Pub Date : 2022-09-13DOI: 10.1177/20514158221092183
Aaina Mittal, F. Kum, M. Rice, Q. Mak, O.O. Cakir, R. Jalil
The use of Quick Response (QR) codes has the potential to overcome some of the healthcare challenges we currently face, especially those presented by the COVID-19 pandemic. The aim of this research was to evaluate the use of QR codes poster in delivering patient information effectively in a Urology Outpatient department. A national online survey of Urologists was distributed, and leaflet costs were estimated. QR codes for the British Association of Urological Surgeons (BAUS) patient information leaflets were incorporated into a poster for the Urology Outpatient department. Feedback on the poster was sought from patients. Overall, 108 Urologists responded to the initial survey; 44% were consultants. However, 54% provided > 50% of patients with an information leaflet during face-to-face clinics prior to the Covid-19 pandemic, decreasing to 33% during COVID-19. Using departmental outgoings, a cost of £3120 was calculated for printed leaflets per year normally. Rise in telephone clinics during the pandemic meant 47% of patients were provided an Internet link or asked to use Google in the clinical letter, up from 17% prior to the pandemic. In response to the QR codes poster, in a patient population, mostly male (82%) and older people(60% between 60 and 80 years of age), 40% were familiar with QR codes, 73% could access Internet and 53% used it to find information, 46% found the poster easy to use or follow and 61% found it informative. QR codes offer benefits, including capability for touch-free access, cost-effectiveness, potential to increase engagement and understanding, enable user-initiated learning and improve adherence. Patient perception varies with age group and smartphone access and usage. 4
{"title":"An innovative use of Quick Response codes to provide patients information in Urology","authors":"Aaina Mittal, F. Kum, M. Rice, Q. Mak, O.O. Cakir, R. Jalil","doi":"10.1177/20514158221092183","DOIUrl":"https://doi.org/10.1177/20514158221092183","url":null,"abstract":"The use of Quick Response (QR) codes has the potential to overcome some of the healthcare challenges we currently face, especially those presented by the COVID-19 pandemic. The aim of this research was to evaluate the use of QR codes poster in delivering patient information effectively in a Urology Outpatient department. A national online survey of Urologists was distributed, and leaflet costs were estimated. QR codes for the British Association of Urological Surgeons (BAUS) patient information leaflets were incorporated into a poster for the Urology Outpatient department. Feedback on the poster was sought from patients. Overall, 108 Urologists responded to the initial survey; 44% were consultants. However, 54% provided > 50% of patients with an information leaflet during face-to-face clinics prior to the Covid-19 pandemic, decreasing to 33% during COVID-19. Using departmental outgoings, a cost of £3120 was calculated for printed leaflets per year normally. Rise in telephone clinics during the pandemic meant 47% of patients were provided an Internet link or asked to use Google in the clinical letter, up from 17% prior to the pandemic. In response to the QR codes poster, in a patient population, mostly male (82%) and older people(60% between 60 and 80 years of age), 40% were familiar with QR codes, 73% could access Internet and 53% used it to find information, 46% found the poster easy to use or follow and 61% found it informative. QR codes offer benefits, including capability for touch-free access, cost-effectiveness, potential to increase engagement and understanding, enable user-initiated learning and improve adherence. Patient perception varies with age group and smartphone access and usage. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42342543","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}
Pub Date : 2022-09-10DOI: 10.1177/20514158221124021
Ahmed Abdelatif, A. Ali, M. Kattan, R. Small, A. Gabr
Multiple nomograms have previously been described to predict recurrence, overall, and cancer-specific survival following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).Our aim was to develop a nomogram for the preoperative prediction of lymph node (LN) metastasis in UCB. We prospectively collected data from 483 patients which were used in construction of the statistical model. The variables considered as predictors in the model were demographic, histopathological and radiological factors. The full model containing all 12 covariates produced an AIC (Akaike information criterion) value of 448.9. After model selection T-stage, grade, CIS (carcinoma in situ), pathology, LV (lymphovascular) invasion and CT (computed tomography) were included as the most parsimonious model while retaining predictive accuracy. Ta in 82 (17%), T1 in 214 (445) and T2 in 187 (38%) patients. This model had an AIC of 436.4, indicating a significant improvement in model fit after the removal of unimportant predictors. The C-indices were 0.821 and 0.808 for the reduced model and the full model, respectively, indicating greater discrimination ability for the reduced model.The nomogram further emphasises the effect of CT and LV invasion on the risk of LN positivity. Specifically, regardless of all other variables, a patient with a CT will have 100 points more than a patient without a CT, corresponding to a difference in risk of approximately 40%. The odds of LN positivity for patients with a CT are 7.45 times that of patients without a CT, regardless of all other covariates. LV invasion, pathology, CIS and T-stage are also statistically significant ( p = 0.05). This nomogram is a preoperative prediction tool that uses different preoperative variables with acceptable predictive accuracy for LN metastasis in patients with BC.
