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Male Infertility. 男性不育。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-20 DOI: 10.1097/JU.0000000000004363
Craig Niederberger
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引用次数: 0
Editorial Comment.
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2025-02-03 DOI: 10.1097/JU.0000000000004442
Katelyn Spencer, Amanda F Buchanan
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引用次数: 0
Impact of Discordance Between Magnetic Resonance Imaging and Ultrasound Volume Measurements on Prostate Fusion Biopsy Outcomes. MRI和US体积测量不一致对前列腺融合活检结果的影响。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-10 DOI: 10.1097/JU.0000000000004368
Tabea Borde, Nicole A Varble, Lindsey A Hazen, Laetitia Saccenti, Charisse Garcia, Meredith Digennaro, Sandeep Gurram, Peter A Pinto, Baris Turkbey, Bradford J Wood

Purpose: Our goal was to determine whether the difference between MRI-based and ultrasound (US)-based volume measurements are associated with MRI/US-targeted fusion-guided biopsy outcomes.

Materials and methods: This retrospective, single-center study involved 4177 consecutive patients biopsied between 2010 and 2023 using both MRI/US-targeted fusion and systematic biopsy. Biopsies were indicated because of elevated PSA levels or abnormal multiparametric MRI results. US volume measurements were calculated using the triplane ellipsoid formula, and MRI volumes were obtained by semiautomatic planimetric segmentation. Performance of fusion biopsy compared with systematic biopsy was analyzed with respect to the discordance between MRI and US volume measurements.

Results: In 2736 patients (66%), biopsy detected prostate cancer. In cases where both techniques yielded prostate cancers (1695/2736 [62%]), a statistically higher proportion of patients had higher Gleason scores on MRI/US-targeted fusion biopsy compared with systematic biopsy (343 patients [20.2%] vs 137 patients [8.1%], P < .001). MRI volume measurements were significantly smaller compared with US volume measurements (median [IQR] 54 mL [39-77], 56 mL [40-80], respectively, P < .001). Beyond 5 mL volume discordance, MRI/US-targeted fusion biopsy gradually showed less added diagnostic benefit compared with systematic biopsy. In the ≤ 5 mL cohort, MRI/US-targeted fusion biopsy detected more aggressive tumors in 4 times as many patients as systematic biopsy (136 vs 32 patients, P < .001).

Conclusions: Although MRI/US-targeted fusion biopsy detected more prostate cancers than systematic biopsy, the performance of MRI/US-targeted fusion biopsy declined with more discordance between volumes measured in MRI vs US. Awareness of volume discordance in MRI- and US-based volume measurements should alert the operator about the possibility of reduced performance of MRI/US-targeted fusion biopsy.

Clinical trial registration no.: NCT00102544.

目的:确定基于MRI和超声(US)的体积测量之间的差异是否与MRI/US靶向融合引导活检结果相关。材料和方法:这项回顾性的单中心研究纳入了2010年至2023年间使用MRI/ us靶向融合和系统活检进行活检的4177例连续患者。由于前列腺特异性抗原水平升高或多参数MRI结果异常,需要活检。使用三平面椭球体公式计算US体积测量值,通过半自动平面分割获得MRI体积。与系统活检相比,融合活检的表现与MRI和US体积测量之间的不一致进行了分析。结果:2736例(66%)患者活检检出前列腺癌。在两种技术均产生前列腺癌的患者中(1695/2736[62%]),与系统活检相比,MRI/US靶向融合活检的Gleason评分较高的患者比例在统计学上更高(343例患者[20.2%]对137例患者[8.1%])。结论:尽管MRI/US靶向融合活检比系统活检检测到更多的前列腺癌,但MRI/US靶向融合活检的性能下降,MRI和US测量的体积之间存在更多不一致。意识到MRI和美国体积测量的体积不一致应该提醒操作员MRI/美国靶向融合活检的性能降低的可能性。
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引用次数: 0
Urologic Oncology: Bladder, Penis, and Urethral Cancer and Basic Principles of Oncology. 泌尿肿瘤学》:膀胱癌、阴茎癌和尿道癌》和《肿瘤学基本原理》。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-11-20 DOI: 10.1097/JU.0000000000004320
Sam S Chang
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引用次数: 0
Intraoperative Tranexamic Acid in Radical Cystectomy: Impact on Bleeding, Thromboembolism, and Survival Outcomes. 术中氨甲环酸治疗根治性膀胱切除术:对出血、血栓栓塞和生存结果的影响。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-02 DOI: 10.1097/JU.0000000000004358
Mohamed E Ahmed, Jack R Andrews, Ahmed M Mahmoud, Giuseppe Reitano, Prabin Thapa, Mark D Tyson, Abhinav Khanna, Paras Shah, Vidit Sharma, R Houston Thompson, Stephen A Boorjian, Igor Frank, Matthew K Tollefson, R Jeffrey Karnes

