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Results of Radical Nephrectomy and Inferior Vena Cava Thrombectomy. 根治性肾切除术和下腔静脉血栓形成术的结果。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-14 DOI: 10.1007/s11934-024-01228-2
Roberto Filizzola, Daniel Romero, Samuel Mendez, David Brunstein, Alejandro Benitez

Purpose of review: Renal Cell Carcinoma (RCC) with invasion into the inferior vena cava (IVC) is a rare and mortal condition. Patients with RCC have an average life expectancy of no more than six months, thus requiring an aggressive surgical approach. We analyze the outcomes of patients that underwent surgery at a single medical institution.

Recent findings: The analysis of recent series of successful treatment with radical nephrectomy and IVC thrombectomy shows a 5 year survival from 45 to 69%. We found in the analyzed series that the success of the treatment in these patients depends on the resection of the renal tumor and venous thrombectomy. We found that at our medical institution nephrectomy and IVC thrombectomy with primary repair have no intraoperative mortality and no pulmonary embolism. Nephrectomy and thrombectomy of IVC is a reliable approach for patients with advance RCC.

综述目的:侵犯下腔静脉(IVC)的肾细胞癌(RCC)是一种罕见的致命疾病。RCC 患者的平均预期寿命不超过 6 个月,因此需要积极的手术治疗。我们分析了在一家医疗机构接受手术的患者的治疗效果:对近期成功接受根治性肾切除术和输尿管血栓切除术治疗的系列患者进行的分析表明,患者的 5 年生存率在 45% 到 69% 之间。我们在分析的系列研究中发现,这些患者的治疗成功与否取决于肾肿瘤切除术和静脉血栓切除术。我们发现,在我们的医疗机构中,肾切除术和静脉血栓切除术加初级修复术没有术中死亡率,也没有肺栓塞。肾切除术和 IVC 血栓切除术是治疗晚期 RCC 患者的可靠方法。
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引用次数: 0
Third-Line Therapeutic Interventions for Non-Neurogenic Bladder Dysfunction in Children. 儿童非神经源性膀胱功能障碍的三线治疗干预。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-02 DOI: 10.1007/s11934-024-01227-3
Alyssa M Lombardo, Seth A Alpert

Purpose of review: The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM).

Recent findings: Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families. BoTNA offers a safe and efficacious treatment to decrease detrusor contractility and improve bladder capacity but is limited by the half-life of BoNTA agent. Percutaneous or transcutaneous PTNS offers improved voided volumes or cure in some patients but is time-intensive. SNM can be utilized in a variety of LUTD pathology with high success rate and cure but should consider cumulative anesthetic and fluoroscopic exposures for battery replacements and re-positioning for patient growth.

综述目的:本文旨在综述治疗小儿非神经源性膀胱功能障碍的三线疗法的注意事项和疗效,包括 A 型肉毒杆菌毒素 (BoTNA)、胫后神经刺激 (PTNS) 和骶神经调控 (SNM):最近的研究结果:美国联邦药品管理局批准使用β-3-激动剂治疗儿童患者的过度逼尿肌活动,这为三线疗法提供了一个新的步骤。关于小儿SNM疗效、并发症和翻修率的新的长期数据将为咨询家庭提供有价值的信息。BoTNA 是一种安全有效的治疗方法,可降低逼尿肌收缩力并改善膀胱容量,但受 BoNTA 制剂半衰期的限制。经皮或经皮 PTNS 可改善部分患者的排尿量或治愈,但耗时较长。SNM可用于各种LUTD病理,成功率和治愈率都很高,但应考虑到更换电池和重新定位以适应患者生长所需的累积麻醉和透视暴露。
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引用次数: 0
Professional Burnout and Career Choice Regret in Urology Residents. 泌尿科住院医生的职业倦怠和职业选择后悔。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-17 DOI: 10.1007/s11934-024-01226-4
Kevin F Hanna, Kevin Koo

Purpose of review: High rates of professional burnout and career choice regret among urology residents may increase professional dissatisfaction, shorten career longevity, and exacerbate urology workforce shortages. Understanding the prevalence of and risk factors for burnout may help develop interventions.

