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A multi-institutional update on surgical outcomes after penile silicone sleeve implantation 多机构更新阴茎硅胶套植入术后的手术结果
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-04-02 DOI: 10.1177/17562872241241858
Alexandra R. Siegal, Kenan E. Celtik, Shirin Razdan, Michaela Sljivich, Bryan Kansas, Bhavik Shah, Laurence A. Levine, Robert J. Valenzuela
Background:The increasing popularity of the silicone sleeve penile implant has been accompanied by concerns over potential risks and adverse events.Objectives:To provide multi-institutional data on safety outcomes in patients undergoing silicone sleeve penile implant surgery across high-volume implant surgeons. In addition, we discuss preventative techniques to minimize postoperative complications and the management of these events.Design and methods:We performed a retrospective analysis of men undergoing penile silicone sleeve implants between November 2020 and November 2022 with four surgeons, each from a separate institution. Perioperative and postoperative adverse events, including unsatisfactory cosmetic outcomes requiring revision, were determined by physician follow-up. Flaccid penile length and girth were measured preoperatively and postoperatively.Results:A total of 299 male patients underwent silicone sleeve implant surgery, with an average age of 42.5 ± 10.5 years and an average body mass index of 28.5 ± 4.0. The patient cohort exhibited minimal comorbidities, with 5% having hyperlipidemia, 2% being smokers, 2% having cardiovascular disease, and 1% having diabetes. Patients experienced an average increase of 4.1 ± 1.5 cm in their flaccid penile length (a 50% increase) and an average increase of 3.4 ± 1.5 cm in their flaccid girth (a 37% increase) ( p < 0.01). Complication rates included new-onset postoperative erectile dysfunction (0%), infection (1.3%), seroma (2.0%), and erosion (5.0%). The average follow-up time was 11.6 months. Notably, our rates of infection and seroma were lower than those reported in a previous single-center review, while erosion rates were higher.Conclusion:This is the largest study to characterize the safety of the penile silicone sleeve implant across multiple institutions. In men who desire cosmetic size augmentation, silicone sleeve implant surgery is associated with significantly increased flaccid penile length and girth. Complications are mainly cosmetic and may be corrected; however, patients should be appropriately counseled on the risk of erosion, which appears to be higher than previously reported.
背景:随着硅胶阴茎套筒植入术的日益普及,人们对其潜在风险和不良事件也产生了担忧.目的:提供有关接受硅胶阴茎套筒植入术的患者在大量植入外科医生处的安全结果的多机构数据。设计与方法:我们对 2020 年 11 月至 2022 年 11 月期间接受硅胶阴茎套筒植入手术的男性进行了回顾性分析,四名外科医生分别来自不同的机构。围手术期和术后不良事件,包括需要翻修的不满意美容效果,均由医生随访确定。结果:共有299名男性患者接受了硅胶套植入手术,平均年龄(42.5±10.5)岁,平均体重指数(28.5±4.0)。患者的合并症极少,其中5%患有高脂血症,2%吸烟,2%患有心血管疾病,1%患有糖尿病。患者的阴茎松弛长度平均增加了 4.1 ± 1.5 厘米(增加了 50%),松弛周长平均增加了 3.4 ± 1.5 厘米(增加了 37%)(p < 0.01)。并发症发生率包括术后新发勃起功能障碍(0%)、感染(1.3%)、血清肿(2.0%)和糜烂(5.0%)。平均随访时间为 11.6 个月。值得注意的是,我们的感染率和血清肿发生率低于之前的单中心综述,而侵蚀发生率则较高。对于希望从外观上增大阴茎尺寸的男性来说,硅胶阴茎套筒植入手术能显著增加阴茎的松弛长度和周长。并发症主要是外观上的,可以得到纠正;但患者应适当了解侵蚀的风险,侵蚀的风险似乎比以前报道的要高。
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引用次数: 0
Targeted augmented reality-guided transperineal prostate biopsies study: initial experience 靶向增强现实引导经会阴前列腺活检研究:初步经验
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-03-08 DOI: 10.1177/17562872241232582
Shenthiuiyan Theivendrampillai, Bob Yang, Mark Little, Christopher Blick
Background:Transperineal biopsy of magnetic resonance imaging (MRI)-detected prostate lesions is now the established technique used in prostate cancer (CaP) diagnostics. Virtual Surgery Intelligence (VSI) Holomedicine by Apoqlar (Hamburg, Germany) is a mixed reality (MR)/augmented reality (AR) software platform that runs on the HoloLens II system (Microsoft, Redford, USA). Multiparametric prostate MRI images were converted into 3D holograms and added into a MR space, enabling visualization of a 3D hologram and image-assisted prostate biopsy.Objective:The Targeted Augmented Reality-GuidEd Transperineal (TARGET) study investigated the feasibility of performing AR-guided prostate biopsies in a MR framework, using the VSI platform in patients with MRI-detected prostate lesions.Methods:Ten patients with a clinical suspicion of CaP on MRI (Prostate Imaging-Reporting and Data System, PI-RADS 4/5) were uploaded to the VSI HoloLens system. Two MR/AR-guided prostate biopsies were then acquired using the PrecisionPoint Freehand transperineal