To assess whether more severe urinary symptoms and poorer quality of life among patients on diuretic therapy are associated with decreased adherence to the diuretic regimen.
Methods
Participants were recruited via ResearchMatch.org and sent a REDCap survey. The Overactive Bladder Questionnaire-Short Form (OAB-q SF) was used to assess urinary symptom bother and health-related quality of life (HRQL). Participants were asked if they skip diuretic doses due to urinary symptoms with a bivariate (yes or no) outcome. Subgroup analyses of loop vs non-loop diuretic and those taking the diuretic for a cardiovascular indication (hypertension or heart failure) were performed.
Results
A total of 4029 surveys were sent, 285 were returned (7.1% response rate), and 279 were included in the study. Fifty-three participants admitted to skipping diuretic doses due to urinary symptoms. Lower HRQL scores were significantly associated with poorer adherence scores among all participants (P < .001), among participants taking a loop diuretic (P < .001), and among participants with hypertension and heart failure (P < .039). Association between symptoms and adherence remained significant after adjustment in the multivariate model for the whole cohort and loop diuretic subgroup but lost significance in the hypertension and heart failure subgroup.
Conclusions
Worsening quality of life due to urinary symptoms may be associated with poorer adherence to diuretics, particularly loop diuretics.
{"title":"Association of lower urinary tract symptoms and diuretic adherence","authors":"Matthew L. Miller, Brent N. Reed, Rena D. Malik","doi":"10.1111/luts.12452","DOIUrl":"10.1111/luts.12452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether more severe urinary symptoms and poorer quality of life among patients on diuretic therapy are associated with decreased adherence to the diuretic regimen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were recruited via ResearchMatch.org and sent a REDCap survey. The Overactive Bladder Questionnaire-Short Form (OAB-q SF) was used to assess urinary symptom bother and health-related quality of life (HRQL). Participants were asked if they skip diuretic doses due to urinary symptoms with a bivariate (yes or no) outcome. Subgroup analyses of loop vs non-loop diuretic and those taking the diuretic for a cardiovascular indication (hypertension or heart failure) were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4029 surveys were sent, 285 were returned (7.1% response rate), and 279 were included in the study. Fifty-three participants admitted to skipping diuretic doses due to urinary symptoms. Lower HRQL scores were significantly associated with poorer adherence scores among all participants (<i>P</i> < .001), among participants taking a loop diuretic (<i>P</i> < .001), and among participants with hypertension and heart failure (<i>P</i> < .039). Association between symptoms and adherence remained significant after adjustment in the multivariate model for the whole cohort and loop diuretic subgroup but lost significance in the hypertension and heart failure subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Worsening quality of life due to urinary symptoms may be associated with poorer adherence to diuretics, particularly loop diuretics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40393560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to compare the safety and efficacy of three different laser prostate vaporization surgeries, which were photoselective vaporization of the prostate (PVP), diode laser vaporization (DVP), and thulium laser vaporization (ThuVAP), for the treatment of benign prostatic hyperplasia (BPH) in a randomized clinical trial.
Methods
A total of 71 consecutive patients with BPH were included; 23 patients were treated with PVP, 23 with DVP, and 25 with ThuVAP. Patients were evaluated with disease-related symptomatic questionnaires, Quality of Life (QOL) Index, and maximum urinary flow rate (Qmax) for 12 months. Patients were monitored to record operation/vaporization time, 24-hour hemoglobin/sodium drop, length of catheterization/hospitalization, and perioperative/postoperative complications.
Results
In all three groups, patients showed significant and comparable improvements in symptom scores, QOL Index, and Qmax during the 12-month follow-up period. The mean operation/vaporization time was equivalent across all three groups at 69/23 (PVP), 81/34 (DVP), and 76/32 minutes (ThuVAP), while the applied laser energy was lower for PVP at 157 kJ compared to the other two techniques (DVP at 358 kJ, ThuVAP at 240 kJ). The mean vaporization rates per unit energy were significantly different between the three groups (PVP 0.16, DVP 0.09, and ThuVAP 0.09 mL/kJ). There were no significant differences in the main safety profiles between the three groups.
