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Long-Term Recurrence Risk, Metastatic Potential, and Length of Cystoscopic Surveillance of Low-Grade Nonmuscle-Invasive Bladder Cancer. 低级别非肌层浸润性膀胱癌的长期复发风险、转移可能性和膀胱镜监测时间。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-29 DOI: 10.1097/JU.0000000000004305
Eunice Villegas, Katherine Lajkosz, Shayan Din, Cynthia Kuk, Amy Chan, Jethro C C Kwong, Christian Vitug, Bruce Gao, Otto Hemminki, Dhiral Kot, Jimmy Misurka, Peter C Black, Michael Jewett, Mark S Soloway, Morgan Roupret, Eva Compérat, Joan Sweet, Thomas Seisen, Neil E Fleshner, Jeffrey Wrana, Theodorus H van der Kwast, Girish S Kulkarni, Alexandre R Zlotta

Purpose: Patients with Ta low-grade (LG) nonmuscle-invasive bladder cancer (NMIBC) rarely develop metastases or die of it. Long-term data are scant and length of follow-up poorly defined.

Materials and methods: This retrospective study included 521 patients diagnosed with primary TaLG NMIBC (n = 491) or papillary urothelial neoplasm of low malignant potential (n = 30) from 1989 to 2019 at an academic center. Patient data were acquired using patient records chart review and a bladder cancer informatics registry at the center. Risk of recurrence and progression in stage to muscle invasion, metastases, and death due to bladder cancer (BC) were analyzed. RNAseq assessed the transcriptomic profiles of 4 TaLG NMIBCs that metastasized. Interobserver variability in pathological grading (WHO 2004/2022 and 1973, n = 80) was blindly assessed by 3 expert pathologists.

Results: The median follow-up was 9.6 (95% CI: 8.6-10.2) years. Among 521 patients (73% men, median age 67.0 years), 350 recurred, 57 progressed in stage, 20 developed metastases, and 15 died of BC (median 9.6 years after diagnosis). Cancer-specific survival probabilities were 0.99, 0.98, and 0.96 at 5, 10, and 15 years, respectively. Fifty patients who were recurrence free for the first 5 years developed late recurrences and 2 of them died of BC. Metastatic TaLG NMIBC had more adverse transcriptomic findings in keeping with higher-grade tumors despite being phenotypically similar to indolent tumors. Grading concordance for the 2004/2022 system and WHO 1973 was 0.78 (95% CI: 0.65-0.90) and 0.41 (95% CI: 0.32-0.50), respectively.

Conclusions: This study with long-term data challenges the assumption that primary TaLG NMIBC nearly never progresses to lethal disease if followed long enough. However, the risk of BC-related mortality is extremely low in patients who are recurrence free for the first 5 years. Minimizing variability in pathological grading remains an unmet need.

