No abstract

4 9What ' s known on the subject? and What does the study add? HAL fl uorescence cystoscopy is known to improve tumour detection in NMIBC cases and to have a potentially favourable impact concerning the recurrence rates.The present trial assessed the advantages of HAL cystoscopy with regard to postoperative treatment changes and 2 years ' recurrence rates, subjects that are poorly evaluated in the literature. OBJECTIVES• To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue-light cystoscopy (HAL-BLC) on the diagnostic accuracy and treatment changes in cases of non-muscle invasive bladder cancer (NMIBC) compared with standard whitelight cystoscopy (WLC).• To compare the long-term recurrence rates in the two study arms. PATIENTS AND METHODS• In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours.• A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate-risk patients and BCG instillations for high-risk cases.• The follow-up protocol consisted of urinary cytology and WLC every 3 months for 2 years.• Only fi rst-time recurrences after the initial diagnosis were considered. RESULTS• In the 142 patients with NMIBC in the HAL-BLC series, tumour detection rates signifi cantly improved for carcinoma in situ , pTa andoverall cases.• In 35.2% of the cases, additional malignant lesions were found by HAL-BLC and consequently, the recurrence-and progression-risk categories of patients and subsequent treatment improved in 19% of the cases due to fl uorescence cystoscopy.• In all, 125 patients in the HAL-BLC group and 114 of the WLC group completed the follow-up.• The recurrence rate at 3 months was lower in the HAL-BLC series (7.2% vs 15.8%) due to fewer ' other site ' recurrences when compared with the WLC series (0.8% vs 6.1%).• The 1 and 2 years recurrence rates were signifi cantly decreased in the HAL-BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively). CONCLUSIONS• HAL-BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates .• HAL-BLC signifi cantly modifi ed the postoperative treatment of cases.• The 3 months, 1 and 2 years recurrence rates were signifi cantly improved in the HAL-BLC arm. KEYWORDShexaminolevulinate blue-light cystoscopy , non-muscle invasive bladder cancer , diagnostic accuracy , treatment changes , recurrence rates Study Type -Therapy (individual cohort) Level of Evidence 2b

Study Type – Therapy (RCT)
Level of Evidence 1b OBJECTIVE To evaluate the efficiency, safety and short‐term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis‐PVP), and to compare it to the standard TUR of the prostate (TURP). PATIENTS AND METHODS In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Qmax) of <10 mL/s, an International Prostate Symptom Score (IPSS) of >19 and prostate volume of 30–80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health‐related quality of life (HRQL) score, Qmax and postvoid residual urine volume (PVR). RESULTS Patients from both series had similar preoperative characteristics. TURis‐PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis‐PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow‐ups, improvements in the variables measured were better in the TURis‐PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05). CONCLUSIONS TURis‐PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short‐term results and complication rates compared with monopolar TURP.

No abstract

Pyelocaliceal anatomy influences the performances of flexible ureteroscopy. This parameter, lesion location (stone or tumor) and the influence of accessory instruments on flexible ureteroscope's deflection should be evaluated before recommending flexible ureteroscopic approach.