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Abstracts Book 2023 摘要第2023卷
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-05-10 DOI: 10.1177/20514158231172341
Mr John Fitzpatrick, M. Shaw, A. Rogers, J. Sayer
Introduction: Patients with urolithiasis undergo regular follow-up. PROM based follow up using the USIQoL would be innovative and resource friendly, if matches traditional outcomes. We undertook a study to assess the feasibility of using the USIQoL as a tool for virtual follow-up. Patients (or Materials) & Methods: The study involved 2 phases. The 1st phase was the development of the USIQoL based model using existing data. The 2nd phase involved prospective, single-blind application of the model (for outpatient follow-up), over a 12 months. The outcomes were need for intervention or not, based on clinical/radiological data. We assessed correlation between the USIQoL scores and clinical outcomes, and also formulated potential USIQol cut-off scores which could be used to discriminate between intervention/no intervention (i.e., follow-up only). This was done using Binomial Logistic regression (BLR), ROC curves and Youden Index. Results: 441 patients [average age group 46-64, M=298, F=143]. The relationship between USIQoL scores and clinical outcome was statistically significant [BLR: PPH exp(B) 1.148, p <0.001, 95% CI 1.063-1.240; PSH exp (B) 1.179, p 0.025, 95% CI 1.020-1.363]. The chosen cut-off scores were PPH 8 and PSH 10. Application of the model with the cut-offs demonstrated appropriate sensitivities and specificities [PPH sensitivity 0.861, specificity 0.400; PSH sensitivity 0.861, specificity 0.420]. Conclusions: This novel feasibility study demonstrates the potential of the USIQoL to be used as an aid to virtual follow-up using the proposed cut-off scores. This could transform outpatient care of patients with urinary calculi. Further larger scale study will confirm our findings.
引言:尿石症患者定期随访。如果与传统结果相匹配,使用USIQoL的基于PROM的后续行动将是创新的,资源友好的。我们进行了一项研究,以评估使用USIQoL作为虚拟随访工具的可行性。患者(或材料)和方法:研究分为两个阶段。第一阶段是利用现有数据开发基于USIQoL的模型。第二阶段涉及该模型的前瞻性、单盲应用(用于门诊随访),为期12个月。根据临床/放射学数据,结果是否需要干预。我们评估了USIQoL评分与临床结果之间的相关性,并制定了潜在的USIQoL临界评分,可用于区分干预/不干预(即仅随访)。这是使用二项式逻辑回归(BLR)、ROC曲线和Youden指数进行的。结果:441例[平均年龄46-64岁,M=298,F=143]。USIQoL评分与临床结果之间的关系具有统计学意义[BLR:PPH exp(B)1.148,p<0.001,95%CI 1.063-1.240;PSH exp(A)1.179,p 0.025,95%CI 1.020-1.363]。所选的分界分为PPH 8和PSH 10。具有截止值的模型的应用证明了适当的敏感性和特异性[PPH敏感性0.861,特异性0.400;PSH灵敏度0.861,特异性0.420]。结论:这项新的可行性研究证明了USIQoL有潜力使用拟议的截止值作为虚拟随访的辅助。这可以改变泌尿系结石患者的门诊护理。进一步的大规模研究将证实我们的发现。
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引用次数: 2
BAUS oncology guidance for implementing streamlining in cancer MDT meetings: Selecting standards of care and operational considerations BAUS肿瘤学指导在癌症MDT会议中实施精简:选择护理标准和操作考虑因素
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-05-02 DOI: 10.1177/20514158231168463
B. Lamb, K. Linton, K. Narahari
