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  • The LACE + index as a predictor of 90-day urologic surgery outcomes
    World J. Urol. (IF 2.761) Pub Date : 2020-01-17
    Gregory Glauser, Eric Winter, Ian F. Caplan, Debanjan Haldar, Stephen Goodrich, Scott D. McClintock, Thomas J. Guzzo, Neil R. Malhotra

    Abstract Purpose This study assessed the ability of the LACE + [Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months] index to predict adverse outcomes after urologic surgery. Methods LACE + scores were retrospectively calculated for all consecutive patients (n = 9824) who received urologic surgery at one multi-center health system over 2 years (2016–2018). Coarsened exact matching was employed to sort patient data before analysis; matching criteria included duration of surgery, BMI, and race among others. Outcomes including unplanned hospital readmission, emergency room visits, and reoperation were compared for patients with different LACE + quartiles. Results 722 patients were matched between Q1 and Q4; 1120 patients were matched between Q2 and Q4; 2550 patients were matched between Q3 and Q4. Higher LACE + score significantly predicted readmission within 90 days (90D) of discharge for Q1 vs Q4 and Q2 vs Q4. Increased LACE + score also significantly predicted 90D emergency room visits for Q1 vs Q4, Q2 vs Q4, and Q3 vs Q4. LACE + score was also significantly predictive of 90D reoperation for Q1 vs Q4. LACE + score did not predict 90D reoperation for Q2 vs Q4 or Q3 vs Q4 or 90D readmission for Q3 vs. Q4. Conclusion These results suggest that LACE + may be a suitable prediction model for important patient outcomes after urologic surgery.

    更新日期:2020-01-17
  • Two-stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective evaluation of functional and cosmetic outcomes
    World J. Urol. (IF 2.761) Pub Date : 2020-01-14
    Ahmed M. Al-Adl, Ashraf M. Abdel Aal, Tarek M. El-Karamany, Yasser A. Noureldin

    To critically evaluate inner preputial graft (IPG) used in staged proximal hypospadias with severe chordee regarding cosmetic and functional outcomes.

    更新日期:2020-01-14
  • Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines
    World J. Urol. (IF 2.761) Pub Date : 2020-01-14
    Konstantinos Dimitropoulos, Muhammad Imran Omar, Athanasios Chalkias, Eleni Arnaoutoglou, James Douketis, Stavros Gravas

    Abstract Purpose The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. Methods A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. Results The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). Conclusion The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.

    更新日期:2020-01-14
  • Assessment of the effects of autologous muscle-derived cell injections on urethral sphincter morphometry using 3D/4D ultrasound
    World J. Urol. (IF 2.761) Pub Date : 2020-01-14
    Salima Ismail, Mélanie Morin, Le Mai Tu

    The primary objective was to evaluate the effect of autologous muscle-derived cell (AMDC) injections on the urethral sphincter morphometry compared to placebo injections. Secondary aims were to explore the reduction of stress incontinence episode frequency (IEF) and factors associated with the efficacy of AMDC.

    更新日期:2020-01-14
  • Traumatic spinal cord injury confers bladder cancer risk to patients managed without permanent urinary catheterization: lessons from a comparison of clinical data with the national database
    World J. Urol. (IF 2.761) Pub Date : 2020-01-13
    Ralf Böthig, Christian Tiburtius, Kai Fiebag, Birgitt Kowald, Sven Hirschfeld, Roland Thietje, Ines Kurze, Wolfgang Schöps, Holger Böhme, Albert Kaufmann, Michael Zellner, Thura Kadhum, Klaus Golka

    Life expectancy for people with traumatic spinal cord injury (SCI) is increasing due to advances in treatment methods and in neuro-urology. Thus, developing urinary bladder cancer (UBC) is gaining importance.

    更新日期:2020-01-13
  • Application of artificial neural networks for automated analysis of cystoscopic images: a review of the current status and future prospects
    World J. Urol. (IF 2.761) Pub Date : 2020-01-10
    Misgana Negassi, Rodrigo Suarez-Ibarrola, Simon Hein, Arkadiusz Miernik, Alexander Reiterer

    Abstract Background Optimal detection and surveillance of bladder cancer (BCa) rely primarily on the cystoscopic visualization of bladder lesions. AI-assisted cystoscopy may improve image recognition and accelerate data acquisition. Objective To provide a comprehensive review of machine learning (ML), deep learning (DL) and convolutional neural network (CNN) applications in cystoscopic image recognition. Evidence acquisition A detailed search of original articles was performed using the PubMed-MEDLINE database to identify recent English literature relevant to ML, DL and CNN applications in cystoscopic image recognition. Evidence synthesis In total, two articles and one conference abstract were identified addressing the application of AI methods in cystoscopic image recognition. These investigations showed accuracies exceeding 90% for tumor detection; however, future work is necessary to incorporate these methods into AI-aided cystoscopy and compared to other tumor visualization tools. Furthermore, we present results from the RaVeNNA-4pi consortium initiative which has extracted 4200 frames from 62 videos, analyzed them with the U-Net network and achieved an average dice score of 0.67. Improvements in its precision can be achieved by augmenting the video/frame database. Conclusion AI-aided cystoscopy has the potential to outperform urologists at recognizing and classifying bladder lesions. To ensure their real-life implementation, however, these algorithms require external validation to generalize their results across other data sets.

    更新日期:2020-01-11
  • Long short-term memory artificial neural network model for prediction of prostate cancer survival outcomes according to initial treatment strategy: development of an online decision-making support system
    World J. Urol. (IF 2.761) Pub Date : 2020-01-10
    Kyo Chul Koo, Kwang Suk Lee, Suah Kim, Choongki Min, Gyu Rang Min, Young Hwa Lee, Woong Kyu Han, Koon Ho Rha, Sung Joon Hong, Seung Choul Yang, Byung Ha Chung

    Abstract Purpose The delivery of precision medicine is a primary objective for both clinical and translational investigators. Patients with newly diagnosed prostate cancer (PCa) face the challenge of deciding among multiple initial treatment modalities. The purpose of this study is to utilize artificial neural network (ANN) modeling to predict survival outcomes according to initial treatment modality and to develop an online decision-making support system. Methods Data were collected retrospectively from 7267 patients diagnosed with PCa between January 1988 and December 2017. The analyses included 19 pretreatment clinicopathological covariates. Multilayer perceptron (MLP), MLP for N-year survival prediction (MLP-N), and long short-term memory (LSTM) ANN models were used to analyze progression to castration-resistant PCa (CRPC)-free survival, cancer-specific survival (CSS), and overall survival (OS), according to initial treatment modality. The performances of the ANN and the Cox-proportional hazards regression models were compared using Harrell’s C-index. Results The ANN models provided higher predictive power for 5- and 10-year progression to CRPC-free survival, CSS, and OS compared to the Cox-proportional hazards regression model. The LSTM model achieved the highest predictive power, followed by the MLP-N, and MLP models. We developed an online decision-making support system based on the LSTM model to provide individualized survival outcomes at 5 and 10 years, according to the initial treatment strategy. Conclusion The LSTM ANN model may provide individualized survival outcomes of PCa according to initial treatment strategy. Our online decision-making support system can be utilized by patients and health-care providers to determine the optimal initial treatment modality and to guide survival predictions.

    更新日期:2020-01-11
  • The effect of focus size and intensity on stone fragmentation in SWL on a piezoelectric lithotripter
    World J. Urol. (IF 2.761) Pub Date : 2020-01-10
    Julian Veser, Victoria Jahrreiss, Christian Seitz, Mehmet Özsoy

    Abstract Purpose We aim to analyze the efficacy of different focus sizes and the influence of pulse pressure (intensity) during shock wave lithotripsy (SWL) in terms of stone fragmentation. Methods Combination of three focal sizes (F1 = 2 mm, F2 = 4 mm, F3 = 8 mm) and 11 output pressure settings (intensity 10–20) of a piezoelectric lithotripter (Wolf PiezoLith 3000) were tested on artificial stones (n = 99). The stones were placed within a 2 mm mesh cage. The needed number of shockwaves (SW) to first visible crack, 50% and 100% stone disintegration were recorded. Results Similar number of SW’s were observed until the first crack 10, 11 and 11 SW’s for F1, F2, and F3, respectively (p > 0,05). The median number of SW needed for 50% stone disintegration was 245 for F1 group, 242 for F2 group and 656 for F3 group. F1 vs F2 p = 0.7, F1 vs F3 and F2 vs F3 p < 0.05. Similarly, with larger focus size a higher number of shockwaves were necessary for 100% stone disintegration. 894, 877 and 1708 SW’s for F1, F2 and F3, respectively. Only for F1 vs F3 and F2 vs F3 (all p < 0.05) a statistical difference was observed. These findings were consistent in all different power settings, with an increased difference in lower power levels (≤ 14). Conclusions A smaller focus size, as well as a higher peak pressure results in a more effective stone fragmentation. However, these results need to be confirmed in an in vivo setting with multiple parameters interfering the efficacy, like BMI, respiration or stone migration.

