Rezum water vaporization therapy versus transurethral resection of the prostate in the management of refractory urine retention: matched pair comparative multicenter experience.

PURPOSE: To compare the efficacy of Rezum with a matched cohort of patients undergoing transurethral resection of the prostate (TURP) for catheter-dependent urine retention secondary to benign prostate hyperplasia (BPH). METHODS: A retrospective review was performed for consecutive catheter-dependent patients who underwent Rezum for BPH. Patients were matched and compared with a similar cohort undergoing TURP, using non-inferiority analysis on propensity score-matched patient pairs. Patients were followed up at 1, 3, 6 and 12 months by international prostate symptoms score (IPSS), quality of life (QoL) index, peak flow rate (Qmax) and postvoid residual urine (PVR). RESULTS: Eighty-one patients undergoing Rezum were compared with equal number of matched patients who undergoing TURP. Patients undergoing Rezum experienced significantly shorter operation time (25.5 ± 8.7 vs. 103.4 ± 12.6 min; p < 0.001), lower intraoperative bleeding (2.4% vs. 20.7%, p < 0.001), shorter hospital stay (1.2 ± 0.9 vs. 2.4 ± 1.3 d, p < 0.001) and longer catheter time (12.6 ± 6.0 vs. 2.3 ± 1.2 d, p < 0.001), with no need for transfusion. Successful postoperative voiding was comparable between both arms (90.2% vs. 92.7%, p = 0.78), respectively. Despite patients undergoing TURP had significantly better voiding outcomes after 1 and 3 months, both groups were comparable after six and 12 months in terms of mean IPSS (11.1 ± 6.4 vs. 10.8 ± 3.4, p = 0.71), QoL indices (2.4 ± 1.6 vs. 2.1 ± 2.3, p = 0.33) and Qmax (22.0 ± 7.7 v. 19.8 ± 6.9 ml/sec, p = 0.06). CONCLUSION: This study supports the safety and efficacy of Rezum in the management of catheter-dependent patients secondary to BPH, with comparable functional outcomes to TURP. Until a randomized clinical comparison is available, long-term data are crucially recommended to compare the recurrence and reoperation rates.

Effective ureteral access sheath insertion during flexible ureteroscopy: Influence of the ureteral orifice configuration.

INTRODUCTION: We sought to determine the possible predictors for effective insertion of the ureteral access sheath (UAS) during flexible ureteroscopy (fURS) in virgin ureters and their impact on postoperative ureteral wall injury and the procedural outcome. METHODS: A retrospective review of prospectively collected data was performed for all consecutive patients scheduled for fURS of virgin ureters at two tertiary care centers between 2018 and 2020. Demographics, stone characteristics, and perioperative data, including the configuration of the ureteral orifice (UO) over introductory guidewire insertion, were collected. Multivariate logistic regression was used to detect possible predictors of successful UAS insertion. RESULTS: In total, 128 patients who underwent primary fURS were included, with a mean age of 43.3±12.3 years and a stone burden of 12.3±6.9 mm. One hundred and ten patients (85.9%) achieved successful ureteral access insertion, including 81 (63.3%) without ureteral dilatation and 35 with dilation, of which 29 (22.7%) had a successful UAS afterward, while six failed. Total patients who underwent ureteral orifice dilatation were 35. 29 had a successful UAS afterward, while 6 failed. Patients who underwent successful UAS placement into virgin ureters were significantly older and had a lower body mass index (BMI). A tent-shaped UO over the guidewire led to successful UAS insertion. In multivariate regression analysis, cases with BMI <30 kg/m2 (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.28-7.03) and those with a tent-shaped UO over the introductory guidewire (OR 6.60, 95% CI 3.8-7.2) maintained their significance to predict successful UAS insertion into virgin ureters. Nine patients (8.2%) had ureteral mucosal injuries, and the overall stone-free rate was 78.2%. CONCLUSIONS: Patients with normal BMIs and tent-shaped UOs over the introductory guidewires are more likely to achieve primary UAS insertion without the need for ureteral dilation.

High-Grade Non-Muscle Invasive Bladder Cancer: When to Move to Early Radical Cystectomy?

Objectives To compare the outcomes of bladder preservation therapy with early or deferred radical cystectomy (RC) in high-grade non-muscle invasive bladder cancer. Methods Prospectively collected data were obtained for patients undergoing transurethral resection of bladder tumor (TURBT) at a tertiary care center between 2007 and 2018. Patients with a high-grade tumor (HGT1) were divided into three groups, depending on the treatment plan: conservative (GI), early RC (GII), or deferred RC (GIII). Kaplan-Meier analysis was performed to assess the cancer-specific survival (CSS). Results Seventy-one patients were included, and the patients had a median (range) age of 49 (32-72) years. The GI, GII, and GIII groups included 34 (47.9%), 14 (19.7%), and 23 (32.4%) patients, respectively. A significantly lower number of GII patients underwent >2 TURBTs (14.3% vs. 100%, p<0.001). Compared to GIII patients, GII patients had a shorter time to RC from the initial diagnosis (5.7 vs. 36.2 months, p=0.03). Ileal conduit and orthotropic bladder diversions were comparable between both groups, with significantly higher postoperative complications in GIII patients. The median (IQR) follow-up times for the groups were 84 (49-102), 82 (52-112), and 73 (36-89) months, respectively. The five-year and 10-year CSS for GII and GIII patients was 79% vs. 75% and 78% vs. 64%, respectively (log rank=0.19). Conclusion Early RC should be considered an alternative treatment option in selected patients with HGT1 BC with expected longer life expectancy, which may significantly decrease postoperative complications and improve the CSS. However, selection bias in the current retrospective study may influence these outcomes.

Eponyms in andrology.

Andrology is the study of male reproductive health, its associated medicines, and biology, including functions and diseases that are specific to men, especially with regard to the reproductive organs. This concise report discusses the eponyms that are encountered in andrological literature.

Eponymes en AndrologieL'andrologie est l'étude de la santé reproductive masculine, de ses médicaments et de sa biologie, ainsi que des fonctions et maladies qui sont spécifiques aux hommes, tout particulièrement celles qui concernent les organes reproducteurs. Ce rapport succinct discute les éponymes rencontrés dans la littérature andrologique.