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Background: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center.
Methods: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16–84). The average stone size was 6.71 mm (3–16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%).
Results: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever.
Conclusions: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied.
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Objectives: We aimed to explore the risk factors and countermeasures of stress urinary incontinence (SUI) after mesh implantation for patients with pelvic organ prolapse (POP).
Methods: A total of 224 POP patients undergoing mesh implantation from January 2018 to December 2021 were divided into group A (n = 68, postoperative new-onset SUI) and group B (n = 156, without postoperative new-onset SUI). Their clinical data were collected, and the treatment outcomes were analyzed. The independent risk factors for postoperative new-onset SUI were determined through multivariate logistic regression analysis. A risk-scoring model was established and assessed. The patients with postoperative new-onset SUI were divided into low-, moderate- and high-risk groups using this model.
Results: Mesh implantation significantly improved the pelvic floor muscle strength and function of patients. Multivariate logistic regression analysis revealed that age ≥50 years old, gravidity ≥3 times, parity ≥3 times, history of macrosomia delivery, history of chronic respiratory diseases, vaginal delivery, and perineal laceration were independent risk factors for postoperative new-onset SUI, and pelvic floor muscle training by biofeedback electrical stimulation was a protective factor (p < 0.05). The risk-scoring model was safe, reliable and practical, with high discrimination, accuracy and efficiency.
Conclusions: Age ≥50 years old, gravidity ≥3 times, parity ≥3 times, history of macrosomia delivery, history of chronic respiratory diseases, vaginal delivery, and perineal laceration are independent risk factors for postoperative new-onset SUI, and pelvic floor muscle training by biofeedback electrical stimulation is a protective factor. Therefore, POP patients with new-onset SUI following mesh implantation should receive more pelvic floor muscle training.
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Aim: This retrospective study aims to analyse the effect of flexible ureteroscopic lithotripsy (FURSL) on the surgical outcome, renal function (RF) and quality of life (QoL) of patients with 2–3 cm renal calculi.
Methods: A total of 111 patients with renal calculi (2–3 cm) admitted from January 2019 to May 2022 were selected. Among them, 55 patients who underwent minimally invasive percutaneous nephrolithotomy (PCNL) were set as the control group and 56 patients treated with FURSL served as the research group. The control group consisted of 29 males and 26 females aged (43.31 ± 6.49) years on average. The research group consisted of 31 males and 25 females, with a mean age of (42.46 ± 7.44) years. Parameters such as surgical outcomes (stone clearance rate, bleeding volume, operation time and postoperative recovery time), incidence of adverse reactions (ARs: Gross hematuria, fever, urinary tract infection (UTI) and urinary tract injury), RF (blood urea nitrogen (BUN) and serum creatinine (Scr)), pain degree and QoL were compared.
Results: No significant difference in the stone clearance rate was found between the groups. Compared with the control group, the research group had statistically longer operation time, less bleeding, postoperative recovery time, and incidence of ARs and pain and obviously higher QoL. BUN and Scr differed insignificantly between the groups before and after surgery.
Conclusions: FURSL can accelerate postoperative recovery in patients with 2–3 cm renal calculi, lower the risk of postoperative ARs, mitigate pain and improve QoL without significantly affecting RF.
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Objective: To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of postoperative recurrence.
Methods: A total of 90 patients with muscle-invasive bladder cancer admitted to our urology department from January 2019 to May 2022 were included in this study. Using the random number table, the patients were assigned equally to ORC and LRC groups. The perioperative data of the patients were collected and recorded. The outcome indicators comprised erythrocyte pressure and creatinine levels, blood gas analysis, type of urinary diversion, and histopathology of surgically removed tumors.
Results: Operation time of LRC was significantly longer than that of ORC, but other perioperative indices of LRC were better than those of ORC (p < 0.05). Hematocrit levels in LRC group were higher than those in ORC group at postoperative 1 day and before discharge (p < 0.05). However, creatinine levels were lower in LRC group than in ORC group at postoperative 1 day and before discharge (p < 0.05). Moreover, LRC resulted in better blood gas indices than ORC (p < 0.05). There were no significant differences in the type of urinary diversion and histopathological results from surgically removed tumor between the two groups (p > 0.05). Patients who received LRC had a lower incidence of complications than those given ORC (p < 0.05).
Conclusions: LRC reduced perioperative complications, decreased mean length of hospital stays, and enhanced recovery of gastrointestinal and renal functions. These data suggest that LRC is safer and more efficient than ORC. However, further studies are required prior to clinical application of this procedure.
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Objective: Determine the evolution of antibiotic resistance of symptomatic bacteriuria caused by Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in Granada.
Material and Method: A descriptive retrospective study was carried out, including antibiograms of urine cultures in which microorganisms identified as E. coli and K. pneumoniae, were isolated in the Microbiology laboratory of the Hospital Universitario Virgen de las Nieves (Granada, Spain) between January 2016 and June 2021.
Results: E. coli was the most frequent isolate (10,048) and its resistance to ampicillin (59.45%) and ticarcillin (59.59%), and the increase to cefepime (15.07%) and amoxicillin-clavulanic acid (17.67%) is noteworthy. K. pneumoniae (2222) is notable for resistance to Fosfomycin (27.91%) and an increase to ciprofloxacin (37.79%) and amoxicillin-clavulanic acid (36.63%). Resistance is generally higher in hospitalized patients, males, and adults.