biopsy system. Cognitive fusion biopsies were performed as standard of care following the MR/AR-guided prostate biopsies.Results:All 10 patients successfully underwent MR/AR-guided prostate biopsy after 3D MR images were overlaid on the patient’s body. Prostatic tissue was obtained in all MR/AR-guided specimens. Seven patients (70%) had matching histology in both the standard and MR/AR-guided biopsies. The remaining three had ISUP (International Society of Urological Pathology) Grade 2 CaP. There were no immediate complications.Conclusion:We believe this is a world first. The initial feasibility data from the TARGET study demonstrated that an MR/AR-guided prostate biopsy utilizing the VSI Holomedicine system is a viable option in CaP diagnostics. The next stage in development is to combine AR images with real-time needle insertion and to provide further data to formally appraise the sensitivity and specificity of the technique.
背景:对磁共振成像(MRI)检测到的前列腺病变进行经会阴活检是目前前列腺癌(CaP)诊断中使用的成熟技术。Apoqlar公司(德国汉堡)的虚拟手术智能(VSI)全息医疗是一个混合现实(MR)/增强现实(AR)软件平台,可在HoloLens II系统(微软,美国雷德福德)上运行。多参数前列腺 MRI 图像被转换成三维全息图,并添加到 MR 空间中,从而实现了三维全息图的可视化和图像辅助前列腺活检。目标:Targeted Augmented Reality-GuidEd Transperineal (TARGET)研究调查了在MR框架下使用VSI平台对MRI检测到前列腺病变的患者进行AR引导前列腺活检的可行性。方法:10名MRI临床怀疑为CaP(前列腺成像报告和数据系统,PI-RADS 4/5)的患者被上传到VSI HoloLens系统。然后使用 PrecisionPoint Freehand 经会阴活检系统进行了两次 MR/AR 引导的前列腺活检。结果:在患者身体上叠加三维磁共振图像后,所有10名患者都成功接受了磁共振/AR引导下的前列腺活检。所有MR/AR引导的标本都获得了前列腺组织。七名患者(70%)的标准和 MR/AR 导向活检组织学结果一致。其余三名患者的钙化程度为 ISUP(国际泌尿病理学会)2 级。结论:我们认为这是世界首例。TARGET研究的初步可行性数据表明,利用VSI Holomedicine系统进行MR/AR引导的前列腺活检是CaP诊断的可行选择。下一阶段的开发工作是将 AR 图像与实时插针相结合,并提供进一步的数据,以正式评估该技术的灵敏度和特异性。
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引用次数: 0
The incidence, pathogenesis, and management of non-clear cell renal cell carcinoma 非透明细胞肾细胞癌的发病率、发病机制和治疗方法
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-29 DOI: 10.1177/17562872241232578
Priyanka Naik, Harshitha Dudipala, Yu-Wei Chen, Brent Rose, Aditya Bagrodia, Rana R. McKay
Renal cell carcinoma (RCC) is the most common type of kidney cancer and is divided into two distinct subtypes, clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC). Although many treatments exist for RCC, these are largely based on clinical trials performed in ccRCC and there are limited studies on the management of nccRCC. Non-clear cell RCC consists of multiple histological subtypes: papillary, chromophobe, translocation, medullary, collecting duct, unclassified, and other rare histologies. Due to variations in pathogenesis and therapeutic response, therapy should be tailored to specific variant histologies. For patients with localized nccRCC, surgical resection remains the gold standard. In the metastatic setting, the standard of care has yet to be clearly defined, and most guidelines recommend clinical trial participation. General therapeutic options include immunotherapy, either as monotherapy or in combination, targeted therapies such as vascular endothelial growth factor tyrosine kinase inhibitors and MET inhibitors, and chemotherapy in certain subtypes. Here we present a review of the incidence and pathogenesis of the various subtypes, as well as available clinical data to support therapeutic recommendations for these subtypes. We also highlight currently available clinical trials in nccRCC and future directions in investigating novel treatment modalities tailored to patients with variant histology.
肾细胞癌(RCC)是最常见的肾癌类型,分为两种不同的亚型:透明细胞肾细胞癌(ccRCC)和非透明细胞肾细胞癌(nccRCC)。虽然目前有许多治疗 RCC 的方法,但这些方法主要基于对 ccRCC 进行的临床试验,而对 nccRCC 的治疗方法研究有限。非透明细胞 RCC 包括多种组织学亚型:乳头型、嗜色型、易位型、髓质型、集合管型、未分类型和其他罕见组织学类型。由于发病机制和治疗反应存在差异,因此应针对特定的变异组织学进行治疗。对于局部 nccRCC 患者,手术切除仍是金标准。对于转移性患者,治疗标准尚未明确,大多数指南都建议参与临床试验。一般治疗方案包括单药或联合免疫疗法、血管内皮生长因子酪氨酸激酶抑制剂和MET抑制剂等靶向疗法以及某些亚型的化疗。在此,我们回顾了各种亚型的发病率和发病机制,以及支持这些亚型治疗建议的现有临床数据。我们还重点介绍了目前针对 nccRCC 的临床试验,以及针对变异组织学患者的新型治疗方法的未来研究方向。
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引用次数: 0
Carboplatin in metastatic castration-resistant prostate cancer patients with molecular alterations of the DNA damage repair pathway: the PRO-CARBO phase II trial. 卡铂用于DNA损伤修复途径发生分子改变的转移性去势抵抗性前列腺癌患者:PRO-CARBO II期试验。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-28 eCollection Date: 2024-01-01 DOI: 10.1177/17562872241229876
Elodie Coquan, Nicolas Penel, Justine Lequesne, Raphaël Leman, Pernelle Lavaud, Zoé Neviere, Pierre-Emmanuel Brachet, Emeline Meriaux, Aurélien Carnot, Jérémy Boutrois, Marie Castera, Nicolas Goardon, Etienne Muller, Alexandra Leconte, Antoine Thiery-Vuillemin, Bénédicte Clarisse, Florence Joly