Conclusions
Our study demonstrated that these three types of laser surgeries are similar in terms of complications and outcomes, with excellent hemostasis and high patient satisfaction. It was suggested that sufficient tissue vaporization could be achieved using less energy through PVP surgery.
{"title":"A prospective, single-center, randomized clinical trial to evaluate the efficacy of three types of laser vaporization surgeries using a 180-W GreenLight XPS laser, a 300-W diode laser, and a 200-W thulium laser for the treatment of benign prostatic hyperplasia","authors":"Tatsunori Okada, Mikifumi Koura, Ryota Sumikawa, Hiroyuki Masaoka, Yoohyun Song, Takashi Dejima, Narihito Seki","doi":"10.1111/luts.12453","DOIUrl":"10.1111/luts.12453","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compare the safety and efficacy of three different laser prostate vaporization surgeries, which were photoselective vaporization of the prostate (PVP), diode laser vaporization (DVP), and thulium laser vaporization (ThuVAP), for the treatment of benign prostatic hyperplasia (BPH) in a randomized clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 71 consecutive patients with BPH were included; 23 patients were treated with PVP, 23 with DVP, and 25 with ThuVAP. Patients were evaluated with disease-related symptomatic questionnaires, Quality of Life (QOL) Index, and maximum urinary flow rate (<i>Q</i><sub>max</sub>) for 12 months. Patients were monitored to record operation/vaporization time, 24-hour hemoglobin/sodium drop, length of catheterization/hospitalization, and perioperative/postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all three groups, patients showed significant and comparable improvements in symptom scores, QOL Index, and <i>Q</i><sub>max</sub> during the 12-month follow-up period. The mean operation/vaporization time was equivalent across all three groups at 69/23 (PVP), 81/34 (DVP), and 76/32 minutes (ThuVAP), while the applied laser energy was lower for PVP at 157 kJ compared to the other two techniques (DVP at 358 kJ, ThuVAP at 240 kJ). The mean vaporization rates per unit energy were significantly different between the three groups (PVP 0.16, DVP 0.09, and ThuVAP 0.09 mL/kJ). There were no significant differences in the main safety profiles between the three groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrated that these three types of laser surgeries are similar in terms of complications and outcomes, with excellent hemostasis and high patient satisfaction. It was suggested that sufficient tissue vaporization could be achieved using less energy through PVP surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39999885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lakshay Khosla, Alia Codelia-Anjum, Christina Sze, Susana Martinez Diaz, Kevin C. Zorn, Naeem Bhojani, Dean Elterman, Bilal Chughtai
Purpose
Among noninvasive modalities for assessing bladder outlet obstruction (BOO), the penile cuff test (PCT) is the most used in clinical practice. The purpose of this review was to evaluate the performance of PCT in diagnosing and managing BOO.
Materials and Methods
PubMed, Scopus, CINAHL, Embase, Cochrane Library, and Web of Science were searched for studies investigating use of PCT for BOO. Studies evaluating diagnostic parameters, inter-observer agreements, or treatment outcomes using PCT were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed (PROSPERO ID: CRD42022300047). A proportional meta-analysis was done for diagnostic accuracy proportions. The Egger's and the Begg-Mazumdar rank-correlation tests were used to assess publication bias. Risk of bias was assessed using the Gradings of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.
Results
Of the 272 articles retrieved, 17 were included in qualitative synthesis and meta-analysis was performed on five studies (comprising 448 patients). Two studies evaluating inter-observer agreement demonstrated 95% agreement and five studies evaluating procedures reported a 66%-80% surgical success rate on obstructed patients using PCT. From the proportional meta-analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.85 (95% CI 0.71-0.95) 0.78 (95% CI 0.67-0.87), 0.74 (95% CI 0.52-0.91), and 0.87 (95% CI 0.73-0.96), respectively. Publication bias was noted for PPV but not for sensitivity, specificity, or NPV. Based on the GRADE criteria, there were two low, six moderate, and nine high-quality studies.