    更新日期:2020-01-11
  • Epidemiology of urological infections: a global burden
    World J. Urol. (IF 2.761) Pub Date : 2020-01-10
    Recep Öztürk, Ahmet Murt

    Abstract Introduction Urinary tract infections (UTIs) are among the most frequent infections in clinical practice worldwide. Their frequency and burden must be higher than available data suggest because they are not among mandatory diseases to be notified. Classification of urinary infections Although there are many different proposals for classifying UTIs, classifications based on acquisition settings and complication status are more widely used. These include community- acquired UTIs (CAUTIs) or healthcare-associated UTIs (HAUTIs) and uncomplicated or complicated UTIs. Epidemiology of urological infections and global burden As the most frequently seen infectious disease, CAUTIs affect more than 150 million people annually. Complicated UTIs in particular constitute a huge burden on healthcare systems as a frequent reason for hospitalization. The prevalence of HAUTIs ranges between 1.4% and 5.1%, and the majority of them are catheter-related UTIs. Community-onset HAUTIs have gained importance in recent years. Conclusion As frequent infectious diseases, UTIs create clinical and economic burdens on healthcare systems, and they also affect quality of life determinants.

    更新日期:2020-01-11
  • Diagnostic ureteroscopy prior to nephroureterectomy for urothelial carcinoma is associated with a high risk of bladder recurrence despite technical precautions to avoid tumor spillage.
    World J. Urol. (IF 2.761) Pub Date : null
    Michael Baboudjian,Khalid Al-Balushi,Floriane Michel,Francois Lannes,Akram Akiki,Sarah Gaillet,Veronique Delaporte,Evelyne Ragni,Harry Toledano,Gilles Karsenty,Dominique Rossi,Cyrille Bastide,Eric Lechevallier,Romain Boissier

    PURPOSE There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. METHODS A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU-23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9-10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. RESULTS Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2-166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU-DFU was an independent predictive factor of BR (OR = 4[1.4-11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). CONCLUSION Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.

    更新日期:2020-01-11
  • Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study.
    World J. Urol. (IF 2.761) Pub Date : null
    Zafer Tandogdu,Bela Koves,Tommaso Cai,Mete Cek,Peter Tenke,Kurt Naber,Florian Wagenlehner,Truls Erik Bjerklund Johansen

    BACKGROUND Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe. METHODS A mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices. RESULTS Bayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data. CONCLUSIONS Our estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.

    更新日期:2020-01-11
  • Simultaneous whole-body PET/MRI with integrated multiparametric MRI for primary staging of high-risk prostate cancer
    World J. Urol. (IF 2.761) Pub Date : 2020-01-06
    Sascha Kaufmann, Stephan Kruck, Sergios Gatidis, Tobias Hepp, Wolfgang M. Thaiss, Jörg Hennenlotter, Johannes Schwenck, Marcus Scharpf, Konstantin Nikolaou, Arnulf Stenzl, Gerald Reischl, Christian la Fougère, Jens Bedke

    Abstract Purpose Whole-body positron emission tomography/magnetic resonance imaging (wbPET/MRI) is a promising diagnostic tool of recurrent prostate cancer (PC), but its role in primary staging of high-risk PC (hrPC) is not well defined. Thus, the aim was to compare the diagnostic accuracy for T-staging of PET-blinded reading (PBR) and PET/MRI. Methods In this prospective study, hrPC patients scheduled to radical prostatectomy (RPx) with extended lymphadenectomy (eLND) were staged with wbPET/MRI and either 68Ga-PSMA-11 or 11C-choline including simultaneous multiparametric MRI (mpMRI). Images were assessed in two sessions, first as PBR (mpMRI and wbMRI) and second as wbPET/MRI. Prostate Imaging Reporting and Data System criteria (PIRADS v2) were used for T-staging. Results were correlated with the exact anatomical localization and extension as defined by histopathology. Diagnostic accuracy of cTNM stage according to PBR was compared to pathological pTNM stage as reference standard. Results Thirty-four patients underwent wbPET/MRI of 68Ga-PSMA-11 (n = 17) or 11C-choline (n = 17). Twenty-four patients meeting the inclusion criteria of localized disease ± nodal disease based on imaging results underwent RPx and eLND, whereas ten patients were excluded from analysis due to metastatic disease. T-stage was best defined by mpMRI with underestimation of tumor lesion size by PET for both tracers. N-stage yielded a per patient sensitivity/specificity comparable to PBR. Conclusion MpMRI is the primary modality for T-staging in hrPC as PET underestimated T-stage in direct comparison to final pathology. In this selected study, cohort MRI shows no inferiority compared to wbPET/MRI considering N-staging.

    更新日期:2020-01-06
  • External validation of Cormio nomogram for predicting all prostate cancers and clinically significant prostate cancers
    World J. Urol. (IF 2.761) Pub Date : 2020-01-06
    Luca Cindolo, Riccardo Bertolo, Andrea Minervini, Francesco Sessa, Gianluca Muto, Pierluigi Bove, Matteo Vittori, Giorgio Bozzini, Pietro Castellan, Filippo Mugavero, Mario Falsaperla, Luigi Schips, Antonio Celia, Maida Bada, Angelo Porreca, Antonio Pastore, Yazan Al Salhi, Marco Giampaoli, Giovanni Novella, Riccardo Rizzetto, Nicoló Trabacchin, Guglielmo Mantica, Giovannalberto Pini, Riccardo Lombardo, Andrea Tubaro, Alessandro Antonelli, Cosimo De Nunzio

    Recently, the Cormio et al. nomogram has been developed to predict prostate cancer (PCa) and clinically significant PCa using benign prostatic obstruction parameters. The aim of the present study was to externally validate the nomogram in a multicentric cohort.

    更新日期:2020-01-06
  • Prognostic significance of pre- and post-treatment PD-L1 expression in patients with primary high-grade non-muscle-invasive bladder cancer treated with BCG immunotherapy
    World J. Urol. (IF 2.761) Pub Date : 2020-01-03
    Ahmet Murat Aydin, Dilek E. Baydar, Berk Hazir, Berrin Babaoglu, Cenk Y. Bilen

    Programmed cell death-1 ligand-1 (PD-L1) expression has been associated with prognostic implications in urologic malignancies. We aimed to investigate prognostic significance of pre- and post-treatment PD-L1 expression in patients treated with BCG for high-grade non-muscle-invasive bladder cancer (NMIBC).

    更新日期:2020-01-04
  • Navigating systemic therapy for metastatic castration-naïve prostate cancer
    World J. Urol. (IF 2.761) Pub Date : 2020-01-02
    E. M. Kwan, I. A. Thangasamy, J. Teh, O. Alghazo, N. J. Sathianathen, N. Lawrentschuk, A. A. Azad

    The last decade has seen a remarkable shift in the treatment landscape of advanced prostate cancer, none more so than in the management of metastatic castration-naïve disease.

    更新日期:2020-01-04
  • Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience
    World J. Urol. (IF 2.761) Pub Date : 2020-01-01
    Michael Daneshvar, Jay Simhan, Stephen Blakely, Javier C. Angulo, Jacob Lucas, Craig Hunter, Justin Chee, Damian Lopez Alvarado, Erick Alejandro Ramirez Perez, Alosh Madala, Juan José de Benito, Francisco Martins, João Felício, Paul Rusilko, Brian J. Flynn, Dmitriy Nikolavsky

    Abstract Purpose To critically evaluate a multi-institutional patient cohort undergoing single-stage distal urethral repair using a novel transurethral buccal mucosa graft inlay urethroplasty technique (TBMGI). Methods A retrospective multi-institutional review of consecutive patients with fossa navicularis (FN) strictures treated with a single-stage TBMGI technique at 12 institutions from March 2014–March 2018 was performed. Patient demographics, stricture characteristics, clinical and patient-reported outcomes were analyzed. The primary outcomes were stricture recurrence and complications. Secondary outcomes were change in maximum urinary flow rate (Qmax), PVR, and changes in IPSS, SHIM and global response assessment (GRA) questionnaire responses. Descriptive statistical analysis was used for evaluation of outcomes. Results Sixty-eight men met inclusion criteria. Median age and stricture length were 60 years (IQR 48–69) and 2 cm (IQR 2–3), respectively. Most common stricture etiology was lichen sclerosus (34%). Median operative time and EBL were 72 min (IQR 50–120) and 20 mL (IQR 10–43), respectively. Fifty-seven men completed ≥ 12-month follow-up. At a median follow-up of 17 months (IQR 13–22), 54 patients (95%) remained stricture-free. Median Qmax improved from 5 to 18 mL/s (p < 0.0001), PVR 76–21 mL (p < 0.0001), and IPSS 15–5 (p < 0.0001); IPSS-QOL score: 5–1 (p < 0.0001). SHIM score did not significantly change following repair (median 22–21 p = 0.85). On GRA assessment, a majority of men reported “marked” (64%) or “moderate” (28%) overall improvement. No patient developed fistula, glanular dehiscence, graft necrosis or chordee. Conclusions This novel minimally invasive transurethral urethroplasty technique is feasible and has demonstrated generalizable outcomes in a multi-institutional cohort with varying etiologies.

    更新日期:2020-01-04
  • Gender-based psychological and physical distress differences in patients diagnosed with non-metastatic renal cell carcinoma
    World J. Urol. (IF 2.761) Pub Date : 2020-01-01
    Rami Ajaj, Jaime Omar Herrera Cáceres, Alejandro Berlin, Christopher J. D. Wallis, Thenappan Chandrasekar, Zachary Klaassen, Ardalan E. Ahmad, Ricardo Leao, Antonio Finelli, Neil Fleshner, Hanan Goldberg

    To analyze gender-based differences in distress symptoms in patients with non-metastatic renal cell carcinoma (RCC) at different stages of disease.

