Therapeutic Advances in Urology最新文献

Traumatic ureteral injury is a rare and challenging condition of the urinary system. To summarize the clinical features of patients with traumatic ureteral injury and examine the literature on traumatic ureteral injuries from the past 20 years. The clinical data of 30 patients with traumatic ureteral injury in Peking University First Hospital, Beijing Jiangong Hospital, as well as Emergency General Hospital from August 2015 to August 2023 were retrospectively collected. The clinical characteristics, management strategies, and follow-up outcomes were analyzed, and a review of the literature on traumatic ureteral injury from the past 20 years was conducted. The traumatic types in the case series was composed of sharp injury, impact injury, and falling injury, with 9, 16, and 5 cases, respectively. Ureteral injury was diagnosed immediately in 12 cases, while 18 cases had a delayed diagnosis. Besides, the median time from ureteral injury to operations was 8.5 months (IQR: 4-13 months) in the patients who received upper urinary tract repair surgery, including ureteral stenting in one case, ureteroureterostomy in four cases, pyeloplasty in two cases, lingual mucosal graft ureteroplasty in one case, ileal ureter replacement in five cases, and nephrectomy in one cases. The mean follow-up time is 39.1 ± 24.8 months. Concerning renal function, postoperative creatinine was substantially lower than preoperative one (78.6 ± 13.7 µmol/L vs 88.8 ± 17.0 µmol/L, p = 0.0009), and postoperative urea was significantly lower than preoperative one (4.6 ± 1.6 µmol/L vs 5.9 ± 1. 3 mmol/L, p = 0.0016). Traumatic ureteral injury is challenging to recognize due to its deep anatomical location, making timely diagnosis crucial. It is important to choose an appropriate reconstruction method based on severity, location, length to restore urinary tract continuity as early as possible.

The advancements of technological devices and software are putting mixed reality in the frontline of teaching medical personnel. The Microsoft^® HoloLens 2^® offers a unique 3D visualization of a hologram in a physical, real environment and allows the urologists to interact with it. This review provides a state-of-the-art analysis of the applications of the HoloLens^® in a medical and healthcare context of teaching through simulation designed for medical students, nurses, residents especially in urology. Our objective has been to perform a comprehensively analysis of the studies in PubMed/Medline database from January 2016 to April 2023. The identified articles that researched Microsoft HoloLens, having description of feasibility and teaching outcomes in medicine with an emphasize in urological healthcare, have been included. The qualitative analysis performed identifies an increasing use of HoloLens in a teaching setting that covers a great area of expertise in medical sciences (anatomy, anatomic pathology, biochemistry, pharmacogenomics, clinical skills, emergency medicine and nurse education, imaging), and above these urology applications (urological procedures and technique, skill improvement, perception of complex renal tumors, accuracy of calyx puncture guidance in percutaneous nephrolithotomy and targeted biopsy of the prostate) can mostly benefit from it. The future potential of HoloLens technology in teaching is immense. So far, studies have focused on feasibility, applicability, perception, comparisons with traditional methods, and limitations. Moving forward, research should also prioritize the development of applications specifically for urology. This will require validation of needs and the creation of adequate protocols to standardize future research efforts.