Conclusions
PCT performs sufficiently in diagnosing and managing BOO. However, due to variability in obstruction criteria assessment, more studies comparing diagnostic criteria are warranted.
目的在评估膀胱出口梗阻(BOO)的无创方法中，阴茎袖试验(PCT)是临床应用最多的方法。本综述的目的是评价PCT在诊断和治疗BOO中的表现。材料与方法检索PubMed、Scopus、CINAHL、Embase、Cochrane Library和Web of Science，查找有关BOO使用PCT的研究。包括使用PCT评估诊断参数、观察者间协议或治疗结果的研究。遵循系统评价和荟萃分析方案的首选报告项目(PROSPERO ID: CRD42022300047)。对诊断准确性比例进行了比例荟萃分析。Egger’s和Begg-Mazumdar秩相关检验用于评估发表偏倚。采用推荐、评估、发展和评价分级(GRADE)标准评估偏倚风险。结果在检索到的272篇文献中，17篇纳入定性综合，对5项研究(包括448名患者)进行了meta分析。两项评估观察者间一致性的研究显示95%的一致性，五项评估方法的研究报告使用PCT治疗梗阻患者的手术成功率为66%-80%。从比例荟萃分析中，敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为0.85 (95% CI 0.71-0.95)、0.78 (95% CI 0.67-0.87)、0.74 (95% CI 0.52-0.91)和0.87 (95% CI 0.73-0.96)。发表偏倚出现在PPV上，但未出现在敏感性、特异性或NPV上。根据GRADE标准，有2项低、6项中等和9项高质量研究。结论PCT对BOO有较好的诊断和治疗效果。然而，由于阻塞标准评估的可变性，需要进行更多的比较诊断标准的研究。
{"title":"Use of the penile cuff test to diagnose bladder outlet obstruction: A systematic review and meta-analysis","authors":"Lakshay Khosla, Alia Codelia-Anjum, Christina Sze, Susana Martinez Diaz, Kevin C. Zorn, Naeem Bhojani, Dean Elterman, Bilal Chughtai","doi":"10.1111/luts.12454","DOIUrl":"10.1111/luts.12454","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Among noninvasive modalities for assessing bladder outlet obstruction (BOO), the penile cuff test (PCT) is the most used in clinical practice. The purpose of this review was to evaluate the performance of PCT in diagnosing and managing BOO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>PubMed, Scopus, CINAHL, Embase, Cochrane Library, and Web of Science were searched for studies investigating use of PCT for BOO. Studies evaluating diagnostic parameters, inter-observer agreements, or treatment outcomes using PCT were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed (PROSPERO ID: CRD42022300047). A proportional meta-analysis was done for diagnostic accuracy proportions. The Egger's and the Begg-Mazumdar rank-correlation tests were used to assess publication bias. Risk of bias was assessed using the Gradings of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 272 articles retrieved, 17 were included in qualitative synthesis and meta-analysis was performed on five studies (comprising 448 patients). Two studies evaluating inter-observer agreement demonstrated 95% agreement and five studies evaluating procedures reported a 66%-80% surgical success rate on obstructed patients using PCT. From the proportional meta-analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.85 (95% CI 0.71-0.95) 0.78 (95% CI 0.67-0.87), 0.74 (95% CI 0.52-0.91), and 0.87 (95% CI 0.73-0.96), respectively. Publication bias was noted for PPV but not for sensitivity, specificity, or NPV. Based on the GRADE criteria, there were two low, six moderate, and nine high-quality studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PCT performs sufficiently in diagnosing and managing BOO. However, due to variability in obstruction criteria assessment, more studies comparing diagnostic criteria are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39986764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nergis Kender Erturk, Fatma Nurgul Tasgoz, Muzaffer Temur
Objectives
We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls.
Methods
Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used.
Results
The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, P < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, P = .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, P < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores.
Conclusions
Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.
