Introduction The ADRENAL score is based on preoperative endocrine, clinical, and radiological parameters, enabling the assessment of surgical complexity and prediction of perioperative risk in adrenal surgery. The Mayo Adhesive Probability (MAP) score is derived from preoperative computed tomography findings and evaluates the degree of perinephric or periadrenal fat adhesiveness, a factor that may increase the technical complexity of surgery. The aim of this study was to compare the performance of the ADRENAL and MAP scores in predicting postoperative complications in patients undergoing adrenalectomy.Patients and methods This was a retrospective, multicenter study including all patients who underwent adrenalectomy between 2015 and 2025. The ADRENAL score was calculated using preoperative data, whereas the MAP score was categorized as low (0–1) or high (>1). Preoperative and perioperative variables, including tumor size, estimated blood loss, operative time, and postoperative complications, were compared between groups. Logistic regression analyses were performed to identify predictors of postoperative complications. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative performance of the ADRENAL and MAP scores.Results A total of 232 patients were included. The mean age was 58.45 ± 8.36 years. Postoperative complications occurred in 45 patients (19.39%). Patients who developed postoperative complications had significantly larger tumors (p = 0.01), higher estimated blood loss (p = 0.02), longer operative times (p = 0.047), and significantly higher ADRENAL (p < 0.001) and MAP (p = 0.03) scores. On multivariable analysis, both the ADRENAL score (OR = 4.628; 95% CI: 3.214–8.907; p = 0.001) and the MAP score (OR = 7.058; 95% CI: 2.216–27.2; p = 0.03) remained independent predictors of postoperative complications. The ADRENAL score demonstrated superior discriminative ability compared with the MAP score, with an area under the ROC curve (AUC) of 0.835 versus 0.715, respectively.Conclusion The ADRENAL and MAP scores are useful tools for predicting postoperative complications after adrenalectomy and may be incorporated into preoperative assessment to improve surgical risk estimation. The ADRENAL score demonstrated superior predictive performance in our cohort and may represent a particularly valuable tool for perioperative risk stratification.
Objectives The role of sampling MRI-negative zones alongside MRI-targeted transperineal (TP) prostate biopsy in MRI-positive men remains debated. We assessed the incremental yield of MRI-negative-zone sampling for clinically significant prostate cancer (csPCa) when added to MRI-targeted TP biopsy, against combined biopsy as the composite reference.Methods Between October 2023 and October 2024, 185 consecutive men with elevated PSA or abnormal digital rectal examination and positive mpMRI (PI-RADS ≥ 3) were assessed; five were excluded, leaving 180. A risk-stratified protocol was used: six targeted cores per MRI-positive zone and four non-targeted cores per MRI-negative zone. Combined biopsy was used as a composite reference, and a sensitivity analysis excluded the 10 men who did not undergo MRI-negative-zone sampling. The PI-RADS subgroup analysis was exploratory.Results Mean age was 70.4 years; median PSA was 9.3 ng/mL (IQR 6.7–16.8), median PSA density 0.20 ng/mL/cc; 93% had PI-RADS 4 or 5. Combined biopsy detected csPCa in 151/180 (83.9%). MRI-targeted biopsy achieved 96.0% sensitivity for csPCa (95% CI 91.6–98.2%). MRI-negative-zone sampling identified csPCa not found by targeted cores in 6/180 men (3.3%; 95% CI 1.2–7.1%) and accounted for 6/151 csPCa diagnoses (4.0%; 95% CI 1.5–8.4%). Among the 170 men who underwent both components, the incremental yield was 6/170 (3.5%; 95% CI 1.3–7.5%).Conclusions Within this risk-stratified protocol, MRI-negative-zone sampling added csPCa detection in 3.3% of men and accounted for 4.0% of csPCa diagnoses. The exploratory PI-RADS subgroup estimates were imprecise and did not identify a group in which additional sampling could safely be omitted; combined sampling should remain standard pending prospective validation. Patients should be counselled regarding the residual incremental yield.
