients resumed diets earlier (SMD=‐2.49, 95%CI ‐4.17, ‐0.82) and had shorter drain duration (SMD=‐0.31, 95%CI ‐0.57, ‐0.05).

Conclusion

The evidence suggests that there are no significant differences in success rate, operative time and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher in the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

Avoiding deep pelvic complications using a ‘Five‐Step’ technique for high submuscular placement of inflatable penile prosthesis reservoirs

Abstract

Objective

To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage ureteropelvic junction obstruction (UPJO) through a meta‐analysis of comparative studies.

Methods

A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were extrapolated. Subgroup analyses were performed according to study design and techniques. PROSPERO REGISTRATION (CRD42020163303).

Results

Eighteen studies describing 2,007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR=0.99; 95%CI 0.97, 1.01), complications (RR=1.09, 95%CI 0.82, 1.45), OT (SMD=0.61, 95%CI ‐0.04, 1.26), LOS (SMD=‐0.30, 95%CI ‐0.63, 0.04), EBL (SMD=‐0.53, 95%CI ‐1.26, 0.21), or analgesic requirements (SMD=‐0.51, 95%CI ‐1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal laparoscopy likely had a higher conversion rate (RR=2.40; 95%CI 1.23, 4.66); however, patients resumed diets earlier (SMD=‐2.49, 95%CI ‐4.17, ‐0.82) and had shorter drain duration (SMD=‐0.31, 95%CI ‐0.57, ‐0.05).

Conclusion

The evidence suggests that there are no significant differences in success rate, operative time and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher in the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

Nephrometry Scores: a validation of three systems for peri‐operative outcomes in retroperitoneal robotic partial nephrectomy

Objectives

To develop and validate a model to predict 12‐month continence status after robot‐assisted radical prostatectomy (RARP) from preoperative and 3‐month postoperative data; this model could help in informing patients on their individualised risk of urinary incontinence (UI) after RP in order to choose the best treatment option.

Patients and Methods

Data on 9421 patients in 25 Belgian centres were prospectively collected (2009–2016) in a compulsory regional database. The primary outcome was the prediction of continence status, using the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ‐UI‐SF) at 12‐months after RARP. Linear regression shrinkage was used to assess the association between preoperative 3‐month postoperative characteristics and 12‐month continence status. This association was visualised using nomograms and an online tool.

Results

At 12 months, the mean (sd) score of the ICIQ‐UI‐SF questionnaire was 4.3 (4.7), threefold higher than the mean preoperative score of 1.4. For the preoperative model, high European Association of Urology risk classification for biochemical recurrence (estimate [Est.] 0.606, se 0.165), postoperative radiotherapy (Est. 1.563, se 0.641), lower preoperative European Organisation for Research and Treatment of Cancer quality of life questionnaire 30‐item core (EORCT QLQ‐C30)/quality of life (QoL) score (Est. −0.011, se 0.003), higher preoperative ICIQ‐UI‐SF score (Est 0.214, se 0.018), and older age (Est. 0.058, se 0.009), were associated with a higher 12‐month ICIQ‐UI‐SF score. For the 3‐month model, higher preoperative ICIQ‐UI‐SF score (Est. 0.083, se 0.014), older age (Est. 0.024, se 0.007), lower 3‐month EORCT QLQ‐C30/QoL score (Est. −0.010, se 0.002) and higher 3‐month ICIQ‐UI‐SF score (Est. 0.562, se 0.009) were associated with a higher 12‐month ICIQ‐UI‐SF score.

Conclusions

Our models set the stage for a more accurate counselling of patients. In particular, our preoperative model assesses the risk of UI according to preoperative and early postoperative variables. Our postoperative model can identify patients who most likely would not benefit from conservative treatment and should be counselled on continence surgery.

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