Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.08.001
D. Carolina Ochoa, Rion Healy
Recurrent urinary tract infections (rUTIs) are common and can significantly impact a patient’s quality of life. The mainstay of treatment is antibiotic-based, which contributes to the global problem of antibiotic resistance among urinary pathogens, so many alternative therapies have been explored. In this mini-review we evaluate evidence for intravesical agents that prevent rUTI, including antibiotic and nonantibiotic options. The current evidence supports the use of intravesical agents that replenish the glycosaminoglycan layer and of aminoglycoside antibiotics as safe and effective therapies to prevent rUTI.
Patient summary
We reviewed evidence on the use of bladder instillations to treat repeated urinary infections. Studies have shown that agents that improve the bladder surface and one specific antibiotic class are effective and safe treatments for prevention of recurrent infections.
{"title":"Intravesical Agents for Prevention of Recurrent Urinary Tract Infections","authors":"D. Carolina Ochoa, Rion Healy","doi":"10.1016/j.euf.2024.08.001","DOIUrl":"10.1016/j.euf.2024.08.001","url":null,"abstract":"<div><div>Recurrent urinary tract infections (rUTIs) are common and can significantly impact a patient’s quality of life. The mainstay of treatment is antibiotic-based, which contributes to the global problem of antibiotic resistance among urinary pathogens, so many alternative therapies have been explored. In this mini-review we evaluate evidence for intravesical agents that prevent rUTI, including antibiotic and nonantibiotic options. The current evidence supports the use of intravesical agents that replenish the glycosaminoglycan layer and of aminoglycoside antibiotics as safe and effective therapies to prevent rUTI.</div></div><div><h3>Patient summary</h3><div>We reviewed evidence on the use of bladder instillations to treat repeated urinary infections. Studies have shown that agents that improve the bladder surface and one specific antibiotic class are effective and safe treatments for prevention of recurrent infections.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 726-730"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.09.018
Jessica Hartmann , Moritz Fritzenwanker , Can Imirzalioglu , Torsten Hain , Borros Michael Arneth , Florian Wagenlehner
Background and objective
Urinary tract infections (UTIs) are some of the most encountered infections in clinical practice, exhibiting increasing antimicrobial resistance. Bacterial species identification and antimicrobial resistance testing at point of care (POCT) could improve adequate initial antibiotic therapy and antimicrobial stewardship. In this work, the Vivalytic UTI test, which represents a qualitative PCR-based microarray test, able to detect specific uropathogenic bacteria and associated antimicrobial resistance genes was evaluated at POCT.
Methods
In September 2023, we used this point-of-care testing (POCT) to analyse 126 consecutive urine samples of patients with complicated UTI. Samples processed with the Vivalytic UTI POCT were preselected for the presence of bacteriuria by screening with urine flow cytometry (cut-off ≥70 bacteria per microlitre). We performed the POCT before and after sample transport, and compared the results to standard urine culture and antibiotic sensitivity tests according to the European Committee on Antimicrobial Susceptibility Testing.
Key findings and limitations
Nineteen different bacterial species were detected. Sixteen species reached a diagnostic accuracy of ≥90.27% with negative predictive values of ≥93.67%. The POCT was able to detect bacterial species under the estimated concentration of 104–5 × 104 CFU/ml. The concordant (Vivalytic vs. culture) antimicrobial resistance gene detection rate reached a higher accuracy after transport (≥84.15%) compared to POC-testing before transport (≥81.71%), except for Vancomycin. Aerococcus urinae, Enterococcus hirae, Hafnia alvei, and Staphylococcus lugdunensis are not part of the POCT test panel; these were detected by urine culture only in 19% of cases.
Conclusions and clinical implications
The Vivalytic UTI POCT displayed high sensitivity and specificity in identifying uropathogenic bacteria and antibiotic resistance markers to be further evaluated in clinical practice. However, it would be helpful to expand the resistance to include information about more commonly used antibiotics like aminopenicillins, cephalosporines and fluoroquinolones.
Patient summary
In this study, we tested 126 consecutive urine samples of urological patients with complicated urinary tract infections (UTIs) by using the Vivalytic UTI point-of-care testing before and after sample transport. We found out that the sample transport to some extent influences the pathogen and resistance detection rate of the Vivalytic UTI assay. Compared to standard-of-care diagnostics, pathogen identification was more accurate before sample transport, while the concordant antimicrobial resistance gene detection rate reached higher accuracy after transport.
