To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure...

BACKGROUND: The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care.
OBJECTIVE: To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma.
METHODS: A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series.
RESULTS: Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance.
CONCLUSIONS: The guidelines provide an evidence-based approach for the management of urological trauma.
RESULTS: Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.

Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.

暂无摘要。

Neurogenic lower urinary tract dysfunction (NLUTD) both threatens the health of affected patients long-term and also has a significantly negative impact on the patients\' quality of life. present, many clinical practice guidelines (CPGs) have been developed for NLUTD patients, but these CPGs may confuse healthcare professionals and patients due to their great difference in terms of scope, quality and content. This review aims to identify the CPGs for NLUTD patients published from 2012 to 2022, assess their quality and then analyse them in an integrated manner.
We will systematically search electronic healthcare databases (English databases including PubMed, EMBASE, OVID, Scopus, Web of Science, Cochrane Library, CINAHL, UpToDate, and Best Practice and Chinese databases including China National Knowledge Infrastructure, Wanfang Database, VIP Periodical Resource Integration Service Platform and SinoMed), online CPG repositories and relevant professional association websites to identify eligible CPGs. The CPGs published in English and Chinese with full texts available within the period from January 2012 to March 2022 will be included in this study. The Appraisal of Guidelines for Research and Evaluation (AGREE) II will be used to assess the quality of included CPGs. According to the predesigned data table, the general characteristics of these CPGs, proposed recommendations and their quality of evidence, strength of recommendation and other information will be extracted. Qualitative thematic analysis will be applied to the extracted recommendations. A summary of the proposed recommendations, their quality of evidence, strength of recommendation and other information will eventually be described in a table. This review is expected to identify knowledge gaps in current CPGs and to identify the areas of the proposed recommendations derived from low-level evidence. ETHICS AND DISSEMINATION : This systematic review does not involve the participation of any subjects, and therefore no ethical approval is required. The findings of this review will be published in a peer-reviewed journal and disseminated via conference presentations.
CRD42022318180.

BACKGROUND: In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare.
METHODS: The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, β3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) of ≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%).
CONCLUSIONS: Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
UNASSIGNED: PROBLEMSTELLUNG: Etwa 1 Mio. Patienten leiden in Deutschland an einer neurogenen Dysfunktion des unteren Harntraktes („neurogenic lower urinary tract dysfunction“, NLUTD). Unbehandelt können verschiedene Formen der NLUTD zu sekundären Schädigungen am unteren (UHT) und oberen Harntrakt (OHT) führen. Die Leitlinie wurde für die medikamentöse Therapie von Patienten mit NLUTD entwickelt, die häufig einer lebenslangen Therapie und Nachsorge bedürfen.
METHODS: Die Leitlinie wurde in einem Konsensusverfahren mit mehreren Treffen und Online-Reviews entwickelt. Finale Empfehlungen wurden in Online-Konferenzen und mittels Stimmzettel mit allen beteiligten Fachgesellschaften ermittelt. Für jede eingehend diskutierte Empfehlung wurde der Grad des Konsensus angegeben.
UNASSIGNED: Die (video)urodynamische Klassifikation der NLUTD sollte vor Beginn einer antimuskarinergen Therapie durchführt werden (84,2 %). Zugelassene orale Antimuskarinika sollten bei neurogener Detrusorüberaktivität (NDO) als erste Wahl eingesetzt werden. Kontraindikationen müssen beachtet werden (100 %). Im Falle von UAW oder bei ineffektiver oraler Medikation sollten alternativ die Instillation von Oxybutynin-Lösung in die Harnblase (83 %) oder die Onabotulinumneurotoxin (OBoNT)-Injektion angeboten werden (89,5 %). Im Falle des Versagens der antimuskarinergen Therapie (AMT) oder bei unerwünschten Arzneimittelwirkungen (UAW) können das β3-sympathomimetische Mirabegron für die Behandlung der NDO eingesetzt werden („off-label use“; 100 %). Bei Paraplegie sub C8 oder multiple Sklerose (Expanded Disability Status Scale [EDSS] ≤ 6,5) kann die OBoNT-Injektion als Alternative angeboten werden (89,5 %). Die medikamentöse Therapie der NDO sollte frühzeitig bei Neugeborenen/Kleinkindern begonnen werden (94,7 %). Eine konservative, nichtmedikamentöse Therapie sollte bei gebrechlichen Älteren erwogen werden (94,7 %). Parasympathikomimetika sollten bei neurogener Detrusorunteraktivität (NDU) nicht eingesetzt werden (94,7 %).
UNASSIGNED: Die genaue Kenntnis der zugrunde liegenden neurologischen Erkrankung/Traumafolge und die exakte Klassifikation der NLUTD sind Voraussetzung für die Entwicklung einer individuell abgestimmten Therapie.