Purpose: Perioperative blood transfusion (PBT) has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, PBT in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and venous thromboembolism (VTE) in patients undergoing RC. We also investigate its long-term impact on overall survival (OS) and cancer-specific survival (CSS) outcomes.

Materials and methods: We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RCs performed for bladder cancer between 1990 and 2021. Primary outcomes assessed include the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS.

Results: Of 2862 patients with complete available data, 468 received TXA (TXA recipient) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (TXA nonrecipient). TXA recipients experienced less estimated blood loss intraoperatively (median 600 vs 650 cc) and were less likely to need PBT (31% vs 50%, P < .001) compared with TXA nonrecipients. There was no difference between groups in deep venous thrombosis and pulmonary embolism rates within 90 days of RC. In the adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, perioperative blood transfusion was associated with poor OS and CSS (P < .001).

Conclusions: TXA use was associated with a significant reduction in estimated blood loss and PBT without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved OS as well as CSS. However, in multivariable analyses, TXA itself was not independently associated with improved OS or CSS; instead, PBT was. Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes.

背景:据报道,50%的根治性膀胱切除术(RC)患者围手术期输血。不幸的是,接受RC的患者围手术期输血与不良的肿瘤预后相关。已建议使用氨甲环酸(TXA)来减少围手术期输血的需要。在这里,我们试图研究术中TXA对根治性膀胱切除术(RC)患者围手术期出血和静脉血栓栓塞风险的影响。我们还研究了其对总生存期(OS)和癌症特异性生存结局(CSS)的长期影响。方法:我们查询了前瞻性维护的梅奥诊所根治性膀胱切除术登记,并确定了1990-2021年间膀胱癌的所有RC。评估的主要结局包括围手术期出血的风险、输血的需要和静脉血栓栓塞的风险。次要结果包括使用TXA对OS和CSS的影响。结果:在有完整可用数据的2862例患者中,468例接受了TXA (TXA受体),在年龄、新辅助化疗、病理分期和术前血红蛋白方面与未接受TXA(非TXA受体)组1:1匹配。TXA受体术中估计失血量(EBL)更少(中位数为600比650)cc,需要PBT的可能性更小(31%比50%,p值)。结论:TXA的使用与EBL和围术期输血的显著降低相关,而不增加静脉血栓栓塞的风险。在单变量分析中,我们观察到TXA的使用与改善总体生存和癌症特异性生存之间的关联。然而,在多变量分析中,TXA本身与改善的总生存期(OS)或癌症特异性生存期(CSS)没有独立的相关性;相反,围手术期输血是。需要进一步的研究来探索减少围手术期输血的策略及其对生存结果的影响。
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引用次数: 0
Editorial Comment. 编辑评论。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-24 DOI: 10.1097/JU.0000000000004377
Trevor C Hunt, Kamil Malshy, Jathin Bandari
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引用次数: 0
Editorial Comment. 编辑评论。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-10 DOI: 10.1097/JU.0000000000004401
Sol C Moon, Theodore M Dowd, Soroush Rais-Bahrami
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引用次数: 0
Development and Validation of the Length, Segment, and Etiology Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data From the Trauma and Urologic Reconstructive Network of Surgeons. 利用来自外科医生创伤和泌尿系统重建网络的纵向尿道成形术结果数据,开发并验证长度、区段和病因(LSE)前尿道狭窄疾病分期系统。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-09 DOI: 10.1097/JU.0000000000004369
Bradley A Erickson, Mei N Tuong, Alithea N Zorn, Charles H Schlaepfer, Nejd F Alsikafi, Benjamin N Breyer, Joshua A Broghammer, Jill C Buckley, Sean P Elliott, Jeremy B Myers, Andrew C Peterson, Keith F Rourke, Thomas G Smith, Alex J Vanni, Bryan B Voelzke, Lee C Zhao

