Journal of Clinical Urology最新文献

Diagnostic value of the abnormal digital rectal examination in the modern MRI-based prostate cancer diagnostic pathway. 基于磁共振成像的现代前列腺癌诊断路径中异常数字直肠检查的诊断价值。

IF 0.2 Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2024-07-01 Epub Date: 2022-04-27 DOI: 10.1177/20514158221091402

Wasiq Sajjad, Vineetha Thankappannair, Syed Shah, Adham Ahmed, Kasra Saeb-Parsy, Christof Kastner, Benjamin Lamb, Vincent J Gnanapragasam

Objective: Currently the National Institute for Health and Care Excellence (NICE) recommends an abnormal digital rectal examination (DRE) as a standalone referral criterion for suspected prostate cancer. Unlike referrals for a raised prostate-specific antigen (PSA) which are triaged directly to magnetic resonance imaging (MRI), an abnormal DRE requires re-examination in a secondary clinic first. Here, we investigated the ongoing value of the abnormal DRE as a referral criterion.

Methods: This study is a retrospective review of patients referred to secondary care for suspected prostate cancer based on an abnormal DRE over a 15-month period at a single UK hospital (n = 158). Age, PSA, primary and repeat DRE findings and eventual diagnosis were collated.

Results: A concurrent raised PSA was present in 65/158 (41%). Concordance between primary and secondary care DRE was only 72/158 (46%). The overall and significant cancer detection rate was 26/158 (16%) and 22/158 (14%), respectively. Among men with a concurrent raised PSA, 19/65 (29%) had significant cancer found, whereas with an abnormal primary care DRE and normal PSA (n = 93), only 3/93 (3%) had a significant cancer. Mandating a PSA before referral for an abnormal DRE would have redirected 65/158 (41%) of men to MRI first, negating the need for a repeat DRE (p < 0.0001). This finding was recapitulated in a second prospective validation cohort (n = 30) with 9/30 (30%) redirected to MRI first.

Conclusions: This is one of the first studies to investigate the value of the DRE in contemporary practice. We propose that PSA is used to triage men with an abnormal DRE to MRI without needing a repeat DRE. If the PSA is normal, the diagnostic yield is low but may still warrant a repeat DRE to assess the need for further investigations. Additional multicentre studies are required to further validate our findings.

Level of evidence: 4.

目的：目前，美国国家健康与护理优化研究所（NICE）建议将数字直肠检查（DRE）异常作为疑似前列腺癌的独立转诊标准。与因前列腺特异性抗原（PSA）升高而直接分流至磁共振成像（MRI）的转诊不同，数字直肠检查异常需要先在二级诊所进行复查。在此，我们调查了异常 DRE 作为转诊标准的持续价值：本研究是对英国一家医院在 15 个月内因 DRE 异常而转诊至二级医院的疑似前列腺癌患者（n = 158）进行的回顾性研究。对患者的年龄、前列腺特异性抗原（PSA）、初次和再次DRE检查结果以及最终诊断结果进行了整理：结果：65/158 例患者（41%）的 PSA 同时升高。初诊和复诊 DRE 结果一致的仅有 72/158 例（46%）。总体癌症检出率为26/158（16%），显著癌症检出率为22/158（14%）。在 PSA 同时升高的男性中，19/65（29%）发现了明显的癌症，而在主治 DRE 异常且 PSA 正常的情况下（n = 93），只有 3/93（3%）发现了明显的癌症。如果在 DRE 异常转诊前强制要求进行 PSA 检查，将有 65/158 名（41%）男性首先接受 MRI 检查，从而无需重复 DRE（p < 0.0001）。这一发现在第二个前瞻性验证队列（n = 30）中得到了重现，9/30（30%）的人被转至磁共振成像检查：这是研究 DRE 在当代实践中的价值的首批研究之一。我们建议使用 PSA 将 DRE 异常的男性分流到 MRI，而无需重复 DRE。如果 PSA 正常，诊断率较低，但仍有必要再次进行 DRE，以评估是否需要进一步检查。需要进行更多的多中心研究来进一步验证我们的发现：4.

