European Urology Today: June/July 2023

main population of patients who might benefit from the treatment. Non-adherence rate was quite high, as missing the daily dose was recorded in 26% of the patients. Laboratory analysis showed that from one side, urinary calcium excretion was lower in the treatment arms compared to placebo. The calcium oxalate and calcium phosphate supersaturations were not significantly different respect to placebo; this finding might pose a serious objection on the actual value of HCT in preventing calcium stones formation. The road to effective treatment options in preventing stone recurrence still has a long way to go. Source: Hydrochlorothiazide and prevention of kidney-stone recurrence. Nasser A Dhayat, Olivier Bonny, Beat Roth, et al. N Engl J Med. 2023 Mar 2;388(9):781-791. doi: 10.1056/NEJMoa2209275 Role of opioids: Postoperative pain management in paediatric urology practice Significant variability is reported in opioid- prescribing practices after ambulatory procedures of paediatric urologists. There is limited evidence on the efficacy of available analgesics in managing postoperative pain in paediatric patients. Opioid medications are an important element of paediatric postoperative pain management but with some perioperative complications. The role of opioids in the paediatric age group warrants examination. There is a need for a better understanding of postoperative pain and analgesia in paediatric urology patients to guide optimum the use of opioids in this patient group. The authors have designed a study to investigate the postoperative pain levels experienced by paediatric urology patients; the factors that correlate with postoperative pain; and the number of

opioids consumed following paediatric urologic procedures.

minimal side effects, and adequate pain management.

Prof. Serdar Tekgül Section Editor Ankara (TR)

A total of 165 paediatric urology patients (57 patients underwent circumcision, 54 underwent orchiopexy, 32 underwent hypospadias repair, and 22 underwent inguinal hernia repair) were included in the study, prospectively, on the day of the procedure. For each of the first seven postoperative days, the patients’ parents completed a text message-based questionnaire which quantified their child’s pain level and the doses of pain medication consumed. “There is a need for evidence- based standardisation of care for postoperative analgesia in this patient population.” For all procedure types, pain scores (p < 0.01) and doses of oxycodone consumed were highest on postoperative day one and steadily declined thereafter. Overall, the average seven-day pain score (2.02; 0.86–5.14) and doses of narcotics consumed (3.50; 0–5) were low. Patients in each surgical subgroup were prescribed narcotics in excess of what was consumed. There was an average excess of 10.9 doses (0–39.0) for hypospadias repair, 8.6 (1.0–30.0) for circumcision, 9.0 (3.0–21.0) for inguinal hernia repair, and 6.1 (0–22.0) for orchiopexy. Overall, the reported pain scores and the number of narcotics consumed were low regardless of surgery type. Opioids were overprescribed regardless of surgery type. The use of opioids seems to be higher than what is actually needed. There is a need for evidence-based standardisation of care for postoperative analgesia in this patient population. Safe and simple paediatric pain management in the perioperative period should be easy to apply. The safe stepwise pain therapy itself should have

The study shows that the level of pain and opioid use vary by procedure type, but that number of narcotics prescribed greatly exceeds the number needed. Using combinations of non-opioid analgesics in a multimodal approach may limit the need for opioids. Source: Opioids and pediatric urology: A prospective study evaluating prescribing habits and patient postoperative pain and narcotic utilization. Lence T, Thinnes R, Foster AJ, Cooper CS, Lockwood GM, Eyck PT, Rye Z, Wu C, Juhr D, Storm DW. J Pediatr Urol. 2023 Jun;19(3):295.e1-295.e8. Effect of combined warm and cold ischemia time after kidney transplantation Prolonged warm ischemia time (WIT) and cold ischemia time (CIT) are independently associated with post-transplant graft failure; their combined impact has not been previously studied. We explored the effect of combined WIT/CIT on all-cause graft failure following kidney transplantation. doi: 10.1016/j.jpurol.2022.12.018. Epub 2023 Jan 18. PMID: 36707266. The Canadian Scientific Registry of Transplant Recipients was used to identify kidney transplant recipients from January 2000 to March 2015 (after which WIT was no longer separately reported), and patients were followed until September 2017. A combined WIT/CIT variable (excluding extreme values) was separately derived for live and deceased donor recipients using cubic splines; for live donor recipients, the reference group was WIT 10 to <23 minutes and CIT >0 to <0.42 hours, and for deceased donor recipients the WIT was 10 to <25 minutes and CIT 1 to <7.75 hours. The adjusted association between combined WIT/CIT and all-cause graft failure (including death) was analysed using Cox regression. Secondary outcomes included delayed graft function (DGF).


A total of 137,125 recipients were included. For live donor recipients, patients with prolonged WIT/CIT (60 to ≤120 minutes/3.04 to ≤24 hours) had the highest adjusted hazard ratio (HR) for graft failure (HR = 1.61, 95% confidence interval [CI] = 1.14-2.29 relative to the reference group). For deceased donor recipients, a WIT/CIT of 63 to ≤120 minutes/28 to ≤48 hours was associated with an adjusted HR of 1.35 (95% CI = 1.16-1.58). Prolonged WIT/CIT was also associated with DGF for both groups although the impact was more driven by CIT. “Combined cold and warm ischemia time determine graft loss and delayed graft function.” Although the results support existing knowledge, this huge retrospective analysis highlights that both WIT and CIT are of great importance and that combined WIT/CIT is associated with graft loss following transplantation. Acknowledging that these are separate variables with different determinants, the authors emphasise the importance of capturing WIT and CIT independently. Furthermore, efforts to reduce WIT and CIT should be prioritised. Source: The impact of combined warm and cold ischemia time on post-transplant outcomes. Martha E Foley, Amanda J Vinson, Thomas A Skinner, Bryce A Kiberd, Karthik K Tennankore. Can J Kidney Health Dis 2023, 10:20543581231178960. doi: 10.1177/20543581231178960. eCollection 2023.

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European Urology Today June/July 2023


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