{"title":"Development of a nomogram for predicting lymph node metastasis in patients with urothelial carcinoma of the bladder","authors":"Ahmed Abdelatif, A. Ali, M. Kattan, R. Small, A. Gabr","doi":"10.1177/20514158221124021","DOIUrl":"https://doi.org/10.1177/20514158221124021","url":null,"abstract":"Multiple nomograms have previously been described to predict recurrence, overall, and cancer-specific survival following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).Our aim was to develop a nomogram for the preoperative prediction of lymph node (LN) metastasis in UCB. We prospectively collected data from 483 patients which were used in construction of the statistical model. The variables considered as predictors in the model were demographic, histopathological and radiological factors. The full model containing all 12 covariates produced an AIC (Akaike information criterion) value of 448.9. After model selection T-stage, grade, CIS (carcinoma in situ), pathology, LV (lymphovascular) invasion and CT (computed tomography) were included as the most parsimonious model while retaining predictive accuracy. Ta in 82 (17%), T1 in 214 (445) and T2 in 187 (38%) patients. This model had an AIC of 436.4, indicating a significant improvement in model fit after the removal of unimportant predictors. The C-indices were 0.821 and 0.808 for the reduced model and the full model, respectively, indicating greater discrimination ability for the reduced model.The nomogram further emphasises the effect of CT and LV invasion on the risk of LN positivity. Specifically, regardless of all other variables, a patient with a CT will have 100 points more than a patient without a CT, corresponding to a difference in risk of approximately 40%. The odds of LN positivity for patients with a CT are 7.45 times that of patients without a CT, regardless of all other covariates. LV invasion, pathology, CIS and T-stage are also statistically significant ( p = 0.05). This nomogram is a preoperative prediction tool that uses different preoperative variables with acceptable predictive accuracy for LN metastasis in patients with BC.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65475564","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}
Pub Date : 2022-09-08DOI: 10.1177/20514158221122622
Rebecca Hilbert, Lisa M. Bibby, N. Boxall, Luxna Srinivasan, T. Aho, B. Lamb
The evidence on the safety of peri-procedural management of more novel antithrombotic medication in the context of a wider option of bladder outflow obstruction (BOO) procedures is limited. We aimed to assess the risk of delayed discharge or readmission (specifically due to haematuria) for all patients undergoing BOO surgery. Prospective identification of all patients undergoing any type of BOO procedure at a single centre between April and December 2019 was performed. Clinical information was obtained from electronic patient records to scrutinise medications, procedure, delayed discharge and readmission within 30 days of surgery due to haematuria. Two hundred forty patients were identified. In all, 78.6% (22/28) of patients on anticoagulants were on novel agents. The delayed discharge rate due to haematuria was 0.58% (1/171) in the no antithrombotic group and 7.14% (2/28) in the anticoagulant-only group. Increased age and perioperative anticoagulant therapy predicated delayed discharge. Readmissions due to haematuria were statistically significant with 1.16% (2/171) readmitted with no antithombotics, compared with 14.3% (4/28) of those on anticoagulants ( p ⩽ 0.01). Perioperative anticoagulant use is associated with an increased risk of readmission following BOO surgery. Further work is required to help stratify and lower risk, especially with evolving surgical and medical technologies. 3b
{"title":"Anticoagulant but not antiplatelet use is associated with haematuria complications after bladder outflow surgery","authors":"Rebecca Hilbert, Lisa M. Bibby, N. Boxall, Luxna Srinivasan, T. Aho, B. Lamb","doi":"10.1177/20514158221122622","DOIUrl":"https://doi.org/10.1177/20514158221122622","url":null,"abstract":"The evidence on the safety of peri-procedural management of more novel antithrombotic medication in the context of a wider option of bladder outflow obstruction (BOO) procedures is limited. We aimed to assess the risk of delayed discharge or readmission (specifically due to haematuria) for all patients undergoing BOO surgery. Prospective identification of all patients undergoing any type of BOO procedure at a single centre between April and December 2019 was performed. Clinical information was obtained from electronic patient records to scrutinise medications, procedure, delayed discharge and readmission within 30 days of surgery due to haematuria. Two hundred forty patients were identified. In all, 78.6% (22/28) of patients on anticoagulants were on novel agents. The delayed discharge rate due to haematuria was 0.58% (1/171) in the no antithrombotic group and 7.14% (2/28) in the anticoagulant-only group. Increased age and perioperative anticoagulant therapy predicated delayed discharge. Readmissions due to haematuria were statistically significant with 1.16% (2/171) readmitted with no antithombotics, compared with 14.3% (4/28) of those on anticoagulants ( p ⩽ 0.01). Perioperative anticoagulant use is associated with an increased risk of readmission following BOO surgery. Further work is required to help stratify and lower risk, especially with evolving surgical and medical technologies. 3b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45254118","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}