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引用次数: 0

Comparison of the diagnostic utility of CHOKAI, STONE and STONE PLUS scores in predicting ureteral stones larger than 5 mm 比较 CHOKAI、STONE 和 STONE PLUS 评分在预测 5 毫米以上输尿管结石方面的诊断效用

IF 0.3 Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-12-04 DOI: 10.1177/20514158231214982

Ali Cankut Tatliparmak, Sarper Yılmaz, Rohat Ak, N. M. Hokenek

The objective of this study is to assess the diagnostic accuracy of CHOKAI, STONE, and STONE plus scores in detecting ureteral stones larger than 5 mm. This comparative diagnostic accuracy study was performed in a tertiary care emergency department (ED) and included consecutive patients who presented to the ED with flank pain over a 1-year period. The performance of these scoring scales in detecting ureteral stones measuring >5 mm was determined by area under the receiver operating characteristics (AUROC) comparison. Ureteral stones were detected in 270 (70.3%) of 384 patients included in the study. While 146 patients (54.1%) had ureteral stones measuring <5 mm, 124 patients (54.1%) had stones measuring 5 mm or more in size. The performance of the CHOKAI score in predicting ureteral stones was superior to that of the STONE PLUS score; STONE PLUS score was also superior to STONE score ( p < 0.001). Analysis of the diagnostic value of CHOKAI score and STONE PLUS scores in predicting >5-mm stones showed no statistically significant difference ( p = 0.59). CHOKAI and STONE PLUS scores are useful in predicting >5-mm ureteral stones and have similar diagnostic utility to each other. STONE score does not provide accurate diagnostic information about ureteral stones larger than 5 mm. Level 2b

本研究的目的是评估CHOKAI、STONE和STONE +评分在检测大于5mm输尿管结石中的诊断准确性。这项比较诊断准确性的研究是在三级护理急诊科(ED)进行的，包括连续1年期间因侧腹疼痛就诊的患者。通过受试者操作特征(AUROC)下面积的比较，确定各评分量表在检测> 5mm输尿管结石中的表现。384例患者中有270例(70.3%)检出输尿管结石。输尿管结石直径为5 mm者146例(54.1%)，差异无统计学意义(p = 0.59)。CHOKAI和STONE PLUS评分可用于预测>5毫米输尿管结石，并且彼此具有相似的诊断效用。对于大于5mm的输尿管结石，结石评分不能提供准确的诊断信息。级别2 b

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引用次数: 0

Quality of life and healthcare resource use in patients with bladder pain syndrome: A survey of UK patients 膀胱疼痛综合征患者的生活质量和医疗资源使用:一项英国患者调查

Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-10-24 DOI: 10.1177/20514158231204591

Sachin Malde, Michael Ho, Jane Griffin

Objectives: The main aim of this study is to characterise the humanistic burden of bladder pain syndrome (BPS) on patients within the United Kingdom and to estimate the key healthcare resource usage and cost of treating these patients. Method: An online survey was administered through two charities. Respondents were asked questions on BPS diagnosis, socio-demographics and health-related quality of life using the O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), the Pelvic Pain and Urinary/Frequency (PUF) and the EQ-5D questionnaires. Healthcare resource and therapy use, for the previous 6 months, were recorded and used to calculate economic burden. Results: A total of 252 patients completed the survey. Mean ICSI ICPI scores were 12.6 and 11.0, respectively, indicating severe symptoms. Mean PUF score was 21.2, indicating poor health status and a high number of BPS-related symptoms and problems. Mean EQ-5D utility score was 0.541. In the previous 6 months, 172 (68%) saw their general practitioner (GP) and 80 (32%) a primary care nurse, and 165 (65%) had one or more outpatient visits, due to their BPS. Conclusion: This survey adds to our current understanding of BPS in the United Kingdom, highlighting that patients with BPS have poor health-related quality of life and incur high resource use. Level of evidence: Not applicable