背景和目的：尿路感染（UTI）是临床实践中最常见的感染之一，抗菌药耐药性不断增加。在护理点（POCT）进行细菌种类鉴定和抗菌药耐药性检测可改善初始抗生素治疗和抗菌药管理。在这项工作中，我们对 Vivalytic UTI 检验进行了评估，该检验是一种基于 PCR 的定性微阵列检验，能够检测特定的尿路致病菌和相关的抗菌药耐药性基因：2023 年 9 月，我们使用这种护理点检测（POCT）分析了 126 份复杂性尿路感染患者的连续尿样。使用 Vivalytic UTI POCT 处理的样本通过尿液流式细胞术筛查（临界值≥每微升 70 个细菌）预选是否存在细菌尿。我们在样本运送前后进行了 POCT，并根据欧洲抗菌药敏感性测试委员会的要求将结果与标准尿培养和抗生素敏感性测试进行了比较：检测出 19 种不同的细菌。其中 16 种细菌的诊断准确率≥90.27%，阴性预测值≥93.67%。POCT 能够检测出估计浓度为 104-5 × 104 CFU/ml 的细菌种类。与运输前的 POC 检测（≥81.71%）相比，除万古霉素外，运输后抗菌药物耐药基因检测的一致性（Vivalytic 与培养）准确率更高（≥84.15%）。尿道气球菌、平滑肠球菌、白葡萄球菌和卢格杜恩葡萄球菌不在 POCT 检测范围内；仅在 19% 的病例中通过尿培养检测到了这些球菌：Vivalytic UTI POCT 在识别尿路致病菌和抗生素耐药性标记物方面显示出较高的灵敏度和特异性，有待在临床实践中进一步评估。患者总结：在本研究中，我们使用 Vivalytic UTI 床旁检测法检测了 126 份复杂性尿路感染（UTI）泌尿科患者的连续尿液样本，包括样本运送前后的尿液样本。我们发现，样本运输在一定程度上影响了 Vivalytic UTI 检测的病原体和耐药性检出率。与标准护理诊断相比，样本运送前的病原体鉴定更为准确，而运送后的抗菌药耐药性基因检出率则更高。
{"title":"Point-of-care Testing in Complicated Urinary Tract Infection: Evaluation of the Vivalytic One Urinary Tract Infection Analyser for Detecting Uropathogenic Bacteria and Antimicrobial Resistance in Urine Samples of Urological Patients in a Point-of-care Setting","authors":"Jessica Hartmann , Moritz Fritzenwanker , Can Imirzalioglu , Torsten Hain , Borros Michael Arneth , Florian Wagenlehner","doi":"10.1016/j.euf.2024.09.018","DOIUrl":"10.1016/j.euf.2024.09.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urinary tract infections (UTIs) are some of the most encountered infections in clinical practice, exhibiting increasing antimicrobial resistance. Bacterial species identification and antimicrobial resistance testing at point of care (POCT) could improve adequate initial antibiotic therapy and antimicrobial stewardship. In this work, the Vivalytic UTI test, which represents a qualitative PCR-based microarray test, able to detect specific uropathogenic bacteria and associated antimicrobial resistance genes was evaluated at POCT.</div></div><div><h3>Methods</h3><div>In September 2023, we used this point-of-care testing (POCT) to analyse 126 consecutive urine samples of patients with complicated UTI. Samples processed with the Vivalytic UTI POCT were preselected for the presence of bacteriuria by screening with urine flow cytometry (cut-off ≥70 bacteria per microlitre). We performed the POCT before and after sample transport, and compared the results to standard urine culture and antibiotic sensitivity tests according to the European Committee on Antimicrobial Susceptibility Testing.</div></div><div><h3>Key findings and limitations</h3><div>Nineteen different bacterial species were detected. Sixteen species reached a diagnostic accuracy of ≥90.27% with negative predictive values of ≥93.67%. The POCT was able to detect bacterial species under the estimated concentration of 10<sup>4</sup>–5 × 10<sup>4</sup> CFU/ml. The concordant (Vivalytic vs. culture) antimicrobial resistance gene detection rate reached a higher accuracy after transport (≥84.15%) compared to POC-testing before transport (≥81.71%), except for Vancomycin. <em>Aerococcus urinae, Enterococcus hirae, Hafnia alvei</em>, and <em>Staphylococcus lugdunensis</em> are not part of the POCT test panel; these were detected by urine culture only in 19% of cases.</div></div><div><h3>Conclusions and clinical implications</h3><div>The Vivalytic UTI POCT displayed high sensitivity and specificity in identifying uropathogenic bacteria and antibiotic resistance markers to be further evaluated in clinical practice. However, it would be helpful to expand the resistance to include information about more commonly used antibiotics like aminopenicillins, cephalosporines and fluoroquinolones.