Pub Date : 2023-02-01DOI: 10.1080/21681805.2023.2172075
Mikkel Rodin Deutch, Thomas Karmark Dreyer, Tau Pelant, Jørgen Bjerggaard Jensen
Objective: Partial nephrectomy is the gold standard treatment in small renal tumours. During partial nephrectomy, the renal artery is clamped which creates transient ischemia. This can damage nephrons and may affect kidney function immediately postoperatively and on long-term.In the present study, we investigated the effect of ischemia time during partial nephrectomy with regards to affection of renal function immediately post-operatively and 1-year post-surgery.
Materials and method: A retrospective cohort study including 124 patients who underwent partial nephrectomy at a single regional hospital in the period from 2018 to 2020 was conducted.
Results: We divided patients into subgroups based on the ischemia time: [0-8], [9-13] and [14-29] minutes. The mean value for kidney function was an eGFR (mL/min) of 73.9 before and 66.8 at a 12-month post-surgery. We found no significant correlation between ischemia time and renal function. Noticeably, none of the patients had ischemia time greater than 30 min.
Conclusion: In this cohort, the duration of ischemia time was not associated with differences in renal affection neither on short term nor long term parameters if the ischemia time was kept below 30 min.
{"title":"Impact of ischemia time during partial nephrectomy on short- and long-term renal function.","authors":"Mikkel Rodin Deutch, Thomas Karmark Dreyer, Tau Pelant, Jørgen Bjerggaard Jensen","doi":"10.1080/21681805.2023.2172075","DOIUrl":"https://doi.org/10.1080/21681805.2023.2172075","url":null,"abstract":"<p><strong>Objective: </strong>Partial nephrectomy is the gold standard treatment in small renal tumours. During partial nephrectomy, the renal artery is clamped which creates transient ischemia. This can damage nephrons and may affect kidney function immediately postoperatively and on long-term.In the present study, we investigated the effect of ischemia time during partial nephrectomy with regards to affection of renal function immediately post-operatively and 1-year post-surgery.</p><p><strong>Materials and method: </strong>A retrospective cohort study including 124 patients who underwent partial nephrectomy at a single regional hospital in the period from 2018 to 2020 was conducted.</p><p><strong>Results: </strong>We divided patients into subgroups based on the ischemia time: [0-8], [9-13] and [14-29] minutes. The mean value for kidney function was an eGFR (mL/min) of 73.9 before and 66.8 at a 12-month post-surgery. We found no significant correlation between ischemia time and renal function. Noticeably, none of the patients had ischemia time greater than 30 min.</p><p><strong>Conclusion: </strong>In this cohort, the duration of ischemia time was not associated with differences in renal affection neither on short term nor long term parameters if the ischemia time was kept below 30 min.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10778120","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}
Objective: Sacral neuromodulation (SNM) is a well-established treatment modality for idiopathic overactive bladder and urgency incontinence, idiopathic fecal incontinence and non-obstructive urinary retention. This study describes the start-up phase of establishing the SNM service. Primary objective: To investigate the patient-reported outcome measures of SNM on lower urinary tract dysfunction symptoms. Secondary objectives: To investigate bowel function, sexual satisfaction and to monitor SNM safety.
Materials and methods: Twenty-two patients with refractory idiopathic and neurogenic lower urinary tract dysfunction were offered a two-stage test-phase procedure and SNM device implantation. On completing the study, the patients rated their satisfaction with the treatment using a five-point Likert scale and a bother score of urinary, bowel and sexual symptoms on a scale of 1-10 (the worst). Their complications were assessed.
Results: Nineteen patients (86%) were responders during the test phase and had the pulse generator implanted. Seventeen patients were very satisfied/satisfied. A statistically significant change in urinary symptoms bother score was observed in the idiopathic and neurogenic patients, a reduction from 10 to 4 (p = .0057) and 10 to 3 (p = .014), respectively. Eleven patients (58%) had symptoms from two or three pelvic compartments. Nine patients (47%) had complications. All but one event was resolved.