目的:本研究的主要目的是描述英国患者膀胱疼痛综合征(BPS)的人文负担，并估计治疗这些患者的关键医疗资源使用和成本。方法:通过两个慈善机构进行在线调查。使用O 'Leary-Sant间质性膀胱炎症状指数(ICSI)和问题指数(ICPI)、盆腔疼痛和尿频(PUF)和EQ-5D问卷，向受访者询问BPS诊断、社会人口统计学和健康相关生活质量问题。记录前6个月的医疗资源和治疗使用情况，并用于计算经济负担。结果:共252例患者完成调查。ICSI ICPI平均评分分别为12.6和11.0，提示症状严重。PUF平均得分为21.2，表明健康状况不佳，bps相关症状和问题较多。平均EQ-5D效用评分为0.541。在过去的6个月中，172人(68%)看了他们的全科医生(GP)， 80人(32%)看了初级保健护士，165人(65%)因为他们的BPS去了一次或多次门诊。结论:这项调查增加了我们目前对英国BPS的了解，强调了BPS患者的健康相关生活质量较差，并且导致资源的大量使用。证据等级:不适用

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引用次数: 0

Analysis of the learning curve for Retzius-sparing robot-assisted radical prostatectomy for a single surgeon 单个外科医生保留retzius机器人辅助根治性前列腺切除术的学习曲线分析

Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-10-18 DOI: 10.1177/20514158231203766

Hany Hussein, Neil Maitra, Li June Tay, Ioannis Saxionis, Robert Makin, Sailantra Sivathasan, Sonny Smart, Anne Warren, Nimish Shah, Benjamin Wilfrid Lamb

Background: The learning curve for Retzius-sparing robotic radical prostatectomy is not fully understood. Objective: This study attempts to identify the learning curve across the first 130 cases of a single surgeon. Design, Setting and Participants: All Retzius-sparing robotic radical prostatectomy cases performed by a single surgeon at a high-volume tertiary hospital between April 2019 and July 2022 were included. Outcome Measurements and Statistical Analysis: Outcome measures included positive surgical margin rate, complication rates and unplanned readmission to hospital, postoperative urinary continence, erectile function and prostate-specific antigen (PSA) measurement. Cases were divided chronologically into three groups and differences between groups assessed. Results and Limitation: A total of 130 Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) cases were identified. Differences were found between groups in several areas. Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Safety, postoperative continence, erectile function and PSA remained stable. Median patient age increased between Group 1 (59 years) and Group 3 (66.5 years) ( p = 0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) ( p = 0.036). Median console time increased between Group 1 (120 minutes) and Group 2 (150 minutes) ( p = 0.01). Median gland weight increased between Group 1 (28 g) and Group 3 (35.5 g) ( p < 0.001). Conclusions: The positive surgical margin rate improved over the learning curve, despite the complexity of cases increasing, reflected in older patients, larger prostates and higher stage disease. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease. Patient Summary: We analysed the learning curve for Retzius-sparing robotic radical prostatectomy. Across the first 130 cases, positive surgical margin rate fell; safety and continence remained excellent. Selection of smaller and less advanced cases may facilitate learning. Level of evidence: III

背景:保留retzius的机器人根治性前列腺切除术的学习曲线尚不完全清楚。目的:本研究试图确定前130例外科医生的学习曲线。设计、环境和参与者:纳入2019年4月至2022年7月在一家大容量三级医院由一名外科医生实施的所有保留retzius的机器人根治性前列腺切除术病例。结果测量和统计分析:结果测量包括手术切缘阳性率、并发症发生率和意外再入院率、术后尿失禁、勃起功能和前列腺特异性抗原(PSA)测量。病例按时间顺序分为三组，并评估各组之间的差异。结果与局限性:共发现130例保留retzius的机器人辅助根治性前列腺切除术(RS-RARP)病例。在几个方面发现了不同群体之间的差异。手术切缘阳性率在1组(30.2%)和3组(9.1%)之间下降。安全性、术后尿失禁、勃起功能和PSA保持稳定。组1(59岁)和组3(66.5岁)患者中位年龄增加(p = 0.04)。与对照组相比，组1(27.9%)和组2(41.9%)患者的T2期患者比例明显增加(p = 0.036)。组1(120分钟)和组2(150分钟)的中位控制台时间增加(p = 0.01)。第1组(28 g)和第3组(35.5 g)中间腺重量增加(p <0.001)。结论:尽管病例复杂性增加，但随着学习曲线的推移，手术切缘阳性率有所提高，这反映在年龄较大、前列腺较大和疾病分期较高的患者中。安全性和功能性结果非常好。仔细的病例选择有利于较小的前列腺和较不严重的疾病，可能会促进学习曲线。患者总结:我们分析了保留retzius的机器人根治性前列腺切除术的学习曲线。在前130例中，手术切缘阳性率下降;安全性和控制性仍然很好。选择较小和较不先进的病例可以促进学习。证据水平:III