目的:比较压力性尿失禁(SUI)患者行经通气带(TOT)手术与大陆对照组患者的性功能影响。方法对70例女性患者进行术前6月和术后24月的泌尿功能和性功能评估。45例无尿失禁且人口统计学上与研究组相匹配的患者在第一次给药时和对照组24个月后进行了性功能评估。采用女性性功能指数(FSFI)。结果SUI患者的基线FSFI总评分(23.4±3.2 vs 27.0±4.3,P < 0.001)显著降低。研究组患者性功能评分在2年内有轻微升高(24.0±3.0,P = 0.167)，而对照组患者FSFI总分在2年内有明显下降(25.0±4.5,P < 0.001)。失禁手术的成功与较高的长期性功能评分相关。结论成功的TOT手术可改善SUI患者的性功能。与健康对照组相比，这种改善随着时间的推移而减少的较少。
{"title":"Effects of transobturator tape procedure on female sexual function at 2-year follow-up: A prospective cohort study with matched control group","authors":"Nergis Kender Erturk, Fatma Nurgul Tasgoz, Muzaffer Temur","doi":"10.1111/luts.12445","DOIUrl":"10.1111/luts.12445","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, <i>P</i> < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, <i>P =</i> .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, <i>P</i> < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72636445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS.
Methods
We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month.
Results
Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate-severe urinary symptoms (IPSS ≥ 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate <12 mL/s or postvoid residual volume >100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed-up patients (CM, n = 32; LCS, n = 47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry.
Conclusions
This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short-term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases.
目的颈椎病(CM)和腰椎管狭窄症(LCS)是老年人常见的退行性脊柱疾病，主要的相关症状包括下尿路症状(LUTS)。本研究的目的是探讨CM和LCS减压手术患者的主客观泌尿学参数。方法回顾性分析CM和LCS减压手术前接受国际前列腺症状评分(IPSS)和尿流测量评估的患者。排除了可能影响LUTS的合并症患者。术后1个月内随访观察患者术后变化。结果在LUTS泌尿科会诊的转诊患者中，231例患者术前接受了评估。92例CM患者中有59.8%出现中重度泌尿系统症状(IPSS≥8)，139例LCS患者中有64.0%出现中重度泌尿系统症状。26.1%的CM患者和25.2%的LCS患者存在排尿不良模式，定义为最大尿流量≤12 mL/s或排尿后残余容量≤100 mL。虽然IPSS与疾病严重程度无关，但较差的患者表现出较差的日本骨科协会评分。此外，由于LCS，贫穷的提供者遭受矫形症状的时间更长。随访患者(CM, n = 32;LCS (n = 47)、总IPSS、储存亚评分和排尿亚评分在手术后显著改善，尿流测量的排尿时间也显著改善。结论CM和LCS患者下尿路功能障碍发生率高，减压手术短期有效。这些结果将鼓励泌尿科医生考虑在退行性脊柱疾病患者中发现下尿路功能障碍时进行骨科会诊。
{"title":"Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short-term outcomes of decompression surgery","authors":"Shingo Kimura, Shunichi Takyu, Naoki Kawamorita, Takashige Namima, Naoki Morozumi, Akihiro Ito","doi":"10.1111/luts.12444","DOIUrl":"10.1111/luts.12444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate-severe urinary symptoms (IPSS ≥ 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate <12 mL/s or postvoid residual volume >100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed-up patients (CM, n = 32; LCS, n = 47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short-term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73730299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Efstathios Papaefstathiou, Maria Papaioannou, Eirini Papaefstathiou, Aikaterini Apostolopoulou, Apostolos Apostolidis
Objective
Urinary bladder ischemia has been implicated in the pathogenesis of lower urinary tract symptoms (LUTS). However, research regarding urinary molecular markers for diagnosis and prognosis of pelvic ischemia is still premature, hindering further implementation in clinical practice. The aim of this study is to systematically appraise biomarkers associated with bladder ischemia detected in urine.