</div></div><div><h3>Patient summary</h3><div>In this study, we tested 126 consecutive urine samples of urological patients with complicated urinary tract infections (UTIs) by using the Vivalytic UTI point-of-care testing before and after sample transport. We found out that the sample transport to some extent influences the pathogen and resistance detection rate of the Vivalytic UTI assay. Compared to standard-of-care diagnostics, pathogen identification was more accurate before sample transport, while the concordant antimicrobial resistance gene detection rate reached higher accuracy after transport.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 734-741"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.04.003
John Heesakkers , Frank Martens , Nikesh Thiruchelvam , Wim Witjes , Christien Caris , Joni Kats , Rizwan Hamid , Frank Van der Aa
Background and objective
The European, prospective, multicenter SATURN registry was developed to analyze surgical devices for male stress urinary incontinence. The primary objective is the cure rate during follow-up.
Methods
Efficacy, complications, patient-reported outcomes, and prognostic factors are being analyzed at various intervals during 10-yr follow-up. The results at 1-yr follow-up are presented here.
Key findings and limitations
The cohort included 1046 patients (mean age 70 yr) from 28 centers in nine countries. The main cause of incontinence was radical prostatectomy (83.5%), followed by radiotherapy (4.5%), endourological procedures (9.7%), neurogenic conditions (1.0%), and trauma (0.2%). Some 19.5% of the patients underwent at least one incontinence procedure before registry inclusion. A baseline pad test was performed in 64% of the patients (mean 525 g, range 3.5–3600), urodynamics in 66%, and cystoscopy in 80%. The main implants used were AMS800 (n = 684) and Advance (n = 210) devices, followed by Atoms (n = 63) Victo/Plus (n = 33), ProACT (n = 30), and others (n = 24). A total of 896 patients had 1-yr follow-up data, of whom 164 completed a 1-yr pad test. Self-reported complete incontinence rates at baseline by device were as follows: Advance, 17%; other slings, 33%; ProACT, 0%; AMS800, 49%; other sphincter prosthesis, 100%; and overall group, 44%. The corresponding 1-yr self-reported continence rates were 73%, 37%, 50%, 76%, 11%, and 68%. Some 32% of the patients were still incontinent. Overall, 132 patients had at least one revision. Among the 110 patients with an artificial urinary sphincter (AUS), 122 revisions were performed, while there were 29 revisions for the 22 patients with a sling or ProACT device. International Consultation on Incontinence Questionnaire Short Form and EuroQol 5-dimensions 5-levels scores improved with all devices.
Conclusions and clinical implications
AUS implants are used in cases with more severe incontinence and are associated with better outcomes but more revisions than the alternatives. Patients report that every improvement is important. Choices for procedures should be made on the basis of these considerations.
Patient summary
We collected data from 29 urology departments in Europe on surgical treatments for patients who suffer from incontinence during exercise, sneezing, and coughing. Results after 1 year show that an artificial urinary sphincter has the best outcomes overall and for patients with heavy urine loss. However, this surgery also requires more revisions. Patients report that every improvement in continence is important to them.
