Objectives To evaluate the effect of a novel sulfonic acid‐coated ureteric stent on encrustation and quality of life in patients with urolithiasis. Patients and Methods A prospective, randomised, controlled trial was conducted between April 2022 and March 2025 at two urological centres in Germany. In all, 100 patients requiring ureteric stenting due to urolithiasis were randomised into intervention and control groups. All patients received identical stents (6 F/28 cm); the stent in the intervention group incorporated a novel covalent coating. Stents were removed after 30 days during secondary stone treatment, followed by the encrustation weight assessment. Symptoms associated with the ureteric stent and quality of life were evaluated using the Ureteric Stent Symptom Questionnaire 7 days after stent placement and 7 days after stent removal. Results The final analysis included 95 patients assessed for the primary endpoint. Coated stents showed a 49.7% reduction in mean encrustation weight (mean difference 22.8 mg, 95% confidence interval [CI] 2.4–43.2; P = 0.006). The increase in lower urinary tract symptoms was 53.8% less in the coated‐stent group (Δ3.6 [95% CI 1.3–6] vs Δ7.8 [95% CI 2.8–12.8]; P = 0.002). Light physical activities improved by 33.9% (mean difference 0.76, 95% CI 0.08–1.44; P = 0.046), and the need for antimicrobial therapy was significantly lower for coated stents (7.1% vs 31.8%, P = 0.02; odds ratio 6.1, 95% CI 1.11–33.1). Additionally, patients in the coated‐stent group reported significantly less fatigue and exhaustion symptoms (mean difference 0.67, 95% CI 0.02–1.32; P = 0.03). Conclusion The novel sulfonic acid coating demonstrated significant benefits over standard ureteric stents by reducing encrustation and improving quality of life.
Objective To evaluate long‐term urodynamic, clinical, and complication outcomes following augmentation cystoplasty (AC) in patients with spinal cord injury (SCI) and refractory neurogenic lower urinary tract dysfunction (NLUTD), and to assess the role of adjunctive intradetrusor onabotulinumtoxinA injections. Patients and Methods We performed a retrospective cohort study of patients with SCI undergoing AC at a tertiary referral centre between 1988 and 2018. Inclusion required refractory NLUTD with documented urodynamic abnormalities and failure of conservative and minimally invasive therapies. Pre‐ and postoperative outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), continence status, recurrent urinary tract infections (rUTIs), vesico‐ureteric reflux (VUR), and complications. A subgroup analysis evaluated outcomes following post‐augmentation intradetrusor onabotulinumtoxinA injections. Statistical comparisons were performed using paired t ‐tests. Results A total of 70 patients (47 male, 23 female) were included, with a mean (range) follow‐up of 19 (5–36) years. AC resulted in significant improvements in MCC (155–490 mL; P < 0.001) and MDP (72–19 cmH 2 O; P < 0.001). Continence was achieved in 67% of patients, with a further 24% reporting only occasional leakage. rUTIs and antimuscarinic use decreased postoperatively, and VUR improved in most affected patients. Long‐term complications included urolithiasis in 10%, malignancy in 4% (all adenocarcinoma), and spontaneous perforation in 1.5%. In patients requiring adjunctive botulinum toxin ( n = 18), significant improvements in MCC and MDP were observed in selected analyses ( P = 0.025 and P = 0.009, respectively). Conclusion Augmentation cystoplasty provides durable long‐term improvements in bladder capacity, storage pressures, and continence in patients with SCI with refractory NLUTD, with sustained protection of the upper urinary tract. Although associated with notable late complications, outcomes remain favourable with structured lifelong surveillance. Adjunctive intradetrusor onabotulinumtoxinA injections offers additional benefit in a subset of patients and may optimise long‐term bladder dynamics.
Objectives To assess the risk of fractures among patients with bladder cancer who underwent radical cystectomy (RC) with urinary diversion (UD), compared with matched referents from the general population. Patients/Subjects and Methods We identified 2908 patients who underwent RC between 2011 and 2019, and 13 669 matched referents in a nationwide, register‐based Swedish cohort study. Outcomes were femoral fracture, any fracture, and initiation of bone‐specific drug therapy (BDT). Cumulative incidence was estimated using competing‐risk analyses, and hazard ratios (HRs) were derived from multivariable Cox models stratified by sex. Additional analyses were conducted among patients with muscle‐invasive bladder cancer treated with curative radiotherapy ( n = 328). Results Compared to referents, RC with UD was associated with a higher cumulative incidence of fractures. Women had an increased risk of femoral fracture (HR 1.97, 95% confidence interval [CI] 1.25–3.10) and any fracture (HR 2.06, 95% CI 1.54–2.76), while men had an increased risk of any fracture (HR 1.51, 95% CI 1.22–1.88). No association was observed for initiation of BDT in either sex. In the additional cohort, men treated with radiotherapy had an increased risk of any fracture (HR 2.14, 95% CI 1.26–3.62), whereas estimates for women were imprecise. Conclusion Patients undergoing RC with UD experienced increased fracture risks, particularly women. Additional analyses suggest that fracture risk may be influenced by factors related to both bladder cancer and its treatment, although the strongest and most consistent associations were observed following RC with UD. These findings support increased attention to bone health in these patients.
Objective Our objective was to evaluate the safety and efficacy of staged, anatomy‐tailored robot‐assisted left renal vein (LRV) transposition procedures for the treatment of nutcracker syndrome (NCS). Patients and Methods This retrospective single‐centre study (2019–2025) included 88 patients stratified by technique: conventional ( n = 27), robotic side‐clamp two‐step ( n = 21), LRV‐proximal left gonadal vein (LGV) transposition ( n = 20), and LRV‐distal LGV transposition ( n = 20). The primary outcome was the renocaval pressure gradient (RPG), with secondary outcomes including operative metrics, symptom resolution, and complications. Median follow‐up was 12 months. Results Robot‐assisted LRV‐distal LGV transposition groups demonstrated superior perioperative outcomes to conventional surgery: operative time (median 200 vs 344 min; P < 0.001), blood loss (36.5 vs 66.0 mL; P < 0.001), and hospital stay (4.5 vs 8.0 days; P < 0.001). Postoperative RPG was ≤3 mmHg in all patients. The LRV–proximal LGV transposition yielded the greatest RPG reduction (Δ2.8 mmHg) and lowest postoperative RPG (1.5 mmHg). Complete resolution of varicocele and pelvic/scrotal pain was achieved in all eligible patients undergoing the LRV–distal LGV transposition. Pain scores were low across all groups (mean pain score: 1.7). Conclusion The staged technical evolution in robotic LRV transposition, from the side clamp two‐step technique to anatomy‐tailored LRV–LGV transposition, demonstrated favourable renocaval pressure gradient normalization, symptom relief, and perioperative outcomes. Based on our single‐centre experience, we propose a preliminary anatomy‐tailored treatment algorithm: the side clamp two‐step technique for uncomplicated cases, LRV‐proximal LGV transposition for proximal LGV dilation (≥5 mm), and LRV‐distal LGV transposition for patients with varicocele or pelvic congestion. This framework serves as an institutional reference that warrants further multicentre validation.
