Urological Surgery

Notable Journals in the Field

The following are reputable journals in urological surgery obtained from the DHET’s 2024 Scopus accredited list and the Colleges of Medicine South Africa Regulation on the Fellowship in Urology^[2,3]:

Journal Name	Website
Journal of Urological Surgery	https://jurolsurgery.org/
European Urology	https://www.europeanurology.com/
International Journal of Urology	https://onlinelibrary.wiley.com/journal/14422042
Current Opinion in Urology	https://journals.lww.com/co-urology/pages/default.aspx
BJU International	https://bjui-journals.onlinelibrary.wiley.com/journal/1464410x

Journal in the Spotlight: Journal of Urological Surgery

The Journal of Urological Surgery is an academic journal published by Galenos Yayinevi, dedicated to providing open access to its content. Since its inception in 2014 as the official scientific publication of the Society of Urological Surgery, the journal has published 340 articles, which have collectively received 495 citations. Based in İstanbul, Turkiye, it adheres to a double-blinded peer-review process and releases issues quarterly in March, June, September, and December.^[4,5]

The Journal of Urological Surgery is committed to covering all aspects of urology and its subspecialties, offering a range of peer-reviewed content including Research Articles, Reviews, Case Reports, Images in Clinical Urology, and Video Articles. It focuses on original scientific contributions in areas such as Urooncology, Endourology, Pediatric Urology, Andrology, Reconstructive Urology, General Urology, Urogynecology and Functional Urology, and Transplantation and Vascular Surgery.^[5]

Article Reviews

Electrical Nerve Stimulation for Overactive Bladder in Children^[6]

Overactive bladder (OAB) is a condition often associated with detrusor overactivity (DO), where involuntary contractions of the bladder muscle occur during the bladder-filling phase, potentially leading to urinary incontinence. This condition is prevalent in paediatric urology and can cause significant renal issues and negatively impact a child’s social life. Standard treatments for lower urinary tract symptoms (LUTS) in DO include behavioural changes and medications which are generally effective. However, some children do not respond to these conventional therapies. For such cases, Parasacral Transcutaneous Electrical Nerve Stimulation (p-TENS) is an alternative treatment method.

In a recent article titled Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity by Elif Altınay Kırlı and Bülent Önal (both from the department of Urology at Istanbul University) researchers set out to see how effective p-TENS is in restoring voiding dynamics and reducing lower urinary tract symptoms.

The study was a retrospective evaluation of medical records, conducted on 12 children who underwent Parasacral transcutaneous electrical nerve stimulation (p-TENS) for refractory lower urinary tract dysfunction (LUTD) symptoms between 2017 and 2019. The study population included children diagnosed with refractory detrusor overactivity (DO), specifically excluding those with neurological diseases (n=7) and dysfunctional voiding (n=15).

To determine effectiveness, researchers used several evaluation methods:

• They looked at symptoms like urinary incontinence (leakage), how often the child needed to urinate, urgency (sudden need to urinate), urge incontinence (leakage with urgency), and behaviours related to holding in urine.
• They used a test called uroflow electromyogram (UFM-EMG) to examine the bladder’s function. This test measured the maximum flow rate of urine (Qmax), how long it took to urinate, the volume of urine, and the pattern of the urine flow.
• The amount of urine left in the bladder after urination, known as post-void residual urine (PVR), was measured with an ultrasound before and after the p-TENS treatment. They considered a PVR significant if it was more than 15% of the expected bladder capacity for the child’s age or more than 20 mL. The bladder capacity was calculated using the formula (age+1) x 30 mL.
• They also reviewed voiding diaries kept by the patients before and after treatment to ensure accurate reporting of symptoms. The frequency of urinary tract infections (UTIs) was checked using urine cultures that showed bacterial growth. Additionally, they assessed constipation using clinical signs and the Bristol stool scale.

The results showed significant improvements in several parameters after p-TENS treatment. There was a notable decrease in urgency, urge incontinence, and constipation complaints. Uroflowmetry parameters also improved, with significant changes in Qmax, voiding time, voided volume, and post-void residual urine (PVR). The dominant tower-shaped voiding pattern at the beginning of treatment shifted to a bell-shaped pattern in most children after treatment. Incontinence completely resolved in 75% of the children. Specifically, the complete response rates were 50% for monosymptomatic enuresis, 86% for non-monosymptomatic enuresis, and 67% for daytime incontinence.

The discussion highlights that p-TENS, administered as 20-minute sessions twice a week at 10 Hz and 250 μs, effectively treated refractory LUTD symptoms and urinary incontinence secondary to detrusor overactivity (DO) over a six-month follow-up period. The study corroborates findings from other research, suggesting that the number of stimulations per day is more critical than the treatment duration for success. The positive changes in uroflowmetry parameters and voiding patterns indicate that p-TENS positively affects voiding dynamics. The underlying mechanism may involve stimulation of reflexogenic pathways and inhibition of parasympathetic excitatory neurons.

Overall, the study supports p-TENS as a viable treatment option for children with refractory LUTD symptoms, with significant improvements observed in both urinary symptoms and voiding dynamics.

Urethral Access Sheaths Reduces Post-op Acute Kidney Injury?^[7]

A ureteral access sheath (UAS) is a medical device used in urological procedures, particularly in retrograde intrarenal surgery (RIRS) for kidney stone treatment. It is a flexible, hollow tube that is inserted into the ureter (the duct through which urine passes from the kidney to the bladder) to facilitate the passage of endoscopic instruments.

The use of a UAS is not regarded as an nescicity to these types of suregries, but is widely recommended based on the following assumptions:

• Facilitation of Instrument Passage: The UAS creates a conduit that allows for easy and repeated passage of endoscopic instruments into the urinary tract without causing trauma or damage to the delicate ureteral lining.
• Improved Visualization: The sheath helps maintain a clear field of view by providing continuous irrigation, which flushes out stone fragments and debris.
• Efficiency: It reduces the time needed for the procedure by allowing instruments to be quickly and smoothly introduced and withdrawn multiple times.
• Reduced Pressure: The use of a UAS helps decrease the intrarenal pressure during the procedure, minimizing the risk of complications such as renal damage or infection.
• Patient Safety: The sheath helps protect the ureter from injury and reduces the risk of complications, improving the overall safety and efficacy of the procedure.

In a recent article titled Assessing the Effects of Using a Ureteral Access Sheath on Kidney Injury in Retrograde Intrarenal Surgery with KIM-1 and NGAL Biomarkers in Urine: A Prospective Cohort Study by Emrah Küçük et al. (from the department of Urology at University of Health Sciences Turkiye) researchers set out to confirm the accuracy of the recommendations for UAS based on the assumption that it reduces early postoperative kidney injury.

The accomplished this by performing a prospective cohort study measuring the biomarkers KIM-1 and NGAL as indicators for kidney injury before and 24 hours after the procedure. Their results showed that more kidney injury developed in the non-UAS group than in the UAS group at the postoperative 24 hour mark. This is supported by the fact that here was no significant difference between the pre-operative KIM-1 and NGAL values and the postoperative 24-h KIM-1 and NGAL values in the UAS group (p>0.05), whereas there was a significant difference in the non-UAS group (p<0.05). The postoperative 24-h KIM-1 and NGAL values were also significantly higher in the UAS group than in the non-UAS group (p<0.05).

Therefore, the authors concluded that the recommendation to use a Urethral Access Sheath to reduce early postoperative kidney injury is supported by evidence and should be implemented.

Acknowledgements

This article was brought to you by the TSSS Research Sub-Committee of 2024. The principal author of the piece was Ivan Möller, with chief editor Catherine Joseph overseeing quality.