Publications by authors named "Nagele U"
Purpose: To investigate the effect of pre-biopsy rectal swab and urine screening combined with a risk-adapted antibiotic treatment strategy on reducing post-biopsy infections (PBIs) following multiparametric magnetic resonance imaging (mpMRI)/ transrectal ultrasound (TRUS) fusion-targeted transrectal prostate biopsy (TRPBx).
Methods: 1119 Patients undergoing mpMRI-TRUS fusion TRPBx between June 2017 and February 2024 were included. Patients were screened for rectal extended-spectrum beta-lactamase (ESBL)/multi-resistant gram-negative (MRGN) and urinary pathogens.
Purpose: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis.
View Article and Find Full Text PDFPurpose: 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).
Background: Multiparametric Magnetic Resonance Imaging (mpMRI)-based targeted biopsy has shown to be beneficial in detecting Clinically Significant Prostate Cancer (csPCa) and avoiding diagnosis of Non-csPCa (ncsPCa); however, its role in the treatment of biopsy-naïve patients is still under discussion.
Methods: After identifying predictors for the diagnosis of csPCa via Multivariate Logistic Regression Analysis (MLRA), a propensity-score (1:1 nearest neighbor) matched comparison was performed between a Systematic-Only Biopsy (SOB) cohort and a mpMRI-based Combined (systematic + targeted) Biopsy (CB) cohort from two tertiary urologic centers (SOB: Department of Urology, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Crete, Greece; CB: LKH Hall in Tirol, Austria). Only biopsy-naïve patients were included in the study.
Article Synopsis
- A new urethral reconstruction technique called the "urethral hammock technique" was introduced to improve early postoperative continence in patients undergoing laparoscopic radical prostatectomy (LRP).
- In a study of 119 patients, those using the hammock technique showed significantly higher rates of continence at 4 weeks and 3 months compared to the control group, although the difference faded by 6 months.
- The technique appears safe and effective for early continence improvement, suggesting a need for further research through randomized controlled trials to validate the findings.
Article Synopsis
- - The study aimed to assess radiation protection practices among endourologists in Europe, focusing on compliance with recommendations from the International Commission on Radiation Protection (ICRP) and measuring annual radiation exposure from 2017 to 2020.
- - A survey of 10 endourologists revealed that while most use basic protective gear such as lead aprons and thyroid shields, advanced protections like leaded gloves and glasses are less common; additionally, the mean radiation exposure was below safety thresholds for the chest, eyes, and extremities.
- - The findings indicated that endourologists effectively adhered to radiation safety standards, with the ALARA (As Low As Reasonably Achievable) protocol in place to further minimize exposure during procedures like per
Purpose: To identify laser settings and limits applied by experts during laser vaporization (vapBT) and laser en-bloc resection of bladder tumors (ERBT) and to identify preventive measures to reduce complications.
Methods: After a focused literature search to identify relevant questions, we conducted a survey (57 questions) which was sent to laser experts. The expert selection was based on clinical experience and scientific contribution.
Article Synopsis
- Two randomized trials have established that triplet therapy (androgen deprivation therapy, ARPI, and docetaxel) provides better survival rates compared to doublet therapy (ADT and docetaxel) for patients with metastatic hormone-sensitive prostate cancer.
- A real-world analysis involving 97 mHSPC patients from various Austrian centers was conducted, tracking treatment responses and clinical parameters, while certain guideline-based treatments were underutilized in a significant percentage of the patients.
- Findings showed that patients who started ARPI after chemotherapy had better treatment responses, while 61.9% experienced adverse events, yet all patients had a notable decline in PSA levels, indicating treatment effectiveness.
Article Synopsis
- The study aims to gather laser lithotripsy settings from experts for different clinical situations and to identify ways to minimize complications.
- A survey was conducted among laser specialists, revealing that the majority use Holmium-YAG lasers, with variations in settings for specific scenarios like middle-ureteral, pelvic, and lower pole stones.
- Experts reported a general consensus on preferred techniques, with preventive measures like power limits and intermittent activation commonly employed to reduce thermal injury risks during procedures.
Purpose: To highlight and compare experts' laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists.
Methods: Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment).
Purpose: To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications.
Methods: A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios.
Purpose: We looked into the Thulium: yttrium-aluminum-garnet (TM:YAG), Thulium Fibre laser (TFL) and Holmium: yttrium-aluminum-garnet (Ho:YAG) thermal laser tissue effect during lithotripsy and tissue ablation.
Methods: We performed a PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) search.