Introduction: DNA damage repair genes are altered in 20-35% of metastatic castration-resistant prostate cancer (mCRPC). Poly-ADP (Adénosine Diphosphate)-ribose polymerase inhibitors (PARPi) showed significant activity for these selected tumors, especially with homologous recombination repair (HRR) deficiency. These alterations could also predict platinum sensitivity. Although carboplatin was inconclusive in unselected mCRPC, the literature suggests an anti-tumoral activity in mCRPC with HHR gene alterations. We aimed to assess the efficacy of carboplatin monotherapy in mCRPC patients with HRR deficiency.

Methods: This prospective multicenter single-arm two-stage phase II addressed mCRPC men with HRR somatic and/or germline alterations, pretreated with ⩾2 taxane chemotherapy regimens and one androgen receptor pathway inhibitor. Prior PARPi treatment was allowed. Enrolled patients received intravenous carboplatin (AUC5) every 21 days for 6-9 cycles. The primary endpoint was the best response rate according to adapted PCWG3 guidelines: radiological response (RECIST 1.1 criteria) and/or biological response [⩾50% prostate-specific antigen (PSA) decline].

Results: A total of 15 out of 16 enrolled patients started carboplatin treatment. Genomic alterations were identified for BRCA2 (n = 5), CDK12 (n = 3), ATM (n = 3) CHEK2 (n = 2), CHEK1 (n = 1), and BRCA1 (n = 1) genes. Objective response (partial biological response + stable radiological response) was achieved in one patient (6.7%), carrying a BRCA2 mutation and not pre-treated with PARPi; stable disease was observed for five patients (33.5%). Among seven patients (46.7%) with previous PARPi treatment, four patients (57.1%) had a stable disease. The median progression-free and overall survivals were 1.9 [95% confidence interval (95% CI), 1.8-9.5] and 8.6 months (95% CI, 4.3-19.5), respectively. The most common severe (grade 3-4) treatment-related toxicities were thrombocytopenia (66.7%), anemia (66.7%), and nausea (60%). Overall, 8 (53.3%) patients experienced a severe hematological event.

Conclusion: The study was prematurely stopped as pre-planned considering the limited activity of carboplatin monotherapy in heavily pre-treated, HHR-deficient mCRPC patients. Larger experience is needed in mCRPC with BRCA alterations.

Trial registration: NCT03652493, EudraCT ID number 2017-004764-35.

