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Medical and Surgical Management of Urinary Tract Diseases
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Medical and Surgical Management of Urinary Tract Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (25 August 2023) | Viewed by 17313

Special Issue Editor

Prof. Dr. Olivier Traxer

E-Mail Website
Guest Editor
Department of Urology at Tenon Hospital, Sorbonne University, GRC #20 Urolithiasis, 75006 Paris, France
Interests: urinary stones; RIRS; kidney; ureter; laser; lithotripsy; UTUC; tumor; technique
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

To date, urinary tract diseases, such as renal or ureteral stones, as well as tumors or polyps in the upper urinary tract, can be treated in a conservative fashion. The prevalence of urolithiasis is increasing worldwide, partly due to dietary modifications, with an increased consumption of sodium, animal proteins, and refined sugar and a decreased intake of fiber. On the other hand, bladder cancer and upper tract urinary carcinoma (UTUC) are two diseases that can be treated in a conservative way (i.e., with laser ablation) depending on several factors.

The arrival of minimal invasive treatments and new technologies is focused on reducing the morbidity of the patient and performing more efficient procedures. Recent innovations include new single-use flexible endoscopes and laser technologies.

This Special Issue of the Journal of Clinical Medicine aims to provide new insights into the medical and surgical management of urinary tract diseases.

Prof. Dr. Olivier Traxer
Guest Editor

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Keywords

  • urinary stones
  • RIRS
  • kidney
  • ureter
  • laser
  • lithotripsy
  • UTUC
  • tumor

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Related Special Issue

Published Papers (8 papers)