Pub Date : 2022-09-07DOI: 10.1177/20514158221122534
G. Brown, Maximillian Johnston, W. Struss, B. Somani
Referrals to the on-call urology team for catheter-related problems are common. Experience and previous studies highlight that urology exposure and catheter skills are unsatisfactory in undergraduate training as well as in subsequent junior clinical practice. These deficiencies may compromise patient safety and delay appropriate treatment. This study aimed to assess catheter insertion confidence and associated knowledge in junior doctors and advanced nurse practitioners in a single teaching hospital and evaluate whether this could be improved by introducing a freely available catheter information and problem-solving guide. An online survey assessing confidence inserting two and three-way urethral catheters, changing suprapubic catheters and assessing knowledge related to common catheter problems was delivered to all non-registrar junior clinicians. Based on these results, an information guide was created and made freely available to these clinicians. The survey was then repeated to check for catheter-related knowledge and confidence. A total of 58 junior clinicians responded to the initial survey and 61 to the repeat survey. Catheterisation confidence and knowledge was generally low in the first survey but improved in all areas and across all grades after the introduction of the information guide. Of the respondents, 100% thought the guide was helpful and 93.4% said they would use it in future. A catheter information guide is a simple and effective method of improving junior clinician confidence with catheter insertion and managing catheter-associated problems. This study does not directly correlate with a defined level of evidence.
{"title":"Role and effectiveness of an information guide in improving catheter confidence and knowledge in junior clinicians","authors":"G. Brown, Maximillian Johnston, W. Struss, B. Somani","doi":"10.1177/20514158221122534","DOIUrl":"https://doi.org/10.1177/20514158221122534","url":null,"abstract":"Referrals to the on-call urology team for catheter-related problems are common. Experience and previous studies highlight that urology exposure and catheter skills are unsatisfactory in undergraduate training as well as in subsequent junior clinical practice. These deficiencies may compromise patient safety and delay appropriate treatment. This study aimed to assess catheter insertion confidence and associated knowledge in junior doctors and advanced nurse practitioners in a single teaching hospital and evaluate whether this could be improved by introducing a freely available catheter information and problem-solving guide. An online survey assessing confidence inserting two and three-way urethral catheters, changing suprapubic catheters and assessing knowledge related to common catheter problems was delivered to all non-registrar junior clinicians. Based on these results, an information guide was created and made freely available to these clinicians. The survey was then repeated to check for catheter-related knowledge and confidence. A total of 58 junior clinicians responded to the initial survey and 61 to the repeat survey. Catheterisation confidence and knowledge was generally low in the first survey but improved in all areas and across all grades after the introduction of the information guide. Of the respondents, 100% thought the guide was helpful and 93.4% said they would use it in future. A catheter information guide is a simple and effective method of improving junior clinician confidence with catheter insertion and managing catheter-associated problems. This study does not directly correlate with a defined level of evidence.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48216277","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}
Pub Date : 2022-08-27DOI: 10.1177/20514158221078724
Y. Park, J. Lee
We report five cases of middle-aged men with low testosterone levels and erectile dysfunction (ED) who were successfully treated with varicocelectomy with long-term follow-up. All five patients presented to our clinic with ED. Upon initial physical examination, each patient had varicoceles on his scrotum, and two consecutive morning samplings showed testosterone levels below 400 ng/mL. Age at varicocelectomy was from 40 to 53 years. Four patients underwent microscopic subinguinal varicocelectomy, whereas one patient underwent inguinal varicocelectomy. After surgery, testosterone increased in all cases, and the normal testosterone level was maintained during follow-up (16–60 months). In addition, all cases reported improvement of ED after surgery. In our clinical cases, microscopic varicocelectomy increased serum testosterone levels and improved erectile function, and this increase and improvement continued up to a follow-up of 60 months. Varicocelectomy would be a good option to treat testosterone deficiency in men with varicocele.