Objective To compare the efficacy as well as the safety of Ultra Mini Percutaneous Nephrolithotomy (UM-PCNL) versus Retrograde Intrarenal Surgery (RIRS) using flexible ureteroscopy (F-URS) in the management of renal calculi between (1–3) cm in size.Patients and methods A total of 66 patients presenting with symptomatic renal stones 1–3 cm were recruited and allocated into two equal groups: Group A underwent Ultra mini PCNL (N = 33) while Group B underwent RIRS (N = 33).Results Clinical success was significantly higher after UM-PCNL than RIRS (93.9% vs 72.7%; absolute difference 21.2%, 95% CI 4.0–38.5%; p = 0.044). Operative time, hospital stay, and return to normal activity differed significantly (all p < 0.001); the mean total procedural cost was approximately three-fold higher in the RIRS group (43,625.04 vs 15,944.38 LE). Postoperative pain was slightly lower after RIRS (mean difference 0.33; 95% CI 0.04–0.62; p = 0.027), a clinically negligible difference. Retreatment (0% vs 12.1%; p = 0.114) and auxiliary procedures (6.1% vs 15.2%; p = 0.427) did not differ significantly. Complications occurred in 10 patients (30.3%) in Group A and 9 (27.3%) in Group B (p = 1.000); all were minor (Clavien–Dindo Grade I or II).Conclusions Ultra-mini PCNL is favored for higher stone clearance and a lower descriptive consumable and instrument cost in this setting, while RIRS is preferred when rapid recovery and shorter hospitalization are the priority. The observed difference in hospital stay partly reflects our institution’s post-PCNL protocol (approximately 48 h) and may not generalize to centers using early-discharge or ambulatory PCNL pathways. Treatment selection should be tailored to patient needs and circumstances.Registration (pactr.samrc.ac.za) PACTR202602813362658.
Objectives Patient satisfaction is an important patient-reported outcome in long-term intermittent catheterization. This study aimed to translate, cross-culturally adapt, and psychometrically validate the Intermittent Catheterization Satisfaction Questionnaire (InCaSaQ) for use in a Tunisian population.Methods The InCaSaQ was translated using a standardized forward-backward methodology and reviewed by a multidisciplinary expert committee to assess semantic and conceptual equivalence. The core questionnaire was formulated in Modern Standard Arabic, with a limited number of Tunisian Arabic explanatory terms added during cognitive pretesting in 20 patients to improve comprehension. The final culturally adapted version was administered to 80 adults performing clean intermittent self-catheterization; 98.8% had neurogenic bladder, and 95% used self-lubricated catheters requiring water addition. Psychometric evaluation, guided by COSMIN recommendations, included acceptability, internal consistency, test-retest reliability, principal component analysis, and Spearman’s rank correlations with the Arabic Intermittent Catheterisation Difficulty Questionnaire (ICDQ).Results The culturally adapted Arabic InCaSaQ showed satisfactory acceptability, with a mean completion time of 3 min 15 s and no missing InCaSaQ responses. The mean overall score was 2.35 ± 0.57 on the original 0–3 scale. Internal consistency was good (Cronbach’s α = 0.854), and test-retest reliability was excellent (ICC = 0.985). Principal component analysis identified two components explaining 64.72% of the total variance. The overall InCaSaQ score was negatively correlated with the total ICDQ score (Spearman’s ρ = −0.468, p < 0.001), and most content-category correlations with ICDQ dimensions were statistically significant.Conclusions The culturally adapted Arabic InCaSaQ demonstrated satisfactory acceptability, reliability, and validity in the Tunisian population studied. Additional cross-cultural adaptation and psychometric validation are required before its use in other Arabic-speaking populations and in patients with non-neurogenic urinary retention.
Objectives This study aims to prospectively evaluate the utility of Mayo Adhesive Probability (MAP) score, for determining stone-free status and post-operative complications in patients undergoing mini-Percutaneous Nephrolithotomy (PCNL).Methods A prospective cohort study of 154 patients undergoing mini-PCNL at a single tertiary care centre in eastern India was conducted. Patients were stratified into two groups based on their preoperative MAP score: group 1 (MAP score < 3, n = 103) and group 2 (MAP score ≥ 3, n = 51). Preoperative patient and stone characteristics were recorded. Postoperative outcomes, including stone-free rate, complications, haemoglobin drop, need for transfusion, fever, operative time and hospital stay were compared between the two groups. MAP score and complications according to Clavien-Dindo grade were correlated using Spearman’s rank correlation coefficient (r). ROC curves were generated to evaluate the diagnostic performance of MAP score in predicting binary outcomes (blood transfusion, fever, stone-free status).Results Patients in group 2 had lower stone-free rate (70.6% vs. 89.3%, p = 0.003), higher complications (39.21% vs. 21.3%, p = 0.007) including post operative fever and greater haemoglobin drop (1.25 vs. 0.369 g/dL, p < 0.001) with higher transfusions. Higher MAP score correlated with increasing severity of complications (r = 0.285, p < 0.001). ROC analysis demonstrated the MAP score’s ability to predict stone-free rate, need for transfusion and postoperative fever.Conclusions Higher MAP score (≥3) is significantly associated with lower stone-free rates, higher incidence of complications and greater blood loss in patients undergoing mini PCNL. Thus, incorporating the MAP score into preoperative assessment can aid clinicians in identifying high-risk patients, informed patient counselling, better surgical planning and aggressive infection control measures.