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Research

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8 pages, 215 KiB  
Article
Modified Supine Percutaneous Nephrolithotomy in the Elderly: Outcomes and Safety
by Kylie Yen-Yi Lim, Amos Nepacina Liew, Zihui Ling, Weranja Ranasinghe and Philip McCahy
J. Clin. Med. 2023, 12(14), 4807; https://doi.org/10.3390/jcm12144807 - 21 Jul 2023
Cited by 3 | Viewed by 1333
Abstract
With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We [...] Read more.
With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We describe our experience of the modified supine position in patients aged 70 years and older. Between April 2011 and March 2021, patients aged 70 years and older undergoing a modified supine PCNL performed by a single surgeon were prospectively evaluated. Data including patient age, operative time, complications, stone clearance, and length of stay were collected and analysed. Sixty-nine procedures were performed on 67 patients with a mean age was 76.5 years. Median total operative time was 95 min with 20 (29%) patients having a combined procedure with ureterorenoscopy. Preoperative mean stone burden was 23.5 mm and complete stone clearance was achieved in 46 (66.7%) patients. Twelve (17.4%) patients had complications during their hospitalisation. Six were Clavien–Dindo class II or less and one Clavien–Dindo class V. The modified supine position for PCNL is safe in the elderly patient population and has advantages including reduced handling of patients and achieving adequate stone-free rates. These benefits are particularly important in the elderly population, which frequently has a reduced tolerance to adaptation. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
10 pages, 4646 KiB  
Article
Tape-Releasing Suture with “Long Loop” on Mid-Urethral Sling: A Novel Procedure for Management of Iatrogenic Urethral Obstruction
by Cheng-Yu Long, Chieh-Yu Chang, Yi-Yin Liu, Zi-Xi Loo, Chang-Lin Yeh, Ming-Ping Wu, Kun-Ling Lin and Feng-Hsiang Tang
J. Clin. Med. 2023, 12(12), 3938; https://doi.org/10.3390/jcm12123938 - 9 Jun 2023
Cited by 1 | Viewed by 1497
Abstract
Background: To report our experiences of a tape-releasing suture with “long-loop” in women with iatrogenic urethral obstruction following the mid-urethral sling procedure. Methods: A total of 149 women underwent a tape-releasing suture with “Long Loop” during the operation. Post-void residual volume was evaluated [...] Read more.
Background: To report our experiences of a tape-releasing suture with “long-loop” in women with iatrogenic urethral obstruction following the mid-urethral sling procedure. Methods: A total of 149 women underwent a tape-releasing suture with “Long Loop” during the operation. Post-void residual volume was evaluated after Foley removal. Lower urinary tract symptoms and urodynamic studies were assessed before and six months postoperatively. Results: Nine women out of 149 who underwent mid-urethral sling surgery were found to have iatrogenic urethral obstruction post-operatively based on their urinary symptoms and ultrasound findings. There was no apparent difference between tested groups in mid-urethral sling products and concomitant procedures. 77.8% had successful releases after the first Long-loop manipulation procedure, and 22.2% required two or more releases. However, the SUI cure rate is similar in groups receiving the Long-loop manipulation or not (88.9% and 87.1%, respectively). Conclusions: We are convinced of the practicability and efficacy of the tape-releasing suture “Long-loop.” We adopted subjective and objective means to evaluate both groups before and after a six-month follow-up. The Long-loop manipulation procedure can successfully resolve the iatrogenic urethral obstruction without compromising the effectiveness of mid-urethral sling for the treatment of SUI. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
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10 pages, 852 KiB  
Article
The Efficacy of Flogofilm® in the Treatment of Chronic Bacterial Prostatitis as an Adjuvant to Antibiotic Therapy: A Randomized Prospective Trial
by Biagio Barone, Benito Fabio Mirto, Alfonso Falcone, Francesco Del Giudice, Achille Aveta, Luigi Napolitano, Dario Del Biondo, Matteo Ferro, Gian Maria Busetto, Celeste Manfredi, Daniela Terracciano, Raffaele Gambardella, Savio Domenico Pandolfo, Francesco Trama, Ciro De Luca, Raffaele Martino, Federico Capone, Gaetano Giampaglia, Enrico Sicignano, Octavian Sabin Tataru, Giuseppe Lucarelli and Felice Crocettoadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(8), 2784; https://doi.org/10.3390/jcm12082784 - 9 Apr 2023