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引用次数: 0

Effectiveness of intravesical glycosaminoglycans in the treatment of recurrent urinary tract infections: Systematic review and meta-analysis 膀胱内糖胺聚糖治疗复发性尿路感染的有效性:系统回顾和荟萃分析

Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-10-16 DOI: 10.1177/20514158231198553

Ricardo Contreras-García, Herney Andrés García-Perdomo

Objective: The objective of the study was to determine the efficacy of glycosaminoglycans in bladder instillation compared with placebo or other forms of prophylaxis in women with recurrent urinary tract infections (UTIs). Methods: A search strategy was performed in the Cochrane central register, Embase, and Medline until October 2020, along with manual searches and reference-list checking. Randomised and nonrandomized studies in women with recurrent UTIs who received hyaluronic acid (HA) or HA plus chondroitin sulfate (CS) were included. A random-effects model was applied to the pooled results. The risk of bias was evaluated using the Cochrane RoB 2 bias tool for clinical trials and MINORS for nonrandomized studies. The quality of the evidence was evaluated by the GRADE method. Results: One randomised study and eight nonrandomized studies were included. All evaluated HA or HA plus CS. HA or HA plus CS decreased the average UTI patient-years (mean difference (MD) = −2.62; 95% confidence interval (CI) = −4.00 to −1.23), increased the time to recurrence (MD = 145.70; 95% CI = 61.57 to 229.83), and improved symptoms and quality of life as evaluated through the total pelvic pain and urgency/frequency score (MD = −6.08; 95% CI = −7.68 to −4.48) and the visual analog scale (MD = −4.79; 95% CI = −5.55 to −4.03). There was high heterogeneity in the results, a high risk of bias in the one randomised study, and a low quality of evidence according to GRADE. The number of included studies was low. Conclusion: The application of HA or HA plus CS in intravesical instillation is associated with fewer UTI recurrences and improved symptoms and quality of life. The quality of the evidence provided by the studies is limited, so more studies of higher quality are needed to yield definitive conclusions. Level of evidence: Not applicable

目的:该研究的目的是确定糖胺聚糖膀胱灌注与安慰剂或其他形式的预防对复发性尿路感染(uti)妇女的疗效。方法:在Cochrane中央注册库、Embase和Medline中执行检索策略，直到2020年10月，同时进行人工检索和参考文献列表检查。随机和非随机研究纳入了接受透明质酸(HA)或HA +硫酸软骨素(CS)治疗的复发性尿路感染妇女。对合并结果采用随机效应模型。临床试验使用Cochrane RoB 2偏倚工具评估偏倚风险，非随机研究使用未成年人评估偏倚风险。采用GRADE方法评价证据的质量。结果:纳入1项随机研究和8项非随机研究。所有评估的都是HA或HA + CS。HA或HA + CS降低平均尿路感染患者年(平均差(MD) = - 2.62;95%可信区间(CI) = - 4.00 ~ - 1.23)，增加复发时间(MD = 145.70;95% CI = 61.57 ~ 229.83)，通过总盆腔疼痛和急迫性/频率评分(MD = - 6.08;95% CI =−7.68 ~−4.48)和视觉模拟量表(MD =−4.79;95% CI =−5.55 ~−4.03)。结果存在高度异质性，一项随机研究存在高偏倚风险，根据GRADE，证据质量较低。纳入的研究数量很少。结论:应用HA或HA + CS膀胱内灌注可减少尿路感染复发，改善症状和生活质量。这些研究提供的证据质量有限，因此需要更多更高质量的研究来得出明确的结论。证据等级:不适用

