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Guo Z, Wang Z, Weng X, Tang Y, Wu D, Cheng F, Chen B, Tang H, Cui J, Gu C, Zou Q, Li Y, Gan S, Xiang S, Wang S. The safety and efficacy of Sotn ureteroscopy for renal and upper ureteral calculi: a prospective multicenter randomized controlled trial. Minerva Urol Nephrol 2024; 76:221-229. [PMID: 38742555 DOI: 10.23736/s2724-6051.24.05595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Sotn ureteroscopy is a new lithotripsy procedure developed on the basis of ureteroscopy and includes a rigid ureteral access sheath, standard mirror, lithotripsy mirror, and Sotn perfusion aspirator. Thus, we performed a prospective multicenter randomized controlled trial comparing the safety and efficacy of Sotn ureteroscopy in the treatment of renal and upper ureteral calculi. METHODS In this study, 224 patients with renal and upper ureteral calculi were randomly divided equally into study and control groups from March 2018 to March 2022. All the patients were approved by the hospital ethics committee (proof number: ZF-2018-164-01 and ZF-2018-165-01) of the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and month after treatment and operation duration. The secondary outcome was postoperative complication rate. RESULTS In total, for upper ureteral calculi, the SFR of 1 day after operation of the Sotn ureteroscopy group was significantly higher than the rigid ureteroscopy group (83.6% vs. 60%, P=0.006). Moreover, operative time (33.7±1.80 vs. 52.9±2.73 min, P<0.005) of the Sotn ureteroscopy group was significantly lower than the rigid ureteroscopy group. Additionally, the SFR of 1 day after operation and operative time for the study group (Sotn ureteroscopy combined with flexible ureteroscopy) and the control group (flexible ureteroscopy alone) were 63.2% and 36.8% (P=0.005), 65.6±4.06 and 80.3±4.91 (P=0.023), respectively. However, there were no significant differences in the SFR of 1 month after operation, success rate of ureteral access sheath placement, and postoperative complications between the two groups (P>0.05). In subgroups with stone diameters ≥1.5 cm and stone CT values ≥1000 Hounsfield units, Sotn ureteroscopy showed more advantages in terms of the SFR of 1 day after operation. Importantly, complications such as ureteral injury, sepsis, fever, and severe hematuria were not statistically different between the two groups (P>0.05). CONCLUSIONS For renal and upper ureteral calculi, Sotn ureteroscopy has the advantage of a higher SFR of 1 day after the operation and a shorter operative time, suggesting that the Sotn ureteroscopy may have further potential applications in clinics.
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Affiliation(s)
- Zhenlang Guo
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Zhichao Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Xiangtao Weng
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Yanquan Tang
- Department of Urology, Jiangmen Wuyi Hospital of Chinese Medicine, Jiangmen, China
| | - Deneng Wu
- Department of Urology, Guilin Hospital of Chinese Traditional and Western Medicine, Guilin, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bin Chen
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huilong Tang
- Department of Urology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jinsheng Cui
- Department of Urology, Heji Hospital of Changzhi Medical College, Changzhi, China
| | - Chiming Gu
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Qianming Zou
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Yuan Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shu Gan
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China -
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Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JYC, Galosi AB, Somani BK, Emiliani E, Gauhar V. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review. Actas Urol Esp 2024; 48:57-70. [PMID: 37302691 DOI: 10.1016/j.acuroe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
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Affiliation(s)
- C Giulioni
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy.
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - N Gadzhiev
- Servicio de Endourología, Universidad Médica Estatal de San Petersburgo, Saint-Petersburgo, Russia
| | - G M Pirola
- Servicio de Urología, Hospital San Giuseppe, Grupo MultiMedica, Milán, Italy
| | - Y Tanidir
- Departamento de Urología, Facultad de Medicina, Universidad de Marmara, Estambul, Turkey
| | - R D da Silva
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - X Glover
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - G Giusti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - S Proietti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - P M Mulawkar
- Servicio de Urología, Hospital Superespecializado de Tirthankar, Akola, India; Universidad de Edimburgo, Edimburgo, United Kingdom
| | - V De Stefano
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - A Cormio
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - J Y-C Teoh
- Clínica de Urología S.H. Ho, Servicio de Cirugía, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - A B Galosi
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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3
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Quhal F, Zeng G, Seitz C. Current evidence for suction in endourological procedures: comprehensive review of literature. Curr Opin Urol 2023; 33:77-83. [PMID: 36336907 DOI: 10.1097/mou.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To identify the latest advances on the utilization of suctioning devices in the surgical treatment of urinary stones. RECENT FINDINGS Advances are being made to incorporate suction and pressure control capabilities in percutaneous and ureteroscopic lithotripsy. Multiple retrospective studies and few prospective studies have shown that suctioning with minimally invasive percutaneous nephrolithotomy, commonly referred to as Super MiniPerc, can lead to better stone-free rates (SFR) and shorter operative time with lower incidence of infectious complications. Suctioning during retrograde intrarenal surgery (RIRS) has mainly been achieved through suctioning ureteral access sheath. Here as well, the incorporation of suction improved the SFR, but most importantly, reduced the risk of postoperative infectious complications. SUMMARY Theoretically suction in endourological procedures could facilitate stone debris removal and could reduce intrarenal pressure at the same time allowing for increased irrigation flow potentially decreasing operation time and infectious complications. These claims are supported in contemporary clinical studies, reporting superior SFR and reduced postoperative infectious complications in both percutaneous nephrolithotomy and RIRS.