    更新日期:2020-01-04
  • Outcomes of treatment for localized prostate cancer in a single institution: comparison of radical prostatectomy and radiation therapy by propensity score matching analysis
    World J. Urol. (IF 2.761) Pub Date : 2019-12-24
    Narihiko Hayashi, Kimito Osaka, Kentaro Muraoka, Hisashi Hasumi, Kazuhide Makiyama, Keiichi Kondo, Noboru Nakaigawa, Masahiro Yao, Yuki Mukai, Madoka Sugiura, Shoko Takano, Eiko Ito, Hisashi Kaizu, Izumi Koike, Masaharu Hata, Masataka Taguri, Yasuhide Miyoshi, Koji Izumi, Takashi Kawahara, Hiroji Uemura

    Abstract Objectives To compare the outcomes of radical prostatectomy (RP), intensity-modulated radiation therapy (IMRT), and low-dose-rate brachytherapy (BT) using propensity score matching analysis in patients with clinically localized prostate cancer. Methods A group of 2273 patients with clinically localized prostate cancer between January 2004 and December 2015 at the Yokohama City University hospital were identified. The records of 1817 of these patients, who were followed up for a minimum of 2 years, were reviewed; 462 were treated with RP, 319 with IMRT, and 1036 with BT. The patients were categorized according to the National Comprehensive Cancer Network risk classification criteria, and biochemical outcomes and overall survival rates were examined. Biochemical failure for RP was defined as prostate-specific antigen (PSA) levels > 0.2 ng/ml, and for IMRT and BT as nadir PSA level + 2 ng/ml. Propensity scores were calculated using multivariable logistic regression based on covariates, including the patient's age, preoperative PSA, Gleason score, number of positive cores, and clinical T stage. Results Median follow-up was 77 months for the RP, 54 months for IMRT, and 66 months for BT patients. After the propensity scores were adjusted, a total of 372 (186 each) and 598 (299 each) patients were categorized into RP vs IMRT and RP vs BT groups, respectively. Kaplan–Meier analysis did not show any statistically significant differences in terms of overall survival rate between these groups (RP vs IMRT: p = 0.220; RP vs BT: p = 0.429). IMRT was associated with improved biochemical failure-free survival compared to RP in all risk groups (high-risk: p < 0.001; intermediate-risk: p = 0.009; low-risk: p = 0.001), whereas significant differences were observed only in the intermediate-risk group (p = 0.003) within the RP vs BT group. Conclusion The results of our propensity score analysis of mid-term localized prostate cancer treatment outcomes demonstrated no significant differences in the overall survival rate. Despite the difference in biochemical failure definition between surgery and radiotherapeutic approaches, the results of this study demonstrate improved biochemical control favoring IMRT and BT as compared to RP.

    更新日期:2020-01-04
  • Influence of regular aspirin intake on PSA values, prostate cancer incidence and overall survival in a prospective screening trial (ERSPC Aarau)
    World J. Urol. (IF 2.761) Pub Date : 2019-12-21
    Lukas Werner Prause, Lukas Manka, Christopher Millan, Elena Lang, Stephen F. Wyler, Rainer Grobholz, Angelika Hammerer-Lercher, Tullio Sulser, Franz Recker, Maciej Kwiatkowski, Daniel Eberli

    Abstract Objectives To analyze the influence of aspirin (ASA) intake on PSA values and prostate cancer (PCa) development in a prospective screening study cohort. Methods 4314 men from the Swiss section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were included. A transrectal prostate biopsy was performed in men with a PSA level ≥ 3 ng/ml. Mortality data were obtained through registry linkages. PCa incidence and grade, total PSA, free-to-total PSA and overall survival were compared between ASA users and non-users. Results Median follow-up time was 9.6 years. In 789 men (18.3%) using aspirin [ASA +], the overall PCa incidence was significantly lower (6.8% vs. 9.6%, p = 0.015), but the multivariate Cox regression analysis showed no significant decrease in risk of PCa diagnosis (HR 0.84, p = 0.297). Total PSA values were significantly lower in ASA users for both baseline (1.6 vs. 1.8 ng/ml, p = 0.007) and follow-up visits (1.75 vs. 2.1 ng/ml, p < 0.001). Multivariate Cox regression analysis predicted significantly higher overall mortality risk among ASA users (HR 1.46, p = 0.009). Conclusions In our study population, PCa incidence was significantly reduced among patients on aspirin. While we did not observe a statistically significant PCa risk reduction during the follow-up period, we found lower PSA values among ASA users compared to non-users, with a more distinct difference after 4 years of ASA intake, suggesting a cumulative effect and a potential protective association between regular ASA intake and PCa development. As for clinical practice, lowering PSA cutoff values by 0.4 ng/ml could be considered in long-term ASA users to avoid a potential bias towards delayed PCa detection.

    更新日期:2020-01-04
  • Decreased accuracy of the prostate cancer EAU risk group classification in the era of imaging-guided diagnostic pathway: proposal for a new classification based on MRI-targeted biopsies and early oncologic outcomes after surgery
    World J. Urol. (IF 2.761) Pub Date : 2019-12-14
    Guillaume Ploussard, Cécile Manceau, Jean-Baptiste Beauval, Marine Lesourd, Christophe Almeras, Jean-Romain Gautier, Guillaume Loison, Ambroise Salin, Michel Soulié, Christophe Tollon, Bernard Malavaud, Mathieu Roumiguié

    To assess the performance of EAU risk classification in PCa patients according to the biopsy pathway (standard versus MRI guided) and to develop a new, more accurate, targeted biopsy (TB)-based classification.

    更新日期:2020-01-04
  • Contemporary application of autologous muscle-derived cells for urinary sphincter regeneration
    World J. Urol. (IF 2.761) Pub Date : 2019-12-13
    Melissa R. Kaufman

    Abstract Objective Stress urinary incontinence (SUI) remains a prevalent condition with substantial economic and quality-of-life impact. Treatment for incontinence historically culminates with invasive surgical procedures with recognized complication profiles. Innovative directions for SUI therapeutics are on the horizon, including the utilization of adult autologous muscle-derived cells for urinary sphincter regeneration (AMDC-USR). Herein, we visit fundamental concepts of innovative regenerative medicine technologies for urologic applications. Methods Synopsis of contemporary literature review regarding adult autologous muscle-derived cells for urinary sphincter regeneration is presented. Results Current published literature presents safety and efficacy data regarding AMDC-USR injection in 80 patients at 12-month follow-up. In these early studies, no long-term adverse events were reported and patients undergoing cellular injection at higher doses revealed at least 50% reduction in stress leaks and pad weight at 12-month follow-up. All dose groups demonstrated statistically significant improvement in patient-reported incontinence-specific quality-of-life scores at 12-month follow-up. Conclusions from the pooled analyses indicate that injection of AMDC-USR across a range of dosages appears safe. Efficacy data suggest a dose response with more patients responsive to the higher doses of AMDC-USR. Conclusion Applications for utilization of autologous cellular therapies for treatment of SUI, and conceivably multiple additional indications, are approaching realization. Multiple Phase III randomized, placebo-controlled studies for AMDC-USR are concluding or ongoing to launch this regenerative option for the millions of patients who may ultimately benefit.

    更新日期:2020-01-04
  • Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey
    World J. Urol. (IF 2.761) Pub Date : 2019-12-13
    F. A. Distler, S. Pahernik, G. Gakis, G. Hutterer, S. Lebentrau, M. Rink, P. Nuhn, S. Brookman-May, M. Burger, C. Gratzke, I. Wolff, M. May

    To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence.

    更新日期:2020-01-04
  • Correction to: Evidence-based approach to active surveillance of prostate cancer
    World J. Urol. (IF 2.761) Pub Date : 2019-12-12
    Luke Witherspoon, Rodney H. Breau, Luke T. Lavallée

    Correction to: In the original publication of the article, the values in the columns “Gleason Score” and “Clinical Stage” under the section Urologic Organization.

    更新日期:2020-01-04
  • The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy
    World J. Urol. (IF 2.761) Pub Date : 2019-12-11
    Zewu Zhu, Yu Cui, Huimin Zeng, Yongchao Li, Feng Zeng, Yang Li, Zhiyong Chen, Chen Hequn

    Abstract Purpose To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). Methods A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. Results Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75–45.38, P < 0.001) and operative time > 120 min (OR 3.53, 95% CI 1.41–8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. Conclusions In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.

    更新日期:2020-01-04
  • An updated meta-analysis of prostatic arterial embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia
    World J. Urol. (IF 2.761) Pub Date : 2019-12-07
    Xin jian Xu, Jingjing Li, Xiang zhong Huang, Qiang Liu

    Abstract Objective To investigate whether prostatic arterial embolization (PAE) could be recommended as a routine therapy for benign prostatic hyperplasia (BPH), we conducted an updated meta-analysis to assess the efficacy and safety of PAE compared with transurethral resection of the prostate (TURP). Methods Systematic literature retrieval by searching data from Web of science, Pubmed, Embase, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP databases was carried out to identify all related trials from the inception dates to June 2019. We also conducted subgroup analyses depending on the kind of study design, kind of PAE and kind of TURP. Results Nine studies comparing PAE with TURP involving a total of 860 BPH patients were selected. Postoperative reduced IPSS score (MD 2.50; 95% CI 0.78–4.21; P = 0.004), postoperative reduced QOL score (MD 0.40; 95% CI 0.09–0.71; P = 0.01), postoperative reduced PV (MD 8.59; 95% CI 4.74–12.44; P < 0.00001) and postoperative increased Qmax (MD 2.54; 95% CI 1.02–4.05; P = 0.001) were better in TURP than in PAE; however, PAE was associated with lower sexual dysfunction rate (OR 0.24; 95% CI 0.15–0.39; P < 0.00001) compared with TURP. Meanwhile, no significant difference in postoperative reduced PVR (MD 0.46; 95% CI − 2.08 to 3.00; P = 0.72) and complication (OR 0.57; 95% CI 0.21–1.55; P = 0.27) between PAE and TURP group was demonstrated. Conclusion PAE was inferior to TURP in the improvement of postoperative IPSS, QOL, PV, Qmax and TURP still remained the gold standard. However, PAE may be a valuable alternative to TURP in the treatment of BPH patients who refuse surgery or with surgery contraindication.