Purpose: The purpose of this study was to create and validate an anterior urethral stricture disease (aUSD) staging system based on the previously validated Length (L), Urethral Segment (S), and Etiology (E; LSE) classification system.

Materials and methods: The Trauma and Urologic Reconstructive Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score was created to aid in ranking the stagings into stricture severity based on (1) functional outcomes, (2) location of urethral meatus (eg, orthotopic, perineal), and (3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared with 2 previously described aUSD severity scores-the U-score and the LSE score.

Results: Five aUSD stages, with 10 total substages, were ultimately created: stage I-short bulbar, stage II-long bulbar, stage III-penile/fossa of favorable etiology, stage IV-penile/fossa of adverse pathology, and stage V-pan-urethral (3-segment). Mean Urethroplasty Triad Score decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a nonorthotopic meatus and was similar in predicting surgical outcomes.

Conclusions: Each stage and substage of this novel LSE staging system was shown to provide unique information on stricture characteristics, repairs, and surgical outcomes. The LSE staging system will improve communication of stricture complexity/severity with our patients and organize aUSD for multi-institutional outcomes studies and clinical trial recruitment purposes.

目的:根据之前验证的长度(L)、尿道段(S)和病因(E、LSE)分类系统,创建并验证前尿道狭窄疾病(aUSD)分期系统:材料/方法:外科医生创伤和泌尿系统重建网络(TURNS)前瞻性数据库用于创建和验证分期系统。根据 1) 功能结果、2) 尿道肉腔位置(如正位、会阴)和 3) 修复所需的手术次数,创建了新的尿道成形术三联评分(UTS),以帮助对狭窄严重程度进行分级。在非 TURNS 数据集中对分期进行了二次验证,然后与之前描述的两个 aUSD 严重程度评分(U-score 和 LSE score)进行比较:结果:最终确定了五个 aUSD 阶段,共十个子阶段:I期--球部短;II期--球部长;III期--病因良好的阴茎/阴茎窝;IV期--病因不良的阴茎/阴茎窝;V期--泛尿道(三段式)。平均UTS随着每个亚分期的增加而降低(严重程度增加),这一线性趋势在单独的验证队列和TURNS外科医生中都得到了验证。LSE 分期在预测是否需要多期手术或非异位肉腔方面优于 LSE 评分和 U 评分,在预测手术结果方面也类似:结论:这一新型 LSE 分期系统的每个阶段和子阶段都能提供有关狭窄特征、修复和手术效果的独特信息。LSE分期系统将改善与患者之间关于狭窄复杂性/严重性的交流,并为多机构结果研究和临床试验招募目的组织AUSD。
{"title":"Development and Validation of the Length, Segment, and Etiology Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data From the Trauma and Urologic Reconstructive Network of Surgeons.","authors":"Bradley A Erickson, Mei N Tuong, Alithea N Zorn, Charles H Schlaepfer, Nejd F Alsikafi, Benjamin N Breyer, Joshua A Broghammer, Jill C Buckley, Sean P Elliott, Jeremy B Myers, Andrew C Peterson, Keith F Rourke, Thomas G Smith, Alex J Vanni, Bryan B Voelzke, Lee C Zhao","doi":"10.1097/JU.0000000000004369","DOIUrl":"10.1097/JU.0000000000004369","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to create and validate an anterior urethral stricture disease (aUSD) staging system based on the previously validated Length (L), Urethral Segment (S), and Etiology (E; LSE) classification system.</p><p><strong>Materials and methods: </strong>The Trauma and Urologic Reconstructive Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score was created to aid in ranking the stagings into stricture severity based on (1) functional outcomes, (2) location of urethral meatus (eg, orthotopic, perineal), and (3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared with 2 previously described aUSD severity scores-the U-score and the LSE score.