Cited by 6 | Viewed by 3472
Abstract
Introduction: Bacterial prostatitis (BP) is a common prostatic infection characterized by a bimodal distribution in young and older men, with a prevalence between 5–10% among all cases of prostatitis and a high impact on quality of life. Although the management of bacterial prostatitis [...] Read more.
Introduction: Bacterial prostatitis (BP) is a common prostatic infection characterized by a bimodal distribution in young and older men, with a prevalence between 5–10% among all cases of prostatitis and a high impact on quality of life. Although the management of bacterial prostatitis involves the use of appropriate spectrum antibiotics, which represent the first choice of treatment, a multimodal approach encompassing antibiotics and nutraceutical products in order to improve the efficacy of chosen antimicrobial regimen is often required. Objective: To evaluate the efficacy of Flogofilm® in association with fluoroquinolones in patients with chronic bacterial prostatitis (CBP). Methods: Patients diagnosed with prostatitis (positivity to Meares–Stamey Test and symptoms duration > 3 months) at the University of Naples “Federico II”, Italy, from July 2021 to December 2021, were included in this study. All patients underwent bacterial cultures and trans-rectal ultrasounds. Patients were randomized into two groups (A and B) receiving antibiotic alone or an association of antibiotics plus Flogofilm® tablets containing Flogomicina® for one month, respectively. The NIH-CPSI and IPSS questionnaires were administered at baseline, four weeks, twelve and twenty-four weeks. Results: A total of 96 (Group A = 47, Group B = 49) patients concluded the study protocol. The mean age was comparable, with a mean age of 34.62 ± 9.04 years for Group A and 35.29 ± 10.32 years for Group B (p = 0.755), and IPSS at the baseline was 8.28 ± 6.33 and 9.88 ± 6.89 (p = 0.256), respectively, while NIH-CPSI at baseline was 21.70 ± 4.38 and 21.67 ± 6.06 (p = 0.959), respectively. At 1, 3 and 6 months, the IPSS score was 6.45 ± 4.8 versus 4.31 ± 4.35 (p = 0.020), 5.32 ± 4.63 versus 3.20 ± 3.05 (p = 0.042) and 4.91 ± 4.47 versus 2.63 ± 3.28 (p = 0.005) for Groups A and B, respectively. Similarly, the NIH-CPSI total score at 1, 3 and 6 months was 16.15 ± 3.31 versus 13.10 ± 5.03 (p < 0.0001), 13.47 ± 3.07 versus 9.65 ± 4.23 (p < 0.0001) and 9.83 ± 2.53 versus 5.51 ± 2.84 (p < 0.0001), respectively. Conclusions: Flogofilm®, associated with fluoroquinolones, demonstrate a significant improvement in pain, urinary symptoms and quality of life in patients affected by chronic bacterial prostatitis in both IPSS and NIH-CPSI scores compared with fluoroquinolones alone. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
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10 pages, 252 KiB  
Article
Validation of the Trifecta Scoring Metric in Vacuum-Assisted Mini-Percutaneous Nephrolithotomy: A Single-Center Experience
by Efrem Pozzi, Matteo Malfatto, Matteo Turetti, Carlo Silvani, Letizia Maria Ippolita Jannello, Susanna Garbagnati, Gilda Galbiati, Stefano Paolo Zanetti, Fabrizio Longo, Elisa De Lorenzis, Giancarlo Albo, Andrea Salonia, Emanuele Montanari and Luca Boeri
J. Clin. Med. 2022, 11(22), 6788; https://doi.org/10.3390/jcm11226788 - 16 Nov 2022
Cited by 5 | Viewed by 1268
Abstract
Background: Scoring metrics to assess and compare outcomes of percutaneous nephrolithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kidney stones. Methods: Data from 287 participants who [...] Read more.
Background: Scoring metrics to assess and compare outcomes of percutaneous nephrolithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kidney stones. Methods: Data from 287 participants who underwent vmPCNL were analysed. Patients’ and stones’ characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxiliary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. Results: After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p < 0.001), a higher rate of single stones (p < 0.001), shorter operative time (p < 0.01), and a higher rate of single percutaneous tract (p < 0.01) than −trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p < 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respectively, all p < 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Conclusions: Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone volume were independent unfavourable risk factors for trifecta. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)