    更新日期:2020-01-04
  • Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials
    World J. Urol. (IF 2.761) Pub Date : 2019-12-07
    Gautier Müllhaupt, Lukas Hechelhammer, Pierre-André Diener, Daniel S. Engeler, Sabine Güsewell, Hans-Peter Schmid, Livio Mordasini, Dominik Abt

    This study aims to specify and explain the previous findings of unexpectedly high rates of ejaculatory disorders, i.e. 56%, found after prostatic artery embolization (PAE) in a randomized controlled trial comparing safety and efficacy of PAE and transurethral resection of the prostate (TURP).

    更新日期:2020-01-04
  • Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10–20 mm lower pole renal stones: a systematic review and meta-analysis
    World J. Urol. (IF 2.761) Pub Date : 2019-12-07
    José D. Cabrera, Braulio O. Manzo, José E. Torres, Fabio C. Vicentini, Héctor M. Sánchez, Ernesto A. Rojas, Edgard Lozada

    To compare the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) versus retrograde intrarenal surgery (RIRS) for treatment of 10–20 mm lower pole renal stones.

    更新日期:2020-01-04
  • Energy output modalities of shockwave lithotripsy in the treatment of urinary stones: escalating or fixed voltage? A systematic review and meta-analysis
    World J. Urol. (IF 2.761) Pub Date : 2019-12-07
    Zihao He, Tuo Deng, Shanfeng Yin, Zihao Xu, Haifeng Duan, Yeda Chen, Xiaolu Duan, Guohua Zeng

    To compare the effectiveness and safety of escalating and fixed energy output modalities of shockwave lithotripsy (SWL) in the treatment of urinary stones.

    更新日期:2020-01-04
  • The evolution and resurgence of perineal prostatectomy in the robotic surgical era
    World J. Urol. (IF 2.761) Pub Date : 2019-12-06
    Juan Garisto, Riccardo Bertolo, Clark A. Wilson, Jihad Kaouk

    Abstract Purpose To review the recent advances in terms of surgical technique and new robotic platforms applied to radical perineal prostatectomy (RPP). Methods A literature review was performed focusing on original articles on perineal prostatectomy searching via Medline/Pubmed and Embase. The entire spectrum was covered such as development of surgical technique including pelvic lymphadenectomy, adoption of novel surgical platforms, learning curve and future directions. Results Surgical removal of the prostate plays a significant role on the treatment of localized prostate cancer (PCa). RPP was the first surgical approach described for radical prostatectomy. This technique declined in popularity secondary to the development of the retropubic approach. Recently, the appearance of novel robotic technology has generated renewed interest in the perineal approach. Conclusion There has been a recent resurgence on the interest of radical perineal prostatectomy for the treatment of localized PCa driven by the advent of new robotic surgical technologies into the field. Future studies are needed to better determine the learning curve of the perineal approach and its current role in the treatment of prostate cancer.

    更新日期:2020-01-04
  • Serum sphingosine-1-phosphate levels in bladder pain syndrome/interstitial cystitis patients: could it help in diagnosis?
    World J. Urol. (IF 2.761) Pub Date : null
    Tariq Asi,Ahmet Asci,Mesut Altan,Ahmet Gudeloglu,Ali Ergen

    PURPOSE To find if there is any potential benefit of serum Sphingosine-1-Phosphate (S1P) level in the diagnosis of Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC). METHODS AND MATERIALS Patients newly or previously diagnosed with BPS/IC between September 2017 and December 2018 were included. Healthy individuals who volunteered to enter the study were included as control group. The measurements of serum S1P in both groups were compared. Multiple regression analysis was conducted to find out the significant factors affecting S1P results. RESULTS A total of 47 BPS/IC patients and 47 healthy controls were included. BPS/IC patients were older than controls (48.5 ± 12.4 vs 38.9 ± 8.1 years, p < 0.001). The female-to-male ratio was 46/1 for patient group and 29/18 for controls. 68.1% (32/47) of BPS/IC patients had previous treatments. 55.3%(26/47) of patient group had accompanying medical or psychiatric disease. The mean serum S1P level was notably elevated in BPS/IC group (median 213.6, mean ± SD 258.9 ± 167.2 vs median 125.4, mean ± SD 142.9 ± 54.8; p < 0.001). Using ROC curve analysis, a value of 165 was a good cutoff point between patient and control groups (AUC = 0.761, p < 0.001). On multiple regression analysis, being BPS/IC patient was the only significant predictor of a serum S1P level above the cutoff point documented on ROC analysis (OR 5.9; 95% CI 1.8-19.9; p = 0.004). CONCLUSION Sphingosine-1-phosphate (S1P) pathway seems to have a potential role in the pathogenesis of BPS/IC. High serum S1P level might support the diagnosis of BPS/IC.

    更新日期:2019-11-01
  • High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration.
    World J. Urol. (IF 2.761) Pub Date : null
    Jennifer N Walker,Ana L Flores-Mireles,Aaron J L Lynch,Chloe Pinkner,Michael G Caparon,Scott J Hultgren,Alana Desai

    PURPOSE Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity worldwide, as they account for 40% of all hospital-associated infections. Microbial biofilm formation on urinary catheters (UCs) limits antibiotic efficacy, making CAUTI extremely difficult to treat. To gain insight into the spatiotemporal microbe interactions on the catheter surface we sought to determine how the presence or absence of bacteriuria prior to catheterization affects the organism that ultimately forms a biofilm on the UC and how long after catheterization they emerge. METHODS Thirty UCs were collected from patients who received a urine culture prior to catheterization, a UC, and antibiotics as part of standard of care. Immunofluorescence imaging and scanning electron microscopy were used to visualize patient UCs. RESULTS Most patients did not have bacteria in their urine (based on standard urinalysis) prior to catheterization, yet microbes were detected on the majority of UCs, even with dwell times of < 3 days. The most frequently identified microbes were Staphylococcus epidermidis, Enterococcus faecalis, and Escherichia coli. CONCLUSIONS This study indicates that despite patients having negative urine cultures and receiving antibiotics prior to catheter placement, microbes, including uropathogens associated with causing CAUTI, could be readily detected on UCs with short dwell times. This suggests that a potential microbial catheter reservoir can form soon after placement, even in the presence of antibiotics, which may serve to facilitate the development of CAUTI. Thus, removing and/or replacing UCs as soon as possible is of critical importance to reduce the risk of developing CAUTI.

    更新日期:2019-11-01
  • Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy.
    World J. Urol. (IF 2.761) Pub Date : null
    Kashyap Shatagopam,Clinton D Bahler,Chandru P Sundaram

    PURPOSE The role of robotic partial nephrectomy (RPN) is becoming increasingly prevalent in managing small renal masses. Renal functional outcomes have been reported with relation to the amount of healthy renal parenchyma resected and ischemia time; however, there is limited data on the effect of renorrhaphy on long-term renal function. Our aim is to evaluate the impact of renorrhaphy technique on renal functional outcomes. METHODS A nonsystematic literature review was performed to retrieve articles assessing renorrhaphy techniques and renal function outcomes, specifically focusing on single-layer vs. traditional two-layer renorrhaphy. RESULTS Performing single-layer renorrhaphy while omitting cortical renorrhaphy appears to improve renal function postoperatively, based on very limited studies in the literature that were evaluated. CONCLUSION Single-layer renorrhaphy may be associated with improved postoperative renal function and could prove to be useful in patients with chronic renal insufficiency or solitary kidney. The ongoing clinical trial NCT02131376 may provide further information on the impact of renorrhaphy technique on long-term renal function.

    更新日期:2019-11-01
  • Urogenital infections.
    World J. Urol. (IF 2.761) Pub Date : null
    Florian Wagenlehner

    更新日期:2019-11-01
  • Histologic characterization of the post-radiation urethral stenosis in men treated for prostate cancer.
    World J. Urol. (IF 2.761) Pub Date : 2019-12-02
    M Hughes,T Caza,Guanqun Li,M Daugherty,S Blakley,D Nikolavsky

    PURPOSE To evaluate histological changes in stenotic urethral tissue post-radiation therapy. Treatment of prostate cancer by radiation therapy carries a risk of off-target injury to the membranous urethra causing urethral stenosis. Limited characterization of post-radiation urethral stenosis exists in the literature. We hypothesize that specific histopathologic parameters distinguish this stricture etiology. METHODS Eighty-two consecutive patients with membranous urethral stenosis underwent urethroplasty between 2013 and 2018. Seventy specimens (86.4%) were available for evaluation: 51 from patients without radiation exposure and 19 from patients with history of radiation therapy for prostate cancer. All specimens were reviewed by a pathologist blinded to patient/stricture information. Histological scoring system was used for the quantification of collagen density, collagen organization, hyalinized fibrosis, vascular density, spindle-cell change, necrosis, hemorrhage, fat entrapment, vacuolation, acute and chronic inflammation, and foreign-body giant cells. Differences in histologic outcomes between groups were statistically analyzed. RESULTS Post-radiation specimens had a higher collagen density (p = 0.01), higher collagen organization (p = 0.001), increased hyalinized fibrosis (p = 0.03), fat entrapment (p = 0.005) and spindle cell change (p = 0.005) when compared to membranous specimens without prior exposure to radiation. Post-radiation specimens also had a significantly decreased vascularity compared to specimens of non-radiated etiology (p = 0.0005). Fibrous connective tissue degenerative change with vacuolation was pronounced in post-radiation specimens and seldom seen in those without radiation (p = 0.0001). CONCLUSIONS Membranous urethral stenosis following radiation demonstrates specific histologic characteristics including vascular loss and increased scarring (collagen density, organization). This histologic grading system may be used in grading severity of radiation damage, and conceivably adopted for correlation with clinical outcomes.

