Search

Eabhann O’Connor,1 Aisling Nic an Riogh,2 Markos Karavitakis,3 Serenella Monagas,4 Arjun Nambiar5 1Department of Urology, Beaumont University Hospital, Dublin, Ireland; 2Department of Urology, Cork University Hospital, Cork, Ireland; 3Department of Urology, University General Hospital of Heraklion, University of Crete, Irakleio, Greece; 4Department of Urology, San Agustín University Hospital, Avilés, Spain; 5Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UKCorrespondence: Eabhann O’Connor Email eabhannoconnor@beaumont.ieAbstract: Urinary incontinence (UI) is a bothersome symptom with population studies suggesting a prevalence of 13.1% in women and 5.4% in men. While a significant cohort of patients with this complaint may ultimately require surgical management to achieve complete continence, a number of non-surgical measures exist to improve symptoms and quality of life. A range of guidelines exist on this topic, including those published by the European Association of Urology (EAU), the International Continence Society (ICS), the American Urological Association (AUA) and the UK’s National Institute for Health and Care Excellence (NICE). The aim of our study is to provide an overview of the initial assessment of patients with UI including history taking, examination and basic investigations. Our review outlines non-surgical management strategies for UI, including conservative measures, behavioral and physical therapies and drug treatment. We shall also examine the above guidelines and present a narrative overview of the literature surrounding the diagnosis and non-surgical management of urinary incontinence.Keywords: urinary incontinence, conservative, non-surgical, behavioral, physical, drug treatment

Background and Objective: The European Association of Urology (EAU) Guidelines Panel on non-neurogenic male lower urinary tract symptoms (LUTS) aimed to develop a new subchapter on underactive bladder (UAB) in non-neurogenic men to inform health care providers of current best evidence and practice. Here, we present a summary of the UAB subchapter that is incorporated into the 2024 version of the EAU guidelines on non-neurogenic male LUTS., Methods: A systematic literature search was conducted from 2002 to 2022, and articles with the highest certainty evidence were selected. A strength rating has been provided for each recommendation according to the EAU Guideline Office methodology., Key Findings and Limitations: Detrusor underactivity (DU) is a urodynamic diagnosis defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is a terminology that should be reserved for describing symptoms and clinical features related to DU. Invasive urodynamics is the only widely accepted method for diagnosing DU. In patients with persistently elevated postvoid residual (ie, >300 ml), intermittent catheterization is indicated and preferred to indwelling catheters. Alpha-adrenergic blockers are recommended before more invasive techniques, but the level of evidence is low. In men with DU and concomitant benign prostatic obstruction (BPO), benign prostatic surgery should be considered only after appropriate counseling. In men with DU and no BPO, a test phase of sacral neuromodulation may be considered., Conclusions and Clinical Implications: The current text represents a summary of the new subchapter on UAB. For more detailed information, refer to the full-text version available on the EAU website (https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts)., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To determine whether preoperative use of JJ stents in patients undergoing shockwave lithotripsy (SWL) impacts on stone clearance and the rate of postoperative complications., Patients and Methods: We screened multiple databases from inception to January 2021, using the relevant search terms for SWL in patients with a preoperative stent. Inclusion criteria were randomised controlled trials of ≥20 patients aged >18 years who had had SWL with a JJ stent. This review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023443195). Statistical analysis was performed using 'meta' in R., Results: There were seven eligible studies (403 patients receiving JJ stents and 394 controls). There was no significant difference in the stone-free rate (SFR) following SWL with a JJ stent compared to SWL alone. When considering the complication rates, there was a significantly reduced risk of steinstrasse in patients with a JJ stent. However, there was no significant difference in the risk of other complications including pain, fever, and haematuria, and no significant difference in the likelihood of requiring auxiliary procedures or re-treatment., Conclusions: There was a reduced risk of steinstrasse in patients undergoing SWL with a JJ stent compared to SWL alone. However, there was no significant difference in the risk of other postoperative complications. Use of a JJ stent had no effect on the efficacy of SWL, with no significant difference in the SFR., (© 2023 BJU International.)

(1) Background: Somatic and germline alterations can be commonly found in prostate cancer (PCa) patients. The aim of our present study was to perform a comprehensive review of the current literature in order to examine the impact of BRCA mutations in the context of PCa as well as their significance as genetic biomarkers. (2) Methods: A narrative review of all the available literature was performed. Only "landmark" publications were included. (3) Results: Overall, the number of PCa patients who harbor a BRCA2 mutation range between 1.2% and 3.2%. However, BRCA2 and BRCA1 mutations are responsible for most cases of hereditary PCa, increasing the risk by 3-8.6 times and up to 4 times, respectively. These mutations are correlated with aggressive disease and poor prognosis. Gene testing should be offered to patients with metastatic PCa, those with 2-3 first-degree relatives with PCa, or those aged < 55 and with one close relative with breast (age ≤ 50 years) or invasive ovarian cancer. (4) Conclusions: The individualized assessment of BRCA mutations is an important tool for the risk stratification of PCa patients. It is also a population screening tool which can guide our risk assessment strategies and achieve better results for our patients and their families.