Recent findings: Up to 48% of contemporary U.S. urology residents experience burnout symptoms, including up to 70% of second-year residents. Among overlapping personal, professional, institutional, and lifestyle risk factors, barriers to accessing medical and mental health care are frequently cited as an important association in residents. Limited intervention studies suggest that providing basic needs, such as on-call meals, and facilitating physical wellness and social engagement among residents may result in sustained reductions in burnout. Urology residents continue to experience high rates of burnout and career choice regret among medical specialties. Evidence-based interventions and sustainable policies that address primary risk factors are urgently needed.

综述目的:泌尿外科住院医师的职业倦怠和职业选择后悔率较高,这可能会增加职业不满情绪、缩短职业寿命并加剧泌尿外科人才短缺。了解职业倦怠的发生率和风险因素有助于制定干预措施:多达 48% 的当代美国泌尿外科住院医师出现职业倦怠症状,其中包括多达 70% 的二年级住院医师。在重叠的个人、职业、机构和生活方式风险因素中,获得医疗和心理健康护理的障碍经常被认为与住院医师的职业倦怠有重要关联。有限的干预研究表明,提供基本需求(如随叫随到的膳食)以及促进住院医师的身体健康和社会参与可能会持续减少倦怠感。泌尿外科住院医师的职业倦怠率和职业选择后悔率在医学专科中一直居高不下。目前迫切需要针对主要风险因素的循证干预措施和可持续政策。
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引用次数: 0
Voiding Dysfunction in Transgender Patients: What We Know and What We Do Not Know. 变性患者的排尿功能障碍:我们知道什么,我们不知道什么。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-05 DOI: 10.1007/s11934-024-01234-4
Gabriela Gonzalez, Jennifer T Anger

Purpose of review: Transgender and non-binary patients (TGNB) undergoing gender affirming genital surgery may experience perioperative voiding dysfunction. This review aims to outline and analyze literature about gender affirming pelvic surgery urinary complications, evaluation, and treatment.

Recent findings: If a patient is seeking bottom surgery, then urinary goals and pre-operative symptoms should be discussed with respect to variable post-operative outcomes. Urologists should also be aware of the effect that gender affirming hormone therapy has on urinary symptoms. Urethral strictures and urethrocutaneous fistulae occur after feminizing and masculinizing procedures and may manifest as LUTS. Although there is no standardized approach for managing post-operative voiding issues, we present available options. The evaluation of TGNB patients is ideally affirming and tailored to the patient. Long-term urinary and voiding outcomes measurements after vaginoplasty and phalloplasty are also needed, as current validated questionnaires do not capture these symptoms well in TGNB patients.

审查目的:接受性别确认生殖器手术的变性和非二元患者(TGNB)可能会在围手术期出现排尿功能障碍。本综述旨在概述和分析有关性别肯定盆腔手术泌尿系统并发症、评估和治疗的文献:最近的研究结果:如果患者想要进行下体手术,那么就应该讨论排尿目标和术前症状,以了解术后的不同结果。泌尿科医生还应了解性别平权激素疗法对泌尿系统症状的影响。女性化和男性化手术后会出现尿道狭窄和尿道皮肤瘘,并可能表现为尿失禁。虽然目前还没有处理术后排尿问题的标准化方法,但我们将介绍可供选择的方案。对 TGNB 患者的评估最好是根据患者的具体情况进行。阴道成形术和阴茎成形术后还需要进行长期的排尿和排空结果测量,因为目前有效的调查问卷并不能很好地反映 TGNB 患者的这些症状。
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引用次数: 0
Focal Therapy in Grade Group 3 Prostate Cancer. 3级前列腺癌的局部治疗
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-02 DOI: 10.1007/s11934-024-01211-x
Lee Pressler, Mariel Pressler