Methods
We performed a systematic review of PubMed/Medline, Embase, Web of Science, and the Cochrane Library in October 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A subsequent reference search of retrieved articles was also performed. The identified reports were reviewed according to Systematic Review Center for Laboratory Animal Experimentation's risk-of-bias tool for animal studies.
Results
Eight publications were selected for this analysis. The included reports used 8-hydroxy-2′-deoxyguanosine (8-OHdG) (in eight studies) as urinary marker of bladder ischemia. The pooled mean difference for urinary 8-OHdG levels between study and control groups was 13.73 ng/mg creatinine (95% CI, 9.79-17.67; P < .001; I2 = 69%) for rat studies and 3.71 ng/mg creatinine (95% CI, 2.91-4.51; P < .001; I2 = 94%) for rabbit studies. The result remained statistically significant favoring the control group independent of the type of intervention used to achieve bladder ischemia. Regarding secondary outcomes, mean voided volume and micturition interval were significantly lower in the ischemia group.
Conclusion
The lack of human randomized controlled trials is a major limitation. 8-OHdG is a urinary biomarker to be investigated in future studies for diagnosis and prognosis of LUTS in patients with vascular injury or bladder outlet obstruction.
{"title":"Do we have enough evidence to propose a urinary biomarker of bladder ischemia? A systematic review and meta-analysis","authors":"Efstathios Papaefstathiou, Maria Papaioannou, Eirini Papaefstathiou, Aikaterini Apostolopoulou, Apostolos Apostolidis","doi":"10.1111/luts.12443","DOIUrl":"10.1111/luts.12443","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Urinary bladder ischemia has been implicated in the pathogenesis of lower urinary tract symptoms (LUTS). However, research regarding urinary molecular markers for diagnosis and prognosis of pelvic ischemia is still premature, hindering further implementation in clinical practice. The aim of this study is to systematically appraise biomarkers associated with bladder ischemia detected in urine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic review of PubMed/Medline, Embase, Web of Science, and the Cochrane Library in October 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A subsequent reference search of retrieved articles was also performed. The identified reports were reviewed according to Systematic Review Center for Laboratory Animal Experimentation's risk-of-bias tool for animal studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight publications were selected for this analysis. The included reports used 8-hydroxy-2′-deoxyguanosine (8-OHdG) (in eight studies) as urinary marker of bladder ischemia. The pooled mean difference for urinary 8-OHdG levels between study and control groups was 13.73 ng/mg creatinine (95% CI, 9.79-17.67; <i>P</i> < .001; <i>I</i><sup>2</sup> = 69%) for rat studies and 3.71 ng/mg creatinine (95% CI, 2.91-4.51; <i>P</i> < .001; <i>I</i><sup>2</sup> = 94%) for rabbit studies. The result remained statistically significant favoring the control group independent of the type of intervention used to achieve bladder ischemia. Regarding secondary outcomes, mean voided volume and micturition interval were significantly lower in the ischemia group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The lack of human randomized controlled trials is a major limitation. 8-OHdG is a urinary biomarker to be investigated in future studies for diagnosis and prognosis of LUTS in patients with vascular injury or bladder outlet obstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82473381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. A. Abelleyra Lastoria, N. Raison, A. Aydın, Shamim Khan, P. Dasgupta, K. Ahmed
The purpose of this review was to summarize and compare the efficacy among surgical interventions in terms of symptomatic relief in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The review protocol was published on PROSPERO. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 checklist was followed. Following database search, a narrative synthesis was performed. Data pertaining symptom scores, pain levels, and voiding frequency following surgery were summarized by calculating percentage change in these parameters. Multiple surgical treatments were identified. These included injections of hyaluronic acid (HA), botulinum toxin A (Botox A), triamcinolone, resiniferatoxin (RTX), platelet‐rich plasma, and 50% dimethyl sulfoxide (DMSO) solution, neuromodulation, hydrodistension (HD), resection/fulguration of Hunner lesions, resection of ilioinguinal and iliohypogastric nerves, reconstructive surgery, and cystectomy. This review found no evidence suggesting that HD and RTX injections can ameliorate IC/BPS symptoms. Current evidence suggests that sacral neuromodulation, cystectomy, and transurethral resection/fulguration of Hunner lesions could lead to symptomatic relief in IC/BPS. Further research into the efficacy of Botox A, triamcinolone, 50% DMSO solution, and HA instillations is required. However, the best treatment options cannot be reliably stated due to the low level of evidence of the studies identified. Further research should report outcomes for Hunner‐type IC and BPS separately given their differing histopathological characteristics. Performing high‐quality randomized controlled trials could be hindered by the low prevalence of the condition and a small proportion of patients progressing to surgery.
