Urology research center journal club: articles presentation 2024.01.29 (1402.11.09)

Journal Club 2024.01.29 (1402.11.09)

1- Dr.Mohamadi: Dilute povidone-iodine irrigation during percutaneous nephrolithotomy to reduce postoperative infective complications – Is there any benefit?

doi: 10.4103/ua.ua_111_21

Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate. This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group). Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications. Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly. Journal Club

2- Dr.zemanati: Intensity-adjustable pain management with prolonged duration based on phase-transitional nanoparticles-assisted ultrasound imaging-guided nerve blockade

https://jnanobiotechnology.biomedcentral.com/articles/10.1186/s12951-022-01707-z

The lack of a satisfactory strategy for postoperative pain management significantly impairs the quality of life for many patients. However, existing nanoplatforms cannot provide a longer duration of nerve blockage with intensity-adjustable characteristics under imaging guidance for clinical applications. To overcome this challenge, we proposed a biocompatible nanoplatform that enables high-definition ultrasound imaging-guided, intensity-adjustable, and long-lasting analgesia in a postoperative pain management model in awake mice. The nanoplatform was constructed by incorporating perfluoropentane and levobupivacaine with red blood cell membranes decorated liposomes. The fabricated nanoplatform can achieve gas-producing and can finely escape from immune surveillance in vivo to maximize the anesthetic effect. The analgesia effect was assessed from both motor reactions and pain-related histological markers. The findings demonstrated that the duration of intensity-adjustable analgesia in our platform is more than 20 times longer than free levobupivacaine injection with pain relief for around 3 days straight. Moreover, the pain relief was strengthened by repeatable ultrasound irradiation to effectively manage postoperative pain in an intensity-adjustable manner. No apparent systemic and local tissue injury was detected under different treatments. Our results suggest that nanoplatform can provide an effective strategy for ultrasound imaging-guided intensity-adjustable pain management with prolonged analgesia duration and show considerable transformation prospects. Journal Club

3-Dr.alphil: Evolution of non-perfused volume after transurethral ultrasound ablation of prostate: A retrospective 12-month analysis

doi: 10.1016/j.ejro.2023.100506

A detailed understanding of the non-perfused volume (NPV) evolution after prostate ablation therapy is lacking. The impact of different diseased prostate tissues on NPV evolution post-ablation is unknown. To characterize the NPV evolution for three treatment groups undergoing heat-based prostate ablation therapy, including benign prostatic hyperplasia (BPH), primary prostate cancer (PCa), and radiorecurrent PCa. Study design and data analysis were performed retrospectively. All patients received MRI-guided transurethral ultrasound ablation (TULSA). 21 BPH, 28 radiorecurrent PCa and 40 primary PCa patients were included. Using the T1-weighted contrast-enhanced MR image, the NPV was manually contoured by an experienced radiologist. All patients received an MRI immediately following the ablation. Follow-up included MRI at 3- and 12 months for BPH and radiorecurrent PCa patients and at 6- and 12 months for primary PCa patients. A significant difference between BPH and radiorecurrent PCa patients was observed at three months (p < 0.0001, Wilcoxon rank sum test), with the median NPV decreasing by 77 % for BPH patients but increasing by 4 % for radiorecurrent PCa patients. At six months, the median NPV decreased by 97 % for primary PCa. Across all groups, although 40 % of patients had residual NPV at 12 months, it tended to be < 1 mL. The resolution of necrotic tissue after ablation was markedly slower for irradiated than treatment-naïve prostate tissue. These results may account for the increased toxicity observed after radiorecurrent salvage therapy. By 12 months, most necrotic prostate tissue had disappeared in every treatment group. Journal Club

4- Dr.Ghiasi: Analysis of the Value of Flexible Ureteroscopy in the Treatment of Renal Calculi