What is this summary about? This is a plain language summary of an article published in the journal Clinical Pharmacology in Drug Development. It is about a study of a medicine called vibegron. Vibegron is approved by the US Food and Drug Administration (also called the FDA) to treat overactive bladder, also known as OAB. It may be easier for people with swallowing issues to take a pill by crushing it and mixing it with applesauce instead of swallowing it whole. Researchers did this study to find out if vibegron could be safely crushed and mixed with applesauce. Participants took vibegron that was either crushed or intact, and researchers compared how much vibegron made it into the bloodstream over time. The researchers asked whether people who took crushed vibegron had more unwanted medical events (called adverse events) than people who took vibegron as an intact pill. What were the results? Crushed vibegron tablets did not change in applesauce for 4 h at room temperature. Just over half of the participants (53%) said that the taste was not different than expected. The amount of vibegron in blood over time was similar between those who took crushed vibegron and those who took intact vibegron. The most common adverse events were headache, constipation, and nausea. No participant experienced a serious adverse event during the study, meaning that no adverse events required hospital care or caused permanent damage or disability. Adverse events that might be related to vibegron occurred in seven participants (23%) after they took crushed vibegron and six participants (20%) after they took the intact pill. What do the results mean? The results of this study show that vibegron can be crushed and taken with applesauce without increases in adverse events compared to taking the intact pill. Crushed vibegron did not change in applesauce and the amount of vibegron in blood over time was similar when vibegron was crushed in applesauce or taken whole. This means that people may take vibegron as a crushed or intact pill for overactive bladder. This may be particularly important for people with difficulty swallowing. Who should read this article? This article is for people with overactive bladder symptoms who have a hard time swallowing pills. It may also be helpful for their families and care partners, and for health care professionals who care for people with overactive bladder. Where can I find the original article on which this summary is based? The original article is called "Pharmacokinetics and Safety of Vibegron 75 mg Administered as an Intact or Crushed Tablet in Healthy Adults." You can read the original article published in Clinical Pharmacology in Drug Development at this link: • https://accp1.onlinelibrary.wiley.com/doi/10.1002/cpdd.1169.

Objective: This study evaluates surgical outcomes in benign prostatic hyperplasia (BPH) patients undergoing transurethral enucleation using various holmium laser (HoLEP) settings and/or bipolar devices (BipoLEP).

Design: This study was retrospective.

Methods: We retrospectively analyzed 158 BPH patients treated surgically, categorized by method: BipoLEP (n = 28), HoLEP with short pulse (HoLEP-SP, n = 26), HoLEP with long pulse and low energy (HoLEP-LP/LE, n = 29), HoLEP with long pulse and high energy (HoLEP-LP/HE, n = 26), HoLEP using Moses technology (HoLEP-Mo, n = 19), and a combination of HoLEP and BipoLEP (HoLEP-mix, n = 30). We assessed enucleation, morcellation, coagulation, and overall operation efficiency, along with complications at immediate, 2-week, and 3-month postoperative intervals.

Results: The HoLEP-LP/LE group exhibited the highest overall operation efficiency (p < 0.05). The BipoLEP and HoLEP-SP groups had lower enucleation efficiency (p < 0.05). HoLEP-LP/LE and BipoLEP showed superior coagulation efficiency (p < 0.05). Excluding hard nodule cases, the HoLEP-mix group had reduced morcellation efficiency compared to HoLEP-LP/LE (p < 0.05). Complication rates did not significantly differ between groups (p > 0.05).

Conclusion: The HoLEP-LP/LE procedure demonstrated superior performance in enucleation, morcellation, coagulation, and overall operation efficiency. Complication rates were comparable across all groups. BipoLEP, while less efficient in enucleation than some HoLEP settings, proved effective and safe. In addition, the Moses technology may offer enhanced bleeding control.

In this paper, we explore the usage of decision aids, patient information leaflets (PILs), videos, social media and modern technology to empower patients and enable shared decision-making (SDM). It explores the role of enhanced consent processes in urology. A re-evaluation of the conventional consent process is required towards more patient-centred care and SDM, which prioritises patient education and understanding of their medical conditions and treatment pathways. The use of decision aids, such as multimedia resources and PILs, is crucial in enhancing patients' understanding, level of satisfaction, quality of life and healthcare utilisation. New tools are opening exciting possibilities for patient education and information distribution, such as Chat Generative Pre-Trained Transformer (ChatGPT). The effectiveness of ChatGPT in comparison to well-established PILs is still up for debate, despite the fact that it makes information easily accessible. Improving patients' involvement, understanding and engagement in SDM procedures relies heavily on decision aids, PILs and current technological integration. Patients and healthcare practitioners should work together in accordance with the principles of SDM, which include considering patients' values, backgrounds, priorities and preferences when making treatment decisions. The emphasis on patient-centred care has prompted a re-evaluation of traditional consent processes in urology, with more emphasis on the shared decision-making process. Several informative aids are currently available as reported in the literature, ranging from 3D models, multimedia presentations and virtual reality (VR) devices. While the costs of these tools might be substantial, the advantages of adopting such informative resources are unmistakable. Social media and platforms such as patient-physician blogs are increasingly popular sources of medical information. Urologists should embrace these platforms to enhance patient engagement and the quality of information provided. Despite recent progress, there remains significant room for improvement in patient education and engagement which is achievable via concerted efforts of a wider medical community.

