Soc. Int. Urol. J., Volume 4, Issue 5 (September 2023) – 10 articles , Pages 355-428

Objectives: Prior studies have suggested that few systematic reviews (SRs) published in the urological literature provide reliable evidence. We performed this study to provide a longitudinal analysis of the methodological quality of SRs published in 5 major urology journals over a 6-year period (2016–2021). Methods: As an extension of a prior study with a written a priori protocol, we systematically searched and analyzed all SRs related to questions of therapy or prevention published in the 5 major urology journals. Three independent reviewers working in pairs selected eligible studies and abstracted the data in duplicate. We used the updated Assessment of Multiple Systematic Reviews (AMSTAR-2) instrument to assess SR quality. We performed pre-planned statistical hypothesis testing by time period and journal of publication in SPSS Version 27.0. Results: Our updated search (2019–2021) identified 563 references of which 114 ultimately met inclusion criteria, which we added to the database of the prior 144 studies (2016–2018). Overall, among 258 SRs, only 6 (2.3%) and 9 SRs (3.5%), achieved a “high” (no critical weakness; up to one non-critical weakness) or “moderate” (no critical weakness; more than one non-critical weakness) confidence rating, respectively. Most SRs published had very low confidence rating (195; 75.6%). The proportion of studies with a high or moderate rating (6.1% versus 4.9%; P = 0.481) did not increase over time. Conclusions: Most SRs published in the urological literature continue to have serious methodological limitations and should not be relied upon. There is a critical need for greater awareness for established methodological standards. Full article

Background: Malignant ureteral obstruction (MUO) is a common presentation in advanced urological and non-urological malignancies. Percutaneous nephrostomy (PCN) and retrograde ureteral stent (RUS) are the most commonly performed procedures to relieve the obstruction. The comparative effectiveness of PCN and RUS for decompression of MUO remains uncertain. Purpose: To systematically review the literature for evidence of improved efficacy of one of these procedures in terms of renal function preservation and clinical outcomes. Methods: We searched Ovid Medline, Ovid EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from the date of inception to October 2022. In addition, gray literature was searched through OpenGray (https://opengrey.eu/), dissertation and thesis database (ProQuest) via (https://www.proquest.com), and Clinical trial.gov website. The reference lists of all the included studies were also searched. Two reviewers independently reviewed and selected studies, assessed the quality, and extracted the data. Results: Overall, 25 eligible studies including 1864 patients compared PCN and RUS (head-to-head). PCN and RUS were found to be similarly effective in improving renal function. However, PCN appears to be superior in maintaining this reduction. The complication rate and quality of life were comparable between the 2 methods, but the length of hospital stay and the financial cost were significantly higher in the PCN group. The mean technical success rate in RUS was 70.3% (21% to 100%) and in PCN was 98.8% (90% to 100%). The conversion rate from RUS to PCN ranged from 10% to 42.6% (mean = 22.5%), while internalization of the PCN occurred in 11.7% to 98% of the patients (mean = 45.5%). Conclusions: Both diversional methods are effective in management of MUO. However, because of the heterogeneity of the included studies, the superiority of one of the procedures cannot be concluded. Full article

Objectives: To review the methods of surgical complication reporting in urological journals, to determine the current utilisation of the Clavien Dindo classification, and to make comparison with previous reports over the last 10 years. Methods: A search was performed of all journal articles published in 5 major urological journals from January 2021 to April 2022, inclusive. All articles reporting surgical outcomes or complications were analysed. The current trend in complication reporting was compared with the results of the systematic search of the same 5 urological journals performed in 2012 by Yoon et al. Results: A total of 137 articles were identified. The Clavien Dindo classification was the most common method used (105/137, 76.6%) followed by a text-based descriptive classification (31/137, 22.6%). Notably, the Clavien Dindo classification was the only standardised method used in any of the articles examined. The prevalence of Clavien Dindo classification usage is 76.6% in the articles analysed in our search compared with the 33.3% reported by Yoon et al. in their search of papers published in the same 5 urological journals between 2010 and 2012. Conclusions: There has been a significant increase in the adoption of the Clavien Dindo classification in the reporting of complications in major urological journals in the last decade. This is a favourable trend which is likely in response to the ad hoc EAU Guidelines Panel 2012 recommendations. With more than 20% of journal articles still using descriptive text-based classifications, we should continue to encourage further implementation of standardised criteria, particularly the Clavien Dindo classification. Full article

Objectives: Postoperative haematuria is a feared complication following prostate enucleation, and it may occur even weeks after discharge. We evaluated the risk of bleeding after discharge and its predictive factors in patients who underwent Thulium laser enucleation of the prostate (ThuLEP). Methods: Between January 2015 and December 2018, patients with surgical indication for benign prostatic hyperplasia underwent ThuLEP in 4 urology departments. All procedures were performed by experienced urologists. Postoperative haematuria was defined as macroscopic haematuria occurring 7 days after discharge. Readmission rate due to macroscopic haematuria was assessed. Logistic regression models tested for predictors of postoperative bleeding requiring readmission. Results: Overall, 748 patients were included, and 52 (6.9%) of them were readmitted after discharge because of macroscopic haematuria. No cases of deep venous thrombosis or pulmonary embolism were diagnosed. Mean length of stay for surgical treatment was 2.1 days, and mean hospitalization for readmission was 5.6 days. None of the readmitted patients required reintervention, while 46.1% of them required blood transfusions. Diabetes mellitus (P < 0.05), a long bridge of oral anticoagulant drugs with low molecular weight heparin (LMWH) (P < 0.05) and history of constipation (P < 0.05) were significant predictors of readmission after discharge due to macroscopic haematuria. Conclusions: Patients with a clinical history of diabetes mellitus or constipation and patients who undergo a long bridge of oral anticoagulant therapy with LMWH are at higher risk of bleeding requiring readmission after ThuLEP. Full article

Background: With the growing elderly population, there is an increasing prevalence of frail patients undergoing surgeries. A common operation in this group is the transurethral resection of prostate (TURP) for the treatment of benign prostatic hyperplasia. Whilst there is a demonstrable link between frailty and general adverse postoperative outcomes, there is limited research on frailty and trial of void (TOV) outcomes post TURP. This study aims to investigate possible associations between frailty, TOV outcomes, and postoperative complications following a TURP. Methods: A retrospective review was conducted of adult patients treated with TURP at 2 hospitals from January 2018 to December 2019, inclusive. Patient demographic data, preoperative Clinical Frailty Scale scores, trial of void outcomes, and complications were recorded and analysed. Clinical frailty scores (CFS) were recorded in accordance with the Dalhousie University Clinical Frailty Scale, ranging from 1 (very fit) to 9 (terminally ill). Results: A total of 226 patients (median age 70.5 years) were identified for this study. Of these patients, 59 were identified as having a CFS of 1 to 2 (Group A), 140 patients had a CFS of 3 to 4 (Group B), and 27 patients had a CFS of 5 to 7 (Group C). Within the initial TOV, Group C had a statistically significant difference in failure rates compared with the other 2 groups, with Group C having the highest failure rate of 33.3% (9/27), followed by Group B with 14.3% (20/140), and then Group A with 13.6 % (8/59) (P = 0.04). Conclusion: In conclusion, greater preoperative frailty is associated with higher rates of initial TOV failure in post-TURP patients. Early objective identification of elderly patients with increased frailty is useful to help preoperative counselling and decision-making, to manage patient postoperative expectations, and to optimise patient care. Full article

Purpose: To identify what information kidney stone patients want and the resources they use to find it, and to evaluate kidney stone-related smartphone apps based on their actionability, understandability, quality, and reliability. Methods: Google Trends was used to assess searches related to kidney stones and related smartphone applications (apps) from 2019 to 2021. A questionnaire aimed at ascertaining where patients obtain kidney stone-related information was posted on popular Facebook groups and one Reddit group. Seven popular kidney stone-related apps were evaluated for reliability, quality, actionability, and understandability. Univariate statistical analysis, search volume index, and descriptive statistics were used to assess correlations and impact of variables on outcomes of interest. Results: Between 2019 and 2021, the peak search volume index of kidney stones was in the summer and winter. Questionnaire participants obtain most information from their doctor (45%), Reddit and Facebook groups (43%), YouTube (9%), and smartphone apps (4%). 23% reported using a kidney stone app at least once to obtain information. The average smartphone app overall has poor reliability (2.43, P < 0.001) and quality (1.96, P = 0.039) and poor review of treatment options with side effects (1.36, P = 0.689), and does not encourage shared decision-making (2.57, P = 0.162). Poor actionability was found in all apps, and good understandability was found in 6 of the 7 apps. Conclusion: While physicians are still the most-used resource for patients, patients are increasingly using online platforms and smartphone applications. Urologists should consider engaging kidney stone patients through such platforms to provide reliable educational information. Full article

Objectives: To compare the rate and predictors of septic complications after shock wave lithotripsy (SWL) and flexible ureteroscopy and laser lithotripsy (FURS) in an Australian population. Methods: Hospital admission data were extracted from the Victorian Admitted Episodes Dataset (VAED) regarding all elective admissions for SWL and FURS for treatment of intrarenal stones from 2009 to 2018, inclusive. Sepsis was defined by the ICD-10 diagnostic code, A41. Results: There were 13 154 inpatient episodes analysed, comprising SWL (6033) and ureterorenoscopic laser lithotripsy (7121). Males made up 67.43% of SWL patients and 63.34% of FURS patients. Median age was 57 years in both groups. Median American Society of Anesthesiologists physical status classification grade (ASA grade) was 2 for both groups, but proportionally more FURS patients were ASA grade 3 to 4 (p < 0.001). Postoperative sepsis was more common in the FURS group (1.43% vs. 0.03%), as was intensive care unit admission (1.00% vs. 0.10%). Average length of stay was longer for FURS (1.43 days vs. 1.06 days). There were 4 inpatient deaths, all from the FURS group. FURS procedure, female sex, and a higher ASA grade were each independent predictors of sepsis. Conclusions: FURS may have a significantly higher relative risk of postoperative sepsis than SWL in high-risk patients as determined in this study. While overall risk is low, higher comorbidity (ASA grade 3 or 4) and female sex were independent predictors of sepsis. For these patients in particular, and when clinically appropriate, SWL may be considered as a potentially safer alternative to FURS. Full article