    更新日期:2019-11-01
  • Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options.
    World J. Urol. (IF 2.761) Pub Date : 2019-12-02
    Valentin Zumstein,Roland Dahlem,Valentin Maurer,Phillip Marks,Luis A Kluth,Clemens M Rosenbaum,Tim A Ludwig,Christian P Meyer,Silke Riechardt,Oliver Engel,Margit Fisch,Malte W Vetterlein

    OBJECTIVES To describe the operative technique and report outcomes from the largest series of patients who underwent single-stage dorsal inlay buccal mucosal graft urethroplasty (BMGU) for isolated meatal stenoses and fossa navicularis strictures. PATIENTS AND METHODS First, we evaluated patients who underwent single-stage BMGU for distal urethral strictures (meatus and fossa navicularis) between 2009 and 2016 at our department. Clinical and surgical characteristics were prospectively collected in an institutional database. Recurrence was defined as symptomatic need of any instrumentation during follow-up, was retrospectively assessed by patient interview, and recurrence-free survival was plotted using Kaplan-Meier curves. Second, a systematic literature review was performed through Medline to summarize the available evidence on distal urethroplasty using flaps or grafts. RESULTS Of 32 patients, 16 (50%) presented with a hypospadias-associated stricture, followed by seven (22%), five (16%), and four (13%) patients with iatrogenic, inflammatory, and congenital strictures, respectively. At a median follow-up of 42 months (IQR 23-65), single-stage dorsal inlay BMGU was successful in 22 patients (69%), and estimated recurrence-free survival rates were 79% and 74% at 12 and 24 months, respectively. Overall, 62 patients from five studies in the literature review underwent BMGU for isolated distal strictures and success rates ranged from 56 to 100%. CONCLUSION Recurrent meatal stenoses and fossa navicularis strictures represent some of the most complex uro-reconstructive challenges. Inlay BMGU proves to be a valid and efficient last-resort single-stage technique. However, higher recurrence risk must be considered and staged urethroplasty should be discussed individually. Prospective randomized controlled trials are needed to prove the superiority of flaps, grafts or staged approaches over each other in this context.

    更新日期:2019-11-01
  • Salvage topical therapy for upper tract urothelial carcinoma.
    World J. Urol. (IF 2.761) Pub Date : 2018-05-29
    Adithya Balasubramanian,Michael J Metcalfe,Gavin Wagenheim,Lianchun Xiao,John Papadopoulos,Neema Navai,John W Davis,Jose A Karam,Ashish M Kamat,Christopher G Wood,Colin P Dinney,Surena F Matin

    PURPOSE Topical therapy (TT) for upper tract urothelial carcinoma (UTUC) has been explored as a kidney sparing approach to treat carcinoma in situ (CIS) and as adjuvant for endoscopically treated Ta/T1 tumors. In bladder cancer, data support use of salvage TT for repeat induction. We investigate the outcomes of salvage TT for UTUC in patients ineligible for or refusing nephroureterectomy. METHODS A single-center retrospective review on patients receiving salvage TT via percutaneous nephrostomy tube or cystoscopically placed ureteral catheters was performed. Primary outcome was response to therapy based on International Bladder Cancer Group criteria. RESULTS 51 patients with 58 renal units (RUs) received TT. Of these, 17 patients with 18 RUs received the second-line TT, with a median follow-up of 36.5 months (IQR 24.5-67 months). 44% (8/18) received salvage TT for refractory disease and 56% (10/18) as reinduction. 5 RUs with CIS were unresponsive to initial TT and went on to receive salvage TT, of which 20% (1/5) responded. 13 RUs recurred or relapsed following initial TT and received salvage TT for papillary tumors, with 62% (8/13) responding. CONCLUSION Our data provide preliminary clinical rationale for the second-line TT for refractory and recurrent, endoscopically managed papillary UTUC in patients ineligible for or refusing nephroureterectomy. However, refractory upper tract CIS appears to have poor response to salvage TT.

    更新日期:2019-11-01
  • Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases.
    World J. Urol. (IF 2.761) Pub Date : null
    Mitsuru Komeya,Hisakazu Odaka,Jun Asano,Takuo Asai,Yusuke Saigusa,Takehiko Ogawa,Masahiro Yao,Junichi Matsuzaki

    PURPOSE To identify risk factors by developing and internally validating a nomogram for preventing perioperative complications in overnight ureteral catheterization cases after fURS for kidney stones. METHODS We retrospectively examined 309 patients with overnight ureteral catheterization after single fURS procedures for renal stones. fURS procedures were performed based on the fragmentation technique. The ureteral catheter was removed on postoperative day 1. Within this group, patients who experienced perioperative complications (complication group) were compared with those who did not experience complications (non-complication group). The complication group included 77 patients whose Clavien-Dindo classification score was I, II, III, or IV and/or those whose body temperature during hospitalization was over 37.5 °C. RESULTS The overall stone volume, stone-free rate, incidence of perioperative complications, and procedure duration were 1.39 mL, 94.8%, 24.9%, and 62 min, respectively. Severe complications of a Clavien-Dindo level III or IV were observed in only four cases (1.3%). Multivariate assessment revealed five independent predictors of perioperative complications after fURS with overnight catheterization: age (p = 0.11), sex (p = 0.067), stone volume (p = 0.33), Hounsfield units (p = 0.16), and narrow ureter (p = 0.018). We developed a nomogram to predict perioperative complications after fURS using these parameters. CONCLUSIONS We developed a predictive model for perioperative complications of patients with overnight catheterization after fURS for renal stones. This model could select patients who were at a low risk of complications.

    更新日期:2019-11-01
  • The fate of urological systematic reviews registered in PROSPERO.
    World J. Urol. (IF 2.761) Pub Date : null
    Sari Khaleel,Brent Cleveland,Arveen Kalapara,Niranjan Sathianathen,Priyamvadha Balaji,Philipp Dahm

    PURPOSE To identify urologic systematic reviews (SRs) registered to PROSPERO that resulted in a publication, and to evaluate their methodological quality and concordance with their stated a priori protocols. METHODS We searched PubMed to identify urologic SR protocols registered in PROSPERO that resulted in a publication and assessed their methodological quality and protocols in relation to their stated a priori protocols in PROSPERO. RESULTS Of the 576 urologic SR protocols registered in PROSPERO up to December 2017, 201 (34.9%) resulted in a full SR publication, but only 40 (17.7%) updated their registration record accordingly. Publications were spread over 100 different journals, with a median time-to-publication of 29 months (95% CI 25.0-33.0). The most common topic by far was prostate cancer (59.7%), followed by voiding issues (15.3%), and renal transplantation (15.3%). Only little over half the reviews (52.74%) explicitly stated primary outcome(s) that matched the primary outcome of their corresponding PROSPERO protocol. Notable methodologic deviations from registered protocols included planned restriction on study design (33%), heterogeneity analysis (42%) and planned risk of bias analysis (65.2%). CONCLUSION SR authors in urology are increasingly using PROSPERO to register their titles, but our findings indicate that registration alone is not a guarantor of a high-quality SR product. There appears to be a critical need to raise the bar for review authors registering protocols in PROSPERO, with an emphasis on transparency in their publication status updates as well as deviations from their a priori protocols.

    更新日期:2019-11-01
  • The impact of age at orchiopexy on testicular cancer outcomes.
    World J. Urol. (IF 2.761) Pub Date : null
    Margaret Higgins,Derek E Smith,Dexiang Gao,Duncan Wilcox,Nicholas G Cost,Amanda F Saltzman

    PURPOSE To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age. METHODS This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0-6 years, 7-9 years, 10-12 years, 13-15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes. RESULTS For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age. CONCLUSION While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities.