目的:Ta低分化(LG)非肌浸润性膀胱癌(NMIBC)患者很少发生转移或死亡。长期数据很少,随访时间也不明确:这项回顾性研究纳入了一家学术中心从1989年至2019年诊断为原发性TaLG(n=491)或低恶性潜能乳头状尿路上皮肿瘤(PUNLMP,n=30)的521名患者。患者数据通过病历审查和该中心的膀胱癌信息登记系统获得。分析了膀胱癌复发、分期进展、肌肉侵犯、转移和死亡的风险。RNAseq 评估了四例发生转移的 TaLG 的转录组特征。三位病理专家对病理分级(WHO 2004/2022 年和 1973 年,n=80)的观察者间差异性进行了盲法评估:中位随访时间为 9.6 年(95%CI:8.6-10.2 年)。在 521 名患者(73% 为男性,中位年龄为 67.0 岁)中,350 人复发,57 人病情恶化,20 人出现转移,15 人死于 BC(诊断后中位数为 9.6 年)。癌症特异性生存概率在5年、10年和15年分别为0.99、0.98和0.96。前5年无复发的50名患者出现了晚期复发,其中2人死于BC。转移性TaLG尽管在表型上与非良性肿瘤相似,但其转录组学的不良结果与高级别肿瘤一致。2004/2022年系统与1973年WHO系统的分级一致性分别为0.78(95%CI:0.65-0.90)和0.41(95%CI:0.32-0.50):本研究的长期数据对 "如果随访时间足够长,原发性TaLG NMIBC几乎不会发展为致命疾病 "这一假设提出了质疑。然而,在前 5 年无复发的患者中,与 BC 相关的死亡风险极低。最大限度地减少病理分级的变异性仍是一项尚未满足的需求。
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引用次数: 0
Benign Prostatic Hyperplasia. 良性前列腺增生。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-09 DOI: 10.1097/JU.0000000000004345
Steven A Kaplan
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引用次数: 0
Reply by Authors. 作者回复。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-17 DOI: 10.1097/JU.0000000000004360
Tina L Leunbach, Agnethe Berglund, Andreas Ernst, Gitte M Hvistendahl, Yazan F Rawashdeh, Claus H Gravholt
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引用次数: 0
Diagnostic Test Characteristics of Ultrasound-Based Hydronephrosis for Chronic Kidney Disease in Children and Adolescents With Myelomeningocele: Results From the UMPIRE and National Spina Bifida Patient Registry Cohort Studies. 儿童和青少年慢性肾脏病伴脊髓脊膜膨出的超声肾积水诊断试验特征:来自UMPIRE和NSBPR队列研究的结果
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-09 DOI: 10.1097/JU.0000000000004342
David I Chu, Tiebin Liu, Tonya Williams, Jacqueline Mix, Jennifer Ahn, J Christopher Austin, Michelle Baum, Douglass Clayton, Susan Jarosz, David Joseph, Elizabeth Roth, Jonathan Routh, Duong Tu, Evalynn Vasquez, M Chad Wallis, John Wiener, Earl Cheng, Elizabeth Yerkes, Stacy Tanaka

Purpose: Renal ultrasounds are performed in patients with myelomeningocele to screen for markers of kidney health, including hydronephrosis. We evaluated the diagnostic accuracy of hydronephrosis to screen for low kidney function defined by estimated glomerular filtration rate (eGFR).

Materials and methods: We performed a retrospective cross-sectional study using data from 2 cohorts of children and youth with myelomeningocele. The first cohort is from UMPIRE (2016-2022) and the second from the National Spina Bifida Patient Registry (NSBPR; 2009-2021). We identified patients aged 1 to 18 years with available eGFR data within 6 months of an ultrasound. We excluded NSBPR patients younger than 6 years to address potential duplication across cohorts. The primary outcome was eGFR < 90 mL/min/1.73 m2, calculated using the bedside Schwartz formula. Hydronephrosis was dichotomized into any/none. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of any hydronephrosis using eGFR as the reference standard.

Results: In UMPIRE, 221 patients were included with median age 2.4 years (IQR, 1.9-3.8) and 24% having eGFR < 90. Any hydronephrosis vs none conferred a sensitivity/specificity/PPV/NPV of 25%/75%/24%/77%, respectively. In NSBPR, 2269 patients were included with median age 13 years (IQR, 9.6-16.3) and 17% having eGFR < 90. Any hydronephrosis vs none conferred a sensitivity/specificity/PPV/NPV of 24%/87%/26%/85%, respectively.

Conclusions: In 2 cohorts of children and youth with myelomeningocele, hydronephrosis conferred a sensitivity of ∼25% for a creatinine-based eGFR < 90 mL/min/1.73 m2. This low sensitivity suggests that hydronephrosis alone is a poor screening marker of kidney health.