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引用次数: 0

Evaluation of functional, perioperative outcomes and common complications of robot-assisted vs open construction of orthotopic neobladder following a radical cystectomy in patients with bladder cancer: A systematic review 膀胱癌患者根治性膀胱切除术后机器人辅助与开放式原位新膀胱构建的功能、围手术期结局和常见并发症评估:一项系统综述

Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-10-11 DOI: 10.1177/20514158231202280

Mansha Bhiryani, Omar El-Taji, Vishwanath Hanchanale

Introduction: Orthotopic neobladder (ONB) reconstruction following radical cystectomy for bladder cancer is a viable alternative to the formation of an ileal conduit. Although robotic surgery is gaining popularity, neobladder reconstruction is still most commonly done extra-corporeally (eONB) with a lower midline-laparotomy rather than intra-corporeal ONB (iONB) reconstruction. The novelty of a robotic approach has made several centres apprehensive to adopt this. This systematic review aims to compare functional outcomes as well as perioperative outcomes and common complications of robotic-assisted radical cystectomy with iONB versus eONB reconstruction. Materials and methods: A search of the literature from 2011 to 2021 was performed through PubMed, EMBASE, Medline and Scopus to identify articles comparing eONB formation with iONB formation. Urodynamic (UDS) outcomes (bladder volume, flow rate, post-voiding residual volume, continence rates and rate of clean intermittent catheterization (CIC) use) and perioperative outcomes (estimated blood loss, length of stay and operative time) were extracted as endpoints of interest. This review was registered with PROSPERO on 19 October 2022 (CRD42022366667). Results: Our searches identified 84 abstracts, of which 4 articles with 410 patients were eligible. Our results showed patients undergoing iONB had a higher bladder capacity and continence rate and achieved full continence much sooner than eONBs. iONBs, however, seemed to be left with higher residual volumes and a higher percentage of patients who needed CIC to void. Conclusion: Both perioperative outcomes and complications favoured the iONB technique; however, eONB seemed to give better functional outcomes. Level of evidence: Not applicable

摘要:膀胱癌根治性膀胱切除术后原位新膀胱(ONB)重建是一种可行的替代回肠导管形成的方法。虽然机器人手术越来越受欢迎，但新膀胱重建术仍然是最常见的体外(eONB)与下中线剖腹手术，而不是体内ONB (iONB)重建术。机器人方法的新颖性使一些中心对采用这种方法感到担忧。本系统综述旨在比较机器人辅助根治性膀胱切除术iONB与eONB重建的功能结局、围手术期结局和常见并发症。材料和方法:通过PubMed、EMBASE、Medline和Scopus检索2011 - 2021年的文献，找出比较eONB形成和iONB形成的文章。尿动力学(UDS)结果(膀胱体积、流量、排尿后残留体积、失禁率和清洁间歇导尿(CIC)使用率)和围手术期结果(估计失血量、住院时间和手术时间)被提取为感兴趣的终点。该综述于2022年10月19日在普洛斯彼罗注册(CRD42022366667)。结果:我们检索到84篇摘要，其中4篇文章410例患者符合条件。我们的研究结果表明，接受iONB的患者比接受eonb的患者有更高的膀胱容量和控制率，并且更快地达到完全控制。然而，ionb似乎留下了更高的残余体积和更高比例的患者需要CIC清空。结论:iONB技术的围手术期预后和并发症均有利;然而，eONB似乎能提供更好的功能结果。证据等级:不适用

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引用次数: 0

Short (23-hour)-stay robotic-assisted radical prostatectomy in a state-funded national health service – Is it safe and feasible? 在国家资助的国家医疗服务中，机器人辅助根治性前列腺切除术是否安全可行?

Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-09-19 DOI: 10.1177/20514158231198362

Li June Tay, Kemal Gillangullari, Neil Maitra, Lourdes Samson, Vishal Patil, Benjamin W Lamb, Nimish Shah

Objectives: The COVID-19 pandemic has led to a long waiting list for elective surgery and increasing bed pressures from acute admissions. This led to widespread cancellations on the day of surgery even for cancer procedures. To address this, all inpatient stay robotic-assisted radical prostatectomy (RARP) cases were managed via our day surgery unit as a 23-hour stay. We report the safety and feasibility of our initial implementation. Methods: A standard operating procedure for admission via the day surgery unit, including a modified enhanced recovery pathway, for patients undergoing RARP with or without pelvic lymph node dissection (PLND) was devised. All pre-operative variables were collected, and all perioperative outcomes analysed. Primary outcomes were number of on the day cancellations, discharge failure as 23-hour stay and 30-day readmissions. Results: Between November 2021 and June 2022, 135 patients underwent RARP with or without PLND via the day surgery unit. Mean patient age was 65 (46–76) years. Mean operative time and estimated blood loss were 153 (67–281) minutes and 197 (50–700) mL, respectively. Concomitant lymph node dissection was performed in 32.7% of cases. No patient required blood transfusion or conversion to open. We had 3 (2.2%) discharge failures, all of which were due to clinical reasons. Our 30-day hospital readmission rate was 3.7%, while another 5.2% attended emergency department and were discharged without admission. Conclusion: Short (23-hour)-stay RARP is safe and feasible and reduces pressure on inpatient beds but requires a multidisciplinary approach and engagement from all stakeholders. Level of evidence: 2

目的:2019冠状病毒病大流行导致选择性手术等待名单变长，急性住院患者的床位压力增加。这导致了手术当天的广泛取消，甚至是癌症手术。为了解决这个问题，所有住院的机器人辅助根治性前列腺切除术(RARP)病例都通过我们的日间外科部门进行了23小时的住院治疗。我们报告初步实施的安全性和可行性。方法:为RARP合并或不合并盆腔淋巴结清扫(PLND)的患者设计了一套标准的日间外科入院操作程序，包括改进的增强恢复途径。收集所有术前变量，分析所有围手术期结果。主要结果是当天取消的数量，出院失败为23小时住院和30天再入院。结果:在2021年11月至2022年6月期间，135名患者通过日间手术单元接受了伴有或不伴有PLND的RARP。患者平均年龄65岁(46 ~ 76岁)。平均手术时间为153(67-281)分钟，估计失血量为197 (50-700)mL。32.7%的病例同时行淋巴结清扫。没有病人需要输血或转化才能打开。我们有3例(2.2%)出院失败，均为临床原因。我们的30天再入院率为3.7%，另有5.2%的患者进入急诊科，出院时未入院。结论:短时间(23小时)住院RARP是安全可行的，减少了住院病床的压力，但需要多学科的方法和所有利益相关者的参与。证据等级:2

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引用次数: 0

HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT 经尿道膀胱肿瘤切除术(HEATT)后血尿:一项多中心、区域合作分析与TURBT术后血尿急诊再入院相关的因素

IF 0.3 Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-08-07 DOI: 10.1177/20514158231190035

P. Sarmah, W. Al-Dhahir, A. Chellapuri, A. Damola, Nnaemeka Eli, Rebecca Foulger, Maria Harrington-Vogt, S. Hulligan, A. Kanthabalan, M. Kitchen, S. Malik, Madeline Moore, D. Nyanhongo, Ridwaan Sohawon, H. Thursby, S. Yallappa, D. Mak, A. Chakravarti