{"title":"Results at 1 Year from SATURN, A European, Prospective, Multicenter Registry for Male Stress Urinary Incontinence Surgery","authors":"John Heesakkers , Frank Martens , Nikesh Thiruchelvam , Wim Witjes , Christien Caris , Joni Kats , Rizwan Hamid , Frank Van der Aa","doi":"10.1016/j.euf.2024.04.003","DOIUrl":"10.1016/j.euf.2024.04.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>The European, prospective, multicenter SATURN registry was developed to analyze surgical devices for male stress urinary incontinence. The primary objective is the cure rate during follow-up.</div></div><div><h3>Methods</h3><div>Efficacy, complications, patient-reported outcomes, and prognostic factors are being analyzed at various intervals during 10-yr follow-up. The results at 1-yr follow-up are presented here.</div></div><div><h3>Key findings and limitations</h3><div>The cohort included 1046 patients (mean age 70 yr) from 28 centers in nine countries. The main cause of incontinence was radical prostatectomy (83.5%), followed by radiotherapy (4.5%), endourological procedures (9.7%), neurogenic conditions (1.0%), and trauma (0.2%). Some 19.5% of the patients underwent at least one incontinence procedure before registry inclusion. A baseline pad test was performed in 64% of the patients (mean 525 g, range 3.5–3600), urodynamics in 66%, and cystoscopy in 80%. The main implants used were AMS800 (<em>n</em> = 684) and Advance (<em>n</em> = 210) devices, followed by Atoms (<em>n</em> = 63) Victo/Plus (<em>n</em> = 33), ProACT (<em>n</em> = 30), and others (<em>n</em> = 24). A total of 896 patients had 1-yr follow-up data, of whom 164 completed a 1-yr pad test. Self-reported complete incontinence rates at baseline by device were as follows: Advance, 17%; other slings, 33%; ProACT, 0%; AMS800, 49%; other sphincter prosthesis, 100%; and overall group, 44%. The corresponding 1-yr self-reported continence rates were 73%, 37%, 50%, 76%, 11%, and 68%. Some 32% of the patients were still incontinent. Overall, 132 patients had at least one revision. Among the 110 patients with an artificial urinary sphincter (AUS), 122 revisions were performed, while there were 29 revisions for the 22 patients with a sling or ProACT device. International Consultation on Incontinence Questionnaire Short Form and EuroQol 5-dimensions 5-levels scores improved with all devices.</div></div><div><h3>Conclusions and clinical implications</h3><div>AUS implants are used in cases with more severe incontinence and are associated with better outcomes but more revisions than the alternatives. Patients report that every improvement is important. Choices for procedures should be made on the basis of these considerations.</div></div><div><h3>Patient summary</h3><div>We collected data from 29 urology departments in Europe on surgical treatments for patients who suffer from incontinence during exercise, sneezing, and coughing. Results after 1 year show that an artificial urinary sphincter has the best outcomes overall and for patients with heavy urine loss. However, this surgery also requires more revisions. Patients report that every improvement in continence is important to them.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 818-825"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.06.010
Adrian Pilatz , Fabian Stangl , Jennifer Kranz , Gernot Bonkat , Rajan Veeratterapillay
{"title":"Transperineal Is the Way To Go","authors":"Adrian Pilatz , Fabian Stangl , Jennifer Kranz , Gernot Bonkat , Rajan Veeratterapillay","doi":"10.1016/j.euf.2024.06.010","DOIUrl":"10.1016/j.euf.2024.06.010","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 691-693"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.08.010
Hannah Voss , Daniel Robert Engel , Florian Wagenlehner , Olga Shevchuk
Antimicrobial peptides (AMPs) play a pivotal role in the innate immune system as a frontline defense against microbial threats. AMPs can serve as biomarkers and alternative antibiotics, overcoming mortality related to multidrug-resistant pathogens in urinary tract infections (UTIs). While the relevance of AMPs in UTIs has been validated and AMP drugs approved by the US Food and Drug Administration are in clinical use, information about their modification status, regulation, and mechanism of action remains sparse. Only a small fraction of sequences with potential AMP activity, predicted on the basis of known AMP characteristics, have been validated. Elucidation of the global profile of AMPs in the bladder, kidney, and urine under UTI conditions would facilitate an in-depth, disease-specific understanding of the innate immune system and the development of tailored AMP biomarkers and antibiotics. This mini-review focuses on a comprehensive strategy for global profiling and validation of AMPs in UTIs that incorporates AMP data repositories, prediction algorithms, and proteomics for healthy individuals and UTI patients.
Patient summary
Short protein molecules called peptides that have antimicrobial activity show promise for the treatment of urinary tract infections. More research and testing of naturally occurring and synthetic peptides with this activity are needed to fully understand how they can help in patient care.