Purpose of this review: Treatment of intermediate risk prostate cancer remains controversial. Clearly some patients with low volume favorable intermediate risk can be followed with active surveillance. Those with high volume bilateral disease need more radical whole gland therapy. The question remains on how to best treat low volume localized unfavorable intermediate risk prostate cancer (GG3) while maintaining quality of life. Focal therapy has been becoming a popular option for many patients with localized prostate cancer. Most studies looking at focal therapy for prostate cancer have been limited to GG1 and GG2, many of whom may not need treatment. We set out to review the literature evaluating the safety and efficacy of focal therapy for GG3 prostate cancer.

Recent findings: We reviewed multiple peer review articles obtained from a PubMed search. While in field biopsy recurrence rates approach 20%, failure free survival and overall survival exceeds 90%. While focal therapy for unfavorable GG3 intermediate risk prostate cancer may have higher rates of local recurrence with appropriate post procedure follow up, patients who need salvage therapy are easily identified and survival rates are very high. Focal therapy is a good option for patients with localized low volume GG3 prostate cancer without compromising cancer survival and preserving quality of life.

本综述的目的:中危前列腺癌的治疗仍存在争议。显然,一些体积较小的中危患者可以接受积极的监测。而那些双侧病变体积较大的患者则需要更彻底的全腺体治疗。问题仍然是如何在保持生活质量的同时,最好地治疗低体积局部不利的中危前列腺癌(GG3)。病灶治疗已成为许多局部前列腺癌患者的首选。大多数关于前列腺癌病灶治疗的研究仅限于 GG1 和 GG2,而其中许多患者可能并不需要治疗。我们着手回顾了评估GG3前列腺癌病灶治疗安全性和有效性的文献:我们查阅了从 PubMed 搜索获得的多篇同行评审文章。虽然现场活检复发率接近 20%,但无失败生存率和总生存率超过 90%。虽然针对不利的 GG3 中危前列腺癌的病灶治疗在适当的术后随访下可能会有较高的局部复发率,但需要挽救治疗的患者很容易被识别出来,而且生存率非常高。对于局部低体积 GG3 型前列腺癌患者来说,病灶治疗是一个不错的选择,既不会影响癌症生存,又能保证生活质量。
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引用次数: 0
Unraveling the Complexities of Uretero-Enteric Strictures: A Modern Review. 解读输尿管-肠管狭窄的复杂性:现代回顾。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI: 10.1007/s11934-024-01222-8
A Abdalla, Joshua A Cohn, J Simhan

Purpose of review: The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes.

Recent findings: In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.

综述的目的:这篇综述文章的目的是对良性输尿管-肠管吻合口狭窄(UAS)的管理和结果进行当代概述:在本文中,我们将回顾有关 UAS 的最新研究,评估病因、潜在风险因素、表现、诊断和处理方案,以及我们在处理这种具有挑战性的重建并发症时获得的个人见解。良性 UAS 是肠道尿路改道术中一种相对常见的长期并发症,大约每 10 名患者中就有 1 人患病。它被认为是由吻合部位的输尿管组织缺血和纤维化引起的。风险因素似乎包括任何增加漏尿或缺血可能性的因素;目前还不清楚吻合方式是否也会影响狭窄风险。处理方法多种多样,包括内窥镜、开放式和机器人方法。内窥镜方法可能发病率较低,但与输尿管休息一段时间后进行的重建相比,效果要差得多。
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引用次数: 0
Functional Outcomes of Orthotopic Neobladder in Women. 女性矫形新膀胱的功能结果。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-28 DOI: 10.1007/s11934-024-01223-7
Unwanaobong Nseyo, David Ginsberg

Purpose of review: This review paper summarizes the available literature on the evolution of surgical approach to radical cystectomy in female bladder cancer patients and its impact on functional outcomes in orthotopic neobladder.

