Background:Accurate complication reporting in endourology remains challenging,with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems.This study aimed to compare...Background:Accurate complication reporting in endourology remains challenging,with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems.This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy(URL),percutaneous nephrolithotomy(PCNL),and extracorporeal shock wave lithotripsy(ESWL)using both systems.Methods:This prospective,single-center,non-interventional study included 473 patients undergoing URL,PCNL,or ESWL from October 2022 to October 2024.Demographic,stone-related,and procedural variables were recorded.Complications were classified using the CDC,and cumulative morbidity was assessed using CCI.Statistical analyses,including univariate and multivariate regression,were performed to identify predictors of higher CCI scores.Results:PCNL was associated with the highest complication rates,including an 11%transfusion rate.ESWL had the lowest complication burden,while URL demonstrated intermediate risk.CCI scores correlated positively with length of stay(LOS;r=0.47),highlighting its ability to capture overall morbidity.Multivariate analysis identified stone size,operating time,and positive urine culture as significant predictors of higher CCI scores.The CCI provided a more comprehensive representation of morbidity compared to the CDC.Conclusions:CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC,particularly in more invasive procedures such as PCNL.Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.展开更多
Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associa...Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.展开更多
Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports,suggestive but not definitive for cancer.The terminology corresponds to some uncertainty...Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports,suggestive but not definitive for cancer.The terminology corresponds to some uncertainty in the biopsy report,as the finding might represent an underlying non-cancerous pathology mimicking cancer or an under-sampled prostate cancer site.Therefore,traditional practice favors an immediate repeat biopsy.However,in modern urological times,the need of urgent repeat biopsy is being challenged by some authors as in the majority of cases,the grade of cancer found in subsequent biopsy is reported to be low or the disease to be non-significant.On the other hand,high risk disease cannot be excluded,whereas no clinical or pathological factors can predict the final outcome.In this review,we discuss the significance of the diagnosis of atypical small acinar proliferation in the biopsy report,commenting on its importance in modern urological practice.展开更多
Dear editor,Premature ejaculation(PE)is a common male sexual dysfunction.It occurs in 4%e39%of men across studies in community samples[1].It is impossible to establish accurately the real prevalence of PE because it l...Dear editor,Premature ejaculation(PE)is a common male sexual dysfunction.It occurs in 4%e39%of men across studies in community samples[1].It is impossible to establish accurately the real prevalence of PE because it lacks a widely accepted definition.Furthermore,PE is frequently a self-reported,self-rated complaint,making it difficult to appreciate its real epidemiology.In addition,the fact that in some couples PE is diagnosed based on distress rather than as an objective symptom complicates the matter even further[2].Oral dapoxetine has been recommended as first-choice therapy for PE.When using this drug,side effects were uncommon,dose-dependent,including nausea,diarrhea,headache,and dizziness[1].Although since the early 1930s,many drugs have been used to treat PE such as topical local anesthetics and selective serotonin reuptake inhibitors.展开更多
文摘Background:Accurate complication reporting in endourology remains challenging,with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems.This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy(URL),percutaneous nephrolithotomy(PCNL),and extracorporeal shock wave lithotripsy(ESWL)using both systems.Methods:This prospective,single-center,non-interventional study included 473 patients undergoing URL,PCNL,or ESWL from October 2022 to October 2024.Demographic,stone-related,and procedural variables were recorded.Complications were classified using the CDC,and cumulative morbidity was assessed using CCI.Statistical analyses,including univariate and multivariate regression,were performed to identify predictors of higher CCI scores.Results:PCNL was associated with the highest complication rates,including an 11%transfusion rate.ESWL had the lowest complication burden,while URL demonstrated intermediate risk.CCI scores correlated positively with length of stay(LOS;r=0.47),highlighting its ability to capture overall morbidity.Multivariate analysis identified stone size,operating time,and positive urine culture as significant predictors of higher CCI scores.The CCI provided a more comprehensive representation of morbidity compared to the CDC.Conclusions:CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC,particularly in more invasive procedures such as PCNL.Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.
文摘Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.
文摘Atypical small acinar proliferation is a histopathological diagnosis of unspecified importance in prostate needle-biopsy reports,suggestive but not definitive for cancer.The terminology corresponds to some uncertainty in the biopsy report,as the finding might represent an underlying non-cancerous pathology mimicking cancer or an under-sampled prostate cancer site.Therefore,traditional practice favors an immediate repeat biopsy.However,in modern urological times,the need of urgent repeat biopsy is being challenged by some authors as in the majority of cases,the grade of cancer found in subsequent biopsy is reported to be low or the disease to be non-significant.On the other hand,high risk disease cannot be excluded,whereas no clinical or pathological factors can predict the final outcome.In this review,we discuss the significance of the diagnosis of atypical small acinar proliferation in the biopsy report,commenting on its importance in modern urological practice.
文摘Dear editor,Premature ejaculation(PE)is a common male sexual dysfunction.It occurs in 4%e39%of men across studies in community samples[1].It is impossible to establish accurately the real prevalence of PE because it lacks a widely accepted definition.Furthermore,PE is frequently a self-reported,self-rated complaint,making it difficult to appreciate its real epidemiology.In addition,the fact that in some couples PE is diagnosed based on distress rather than as an objective symptom complicates the matter even further[2].Oral dapoxetine has been recommended as first-choice therapy for PE.When using this drug,side effects were uncommon,dose-dependent,including nausea,diarrhea,headache,and dizziness[1].Although since the early 1930s,many drugs have been used to treat PE such as topical local anesthetics and selective serotonin reuptake inhibitors.