    更新日期:2019-11-01
  • Extirpative renal surgery volume in training: different roads to the (same?) destination.
    World J. Urol. (IF 2.761) Pub Date : null
    Madison Lyon,Nicholas G Cost,Randall Meacham,Amanda F Saltzman

    PURPOSE To describe the overall extirpative renal surgery (ERS) training volume reported by PU and PS. METHODS Case log data from the Accreditation Council for Graduate Medical Education (ACGME) was examined from 2013-2016 for surgery residents (Sres), urology residents (Ures), pediatric surgery fellows (PSfel) and pediatric urology fellows (PUfel). Case log information for all levels of participation over all case categories that could potentially offer ERS volume were recorded. Volume was estimated using the mean number of included cases during residency and fellowship and the sum was used to estimate total training volume. Volume between groups was compared using the student's t test. RESULTS Case logs were included for 4447 residents (4259 Sres, 840 Ures) and fellows (188 PSfel, 71 PUfel). Mean PU volume was 113.1, which was higher than the mean PS volume of 10.3 (p < 0.001). For PU, more ERS were performed during residency than fellowship (p < 0.001). For PS the opposite was true (p < 0.001). When examining fellow training only, PUfel performed more ERS than PSfel (11.7 vs. 7.0 p < 0.001). CONCLUSION While previous publications note similar short-term outcomes for ERS for malignancy for PU and PS, ERS case volume during training is significantly different. Review of recent ACGME data indicate that PU have more overall experience with ERS, with most gained during residency. Additionally, PUfel performed significantly more ERS than PSfel. Further study into how these training differences affect long-term outcomes is necessary.

    更新日期:2019-11-01
  • Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures.
    World J. Urol. (IF 2.761) Pub Date : null
    Christopher G Keith,Michael T Davenport,Mehraban Kavoussi,Yooni A Yi,Rachel L Bergeson,Allen F Morey

    PURPOSE To present our experience with excision and primary anastomosis (EPA) of radiation-induced urethral strictures (RUS) in men, including risk factors for stricture recurrence and long-term recurrence rates. METHODS A retrospective review was performed of patients who underwent EPA of RUS between 2007 and 2018 at a single tertiary referral center. Demographic information, stricture location and length, complications, and stricture recurrence were analyzed. Univariate and multivariate Cox regression analyses were performed to identify variables impacting recurrence. RESULTS EPA was performed in 116 patients with RUS. The majority of patients (86.2%, 100/116) underwent at least one prior urologic intervention. Mean stricture length was 2.3 cm. Stricture recurrence occurred in 19.0% (22/116) at a mean of 8.6 months. For patients with at least 1 year of postoperative follow-up (mean 30.7 months), stricture recurrence significantly increased to 36.6% (15/41; p = 0.03). On univariate and multivariate analyses, postoperative complications were associated with stricture recurrence (p < 0.001). CONCLUSION EPA remains a viable option for men with RUS. Nearly two-thirds of RUS patients remain recurrence-free with long-term follow-up following EPA.

    更新日期:2019-11-01
  • Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer.
    World J. Urol. (IF 2.761) Pub Date : 2019-05-13
    Joanne Nyaboe Nyarangi-Dix,Georgi Tosev,Ivan Damgov,Philipp Reimold,Cem Aksoy,Gencay Hatiboglu,Dogu Teber,Josef Mansour,Franklin Emmanuel Kuehhas,Jan Philipp Radtke,Markus Hohenfellner

    PURPOSE To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70 years. METHODS Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D'Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models. RESULTS Median age in the age group ≥ 70 years was 73 years compared with 62 years in the < 70 year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36 months after surgery of men aged ≥ 70 years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70 years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery. CONCLUSIONS Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12 months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.

    更新日期:2019-11-01
  • Oral quality of life after buccal mucosal graft harvest for substitution urethroplasty. More than a bite?
    World J. Urol. (IF 2.761) Pub Date : 2018-06-23
    E Morán,M A Bonillo,L Fernández-Estevan,E Martínez-Cuenca,S Arlandis,E Broseta,F Boronat

    INTRODUCTION The aim of our study was to analyze the oral quality of life (QoL) in patients with urethral stricture treated with BMG by using a validated questionnaire (OIDP). MATERIALS AND METHODS A prospective, single-arm, observational single-centre study of a cohort of patients scheduled for BMG Urethroplasty was conducted. OIDP assesses the impact of oral conditions on daily activities including an oral QoL question (0-10). The questionnaire was self-administered before, 3 months postoperatively and at the end of the study. Means, pre- and postoperatively, were compared. Multivariate analysis was performed to analyze the risk factors for a low quality of life (<8) after surgery. RESULTS We included 41 patients (2013-2017). The mean preoperative oral QoL was 9.33 points (SD1.16). Preoperative mean OIDP dimensional score and global score were 0,5 (SD:0.02) and 0,8%. The most frequently preoperative altered aspect was hygiene. Mean oral QoL, 3 months after surgery, was 8,56 (SD1.89) and OIDP dimensional score and global score were 0,67 (SD0.21) and 1,1%. Mean oral QoL at the end of the study (mean 3,12 years) was 8,50 (SD1.13). OIDP dimensional score and global score were 0,7 (SD 0.16) and 1,1%.The most frequently altered aspect at the end of the study was eating. No statistical (p = 0.07) decrease in oral QoL was found. The increase in OIDP dimensional and global score was also not statistically significant. Neither age nor smoking, diabetes mellitus, cardiovascular morbidity, previous OIDP score, width, length of the graft, or surgery success could explain a low oral QoL alter graft harvesting. CONCLUSIONS BMG harvesting is not free of problems at the donor site. Eating seems to be the most affected aspect after surgery. Nevertheless, those sequelae do not induce a reduction in oral QoL.

    更新日期:2019-11-01
  • How to implement the requirements of a quality assurance system for prostate cancer.
    World J. Urol. (IF 2.761) Pub Date : null
    Barbara Noris Chiorda,Fabiana Zollo,Tiziana Magnani,Fabio Badenchini,Lucia Gatto,Melanie Claps,Alberto Macchi,Laure Andreoli,Nicola Nicolai,Sergio Villa,Riccardo Valdagni

    PURPOSE In 2003, the German Cancer Society (Deutsche Krebsgesellschaft, DKG) launched a certification program aimed at improving the quality of cancer care. The purpose of this article is to describe the experience of the Prostate Cancer Unit (PCU) at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, in the process towards DKG certification. METHODS In 2018, PCU decided to apply for certification by adopting DKG catalogue of requirements (CoR) and quality indicators. A multiprofessional working group was established with the aim of acting the necessary steps to meet DKG standards. RESULTS Our organizational setting (procedures, personnel) and activities were accurately analyzed, thus outlining strengths and weaknesses, and modified to comply with DKG CoR and indicators. As examples, (1) a quality management plan was developed; (2) measures were taken to strengthen the surgical expertise; (3) cases evaluated in weekly tumor boards were expanded to include surgical cases with pathological risk factors, metastatic, relapsed and castration-resistant patients; (4) a survey was added to the patient-dedicated initiatives already scheduled; (5) the TuDoc software became the tool to register all new cases of prostate cancer patients referred to PCU. CONCLUSIONS The process of certification requires many efforts but represents a unique opportunity of improving quality of care of prostate cancer patients, making it comparable on an international scale.

    更新日期:2019-11-01
  • Artificial intelligence and robotics: a combination that is changing the operating room.
    World J. Urol. (IF 2.761) Pub Date : null
    Iulia Andras,Elio Mazzone,Fijs W B van Leeuwen,Geert De Naeyer,Matthias N van Oosterom,Sergi Beato,Tessa Buckle,Shane O'Sullivan,Pim J van Leeuwen,Alexander Beulens,Nicolae Crisan,Frederiek D'Hondt,Peter Schatteman,Henk van Der Poel,Paolo Dell'Oglio,Alexandre Mottrie

    PURPOSE The aim of the current narrative review was to summarize the available evidence in the literature on artificial intelligence (AI) methods that have been applied during robotic surgery. METHODS A narrative review of the literature was performed on MEDLINE/Pubmed and Scopus database on the topics of artificial intelligence, autonomous surgery, machine learning, robotic surgery, and surgical navigation, focusing on articles published between January 2015 and June 2019. All available evidences were analyzed and summarized herein after an interactive peer-review process of the panel. LITERATURE REVIEW The preliminary results of the implementation of AI in clinical setting are encouraging. By providing a readout of the full telemetry and a sophisticated viewing console, robot-assisted surgery can be used to study and refine the application of AI in surgical practice. Machine learning approaches strengthen the feedback regarding surgical skills acquisition, efficiency of the surgical process, surgical guidance and prediction of postoperative outcomes. Tension-sensors on the robotic arms and the integration of augmented reality methods can help enhance the surgical experience and monitor organ movements. CONCLUSIONS The use of AI in robotic surgery is expected to have a significant impact on future surgical training as well as enhance the surgical experience during a procedure. Both aim to realize precision surgery and thus to increase the quality of the surgical care. Implementation of AI in master-slave robotic surgery may allow for the careful, step-by-step consideration of autonomous robotic surgery.

    更新日期:2019-11-01
  • The BET-inhibitor PFI-1 diminishes AR/AR-V7 signaling in prostate cancer cells.
    World J. Urol. (IF 2.761) Pub Date : 2018-06-24
    Marie C Hupe,M Raschid Hoda,Friedemann Zengerling,Sven Perner,Axel S Merseburger,Marcus V Cronauer

    OBJECTIVE The bromodomain and extra-terminal (BET) family of proteins provides a scaffolding platform for the recruitment and tethering of transcription factors to acetylated chromatin, thereby modulating gene expression. In this study, we evaluated the efficacy of the BET-inhibitor PFI-1 to diminish AR/AR-V7 signaling and proliferation in castration-resistant prostate cancer cells. METHODS Prostate-specific antigen and androgen receptor (AR) protein were quantified by means of two commercial ELISAs. Transactivation of the AR, AR-V7 and Q641X was determined by reporter gene assays. Cell proliferation was measured using a colorimetric MTT-assay. RESULTS PFI-1 dose-dependently inhibited transactivation of full-length AR (non- mutated, i.e., wild-type or point-mutated/promiscuous forms) without affecting their cellular protein levels. Moreover, PFI-1 was active against C-terminally truncated constitutively active ARs like AR-V7 and Q641X. Prostate cancer cells exhibiting a transcriptionally active AR-signaling complex (LNCaP, 22Rv1) were more susceptible to the growth-inhibitory effects than the AR-negative PC-3 cells. CONCLUSION The quinazolinone PFI-1 is a highly efficient inhibitor of AR-signaling-competent prostate cancer cells in vitro. PFI-1 could serve as a lead compound for the development of new therapeutics able to block AR/AR-V7 signaling in advanced prostate cancer.