</p><p><strong>Results: </strong>Five aUSD stages, with 10 total substages, were ultimately created: stage I-short bulbar, stage II-long bulbar, stage III-penile/fossa of favorable etiology, stage IV-penile/fossa of adverse pathology, and stage V-pan-urethral (3-segment). Mean Urethroplasty Triad Score decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a nonorthotopic meatus and was similar in predicting surgical outcomes.</p><p><strong>Conclusions: </strong>Each stage and substage of this novel LSE staging system was shown to provide unique information on stricture characteristics, repairs, and surgical outcomes. The LSE staging system will improve communication of stricture complexity/severity with our patients and organize aUSD for multi-institutional outcomes studies and clinical trial recruitment purposes.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"512-523"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Upper TRACT Endometry Score: Development and Internal Validation of an Objective Measure of Variables That Affect Endoscopic Procedures for Upper Tract Urothelial Carcinoma. 上尿路尿路上皮癌内窥镜检查评分:对影响上尿路尿路上皮癌内窥镜手术的变量进行客观测量的开发和内部验证。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-12 DOI: 10.1097/JU.0000000000004383
Suzanne Lange, Alec Reinhardt, Daniel Igel, Craig Labbate, Mehrad Adibi, Suprateek Kundu, Surena F Matin

Purpose: Endoscopic management (EM) is an increasingly accepted option for upper tract urothelial carcinoma (UTUC). Feasibility can be dependent on a variety of variables. The objective of this study was to identify anatomic and phenotypic tumor characteristics that affect EM, using structured expert forecasting, develop and obtain consensus on an assessment score, and perform initial validation of the score in a retrospective database.

Materials and methods: We used a modified Delphi method to elicit expert opinions, develop a scale, and gain consensus. Two survey rounds identified 5 consensus categories from which the Upper anatomic Tract, tumor Radius, tumor Architecture, tumor Count, tumor locaTion (TRACT) Endometry Score was created. An institutional UTUC database was used for initial validation. Patients with low-grade or high-grade UTUC undergoing EM were included. The Upper TRACT Endometry Score was calculated based on variables present at initial ureteroscopy. The primary outcome was extent of procedures received defined as a categorical, ordinal scale. The association of the Upper TRACT Endometry Score with outcomes was evaluated using multivariable ordinal logistic regression and exact tests.

Results: Thirty international endourologic and urologic oncology experts participated in the surveys. One hundred ten renal units (102 patients) were identified for validation. Multivariable ordinal logistic regression demonstrated that as the Upper TRACT Endometry Score increases, the likelihood of requiring a more intensive intervention increases. The Fisher exact test suggested a significant relationship between the Upper TRACT Endometry Score and procedures received (P = .004).

Conclusions: The Upper TRACT Endometry Score is a straightforward tool that with additional validation could be used to help counsel patients and to standardize reporting of variables that may affect EM of UTUC.