导言:20%-35%的转移性去势抵抗性前列腺癌(mCRPC)的DNA损伤修复基因发生了改变。聚-ADP(腺苷二磷酸)-核糖聚合酶抑制剂(PARPi)对这些被选中的肿瘤,尤其是同源重组修复(HRR)缺陷的肿瘤有显著的活性。这些改变还可以预测铂类药物的敏感性。虽然卡铂在未经筛选的mCRPC中的疗效并不确定,但文献表明,卡铂对存在HHR基因改变的mCRPC具有抗肿瘤活性。我们旨在评估卡铂单药治疗对HRR缺乏的mCRPC患者的疗效:这项前瞻性多中心单臂两阶段 II 期研究针对 HRR 体系和/或种系改变的 mCRPC 男性患者,他们接受了⩾2 种类固醇化疗方案和一种雄激素受体通路抑制剂的预处理。允许事先接受 PARPi 治疗。入组患者接受静脉注射卡铂(AUC5),每21天一次,共6-9个周期。主要终点是根据PCWG3指南调整后的最佳反应率:放射学反应(RECIST 1.1标准)和/或生物学反应[前列腺特异性抗原(PSA)下降50%]:16名入组患者中,共有15名患者开始接受卡铂治疗。确定了 BRCA2(5 个)、CDK12(3 个)、ATM(3 个)、CHEK2(2 个)、CHEK1(1 个)和 BRCA1(1 个)基因的基因组改变。一名携带 BRCA2 基因突变且未接受 PARPi 治疗的患者(6.7%)获得了客观应答(部分生物学应答+稳定的放射学应答);五名患者(33.5%)病情稳定。在 7 名接受过 PARPi 治疗的患者(46.7%)中,有 4 名患者(57.1%)病情稳定。无进展生存期和总生存期的中位数分别为1.9个月[95% 置信区间(95% CI),1.8-9.5]和8.6个月(95% CI,4.3-19.5)。最常见的严重(3-4级)治疗相关毒性反应是血小板减少(66.7%)、贫血(66.7%)和恶心(60%)。总体而言,8 名(53.3%)患者出现了严重的血液学事件:考虑到卡铂单药疗法在预处理严重、HHR缺乏的mCRPC患者中活性有限,研究按照预先计划提前结束。对于有 BRCA 基因改变的 mCRPC 患者,还需要更多的经验:NCT03652493,EudraCT ID编号:2017-004764-35。
{"title":"Carboplatin in metastatic castration-resistant prostate cancer patients with molecular alterations of the DNA damage repair pathway: the PRO-CARBO phase II trial.","authors":"Elodie Coquan, Nicolas Penel, Justine Lequesne, Raphaël Leman, Pernelle Lavaud, Zoé Neviere, Pierre-Emmanuel Brachet, Emeline Meriaux, Aurélien Carnot, Jérémy Boutrois, Marie Castera, Nicolas Goardon, Etienne Muller, Alexandra Leconte, Antoine Thiery-Vuillemin, Bénédicte Clarisse, Florence Joly","doi":"10.1177/17562872241229876","DOIUrl":"10.1177/17562872241229876","url":null,"abstract":"<p><strong>Introduction: </strong>DNA damage repair genes are altered in 20-35% of metastatic castration-resistant prostate cancer (mCRPC). Poly-ADP (Adénosine Diphosphate)-ribose polymerase inhibitors (PARPi) showed significant activity for these selected tumors, especially with homologous recombination repair (HRR) deficiency. These alterations could also predict platinum sensitivity. Although carboplatin was inconclusive in unselected mCRPC, the literature suggests an anti-tumoral activity in mCRPC with HHR gene alterations. We aimed to assess the efficacy of carboplatin monotherapy in mCRPC patients with HRR deficiency.</p><p><strong>Methods: </strong>This prospective multicenter single-arm two-stage phase II addressed mCRPC men with HRR somatic and/or germline alterations, pretreated with ⩾2 taxane chemotherapy regimens and one androgen receptor pathway inhibitor. Prior PARPi treatment was allowed. Enrolled patients received intravenous carboplatin (AUC5) every 21 days for 6-9 cycles. The primary endpoint was the best response rate according to adapted PCWG3 guidelines: radiological response (RECIST 1.1 criteria) and/or biological response [⩾50% prostate-specific antigen (PSA) decline].</p><p><strong>Results: </strong>A total of 15 out of 16 enrolled patients started carboplatin treatment. Genomic alterations were identified for <i>BRCA2</i> (<i>n</i> = 5), <i>CDK12</i> (<i>n</i> = 3), <i>ATM</i> (<i>n</i> = 3) <i>CHEK2</i> (<i>n</i> = 2), <i>CHEK1</i> (<i>n</i> = 1), and <i>BRCA1</i> (<i>n</i> = 1) genes. Objective response (partial biological response + stable radiological response) was achieved in one patient (6.7%), carrying a BRCA2 mutation and not pre-treated with PARPi; stable disease was observed for five patients (33.5%). Among seven patients (46.7%) with previous PARPi treatment, four patients (57.1%) had a stable disease. The median progression-free and overall survivals were 1.9 [95% confidence interval (95% CI), 1.8-9.5] and 8.6 months (95% CI, 4.3-19.5), respectively. The most common severe (grade 3-4) treatment-related toxicities were thrombocytopenia (66.7%), anemia (66.7%), and nausea (60%). Overall, 8 (53.3%) patients experienced a severe hematological event.</p><p><strong>Conclusion: </strong>The study was prematurely stopped as pre-planned considering the limited activity of carboplatin monotherapy in heavily pre-treated, HHR-deficient mCRPC patients. Larger experience is needed in mCRPC with BRCA alterations.</p><p><strong>Trial registration: </strong>NCT03652493, EudraCT ID number 2017-004764-35.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"16 ","pages":"17562872241229876"},"PeriodicalIF":2.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Formation of vesicovaginal fistula after modified McDonald cerclage placement: a case report with literature review 改良麦克唐纳环扎术后形成膀胱阴道瘘:病例报告与文献综述