Background: Many metastatic prostate cancer prognostics have been suggested, but few are validated. Nodal metastasis burden and baseline biochemical characteristics are overlooked in the currently accepted stratifications for metastatic hormone-sensitive prostate cancer (mHSPC). Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is likely to increase the incidence of pelvic nodal and mHSPC undetected by conventional scans. However, there is no consensus on managing regional nodal metastasis (N1M0) and no separate guidelines for non-regional nodal (M1a) and low-volume bone (M1b) spread but collectively as a part of low-volume CHAARTED disease.

Objectives: To assess the different prognostic factors for stage IV disease classified as CHAARTED low-volume on a real-world series of patients and to examine treatment preference for each of the disease subcategories.

Methods and design: This retrospective cross-sectional study included patients diagnosed with HSPC at stage IV, with low-volume disease according to the CHAARTED criteria. Data were collected from the database of Portsmouth and St. Mary NHS Hospitals between February 2017 and August 2023. Patient characteristics were analysed, and prognostic factors were evaluated using Cox regression analysis. 5-year progression-free survival (PFS) was the primary outcome measure.

Results: Data on 126 patients were analysed. Seven patients (6%) had N1M0, 28 (22%) M1a, and 91 (72%) M1b. 5-year PFS was 80.9% for M1a and 54.9% for M1b metastases, p = 0.3. High prostate-specific antigen (PSA) value (⩾25) was identified as an independent prognostic factor for PFS with HR = 2.80 (95% CI: 1.19-6.56), p = 0.0179. Variable treatment preference for each subclass reflects the uncertainty regarding the best regimen and the importance of consolidation prostate radiotherapy (cRT) in clinical practice.

Conclusion: Early results of our data analysis underscore the significance of baseline PSA as an independent prognostic factor alongside anatomical tumour extent of spread in stage IV low-volume metastasis prostate cancer. There is no agreement on treatment for each subcategory, necessitating further real-world studies and clinical trials. Further follow-up would assess the prognostic benefit of cRT.

Background and objectives: Intermittent androgen deprivation therapy (iADT) may result in measurable improvements in quality of life over continuous ADT in patients with advanced prostate cancer (aPC). Here, we studied time to castration and testosterone recovery in real-world patients with aPC undergoing iADT with relugolix.

Methods and design: Eligibility criteria for this retrospective study were histologically confirmed through the diagnosis of aPC and initiation of iADT with relugolix. Primary endpoints were time to castrate level of testosterone after relugolix initiation and time to recovery to noncastrate levels after relugolix discontinuation.

Results: Overall, 25 patients with aPC were treated with iADT and with relugolix. Median time to serum testosterone <50 ng/dL was 1.13 months [range 0.67-2.5 months]. The median time to recovery >50 ng/dL was 1.4 months [range 0.83-6.57 months] from holding treatment with relugolix.

Conclusion: iADT with relugolix is associated with a rapid time to testosterone suppression and recovery. These results may guide patients' counseling and monitoring of serum testosterone and PSA levels in patients wishing to pursue iADT for aPC.

Background: Cystitis glandularis is a chronic inflammatory disease of the urinary system characterized by high recurrence rates, the reasons for which are still unknown.

Objectives: This study aims to identify potential factors contributing to recurrence and propose a simple and feasible prognostic model through nomogram construction.

Design: Patients with confirmed recurrence based on outpatient visits or readmissions were included in this study, which was subsequently divided into training and validation cohorts.

Methods: Machine learning techniques were utilized to screen for the most important predictors, and these were then employed to construct the nomogram. The reliability of the nomogram was assessed through receiver operating characteristic curve analysis, decision curve analysis, and calibration curves.