Context: Overactive bladder syndrome (OAB) is highly prevalent among women and has a negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities., Objective: To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome., Evidence Acquisition: The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. The risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions, and quality of evidence was assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis was performed where appropriate., Evidence Synthesis: Antimuscarinics and beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists being more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events. Onabotulinumtoxin-A (Onabot-A) was more effective than placebo across most outcomes, but with significantly higher rates of acute urinary retention/clean intermittent self-catheterisation (six to eight times) and urinary tract infections (UTIs; two to three times). Onabot-A was also significantly better than antimuscarinics in the cure of urgency urinary incontinence (UUI) but not in the reduction of mean UUI episodes. Success rates of sacral nerve stimulation (SNS) were significantly higher than those of antimuscarinics (61% vs 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% vs 10%). SNS was associated with 9% removal rate and 3% revision rate., Conclusions: Overactive bladder is a manageable condition, with first-line treatment options including antimuscarinics, beta-3 agonists, and posterior tibial nerve stimulation. Second-line options include Onabot-A bladder injections or SNS. The choice of therapies should be guided by individual patient factors., Patient Summary: Overactive bladder is a manageable condition. All patients should be informed and advised on conservative treatment measures in the first instance. The first-line treatment options for its management include antimuscarinics or beta-3 agonists medication, and posterior tibial nerve stimulation procedures. The second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation procedure. The therapy should be chosen based on individual patient factors., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology., Objective: To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS., Evidence Acquisition: A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations., Evidence Synthesis: The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities., Conclusions: The guidelines provide an evidence-based approach for the management of male LUTS., Patient Summary: A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Multiple endocrine neoplasia (MEN) syndromes are rare and potentially malignant hereditary entities. Clinical manifestations of MEN 2B include medullary thyroid cancer, pheochromocytoma, gastrointestinal ganglioneuromatosis, and musculoskeletal and ophthalmologic lesions. Metastases to the prostate from the cancers of other organs are extremely rare. There are only a few cases of metastases to the prostate gland, originating from medullary thyroid cancer, found in literature, especially associated with MEN 2B syndrome. In this case report, we present the extremely rare case of a 28-year-old patient, diagnosed with MEN 2B syndrome, with medullary thyroid cancer metastasis to the prostate. Although a few reports of medullary thyroid cancer metastasis into the prostate gland can be found in the literature, to our knowledge, this is the first case of a laparoscopic radical prostatectomy procedure performed as a metastasectomy to treat the prostatic metastasis. Laparoscopic radical prostatectomy, performed as a metastasectomy, for the treatment of metastatic cancer, is an extremely rare surgical indication with distinctive requirements and difficulties. The extraperitoneal access enables the realization of the laparoscopic radical prostatectomy procedure even in the cases of patients with a history of multiple intra-abdominal operations., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Urology Annals.)

Objectives: To determine stone-free rate following shockwave lithotripsy (SWL) with/without alpha-blockers as well as complication rates (individual and classified using the Clavien-Dindo system)., Materials and Methods: We performed a systematic review of all randomized controlled trials that included more than 20 patients (age > 18 years) and examined the use of alpha-blockers after SWL. Meta-analysis was performed using 'metafor' in R. We report risk ratios (RRs) with 95% confidence intervals (95% CIs). The PROSPERO ID for the trial was: CRD42021248108., Results: We assessed 158 full-text articles and included a total of 21 studies in our review. There were 1445 patients receiving alpha-blockers and 1478 control patients. Those receiving alpha-blockers were significantly more likely to be stone-free (RR 1.12, 95% CI 1.07-1.16; P < 0.001). This effect was robust to 'trim-and-fill' adjustment. In those taking alpha-blockers there was a significant reduction in Clavien III-V complications and, on trim-and-fill adjustment, a significant reduction in Clavien I-II complications. There were also significant reduction in rates of steinstrasse, pain and requirement for auxiliary procedures. There was no significant difference in retreatment rates. These effects were robust to trim-and-fill adjustment., Conclusions: There is a modest increase in stone-free rates in those receiving alpha-blockers following SWL, with a reciprocal modest risk reduction for steinstrasse, pain and auxiliary procedures. However, alpha-blockers do not reduce the risk of requiring retreatment., (© 2022 BJU International.)

Purpose: Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien-Dindo graded complications after SWL in children., Methods: MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien-Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data., Results: Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1-49.4] suffered Clavien I complications, 4.9% [95% CI 3.1-7.6] Clavien II complications, 2.7% [95% CI 1.6-4.7] Clavien III complications, 2.3% [95% CI 1.3-4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6-45.3] of children suffered minor complications (Clavien-Dindo I-II), while 3% [95% CI 1.8-5] major complications (Clavien-Dindo III-V). Pooled analysis revealed that 10.7% [95% CI 3.2-30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1-22.7] pain, 5.5% [95% CI 3.3-9] steinstrasse, 5.3% [95% CI 3-9.3] fever, 2.2% [95% CI 0.8-5.6] sepsis, 1.1% [95% CI 0.3-3.7] urinoma, 1% [95% CI 0.4-2.7] symptomatic hematoma and 1% [95% CI 0.3-2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4-54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5-16.1]., Conclusion: SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Fontan procedure is a palliative operation for patients with single ventricle congenital heart disease. In this case-report, we present the case of a 36-years-old man, with Fontan physiology and ureteropelvic junction obstruction, undergoing laparoscopic pyeloplasty. He presented with right flank pain and mild hydronephrosis of his right kidney. Although few laparoscopic operations have been described in the literature, this, to our knowledge, is the first laparoscopic urological procedure described in a patient with Fontan physiology. Laparoscopic pyeloplasty in patients with Fontan physiology, is an efficient and safe technique when performed in centers with extensive experience in laparoscopic procedures., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors.)