Recent findings: Traditionally, radical cystectomy in female bladder cancer patients has been maximally extirpative with pelvic exenteration. Recently, new techniques which include pelvic organ-sparing, nerve-sparing and vaginal-sparing have demonstrated improved rates of urinary incontinence and retention. Additional techniques include prophylactic apical suspension which reduces the likelihood of pelvic organ prolapse, a risk factor for voiding dysfunction in the setting of orthotopic neobladder. Surgical management of bladder cancer in female patients has evolved to include surgical approaches which center quality of life and functional outcomes that are unique to female patients who have undergone radical cystectomy with ileal neobladder and can be optimized based on considerations regarding an approach that limits pelvic floor and pelvic nerve disruption.

综述目的:本综述总结了女性膀胱癌患者根治性膀胱切除术手术方法的演变及其对正位新膀胱功能预后影响的现有文献:传统上,女性膀胱癌患者的根治性膀胱切除术都是通过盆腔外扩进行最大限度的切除。最近,包括骨盆器官保留、神经保留和阴道保留在内的新技术已证明尿失禁和尿潴留的发生率有所改善。其他技术还包括预防性顶端悬吊术,该术式可降低盆腔器官脱垂的可能性,而盆腔器官脱垂是正位新膀胱情况下导致排尿功能障碍的危险因素。女性患者膀胱癌的手术治疗已发展到包括以生活质量和功能结果为中心的手术方法,这些结果是接受根治性膀胱切除术并行回肠新膀胱术的女性患者所特有的,并且可以根据限制盆底和盆腔神经损伤的方法进行优化。
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引用次数: 0
Telemedicine in Endourology for Patient Management and Healthcare Delivery: Current Status and Future Perspectives. 远程医疗在腔内泌尿学中用于患者管理和医疗服务:现状与未来展望》。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI: 10.1007/s11934-024-01224-6
Ali Talyshinskii, Nithesh Naik, B M Zeeshan Hameed, Gafour Khairley, Princy Randhawa, Bhaskar Kumar Somani

Purpose of review: Researchers have examined how telemedicine affects endourological patients. This review analyzes the literature to determine telemedicine's benefits and limitations in endourology.

Recent findings: Many studies were devoted to describing the effect of telemedicine on endourological patient satisfaction, optimization of the clinical decision-making among patients with kidney and ureteric stones, the effectiveness of telemedicine in the management of patients with indications for PCNL, follow-up for patients with urolithiasis and describing financial effectiveness for the patients after BOO surgery. The authors describe phone calls, video calls, and online booking platforms as used as telemedicine technology. However, several concerns also exist, such as the necessity of internet connections and appropriate devices, different receptivity among certain subgroups, data safety, and different regulatory environments among countries. Telemedicine offers the potential to reduce patient travel time, expedite decision-making, and save costs in endourology. However, its everyday implementation is challenging due to various obstacles faced by patients and providers, hindering the realization of its full potential and necessitating a systematic approach to problem-solving.

综述目的:研究人员对远程医疗如何影响腔内科患者进行了研究。本综述分析了相关文献,以确定远程医疗在腔内放射学中的益处和局限性:许多研究致力于描述远程医疗对排尿内科患者满意度的影响、肾结石和输尿管结石患者临床决策的优化、远程医疗在 PCNL 适应症患者管理中的有效性、尿路结石患者的随访以及描述 BOO 手术后患者的经济效益。作者介绍了电话、视频通话和在线预约平台等远程医疗技术。然而,也存在一些令人担忧的问题,如互联网连接和适当设备的必要性、某些亚群体的接受能力、数据安全性以及各国不同的监管环境。在腔内泌尿学领域,远程医疗有可能缩短患者的旅行时间、加快决策进程并节约成本。然而,由于患者和医疗服务提供者面临的各种障碍,远程医疗的日常实施具有挑战性,阻碍了其潜力的充分发挥,因此有必要采用系统的方法来解决问题。
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引用次数: 0
Current and Future Directions of Technology in Assessment of Peyronie's Disease. 评估佩罗尼氏病的当前和未来技术发展方向。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s11934-024-01247-z
Abrar H Mian, Matthew J Ziegelmann

Purpose of review: This review assesses the effectiveness of various imaging modalities for diagnosing and managing Peyronie's disease (PD), exploring their clinical utility and limitations.