{"title":"Long-term efficacy of varicocele repair in middle-aged men with erectile dysfunction (ED) and low testosterone: Five cases with follow-up from 16 to 60 months","authors":"Y. Park, J. Lee","doi":"10.1177/20514158221078724","DOIUrl":"https://doi.org/10.1177/20514158221078724","url":null,"abstract":"We report five cases of middle-aged men with low testosterone levels and erectile dysfunction (ED) who were successfully treated with varicocelectomy with long-term follow-up. All five patients presented to our clinic with ED. Upon initial physical examination, each patient had varicoceles on his scrotum, and two consecutive morning samplings showed testosterone levels below 400 ng/mL. Age at varicocelectomy was from 40 to 53 years. Four patients underwent microscopic subinguinal varicocelectomy, whereas one patient underwent inguinal varicocelectomy. After surgery, testosterone increased in all cases, and the normal testosterone level was maintained during follow-up (16–60 months). In addition, all cases reported improvement of ED after surgery. In our clinical cases, microscopic varicocelectomy increased serum testosterone levels and improved erectile function, and this increase and improvement continued up to a follow-up of 60 months. Varicocelectomy would be a good option to treat testosterone deficiency in men with varicocele.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45317787","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}
Pub Date : 2022-08-24DOI: 10.1177/20514158221113466
J. Pfeifer, Luke L Wang, David Fu, Gavin Stormont, B. Hill, Chad A. LaGrange
This study is conducted to investigate characteristics of patients with xanthogranulomatous pyelonephritis (XGP) who undergo nephrectomy and to identify ways to optimise outcomes for these patients. 1587 patients were queried from our institutional electronic medical records. 12 patients who underwent nephrectomy with preoperative diagnoses of XGP in the operative note were identified. Associations were analysed with Kendall’s τb. p < 0.05 was statistically significant. All patients were hemodynamically stable on day of surgery. Two patients died on postoperative days 1 and 3 from septic shock. Both had surgery during inpatient admission rather than electively, received relatively short duration of preoperative antibiotics (8 and 10 days), and both were on hemodialysis preoperatively. There was possible association between decreased glomerular filtration rate (τb = −0.550, p = 0.032) and death postoperatively. Among patients who lived, there was no significant association between duration of antibiotic therapy after intervention and duration of postoperative hospitalisation. These findings could suggest a possible association between declining renal function and mortality in our case series; and performing nephrectomy electively after a longer course of antibiotics may be associated with improved outcomes compared to nephrectomy performed during hospitalisation with a shorter course of antibiotics. Level 4
{"title":"Characteristics of patients with xanthogranulomatous pyelonephritis undergoing nephrectomy: Identifying ways to optimise outcomes","authors":"J. Pfeifer, Luke L Wang, David Fu, Gavin Stormont, B. Hill, Chad A. LaGrange","doi":"10.1177/20514158221113466","DOIUrl":"https://doi.org/10.1177/20514158221113466","url":null,"abstract":"This study is conducted to investigate characteristics of patients with xanthogranulomatous pyelonephritis (XGP) who undergo nephrectomy and to identify ways to optimise outcomes for these patients. 1587 patients were queried from our institutional electronic medical records. 