Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis

PURPOSE

We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors.

METHODS

We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design).

RESULTS

A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively.

CONCLUSIONS

The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

Comparative analysis of robot-assisted simple prostatectomy: the HUGO™ RAS system versus the DaVinci® Xi system

BACKGROUND

Robot-Assisted Simple Prostatectomy (RASP) has emerged as a promising alternative in the treatment of benign prostatic obstruction (BPO). However, there is currently a lack of comparative studies evaluating different robotic platforms for performing RASP. Therefore, we aimed to compare perioperative and functional outcomes of RASP performed using the HUGO™ RAS System versus the DaVinci® Xi System.

METHODS

Forty consecutive cases of RASP performed between May 2021 and March 2023 with the HUGO™ RAS and the DaVinci® Xi at OLV Hospital (Aalst, Belgium) were included in this retrospective study. All surgeries were performed by three experienced surgeons using the same approach. Baseline characteristics, peri-operative and functional outcomes were collected and compared between the two groups.

RESULTS

The population was equally divided between the two groups with 20 patients in each group. There were no significant differences in preoperative patient characteristics between the two groups, except for the presence of bladder stones prior to the surgery (p = 0.03). No significant differences in total operative time and console time between the two groups were reported (p = 0.3). No cases required conversion to open surgery or additional port placement. During one case performed with the HUGO™ RAS, a malfunctioning monopolar curved shear had to be replaced. However, there was no statistically significant differences in terms of technical robotic problems between the groups (p = 0.3). There was no significant difference between the two groups in perioperative and functional outcomes (all p ≥ 0.2).

CONCLUSIONS

We did not observe any statistically significant difference in perioperative and functional outcomes in case of RASP performed with the HUGO™ RAS System and with the DaVinci® Xi System. These findings provide compelling support for considering the HUGO™ RAS as a promising tool for robot-assisted procedures, thereby expanding the utilization of robotics for benign conditions.

Angled BIO-RSA leads to better inclination and clinical outcomes compared to Standard BIO-RSA and eccentric reaming: A comparative study

Background

Two surgical techniques were compared : Standard BIO-RSA, performed with a glenoid eccentric reaming along with a cylindric bone graft augmentation vs. the Angled BIO-RSA, performed with a glenoid concentric reaming and a defect correction with an angled bone graft.

Methods

Patients undergoing RSA from January 2016 to April 2019, with one of the two techniques being performed, were retrospectively reviewed. Glenoids were classified according to Favard. Clinical (Constant-Murley, VAS and ROM) and radiographic (superior tilt correction) data were collected pre-operatively and at 12 months post-operatively.

Results

141 shoulders were included. Angled BIO-RSA group showed statistically significant better outcomes in terms of forward flexion (149.9° Vs 139.3°) and abduction (136.4° Vs 126.7°). The use of an Angled BIO-RSA showed a statistically significant better superior tilt correction (1.252° Vs 4.09°). Angled BIO-RSA, leads to a better inclination correction and a mean postoperative tilt value inferior to 5° in E1 and E3 differently from standard BIO-RSA.

Discussion

Both techniques were able to correct glenoid superior inclination with excellent postoperative short-term results. However, angled BIO-RSA technique appears to be more effective in ensuring a correct inclination of the prosthetic glenoid component with better clinical outcomes.

The management of the long head of the biceps in rotator cuff repair: A comparative study of high vs. subpectoral tenodesis

BACKGROUND

Tenodesis of the long head of the biceps (LHB) is commonly undertaken during arthroscopic rotator cuff repair. We assessed the clinical and structural outcomes after high arthroscopic tenodesis (HAT) or mini-open subpectoral tenodesis (ST). We hypothesized that the clinical and structural results after HAT and ST are similar.

METHODS

We included 40 patients with rotator cuff tear and LHB tendinopathy. Twenty patients (7 women and 13 men; mean age: 57.9 years; range: 56-63 years) were treated using HAT, and 20 patients (8 women and 12 men; mean age: 58.5 years; range: 55-64 years) were treated using ST. Functional evaluation was performed preoperatively and at 6 weeks, 6 months, and 1 year after surgery, using the Constant Murley Score and Simple Shoulder Test scores; the LHB was evaluated using the LHB score. A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.

RESULTS

The postoperative total and pain subscale's Constant scores were significantly higher in the ST group. Moreover, 2 LHB score values were significantly different between the groups. The postoperative LHB total score in the ST and HAT groups averaged 86.9 ± 4.1 (mean ± SD) points and 73.3 ± 6.4 points, respectively. The Pain/Cramps subscale in the ST and HAT groups averaged 47.1 ± 5.9 and 33.2 ± 4.6 points, respectively. The 2 groups showed no difference in Visual Analogue Scale values (5.5 in the HAT group; 5.8 in the ST group) postoperatively. One patient in the HAT group reported a secondary onset of Popeye deformity.

CONCLUSION

Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results, but the ST group was associated with better postoperative clinical outcomes.

Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review

IMPORTANCE

One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery.

OBJECTIVE

The aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance.

EVIDENCE REVIEW

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA.

FINDINGS

A total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33-88 years) and 3.6 years (range 1-9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases.

CONCLUSIONS AND RELEVANCE

Based on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure.

LEVEL OF EVIDENCE

IV.