    更新日期:2019-11-01
  • Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases.
    World J. Urol. (IF 2.761) Pub Date : null
    Alessandro Veccia,Alessandro Antonelli,Simone Francavilla,Claudio Simeone,Georgi Guruli,Homayoun Zargar,Sisto Perdoná,Matteo Ferro,Giuseppe Carrieri,Lance J Hampton,Francesco Porpiglia,Riccardo Autorino

    PURPOSE To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. METHODS A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. RESULTS Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI - 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. CONCLUSIONS Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined.

    更新日期:2019-11-01
  • Versatile algorithmic midline approach to perineal urethrostomy for complex urethral strictures.
    World J. Urol. (IF 2.761) Pub Date : 2018-10-20
    Maxim J McKibben,Alexander T Rozanski,Joceline S Fuchs,Varun Sundaram,Allen F Morey

    PURPOSE To present results of an algorithmic approach to perineal urethrostomy (PU) based on a midline perineal incision among men with complex urethral strictures. METHODS A single surgeon retrospective review of consecutive patients who underwent PU between 2008 and 2017 was performed. Patient demographics and outcomes were collected via medical record review. After a midline perineal incision, the PU was matured either by (a) mobilization of the urethral plate (loop) alone in cases with distal strictures or low body mass index (BMI), or (b) with creation of a lateral perineal skin flap (7-flap) for those with longer urethra-to-skin distances. Success was defined as functional voiding without the need for further procedures. Patients were contacted by phone and administered validated questionnaires. RESULTS Of 62 PU patients, 20 (32.3%) underwent the loop technique, and 42 (67.7%) had the 7-flap procedure, 7 of which were reoperative for prior failed PU. Median age was 61.9 years (range 23-85) and the median stricture length was 8.0 cm (range 2.5-18 cm). Mean BMI was greater among 7-flap compared to loop patients (34.9 vs. 30.0 kg/m2, p = 0.01). Success rates were 92.9% (39/42) in the 7-flap group and 100% (20/20) in the loop PU cohort during a median follow-up of 30.7 months. Among 62 PU patients, 19 (30.6%) responded to the survey-median PGI-I score was 1.0 (range 1-2) indicating that symptoms were "very much improved". CONCLUSIONS The algorithmic midline approach to PU offers a standardized, versatile solution with excellent surgical outcomes and high patient satisfaction, even in obese or refractory stricture patients.

    更新日期:2019-11-01
  • Functional follow-up after Advance® and Advance XP® male sling surgery: assessment of predictive factors.
    World J. Urol. (IF 2.761) Pub Date : 2018-06-28
    Argimiro Collado,José Domínguez-Escrig,Isabel María Ortiz Rodríguez,Miguel Ramirez-Backhaus,Carmelo Rodríguez Torreblanca,José Rubio-Briones

    PURPOSE To evaluate the efficacy of the Advance® and AdvanceXP® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome. METHODS Included were male patients with SUI following radical prostatectomy who had a positive "repositioning test", 24 h-pad weight (PW) test < 400 g and who were continent at night and at rest. Urgency was defined as a sudden compelling desire to pass urine, which was difficult to defer. The cure rate was defined as no pad use. RESULTS From February 2008 to October 2014, 24 AdVance® and 70 AdVance XP® were implanted. The median (range) follow-up was 49 (12-102) months. The overall cure rate was 77%. The preoperative 24 h PW was significantly related to the continence outcome (p = 0.044). A total of 12 patients (13%) presented with postoperative AUR, which was significantly related to abnormal voiding detrusor activity (p = 0.036). Twenty-two patients (23%) had postoperative urgency (16% "de novo"), which was significantly related to preoperative urgency (p = 0.003). During follow-up, a degree of deterioration of continence was observed in five patients who were classed as cured initially. To date, no reports of urethral sling erosion have been made. CONCLUSIONS The AdVance® and AdVanceXP® slings are safe and effective in relieving SUI following post-radical prostatectomy. There were no differences between the two slings in terms of efficacy, urgency or postoperative AUR. There was a moderate rate of "de novo "urgency and low rate of loss of continence during follow-up.

    更新日期:2019-11-01
  • Safety and efficacy of Tamsulosin as medical expulsive therapy in pregnancy.
    World J. Urol. (IF 2.761) Pub Date : null
    Benoît Theriault,Fannie Morin,Jonathan Cloutier

    PURPOSE Use of medical expulsive therapy (MET) is common practice in urology for the treatment of symptomatic urolithiasis, despite this its efficacy is debated. Its use in pregnancy is controversial. Our objective was to evaluate the safety and efficacy of Tamsulosin as a MET in pregnant women. MATERIAL AND METHODS We retrospectively identified pregnant patients who presented with renal colic at the CHU de Québec from 2000 to 2015. We compared patients who received Tamsulosin as MET to a control group without MET. We evaluated efficacy as passage rate of lithiasis and necessity of intervention. We evaluated safety of the treatment according to fetal outcomes (birth weight, APGAR, gestational age). RESULTS We evaluated 207 pregnant patients presenting renal colic, 69 patients in the MET group were compared to 138 patients in the control group. Of these, 48 (70%) in the Tamsulosin therapy group and 76 (56%) in the control group had proven urolithiasis. No significant difference was found for mean gestational age at birth, birth weight and APGAR. No sudden infant death syndrome was encountered in Tamsulosin group. There was no significant difference for length of hospital stay and need for surgical intervention. The spontaneous passage rate was 58% (25/48) in the MET group compared to 43% (29/76), but this difference was not statistically significant (p = 0.18). CONCLUSIONS Short-term utilisation of Tamsulosin as MET in second and third trimester of pregnancy is not associated with adverse maternal or infant outcomes. Moreover, there was no significant adjunct for the rate of stone passage.

    更新日期:2019-11-01
  • Developments in oligometastatic hormone-sensitive prostate cancer.
    World J. Urol. (IF 2.761) Pub Date : 2019-11-11
    Phuoc T Tran,Piet Ost

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • The risk factors of urinary tract infection after transurethral resection of bladder tumors.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-28
    Yuki Kohada,Akihiro Goriki,Kazuma Yukihiro,Shinya Ohara,Mitsuru Kajiwara

    PURPOSE Few studies mention the necessity of antimicrobial prophylaxis (AMP) for transurethral resection of bladder tumor (TURBT) and the risk factors for postoperative urinary tract infections (UTIs) after TURBT. To evaluate the necessity of AMP and to detect the risk of UTIs, we examined the perioperative clinical factors. METHODS 687 patients who underwent TURBT between 2006 and 2017 at Hiroshima Prefectural Hospital were examined retrospectively. We defined the postoperative UTIs as febrile UTIs (≥ 38 °C). The AMP for the TURBT that we used was mostly cephalosporin generation 1. The association between the perioperative clinical/pathological factors and postoperative UTIs was assessed by logistic regression retrospectively. RESULTS 21 patients (3.1%) suffered from postoperative UTIs, and almost all of them were successfully treated with the immediate administration of antibiotics. Univariate analysis showed that past pelvic radiotherapy (p = 0.024, odds ratio (OR) 6.00), tumor size (≥ 2cm) (p = 0.008, OR 3.38), age (≥ 75 years) (p = 0.036, OR 2.65), preoperative hospital stay (≥ 5 days) (p = 0.017, OR 3.76), asymptomatic pyuria (p = 0.038, OR 2.54) and bacteriuria (p = 0.044, OR 2.97) were all associated with postoperative UTIs. CONCLUSIONS We demonstrated that AMP was effective for patients who underwent TURBT, and history of pelvic radiotherapy, high age, preoperative hospital stay and a certain tumor size were the risk factors as well as pyuria and bacteriuria of postoperative UTIs.

    更新日期:2019-11-01
  • Utility of the EORTC risk tables and CUETO scoring model for predicting recurrence and progression in non-muscle-invasive bladder cancer patients treated with routine second transurethral resection.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-27
    Guoxian Zhang,Daniel Steinbach,Marc-Oliver Grimm,Marcus Horstmann

    PURPOSE Routine second transurethral resection (TUR) for non-muscle-invasive bladder cancer (NMIBC) is common practice in Germany. Applicability of European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) models in NMIBC patients is still controversial. Aim of the study was to assess the performance of EORTC and CUETO predictive models in NMIBC patients treated with second TUR. METHODS 479 NMIBC patients with routine second TUR were analyzed retrospectively between 2003 and 2011, and investigated with clinical and pathological variables in regard to tumor recurrence and progression. Furthermore, recurrencefree survival (RFS) and progression-free survival (PFS) were evaluated according to EORTC and CUETO, and the discrimination of the models assessed. RESULTS With a median follow-up of 60 months, prior recurrence rate, grade, and second TUR pathology were independent prognostic factors for the risk of disease recurrence and progression. The concordance index of the EORTC and the CUETO model was 0.563 and 0.516 for recurrence and 0.681 and 0.702 for progression, respectively. The positive pathology after second TUR was significantly associated with risk of disease recurrence and progression. EORTC and CUETO risk models estimated progression better than recurrence, especially with higherscore groups. CONCLUSIONS Improved predictive tools should be developed for optimal treatment selection.