Results: A total of 252 patients met the screening criteria and were enrolled in this study. Over the 12-month follow-up period, the relapse rate was found to be 57.14% (n = 144). The five final predictors identified through machine learning were urinary infections, urinary calculi, eosinophil count, lymphocyte count, and serum magnesium. The area under curve values for all three time points assessing recurrence exceeded 0.75. Furthermore, both calibration curves and decision curve analyses indicated good performance of the nomogram.

Conclusion: We have developed a reliable machine learning-based nomogram for predicting recurrence in cystitis glandularis.

Background: The Penuma is a soft silicone penile implant designed for cosmetic enhancement of the flaccid penis in men who have normal erections.

Objectives: The goal of this study is to report outcomes on patient satisfaction at least 6 months after Penuma subcutaneous penile implant for cosmetic enhancement of the penis, and to determine if modifications in surgical approach resulted in reduction in postoperative complications.

Design: Penile measurements, adverse events, and patient satisfaction were compared between patients undergoing the new lateral scrotal incision versus the traditional infrapubic approach.

Methods: A retrospective chart review was performed on all patients who underwent a Penuma implant by a single surgeon from April 2019 to December 2022. A 26-item non-validated device-specific questionnaire was sent to patients at least 6 months after the date of their initial surgery.

Results: A total of 92 cases were performed by a single surgeon. The average increase in flaccid length was 2.5 cm (±2.2), representing a 44% increase (p < 0.01). The average increase in girth was 3.1 cm (±1.8 cm), a 32% change (p < 0.01). Seroma requiring drainage occurred in 12%. 7% of patients required operative revision of the implant. When assessed by surgical approach, the revision rate was significantly higher in infrapubic patients (13% vs 2%, p < 0.05). The implant removal rate was also significantly higher when the infrapubic approach was used (21% vs 6%, p < 0.05). 82% of patients reported being satisfied or very satisfied with their postoperative penile appearance. 75% of patients would undergo surgery again.

Conclusion: The subcutaneous Penuma penile implant appears to improve satisfaction with regard to the appearance of the penis and is a viable option for men who desire to enhance flaccid penile length and girth. Furthermore, the lateral scrotal surgical approach appears to have a lower postoperative complication rate.

Background: Artificial urinary sphincter (AUS) placement remains the gold-standard treatment for post-prostatectomy urinary incontinence (PPUI), despite their need for periodic surgical revision.

Objective: To understand the experiences of patients who undergo repeat AUS revisions.

Design: Mixed design including quantitative surveys and qualitative interviews for thematic analysis.

Methods: Men with ⩾2 revisions were collected from a single-institution, retrospective database of AUS patients. Participants were interviewed about their prostatectomy, incontinence, AUS placement, and revisions. A survey was administered utilizing validated tools (e.g., Decision Regret Scale (DRS), Incontinence Impact Questionnaire-7) for quantitative analysis. Interview transcripts were used for qualitative thematic analysis.

Results: Of 26 respondents, 20 completed the interview. Twenty-three men completed the survey. The mean DRS score for prostatectomy was 24 (standard deviation (SD) = 27), indicating low regret. Median Incontinence Impact Questionnaire score was 54 (SD = 27), with 70% of participants describing their PPUI as "severe." Participants experienced a significant decrease in daily pad usage with AUS placement (5.5 pre-AUS vs 1.4 post-AUS, p < 0.0001). Qualitative analysis revealed themes involving prostatectomy urgency, physician-patient relationships, expectation setting, and quality of follow-up. Most participants (96%) were satisfied with their initial AUS placement and endorsed a positive relationship with their urologist. However, 22% of participants were unaware of device limitations, including the need for revision. Some participants (26%) were uncertain of the status of their AUS, while some participants (35%) desired improved follow-up.

Conclusions: Initial improvement and positive experiences with urologists motivate patients to undergo AUS repeat revision. Urologists should emphasize the limitations of the AUS before placement and follow up with patients to evaluate their needs for future care.