It is widely recognised that multidisciplinary team meetings (MDTMs) are the cornerstone of cancer practice in the United Kingdom and many countries around the world. While MDTMs offer several key benefits to patients, healthcare professionals and cancer registration, data and audit services, in the United Kingdom they have over time become too large, onerous and ‘transactional’ often discussing cases that have a pre-determined management plan. In response to this growing problem, National Health Service (NHS) England and NHS Improvement produced an multidisciplinary team (MDT) streamlining document as a guide to encourage MDTM to consider a ‘Standard of Care’ (SoC) approach to conditions with a predictable agreed management plan based on national, regional cancer network or local cancer unit protocols. This would then enable more meaningful discussion of complex cases with in the MDT. This document did not gain much traction and had little impact on UK urological cancer MDTM. As a result, The British Association of Urological Surgeons (BAUS) was approached by the NHS Getting It Right First Time (GIRFT) Leads in 2021 to promote an SoC-based streamlining to urological cancer MDT working. Having consulted widely with colleagues, cancer networks and cancer delivery teams, the BAUS Section of Oncology sought views from its membership during a dedicated MDTM session in the Sections of Oncology Meeting, December 2021. From this extensive engagement with stakeholders, we have put together the following guidance for use as a framework to facilitate the agreement of local policies in the interests of supporting the needs of patients and MDTs. Level of evidence: level 5 (Expert opinions based on non-systematic reviews of results or mechanistic studies)
人们普遍认识到,多学科团队会议(MDTM)是英国和世界许多国家癌症实践的基石。虽然MDTM为患者、医疗保健专业人员和癌症注册、数据和审计服务提供了几个关键好处,但在英国,随着时间的推移,它们变得过于庞大、繁重和“交易性”,经常讨论有预先确定的管理计划的病例。为了应对这一日益严重的问题,英国国家医疗服务体系(NHS)和英国国家医疗保健体系改善组织(NHS Improvement)制定了一份多学科团队(MDT)精简文件,作为指导,鼓励MDTM考虑采用“护理标准”(SoC)方法来应对疾病,并根据国家、区域癌症网络或当地癌症单位协议制定可预测的商定管理计划。这样可以在MDT中对复杂案例进行更有意义的讨论。该文件没有获得太多的吸引力,对英国泌尿外科癌症MDTM几乎没有影响。因此,英国泌尿外科医师协会(BAUS)于2021年获得了英国国家医疗服务体系(GIRFT)领导的接洽,以促进基于SoC的泌尿外科癌症MDT精简工作。在广泛咨询了同事、癌症网络和癌症交付团队后,BAUS肿瘤科在2021年12月肿瘤科会议的MDTM专题会议上征求了其成员的意见。通过与利益相关者的广泛接触,我们制定了以下指导意见,作为促进地方政策达成一致的框架,以支持患者和MDT的需求。证据级别:5级(基于对结果或机制研究的非系统审查的专家意见)
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引用次数: 1
Editorial 编辑
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-05-01 DOI: 10.1177/20514158231170664
B. Somani
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引用次数: 0
Widening participation and implementation of the BAUS 10-point plan: A progressive step for an inclusive association 扩大BAUS 10点计划的参与和实施:向包容性协会迈进的一步
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-05-01 DOI: 10.1177/20514158231167659
V. Massella, John Cresswell, Susan Willis, O. Gbolahan, N. Shrotri, Joe Philip, Ian Pearce, B. Somani
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引用次数: 0
A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic. 新冠肺炎大流行期间机器人辅助腹腔镜前列腺切除术前接受新辅助雄激素剥夺治疗的患者队列分析
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-03-01 DOI: 10.1177/20514158211022216
Sahan S Bennett, Hing Y Leung, Imran Ahmad

Objectives: The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes.

Patients and methods: Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019-September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery.

Results: Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins (p=0.134), N1 disease (p=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels (p<0.007).

Conclusion: Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels.

Level of evidence: 2b.