12 patients who underwent nephrectomy with preoperative diagnoses of XGP in the operative note were identified. Associations were analysed with Kendall’s τb. p < 0.05 was statistically significant. All patients were hemodynamically stable on day of surgery. Two patients died on postoperative days 1 and 3 from septic shock. Both had surgery during inpatient admission rather than electively, received relatively short duration of preoperative antibiotics (8 and 10 days), and both were on hemodialysis preoperatively. There was possible association between decreased glomerular filtration rate (τb = −0.550, p = 0.032) and death postoperatively. Among patients who lived, there was no significant association between duration of antibiotic therapy after intervention and duration of postoperative hospitalisation. These findings could suggest a possible association between declining renal function and mortality in our case series; and performing nephrectomy electively after a longer course of antibiotics may be associated with improved outcomes compared to nephrectomy performed during hospitalisation with a shorter course of antibiotics. Level 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49433783","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}
Pub Date : 2022-08-08DOI: 10.1177/20514158221088687
M. Alsawi, S. Nalagatla, N. Ahmad, A. Chandiramani, L. Mokool, S. Nalagatla, B. Somani, O. Aboumarzouk, T. Amer
Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (> 16 years) with ureteric stones presenting as an emergency were included. Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Not applicable
输尿管绞痛是国民健康服务的主要临床和经济负担。最近有一种范式转变，认为在最初表现时，最终手术是主要的干预措施。系统评价原发性/急诊输尿管镜与延迟性/择期输尿管镜的疗效。我们于2020年4月对MEDLINE、EMBASE、Cochrane Central Register of Controlled Trials-CENTRAL、CINAHL、Clinicaltrials.gov、谷歌Scholar和个别泌尿学期刊进行了一项批判性综述。使用“原发性输尿管镜检查”、“即刻输尿管镜检查”、“延迟输尿管镜检查”和“紧急输尿管镜检查”等术语组合进行了强大的数据库搜索。以紧急输尿管结石就诊的成年患者(bb0 - 16岁)被纳入研究对象。12项研究符合纳入标准，其中4项研究直接比较了急性输尿管绞痛的原发性/急诊输尿管镜检查与延迟/择期输尿管镜检查。在这些研究中，1708名患者因输尿管结石接受了初级/紧急输尿管镜检查，990名患者接受了延迟输尿管镜检查。两组间结石清除率无显著差异，初级/急诊达到85%，延迟/选择性达到91% (p = 0.68)。两组治疗的结石大部分位于输尿管远端。总体而言，两组间并发症(p = 0.42)和主要并发症(p = 0.17)均无差异。然而，原发性尿路损伤组的轻微并发症较少(p = 0.02)。71%的延迟/择期输尿管镜病例使用输尿管导管或双j型支架，而46.8%的原发性/急诊病例使用输尿管导管或双j型支架(p = 0.001)。在接受初级/紧急输尿管镜检查的患者中，6.4%的患者需要辅助手术。在延迟/选择性组中，7.6%需要进一步的最终治疗(NS)。输尿管镜检查是一种安全可行的手术，在合适的急性患者中进行。与延迟/择期输尿管镜检查相比，其支架使用率明显降低，结石清除率相当，总体或主要并发症(包括败血症)未增加，轻微并发症较少。前瞻性研究将进一步探索这一领域，但目前的证据表明，输尿管镜检查是安全的。不适用
{"title":"Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis","authors":"M. Alsawi, S. Nalagatla, N. Ahmad, A. Chandiramani, L. Mokool, S. Nalagatla, B. Somani, O. Aboumarzouk, T. Amer","doi":"10.1177/20514158221088687","DOIUrl":"https://doi.org/10.1177/20514158221088687","url":null,"abstract":"Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (> 16 years) with ureteric stones presenting as an emergency were included. Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47165512","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}
Pub Date : 2022-08-08DOI: 10.1177/20514158221115986
P. Juliebø‐Jones, E. X. Keller, Julie Nøss Haugland, M. S. Æsøy, C. Beisland, B. Somani, Ø. Ulvik
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
{"title":"Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST)","authors":"P. Juliebø‐Jones, E. X. Keller, Julie Nøss Haugland, M. S. Æsøy, C. Beisland, B. Somani, Ø. Ulvik","doi":"10.1177/20514158221115986","DOIUrl":"https://doi.org/10.1177/20514158221115986","url":null,"abstract":"Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"190 - 198"},"PeriodicalIF":0.3,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49006932","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}
Pub Date : 2022-08-01DOI: 10.1177/20514158221078474
A. Krishan, J. Vukina, I. Pearce, V. Modgil
Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species. Level of evidence: Not applicable
{"title":"Male factor infertility: A contemporary overview of investigation, diagnosis and management","authors":"A. Krishan, J. Vukina, I. Pearce, V. Modgil","doi":"10.1177/20514158221078474","DOIUrl":"https://doi.org/10.1177/20514158221078474","url":null,"abstract":"Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species. Level of evidence: Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46621217","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}
Background: This study investigated whether the age of patients undergoing pacemaker implantation is increasing.