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-22 DOI: 10.1177/17562872241232581
Deama AlGhamdi, Samera F. AlBasri
Cervical cerclage is a common procedure employed to prevent preterm birth in women with cervical insufficiency. Complications such as injuries to the cervix and bladder, and premature membrane rupture are well-documented, while genitourinary fistulas are a rare occurrence. This article reports a rare case of vesicovaginal fistula (VVF) formation in a 27-year-old woman following the placement of a McDonald cervical cerclage. The patient presented with continuous watery vaginal leakage, which began during the last 2 months of her pregnancy. Clinical and cystoscopic examinations revealed the presence of a VVF, which was further confirmed through voiding cystourethrography and perineal magnetic resonance imaging. Notably, the patient had undergone the cerclage procedure 18 months prior to the onset of symptoms, making this case particularly unusual. We believe that the VVF formation was associated with the use of Mersilene tape, which may have slowly eroded through the cervix and subsequently breached the urothelium. This case underscores the importance of considering cerclage-related genitourinary fistulas as potential complications, especially when evaluating and counseling patients who have undergone cervical procedures like the McDonald technique. In conclusion, this case highlights the need for vigilant monitoring and a high index of suspicion in patients presenting with symptoms of genitourinary fistulas after such procedures. Further research and awareness in this area are warranted to better understand the risk factors and mechanisms underlying this unusual complication.
宫颈环扎术是宫颈机能不全妇女预防早产的常用手术。宫颈和膀胱损伤、胎膜早破等并发症已得到充分证实,而泌尿生殖道瘘则很少发生。本文报告了一例罕见的膀胱阴道瘘(VVF)病例,患者为一名 27 岁女性,在放置麦克唐纳宫颈环扎器后形成膀胱阴道瘘。患者在怀孕的最后两个月开始出现持续的水样阴道渗漏。临床和膀胱镜检查显示存在 VVF,排尿膀胱造影和会阴部磁共振成像进一步证实了这一点。值得注意的是,患者在症状出现前 18 个月接受了子宫环扎术,这使得该病例尤为罕见。我们认为,VVF 的形成与 Mersilene 胶带的使用有关,该胶带可能缓慢地侵蚀宫颈,随后突破尿路上皮。本病例强调了将与宫颈相关的泌尿生殖道瘘视为潜在并发症的重要性,尤其是在对接受过宫颈手术(如麦克唐纳技术)的患者进行评估和咨询时。总之,本病例强调了对此类手术后出现泌尿生殖道瘘症状的患者进行警惕性监测和高度怀疑的必要性。为了更好地了解这种不寻常并发症的风险因素和发生机制,有必要在这一领域开展进一步的研究和宣传。
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引用次数: 0
Is suction the future of endourology? Overview from EAU Section of Urolithiasis 抽吸术是腔内泌尿学的未来吗?来自 EAU 尿路结石科的概述
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-22 DOI: 10.1177/17562872241232275
Victoria Jahrreiss, Carlotta Nedbal, Daniele Castellani, Vineet Gauhar, Christian Seitz, Guohua Zeng, Patrick Juliebø-Jones, Etienne Keller, Lazaros Tzelves, Rob Geraghty, Karan Rangarajan, Olivier Traxer, Joe Philip, Andreas Skolarikos, Panagiotis Kallidonis, Ewa Bres-Niewada, Bhaskar Somani
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引用次数: 0
The impact of prognostic group classification on prostate cancer progression in intermediate-risk patients according to the European Association of Urology system: results in 479 patients treated with robot-assisted radical prostatectomy at a single tertiary referral center. 根据欧洲泌尿外科协会系统划分的预后组别对中危患者前列腺癌进展的影响:在一家三级转诊中心接受机器人辅助前列腺癌根治术的479名患者的治疗结果。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-11 eCollection Date: 2024-01-01 DOI: 10.1177/17562872241229260
Antonio Benito Porcaro, Alberto Bianchi, Andrea Panunzio, Sebastian Gallina, Alessandro Tafuri, Emanuele Serafin, Rossella Orlando, Giovanni Mazzucato, Stefano Vidiri, Damiano D'Aietti, Francesca Montanaro, Giulia Marafioti Patuzzo, Francesco Artoni, Alberto Baielli, Francesco Ditonno, Riccardo Rizzetto, Alessandro Veccia, Alessandra Gozzo, Vincenzo De Marco, Matteo Brunelli, Maria Angela Cerruto, Alessandro Antonelli