To examine and critique current international clinical practice guidelines (CPGs) on management of paediatric neurogenic lower urinary tract dysfunction (NLUTD) and assess the applicability of these guidelines to clinical practice.
We conducted a systematic review of all CPGs on NLUTD published in English from the year 2010 to 2022. Six reviewers independently used the Appraisal of Guidelines and Research Evaluation (AGREE) II instrument to appraise all eligible CPGs. This instrument is comprised of 23 items organised into six quality domains. The scores for each item and domain were tabulated for each reviewer and interrater reliability was assessed for each domain using the intraclass correlation coefficient (ICC).
Six CPGs were appraised and these included: National Institute for Health and Care Excellence (NICE), European Society for Paediatric Urology, International Children\'s Continence Society, Irish, Spina Bifida Association (SBA), and International Brazilian Journal of Urology guidelines. They had high mean standardised scores in the domain on \'scope and purpose\' and \'clarity of presentation\' but had low scores in the domain of \'applicability\'. The top three CPGs based on overall score were the NICE, Irish and SBA guidelines and the reviewers had high degree of interrater reliability (ICC 0.912, P < 0.001). The mean scores in various domains for the top three guidelines were 95.8 (scope and purpose), 87.5 (stakeholder involvement), 69.1 (rigour of development), 94.0 (clarity of presentation), 68.4 (applicability), and 59.7 (editorial independence). The diagnostic and treatment recommendations of the top three guidelines were presented.
The existing CPGs on paediatric NLUTD provide high-quality evidence based recommendations. The NICE, Irish and SBA guidelines were the top three CPGs identified. They scored high on most domains except applicability and editorial independence. These domains need to be considered for future updates to improve the utility.

暂无摘要。

Hypospadias is the most frequent genital variation in male newborns with an incidence of 1:200-300. The variation within this anomaly is very high, from isolated distal hypospadias to very complex penoscrotal cases with accompanying genital or nongenital anomalies, genetic anomalies or even disorders of sexual differentiation. In the literature one can find up to 250 different surgical techniques for hypospadias repair. The goal of the new S2k guideline on hypospadias (AWMF registry no. 006-026), developed by the German Association of Urology (DGU) and the German Association of Pediatric Surgery (DGKCH), was a certain standardisation of the preoperative diagnostic workup, the surgical management and the postoperative care of patients with distal, middle or proximal hypospadias. In this article, the most important facts of the guideline are presented using a fictional case of an infant with distal hypospadias. For further reading, we refer to the S2k guideline, which can be easily accessed by scanning the pictured QR code.
UNASSIGNED: Die Hypospadie ist mit einer Inzidenz von 1:200–300 die häufigste Fehlbildung bei männlichen Neugeborenen. Dabei ist die Variabilität der Ausprägung sehr hoch, von einer isolierten distalen Hypospadie bis hin zu komplexen penoskrotalen Hypospadien mit begleitenden genitalen oder nicht-genitalen Anomalien und ggf. auch genetischen Anomalien und Störungen der Geschlechtsentwicklung. In der Literatur finden sich bis zu 250 verschiedene operative Verfahren zur Korrektur einer Hypospadie. Die Zielsetzung der hier anhand eines Fallbeispiels präsentierten S2k-Leitlinie für Hypospadie (AWMF-Register Nr. 006-026 [Arbeitsgemeinschaft Medizinisch-Wissenschaftlicher Fachgesellschaften]), herausgegeben von der Deutschen Gesellschaft für Urologie e. V. (DGU) und der Deutschen Gesellschaft für Kinderchirurgie e. V. (DGKCH), ist eine Standardisierung der präoperativen Diagnostik, des operativen Vorgehens und der postoperativen Behandlung sowie der Nachsorge bei distalen, mittleren und proximalen Hypospadien. Anhand eines fiktiven Falles einer distalen Hypospadie sollen die wichtigsten Punkte der Leitlinie anschaulich dargestellt werden. Zur Vertiefung der Thematik verweisen wir auf die Leitlinie, die mittels abgebildeten QR-Codes direkt aufgerufen werden kann.

OBJECTIVE: To develop technical guidelines for magnetic resonance imaging aimed at characterising renal masses (multiparametric magnetic resonance imaging, mpMRI) and at imaging the bladder and upper urinary tract (magnetic resonance urography, MRU).
METHODS: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Two separate questionnaires were issued for renal mpMRI and for MRU. Consensus was strictly defined using a priori criteria.
RESULTS: Forty-two expert uroradiologists completed both survey rounds with no attrition between the rounds. Fifty-six of 84 (67%) statements of the mpMRI questionnaire and 44/71 (62%) statements of the MRU questionnaire reached final consensus. For mpMRI, there was consensus that no injection of furosemide was needed and that the imaging protocol should include T2-weighted imaging, dual chemical shift imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm2) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic) contrast-enhanced imaging; late imaging (more than 10 min after injection) was judged optional. For MRU, the patients should void their bladder before the examination. The protocol must include T2-weighted imaging, anatomical fast T1/T2-weighted imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm2) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic, excretory) contrast-enhanced imaging. An intravenous injection of furosemide is mandatory before the injection of contrast medium. Heavily T2-weighted cholangiopancreatography-like imaging was judged optional.
CONCLUSIONS: This expert-based consensus conference provides recommendations to standardise magnetic resonance imaging of kidneys, ureter and bladder.
CONCLUSIONS: • Multiparametric magnetic resonance imaging (mpMRI) aims at characterising renal masses; magnetic resonance urography (MRU) aims at imaging the urinary bladder and the collecting systems. • For mpMRI, no injection of furosemide is needed. • For MRU, an intravenous injection of furosemide is mandatory before the injection of contrast medium; heavily T2-weighted cholangiopancreatography-like imaging is optional.