Rosen GH, Hargis PA, Kahveci A, et al. Randomized controlled trial of single-dose perioperative pregabalin in ureteroscopy. J Urol. 2023;210(3):517-528.

Special thanks to Drs Halsie Donaldson and Mahmoud Mima at the University of Illinois at Chicago.

As urologists, we have all cared for patients who unfortunately experience severe postoperative pain following ureteroscopy. Despite our rigorous efforts to mitigate that pain, persistent patient discomfort results in more emergency department visits, patient calls, and opioid usage. Gabapentinoids have been used as part of multimodal pain control in other surgical specialties and are now being used at some institutions as part of the enhanced recovery after surgery protocols for ureteroscopy. The authors of this study aimed to evaluate the safety and efficacy of preoperative pregabalin in decreasing pain after ureteroscopy. Patients were administered 300 mg of pregabalin or placebo 1 hour prior to ureteroscopy. Pain level was evaluated before and 1 hour after surgery. Postoperative pain was also monitored for 30 days while emergency department visits, admissions, and phone calls were tracked. The investigators observed significantly higher postoperative pain at the 1-hour postoperative time point with pregabalin usage. The pain did not improve at any point compared to placebo within the 30-day study period. There was no difference in rates of opioid prescriptions, amounts of opioid prescribed, emergency department visits, patient calls, or measures of cognition. This randomized, blinded, placebo-controlled trial demonstrated that while pregabalin didn’t pose any adverse risks, it was not effective in alleviating postoperative pain or curtailing opioid use after ureteroscopy. The search for an optimal pain management regimen following ureteroscopy must go on!

Frendl DM, Chou WH, Chen YW, Chang DC, Kim MM. Early vs delayed transurethral surgery in acute urinary retention: does timing make a difference?. J Urol. 2023;210(3):492-499.

Special thanks to Drs Gabriel van de Walle and Daniel Garvey at the University of Illinois at Chicago.

While great advances in pharmacologic therapies have reduced the need for surgical intervention in benign prostatic hyperplasia, the incidence of acute urinary retention is rising. Does delayed surgery affect the risk of urinary retention? That’s what these authors set out to determine.

Over 17,000 patients who underwent transurethral resection or photoselective vaporization of the prostate were identified by Current Procedural Terminology codes. Patients with prostate cancer, previous prostate surgery, neurogenic bladder, and age younger than 40 years were excluded. Treatment failure was defined as requiring reoperation or recurrent retention. Greater failure rates were observed with those men who had undergone prior catheterization and were significantly increased with 2 catheterizations and a delay to surgery of 6 months.

This study illustrates that retention due to benign prostatic hyperplasia and delayed surgical management after catheterization both lead to worse long-term surgical outcomes. So, does timing make a difference? The answer is yes, and we need to keep an eye on our patients treated with pharmacotherapy to get those who would benefit from surgery more quickly there.

Frainey BT, Majerus SJA, Derisavifard S, et al. First in human subjects testing of the UroMonitor: a catheter-free wireless ambulatory bladder pressure monitor. J Urol. 2023;210(1):186-195.

Special thanks to Drs Jose Quesada Olarte and Omer Acar at the University of Illinois at Chicago.

Urologists have always been and will continue to be great innovators in medicine and surgery. With wireless communication and small, inexpensive, highly accurate sensors and computers, all sorts of problems become possible to solve. One problem we’ve had in diagnosing bladder dysfunction is that the laboratory is a very artificial environment, and what happens outside of it may be very different than what we’re measuring in the clinic.

These investigators developed a catheter-free intravesical pressure measuring device that talks wirelessly to a tiny computer taped to the lower abdomen and tested it in 11 adult women. It captured 98% of urodynamic events. No complications were observed, and the device inside the bladder did not have a significant impact on bladder capacity or sensation, or on flow, during urodynamics.

This device solves the problem of observing bladder function in the real world and portends a future of more robust diagnosis for bladder dysfunction. But it also illustrates how the rich array of available, inexpensive, and powerful technologies is providing new tools for medicine, and urological innovators, as always, are at the forefront.