    更新日期:2019-11-01
  • The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-27
    Stefania Zamboni,Marco Moschini,Andrea Gallina,Renzo Colombo,Francesco Montorsi,Alberto Briganti,Andrea Salonia,Alessandro Antonelli,Claudio Simeone,Sandra Belotti,Luca Cristinelli,Agostino Mattei,Philipp Baumeister

    PURPOSE To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features. METHODS We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3-T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM). RESULTS A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0-pTa-pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3-T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33-27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM. CONCLUSION We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3-T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

    更新日期:2019-11-01
  • Testosterone replacement therapy is associated with an increased risk of urolithiasis.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-25
    Tyler R McClintock,Marie-Therese I Valovska,Nicollette K Kwon,Alexander P Cole,Wei Jiang,Martin N Kathrins,Naeem Bhojani,George E Haleblian,Tracey Koehlmoos,Adil H Haider,Shehzad Basaria,Quoc-Dien Trinh

    PURPOSE To determine whether TRT in men with hypogonadism is associated with an increased risk of urolithiasis. METHODS We conducted a population-based matched cohort study utilizing data sourced from the Military Health System Data Repository (a large military-based database that includes beneficiaries of the TRICARE program). This included men aged 40-64 years with no prior history of urolithiasis who received continuous TRT for a diagnosis of hypogonadism between 2006 and 2014. Eligible individuals were matched using both demographics and comorbidities to TRICARE enrollees who did not receive TRT. The primary outcome was 2-year absolute risk of a stone-related event, comparing men on TRT to non-TRT controls. RESULTS There were 26,586 pairs in our cohort. Four hundred and eighty-two stone-related events were observed at 2 years in the non-TRT group versus 659 in the TRT group. Log-rank comparisons showed this to be a statistically significant difference in events between the two groups (p < 0.0001). This difference was observed for topical (p < 0.0001) and injection (p = 0.004) therapy-type subgroups, though not for pellet (p = 0.27). There was no significant difference in stone episodes based on secondary polycythemia diagnosis, which was used as an indirect indicator of higher on-treatment testosterone levels (p = 0.14). CONCLUSION We observed an increase in 2-year absolute risk of stone events among those on TRT compared to those who did not undergo this hormonal therapy. These findings merit further investigation into the pathophysiologic basis of our observation and consideration by clinicians when determining the risks and benefits of placing patients on TRT.

    更新日期:2019-11-01
  • Impact of routine imaging in the diagnosis of recurrence for patients with localized and locally advanced renal tumor treated with nephrectomy.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-22
    Baptiste Gires,Zine-Eddine Khene,Pierre Bigot,Quentin Alimi,Benoit Peyronnet,Grégory Verhoest,Andrea Manunta,Karim Bensalah,Romain Mathieu

    OBJECTIVE Modalities of surveillance to detect recurrence after nephrectomy for localized or locally advanced renal tumor are not standardized. The aim was to assess the impact of surveillance scheme on oncological outcomes. METHODS Patients treated for localized or locally advanced renal tumor with total or partial nephrectomy between 2006 and 2010 in an academic institution were included retrospectively. According to the University of California Los Angeles Integrated Staging System (UISS) protocol, follow-up was considered adequate or not. Symptoms, location and number of lesions at recurrence diagnosis were collected. Recurrence-free, cancer-specific and overall survivals were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were calculated to identify prognostic factors. RESULTS A total of 267 patients were included. Median follow-up was 72 months. Recurrence rate was 23.2% (62/267 patients). Recurrences were local (16%), single metastatic (23%), oligo-metastatic (15%) or multi-metastatic (46%). 72.6% of the recurrences occurred within the 3 years after surgery. No recurrence was diagnosed by chest X-ray or abdominal ultrasound. One hundred and twenty-one patients had inadequate follow-up. They had similar recurrence-free survival, cancer-specific survival and overall survival as patients with adequate follow-up. In multivariable analysis, the presence of multi-metastatic lesions was an independent prognostic factor of worse cancer-specific mortality after recurrence diagnosis (HR = 10.15, 95% CI: 2.29-44.82, p = 0.002). CONCLUSION Role of chest X-ray and abdominal ultrasound for the detection of recurrences is limited. Rigorous follow-up according to the UISS protocol does not improve oncological outcomes. Follow-up schedules with less frequent imaging should be discussed.

    更新日期:2019-11-01
  • Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-22
    Xiaonan Zheng,Xin Han,Dehong Cao,Hang Xu,Lu Yang,Jianzhong Ai,Qiang Wei

    BACKGROUND Previous study compared limited number of parameters post the treatment of cold knife and laser urethrotomy for urethral stricture and controversy about the superiority of those two techniques still remains. This study aims to update the evidence and provide better clinical guidance. METHOD We systematically searched Pubmed, Embase, ClinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles comparing cold knife and laser urethrotomy for urethral stricture. Parameters including maximum urinary flow (Qmax), recurrence, reoperation, complications, operation time, and Visual Analog Scale (VAS) pain score were compared using RevMan 5.3. RESULTS Seven articles involving 453 patients were eventually included. The cold-knife group had better 6-month Qmax (MD - 0.95, 95% CI - 1.49 to - 0.41) and similar 3-month and 12-month Qmax compared with the laser group. No significance was observed regarding the comparison of recurrence rate. The laser group had lower risk of bleeding (OR 0.08, 95% CI 0.01-0.43), lower rate of reoperation (OR 0.39, 95% CI 0.19-0.81) and longer operation time (MD 4.09, 95% CI 3.35-4.82). There was no significant difference in terms of other complications and VAS pain score. CONCLUSION Cold knife and laser urethrotomy had similar efficacy regarding short-term and long-term recurrence rate and Qmax, except that the cold-knife group had slightly better 6-month Qmax. However, the laser group had less risk of bleeding and lower rate of reoperation but also longer operation time.

    更新日期:2019-11-01
  • CD163+ macrophages predict a poor prognosis in patients with primary T1 high-grade urothelial carcinoma of the bladder.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-15
    Guoliang Yang,Lianhua Zhang,Mengyao Liu,Qiang Liu,Xuehui Duan,Juanjie Bo

    PURPOSE Macrophages are a major cell type that can infiltrate solid tumors and exhibit distinct phenotypes in different tumor microenvironments. This study investigates the prognostic value of tumor-infiltrated CD163+ macrophages in patients with T1 high-grade (T1HG) bladder cancer. METHODS CD163+ macrophages were assessed by immunohistochemistry in 94 T1HG bladder cancer samples. Kaplan-Meier analyses and Cox proportional hazards' regression models were applied to evaluate recurrence-free survival, progression-free survival and disease-specific survival. RESULTS With a median follow-up of 60 months, 37 (39.4%) patients experienced disease recurrence, 14 (14.9%) progression, 11 (11.7%) disease-specific mortality. High CD163+ macrophages were associated with higher risk of disease recurrence and progression (P < 0.05, for both). In multivariate Cox proportional hazards regression analysis, high CD163+ macrophages were a significant negative predictor of recurrence-free survival, progression-free survival and disease-specific survival (P < 0.05 for all). CONCLUSION CD163+ macrophages are a poor prognostic factor in T1HG bladder cancer. This finding provide the ground for further testing it in predicting the outcome of this challenging disease.

    更新日期:2019-11-01
  • Sacral neuromodulation in congenital lumbo-sacral and traumatic spinal cord defects with neurogenic lower urinary tract symptoms: a single-center experience in children and adolescents.
    World J. Urol. (IF 2.761) Pub Date : 2019-03-14
    Farzaneh Sharifiaghdas

    PURPOSE This study evaluated sacral neuromodulation's effectiveness for managing refractory neuropathic lower urinary tract dysfunction in children and adolescents. METHODS Twenty-five children and adolescents underwent peripheral nerve evaluation test phase of sacral neuromodulation at our center. Thirteen (seven boys and six girls) cases suffered from neuropathic lower urinary tract dysfunction refractory to the maximum medical treatment. The test was done with temporary wire in all patients. Patients with more than 50% improvement in symptoms were chosen for the second stage of implantation of quadripolar tined lead and implantable pulse generator. Bowel transit symptoms were recorded before and after the surgery. RESULTS Eight patients (61.53%; five boys and three girls) had positive responses to the peripheral nerve evaluation test phase. They underwent implantation of permanent quadripolar tined lead and implantable pulse generator. The etiologies were lumbosacral myelomeningocele, occult spina bifida, partial sacral agenesis and incomplete spinal cord injury. Positive clinical response (> 50% improvement in symptoms) was achieved in seven (85%) at a mean follow-up of 14.25 months. Three patients became capable to stop clean intermittent catheterization (P =0.125). The 24-h pad test decreased from 484 to 78 g from before to after the surgery (P =0.043). CONCLUSION This clinical study on a small sample size of children and adolescents demonstrates positive results in short-term follow-up. However, as the procedure is still not approved officially, multicenter studies with more patients can prove the safety and efficacy of sacral neuromodulation in long term among this special group of patients.

    更新日期:2019-11-01
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