{"title":"Discovery of Antimicrobial Peptides in Urinary Tract Infections","authors":"Hannah Voss , Daniel Robert Engel , Florian Wagenlehner , Olga Shevchuk","doi":"10.1016/j.euf.2024.08.010","DOIUrl":"10.1016/j.euf.2024.08.010","url":null,"abstract":"<div><div>Antimicrobial peptides (AMPs) play a pivotal role in the innate immune system as a frontline defense against microbial threats. AMPs can serve as biomarkers and alternative antibiotics, overcoming mortality related to multidrug-resistant pathogens in urinary tract infections (UTIs). While the relevance of AMPs in UTIs has been validated and AMP drugs approved by the US Food and Drug Administration are in clinical use, information about their modification status, regulation, and mechanism of action remains sparse. Only a small fraction of sequences with potential AMP activity, predicted on the basis of known AMP characteristics, have been validated. Elucidation of the global profile of AMPs in the bladder, kidney, and urine under UTI conditions would facilitate an in-depth, disease-specific understanding of the innate immune system and the development of tailored AMP biomarkers and antibiotics. This mini-review focuses on a comprehensive strategy for global profiling and validation of AMPs in UTIs that incorporates AMP data repositories, prediction algorithms, and proteomics for healthy individuals and UTI patients.</div></div><div><h3>Patient summary</h3><div>Short protein molecules called peptides that have antimicrobial activity show promise for the treatment of urinary tract infections. More research and testing of naturally occurring and synthetic peptides with this activity are needed to fully understand how they can help in patient care.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 710-712"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2023.12.005
Melanie R. Hassler , Verena Moedlagl , Hanna Hindinger , Johanna Krauter , Sonja Klager , Irene Resch , Nicolai Huebner , Ozan Yurdakul , Heidemarie Ofner , Stephan M. Korn , David D'Andrea , Kilian Gust , Shahrokh F. Shariat
Background and objective
There are limited data on real-world outcomes for patients with advanced or metastatic urothelial cancer (mUC) since immune checkpoint inhibitors (ICIs) became available. Our objective was to analyze outcomes for patients with mUC since ICIs became available.
Methods
We performed a retrospective analysis of 131 patients with mUC attending the outpatient clinic of a single tertiary care center who received systemic therapy between June 2017 and July 2021 with follow-up up to December 2022. Summary and descriptive statistics were calculated for categorical and continuous variables. The Kaplan-Meier method was applied to calculate survival, and a Cox proportional-hazards model was used to explore associations between clinical variables and outcomes.
Key findings and limitations
The median patient age was 68 yr (range 35–90). The first systemic therapy administered was platinum-based in 79% of cases and ICI-based in 21%. Some 61% of the cohort received a second systemic treatment, with 75% of these an ICI. Median overall survival for the entire cohort was 24 mo (interquartile range 9–35). Patients on ICI therapy for ≥6 mo had median overall survival of 59 mo (95% confidence interval 39 mo–not reached). Metastatic sites on initiation of ICI therapy and C-reactive protein kinetics were prognostic in patients receiving ICIs. Limitations include the retrospective design and inherent selection bias.
Conclusions and clinical implications
More than 60% of patients with mUC received second-line treatment, and 75% of these received an ICI. Patients staying on immunotherapy for more than 6 mo have substantially better outcomes in comparison to patients with less time on immunotherapy and historical cohorts.
Patient summary
We looked at the lines of therapy and outcomes for patients with advanced or metastatic cancer of the urinary tract, starting from when immunotherapy drugs called immune checkpoint inhibitors (ICIs) became available. We found that 60% of patients have received second-line therapy, which is a double the rate in comparison to historical groups of patients. Patients with long-term ICI therapy (>6 months) had significantly better outcomes, with a median survival of more than 3 years.