Conclusions: SNM is safe in this heterogeneous group of patients with refractory lower urinary tract dysfunction of various etiologies. A substantial improvement was observed in the pelvic organ dysfunction, demanding a multidisciplinary approach. More studies are required to standardize the evaluation of the subjective and objective outcomes of SNM.
{"title":"Implementation of sacral neuromodulation for urinary indications. A Danish prospective study during the initial 15 months of a new service in a tertiary referral hospital.","authors":"Hanne Kobberø, Margrethe Andersen, Karin Andersen, Torben Brøchner Pedersen, Mads Hvid Poulsen","doi":"10.1080/21681805.2022.2120066","DOIUrl":"https://doi.org/10.1080/21681805.2022.2120066","url":null,"abstract":"<p><strong>Objective: </strong>Sacral neuromodulation (SNM) is a well-established treatment modality for idiopathic overactive bladder and urgency incontinence, idiopathic fecal incontinence and non-obstructive urinary retention. This study describes the start-up phase of establishing the SNM service. <i>Primary objective:</i> To investigate the patient-reported outcome measures of SNM on lower urinary tract dysfunction symptoms. <i>Secondary objectives</i>: To investigate bowel function, sexual satisfaction and to monitor SNM safety.</p><p><strong>Materials and methods: </strong>Twenty-two patients with refractory idiopathic and neurogenic lower urinary tract dysfunction were offered a two-stage test-phase procedure and SNM device implantation. On completing the study, the patients rated their satisfaction with the treatment using a five-point Likert scale and a bother score of urinary, bowel and sexual symptoms on a scale of 1-10 (the worst). Their complications were assessed.</p><p><strong>Results: </strong>Nineteen patients (86%) were responders during the test phase and had the pulse generator implanted. Seventeen patients were very satisfied/satisfied. A statistically significant change in urinary symptoms bother score was observed in the idiopathic and neurogenic patients, a reduction from 10 to 4 (<i>p</i> = .0057) and 10 to 3 (<i>p</i> = .014), respectively. Eleven patients (58%) had symptoms from two or three pelvic compartments. Nine patients (47%) had complications. All but one event was resolved.</p><p><strong>Conclusions: </strong>SNM is safe in this heterogeneous group of patients with refractory lower urinary tract dysfunction of various etiologies. A substantial improvement was observed in the pelvic organ dysfunction, demanding a multidisciplinary approach. More studies are required to standardize the evaluation of the subjective and objective outcomes of SNM.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10436866","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2119276
Lars Lund
{"title":"A new important tool to report and analyse adverse incidents that all urologists should use Editorial comment to: Nisen H, Erkkilä K, Ettala O, Ronkainen H, et al. Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification. Scand J Urol. 2022 Jun 22:1-8.","authors":"Lars Lund","doi":"10.1080/21681805.2022.2119276","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119276","url":null,"abstract":"","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10473491","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2119275
Börje Ljungberg
Biopsies of kidney tumors have been utilized for decades but have not reached a widespread use despite high specificity and sensitivity. In contrast, biopsies are generally used in patients with other urological malignancies as prostate, bladder, and upper tract cancers. The reason for the rare use of biopsies for kidney masses might be historical. Previously, renal tumors were large at the time of diagnosis and the only treatment option was surgery since systemic treatment was ineffective. After the introduction of targeted treatments and especially immunotherapies, prolonged survival and complete responses have been observed [1]. In addition, immunotherapy of sarcomatoid dedifferentiated renal cell carcinoma (RCC) has shown promising effects in these tumors that have a dismal prognosis [2]. It has been claimed that renal tumor biopsy is not necessary in patients with a contrast-enhancing renal mass for whom surgery is planned. However, even large contrastenhancing renal masses can occasionally be benign. The proportion of renal masses with benign histology is inverse to tumor size, and at a tumor diameter of 2 cm the proportion between benign and malignant histology is roughly even. It was shown in a large multicenter study that benign histology in the nephrectomy specimens was significantly less common in centers where biopsies were performed compared with hospitals where regular biopsies were not performed (5% vs. 16%) [3]. This study showed that tumor biopsies reduced surgery for patients with benign histology with a decreased risk for short-term and long-term morbidity associated with surgery. Biopsies can also be useful in patients on surveillance, before ablative, i.e. minimally invasive therapy and during follow-up for patients on these treatment strategies. It is currently recommended that biopsies are obtained before any ablative treatment in order to reduce unnecessary treatment of benign tumors [4]. It might also be important to diagnose malignant histology, e.g. RCC, since prolonged waiting time for surgical can reduce overall survival [5]. Histological characterization by percutaneous biopsies of undefined retroperitoneal masses diagnosed by imaging seems to be especially valuable for decision-making in younger patients [6]. For more advanced or larger kidney tumors, the value of biopsies has been less evaluated. In this issue of Scandinavian Journal of Urology, Nazzani et al., present their results on renal tumor biopsy in patients with cT1b-T4-M0 RCC [7]. The authors conclude that renal tumor biopsy is a safe procedure that confirms the indication of nephrectomy in most tumors larger than 4 cm. However, around 15% of the patients exhibited non-RCC histology while in only 3% of the patients the biopsies were non-diagnostic. This preoperative histological information, combined with clinical information on patient characteristics, is useful since it can lead to alternative treatment decisions other than radical nephrectomy, includin
{"title":"Kidney tumor biopsy - an unmet need for personalized treatment.","authors":"Börje Ljungberg","doi":"10.1080/21681805.2022.2119275","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119275","url":null,"abstract":"Biopsies of kidney tumors have been utilized for decades but have not reached a widespread use despite high specificity and sensitivity. In contrast, biopsies are generally used in patients with other urological malignancies as prostate, bladder, and upper tract cancers. The reason for the rare use of biopsies for kidney masses might be historical. Previously, renal tumors were large at the time of diagnosis and the only treatment option was surgery since systemic treatment was ineffective. After the introduction of targeted treatments and especially immunotherapies, prolonged survival and complete responses have been observed [1]. In addition, immunotherapy of sarcomatoid dedifferentiated renal cell carcinoma (RCC) has shown promising effects in these tumors that have a dismal prognosis [2]. It has been claimed that renal tumor biopsy is not necessary in patients with a contrast-enhancing renal mass for whom surgery is planned. However, even large contrastenhancing renal masses can occasionally be benign. The proportion of renal masses with benign histology is inverse to tumor size, and at a tumor diameter of 2 cm the proportion between benign and malignant histology is roughly even. It was shown in a large multicenter study that benign histology in the nephrectomy specimens was significantly less common in centers where biopsies were performed compared with hospitals where regular biopsies were not performed (5% vs. 16%) [3]. This study showed that tumor biopsies reduced surgery for patients with benign histology with a decreased risk for short-term and long-term morbidity associated with surgery. Biopsies can also be useful in patients on surveillance, before ablative, i.e. minimally invasive therapy and during follow-up for patients on these treatment strategies. It is currently recommended that biopsies are obtained before any ablative treatment in order to reduce unnecessary treatment of benign tumors [4]. It might also be important to diagnose malignant histology, e.g. RCC, since prolonged waiting time for surgical can reduce overall survival [5]. Histological characterization by percutaneous biopsies of undefined retroperitoneal masses diagnosed by imaging seems to be especially valuable for decision-making in younger patients [6]. For more advanced or larger kidney tumors, the value of biopsies has been less evaluated. In this issue of Scandinavian Journal of Urology, Nazzani et al., present their results on renal tumor biopsy in patients with cT1b-T4-M0 RCC [7]. The authors conclude that renal tumor biopsy is a safe procedure that confirms the indication of nephrectomy in most tumors larger than 4 cm. However, around 15% of the patients exhibited non-RCC histology while in only 3% of the patients the biopsies were non-diagnostic. This preoperative histological information, combined with clinical information on patient characteristics, is useful since it can lead to alternative treatment decisions other than radical nephrectomy, includin","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839178","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2094463
Magnus Fall
Electrical stimulation is an underestimated asset in the treatment of urinary dysfunctions—unfortunately still unfamiliar to many urologists and with comparatively few people involved in this research area, being overshadowed by successful activities in other fields of urology. That been said, a plethora of interesting and important contributions have been published on a variety of technologies [1], but electrical stimulation in comparison with treatments like drugs and surgery is sparse in urology. The use of electro-medicine has been more prominent in other medical fields (for example, cardiology) and many highly rewarding experiences have been gained. A different recent example is research under way at the Karolinska Institute in Stockholm, in detail describing mechanisms for remission of gut inflammation resulting from n. vagus electrical stimulation, illustrating communications between nerves and the immune system [2]. In this context it may be relevant to mention some observations from our unit on effects on the lower urinary tract (LUT) of electrical stimulation made almost 40 years ago: In women with various forms of urinary incontinence treated by means of individually adjusted vaginal electrodes there was an effect on symptoms to various degrees in 90% of subjects and, even more remarkably, 45% of subjects were free of symptoms even when stimulation was interrupted, a phenomenon called reeducation [3]. In a case report on a quite different mode of electrical stimulation, implantation of electrodes into the conus medullaris because of the unusual state of persistent spinal shock, followed by subsequent chronic stimulation, another remarkable effect was observed; after several years of daily use of the stimulator the bladder state reverted into a reflex bladder, with no further need to use the electrical stimulator [4]. In quite a different population a limited part of patients treated with suprapubic transcutaneous electrical nerve stimulation owing to chronic interstitial cystitis became free of symptoms combined with loss of the distinctive clinical marks of the disease. Cases in question had suffered the typical features of bladder wall chronic inflammation, with decades of disease duration [5]. The described effects were unexpected and are still unexplored in detail. However, they indicate a unique potential of electrical stimulation to restore functions of LUT central neural pathways, among other things involving long term potentiation of synapses, and also inhibition of inflammatory responses following electrical stimulation. There is an underused potential for these techniques in urology. Unfortunately, just a few urology applications of electrostimulation have matured into general use progress requiring continuous technical and commercial efforts and support. The technique of sacral root neuromodulation pioneered by Tanagho and Schmidt [6] is one exception, has multiple users, and is constantly improving; now working quite well i
{"title":"Editorial comment to \"Implementation of sacral neuromodulation for urinary indication. A Danish prospective cohort study from the first 15 months\" by Kobberø H, Andersen M, Andersen K, et al.","authors":"Magnus Fall","doi":"10.1080/21681805.2022.2094463","DOIUrl":"https://doi.org/10.1080/21681805.2022.2094463","url":null,"abstract":"Electrical stimulation is an underestimated asset in the treatment of urinary dysfunctions—unfortunately still unfamiliar to many urologists and with comparatively few people involved in this research area, being overshadowed by successful activities in other fields of urology. That been said, a plethora of interesting and important contributions have been published on a variety of technologies [1], but electrical stimulation in comparison with treatments like drugs and surgery is sparse in urology. The use of electro-medicine has been more prominent in other medical fields (for example, cardiology) and many highly rewarding experiences have been gained. A different recent example is research under way at the Karolinska Institute in Stockholm, in detail describing mechanisms for remission of gut inflammation resulting from n. vagus electrical stimulation, illustrating communications between nerves and the immune system [2]. In this context it may be relevant to mention some observations from our unit on effects on the lower urinary tract (LUT) of electrical stimulation made almost 40 years ago: In women with various forms of urinary incontinence treated by means of individually adjusted vaginal electrodes there was an effect on symptoms to various degrees in 90% of subjects and, even more remarkably, 45% of subjects were free of symptoms even when stimulation was interrupted, a phenomenon called reeducation [3]. In a case report on a quite different mode of electrical stimulation, implantation of electrodes into the conus medullaris because of the unusual state of persistent spinal shock, followed by subsequent chronic stimulation, another remarkable effect was observed; after several years of daily use of the stimulator the bladder state reverted into a reflex bladder, with no further need to use the electrical stimulator [4]. In quite a different population a limited part of patients treated with suprapubic transcutaneous electrical nerve stimulation owing to chronic interstitial cystitis became free of symptoms combined with loss of the distinctive clinical marks of the disease. Cases in question had suffered the typical features of bladder wall chronic inflammation, with decades of disease duration [5]. The described effects were unexpected and are still unexplored in detail. However, they indicate a unique potential of electrical stimulation to restore functions of LUT central neural pathways, among other things involving long term potentiation of synapses, and also inhibition of inflammatory responses following electrical stimulation. There is an underused potential for these techniques in urology. Unfortunately, just a few urology applications of electrostimulation have matured into general use progress requiring continuous technical and commercial efforts and support. The technique of sacral root neuromodulation pioneered by Tanagho and Schmidt [6] is one exception, has multiple users, and is constantly improving; now working quite well i","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10528638","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2092549
Sebastiano Nazzani, Carlotta Zaborra, Davide Biasoni, Mario Catanzaro, Alberto Macchi, Silvia Stagni, Antonio Tesone, Tullio Torelli, Rodolfo Lanocita, Tommaso Cascella, Carlo Morosi, Carlo Spreafico, Maurizio Colecchia, Alfonso Marchianò, Emanuele Montanari, Roberto Salvioni, Nicola Nicolai
Purpose: Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass ≥4 cm, to evaluate treatment deviation.
Methods: Between 2008 and 2017, 102 patients with a solid renal mass ≥4 cm with no distant metastases underwent preliminary renal tumor biopsy. We investigated the proportion of patients who proceeded with radical nephrectomy, variables predicting non-renal cell carcinoma (RCC) and concordance between biopsy findings and definitive pathology.
Results: Median tumor size was 70 mm (IQR 55-110). Clinical stage was cT1b in 41, cT2 in 33, cT3 in 25 and cT4 in three patients. A median of three (IQR 2-3) renal tumor biopsies were taken with 16/18 Gauge needles in 97% of cases. Clavien grade I complications occurred in five cases. Malignant tumors were documented in 84 patients: 78 RCCs and six non-RCCs. Fifteen biopsies documented oncocytoma and three were non-diagnostic. Grade was reported in 50 RCCs: 42 (84%) were low and eight (16%) high grade. Eighty-three patients proceeded with radical nephrectomy; six non-RCC malignant tumors underwent combined and/or intensified treatment; 13 of 15 patients with oncocytoma did not undergo radical nephrectomy (eight underwent observation). Definitive pathology confirmed diagnosis in all cases. Grade concordance was 84%, considering two tiers (high vs low grade). No preoperative clinical variable predicted definitive pathology.
Conclusions: Renal tumor biopsy is a safe procedure that leads to radical nephrectomy in most tumors ≥4 cm. Nonetheless, 20% of patients exhibited non-RCC histology. Renal tumor biopsy should be considered in this setting.
{"title":"Renal tumor biopsy in patients with cT1b-T4-M0 disease susceptible to radical nephrectomy: analysis of safety, accuracy and clinical impact on definitive management.","authors":"Sebastiano Nazzani, Carlotta Zaborra, Davide Biasoni, Mario Catanzaro, Alberto Macchi, Silvia Stagni, Antonio Tesone, Tullio Torelli, Rodolfo Lanocita, Tommaso Cascella, Carlo Morosi, Carlo Spreafico, Maurizio Colecchia, Alfonso Marchianò, Emanuele Montanari, Roberto Salvioni, Nicola Nicolai","doi":"10.1080/21681805.2022.2092549","DOIUrl":"https://doi.org/10.1080/21681805.2022.2092549","url":null,"abstract":"<p><strong>Purpose: </strong>Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass ≥4 cm, to evaluate treatment deviation.</p><p><strong>Methods: </strong>Between 2008 and 2017, 102 patients with a solid renal mass ≥4 cm with no distant metastases underwent preliminary renal tumor biopsy. We investigated the proportion of patients who proceeded with radical nephrectomy, variables predicting non-renal cell carcinoma (RCC) and concordance between biopsy findings and definitive pathology.</p><p><strong>Results: </strong>Median tumor size was 70 mm (IQR 55-110). Clinical stage was cT1b in 41, cT2 in 33, cT3 in 25 and cT4 in three patients. A median of three (IQR 2-3) renal tumor biopsies were taken with 16/18 Gauge needles in 97% of cases. Clavien grade I complications occurred in five cases. Malignant tumors were documented in 84 patients: 78 RCCs and six non-RCCs. Fifteen biopsies documented oncocytoma and three were non-diagnostic. Grade was reported in 50 RCCs: 42 (84%) were low and eight (16%) high grade. Eighty-three patients proceeded with radical nephrectomy; six non-RCC malignant tumors underwent combined and/or intensified treatment; 13 of 15 patients with oncocytoma did not undergo radical nephrectomy (eight underwent observation). Definitive pathology confirmed diagnosis in all cases. Grade concordance was 84%, considering two tiers (high vs low grade). No preoperative clinical variable predicted definitive pathology.</p><p><strong>Conclusions: </strong>Renal tumor biopsy is a safe procedure that leads to radical nephrectomy in most tumors ≥4 cm. Nonetheless, 20% of patients exhibited non-RCC histology. Renal tumor biopsy should be considered in this setting.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10446721","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2124305
Oskar Bergengren, Marcus Westerberg
Ever heard of sticky diagnosis bias, when death from other causes is erroneously attributed to the target diagnosis, thus incorrectly increasing cause specific mortality estimates? The article by Innos et al. featured in the current issue of the Scandinavian Journal of Urology highlights this important topic [1]. In this article, the authors evaluated the validity in the official mortality statistics in Estonia for prostate cancer as the underlying cause of death. An expert panel performed a blinded review of medical records to assess if prostate cancer stated as the underlying cause of death in the death certificate was accurate. The authors found a substantial 1.5-fold overestimation of prostate cancer mortality in Estonia. The overestimation was more than two-fold in men age 85 years but was also present and ranged from 1.3 to 1.4 in other age groups. Medical review verified less than half of prostate cancer deaths in men who had localized prostate cancer at diagnosis, while the verification rate was close to 90% in men who had distant metastases. Only a modest underreporting of prostate cancer deaths was observed among men previously recorded to have died of other causes. In other words, the authors found a strong sticky diagnosis bias. The current study is in accordance with several previous studies that have assessed the validity of prostate cancer as the underlying cause of death in official mortality statistics in Nordic countries. Danish [2] and Norwegian [3] studies reported that the cause of death was misclassified in cause of death registers, resulting in an overestimation of the proportion of deaths from prostate cancer. For example, in the Norwegian study over-reporting of prostate cancer deaths was as high as 33% and misattribution of prostate cancer death increased significantly with increasing age and decreasing Gleason score. However, it is important to point out that the absence of evidence is not evidence of absence [4] and it is close to impossible to prove that someone did not die from a particular cause. Therefore, it is challenging to evaluate the accuracy of reported prostate cancer death among men without any recorded signs of death by prostate cancer, in particular among older men with multiple comorbidities [3]. Older men with localized prostate cancer without signs of progression are often followed in primary care, with little use of PSA testing or imaging, resulting in absence of evidence. This may result in misclassification of death in a review of medical records, both among men for whom death was originally attributed to prostate cancer and to other causes. Without evidence of a specific cause of death, we argue that an otherwise seemingly healthy man with a prior prostate cancer diagnosis is more likely to have his prostate cancer assigned as the cause of death, again due to a sticky diagnosis bias. His assigned cause of death to prostate cancer will be challenging to validate retrospectively but may be wrong. Ad
{"title":"Watch out for sticky diagnosis bias in older men with prostate cancer.","authors":"Oskar Bergengren, Marcus Westerberg","doi":"10.1080/21681805.2022.2124305","DOIUrl":"https://doi.org/10.1080/21681805.2022.2124305","url":null,"abstract":"Ever heard of sticky diagnosis bias, when death from other causes is erroneously attributed to the target diagnosis, thus incorrectly increasing cause specific mortality estimates? The article by Innos et al. featured in the current issue of the Scandinavian Journal of Urology highlights this important topic [1]. In this article, the authors evaluated the validity in the official mortality statistics in Estonia for prostate cancer as the underlying cause of death. An expert panel performed a blinded review of medical records to assess if prostate cancer stated as the underlying cause of death in the death certificate was accurate. The authors found a substantial 1.5-fold overestimation of prostate cancer mortality in Estonia. The overestimation was more than two-fold in men age 85 years but was also present and ranged from 1.3 to 1.4 in other age groups. Medical review verified less than half of prostate cancer deaths in men who had localized prostate cancer at diagnosis, while the verification rate was close to 90% in men who had distant metastases. Only a modest underreporting of prostate cancer deaths was observed among men previously recorded to have died of other causes. In other words, the authors found a strong sticky diagnosis bias. The current study is in accordance with several previous studies that have assessed the validity of prostate cancer as the underlying cause of death in official mortality statistics in Nordic countries. Danish [2] and Norwegian [3] studies reported that the cause of death was misclassified in cause of death registers, resulting in an overestimation of the proportion of deaths from prostate cancer. For example, in the Norwegian study over-reporting of prostate cancer deaths was as high as 33% and misattribution of prostate cancer death increased significantly with increasing age and decreasing Gleason score. However, it is important to point out that the absence of evidence is not evidence of absence [4] and it is close to impossible to prove that someone did not die from a particular cause. Therefore, it is challenging to evaluate the accuracy of reported prostate cancer death among men without any recorded signs of death by prostate cancer, in particular among older men with multiple comorbidities [3]. Older men with localized prostate cancer without signs of progression are often followed in primary care, with little use of PSA testing or imaging, resulting in absence of evidence. This may result in misclassification of death in a review of medical records, both among men for whom death was originally attributed to prostate cancer and to other causes. Without evidence of a specific cause of death, we argue that an otherwise seemingly healthy man with a prior prostate cancer diagnosis is more likely to have his prostate cancer assigned as the cause of death, again due to a sticky diagnosis bias. His assigned cause of death to prostate cancer will be challenging to validate retrospectively but may be wrong. Ad","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10477747","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2137231
Jonathan Aning
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{"title":"The pursuit of excellence.","authors":"Jonathan Aning","doi":"10.1080/21681805.2022.2137231","DOIUrl":"https://doi.org/10.1080/21681805.2022.2137231","url":null,"abstract":"We present here because it will be so easy for you to access the internet service. As in this new era, much technology is sophistically offered by connecting to the internet. No any problems to face, just for this day, you can really keep in mind that the book is the best book for you. We offer the best here to read. After deciding how your feeling will be, you can enjoy to visit the link and get the book.","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472084","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2137230
Truls E Bjerklund Johansen, Tommaso Cai
Sepsis
{"title":"Facing urosepsis- the most deadly of all urological diseases.","authors":"Truls E Bjerklund Johansen, Tommaso Cai","doi":"10.1080/21681805.2022.2137230","DOIUrl":"https://doi.org/10.1080/21681805.2022.2137230","url":null,"abstract":"Sepsis","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472094","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}
Pub Date : 2022-10-01DOI: 10.1080/21681805.2022.2119273
Antonios Tzortzakakis, Thomas Papathomas, Ove Gustafsson, Stefan Gabrielson, Kiril Trpkov, Linnea Ekström-Ehn, Alexandros Arvanitis, Maria Holstensson, Mattias Karlsson, Georgia Kokaraki, Rimma Axelsson
Background: 99mTc-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) contributes to the non-invasive differentiation of renal oncocytoma (RO) from renal cell carcinoma (RCC) by characterising renal tumours as Sestamibi positive or Sestamibi negative regarding their 99mTc-Sestamibi uptake compared to the non-tumoral renal parenchyma.
Purpose: To determine whether 99mTc- Sestamibi uptake in renal tumour and the non-tumoral renal parenchyma measured using Standard Uptake Value (SUV) SPECT, has a beneficial role in differentiating RO from RCC.
Material and methods: Fifty-seven renal tumours from 52 patients were evaluated. In addition to visual evaluation of 99mTc-Sestamibi uptake, SUVmax measurements were performed in the renal tumour and the ipsilateral non-tumoral renal parenchyma. Analysis of the area under the receiver operating characteristic curve identified an optimal cut-off value for detecting RO, based on the relative ratio of 99mTc- Sestamibi uptake.
Results: Semiquantitative evaluation of 99mTc-Sestamibi uptake did not improve the performance of 99mTc- Sestamibi SPECT/CT in detecting RO. 99mTc- Sestamibi SPECT/CT identifies a group of mostly indolent Sestamibi-positive tumours with low malignant potential containing RO, Low-Grade Oncocytic Tumours, Hybrid Oncocytic Tumours, and a subset of chromophobe RCCs.
Conclusion: The imaging limitations for accurate differentiation of Sestamibi-positive renal tumours mirror the recognised diagnostic complexities of the histopathologic evaluation of oncocytic neoplasia. Patients with Sestamibi-positive renal tumours could be better suited for biopsy and follow-up, according to the current active surveillance protocols.
{"title":"<sup>99m</sup>Tc-Sestamibi SPECT/CT and histopathological features of oncocytic renal neoplasia.","authors":"Antonios Tzortzakakis, Thomas Papathomas, Ove Gustafsson, Stefan Gabrielson, Kiril Trpkov, Linnea Ekström-Ehn, Alexandros Arvanitis, Maria Holstensson, Mattias Karlsson, Georgia Kokaraki, Rimma Axelsson","doi":"10.1080/21681805.2022.2119273","DOIUrl":"https://doi.org/10.1080/21681805.2022.2119273","url":null,"abstract":"<p><strong>Background: </strong><sup>99m</sup>Tc-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) contributes to the non-invasive differentiation of renal oncocytoma (RO) from renal cell carcinoma (RCC) by characterising renal tumours as Sestamibi positive or Sestamibi negative regarding their <sup>99m</sup>Tc-Sestamibi uptake compared to the non-tumoral renal parenchyma.</p><p><strong>Purpose: </strong>To determine whether <sup>99m</sup>Tc- Sestamibi uptake in renal tumour and the non-tumoral renal parenchyma measured using Standard Uptake Value (SUV) SPECT, has a beneficial role in differentiating RO from RCC.</p><p><strong>Material and methods: </strong>Fifty-seven renal tumours from 52 patients were evaluated. In addition to visual evaluation of <sup>99m</sup>Tc-Sestamibi uptake, SUV<sub>max</sub> measurements were performed in the renal tumour and the ipsilateral non-tumoral renal parenchyma. Analysis of the area under the receiver operating characteristic curve identified an optimal cut-off value for detecting RO, based on the relative ratio of <sup>99m</sup>Tc- Sestamibi uptake.</p><p><strong>Results: </strong>Semiquantitative evaluation of <sup>99m</sup>Tc-Sestamibi uptake did not improve the performance of <sup>99m</sup>Tc- Sestamibi SPECT/CT in detecting RO. <sup>99m</sup>Tc- Sestamibi SPECT/CT identifies a group of mostly indolent Sestamibi-positive tumours with low malignant potential containing RO, Low-Grade Oncocytic Tumours, Hybrid Oncocytic Tumours, and a subset of chromophobe RCCs.</p><p><strong>Conclusion: </strong>The imaging limitations for accurate differentiation of Sestamibi-positive renal tumours mirror the recognised diagnostic complexities of the histopathologic evaluation of oncocytic neoplasia. Patients with Sestamibi-positive renal tumours could be better suited for biopsy and follow-up, according to the current active surveillance protocols.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10436859","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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