{"title":"Comparing surgical interventions for interstitial cystitis: A systematic review","authors":"D. A. Abelleyra Lastoria, N. Raison, A. Aydın, Shamim Khan, P. Dasgupta, K. Ahmed","doi":"10.1111/luts.12441","DOIUrl":"https://doi.org/10.1111/luts.12441","url":null,"abstract":"The purpose of this review was to summarize and compare the efficacy among surgical interventions in terms of symptomatic relief in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The review protocol was published on PROSPERO. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 checklist was followed. Following database search, a narrative synthesis was performed. Data pertaining symptom scores, pain levels, and voiding frequency following surgery were summarized by calculating percentage change in these parameters. Multiple surgical treatments were identified. These included injections of hyaluronic acid (HA), botulinum toxin A (Botox A), triamcinolone, resiniferatoxin (RTX), platelet‐rich plasma, and 50% dimethyl sulfoxide (DMSO) solution, neuromodulation, hydrodistension (HD), resection/fulguration of Hunner lesions, resection of ilioinguinal and iliohypogastric nerves, reconstructive surgery, and cystectomy. This review found no evidence suggesting that HD and RTX injections can ameliorate IC/BPS symptoms. Current evidence suggests that sacral neuromodulation, cystectomy, and transurethral resection/fulguration of Hunner lesions could lead to symptomatic relief in IC/BPS. Further research into the efficacy of Botox A, triamcinolone, 50% DMSO solution, and HA instillations is required. However, the best treatment options cannot be reliably stated due to the low level of evidence of the studies identified. Further research should report outcomes for Hunner‐type IC and BPS separately given their differing histopathological characteristics. Performing high‐quality randomized controlled trials could be hindered by the low prevalence of the condition and a small proportion of patients progressing to surgery.","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81103841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammet İrfan Dönmez, Mehmet Serkan Özkent, Mustafa Bilal Hamarat, Mehmet Kocalar
Objective
To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS).
Methods
Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters.
Results
A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P = .0001).
Conclusion
Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.
目的评价无下尿路症状(LUTS)的健康男性，通过拉链排尿或尿裤排尿对尿流仪参数和排尿后残尿量的影响。方法对18岁以上无LUTS的健康男性采用尿流法进行前瞻性评价。每个人都被要求在不同的时间脱下拉链(第一组)和裤子(第二组)。如果尿量不超过150ml，则重复尿流测定。记录尿流测量结果，如排尿量、最大流量(Qmax)、平均流量(Qave)、排尿时间等。超声检查PVR体积。未使用肌电图。数据以平均值±标准差表示。统计分析采用配对t检验分析参数参数。结果共入组44例男性。患者年龄中位数为24岁(18-44岁)。两种方法在排尿量(307±121 mL vs 325±145 mL, P = .365)和排尿时间(25±11 s vs 23.8±11.6 s, P = .526)方面差异无统计学意义。Qmax(26.6±6.7 mL/s vs 30.0±8.2 mL/s, P = 0.001)、Qave(14.4±3.6 mL/s vs 16.2±5.1 mL/s, P = 0.009)、PVR容积(23.9±19.4 mL vs 3.9±9.6 mL, P = 0.0001)差异有统计学意义。结论在无LUTS的人群中，尿裤排尿比拉链排尿流速高，PVR低。未来的研究需要更多的个体(包括LUTS患者)和更广泛的年龄范围队列来得出可靠的结论。
{"title":"Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?","authors":"Muhammet İrfan Dönmez, Mehmet Serkan Özkent, Mustafa Bilal Hamarat, Mehmet Kocalar","doi":"10.1111/luts.12442","DOIUrl":"10.1111/luts.12442","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired <i>t</i> test was used to analyze parametric parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, <i>P</i> = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, <i>P</i> = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, <i>P</i> = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, <i>P</i> = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, <i>P</i> = .0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80192434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy.