目的:对脊髓脊膜膨出患者进行肾脏超声检查,以筛查肾脏健康的标志物,包括肾积水。我们通过肾小球滤过率(eGFR)来评估肾积水的诊断准确性,以筛查低肾功能。材料和方法:我们进行了一项回顾性横断面研究,使用了来自2个脊髓脊膜膨出儿童和青少年队列的数据。第一个队列是保存脊柱裂幼儿初始肾功能的泌尿外科治疗方案(UMPIRE;2016-2022),第二份来自国家脊柱裂患者登记处(NSBPR;2009 - 2021)。我们确定了年龄在1至18岁的患者,在超声检查后6个月内有可用的eGFR数据。我们排除了6岁以下的NSBPR患者,以解决队列中潜在的重复。主要终点是eGFR < 90 mL/min/1.73 m2,使用床边Schwartz公式计算。肾积水分为有/无。我们以eGFR作为参考标准计算任何肾积水的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)。结果:UMPIRE纳入221例患者,中位年龄为2.4岁(IQR, 1.9-3.8), 24%的患者eGFR < 90。有肾积水与无肾积水的敏感性/特异性/PPV/NPV分别为25%/75%/24%/77%。NSBPR纳入2269例患者,中位年龄13岁(IQR, 9.6-16.3), 17%的患者eGFR < 90。有肾积水与无肾积水的敏感性/特异性/PPV/NPV分别为24%/87%/26%/85%。结论:在2组患有脊髓脊膜膨出的儿童和青少年队列中,基于肌酐的eGFR < 90 mL/min/1.73 m2时,肾积水的敏感性为~ 25%。这种低敏感性表明,单独的肾积水是一个较差的肾脏健康筛查标志物。
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引用次数: 0
Use and Disuse of Catheterizable Channels as the Primary Method of Emptying the Neuropathic Bladder: A Single Institutional Cohort Study. 使用和废弃可导尿的通道作为排空神经性膀胱的主要方法:一项单一机构队列研究。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-04 DOI: 10.1097/JU.0000000000004313
Yifan Meng Griffin, Rosalia Misseri, Joshua D Roth, Benjamin M Whittam, Pankaj Dangle, Shelly King, Kirstan K Meldrum, Martin Kaefer, Mark P Cain, Richard C Rink, Konrad M Szymanski

Purpose: We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors of disuse.

Materials and methods: People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.

Results: Five hundred sixty-one people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow-up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. The most common reasons for disuse were nonmechanical (64%). After disuse, 46% underwent incontinent diversion. After correcting for differential follow-up, 89% of people still used their channels at 10 years and 81% at 20 years. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk of disuse compared with self-catheterized channels (P < .001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (P = .02). For channels disused for nonmechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (P ≤ .04). No variables were associated with disuse for mechanical reasons (P ≥ .22).

Conclusions: Most people with CCCs use them on long-term follow-up. One percent stopped using them annually. People who never self-catheterized, never attended transition clinic, or never had RLQ stomas were at higher risk of channel disuse, particularly because of nonmechanical reasons.

目的:我们旨在评估可持续导尿的尿道(CCC)的长期使用情况,并探讨其废弃的潜在风险因素:我们对在本院接受阑尾造口术和蒙蒂手术的患者进行了回顾性研究(1991-2023 年)。主要结果是CCC失用(不将间歇性导尿通道作为排空膀胱的主要方法)。结果561人(46%为男性,57%为分流患者,72%为脊柱裂患者)符合纳入标准(244人为阑尾造口术患者,317人为蒙蒂患者;69%为右下腹[RLQ]患者)。建立管道的年龄中位数为 8 岁(随访时间中位数:11 年,78% 的患者自行导尿)。总共有 76 人停用了管道。最常见的停用原因是非机械性的(64%)。在校正随访差异后,分别有 89% 和 81% 的人在 10 年和 20 年后仍在使用导尿管。在对成年患者的所有废弃导尿管进行多变量分析后发现,与自行导尿管相比,由他人导尿的患者废弃导尿管的风险是自行导尿的患者的3.78倍(p结论:大多数CCC患者都会使用导尿管:在长期随访中,大多数人都使用 CCC。1%的人每年都会停止使用。从未自行导尿、从未去过过渡诊所或拥有 RLQ 造口的人停用导尿管的风险较高,尤其是由于非机械原因。
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引用次数: 0
Office Urology, Perioperative Care, Urinary Diversions. 办公室泌尿科、围手术期护理、尿路转流。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-18 DOI: 10.1097/JU.0000000000004321
David S Wang
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引用次数: 0
Reply: Adults With Spina Bifida Fare Worse Than Young Adults: A Systemic Vulnerability in Urinary Tract Infection-Related Hospital Care. 答复:脊柱裂患者的健康脆弱性:从青少年到成人的过渡。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-19 DOI: 10.1097/JU.0000000000004317
Kathy H Huen, Carol Davis-Dao
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引用次数: 0
Infection and Inflammation of the Genitourinary Tract. 泌尿生殖道感染和炎症。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-10 DOI: 10.1097/JU.0000000000004340
J Quentin Clemens
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引用次数: 0
The Journal of Urology® Home Study Course 2025 Volume 213/214.
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-07 DOI: 10.1097/JU.0000000000004411
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引用次数: 0
Two-Year Efficacy and Safety Outcomes of the Pivotal OASIS Study Using the Revi System for Treatment of Urgency Urinary Incontinence. 使用 Revi® 系统治疗急迫性尿失禁的关键性 OASIS 研究的两年疗效和安全性结果。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-25 DOI: 10.1097/JU.0000000000004328
John P F A Heesakkers, Philip Toozs-Hobson, Suzette E Sutherland, Alex Digesu, Cindy L Amundsen, Rebecca J McCrery, Stefan De Wachter, Emily R Kean, Frank Martens, Kevin Benson, Kimberly L Ferrante, Kevin J Cline, Osvaldo F Padron, Laura Giusto, Felicia L Lane, Lambertus P W Witte, Roger R Dmochowski