https://pubmed.ncbi.nlm.nih.gov/37971443/

Kidney stones (renal calculi) are a prevalent medical condition, causing significant pain and discomfort to patients. The existing treatment options for kidney stones include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and flexible ureteroscopy. It is crucial to evaluate the effectiveness of different treatment modalities, including flexible ureteroscopy, to ensure optimal patient outcomes. This study aims to assess the effectiveness of flexible ureteroscopy in treating renal calculi and determine its value in managing this condition. The study involved a total of 106 patients with kidney stones admitted to the hospital. The patients were divided into an experimental group and a control group. In the control group, percutaneous nephrolithotomy was performed on the patients. The procedure involved placing the patient in the lithotomy position, making an opening at the urethra, inserting a ureteral catheter retrograde to the affected side, and performing puncture under ultrasound guidance. Postoperative anti-infection treatment was given and the results were evaluated through imaging.In the experimental group, ureteral lithotripsy was performed with the patient under general anesthesia. The procedure included dilating the patient’s ureter, exploring the location of the kidney stone, using a laser lithotripter to crush the stone, and clearing the fragments. A double J tube was placed at the end of the procedure, and the patient received appropriate antibiotics. Treatment and care continued until the patients were discharged. Clinical efficacy, clinical indicators, renal function, coagulation function, complications, and other factors were observed and recorded. The experimental group showed higher rates of treatment effectiveness (98.11%) and significance (79.25%) compared to the control group, while the treatment failure rate (1.89%) was lower in the experimental group (P < .05). In terms of surgical outcomes, the experimental group had lower intraoperative bleeding volume, catheter removal time, hospitalization time, and postoperative activity time compared to the control group. The time to get out of bed after surgery and drainage tube removal time were also lower in the experimental group. However, the operation time was longer in the experimental group (P < .05). Regarding postoperative indicators, the experimental group exhibited lower levels of KIM-1, Cys-c, and NGAL compared to the control group (P < .05). The experimental group also had lower MA and α values, but higher R and K values during the postoperative period compared to the control group (P < .05). Overall, the experimental group had a significantly lower complication rate (11.32%) compared to the control group (28.30%) (P < .05). The use of ureteroscopic lithotripsy in the treatment of kidney stones can effectively improve the efficiency of patient treatment, with better intraoperative conditions and better prognosis, and less impact on the patient’s renal function and coagulation function, as well as reducing the occurrence of postoperative complications in patients, which is worthy of wide application and promotion in clinical practice. Journal Club

5- Dr.Najarzadegan: Surgical outcomes and postoperative hemorrhage risk of percutaneous nephrolithotomy (PCNL) for deer horn shaped stones analyzed by Lasso regression

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579023/

To predict surgical outcomes and postoperative hemorrhage risk for percutaneous nephrolithotomy (PCNL) in cases of staghorn-shaped stones using lasso regression. Methods: We collected data from 104 patients with staghorn-shaped stones treated with PCNL between January 2019 and December 2022 at the Department of Urology Surgery, the Third People’s Hospital of Gansu Province. Medical history, stone-related parameters, and lab test data were collected. Patients were categorized into stone clearance or residual groups based on postoperative stone status, and bleeding or non-bleeding groups based on post-surgery blood transfusion. The lasso model’s predictive ability for post-PCNL Stone Free Rate (SFR) and hemorrhage risk was evaluated using ROC curves. The lasso model’s predictive performance for post-PCNL SFR was compared to the S.T.O.N.E. score. Results: Overall stone clearance rate was 59.29%. The lasso model identified hypertension history, calyx count at stone location, prior calyx surgeries, age, operation duration, and pre-op creatinine level as SFR predictors. The AUC of lasso model (0.867) significantly surpassed the S.T.O.N.E. model (0.748) (P=0.006) in predicting post-PCNL SFR. In addition, the AUC of lasso model in predicting the risk of postoperative bleeding was 0.779, suggesting an ability in the prediction of bleeding occurrence. Conclusion: A predictive model utilizing lasso algorithm was successfully established. It effectively predicts stone clearance rate and bleeding risk after PCNL for staghorn shaped kidney stones. Journal Club

6- Dr.alfil: Medical Treatment for Peyronie’s Disease: Systematic Review and Network Bayesian Meta-Analysis

https://pubmed.ncbi.nlm.nih.gov/37382281/

To investigate the efficacy of medical treatment options for Peyronie’s disease (PD) including oral drugs, intralesional treatment and mechanical treatment compared with placebo treatment using network meta-analysis (NMA). We searched the randomized controlled trials (RCTs) of PD in PubMed, Cochrane library, and EMBASE up to October 2022. RCTs included medical treatment options: oral drugs, intralesional treatment and mechanical treatment. Studies reporting at least one of the outcome measures of interest including curvature degree, plaque size, and structured questionnaires (International Index of Erectile Function, IIEF) were included. Finally, 24 studies including 1,643 participants met our selection criteria for NMA. There was no statistically significant treatment compared to placebo of the curvature degree, plaque size, IIEF in Bayesian analysis. The SUCRA values of ranking probabilities for each treatment performance, which indicated that hyperthermia device ranked first in NMA. However, in frequentist analysis, 7 of mono treatments (coenzyme Q10 [CoQ10] 300 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, penile traction therapy [PTT], vitamin E 300 mg) and 2 of combination treatments (“PTT-extracorporeal shockwave treatment”, “vitamin E 300 mg-propionyl-L-carnitine 1 g”) were statistically significant for improvement of curvature degree, and 9 of mono treatments (CoQ10 300 mg, hyaluronic acid 16 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, verapamil 10 mg, vitamin E 300 mg, vitamin E 400 U) and 3 of combination treatments (“interferon alpha 2b-vitamin E 400 U”, “verapamil 10 mg-antioxidants”, “vitamin E 300 mg-propionyl-L-carnitine 1 g”) were statistically significant in the improvement of plaque size. At present, there is no clinical treatment alternatives that have been demonstrated to be effective compared to placebo. Nonetheless, as the frequentist approach has shown that a number of agents are efficacious, further research is expected to develop more effective treatment options. Journal Club

7- Dr.Karimian: 2023 International Cancer Education Conference Program and Abstracts

https://link.springer.com/article/10.1007/s13187-023-02359-9