Archivio Italiano di Urologia e Andrologia

Should patients with encrusted JJ stents involving the proximal/renal loop undergo primarily endoscopic combined intrarenal surgery?

Alexandra Rocha — 2024-11-11

Background: Ureteral stents are one of the most used devices in Urology, allowing drainage of the upper urinary system, and can be used either in elective or emergency procedures. However, as a foreign body inside the urinary system, they are subject to encrustation. Encrustation is one of the burdens seen with double-J stents and, to date, there is no consensus about its best management. This study aims to prove that Endoscopic Combined Intra-Renal Surgery (ECIRS) is the best choice when there’s an encrusted proximal loop of a ureteral stent.
Methods: The authors conducted a retrospective cohort study of patients with an encrusted proximal loop of the ureteral stent who underwent surgery at a single center, comparing ECIRS with other procedures.
Results: Between July 2011 and June of 2024, 33 patients (18 females and 15 males) were submitted to surgery. The median indwelling time of the stent was 11 (8-19) months and a stentfree rate of 100% was achieved. The authors demonstrated a significant stone-free rate of 61.1% following ECIRS compared to merely 20% with other procedures (p = 0.023). Notably, while the complication rate was low across all procedures, the ECIRS group exhibited fewer complications (5.6%) than those undergoing alternate techniques (13.3%), though this difference was not statistically significant (p = 0.439).
Conclusions: Our study advocates for ECIRS as the preferred initial treatment for encrusted proximal ureteral stents, as it facilitates superior stone clearance, minimizes complications, and maintains comparable operative efficiency. This research contributes valuable insights into the management of challenging cases involving encrusted ureteral stents, calling for future studies to further validate these findings.

Multiparametric MRI targeted prostate biopsy: When omit systematic biopsy?

Pietro Pepe — 2024-11-11

Introduction: To evaluate the detection rate for prostate cancer (PCa) performing multiparametric magnetic resonance imaging (mpMRI) fusion targeted biopsy (TPBx) combined only with ipsilateral systematic prostate biopsy (SPBx).
Materials and Methods: From January 2023 to December 2023, 495 men with clinical suspicion of PCa underwent transperineal SPBx plus TPBx in the presence of PI-RADS score lesions ≥ 3.
Results: In 250/495 men (50.5%) a PCa was found, while 36/250 (14.4%) men had negative mpMRI. In comparison to TPBx, SPBx diagnosed a higher number of indolent PCa, 38.5 vs. 5.8%, respectively; conversely, SPBx demonstrated a higher detection rate for clinically significant PCa (97.3 vs. 85.4%) in the presence of ISUP Grade Group 2 (GG2). In details, rates were higher in the presence of GG2 (100 vs. 76%), GG3 (85.7 vs. 75.8%) and GG4 (100 vs. 86.4%) tumors. However, in GG5, both SPBx and TPBx diagnosed 100% of csPCa. Furthermore, 89.4% of the cases showed csPCa on the negative mpMRI side.
Conclusions: SPBx combined with TPBx maximized csPCa diagnosis; the use of reduced biopsy scheme limited to ipsilateral side of mpMRI lesion plus TPBx missed 11.6% csPCa. Only in the presence of PI-RADS score 5 SPBx and TPBx diagnosed both 100% of csPCa.

The learning curve for robotic-assisted pyeloplasty in urologists with no prior robotic experience using an ex-vivo model: A prospective, controlled study

Abdullah Ayed — 2024-11-11

Introduction: Despite the increasing trend of utilizing robotic techniques in pyeloplasty, little is known about the learning curve for robot-assisted pyeloplasty (RAP) amongst urologists with no prior robotic experience. Therefore, the present study aimed to evaluate the learning curve of residents in the last year or new urologists performing RAP using an ex-vivo model.
Methods: A prospective ex-vivo model study was conducted including participants who were either residents in the last year or new urologists. All participants had obtained the E-BLUS certification or they were able to complete its 4 tasks successfully in a dry lab, without prior robotic experience. Each participant performed four consecutive RAPs using the Avatera system on an ex-vivo porcine model. The primary endpoint of the present study was the change in the average time to complete the anastomosis from the first to fourth attempts.
Results: Nine urologists and 8 residents were enrolled in this study. All participants successfully completed the four RAP attempts. Each surgeon demonstrated a reduction in the time to complete anastomosis from the 1^st to 4^th attempt with an average of value of 4.41±1.06 minutes (p=0.003). The decrease in time was statistically significant in both urologists and residents subgroups (4.5±1.41 minutes p=0.049 and 4.33±0.71 minutes p=0.035, respectively).
Conclusions: The training on the ex-vivo model could lead, in only a few attempts, to a significant improvement in skills and in the required time of experienced-naïve surgeons to complete a RAP.