Su-Min Lee

Aims This study aimed to investigate the role of endoscopic ultrasonography (EUS) for evaluation of remnant rectalneuro-endocrine tumor (NET) after forceps biopsy, snare polypectomy, and endoscopic mucosal resection (EMR) for diagnostic or therapeutic purposes Methods From January 2013 and October 2021, we analyzed a total of 68 patients medical records of patients who underwent EUS and salvage endoscopic therapy for remnant rectal NETs. Results Of 68 remnant rectal NETs, lesion with positive margin was 59 (86.8%) and lesion with indeterminate margin was 9 (13.2%). For all lesions, salvage therapy such as endoscopic submucosal dissection (21, 30.9%), modified EMR (39, 57.4%), biopsy and APC ablation (7, 10.2%) and surgery (1, 1.4%) were performed, and NET was confirmed by pathological examination in 47 lesions out of 68 lesions. Detection rate of colonoscopic gross evaluation was 63.2% and mean detected lesion size was 3.63±3.93cm. Detection rate of EUS was 73.5% and mean detected lesion size was 3.46±2.59cm. When lesions were detected in colonoscopic gross evaluation and EUS, the diagnostic rate (85.1%, P=0.001) was the highest. For remnant rectal NETs, the specificity of EUS evaluation was 91.4% and the specificity was 85.7%, respectively. The specificity of colonoscopic gross evaluation was 85.1% and the specificity was 66.6%, respectively. Conclusions In this study, EUS showed good detection rate compared to colonoscopic gross evaluation. Although further prospective studies are needed, EUS can be considered as a useful tool in evaluating remnant rectal NETs. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Purpose of Review: Extracorporeal shock wave lithotripsy success rates depend on several stone and patient-related factors, one of which is stone density which is calculated on computed tomography scan in Hounsfield Units. Studies have shown inverse correlation between SWL success and HU; however, there remains considerable variation between studies. We performed a systematic review regarding the use of HU in SWL for renal calculi to consolidate the current evidence and address current knowledge gaps. Recent Findings: Database including MEDLINE, EMBASE, and Scopus were searched from inception through August 2022. Studies in English language analysing stone density/attenuation in adult patients undergoing SWL for renal calculi were included for assessment of Shockwave lithotripsy outcomes, use of stone attenuation to predict success, use of mean and peak stone density and Hounsfield unit density, determination of optimum cut-off values, nomograms/scoring systems, and assessment of stone heterogeneity. 28 studies with a total of 4,206 patients were included in this systematic review with sample size ranging from 30 to 385 patients. Male to female ratio was 1.8, with an average age of 46.3 years. Mean overall ESWL success was 66.5%. Stone size ranged from 4 to 30 mm in diameter. Mean stone density was used by two-third of the studies to predict the appropriate cut-off for SWL success, ranging from 750 to 1000 HU. Additional factors such as peak HU and stone heterogeneity index were also evaluated with variable results. Stone heterogeneity index was considered a better indicator for success in larger stones (cut-off value of 213) and predicting SWL stone clearance in one session. Prediction scores had been attempted, with researchers looking into combining stone density with other factors such as skin to stone distance, stone volume, and differing heterogeneity indices with variable results. Summary: Numerous studies demonstrate a link between shockwave lithotripsy outcomes and stone density. Hounsfield unit < 750 has been found to be associated with shockwave lithotripsy success, with likelihood of failure strongly associated with values over 1000. Prospective standardisation of Hounsfield unit measurement and predictive algorithm for shockwave lithotripsy outcome should be considered to strengthen future evidence and help clinicians in the decision making. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) database: CRD42020224647

Objectives: To determine the preoperative assessment and perioperative outcomes of men undergoing bladder outlet obstruction (BOO) surgery in the UK. Patients and Methods: A retrospective cohort study was conducted of all men undergoing BOO surgery in 105 UK hospitals over a 1‐month period. The study included 1456 men, of whom 42% were catheter dependent prior to undergoing surgery. Results: There was no evidence that a frequency–volume chart or urinary symptom questionnaire had been completed in 73% or 50% of men, respectively in the non‐catheter‐dependent group. Bipolar transurethral resection of the prostate (TURP) was the most common BOO surgical procedure performed (38%). Monopolar TURP was the next most prevalent modality (23%); however, minimally invasive BOO surgical procedures combined accounted for 17% of all procedures performed. Of the cohort 5% of men had complications within 30 days of surgery, only 1% had Clavien–Dindo Grade ≥III complications. Less than 1% of the cohort received a blood transfusion after BOO surgery and 2% were re‐admitted to hospital after their BOO surgery. In total only 4% of the whole cohort were catheter dependent after BOO surgery. Pre‐ and postoperative paired International Prostate Symptom Score scores reviewed suggest that minimally invasive surgical procedures achieved comparable levels of improvement in both symptoms and bother at 3 months postoperatively in men who were not catheter dependent preoperatively. Conclusions: There has been a substantial shift in the available choice of procedure for BOO surgery around the UK in recent years. However, men can be reassured that overall BOO surgery treatments are safe and effective. Evidence of adherence to guidelines in the preoperative assessment of men with lower urinary tract symptoms undergoing surgery was poorly documented and must be improved.