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Affiliation(s)
- Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
- European Urolithiasis Society (EULIS), Arnhem, The Netherlands
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Bragaru M, Multescu R, Georgescu D, Bulai C, Ene C, Popescu R, Geavlete P, Geavlete B. Single-use versus conventional reusable flexible ureteroscopes - an evaluation of the functional parameters. J Med Life 2023; 16:10-15. [PMID: 36873117 PMCID: PMC9979166 DOI: 10.25122/jml-2022-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 03/07/2023] Open
Abstract
The purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the limitations of conventional reusable ureteroscopes in terms of maneuverability and maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS focusing on clinical data. A systematic research using Pubmed was performed evaluating single-use fURS and reusable fURS in urinary tract stone disease, including prospective assessments and case series. This review aimed to provide an overview of single-use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). We included 11 studies, where the single-use fURS were compared to the reusable fURS. The studies with single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). For reusable ureteroscopes, data were included on three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were no significant differences in stone-free rate, procedure duration, or functional capabilities between single-use fURS and reusable fURS. The systematic literature review analyzed operative time, functional capabilities, stone-free rates, and postoperative complications of the ureteroscopes, and a special chapter about renal abnormalities to emphasize that they are a good choice having a high proportion of stone-free rates and few risks, particularly in treating difficult-to-access calculi. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. Further studies on clinical efficacy are needed to determine whether single-use fURS will reliably replace its reusable counterpart.
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Affiliation(s)
- Marius Bragaru
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Multescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cătălin Bulai
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cosmin Ene
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Popescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Petrişor Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Bogdan Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Lai L, Zhang W, Zheng F, Wang T, Bai P, Liu Z, Zheng J, Shao Z, Duan B, Wang H, Xing J, Chen H, Huang Y, Chen B. Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi. Front Surg 2021; 8:707022. [PMID: 34646858 PMCID: PMC8503526 DOI: 10.3389/fsurg.2021.707022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.
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Affiliation(s)
- Longhui Lai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wenzhao Zhang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Fangjian Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhengsheng Liu
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiqiang Shao
- Xiamen University Laboratory Animal Center, Xiamen University, Xiamen, China
| | - Bo Duan
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jinchun Xing
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Huixin Chen
- Department of Urology Surgery, Zhangzhou Hospital of Traditional Chinese Medicine, Zhangzhou, China
| | - Yushan Huang
- Department of Urology Surgery, Anxi County Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Bin Chen
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Chen H, Zhu Z, Cui Y, Li Y, Chen Z, Yang Z, Zeng F. Suctioning semirigid ureteroscopic lithotomy versus minimally invasive percutaneous nephrolithotomy for large upper ureteral stones: a retrospective study. Transl Androl Urol 2021; 10:1056-1063. [PMID: 33850740 PMCID: PMC8039583 DOI: 10.21037/tau-20-1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To compare the safety and validity of a suctioning semirigid ureteroscopic lithotomy (Sotn-URSL) and minimally percutaneous nephrolithotomy (mPCNL) in treating upper ureteral stone larger than 15 mm. Methods Between February 2018 and December 2019, 97 patients who had upper ureteral stone >15 mm were consecutively included in this study. Forty-six patients underwent Sotn-URSL and 51 underwent mPCNL by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFRs). Results No significant difference was observed in two groups for patient and stone characteristics, except that mPCNL group had a higher incidence of severe hydronephrosis (19.6% vs. 41.2%, P=0.021). Sotn-URSL group was similar to mPCNL group in terms of the mean duration of surgery (50.5±5.9 vs. 52.9±8.0 min, P=0.106) and the SFR after 1 month (91.3% vs. 98%, P=0.187). The hospital stay after surgery of Sotn-URSL group was significant shorter than mPCNL group (1.4±0.6 vs. 2.3±0.7 days, P<0.001), and postoperative complications in Sotn-URSL group was less, especially postoperative pain (P=0.044). Conclusions Both mPCNL and Sotn-URSL are suitable for upper ureteral stones with a diameter of >15 mm. Nevertheless, further well-designed studies with long-term follow-up are needed to confirmed the results.
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Affiliation(s)
- Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
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