Review

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10 pages, 429 KiB  
Review
Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review
by Luigi Candela, Eugenio Ventimiglia, Catalina Solano, Marie Chicaud, Stessy Kutchukian, Frederic Panthier, Mariela Corrales, Luca Villa, Alberto Briganti, Francesco Montorsi, Andrea Salonia, Steeve Doizi and Olivier Traxer
J. Clin. Med. 2023, 12(15), 4907; https://doi.org/10.3390/jcm12154907 - 26 Jul 2023
Cited by 3 | Viewed by 1801
Abstract
Introduction: Thulium lasers (TLs), namely the Thulium fiber laser (TFL) and the Thulium:YAG (Tm:YAG), are being increasingly adopted for the conservative treatment of upper urinary tract urothelial carcinoma (UTUC). However, to date, the real clinical impact of TLs on UTUC management remains not [...] Read more.
Introduction: Thulium lasers (TLs), namely the Thulium fiber laser (TFL) and the Thulium:YAG (Tm:YAG), are being increasingly adopted for the conservative treatment of upper urinary tract urothelial carcinoma (UTUC). However, to date, the real clinical impact of TLs on UTUC management remains not well-characterized. We performed a review of the literature to summarize the current evidence on TLs for UTUC treatment. Materials and Methods: We performed a systematic review in January 2023 using the Embase and Medline online databases, according to the PRISMA recommendations and using the PICO criteria. Outcomes of interest were: (i) to assess the safety and feasibility of TLs in the treatment of UTUC, and (ii) to evaluate the oncological outcomes in terms of tumor recurrence and conservative treatment failure. Moreover, we described TL characteristics and its interaction with soft tissue. Results: a total of 458 articles were screened, and six full texts including 273 patients were identified. All the included studies were retrospective series. Mean patient age ranged from 66 to 73 years. The indication of a conservative treatment was elective and imperative in 21.7–85% and 15–76% of cases, respectively. Laser power settings varied from 5 to 50 W. No intraoperative complications were reported, and all the procedures were successfully performed. The tumor recurrence rate was 17.7–44%, and the indication to radical nephroureterectomy was 3.7–44% during a follow-up of 6–50 months. Most of the postoperative complications were mild and transient, and ureteral strictures were reported in two studies. Major limitations were the retrospective nature of the studies, the small sample sizes, and the short follow-up. Conclusions: TL is an effective and safe technology for endoscopic UTUC treatment. However, current available literature lacks prospective and multicentric studies with large population sizes and long-term follow-up. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
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10 pages, 2240 KiB  
Review
Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature
by Clara Cerrato, Victoria Jahrreiss, Carlotta Nedbal, Francesco Ripa, Vincenzo De Marco, Manoj Monga, Amelia Pietropaolo and Bhaskar Somani
J. Clin. Med. 2023, 12(13), 4389; https://doi.org/10.3390/jcm12134389 - 29 Jun 2023
Cited by 7 | Viewed by 2377
Abstract
Background: Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients [...] Read more.
Background: Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. Methods: A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. Results: Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50–100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. Conclusions: SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
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12 pages, 295 KiB  
Review
Optimizing Outcomes in Flexible Ureteroscopy: A Narrative Review of Suction Techniques
by Catalina Solano, Marie Chicaud, Stessy Kutchukian, Luigi Candela, Mariela Corrales, Frédéric Panthier, Steeve Doizi and Olivier Traxer
J. Clin. Med. 2023, 12(8), 2815; https://doi.org/10.3390/jcm12082815 - 11 Apr 2023
Cited by 17 | Viewed by 2834
Abstract
Objective: The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. Methods: A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we [...] Read more.
Objective: The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. Methods: A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we conducted a search on the Twitter platform. Studies including suctions systems in fURS were included. Editorials, letters and studies reporting intervention with semirigid ureteroscopy, PCNL and mPCNL were excluded. Results: A total of 12 studies were included in this review. These studies comprised one in vitro study, one ex vivo study, one experimental study and eight cohort studies. The Pubmed and WoSCC searches identified three suction techniques (Irrigation/Suctioning system with control of pressure, suction ureteral access sheath (sUAS) and direct in scope suction (DISS)), and the Twitter search identified four of them. The overall results showed that suction is an effective and safe technique that improves stone-free rates, reduces operative time and limits complication rates after fURS. Conclusions: The use of suctioning during common endourological procedures has been shown to improve safety and efficacy in several indications. However, randomized controlled trials are needed to confirm this. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)

Other

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8 pages, 267 KiB  
Commentary
Bowel Perforation after Extracorporeal Wave Lithotripsy: A Review of the Literature
by Sofia Fontanet, Alba Farré, Oriol Angerri, Andrés Kanashiro, Edgar Suquilanda, Jesús Bollo, Maria Gallego, Francisco Maria Sánchez-Martín, Félix Millán, Joan Palou, Diana Bonnin and Esteban Emiliani
J. Clin. Med. 2023, 12(3), 1052; https://doi.org/10.3390/jcm12031052 - 29 Jan 2023
Cited by 1 | Viewed by 1805
Abstract
Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case [...] Read more.
Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case reports but requires rapid diagnosis and treatment. Methods: A review of the literature from PubMed/Medline, Embase, Cochrane, and Web of Science databases was performed including studies reporting bowel perforation secondary to ESWL between January 1990 and June 2022. Results: We found 16 case reports of intestinal perforation in the literature. Although some patients had previously undergone abdominal surgery or had inflammatory intestinal disease, others were without comorbidities that could lead to complications. Abdominal pain was the main symptom and imaging was required to confirm the diagnosis, which usually necessitated a surgical intervention. As regards the ESWL technique, it appears that the combination of a high energy level and the prone position constitutes a risk factor for these rare complications. At the authors’ centre, only one case has been reported among 24,000 ESWL procedures over 20 years: A 59-year-old female who underwent ESWL for a distal right ureteral stone presented acute abdominal pain and free intraperitoneal pelvic fluid on ultrasound. A CT scan revealed a small bowel perforation requiring open laparotomy with primary closure. Conclusions: In conclusion, although bowel perforation after ESWL is rare, progressive abdominal pain with tenderness at physical examination requires proper imaging evaluation to exclude bowel perforation and prompt intervention if required. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
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