Results: During lithotripsy, the Ho:YAG generated temperatures from 24 to 68.
Article Synopsis
- A standardized tool called the TULIP tool was developed to evaluate flexible ureterorenoscopes (fURS) through a consensus-building approach using the modified Delphi technique.
- A systematic review identified relevant parameters, leading to six main categories and 12 subcategories for evaluation, with high consensus among a panel of 30 endourology experts.
- The project reached a high agreement on both the definitions and measurement methods of these categories, setting the stage for more uniform comparisons in fURS research.
Introduction: Renal colic due to ureteral stones represents the primary acute condition in urology. Although guideline recommendations are available the institution, urologist, and patient preferences in diagnosis and treatment may differ. We aimed to evaluate the adherence of different European countries to the European Association of Urology (EAU) guidelines of urolithiasis and demonstrate trends in diagnostic and treatment approaches.
View Article and Find Full Text PDFPurpose: To perform a review on the latest evidence related to generated temperatures during Ho:YAG laser use, and present different tools to maintain decreased values, and minimize complication rates during endourological procedures.
Methods: We performed a literature search using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were URS, RIRS, ureteroscopy, percutaneous, PCNL, and laser.
Purpose: Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum.
Methods: A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL.
Purpose Of Review: To review the latest evidence about intrarenal pressures (IRPs) generated during flexible ureteroscopy (fURS) and mini percutaneous nephrolithotomy (mPCNL) and present tools and techniques to maintain decreased values.
Recent Finding: fURS and PCNL constitute the primary means of stone treatment. New flexible ureterorenoscopes with small diameter and miniaturized PCNL instruments achieve optimal stone-free rates (SFRs) while decreasing invasiveness and morbidity.
Purpose: Transurethral endoscopic procedures using bipolar current, or laser energy are nowadays widely accepted and have replaced the traditional monopolar resection. A major advantage of these techniques is the utilization of isotonic saline as irrigation solution, which minimizes side effects such as symptoms associated to classical transurethral resection syndrome (TUR-syndrome). Nonetheless, clinically significant IFA also occurs with saline and is determined by pressure gradients, systemic resistance and by the amount of irrigation fluid.
View Article and Find Full Text PDFPurpose: Using the Swiss LithoClast Trilogy, urinary stones can be fragmented and removed simultaneously by suction at different selectable suction settings. The aim was to evaluate pressure stability at different settings and test stone fragmentation and suction at the optimal settings.
Methods: In an ex vivo porcine kidney model, we recorded intrarenal pressure levels with different suction levels.
Context: Magnetic resonance imaging (MRI)-targeted biopsies have changed the dogma in prostate cancer diagnosis. Biopsies can be performed either transrectally (MRI-guided and transrectal ultrasound fusion transrectal biopsy [MRI-TRUSB]) or transperineally (MRI-guided and transrectal ultrasound fusion transperineal biopsy [MRI-TPB]).
Objective: To evaluate the detection and complication rates of MRI-TRUSB and MRI-TPB.
Objective: To compare three-dimensional (3D) with standard two-dimensional (2D) laparoscopic partial nephrectomy (LPN) with respect to intra- and postoperative outcomes.
Material And Methods: Data from 112 patients who underwent transperitoneal LPN from 2012 to 2014 by a single experienced surgeon were collected. Sixty patients (group 1) underwent conventional 2D LPN and 52 patients (group 2) 3D LPN.
In patients suspicious for prostate cancer, a prostate biopsy should be performed. Biopsies are possible either by the transrectal or transperineal routes. Compared with the transrectal prostate biopsy (TRPBx), transperineal prostate biopsy (TPPBx) offers a non-inferior cancer detection rate (CDR), especially in patients undergoing re-biopsy for persistently elevated PSA and in cases of active surveillance (AS), in which TPPBx seems to be superior.
View Article and Find Full Text PDFPurpose: Endourology has undergone fundamental changes over the last 2 decades. Maintaining low intrarenal pressure (IRP) during upper urinary tract procedures is an established concept. However, researchers have not yet studied the concept of reduced intravesical pressures (IVPs) during transurethral (TUR) surgery as thoroughly.
View Article and Find Full Text PDFPurpose: To investigate the fragmentation capacity, clearance time, and drilling speed of combined ultrasonic with impact dual-energy and single energy ultrasonic lithotripter devices.
Methods: Stone fragmentation and clearance tests were performed under direct view in an underwater layered hemisphere by four different operators using artificial stones (n = 10/operator). Time for complete clearance was measured.