PurposeTo investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx.Materials and MethodsPatients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups.ResultsPatients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4±13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status.ConclusionsRIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.
ObjectiveTo investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study.Subjects and methodsFrom May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of ‘satisfaction with treatment question’ (STQ), ‘overall response assessment’ (ORA), and ‘willingness to undergo surgery question’ (WSQ).ResultsA total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with ‘dissatisfied’, and no patients replied with ‘very dissatisfied’. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively.ConclusionsThe overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.
PurposeLower urinary tract dysfunction is the most common complication after radical pelvic surgery. The aims of this study were to assess the effect of radical hysterectomy (RH) on the storage function of the lower urinary tract and to evaluate the impact of radiation therapy (RT) on postoperative urodynamic parameters.MethodsThis was a retrospective review of preoperative and postoperative urodynamic variables, which were prospectively collected. All women from 2006 to 2008, who underwent RH for uterine cervical cancer with a stage of 1A to 2B with or without adjuvant RT were enrolled. All patients were divided into two groups: group 1, without RT, and group 2, with adjuvant RT. Urodynamic studies were performed before, 10 days after, and 6 months after RH.ResultsA total of 42 patients with a mean (±standard error) age of 51.9 (±12.3) years were analyzed. There were no significant differences in age, body mass index or clinical stage between the two groups. On the 10th postoperative day, all parameters were decreased except postvoid residual volume. In comparison with group 2 (n=14), group 1 (n=28) showed a significant increase in bladder compliance. At 6 months postoperatively, bladder compliance in group 1 had increased four times or more compared with that on postoperative 10 days. However, it had increased only 2.5 times in group 2 at the same time point (P<0.001).ConclusionsThe results of our study suggest that adjuvant RT after RH might result in a deterioration of bladder compliance. It is highly suggested that practitioners pay attention to low bladder compliance, especially in patients who have adjuvant RT after RH.
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