目的:本研究的目的是调查局部前列腺癌在机器人辅助腹腔镜前列腺切除术前接受或不接受新辅助雄激素剥夺治疗,以及Covid-19治疗中断对临床病理结果的影响。患者和方法:回顾性收集2019年11月至2020年9月期间124例连续接受机器人辅助腹腔镜前列腺切除术的患者的数据。在2020年3月13日之前治疗了62例患者(历史队列),之后治疗了62例患者(新冠队列)。在covid队列中,37名患者另外接受了新辅助雄激素剥夺治疗(平均持续时间3个月),包括比卡鲁胺150毫克,每天一次,持续4周,并在第1周后开始每月注射3.75毫克,直到手术日期。结果:统计分析发现,接受或不接受新辅助雄激素剥夺治疗的患者围手术期措施和住院时间无差异。延迟手术治疗接受新辅助雄激素剥夺治疗的患者显示手术阳性切缘减少(p=0.134), N1疾病(p=0.424)和病理分期降低(50%的患者患有pT2疾病)的趋势。结论:我们的研究表明,在机器人辅助腹腔镜前列腺切除术前进行为期三个月的新辅助雄激素剥夺治疗可能会改善病理结果,但这一时间框架不足以影响可检测的前列腺特异性抗原水平。与covid -19相关的治疗延误导致可检测的前列腺特异性抗原水平显著升高。证据等级:2b。
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引用次数: 0
Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon 单个外科医生保留retzius与前路机器人根治性前列腺切除术早期术后结果的比较分析
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-03-01 DOI: 10.1177/20514158231156314
L. Tay, Robert Makin, I. Saxionis, I. Dokubo, K. Patel, S. Sivathasan, S. Smart, A. Warren, N. Shah, B. Lamb
The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p < 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels < 0.1 ng/mL (85% versus 93%). Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. 2.
本研究的目的是比较保留retzius的机器人辅助根治性前列腺切除术(RS-RARP)与RARP的标准入路(S-RARP)的术中和术后早期结果。纳入同一位外科医生的所有rarp,并分为两组:(1)标准入路,包括前后联合入路(S-RARP);(2)保留retzius后入路(RS-RARP)。根据前列腺大小和MRI上指数病变的位置进行分配。术后随访时间为6周。总体而言,在2018年3月至2021年10月期间进行了169次rarp: S-RARP = 99对RS-RARP = 70。术前体重指数(BMI)、前列腺特异性抗原(PSA)、国际泌尿病理学会(ISUP)分级组及临床T分期差异无统计学意义。术中出血量(300 mL vs 200 mL, p = 0.008)、控制台时间(180分钟vs 135分钟,p < 0.001)均有利于RS-RARP,而神经备用或淋巴结清扫方面无差异。术后ISUP分级、病理T分期、阳性手术切缘、淋巴结取样数、再入院及并发症均无差异。RS组的腺体大小较小(38 g对29 g, p = 0.001)。术后早期(6周)随访显示两组无尿垫失禁(35%对53%,p = 0.011)和社交失禁(79%对89%,p = 0.024)有显著差异,但勃起功能恢复(27%对基线的50%)和术后PSA水平< 0.1 ng/mL(85%对93%)无差异。即使在学习曲线的早期,RS-RARP的失禁恢复、手术时间和出血量也明显优于S-RARP。两组的切缘状态和PSA水平与已发表的文献相当。RS-RARP的标准化培训可能有助于提高这种新技术的吸收。2.
{"title":"Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon","authors":"L. Tay, Robert Makin, I. Saxionis, I. Dokubo, K. Patel, S. Sivathasan, S. Smart, A. Warren, N. Shah, B. Lamb","doi":"10.1177/20514158231156314","DOIUrl":"https://doi.org/10.1177/20514158231156314","url":null,"abstract":"The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p < 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels < 0.1 ng/mL (85% versus 93%). Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. 2.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46329269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Outcomes for active surveillance are similar for men with favourable risk ISUP-2 to those with ISUP-1 prostate cancer: A pair matched cohort study 一项配对队列研究表明,ISUP-2前列腺癌患者与ISUP-1前列腺癌患者积极监测的结果相似
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-03-01 DOI: 10.1177/20514158231154702
A. Katelaris, A. Amin, A. Blazevski, M. Scheltema, T. Cusick, M. Farraha, Daniela Barreto, A. Haynes, W. Gondoputro, S. Agrawal, P. Stricker, James E. Thompson
To compare medium-term outcomes of active surveillance (AS) for men with favourable risk International Society for Urologic Pathology (ISUP)-2 prostate cancer (PCa) to a pair matched group of men with ISUP-1 PCa. This was a retrospective analysis of prospectively collected data from a single institution clinical outcomes registry, using propensity score matching. Men enrolled on AS with favourable risk ISUP-2 PCa with minimum 5-year follow-up were 1:2 propensity score matched to men with ISUP-1 disease. We assessed rates of progression to treatment, metastatic disease, adverse surgical pathology and overall survival. Fifty-five ISUP-2 patients were matched to 105 ISUP-1 patients by propensity score. Median follow-up was 81 months (interquartile range (IQR), 61–109 months). Fifty-seven per cent in the ISUP-1 group progressed to treatment versus 58% in the ISUP-2 group (KM log rank p = 0.24). Estimated 1-, 2- and 5-year progression free survival rates were 93%, 60% and 33% for ISUP-1 patients and 94%, 63% and 16% for ISUP-2 patients, respectively. No patient from either group died of PCa. There was no statistical difference in rates of adverse pathology or metastatic disease between ISUP-2 and ISUP-1 patients on AS. AS for carefully selected men with favourable risk ISUP-2 disease appears safe, with similar oncologic outcomes to men with ISUP-1 disease. Level 2b.