Introduction: To ensure quality, the International Continence Society recommends asking the patient to cough every minute or 50 ml of infused volume. However, on occasions, it was noticed that if cough transmission was poor, Valsalva maneuvers could show pressure transmission was satisfactory. Hence, a study was designed to compare the two methods.Methods: Cough and Valsalva maneuver pressures were compared in 40 patients, 20 consecutive men and 20 consecutive women, undergoing urodynamics at three time points: baseline (20 ml filling), prevoid and postvoid.Results: At baseline, the percentage difference between p_abd and p_ves was significantly lower for Valsalva maneuvres compared with coughs for all patients (median 5.1% vs. 10.2%). This association was consistent in male patients, but not for female. At prevoid, this was reversed with coughs providing more consistent pressure spikes than Valsalva maneuvers (median 7.0% vs. 24.1%), for all patients. Postvoid, no difference was noted in either men or women.Conclusions: Quality control during urodynamics is important to ensure diagnostic accuracy. This is the first study to compare two methods of quality control, coughs, and Valsalva maneuvers. Coughs are a useful indicator of pressure transmission quality at all time points throughout urodynamic studies. However, at low volumes, Valsalva maneuvers give a better indication of quality, with lower variability, whereas at cystometric capacity coughs performed better. Therefore, if poor pressure transmission occurs with cough during urodynamics, particularly at low volumes, it is recommended that a Valsalva maneuver is used to further assess whether pressure transmission and thus urodynamic quality is satisfactory.

Shock wave lithotripsy (SWL) remains an important treatment option for the management of upper urinary tract stones. The optimisation of certain technical principles can help to improve the results of SWL. We performed a systematic review based on preferred reporting items for systematic review and meta-analysis (PRISMA) standards for studies reporting on technical aspects of SWL. A literature search was conducted on the PubMed database between January 1984 and November 2018 using ‘shockwave lithotripsy’ and ‘stone’ as keywords. Summaries and manuscripts of relevant articles were reviewed in order to select studies with the best level of evidence in each theme covered during the review. From 4,135 titles, 165 abstracts and full-text articles were reviewed. Overall, SWL has good outcomes in the treatment of upper urinary tract stones. It remains the only truly non-invasive stone treatment. While stone-free rate (SFR) might not be equivalent to ureteroscopy or percutaneous nephrolithotomy outcomes, SWL can be optimised by changing several technical factors, including type of machine, patient position, number, rate and energy of shocks, stone targeting, and patient analgesia. For each of these included SWL themes, relevant and selected studies with the highest level of evidence were described and discussed. Paired with these improved technical factors and appropriate patient selection, SWL, with its low complication rates, remains an excellent treatment option in 2019.

Abstract Objective: To determine the role of lymph node dissection (LND) in the treatment of upper tract transitional cell carcinoma (UTTCC), as the role of LND along with nephroureterectomy in treating UTTCC is unclear and several retrospective studies have been published on this topic with conflicting results. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials database (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, Google Scholar, and individual urological journals, were searched for all studies investigating the role of LND in the treatment of UTTCC. Of the studies identified, those that met inclusion criteria were included in this review. Results: In all, 27 studies were included in this review, with 9303 patients who underwent LND. No randomised controlled trials (RCTs) were identified. Tumours were located in the renal pelvis in 62% of patients, in the ureter in 35.5%, and multifocal in 2.3%. In total: 77.1% were LN-negative and 22.9% had LN metastasis. For all patients undergoing LND, the 5-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were 27–65.4% and 32.3–95%, respectively. For patients who underwent a LND in accordance with a standardised anatomical template, the 5-year RFS and CSS rates were 84.3–93% and 83.5–94%, respectively. Conclusion: LND may provide a survival benefit in patients undergoing nephroureterectomy for UTTCC, particularly if following a standardised anatomical template and in those patients with muscle-invasive disease; however, a prospective RCT is required to confirm this. Abbreviations: CSS: cancer-specific survival; LN(D): lymph node (dissection); MeSH: Medical Subject Headings; OS: overall survival; pT: pathological T stage; RCT: randomised controlled trial; RFS: recurrence-free survival; UTTCC: upper tract TCC

Objective: Radiological features of granulomatous prostatitis (GP) overlap with those of prostate adenocarcinoma. Identification of specific GP features may aid diagnosis. We aimed to evaluate the ...

Underactive bladder (UAB) is an important and complex urological condition resulting from the urodynamic finding of detrusor underactivity. It can manifest in a wide range of lower urinary tract symptoms, from voiding to storage complaints, and can overlap with other conditions, including overactive bladder and bladder outlet obstruction. However, UAB continues to be poorly understood and inadequately researched. In this article, we review the contemporary literature pertaining to recent advances in defining, understanding, and managing UAB.