{"title":"Treatment Patterns and Real-World Outcomes for Locally Advanced or Metastatic Urothelial Cancer in the Era of Immunotherapy","authors":"Melanie R. Hassler , Verena Moedlagl , Hanna Hindinger , Johanna Krauter , Sonja Klager , Irene Resch , Nicolai Huebner , Ozan Yurdakul , Heidemarie Ofner , Stephan M. Korn , David D'Andrea , Kilian Gust , Shahrokh F. Shariat","doi":"10.1016/j.euf.2023.12.005","DOIUrl":"10.1016/j.euf.2023.12.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>There are limited data on real-world outcomes for patients with advanced or metastatic urothelial cancer (mUC) since immune checkpoint inhibitors (ICIs) became available. Our objective was to analyze outcomes for patients with mUC since ICIs became available.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 131 patients with mUC attending the outpatient clinic of a single tertiary care center who received systemic therapy between June 2017 and July 2021 with follow-up up to December 2022. Summary and descriptive statistics were calculated for categorical and continuous variables. The Kaplan-Meier method was applied to calculate survival, and a Cox proportional-hazards model was used to explore associations between clinical variables and outcomes.</div></div><div><h3>Key findings and limitations</h3><div>The median patient age was 68 yr (range 35–90). The first systemic therapy administered was platinum-based in 79% of cases and ICI-based in 21%. Some 61% of the cohort received a second systemic treatment, with 75% of these an ICI. Median overall survival for the entire cohort was 24 mo (interquartile range 9–35). Patients on ICI therapy for ≥6 mo had median overall survival of 59 mo (95% confidence interval 39 mo–not reached). Metastatic sites on initiation of ICI therapy and C-reactive protein kinetics were prognostic in patients receiving ICIs. Limitations include the retrospective design and inherent selection bias.</div></div><div><h3>Conclusions and clinical implications</h3><div>More than 60% of patients with mUC received second-line treatment, and 75% of these received an ICI. Patients staying on immunotherapy for more than 6 mo have substantially better outcomes in comparison to patients with less time on immunotherapy and historical cohorts.</div></div><div><h3>Patient summary</h3><div>We looked at the lines of therapy and outcomes for patients with advanced or metastatic cancer of the urinary tract, starting from when immunotherapy drugs called immune checkpoint inhibitors (ICIs) became available. We found that 60% of patients have received second-line therapy, which is a double the rate in comparison to historical groups of patients. Patients with long-term ICI therapy (>6 months) had significantly better outcomes, with a median survival of more than 3 years.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 779-787"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139069974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.08.003
Lorenz Leitner , Laila Schneidewind , Gernot Bonkat , Fabian P. Stangl , Jennifer Kranz
Urinary tract infections (UTIs) are frequently associated with lower urinary tract dysfunction (LUTD). Urodynamic investigation (UDI) is the gold standard for assessing LUTD, but its value in identifying UTI risk factors remains underexplored. Studies have shown high rates of storage and voiding dysfunction in patients with recurrent UTIs, suggesting a causal link between LUTD and UTIs. Specific UDI findings, such as low bladder capacity, high detrusor pressures, and detrusor overactivity, have been associated with greater UTI risk, especially in kidney transplant recipients and infants. However, the current evidence is limited by the lack of control groups and therapeutic interventions, making it difficult to draw definitive conclusions. Further well-designed studies are needed to determine if UDI-guided therapies can improve UTI management outcomes.
Patient summary
Urinary infections are often linked to problems with the lower urinary tract. Tests that measure lower urinary tract function can help in identifying these issues. More research is needed to see if treating bladder problems can prevent urinary infections.