Purpose: The BlueWind Medical Device, Revi, is a novel implantable tibial neuromodulation system powered by an external, battery-operated wearable that facilitates individually tailored stimulation to provide treatment for urgency urinary incontinence (ie, overactive bladder wet). The Revi System is the first Food and Drug Administration-cleared implantable neuromodulation device which can be used without prior failure with more conservative treatment options. Two-year follow-up results of the OASIS (Overactive Bladder Stimulation System) study are presented.

Materials and methods: The Revi System was implanted in 151 female participants. The primary efficacy and safety end points were assessed at 6 and 12 months, after which participants either consented to extend follow-up for long-term assessment of treatment durability and safety or they chose to exit the study.

Results: Ninety-seven participants completed the 24-month assessment, and of these, 79% were therapy responders (≥50% reduction in urgency urinary incontinence episodes, demonstrated on a 3-day voiding diary). Importantly, therapeutic response was durable, with comparable effectiveness at 6, 12, and 24 months (response rates of 78%, 82%, and 79%, respectively). Participants who completed both the 6- and 24-month assessment had similar demographics and treatment results at the 6-month visit, indicating that these results at 24 months are representative of the overall study population. In addition, high satisfaction and patient impression of improvement were reported, with 97% (88/91) of the participants satisfied with the therapy and 80% (78/97) feeling "much better" or "very much better." There were no serious adverse events related to the device or the procedure through 24 months.

Conclusions: Two-year results demonstrate durable efficacy, high patient satisfaction, and a very favorable safety profile.

Trial registration: ClinicalTrials.gov Identifier: NCT03596671.

目的:BlueWind 医疗设备 Revi® 是一种新型植入式胫骨神经调控系统,由外置电池驱动的可穿戴设备提供动力,可进行单独定制的刺激,以治疗尿急尿失禁(即膀胱过度活跃症)。Revi 系统是首个获得 FDA 批准的植入式神经调控设备,可在保守治疗方案失败前使用。本文介绍了 OASIS 研究的两年随访结果:151 名女性参与者植入了 Revi 系统。主要疗效和安全性终点分别在6个月和12个月时进行评估,之后,参与者要么同意延长随访时间,以便对治疗的持久性和安全性进行长期评估,要么选择退出研究:97名参与者完成了为期24个月的评估,其中79%为治疗应答者(3天排尿日记显示尿急尿失禁发作次数减少≥50%)。重要的是,治疗反应是持久的,6 个月、12 个月和 24 个月的疗效相当(反应率分别为 78%、82% 和 79%)。完成 6 个月和 24 个月评估的参与者的人口统计学特征和 6 个月访问时的治疗结果相似,这表明 24 个月的结果在整个研究人群中具有代表性。此外,患者的满意度和对病情改善的印象也很高,97%(88/91)的参与者对治疗感到满意,80%(78/97)的参与者感觉 "好多了 "或 "非常好"。在24个月的治疗过程中,没有发生与设备或手术相关的严重不良事件:为期两年的研究结果表明,该疗法疗效持久,患者满意度高,安全性非常好。
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引用次数: 0
期刊
Journal of Urology
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