目的:对于上尿路尿路上皮癌(UTUC),内镜治疗(EM)越来越被接受。其可行性取决于多种变量。本研究的目的是利用结构化专家预测法确定影响内镜下治疗的肿瘤解剖和表型特征,制定评估评分并达成共识,并在回顾性数据库中对评分进行初步验证:我们采用改良德尔菲法征求专家意见、制定量表并达成共识。两轮调查确定了 5 个共识类别,并据此创建了上 TRACT 内径测量评分。机构 UTUC 数据库用于初步验证。接受EM检查的低级别或高级别UTUC患者均包括在内。根据初次输尿管镜检查时存在的变量计算出上TRACT内径测量评分。主要结果是接受手术的程度,定义为分类序数量表。采用多变量序数逻辑回归和Exact检验评估了上TRACT内径测量评分与结果的相关性:结果:30 位国际内镜学和泌尿肿瘤学专家参与了调查。110个肾单位(102名患者)被确定为验证对象。多变量序数逻辑回归表明,随着上TRACT内径测量评分的增加,需要进行更深入干预的可能性也会增加。费舍尔精确检验表明,上TRACT内径测量评分与接受的手术之间存在显著关系(P=0.004):上TRACT内径测量评分是一种简单明了的工具,经过进一步验证后可用于帮助为患者提供咨询,并对可能影响UTUC内镜管理的变量进行标准化报告。
{"title":"The Upper TRACT Endometry Score: Development and Internal Validation of an Objective Measure of Variables That Affect Endoscopic Procedures for Upper Tract Urothelial Carcinoma.","authors":"Suzanne Lange, Alec Reinhardt, Daniel Igel, Craig Labbate, Mehrad Adibi, Suprateek Kundu, Surena F Matin","doi":"10.1097/JU.0000000000004383","DOIUrl":"10.1097/JU.0000000000004383","url":null,"abstract":"<p><strong>Purpose: </strong>Endoscopic management (EM) is an increasingly accepted option for upper tract urothelial carcinoma (UTUC). Feasibility can be dependent on a variety of variables. The objective of this study was to identify anatomic and phenotypic tumor characteristics that affect EM, using structured expert forecasting, develop and obtain consensus on an assessment score, and perform initial validation of the score in a retrospective database.</p><p><strong>Materials and methods: </strong>We used a modified Delphi method to elicit expert opinions, develop a scale, and gain consensus. Two survey rounds identified 5 consensus categories from which the Upper anatomic Tract, tumor Radius, tumor Architecture, tumor Count, tumor locaTion (TRACT) Endometry Score was created. An institutional UTUC database was used for initial validation. Patients with low-grade or high-grade UTUC undergoing EM were included. The Upper TRACT Endometry Score was calculated based on variables present at initial ureteroscopy. The primary outcome was extent of procedures received defined as a categorical, ordinal scale. The association of the Upper TRACT Endometry Score with outcomes was evaluated using multivariable ordinal logistic regression and exact tests.</p><p><strong>Results: </strong>Thirty international endourologic and urologic oncology experts participated in the surveys. One hundred ten renal units (102 patients) were identified for validation. Multivariable ordinal logistic regression demonstrated that as the Upper TRACT Endometry Score increases, the likelihood of requiring a more intensive intervention increases. The Fisher exact test suggested a significant relationship between the Upper TRACT Endometry Score and procedures received (<i>P</i> = .004).</p><p><strong>Conclusions: </strong>The Upper TRACT Endometry Score is a straightforward tool that with additional validation could be used to help counsel patients and to standardize reporting of variables that may affect EM of UTUC.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"467-474"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter: Impact of SPY Fluorescence Angiography on Incidence of Ureteroenteric Stricture After Urinary Diversion. 信:SPY荧光血管造影对尿分流后输尿管肠狭窄发生率的影响。
IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-20 DOI: 10.1097/JU.0000000000004362
Haci Ibrahim Cimen
{"title":"Letter: Impact of SPY Fluorescence Angiography on Incidence of Ureteroenteric Stricture After Urinary Diversion.","authors":"Haci Ibrahim Cimen","doi":"10.1097/JU.0000000000004362","DOIUrl":"10.1097/JU.0000000000004362","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"524"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Urology
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