Purpose: Recurrent urinary retention due to benign prostate hyperplasia (BPH), requiring permanent catheterization, represents one of the most challenging issues geriatric patients can face. Rezūm, as a minimal invasive treatment for BPH, takes the advantage of sterile water vapor injections directly into the prostate. The purpose of this Systematic Review is to report the safety and the efficacy of Rezūm regarding urinary retention relief and permanent catheter withdrawal., Methods: PubMed, Scopus and Cochrane databases were meticulously screened using the keywords "Rezum", "retention" and "permanent catheter". Only human studies and articles in English were included. Rezūm should be the only intervention employed in patients. Patients of included studies should not have been submitted to any prior interventions, such as transurethral prostatectomy (TURP) for the relief of their symptoms. Patients' baseline characteristics along with intraoperative and postoperative parameters were collected and analysed. Catheter relief was the primary outcome., Results: Five studies fulfilled all the criteria and were included in the final qualitative synthesis. Four studies were retrospective and one was prospective. All studies were non-comparative. The success rate ranged from 70.3 to 100%, while no grade ≥ III Clavien-Dindo complications were reported in any of the studies., Conclusion: Rezūm Water Vapor Therapy Treatment seems to be a feasible, safe and efficient minimally-invasive procedure for catheterized patients with urinary retention secondary to BPH, especially for frail ones with comorbidities who cannot undergo general anesthesia., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Zinner's syndrome is a rare congenital disorder presenting with unilateral renal agenesis or dysgenesis, ipsilateral seminal vesicle cysts, and ejaculatory duct obstruction. Treatment of this syndrome can be conservative or surgical. In this case report, we describe the case of a 72-year-old patient who was diagnosed with Zinner's syndrome and underwent laparoscopic radical prostatectomy for prostate cancer treatment. The peculiarity of our case was that the patient's ureter emptied ectopically into the left seminal vesicle, which was notably enlarged and multicystic in appearance. Although many minimally invasive procedures have been reported for treating symptomatic Zinner's syndrome, to our knowledge, this is the first reported case of prostate cancer in a patient with Zinner's syndrome who was treated with laparoscopic radical prostatectomy. Laparoscopic radical prostatectomy can be safely and efficiently performed in patients with Zinner's syndrome and synchronous prostate cancer by urological surgeons with extensive experience in laparoscopy in high-volume centers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Spinos et al.)

Context: Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems., Objective: To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI., Evidence Acquisition: A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned., Evidence Synthesis: UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion., Conclusions: This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI., Patient Summary: Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care., (Copyright © 2022. Published by Elsevier B.V.)

Context: Shockwave lithotripsy (SWL) shows clear associated benefits for urolithiasis patients., Objective: To identify and classify SWL complications according to modified Clavien-Dindo grading system while assessing the effect of different patient characteristics, stone parameters, types of lithotripters, and lithotripsy techniques., Evidence Acquisition: Literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement., Evidence Synthesis: We analyzed the results of 115 randomized trials including 17827 patients, of whom 16.06%, 2.07%, 2.23%, 1.32%, 0.85%, 0.16%, and 0% suffered from Clavien I, II, III, IIIa, IIIb, IV, and V complications, respectively. In total, 18.43% of patients suffered from Clavien I-II and 2.48% from Clavien III-IV complications. In studies with >100 treated patients, Clavien I, III, and IV complication rates and need for auxiliary procedure rates were lower than in studies with smaller sample size. Electrohydraulic lithotripters led to a higher rate of Clavien IIIb and IV complications than electromagnetic lithotripters. Clavien I-II complications were increased by 14.3% in patients with multiple and complicated stones. Hematuria was increased by 8.29% in patients who underwent intravenous urography preoperatively and had longer duration of SWL. Pain occurrence was increased by 14.79% in patients with more than one stone at the time of SWL and by 3.21% in those who were managed with a piezoelectric lithotripter., Conclusions: SWL should not be considered an uneventful procedure, as in 2.5% of cases an intervention or Clavien III-V complication will be observed. Low-volume centers, treatment of multiple or complex stones, a long-lasting SWL session, and electrohydraulic lithotripters are associated with higher rates of complications., Patient Summary: We analyze the occurrence of shockwave lithotripsy (SWL) complications in 17000 patients. In centers with larger caseloads, complications were less common. The type of lithotripter is associated with complications. An increased number of treated stones, complex stones, and increased SWL duration were associated with a higher incidence of pain and hematuria., (Copyright © 2021. Published by Elsevier B.V.)