Methods and results: This study retrospectively reviewed the consecutive cases of 3,582 patients who underwent an initial pacemaker implantation at our hospitals because of symptomatic bradyarrhythmias between 1970 and 2019. The exclusion criteria were: patients with AV block due to cardiac surgery or AV junction ablation, and patients aged <20 years. The patients were divided into 5×10-year groups: those treated in the 1970s (1970-1979), 1980s (1980-1989), 1990s (1990-1999), 2000s (2000-2009), and 2010s (2010-2019). A total of 3,395 patients satisfied the study criteria. The average age at which the patients underwent a first pacemaker implantation increased across the 10-year periods: 63.7±13.2 years in the 1970s, 66.2±12.6 years (1980s), 69.1±12.4 years (1990s), 72.0±11.1 years (2000s), and 75.8±10.0 years (2010s) and advanced significantly in the 1990s, 2000s, and 2010s compared to the 1970s (all P<0.001). The ratio of patients aged ≥80 and ≥90 years increased from 10.6% and 0% in the 1970 s to 38.2% (P<0.001) and 5.2% (P= 0.017) in the 2010s, respectively.
Conclusions: The average age at initial pacemaker implantation increased by 12.1 years over the last 50 years in Japan. In particular, the ratios of ≥80 and ≥90 years as the patients age increased significantly.
{"title":"Trend in Age at the Initial Pacemaker Implantation in Patients With Bradyarrhythmia - A 50-Year Analysis (1970-2019) in Japan.","authors":"Tomomi Matsubara, Masataka Sumiyoshi, Atsushi Kimura, Asuka Minami-Takano, Kazuki Maruyama, Yuki Kimura, Haruna Tabuchi, Hidemori Hayashi, Fuminori Odagiri, Gaku Sekita, Takashi Tokano, Yuji Nakazato, Yasuro Nakata, Tohru Minamino","doi":"10.1253/circj.CJ-21-0947","DOIUrl":"10.1253/circj.CJ-21-0947","url":null,"abstract":"<p><strong>Background: </strong>This study investigated whether the age of patients undergoing pacemaker implantation is increasing.</p><p><strong>Methods and results: </strong>This study retrospectively reviewed the consecutive cases of 3,582 patients who underwent an initial pacemaker implantation at our hospitals because of symptomatic bradyarrhythmias between 1970 and 2019. The exclusion criteria were: patients with AV block due to cardiac surgery or AV junction ablation, and patients aged <20 years. The patients were divided into 5×10-year groups: those treated in the 1970s (1970-1979), 1980s (1980-1989), 1990s (1990-1999), 2000s (2000-2009), and 2010s (2010-2019). A total of 3,395 patients satisfied the study criteria. The average age at which the patients underwent a first pacemaker implantation increased across the 10-year periods: 63.7±13.2 years in the 1970s, 66.2±12.6 years (1980s), 69.1±12.4 years (1990s), 72.0±11.1 years (2000s), and 75.8±10.0 years (2010s) and advanced significantly in the 1990s, 2000s, and 2010s compared to the 1970s (all P<0.001). The ratio of patients aged ≥80 and ≥90 years increased from 10.6% and 0% in the 1970 s to 38.2% (P<0.001) and 5.2% (P= 0.017) in the 2010s, respectively.</p><p><strong>Conclusions: </strong>The average age at initial pacemaker implantation increased by 12.1 years over the last 50 years in Japan. In particular, the ratios of ≥80 and ≥90 years as the patients age increased significantly.</p>","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"9 1","pages":"1292-1297"},"PeriodicalIF":0.2,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87549088","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}
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