尿路感染（UTI）常常与下尿路功能障碍（LUTD）有关。尿动力学检查（UDI）是评估下尿路功能障碍的黄金标准，但其在确定 UTI 风险因素方面的价值仍未得到充分开发。研究显示，复发性尿毒症患者的储尿和排尿功能障碍发生率很高，这表明 LUTD 与尿毒症之间存在因果关系。特定的 UDI 发现，如膀胱容量小、逼尿肌压力高和逼尿肌过度活动，与 UTI 风险增大有关，特别是在肾移植受者和婴儿中。然而，由于缺乏对照组和治疗干预措施，目前的证据还很有限，因此很难得出明确的结论。要确定 UDI 指导疗法是否能改善 UTI 的治疗效果，还需要进一步开展精心设计的研究。患者摘要：尿路感染通常与下尿路问题有关。测量下尿路功能的检查有助于发现这些问题。治疗膀胱问题是否能预防泌尿感染还需要更多的研究。
{"title":"Urodynamic Risk Factors for Urinary Infection","authors":"Lorenz Leitner , Laila Schneidewind , Gernot Bonkat , Fabian P. Stangl , Jennifer Kranz","doi":"10.1016/j.euf.2024.08.003","DOIUrl":"10.1016/j.euf.2024.08.003","url":null,"abstract":"<div><div>Urinary tract infections (UTIs) are frequently associated with lower urinary tract dysfunction (LUTD). Urodynamic investigation (UDI) is the gold standard for assessing LUTD, but its value in identifying UTI risk factors remains underexplored. Studies have shown high rates of storage and voiding dysfunction in patients with recurrent UTIs, suggesting a causal link between LUTD and UTIs. Specific UDI findings, such as low bladder capacity, high detrusor pressures, and detrusor overactivity, have been associated with greater UTI risk, especially in kidney transplant recipients and infants. However, the current evidence is limited by the lack of control groups and therapeutic interventions, making it difficult to draw definitive conclusions. Further well-designed studies are needed to determine if UDI-guided therapies can improve UTI management outcomes.</div></div><div><h3>Patient summary</h3><div>Urinary infections are often linked to problems with the lower urinary tract. Tests that measure lower urinary tract function can help in identifying these issues. More research is needed to see if treating bladder problems can prevent urinary infections.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 5","pages":"Pages 702-705"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.09.015
Marcus J. Drake , Francesco Clavica , Cathy Murphy , Mandy J. Fader
Background and objective
Bacteriuria is anticipated in long-term indwelling catheter (IDC) use, and urinary tract infections (UTIs) and related issues are common. Defence mechanisms against infection are undermined by the presence of a Foley catheter, and adjustments to design could influence UTI risk.
Methods
We reviewed the various aspects of IDCs and ureteric stent designs to discuss potential impact on UTI risk.
Key findings and limitations
Design adaptations have focussed on reducing the sump of undrained urine, potential urinary tract trauma, and bacterial adherence. Experimental and computational studies on ureteral stents found an interplay between urine flow, bacterial microcolony formation, and accumulation of encrusting particles. The most critical regions for biofilm and crystal accumulation are associated with low shear stress. The full drainage system is the functioning unit, not just the IDC in isolation. This means reliably keeping the drainage system closed and considering whether a valve is preferred to a collection bag. Other developments may include one-way valves, obstacles to “bacterial swimming”, and ultrasound techniques. Preventing or clearing IDC blockage can exploit access via the lumen or retaining balloon. Progress in computational fluid dynamics, energy delivery, and soft robotics may increase future options. Clinical data on the effectiveness of IDC design features are lacking, which is partly due to reliance on proxy measures and the challenges of undertaking trials.
Conclusions and clinical implications
Design changes are legitimate lines of development, but are only indirect for UTI prevention. Modifications may be advantageous, but might potentially bring problems in other ways. Education of health care professionals can improve UTIs and should be prioritised.
Patient summary
Catheters used to help bladder drainage can cause urinary infections, and improvements in design might reduce the risk. Several approaches are described in this review. However, proving that these approaches work is a challenge. Training professionals in the key aspects of catheter care is important.
背景和目的：长期使用留置导尿管（IDC）会导致细菌尿，尿路感染（UTI）和相关问题也很常见。福里导尿管的存在破坏了防止感染的机制，对设计进行调整可能会影响 UTI 风险：我们回顾了 IDC 和输尿管支架设计的各个方面，讨论了其对 UTI 风险的潜在影响：主要发现和局限性：设计调整的重点是减少未排出尿液的底盘、潜在的尿路创伤和细菌附着。对输尿管支架进行的实验和计算研究发现，尿流、细菌微菌落的形成和结壳颗粒的积累之间存在相互作用。生物膜和晶体积聚的最关键区域与低剪切应力有关。整个排水系统是一个功能单元，而不仅仅是孤立的 IDC。这意味着要可靠地保持排水系统的封闭性，并考虑是否应使用阀门而不是收集袋。其他发展可能包括单向阀、"细菌游动 "障碍和超声波技术。防止或清除 IDC 堵塞可以利用通过管腔或固定球囊的通道。计算流体动力学、能量输送和软机器人技术的进步可能会增加未来的选择。目前缺乏有关 IDC 设计特点有效性的临床数据，部分原因是依赖于替代措施和开展试验的挑战：设计变更是合理的发展方向，但只能间接预防UTI。修改可能会带来好处，但也可能在其他方面带来问题。对医护人员的教育可以改善 UTI，应优先考虑。患者总结：用于帮助膀胱引流的导尿管可能会引起泌尿系统感染，改进设计可以降低风险。本综述介绍了几种方法。然而，证明这些方法有效是一项挑战。对专业人员进行导尿管护理关键方面的培训非常重要。
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Pub Date : 2024-09-01DOI: 10.1016/j.euf.2024.03.003
Romain Diamand , Karsten Guenzel , Georges Mjaess , Yolène Lefebvre , Mariaconsiglia Ferriero , Giuseppe Simone , Alexandre Fourcade , Georges Fournier , Alexandre-Patrick Bui , Fayek Taha , Marco Oderda , Paolo Gontero , Katerina Rysankova , Adrian Bernal-Gomez , Alessandro Mastrorosa , Jean-Baptiste Roche , Gaelle Fiard , Rawad Abou Zahr , Guillaume Ploussard , Olivier Windisch , Alexandre Peltier
Background and objective
A notable paradigm shift has emerged in the choice of prostate biopsy approach, with a transition from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) driven by the lower risk of severe urinary tract infections. The impact of this change on detection of clinically significant prostate cancer (csPCa) remains a subject of debate. Our aim was to compare the csPCa detection rate of TRBx and TPBx.