Background: Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients.

Objectives: To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP).

Design: Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk.

Methods: PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox's proportional hazards, Kaplan-Meyer survival curves, and binomial and multinomial logistic regression models.

Results: After a median (interquartile range) of 35 months (15-57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models.

Conclusion: The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.

背景:中危前列腺癌(PCa)的治疗效果可能会受到不良病理分类(包括肿瘤升级和上分期)的影响。需要改进这类患者疾病进展的临床预测指标:目的:确定PCa预后因素,以确定接受机器人辅助前列腺癌根治术(RARP)治疗的中危患者的预后分组:收集了2013年1月至2020年10月期间接受机器人辅助前列腺癌根治术(RARP)的1143名患者的数据:901名受试者接受了随访,其中479名为中危患者:PCa进展定义为生化复发和/或局部复发和/或远处转移。研究终点通过统计学方法进行评估,包括考克斯比例危险度、卡普兰-迈耶生存曲线、二项式和多项式逻辑回归模型:中位数(四分位数间距)为35个月(15-57个月)后,84名患者(17.5%)出现疾病进展,临床因素中活检阳性核的百分比⩾50%和国际泌尿病理学会(ISUP)3级组可以独立预测疾病进展,病理特征中ISUP>2、手术切缘阳性和盆腔淋巴结侵犯可以独立预测疾病进展。患者在临床和病理上被分为有利组、不利组(一个预后因素)和不利组(一个以上预后因素)。随着各组预后的恶化,PCa恶化的风险也随之增加。因此,随着临床预后的恶化,在未调整模型和调整模型中检测到不利和不良病理预后群组的风险都会增加:结论:这项研究确定了预测疾病进展的因素,从而可以计算出高度相关的预后分组。随着预后的恶化,PCa 进展的风险也在增加。中危PCa需要更多的预后分层来进行适当的治疗。
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引用次数: 0
Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension. 术中细胞挽救技术在治疗伴有 III 和 IV 级下腔静脉血栓扩展的肾肿瘤中的当前作用。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-07 eCollection Date: 2024-01-01 DOI: 10.1177/17562872241229248
Cristian Surcel, Robert Dotzauer, Cristian Mirvald, Calin Popa, Cosmin Olariu, Catalin Baston, Mihai Harza, Constantin Gangu, Igor Tsaur, Ioanel Sinescu

Background: En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications.

Objective: In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest.

Design and method: In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay.

Results: The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood (p < 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056-331.703, p = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062-0.825, p = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases.

Conclusion: Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.