Outcome
We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon's open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction.
Conclusion
Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.
{"title":"Rare cases of vesicouterine fistula","authors":"Maulidina Medika Rahmita, Arry Rodjani, Irfan Wahyudi, Fina Widia","doi":"10.1111/luts.12440","DOIUrl":"10.1111/luts.12440","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome</h3>\u0000 \u0000 <p>We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon's open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81473002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabete de Souza Pereira, Ana Paula de Lima Ferreira, Milene de Oliveira Almeida, Cinthia Silva Barbosa, Gleyce de Melo Falcão Monteiro, Leila Barbosa, Andrea Lemos
Objective
To determine the prevalence and factors associated with urinary incontinence (UI) in female crossfitters.
Methods
This is a cross-sectional study. Data were collected using assessment forms: Knowledge, Attitude and Practice survey for young female athletes; Incontinence Severity Index; and International Consultation on Incontinence Questionnaire for UI. Descriptive analysis was conducted to obtain absolute and relative frequencies, means and 95% confidence intervals (95% CI). Multivariate analysis was carried out to determine the association between UI and sociodemographic, gynecological-obstetric, and anthropometric variables, associated morbidities, previous history and physical activity.
Results
Prevalence of UI, in the 189 included volunteers, was 38.6% and the most frequent type was stress UI (69.9%). A total of 72.6% of incontinent women reported urine loss during CrossFit training. Knowledge (53.4%) and attitude (86.2%) regarding UI were generally adequate, while prevention, management and treatment were inadequate (96.3%). The predominant characteristics of UI were frequency of once a week or less (74.0%), in small amounts (86.3%), mild intensity (57.5%) and slight impact on quality of life (64.3%). In multivariate analysis, no variable was significantly associated with UI.
Conclusions
The prevalence of UI in female crossfitters was 38.6%. The factors investigated did not contribute to the development of UI.
{"title":"Prevalence and factors associated with urinary incontinence in female crossfitters: A cross-sectional study","authors":"Elizabete de Souza Pereira, Ana Paula de Lima Ferreira, Milene de Oliveira Almeida, Cinthia Silva Barbosa, Gleyce de Melo Falcão Monteiro, Leila Barbosa, Andrea Lemos","doi":"10.1111/luts.12437","DOIUrl":"10.1111/luts.12437","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence and factors associated with urinary incontinence (UI) in female crossfitters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a cross-sectional study. Data were collected using assessment forms: Knowledge, Attitude and Practice survey for young female athletes; Incontinence Severity Index; and International Consultation on Incontinence Questionnaire for UI. Descriptive analysis was conducted to obtain absolute and relative frequencies, means and 95% confidence intervals (95% CI). Multivariate analysis was carried out to determine the association between UI and sociodemographic, gynecological-obstetric, and anthropometric variables, associated morbidities, previous history and physical activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Prevalence of UI, in the 189 included volunteers, was 38.6% and the most frequent type was stress UI (69.9%). A total of 72.6% of incontinent women reported urine loss during CrossFit training. Knowledge (53.4%) and attitude (86.2%) regarding UI were generally adequate, while prevention, management and treatment were inadequate (96.3%). The predominant characteristics of UI were frequency of once a week or less (74.0%), in small amounts (86.3%), mild intensity (57.5%) and slight impact on quality of life (64.3%). In multivariate analysis, no variable was significantly associated with UI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prevalence of UI in female crossfitters was 38.6%. The factors investigated did not contribute to the development of UI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40314227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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