比较国际泌尿病理学会(ISUP)-2前列腺癌(PCa)高危男性与ISUP-1前列腺癌配对组的中期预后。这是一项回顾性分析,使用倾向评分匹配,从单一机构临床结果登记处前瞻性收集数据。经至少5年随访的ISUP-2前列腺癌风险较高的AS患者倾向评分与ISUP-1前列腺癌患者匹配为1:2。我们评估了治疗进展率、转移性疾病、不良手术病理和总生存率。55例ISUP-2患者与105例ISUP-1患者进行倾向性评分匹配。中位随访81个月(四分位间距61-109个月)。ISUP-1组57%的患者进展到治疗,ISUP-2组58% (KM log rank p = 0.24)。ISUP-1患者的1、2和5年无进展生存率分别为93%、60%和33%,ISUP-2患者的1、2和5年无进展生存率分别为94%、63%和16%。两组均无患者死于PCa。ISUP-2和ISUP-1 AS患者的不良病理或转移性疾病发生率无统计学差异。对于精心挑选的具有有利风险的ISUP-2疾病的男性来说是安全的,其肿瘤预后与ISUP-1疾病的男性相似。级别2 b。
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引用次数: 0
Thanks to Reviewers 感谢审稿人
Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-03-01 DOI: 10.1177/20514158231153465
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引用次数: 0
An introduction to quality improvement 质量改进导论
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-02-27 DOI: 10.1177/20514158221075405
S. Russ, J. Green, L. de Winter, Ellie Herrington, A. Hughes-Hallett, Julia Taylor, N. Sevdalis
The concept of quality has moved to the top of the international healthcare agenda in the past 30 years. This has been driven by a growing awareness of the scale of variation in patient outcomes, influenced by both the paucity of and consistency in implementation of evidence-based actions or interventions performed during the delivery of patient care. Concurrently there has been growing interest on the part of healthcare professionals to use a wider range of knowledge and available techniques, from outside of medicine, to continuously improve standards of safe and effective patient care. This is the first in a series of three articles introducing Quality Improvement (QI) methodology and supporting concepts to multidisciplinary teams working in Urology departments in the United Kingdom. We start, in this article, by providing an overview of key QI principles and their industrial roots; we position QI in the context of other approaches to improvement, such as audit, and we outline the key organisations and infrastructure supporting QI work on the ground.
在过去的30年里,质量的概念已经成为国际医疗保健议程的首要内容 年。这是由于人们越来越意识到患者结果的变化程度,同时受到在提供患者护理期间实施循证行动或干预措施的缺乏和一致性的影响。与此同时,医疗保健专业人员越来越有兴趣利用医学之外更广泛的知识和可用技术,不断提高安全有效的患者护理标准。这是三篇系列文章中的第一篇,介绍了英国泌尿外科多学科团队的质量改进(QI)方法和支持概念。在这篇文章中,我们首先概述了关键的QI原则及其工业根源;我们在其他改进方法(如审计)的背景下定位QI,并概述了支持QI实地工作的关键组织和基础设施。
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引用次数: 0
Editorial 社论
IF 0.3 Q4 UROLOGY & NEPHROLOGY Pub Date : 2023-02-18 DOI: 10.1177/20514158231159154
B. Somani
{"title":"Editorial","authors":"B. Somani","doi":"10.1177/20514158231159154","DOIUrl":"https://doi.org/10.1177/20514158231159154","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"85 - 85"},"PeriodicalIF":0.3,"publicationDate":"2023-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49029887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Clinical Urology
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