背景:在多学科团队的合作下进行肾脏全切并切除肿瘤血栓仍是治疗肿瘤血栓扩展的肾细胞癌(RCC)的标准方法。为了将手术失血对血流动力学的影响降至最低,术中细胞挽救(IOCS)技术可减少对异体血的需求,并预防输血相关并发症:本文评估了在有或无深低温循环停滞的心肺旁路下进行根治性肾切除术合并下腔静脉血栓切除术时使用 IOCS 的安全性:在这项多中心回顾性对比分析中,数据库收集了2012年至2022年期间在三家转诊医疗机构接受IOCS手术或未接受IOCS手术的27例连续患者的临床特征。同时还记录了异体输血(ABT)需求,即术中或住院期间发生的任何输血:结果:由于重新输注了抢救血液,细胞保存者治疗组的异体输血需求明显减少(P = 0.046]。未使用 IOCS 是降低死亡风险的独立预测因素(OR 0.277,95% CI 0.062-0.825,P = 0.024)。在随访期间,接受挽救血液的患者发生局部复发或远处转移的风险并没有增加:结论:输注自体血是安全的,可在晚期RCC肾切除术和血栓切除术中使用。
{"title":"Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension.","authors":"Cristian Surcel, Robert Dotzauer, Cristian Mirvald, Calin Popa, Cosmin Olariu, Catalin Baston, Mihai Harza, Constantin Gangu, Igor Tsaur, Ioanel Sinescu","doi":"10.1177/17562872241229248","DOIUrl":"10.1177/17562872241229248","url":null,"abstract":"<p><strong>Background: </strong>En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications.</p><p><strong>Objective: </strong>In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest.</p><p><strong>Design and method: </strong>In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay.</p><p><strong>Results: </strong>The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood (<i>p</i> < 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056-331.703, <i>p</i> = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062-0.825, <i>p</i> = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases.</p><p><strong>Conclusion: </strong>Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"16 ","pages":"17562872241229248"},"PeriodicalIF":2.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor. 机器人辅助前列腺癌根治术的肿瘤预后:PSA密度作为术前预测因素的价值。
IF 2.6 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-07 eCollection Date: 2024-01-01 DOI: 10.1177/17562872241229250
Roser Vives Dilme, Juan Gómez Rivas, Laura Fernández Hernández, Irene De la Parra Sánchez, Rafael Sánchez Del Hoyo, María Isabel Galante Romo, Enrique Redondo González, José Luis Senovilla Pérez, Lorena Fernández Montarroso, Jesús Moreno Sierra

Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate.

Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA).

Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months.

Results: PSAD showed a significant association with PSM (p < 0.0001), PSA persistence (p < 0.0001), and Gleason ⩾ 7 (p < 0.0001), without being statistically significant in predicting BCR (p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649).

Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.

背景:对确诊为局部前列腺癌(PCa)的患者进行治疗前评估对于治疗决策至关重要。目前可用的基于前列腺特异性抗原(PSA)、格里森评分和临床分期的分期系统可以确定这些患者的预后特征。有几项研究对术前使用前列腺特异性抗原密度(PSAD)作为进一步风险分层的预后因素进行了评估。迄今为止,PSAD 在这种情况下的作用仍存在争议:本分析旨在评估 PSAD 对机器人辅助前列腺癌根治术(RARP)后不良肿瘤结果的预测潜力,并将其准确性与术前 PSA(pPSA)进行比较:我们回顾性分析了2015年1月至2020年1月期间在一家机构接受RARP手术的427名确诊为局部PCa的患者。通过生成接收器操作者特征曲线(ROC)、计算曲线下面积(AUC)并使用线性回归模型,我们分析了PSAD和pPSA与术后手术切缘阳性(PSM)、Gleason评分⩾ 7、持续PSA和生化复发(BCR)的关系,中位随访时间为47个月:结果:PSAD 与 PSM 有明显相关性(p p p p = 0.098)。PSAD 对 PSA 持续率(AUC 0.727 对 0.771)和 Gleason ⩾ 7(AUC 0.683 对 0.649)结果的预测价值与 pPSA 相当:PSAD是PSM术后肿瘤结局、Gleason评分⩾ 7和PSA持续存在的预测因素。尽管还需要进一步研究,但 PSAD 仍可作为预后参数与既定的分期系统结合使用。
{"title":"Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor.","authors":"Roser Vives Dilme, Juan Gómez Rivas, Laura Fernández Hernández, Irene De la Parra Sánchez, Rafael Sánchez Del Hoyo, María Isabel Galante Romo, Enrique Redondo González, José Luis Senovilla Pérez, Lorena Fernández Montarroso, Jesús Moreno Sierra","doi":"10.1177/17562872241229250","DOIUrl":"10.1177/17562872241229250","url":null,"abstract":"<p><strong>Background: </strong>Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate.</p><p><strong>Objectives: </strong>The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA).</p><p><strong>Design and methods: </strong>We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months.</p><p><strong>Results: </strong>PSAD showed a significant association with PSM (<i>p</i> < 0.0001), PSA persistence (<i>p</i> < 0.0001), and Gleason ⩾ 7 (<i>p</i> < 0.0001), without being statistically significant in predicting BCR (<i>p</i> = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 <i>versus</i> 0.771) and Gleason ⩾ 7 (AUC 0.683 <i>versus</i> 0.649).</p><p><strong>Conclusion: </strong>PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"16 ","pages":"17562872241229250"},"PeriodicalIF":2.6,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Randomized trial of mechanotherapy for the treatment of stress urinary incontinence in women. 机械疗法治疗女性压力性尿失禁的随机试验。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-02-06 eCollection Date: 2024-01-01 DOI: 10.1177/17562872241228023
Nissrine Nakib, Suzette Sutherland, Kevin Hallman, Marcus Mianulli, David R Boulware

Background: Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking.