Methods
Patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for clinically localized PCa at 15 European referral centers from 2016 to 2023 were included. A propensity score matching (PSM) analysis was performed to minimize selection biases. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Key findings and limitations
Of 3949 patients who met the study criteria, 2187 underwent TRBx and 1762 underwent TPBx. PSM resulted in 1301 matched pairs for analysis. Patient demographics and tumor characteristics were comparable in the matched cohorts. TPBx versus TRBx was associated with greater detection of csPCa, whether defined as International Society of Urological Pathology grade group ≥2 (51% vs 45%; OR 1.37, 95% CI 1.15–1.63; p = 0.001) or grade group ≥3 (29% vs 23%; OR 1.38, 95% CI 1.13–1.67; p = 0.001). Similar results were found when considering MRI-targeted biopsy alone and after stratifying patients according to tumor location, Prostate Imaging-Reporting and Data System score, and clinical features. Limitations include the retrospective nature of the study and the absence of centralized MRI review.
Conclusions
Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited.
Patient summary
We compared the rate of detection of clinically significant prostate cancer with magnetic resonance imaging (MRI)-guided biopsies in which the sample needle is passed through the perineum or the rectum. Our results suggest that the perineal approach is associated with better detection of aggressive prostate cancer.
背景和目的：随着经直肠活检（TRBx）向经会阴活检（TPBx）过渡，严重尿路感染的风险降低，前列腺活检方法的选择出现了明显的范式转变。这一变化对临床意义重大的前列腺癌（csPCa）检测的影响仍存在争议。我们的目的是比较 TRBx 和 TPBx 的 csPCa 检出率：方法：纳入2016年至2023年期间在15个欧洲转诊中心接受磁共振成像（MRI）靶向和系统性活检治疗临床局部PCa的患者。进行倾向评分匹配（PSM）分析以尽量减少选择偏差。采用逻辑回归模型估算调整后的几率比（OR）和95%置信区间（CI）：在符合研究标准的 3949 名患者中，2187 人接受了 TRBx，1762 人接受了 TPBx。通过PSM分析得出了1301对匹配的患者。配对组患者的人口统计学特征和肿瘤特征具有可比性。TPBx 与 TRBx 相比，csPCa 的检出率更高，无论是定义为国际泌尿病理学会分级组≥2（51% vs 45%；OR 1.37，95% CI 1.15-1.63；p = 0.001）还是分级组≥3（29% vs 23%；OR 1.38，95% CI 1.13-1.67；p = 0.001）。如果仅考虑核磁共振靶向活检，以及根据肿瘤位置、前列腺成像报告和数据系统评分以及临床特征对患者进行分层后，结果也相似。研究的局限性包括研究的回顾性和缺乏集中的磁共振成像审查：我们的研究结果增强了人们对TPBx额外优势的认识。患者摘要：我们比较了磁共振成像（MRI）引导下活检与会阴或直肠穿刺活检对有临床意义的前列腺癌的检出率。我们的结果表明，会阴部方法能更好地发现侵袭性前列腺癌。
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