Recent findings: Ultrasonography, currently the only modality endorsed by the American Urological Association, effectively detects calcifications and assesses vascular status but struggles with identifying non-palpable plaques. Computed tomography and magnetic resonance imaging provide detailed anatomical views but are costly along with other deterring factors. Autophotography and 3-dimensional imaging offer convenient home assessments but with variable accuracy. Elastography improves upon traditional ultrasonography, while emerging AI technologies show promise for automating precise curvature assessments, pending further validation. A combined approach tailored to each individual patient based on their needs enhances diagnostic accuracy. Supplementing ultrasonography with elastography and potentially AI could improve diagnostic outcomes and better guide treatment decisions. Continued research is vital to integrate these advancements into standard clinical practice and develop updated standardized protocols.

综述的目的:本综述评估了各种成像模式在诊断和治疗佩罗尼氏病(PD)方面的有效性,探讨了它们的临床实用性和局限性:超声波检查是目前唯一获得美国泌尿外科协会认可的检查方式,它能有效检测钙化并评估血管状态,但在识别不可扪及的斑块方面存在困难。计算机断层扫描和磁共振成像可提供详细的解剖视图,但费用昂贵,还有其他阻碍因素。自动照相术和三维成像可提供方便的家庭评估,但准确性不一。弹性成像技术改进了传统的超声波成像技术,而新兴的人工智能技术则有望自动进行精确的弧度评估,但仍有待进一步验证。根据每位患者的需求量身定制的综合方法可提高诊断准确性。用弹性成像和潜在的人工智能来补充超声波检查,可以改善诊断结果,更好地指导治疗决策。要将这些先进技术融入标准临床实践并制定最新的标准化方案,继续开展研究至关重要。
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引用次数: 0
The Intersection of Artificial Intelligence, Wearable Devices, and Sexual Medicine. 人工智能、可穿戴设备和性医学的交叉点。
IF 2.5 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-11 DOI: 10.1007/s11934-024-01244-2
Dayna R Smerina, Amy M Pearlman

Purpose of review: The aim of our review paper is to provide a comprehensive overview of the current technologies in artificial intelligence and wearable devices dedicated to sexual health.

Recent findings: Currently, AI-powered technologies are enhancing our understanding of reproductive health and sexually transmitted infections, and facilitating empathetic education and outreach to diverse populations. Additionally, innovative wearable devices are providing insights into men's erectile health, addressing ejaculatory concerns, and exploring women's orgasms in relation to pelvic floor muscles and clitoral blood flow. The field of sexual health technology is rapidly expanding, with recent innovations transforming our understanding of sexual health. As technology progresses, it is crucial to address significant ethical considerations to protect users, particularly due to the sensitive nature of the data involved.

综述的目的:我们这篇综述论文的目的是全面概述当前的人工智能技术和专用于性健康的可穿戴设备:目前,人工智能技术正在增强我们对生殖健康和性传播感染的了解,并促进对不同人群的移情教育和外联工作。此外,创新的可穿戴设备正在深入了解男性的勃起健康,解决射精问题,并探索女性性高潮与盆底肌肉和阴蒂血流的关系。性健康技术领域正在迅速扩大,最近的创新改变了我们对性健康的认识。随着技术的进步,解决重要的伦理问题以保护用户至关重要,特别是由于所涉及数据的敏感性。
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引用次数: 0
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Current Urology Reports
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