Conclusions: Antibiotic resistance to the studied Enterobacteriaceae is on the rise, requiring empirical treatment targeted to the population area.
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Background: Ubiquitination, a post-translational modification, is crucial for cancer regulation. However, the predictive significance of ubiquitination-related genes (URGs) for prostate adenocarcinoma (PRAD) remains unclear.
Objectives: The objectives of the study were to investigate the role of URGs in PRAD and their potential impact on patient prognosis.
Methods: This study acquired data for more than 800 patients with PRAD from public databases. The unique ubiquitination-related patterns of PRAD were detected by unsupervised clustering approach. URGs relevant to the prognosis of patients with PRAD and a ubiquitination-related prognostic index (URPI) were identified and generated using the log-rank test, univariate and multivariate Cox proportional hazards regression, least absolute shrinkage and selection operator (LASSO) Cox regression, and bootstrap strategy.
Results: Four ubiquitination-related subpopulations were then defined, and 39 ubiquitination-related differentially expressed genes in prostate cancer and paracancerous samples were screened, with LASSO analysis distinguishing six of them. The URPI was built and verified using the identified URGs that played critical roles in survival stratification. Several potential URPI-targeting drugs were also analyzed. Subsequently, the URPI was combined with clinical characteristics, which provided a more accurate estimate of PRAD survival and was a superior choice for PRAD prognostic forecasts.
Conclusions: This investigation has thus established and verified a URPI, which may provide unique insights to improve survival estimations for patients with PRAD.
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Objective: This study aimed to explore the risk factors of patients with endometriosis (EMS) and ureteral stricture and to establish a prediction model based on logistic-regression analysis.
Methods: The clinical data of 228 EMS patients in Jiaozhou Central Hospital of Qingdao from May 2019 to May 2022 were selected for a retrospective study. According to the results of ureteroscopic biopsy, they were divided into concurrent (n = 32) and nonconcurrent (n = 196) groups. Univariate analysis was performed on the general data and situations of clinical treatment in both groups. Single factor with statistically significant differences was included in unconditional logistic-regression analysis with multiple factors to explore the risk factors of such patients and establish a prediction model.
Results: Overt differences were found in previous history of ureter operation (odds ratio (OR) = 3.711, p = 0.006), course of EMS (OR = 3.987, p = 0.007), presence or absence of haematuria (OR = 3.586, p = 0.009) and lateral abdominal pain (OR = 4.451, p = 0.002), and invasion depth of lesion (OR = 7.271, p < 0.001) between the two groups (p < 0.05), without distinct difference in age, menstrual duration, BMI values, history of dysmenorrhea, previous history of drug therapy, smoking history, and drinking history (p > 0.05). Logistic-regression analysis showed that previous history of ureter operation (a1), course of EMS (b2), occurrence of haematuria (c3) and lateral abdominal pain (d4), and invasion depth of lesion ≥5 mm (e5) were risk factors for EMS combined with ureteral stricture (p < 0.05), taking logit (p) = –4.990 + 1.311a1 + 1.383b2 + 1.277c3 + 1.493d4 + 1.984e5 as regression model. The receiver operating characteristic (ROC) curve analysis based on this model showed that the area under the curve (AUC), standard error, and 95% confidence interval (CI) were 0.813, 0.062, and 0.692–0.934, respectively. One hundred EMS patients were re-included, whose values for predictive sensitivity, specificity, and kappa coefficient were 71.40%, 91.10% and 0.615.
Conclusions: Previous history of ureter operation, course of EMS, occurrence of haematuria and lateral abdominal pain, and invasion depth of lesion ≥5 mm were risk factors for EMS combined with ureteral stricture. Therefore, the use of this model has a certain clinical value.
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Background: Ureteral metastasis is a rare phenomenon. Synchronous recurrence in both the pelvis and ureter with symptoms that are typical of upper urinary tract urothelial carcinoma (UTUC) has not been reported previously.
Methods: We present a case of metastasis of clear cell renal cell carcinoma (ccRCC) to the ipsilateral pelvis and ureter in a 37-year-old man who underwent open partial nephrectomy (PN) after laparoscopic exploration 20 months after surgery. We suspected painless hematuria with clots and upper UTUC based on the imagological diagnosis. We performed complete transperitoneal laparoscopic nephroureterectomy in a single position. We also searched PubMed for studies with the keywords “renal cell carcinoma” and “ureteral metastasis” that had been published since 2000.
Results: Postoperative pathology demonstrated ccRCC in the left pelvis that had spread along the ureter. The patient was discharged 1 week after surgery, without a drainage tube, and free to eat and perform normal activities. We identified 10 cases from nine studies that had been published since 2000. Nephrectomy was performed in all 10 cases, and nine of the patients had hematuria. Open ureterectomy was performed on two patients who had ipsilateral ureteral metastasis.
Conclusions: Recurrent ccRCC in the ureter is rare. Due to the difficulty in distinguishing it from ipsilateral upper UTUC, complete transperitoneal laparoscopic nephroureterectomy in a single position is a safe and feasible treatment option in this situation.