To calculate the re-admission rate with haematuria within 30 days of elective transurethral resection of bladder tumour (TURBT), and identify factors associated with this. This was a multicentre, retrospective audit, identifying all adult patients over the age of 16 who underwent elective TURBT between 1 September and 30 November 2019. Data were collected from medical records and operation notes on patient demographics, intra-operative factors and post-operative management. Primary outcome measure was the proportion of patients emergently re-admitted with haematuria. Secondary outcome measures were the re-operation rate for haematuria, and the rate of new acute thrombotic event (TE). Fisher’s exact test was used to calculate p values within subgroups for re-admission rates. 443 patients from 12 hospitals were included. Median age was 75 years (17–99). 15 patients (3.4%) were re-admitted with haematuria. Subgroup analysis demonstrated higher rate of re-admission for pre-existing antithrombotic agents (ATAs) (2.0% vs. 6.1%, p = 0.046), increased for non-Aspirin ATAs (10.5%, p = 0.0015). 52% of non-Aspirin ATAs were restarted within 48 hours of surgery; post-operative plan for restarting was not documented in 22.1%. One patient (0.23%) developed acute TE (pulmonary embolus). Pre-existing use of non-Aspirin ATAs is associated with increased risk of post-TURBT haematuria, with variable practice in post-operative recommencement. Level 3

计算择期经尿道膀胱肿瘤切除术(TURBT)术后30天内血尿再入院率，并确定与此相关的因素。这是一项多中心回顾性审计，确定了2019年9月1日至11月30日期间接受选择性TURBT的所有16岁以上成年患者。从医疗记录和手术记录中收集有关患者人口统计学、术中因素和术后管理的数据。主要结局指标是因血尿而紧急再次入院的患者比例。次要观察指标为血尿再手术率和新发急性血栓事件(TE)率。Fisher精确检验用于计算亚组内再入院率的p值。纳入了来自12家医院的443名患者。中位年龄为75岁(17-99岁)。15例(3.4%)患者因血尿再次入院。亚组分析显示，已有抗血栓药物(ATAs)的再入院率较高(2.0% vs. 6.1%， p = 0.046)，非阿司匹林ATAs的再入院率升高(10.5%，p = 0.0015)。52%的非阿司匹林类ATAs在手术48小时内重新启动;22.1%的患者未记录术后重启计划。1例(0.23%)发生急性TE(肺栓塞)。既往使用非阿司匹林类ATAs与turbt术后血尿风险增加相关，术后重新使用的做法不同。3级

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引用次数: 0

Stress among UK consultant urologists and factors influencing when they leave full-time NHS practice 英国泌尿科顾问医生的压力及其离开全职NHS的影响因素

IF 0.3 Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-08-07 DOI: 10.1177/20514158231190949

Steven Payne, Amy Kane, K. Thomas, H. Bolderston, M. Greville-harris, K. Turner

The UK medical workforce is in crisis. The number of surgeons in National Health Service (NHS) practice has decreased, partly because newly qualified doctors withdraw from the workforce, and partly because of the early retirement of experienced surgeons. The reasons for urological trainee loss are largely known, but stress factors influencing the retirement of consultants before state pension age (SPA) are not. An online survey of the consultant membership of the British Association of Urological Surgeons was carried out over a 12-week period starting in September 2020. Information was sought regarding stresses at work and home, together with factors affecting retirement decisions. Data analysis was performed if > 90% of questions were complete. Overall, 36.5% of 1374 invitees completed the survey. Workplace-based issues were the main causes of stress: on-call, an unsupportive working environment, complaint handling and poor relations with hospital managers were predominant factors which were exacerbated by punitive taxation. Experienced urologists ameliorated these factors by reducing their contracted activity, increasing part-time working and, ultimately, retiring before SPA. Workplace-based factors are associated with stress reported by consultant urologists. Alleviation of stressor factors, especially those related to on-call activity, should be explored to reduce the erosion of the senior workforce. Not applicable

英国的医护人员正处于危机之中。国家医疗服务体系（NHS）执业的外科医生数量有所减少，部分原因是新获得资格的医生退出了工作队伍，部分原因也是经验丰富的外科医生提前退休。泌尿外科实习医生流失的原因众所周知，但影响顾问在国家养老金年龄（SPA）之前退休的压力因素却不清楚。从2020年9月开始，对英国泌尿外科医师协会顾问会员进行了为期12周的在线调查。有人要求提供有关工作和家庭压力以及影响退休决定的因素的信息。如果 > 90%的问题都完成了。总体而言，1374名受邀者中有36.5%完成了调查。基于工作场所的问题是压力的主要原因：随叫随到、不支持的工作环境、投诉处理以及与医院管理人员的不良关系是主要因素，惩罚性税收加剧了这些因素。经验丰富的泌尿科医生通过减少合同活动、增加兼职工作以及最终在SPA前退休来改善这些因素。泌尿科顾问医生报告的工作场所因素与压力有关。应探索缓解压力因素，特别是与随叫随到活动有关的压力因素，以减少对高级劳动力的侵蚀。不适用

