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Have You Read?
By: Craig Niederberger, MD, FACS, College of Medicine and College of Engineering, University of Illinois at Chicago | Posted on: 30 Dec 2024
Chew BH, Harper JD, Sur RL, et al. Break wave lithotripsy for urolithiasis: results of the first-in-human international multi-institutional clinical trial. J Urol. 2024;212(4):580-589. doi: 10.1097/JU.0000000000004091
Special thanks to Drs Halsie Donaldson and Mahmoud Mima at the University of Illinois at Chicago.
Imagine the dread a patient must have of a kidney stone, a painful, rocky intruder in their body, and learning that they may need to undergo multiple operations to be free of it. What if there were another solution that was more effective and less painful that didn’t require anesthesia? This clinical trial studied a Break Wave lithotripsy device to determine its safety and efficacy for treating kidney and ureteral stones in the clinic. This innovative approach transmits low-amplitude focused ultrasound waves to break up kidney stones without the need for anesthesia.
Forty-four patients with a ureteral or renal stone were treated and monitored postoperatively with CT scans to assess the resolution of stones. There were no adverse events. The effectiveness of fragmentation or stone-free rates differed based on the location of the stone in the kidney and ureter. Approximately half of patients with renal stones were stone-free after treatment, and this increased to about 60% when optimal settings were used. Lower pole renal stones had the lowest rates of success, with only about 30% being stone-free. The highest rate of success was observed in patients with distal ureteral stones, where nearly 90% of patients were completely stone-free after a single treatment. The majority of patients required no or mild pain medication for the procedure.
With proper patient selection, this device shows great promise in our quest for optimal stone treatment.
Leni R, Vickers AJ, Brasso K, et al. Management and oncologic outcomes of incidental prostate cancer after transurethral resection of the prostate in Denmark. J Urol. 2024;212(5):692-700. doi:10.1097/JU.0000000000004159
Special thanks to Drs Luca Lambertini and Simone Crivellaro at the University of Illinois at Chicago.
How should we handle bad news? Probably by not underestimating our worst-case scenarios. A growing body of evidence supports that a human factor still compromises diagnostic accuracy, particularly in cases of incidental tumor findings following benign surgery. In this study, the authors analyzed clinical data from over 24,000 Danish patients who underwent transurethral resection of the prostate for benign prostatic hyperplasia with a focus on those who had incidental prostate cancer findings. Notably, more than 1 in 4 patients in this group did not receive further postoperative investigation, such as a prostate biopsy or MRI.
Cancer-specific mortality in this population was significantly higher compared to patients with a primary diagnosis of prostate cancer, with over 8% for low-risk tumors and 14% for intermediate-risk tumors. This outcome was primarily driven by a high rate of undetected high-grade histology in the peripheral zone, leading to undertreatment and subsequent disease progression. In contrast, patients who underwent postoperative prostate biopsy or MRI and had benign histology had significantly lower cancer-related mortality, with 0.6% and 2.1% in the Gleason Grade 1 and 2 groups, respectively.
Interestingly, PSA levels were not correlated with the rate of postoperative diagnostic evaluation or patient prognosis, potentially limiting their role in decision-making. Based on these findings, incidental prostate cancer discovered after benign surgery warrants enhanced diagnostic assessment even for low-grade cases, and we should not rely solely on postoperative PSA recurrence.
Zillioux J, Camacho FT, Anderson RT, You W, Rapp DE. Prevalence of cognitive and manual dexterity disorders among men following artificial urinary sphincter placement. J Urol. 2024;212(3):441-450. doi:10.1097/JU.0000000000004049
Special thanks to Drs Gabriel van de Walle and Mahmoud Mima at the University of Illinois at Chicago.
Your patient, Richard, a vibrant and active man, had always been independent. However, his recent prostate cancer diagnosis and subsequent incontinence had taken a toll on his quality of life. An artificial urinary sphincter was like a beacon of hope to him, offering a solution to his embarrassment and physical discomfort. Yet, as Richard prepared for the procedure, a crucial detail went unnoticed: his recent fall and family history of dementia.
In this retrospective study, the investigators shed light on an often overlooked area in urologic care: the risk of developing cognitive and manual dexterity disorders post artificial urinary sphincter implantation. Startlingly, nearly half of their cohort developed a cognitive disorder within 15 years of surgery, and 1 in 6 patients developed a manual dexterity disorder that correlated with an increased risk of postsurgical complications such as urinary tract infections and retention. The authors emphasize the importance of adequate baseline assessment of cognitive and dexterity functions and close monitoring after implant.
These authors bring to light a profound intersection of geriatric and surgical care that impacts patient safety and quality of life. Crucially, while the artificial urinary sphincter offers a way to reclaim physical control over incontinence, the cognitive load and manual dexterity needed to manage the device introduce a new layer of complexity. Looking forward, the study doesn’t simply spotlight a problem; rather, it promotes the integration of regular cognitive and dexterity evaluations into routine postimplantation care, ensuring that patients like Richard receive improved quality of life while minimizing dangerous complications.
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