Ureteral stent complications - experience on 50,000 procedures.

Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks - 34,213 procedures), respectively long-term stenting (more than 6 weeks - 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.

Continuous vs conventional bipolar plasma vaporisation of the prostate and standard monopolar resection: a prospective, randomised comparison of a new technological advance.

OBJECTIVES: To evaluate in a prospective, randomised trial the surgical efficiency and safety of a new energy source enabling a continuous bipolar plasma vaporisation of the prostate (C-BPVP) by comparing with standard vaporisation (S-BPVP) and monopolar transurethral resection of the prostate (TURP) in men with benign prostatic hyperplasia (BPH). To comparatively assess the short-term functional outcome of the three methods. PATIENTS AND METHODS: In all, 180 men with BPH with prostate volumes of 30-80 mL, maximum urinary flow rates (Q(max)) of <10 mL/s and International Prostate Symptom Score (IPSS) of >19 were equally randomised for C-BPVP, S-BPVP and monopolar TURP. All men were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, Q(max), health-related quality of life (HRQL) score and post-void residual urine volume (PVR). The prostate volume and PSA level were postoperatively assessed at 6 months. RESULTS: The mean operation time was significantly reduced in C-BPVP vs S-BPVP and TURP, with a substantial 22.4% and 39.1% decrease in duration for C-BPVP when compared with S-BPVP and TURP, respectively. The mean haemoglobin level decrease (0.4 and 0.6 vs 1.4 g/dL), capsular perforation rate (1.7% and 3.3% vs 10%), postoperative haematuria rate (1.7% and 1.7% vs 13.3%), catheterisation period (24.1 and 23.9 vs 73.6 h) and hospital stay (2.1 and 2.2 vs 4.5 days) were significantly lower for C-BPVP and S-BPVP vs TURP. At 1, 3 and 6 months follow-up, there were statistically ameliorated IPSS and Q(max) measurements in the C-BPVP and S-BPVP series, while similar HRQL scores, PVRs, PSA levels and postoperative prostate volumes were found in all three study arms. CONCLUSIONS: The operation time for C-BPVP was on average 20% and 40% quicker than S-BPVP and TURP, respectively. Both C-BPVP and S-BPVP had better perioperative safety and improved follow-up voiding and symptom scores than TURP.

Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases - a medium term, prospective, randomized comparison.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: According to the EAU Guidelines 2012, large size benign prostatic hyperplasia (BPH) cases (>80 mL) continue to have open prostatectomy as the first line treatment alternative, despite the substantial peri-operative morbidity and extended catheterization and convalescence periods related to this undoubtedly invasive approach. During the past two decades, holmium laser enucleation of the prostate was constantly described as a successful choice for this category of patients. According to rather numerous studies, the technique displayed superior results in terms of surgical safety and postoperative recovery compared with the open procedure. On the other hand, the concept of electrosurgical enucleation of the prostate, using either a monopolar or bipolar cutting current, materialized into several technical applications that eventually failed to gain general acknowledgement as reliable alternatives to the BPH transurethral approach. While keeping in mind the already proved advantage of enucleating substantial quantities of BPH tissue, bipolar plasma enucleation of the prostate was introduced as a novel endoscopic approach in cases of large prostates. The present trial represents the first prospective, medium-term, randomized comparison to be published of this innovative technique with standard open prostatectomy. Basically, the premises for a viable alternative relied on the practical advantages provided by the 'button' electrode, mainly the large surface creating the conditions for a fast enucleation process, continuous vaporization and concomitant haemostasis. Eventually, it was concluded that the plasma enucleation procedure distinguished itself as a successful treatment option in large BPH patients, characterized by good surgical efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Most importantly, plasma-button enucleation patients benefited from a similar 12 months' outcome from the perspectives of symptom scores and voiding parameters when drawing a parallel with open surgery results, thus underlining the reliable viability of this type of endoscopic approach. OBJECTIVES: To evaluate the viability of bipolar plasma enucleation of the prostate (BPEP) by comparison with open transvesical prostatectomy (OP) in cases of large prostates with regard to surgical efficacy and peri-operative morbidity. To compare the medium-term follow-up parameters specific for the two methods. PATIENTS AND METHODS: A total of 140 benign prostatic hyperplasia (BPH) patients with prostate volume >80 mL, maximum flow rate (Qmax ) <10 mL/s and International Prostate Symptom Score (IPSS) >19 were randomized in the two study arms. All cases were assessed preoperatively and at 1, 3, 6 and 12 months after surgery by IPSS, Qmax , quality of life score (QoL) and post-voiding residual urinary volume (PVR). The prostate volume and prostate specific antigen (PSA) level were measured at 6 and 12 months. RESULTS: The BPEP and OP techniques emphasized similar mean operating durations (91.4 vs 87.5 min) and resected tissue weights (108.3 vs 115.4 g). The postoperative haematuria rate (2.9% vs 12.9%) as well as the mean haemoglobin drop (1.7 vs 3.1 g/dL), catheterization period (1.5 vs 5.8 days) and hospital stay (2.1 vs 6.9 days) were significantly improved for BPEP. Recatheterization for acute urinary retention was more frequent in the OP group (8.6% vs 1.4%), while the rates of early irritative symptoms were similar for BPEP and OP (11.4% vs 7.1%). During the follow-up period, no statistically significant difference was determined in terms of IPSS, Qmax , QoL, PVR, PSA level and postoperative prostate volume between the two series. CONCLUSIONS: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good surgical efficiency and similar BPH tissue removal capabilities compared with standard transvesical prostatectomy. BPEP patients benefited from significantly reduced complications, shorter convalescence and satisfactory follow-up symptom scores and voiding parameters.

Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors--results of a prospective, randomized comparison to the standard approach.

OBJECTIVE: To evaluate the efficacy of narrow band imaging (NBI) cystoscopy associated with bipolar plasma vaporization (BPV) in cases of large nonmuscle-invasive bladder tumors (NMIBTs) compared with white light cystoscopy (WLC) and monopolar transurethral resection of bladder tumors (TURBTs). METHODS: A total of 220 cases with ≥ 1 bladder tumor >3 cm determined by abdominal ultrasonography, computed tomography, and flexible WLC were included in the present trial. The patients in the first arm underwent WLC and NBI cystoscopy followed by BPV, and the patients in the second arm underwent only WLC and TURBT. The patients with NMIBTs underwent standard repeat TUR at 4 weeks and follow-up urinary cytology and WLC at 3, 6, 9, and 12 months. RESULTS: The carcinoma in situ, Stage pTa, and overall NMIBT detection rates were significantly improved for NBI compared with WLC. BPV provided lower obturator nerve stimulation and bladder wall perforation rates and significantly reduced the mean hemoglobin decrease, catheterization period, and hospital stay compared with TURBT. The repeat TUR overall and primary site residual tumor rates were significantly decreased in the NBI-BPV group (6.3% vs 17.5% and 4.2% vs 13.4%, respectively). The overall and other site 1-year recurrence rates were significantly reduced in the NBI-BPV series (7.9% vs 17.8% and 3.4% vs 12.2%, respectively). CONCLUSION: NBI cystoscopy significantly improved the diagnostic accuracy in cases of large NMIBTs, and BPV emphasized superior efficacy and safety compared with TURBT. This combined approach provided a lower residual tumor rate at repeat TUR and a reduced 1-year recurrence rate.

Treatment changes and long-term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non-muscle-invasive bladder cancer (NMIBC)?

OBJECTIVES: • To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue-light cystoscopy (HAL-BLC) on the diagnostic accuracy and treatment changes in cases of non-muscle invasive bladder cancer (NMIBC) compared with standard white-light cystoscopy (WLC). • To compare the long-term recurrence rates in the two study arms. PATIENTS AND METHODS: • In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours. • A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate-risk patients and BCG instillations for high-risk cases. • The follow-up protocol consisted of urinary cytology and WLC every 3 months for 2 years. • Only first-time recurrences after the initial diagnosis were considered. RESULTS: • In the 142 patients with NMIBC in the HAL-BLC series, tumour detection rates significantly improved for carcinoma in situ, pTa andoverall cases. • In 35.2% of the cases, additional malignant lesions were found by HAL-BLC and consequently, the recurrence- and progression-risk categories of patients and subsequent treatment improved in 19% of the cases due to fluorescence cystoscopy. • In all, 125 patients in the HAL-BLC group and 114 of the WLC group completed the follow-up. • The recurrence rate at 3 months was lower in the HAL-BLC series (7.2% vs 15.8%) due to fewer 'other site' recurrences when compared with the WLC series (0.8% vs 6.1%). • The 1 and 2 years recurrence rates were significantly decreased in the HAL-BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively). CONCLUSIONS: • HAL-BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates. • HAL-BLC significantly modified the postoperative treatment of cases. • The 3 months, 1 and 2 years recurrence rates were significantly improved in the HAL-BLC arm.

Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison.

OBJECTIVE: To perform a prospective, randomized, long-term comparison between bipolar plasma vaporization of the prostate (BPVP), bipolar transurethral resection in saline (TURis), and monopolar transurethral resection of the prostate (TURP) concerning the perioperative and follow-up parameters. METHODS: A total of 510 patients with benign prostatic hyperplasia (BPH), Q(max) <10 mL/s, International Prostate Symptom Score (IPSS) >19, and prostate volume between 30 and 80 mL were enrolled in the trial. All cases were evaluated preoperatively and at 1, 3, 6, 12, and 18 months after surgery by IPSS, quality of life, Q(max), and ultrasonography. RESULT: Each study arm including 170 cases emphasized similar preoperative parameters. The capsular perforation and intraoperative bleeding rates as well as the mean hemoglobin drop were significantly decreased for BPVP by comparison with TURis and TURP. The postoperative hematuria, blood transfusion, and clot retention rates were significantly higher in the TURP group. The operation time was significantly shorter only for BPVP patients, whereas the catheterization period and hospital stay were significantly reduced for BPVP, followed by TURis. The rates of irritative symptoms and urethral strictures were similar in the 3 series. The recatheterization, bladder neck sclerosis, and retreatment rates were significantly lower in the BPVP group. During the 1, 3, 6, 12, and 18 months' follow-up, the BPVP series emphasized significantly superior parameters in terms of IPSS and Q(max). CONCLUSION: BPVP represents a valuable endoscopic treatment alternative for BPH patients, with superior efficacy and satisfactory complication rate. The long-term follow-up emphasized durable improvements of the postoperative parameters for BPVP.