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引用次数: 0

Pre-operative risk stratification of high-risk prostate cancer patients can predict risk of biochemical recurrence for individual patients post radical surgery: A multi-institutional study 一项多机构研究表明，高危前列腺癌患者术前风险分层可以预测根治性手术后个体患者生化复发的风险

IF 0.3 Q4 UROLOGY & NEPHROLOGY

Journal of Clinical Urology

Pub Date : 2023-07-22 DOI: 10.1177/20514158231185993

C. Devlin, M. Raslan, A. Deytrikh, Shacheesh Sinha, Samuel Murgatroyd, D. Yates, M. Dooldeniya, Nicholas Smith, M. Simms, R. Beekharry, Rajindra Singh, C. Molokwu, R. Chahal

The aim of this study was to identify which high-risk prostate cancer (HRPCa) patients would suffer biochemical recurrence (BCR) after radical prostatectomy (RP), providing a personalised % risk at initial consultation. BCR is more likely in HRPCa; however, the incidence is not equal in this cohort. A total of 850 patients underwent RP for HRPCa in four institutions between 2013 and 2019. Immediate additional treatment post RP was exclusion criteria, leaving 832 patients. Patient demographics, pre-operative, histological features and incidence of BCR (PSA ⩾ 0.2 ng/mL) were recorded. Patients were risk-stratified patients according to having one, two or three high-risk factors. Chi-square test was used for categorical variables. Univariate analysis was performed, and BCR-free survival between groups was explored with Kaplan–Meier method. Median follow-up was 48 months. Overall rate of BCR was 19.8%. Median time to BCR was 19 months. In the risk stratification analysis, 75% of patients had one risk feature. Multiple risk features carried a significantly higher risk of positive surgical margin and incidence of BCR ( p < 0.001), but not time to BCR ( p = 0.06) compared with single features. Univariate analysis demonstrated that the risk of BCR was greater with a PSA ⩾ 20 ng/mL compared to GS ⩾ 8 ( p = 0.05). Limitations of the study include limited follow-up time and BCR numbers for analysis. Overall, one in five high-risk patients will develop BCR by 4 years. However, those with multiple risk factors have a significantly increased risk. This aids the consultation regarding potential additional therapies alongside surgery in the treatment of HRPCa. Not applicable

本研究的目的是确定哪些高危前列腺癌症（HRPCa）患者在根治性前列腺切除术（RP）后会发生生化复发（BCR），在首次咨询时提供个性化的%风险。BCR更可能存在于HRPCa中；然而，这一群体的发病率并不相等。2013年至2019年间，四家机构共有850名患者接受了HRPCa RP治疗。RP后立即进行额外治疗是排除标准，剩下832名患者。患者人口统计学、术前、组织学特征和BCR（PSA）的发生率 ⩾ 0.2 ng/mL）。患者是根据一个、两个或三个高危因素进行风险分层的患者。分类变量采用卡方检验。进行单变量分析，并采用Kaplan–Meier方法探讨各组间无BCR生存率。中位随访时间为48 月。BCR的总发生率为19.8%。BCR的中位时间为19 月。在风险分层分析中，75%的患者有一个风险特征。多种风险特征具有显著更高的手术切缘阳性风险和BCR发生率（p < 0.001），但不是BCR的时间（p = 0.06）。单变量分析表明，PSA患者发生BCR的风险更大 ⩾ 20 ng/mL与GS相比 ⩾ 8（p = 0.05）。研究的局限性包括有限的随访时间和用于分析的BCR数。总体而言，五分之一的高危患者将在4岁时出现BCR 年。然而，那些具有多种风险因素的人的风险显著增加。这有助于就HRPCa治疗中的潜在额外治疗进行咨询。不适用

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引用次数: 0