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    Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey
    (Elsevier (Singapore) Pte. Ltd., 2024) Cheng, Bryan Kwun-Chung; Yuen, Steffi Kar-Kei; Castellani, Daniele; Wroclawski, Marcelo Langer; Zhao, Hongda; Chiruvella, Mallikarjuna; Chua, Wei -Jin; Tiong, Ho-Yee; Tanıdır, Yılören; de la Rosette, Jean J. M. C. H.; Gauhar, Vineet
    Objective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists' knowledge, attitudes, and practices for benign prostatic obstruction surgeries. Methods: A 36 -item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were "agree or strongly agree" and less than or equal to 15% responses were "disagree or strongly disagree" (consensus agree), or when more than or equal to 70% responses were "disagree or strongly disagree" and less than or equal to 15% responses were "agree or strongly agree" (consensus disagree). Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post -operative recovery (n=4 31, 74 .3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift (R) (n=361, 62.2%), Rezum (R) (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift (R), Rezum (R), and iTIND (R) over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post -operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift (R), Rezum (R), and iTIND (R) over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion: Minimal blood loss, fast post -operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift (R), Rezum (R), and EEP were regarded as MIST by most urologists.
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    Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities
    (Springer, 2022) Teoh, Jeremy Yuen-Chun; Ng, Chi-Fai; Eto, Masatoshi; Chiruvella, Mallikarjuna; Capitanio, Umberto; Esen, Tarık; Zeng, Guohua; Lechevallier, Eric; Andonian, Sero; de la Rosette, Jean J. M. C. H.
    Purpose We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC). Methods The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (<= 70 and > 70 years old) and ASA grade (I-II and III-V)/CCI (0-1 and >= 2). Results A total of 2352 patients were included in this study. Patients aged <= 70 years with ASA grading of I-II (p = 0.002), and patients aged <= 70 years with a CCI of 0-1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged <= 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged <= 70 years with ASA grading of III-IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged <= 70 and > 70 years; CCI of >= 3 was significantly associated with worse DFS in patients <= 70 years; ASA grading was not associated with DFS in patients aged <= 70 and > 70 years. Conclusions A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment.