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Outcomes of Robotic Surgery for Low-Volume Surgeons 小容量外科医生的机器人手术效果
Pub Date : 2022-09-14 DOI: 10.48083/ppsc8658
Sridhar Panaiyadiyan, Rajeev Kumar
When the outcomes are equivalent to the open technique, conventional laparoscopy is a preferred surgical approach because of its minimal invasiveness. However, outcomes following laparoscopy depend on the surgeon’s expertise, and there is a significant learning curve to attain efficiency in complex reconstructing laparoscopic procedures. Robotic assistance bridges the gap between open and laparoscopic procedures and allows surgeons with limited laparoscopy experience to offer the benefits of minimally invasive surgery to their patients. While existing data do not show better outcomes with robot assistance compared with laparoscopy for most procedures, these studies are based on data from high-volume surgeons and centers. In reality, a significant number of surgeries are performed by low-volume centers and surgeons, and robotic assistance may enable them to offer benefits of minimally invasive surgery equivalent to those of higher volume centers since robotic assistance is associated with a shorter learning curve than laparoscopy. We review the data on the outcomes of robotic surgery for low-volume surgeons with a focus on centers and surgeons in Asia.
当结果与开放技术相当时,传统腹腔镜手术是首选的手术方法,因为它的侵入性最小。然而,腹腔镜手术后的结果取决于外科医生的专业知识,并且在复杂的腹腔镜重建手术中要达到效率需要大量的学习曲线。机器人辅助弥补了开放手术和腹腔镜手术之间的差距,使腹腔镜手术经验有限的外科医生能够为患者提供微创手术的好处。虽然现有的数据并没有显示在大多数手术中机器人辅助的效果比腹腔镜更好,但这些研究是基于大量外科医生和中心的数据。在现实中,大量的手术是由小容量中心和外科医生进行的,机器人辅助可能使他们能够提供与大容量中心相同的微创手术的好处,因为机器人辅助与腹腔镜相比具有更短的学习曲线。我们回顾了小容量外科医生的机器人手术结果的数据,重点是亚洲的中心和外科医生。
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引用次数: 0
Intra-Diverticular Bladder Tumours: How to Manage Rationally 膀胱憩室内肿瘤:如何合理处理
Pub Date : 2022-09-14 DOI: 10.48083/jclw6772
Mohammed Lotfi Amer, H. Mumtaz, B. Russell, Jason Gan, Z. Rehman, Rajesh M. Nair, R. Thurairaja, Muhammad S. Khan
Objective To report changing practice in the management of intra-diverticular bladder tumours. Methods We undertook a review of all intra-diverticular bladder tumours in our prospectively maintained institutional database. Results A total of 28 patients (male = 27, female = 1) with a median age of 71 years (IQR 61 to 76) were diagnosed with intra-diverticular bladder tumours (IDBT) between March 2013 and February 2021. Fourteen had visible and 3 had non-visible haematuria, while 11 patients had lower urinary tract symptoms. Median axial diameter of the diverticula was 46 mm (IQR 35 to 69), and median neck diameter was 9 mm (IQR 7 to 11). All patients had CT-urography and 5 patients also had an MRI. Surgical treatment consisted of diverticulectomy (n = 11), diverticulectomy and ipsilateral ureteric reimplantation (n = 11), radical cystectomy and ileal conduit (n = 4), or radical cystectomy and orthotopic bladder (n = 2). Eleven patients had open procedures, and 17 had robotic assisted surgery. Final pathological stages were T0 (n = 2), Ta (n = 5), T1 (n = 7), T3a (n = 8) and T3b (n = 6). Twenty-four patients had urothelial carcinoma (including one nested variant and 4 with squamous differentiation) and 2 had small cell carcinoma. Three patients had neoadjuvant systemic chemotherapy, 2 had intravesical bacillus Calmette-Guerin (BCG) with mitomycin, and one had BCG monotherapy preoperatively. Five patients had adjuvant systemic chemotherapy while 7 had adjuvant intravesical therapies. Mean follow-up period was 37.8 months (±25.3). Mean recurrence-free survival was 61.5% (CI 45.7 to 77.4) and mean overall survival 71.6 % (CI 57.4 to 85.8). Ten patients (37%) died of cancer. Conclusion Management of intra-diverticular bladder tumours is evolving. Bladder-sparing approaches are gaining popularity. Robot-assisted diverticulectomy is preferable as it reduces the morbidity resulting from treatment.
目的探讨膀胱憩室内肿瘤的治疗方法。方法:我们在前瞻性维护的机构数据库中对所有憩室内膀胱肿瘤进行了回顾。结果2013年3月至2021年2月,共有28例患者被诊断为憩室内膀胱肿瘤(IDBT),其中男性27例,女性1例,中位年龄71岁(IQR 61 ~ 76岁)。14例可见血尿,3例不可见血尿,11例有下尿路症状。憩室中轴径46 mm (IQR 35 ~ 69),颈中径9 mm (IQR 7 ~ 11)。所有患者行ct尿路造影,5例患者行MRI。手术治疗包括憩室切除术(n = 11)、憩室切除术+同侧输尿管再植(n = 11)、根治性膀胱切除术+回肠导管(n = 4)或根治性膀胱切除术+原位膀胱(n = 2)。11例患者采用开腹手术,17例患者采用机器人辅助手术。最终病理分期为T0 (n = 2)、Ta (n = 5)、T1 (n = 7)、T3a (n = 8)、T3b (n = 6)。24例患者为尿路上皮癌(其中巢状变异1例,鳞状分化4例),2例为小细胞癌。3例患者行新辅助全身化疗,2例患者行膀胱内卡介苗联合丝裂霉素治疗,1例患者术前行卡介苗单药治疗。5例患者行辅助全身化疗,7例行辅助膀胱内化疗。平均随访37.8个月(±25.3个月)。平均无复发生存率为61.5% (CI 45.7 ~ 77.4),平均总生存率为71.6% (CI 57.4 ~ 85.8)。10名患者(37%)死于癌症。结论膀胱憩室内肿瘤的治疗方法在不断发展。保留膀胱的方法越来越受欢迎。机器人辅助憩室切除术是可取的,因为它减少了治疗引起的发病率。
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引用次数: 0
Urology in Syria: A View From Inside 叙利亚的泌尿外科:从内部看
Pub Date : 2022-09-14 DOI: 10.48083/irjo4841
Khaled Altopajee, M. Shahait
None available.
没有可用的。
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引用次数: 0
A Quality Assessment of Information Available on Renal Cancer on YouTube YouTube上关于肾癌信息的质量评估
Pub Date : 2022-09-14 DOI: 10.48083/hmug9514
J. Saad, R. Shanmugasundaram, D. Ashrafi, D. Gilbourd
Objectives Many people are turning to alternatives to the conventional doctor-patient relationship, such as webbased search engines and video forums for their health care information. We undertook this study to investigate the quality of videos and information on renal cancer available on the streaming platform YouTube. Methods We completed a search of YouTube (www.YouTube.com) in September 2021 with the term “kidney cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score (GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to further analyse the quality assessment tool results before, during, and after 2016. Results Most videos were published during or after 2016 (63.3%), were predominantly created in North America (77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading for overall level of misinformation was moderate. Conclusion The quality of information accessed from YouTube on kidney cancer is of a low to moderate overall standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical practitioner and the health care system.
许多人正在转向替代传统的医患关系,如基于网络的搜索引擎和视频论坛的医疗保健信息。我们进行这项研究是为了调查流媒体平台YouTube上有关肾癌的视频和信息的质量。我们于2021年9月在YouTube (www.YouTube.com)上搜索“肾癌”一词。前120个符合入选标准的视频(英语,时长超过一分钟,观看次数超过500次,涉及肾癌)被选中。我们记录的信息包括时长、观看次数、喜欢、不喜欢、评论、出版商和作者。使用改进的DISCERN工具和全球质量评分(GQS)问卷来评估所纳入视频的质量。使用李克特5分制评估错误信息的水平。采用描述性统计方法对收集到的数据进行分析。采用2样本t检验进一步分析2016年前、期间和之后的质量评估工具结果。大多数视频在2016年期间或之后发布(63.3%),主要创作于北美(77.5%),由卫生保健专业人员呈现(60%)。视频长度的中位数为4.23分钟(1.01至65.55分钟),观看次数的中位数为3087次(514至228 152次)。喜欢和不喜欢的中位数分别是24和5。修正后的DISCERN得分中位数为3分,GQS得分中位数为3分,错误信息总体水平评分为中等。结论YouTube上关于肾癌的信息质量总体为中低水平,存在明显的错误信息。YouTube不应仅用于肾癌患者或公众的教育目的。它最好与来自医生和卫生保健系统的信息和建议结合使用。
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引用次数: 0
Malakoplakia Causing Poor Bladder Compliance and Bilateral Hydroureteronephrosis 斑疹导致膀胱顺应性差和双侧输尿管积水
Pub Date : 2022-07-15 DOI: 10.48083/qfcw5582
C. Pham, A. Chung, V. Chalasani
presented with lower urinary tract (LUTS) including frequency, urgency urge incontinence. She had a 2-year history of recurrent urinary tract infections (UTI) with Escherichia coli of varying susceptibility. Background included rheumatoid arthritis treated with corticosteroids, and kidney to hypertensive nephrosclerosis.
表现为下尿路(LUTS),包括尿频、急迫性尿失禁。她有2年复发性尿路感染(UTI)史,伴有不同易感性的大肠杆菌。背景包括用皮质类固醇治疗的类风湿关节炎和肾向高血压性肾硬化。
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引用次数: 0
The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer CABEM计划:拯救肌肉浸润性膀胱癌患者
Pub Date : 2022-07-15 DOI: 10.48083/dfbq7749
F. Korkes, J. H. Santiago, G. Peixoto, F. Timóteo, S. Martins, N. P. Leite, Daisy Barreiros, S. Glina
Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralized program involving a multidisciplinary clinic in a region comprising 7 municipalities. Helping patients with adequate performance status get the right treatment helped to reduce 90-day mortality after radical cystectomy from 37% to 1.9%.
肌浸润性膀胱癌(MIBC)是一种侵袭性疾病,治疗复杂。与大多数发展中国家一样,巴西的数据很少,但死亡率似乎非常高。我们在一个由7个城市组成的地区建立了一个涉及多学科诊所的集中项目。帮助表现良好的患者获得正确的治疗有助于将根治性膀胱切除术后90天死亡率从37%降至1.9%。
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引用次数: 0
The Value of Conflicts of Interest Disclosures in Oral Presentations at Major Urological Conferences 利益冲突披露在泌尿科主要会议口头报告中的价值
Pub Date : 2022-07-15 DOI: 10.48083/spql8302
Anique Le Roux, N. Touma
The objective of this study is to assess the value of disclosure slide reporting at major urology conferences. In total, 557 speakers were evaluated from the conferences of the Canadian Urology Association (n = 36), American Urology Association (n = 160), and European Association of Urology (n = 361) in 2020. Overall, 49.0% of speakers had no disclosure slide. Among speakers presenting a disclosure slide, the median number of conflicts was 5, median time spent on the slide was 4.4 seconds, and 34.8% gave context to disclosures. Overall disclosure slide reporting seems inconsistent, and given how little time is spent on them and the lack of contextualization, their value is unclear.
本研究的目的是评估在主要泌尿外科会议上披露幻灯片报告的价值。总共有557名演讲者被评估,他们来自2020年加拿大泌尿外科协会(n = 36)、美国泌尿外科协会(n = 160)和欧洲泌尿外科协会(n = 361)的会议。总体而言,49.0%的演讲者没有披露幻灯片。在发表披露幻灯片的演讲者中,冲突的中位数为5次,在幻灯片上花费的中位数时间为4.4秒,34.8%的人给出了披露的背景。整体披露幻灯片报告似乎不一致,考虑到花在它们上面的时间很少,缺乏背景化,它们的价值是不清楚的。
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引用次数: 1
Overnight Ambulatory Urodynamics Change Patient Management Strategies and Improve Symptomatic Outcomes 夜间流动尿动力学改变患者管理策略和改善症状结果
Pub Date : 2022-07-15 DOI: 10.48083/rdtd8562
R. Axell, H. Yasmin*, K. Aleksejeva, E. Solomon, B. Toia, M. Thommyppillai, M. Pakzad, R. Hamid, J. Ockrim, T. Greenwell
ObjectivesTo determine the diagnostic value of overnight ambulatory urodynamics (aUDS) and to assess if a urodynamic diagnosis of detrusor overactivity (DO) or nocturnal enuresis resulted in a change in patient management and an improvement in their urinary symptoms.MethodsA retrospective review of 25 consecutive patients (28% male) with a median age of 38 years (range 18 to 86) having overnight aUDS for bothersome urinary symptoms of primarily nocturia and/or nocturnal enuresis following non-diagnostic conventional urodynamics between November 1998 and August 2018. Urinary symptoms were assessed before overnight aUDS and again after urological treatment following any changes in urodynamics diagnosis and treatment. Six patients were excluded as follow-up data were not available.ResultsTwenty-four patients (96%) presented with nocturia and 20 (80%) presented with nocturnal enuresis. DO was demonstrated in 19 (76%) patients (mean pressure 69.1±53.3 cmH2O). UUI was demonstrated in 16 (80%) out of the 20 patients who complained of nocturnal enuresis. Of the 19 patients with follow-up data, following overnight aUDS a change in urodynamic diagnosis was made in 15 patients (79%); 16 patients (84%) also had their clinical diagnosis and subsequent management changed; and 15 patients (79%) reported an improvement in their urinary symptoms following these changes in diagnosis and treatment. There was a significant improvement in ICIQ-OAB (120±44 versus 32±53, P < 0.0001) scores following the changes to clinical management post-overnight aUDS.ConclusionIn our study cohort, change in primary diagnosis following overnight aUDS led to a significant change in treatment care pathway and resulted in significant improvement in urinary symptoms at follow-up.
目的探讨夜间动态尿动力学(aUDS)的诊断价值,并评估尿动力学诊断为逼尿肌过度活动(DO)或夜间遗尿是否会改变患者的治疗方法和改善泌尿系统症状。方法回顾性分析1998年11月至2018年8月期间,连续25例患者(28%为男性),中位年龄38岁(18至86岁),在非诊断性常规尿动力学治疗后,因主要为夜尿症和/或夜尿症的泌尿系统症状而发生夜间aUDS。在夜间aUDS前评估泌尿系统症状,并在泌尿外科治疗后评估尿动力学诊断和治疗的任何变化。由于没有随访数据,6例患者被排除在外。结果夜尿24例(96%),夜尿20例(80%)。19例(76%)患者出现DO(平均血压69.1±53.3 cmH2O)。20例夜间遗尿患者中有16例(80%)出现UUI。在随访数据的19例患者中,15例患者(79%)在夜间aUDS后尿动力学诊断发生变化;16例(84%)患者的临床诊断和后续管理也发生了变化;15名患者(79%)报告说,在这些诊断和治疗的改变后,他们的泌尿系统症状有所改善。夜间aUDS后临床管理改变后,ICIQ-OAB评分显著改善(120±44比32±53,P < 0.0001)。结论在我们的研究队列中,夜间aUDS后的初诊改变导致治疗护理途径的显著改变,并导致随访时泌尿系统症状的显著改善。
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引用次数: 0
Predictive Biomarkers in the Management of Bladder Cancer: Perspectives in an Evolving Therapeutic Landscape 膀胱癌管理中的预测性生物标志物:不断发展的治疗前景的观点
Pub Date : 2022-07-15 DOI: 10.48083/rvzv1144
P. Hensley, N. Lobo, K. Bree, W. Tan, P. Gontero, S. Williams, C. C. Guo, G. Giannarini, L. Dyrskjøt, A. Kamat
Bladder cancer (BC) is a heterogeneous disease with prognosis and therapeutic strategies highly dependent on tumor grade and stage. Predictive biomarkers of therapeutic response have been studied to guide selection of intravesical and/or systemic therapy. A predictive biomarker is measured before the start of treatment and provides information on the likelihood of response to a specific therapy. Many candidate predictive biomarkers for BC have been identified, but few have been rigorously validated or distinguished from simply having treatment-agnostic prognostic capacity. Identifying predictive biomarkers tailored to therapeutic mechanism of action has considerable implications for the sequencing of therapies, as well as bladder preservation strategies in advanced disease states. We evaluate predictive tissue-based, urine-based, and serum-based biomarkers across the spectrum of non–muscle-invasive and muscle-invasive BC and preview predictive biomarkers for emerging targeted therapies.
膀胱癌(BC)是一种异质性疾病,其预后和治疗策略高度依赖于肿瘤的分级和分期。已经研究了治疗反应的预测性生物标志物,以指导膀胱内和/或全身治疗的选择。在治疗开始前测量预测性生物标志物,并提供对特定治疗反应可能性的信息。许多候选的预测BC的生物标志物已经被确定,但很少有被严格验证或区分为具有治疗不可知论的预后能力。确定适合治疗作用机制的预测性生物标志物对治疗的测序以及晚期疾病状态下的膀胱保存策略具有重要意义。我们评估了非肌肉侵入性和肌肉侵入性BC的预测性组织、尿液和血清生物标志物,并预览了新兴靶向治疗的预测性生物标志物。
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引用次数: 1
A Systematic Review of Plant-Based Diets and Bladder Cancer: A Call for Further Research 植物性饮食与膀胱癌的系统综述:进一步研究的呼吁
Pub Date : 2022-07-15 DOI: 10.48083/gbma2534
Jacob Taylor, N. Gupta, J. Blanck, S. Loeb
The relationship between plant-based dietary patterns and bladder cancer has not been extensively studied. Our objective was to perform a systematic review of the relationship between plant-based diets and bladder cancer risk and/or outcomes. We searched the literature for all relevant papers published before October 2020 was conducted. Of 74 identified records, only 2 references were included in the final qualitative analysis. These publications found that vegetarian diets are associated with a lower risk of bladder cancer diagnosis. We did not identify any studies investigating the impact of plant-based dietary patterns on outcomes for individuals diagnosed with bladder cancer, which represents an important area for further study.
植物性饮食模式与膀胱癌之间的关系尚未得到广泛研究。我们的目的是对植物性饮食与膀胱癌风险和/或结果之间的关系进行系统回顾。我们检索了2020年10月之前发表的所有相关论文。在确定的74份记录中,只有2份参考文献被纳入最终的定性分析。这些出版物发现,素食与膀胱癌诊断风险较低有关。我们没有发现任何研究调查植物性饮食模式对膀胱癌患者预后的影响,这是一个值得进一步研究的重要领域。
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引用次数: 1
期刊
Société Internationale d’Urologie Journal
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