Objective: To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT).

Design: This was a randomized, controlled, double-blinded trial.

Materials and methods: Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)].

Results: Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (p = <0.0001), with further reduction from 6 to 12 weeks (p = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild p = <0.0001, moderate p = <0.0001, severe p = <0.01). QoL was similarly improved at 6 weeks (ICIQ p = <0.0001, IQOL p = <0.0001), and 12 weeks (ICIQ p = <0.0001, IQOL p = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks.

Conclusion: Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up.

Trial registration: Registered on ClinTrials.gov (NCT02954042).

背景:压力性尿失禁(SUI)表现为与活动相关的意外漏尿。它严重影响生活质量(QoL),是女性最常见的尿失禁类型。目前缺乏治疗方案,尤其是非手术疗法:评估 Flyte® 阴道内装置在盆底肌肉训练(PFMT)过程中提供的机械疗法的疗效:设计:这是一项随机、对照、双盲试验:Flyte 是一种用于调节和增强盆底肌肉(PFMs)的重复使用设备。它提供两部分机械疗法。第一部分是通过内部魔杖对盆底肌进行拉伸和预压。第 2 部分整合了机械脉冲,可引起肌肉细胞和组织水平的反应,从而触发细胞再生,改善神经肌肉促进和运动学习。受试者每天使用该装置 5 分钟,持续 12 周。受试者(144 人)被随机分配,并在 6 周和 12 周时接受评估。A组(72人)接受第一部分和第二部分机械疗法,为期12周;B组(72人)接受第一部分疗法,为期6周,然后转为全面疗法。平均年龄分别为 50 岁和 49 岁,曾接受过盆腔/腹部手术的比例分别为 26% 和 46%,曾接受过尿失禁治疗的比例分别为 13% 和 22%。主要终点是 6 周后的 24 小时尿垫重量(24-HR PW)。次要终点是 12 周时的 24-HR PW 和 QoL [国际尿失禁咨询问卷 (ICIQ)、尿失禁生活质量 (IQOL)]:结果:第一部分疗法的治疗效果高于预期。结果:第一部分疗法的治疗效果超出预期,因此,该研究的力量不足以确定研究臂之间的差异。因此,对数据进行了汇总,以评估机械疗法的效果。6周时,24-HR PW明显减少(6周时减少80%,12周时减少70%):结论:两部分机械疗法可明显改善所有严重程度 SUI 的 24-HR PW 和 QoL。试验注册:试验注册:已在 ClinTrials.gov (NCT02954042) 上注册。
{"title":"Randomized trial of mechanotherapy for the treatment of stress urinary incontinence in women.","authors":"Nissrine Nakib, Suzette Sutherland, Kevin Hallman, Marcus Mianulli, David R Boulware","doi":"10.1177/17562872241228023","DOIUrl":"10.1177/17562872241228023","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking.</p><p><strong>Objective: </strong>To assess the efficacy of mechanotherapy provided by the Flyte<sup>®</sup> intra-vaginal device during pelvic floor muscle training (PFMT).</p><p><strong>Design: </strong>This was a randomized, controlled, double-blinded trial.</p><p><strong>Materials and methods: </strong>Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)].</p><p><strong>Results: </strong>Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (<i>p</i> = <0.0001), with further reduction from 6 to 12 weeks (<i>p</i> = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild <i>p</i> = <0.0001, moderate <i>p</i> = <0.0001, severe <i>p</i> = <0.01). QoL was similarly improved at 6 weeks (ICIQ <i>p</i> = <0.0001, IQOL <i>p</i> = <0.0001), and 12 weeks (ICIQ <i>p</i> = <0.0001, IQOL <i>p</i> = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks.</p><p><strong>Conclusion: </strong>Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up.</p><p><strong>Trial registration: </strong>Registered on ClinTrials.gov (NCT02954042).</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"16 ","pages":"17562872241228023"},"PeriodicalIF":2.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10848796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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