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Paediatric kidney stone surgery: state-of-the-art review. 儿科肾结石手术:最新的回顾。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231159541
Patrick Juliebø-Jones, Etienne Xavier Keller, Lazaros Tzelves, Christian Beisland, Bhaskar K Somani, Peder Gjengstø, Mathias Sørstrand Æsøy, Øyvind Ulvik

While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.

虽然儿童尿石症很少见,但全球发病率正在上升,微创手术的数量反映了这一点。该技术已经取得了许多进展,为这些干预措施的进步提供了支持。然而,这种创新也导致了广泛的实践模式和关于如何最好地实施它们的争论。除此之外,在治疗儿童结石疾病时还面临着额外的挑战,因为儿童患者群体通常有更多的合并症,例如,需要避免电离暴露等风险。总体结果是围绕儿科结石手术的许多方面的挑战和争议,如影像学选择,随访和不同的治疗选择,例如医学排出治疗,冲击波碎石术,输尿管镜检查和经皮肾镜取石术。本文概述了目前儿科结石手术的现状,并讨论了争论的关键话题。
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引用次数: 2
Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques. 当代男性压力性尿失禁的吊带:设备技术的进步和手术技术的改进。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231187199
Eric Chung

Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.

合成男性吊带(MS)被认为是恢复男性压力性尿失禁的有效手术治疗方法。现代多发性硬化症可分为可调节型或不可调节型,而手术技术可分为耻骨后入路或经闭孔入路。这篇叙述性综述文章评估了当前商业市场上关于临床结果和手术技术改进的当代MS设备。设备设计和技术的科学进步,再加上手术的进一步改进,将增强临床结果,提高MS手术的安全性。新一代的现代MS不仅可以直接压迫球尿道,还可以通过重新调整可移动的括约肌复合体来提供进一步的尿道括约肌复合体配合,从而实现尿道近端移位。严格的患者选择,使用有临床记录的MS,遵守安全的手术原则和明智的术后护理是确保高控制率,良好的患者满意度和低术后并发症的关键。
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引用次数: 0
State-of-art review of current malleable penile prosthesis devices in the commercial market. 目前商业市场上可塑阴茎假体的现状综述。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231179008
Eric Chung, Juan Wang

The malleable penile implant is often considered an inferior device to the three-piece inflatable penile prosthesis implant. Nonetheless, the malleable prosthesis has its unique advantages such as lower cost, easier to perform and fewer mechanical complications than inflatable prostheses. Furthermore, its role can be extended to patients with issues relating to poor manual hand dexterity, those undergoing a salvage for infection prosthesis and as an emergency surgical measure in patients presenting with acute ischaemic priapism. Over the past few decades, there have been numerous design and technological advancements to improve overall clinical efficacy, mechanical durability, axial rigidity and device concealability of malleable penile prostheses. The following article provides a narrative review of the six major contemporary malleable penile prosthesis devices in the commercial market, namely, the Coloplast Genesis prosthesis, the Boston Scientific Tactra prosthesis, the Zephyr ZSI 100 and 100 (female-to-male) FTM devices, the Rigi10 prosthesis, the TUBE malleable prosthesis and the Shah prosthesis and evaluates the published outcomes. Appropriate patient selection and strict counselling regarding what to expect with malleable prostheses coupled with adherence to safe surgical principles are paramount to ensure excellent clinical success and patient satisfaction rates.

可塑阴茎植入物通常被认为是三件套式充气阴茎植入物的次等装置。然而,可塑假体比可充气假体有其独特的优点,如成本低、操作简单、机械并发症少。此外,它的作用可以扩展到与手灵巧性差有关的患者,那些正在进行感染假体抢救的患者,以及急性缺血性阴茎勃起症患者的紧急手术措施。在过去的几十年里,有许多设计和技术进步,以提高整体临床疗效,机械耐用性,轴向刚度和装置隐蔽性。以下文章对商业市场上的六种主要的可延展性阴茎假体进行了叙述回顾,即Coloplast Genesis假体,Boston Scientific Tactra假体,Zephyr ZSI 100和100(女对男)FTM假体,Rigi10假体,TUBE可延展性假体和Shah假体,并评估了已发表的结果。适当的患者选择和严格的咨询,关于什么期望与延展性假体加上遵守安全的手术原则是至关重要的,以确保良好的临床成功和患者满意度。
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引用次数: 0
Bispecific PSMA antibodies and CAR-T in metastatic castration-resistant prostate cancer. 转移性去势抵抗性前列腺癌的双特异性PSMA抗体和CAR-T。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231182219
Kevin K Zarrabi, Vivek Narayan, Patrick J Mille, Matthew R Zibelman, Benjamin Miron, Babar Bashir, William Kevin Kelly

Prostate cancer is the most common cancer among men and the second leading cause of cancer-related deaths in men in the United States. The treatment paradigm for prostate cancer has evolved with the emergence of a variety of novel therapies which have improved survival; however, treatment-related toxicities are abundant and durable responses remain rare. Immune checkpoint inhibitors have shown modest activity in a small subset of patients with prostate cancer and have not had an impact on most men with advanced disease. The discovery of prostate-specific membrane antigen (PSMA) and the understanding of its specificity to prostate cancer has identified it as an ideal tumor-associated antigen and has revived the enthusiasm for immunotherapeutics in prostate cancer. T-cell immunotherapy in the form of bispecific T-cell engagers (BiTEs) and chimeric antigen receptor (CAR) T-cell therapy have shown exceptional success in treating various hematologic malignancies, and are now being tested in patients with prostate cancer with drug design centered on various target ligands including not just PSMA, but others as well including six-transmembrane epithelial antigen of the prostate 1 (STEAP1) and prostate stem cell antigen (PSCA). This summative review will focus on the data surrounding PSMA-targeting T-cell therapies. Early clinical studies with both classes of T-cell redirecting therapies have demonstrated antitumor activity; however, there are multiple challenges with this class of agents, including dose-limiting toxicity, 'on-target, off-tumor' immune-related toxicity, and difficulty in maintaining sustained immune responses within a complex and overtly immunosuppressive tumor microenvironment. Reflecting on experiences from recent trials has been key toward understanding mechanisms of immune escape and limitations in developing these drugs in prostate cancer. Newer generation BiTE and CAR T-cell constructs, either alone or as part of combination therapy, are currently under investigation with modifications in drug design to overcome these barriers. Ongoing innovation in drug development will likely foster successful implementation of T-cell immunotherapy bringing transformational change to the treatment of prostate cancer.

前列腺癌是男性中最常见的癌症,也是美国男性癌症相关死亡的第二大原因。前列腺癌的治疗模式随着各种新疗法的出现而发展,这些新疗法提高了生存率;然而,治疗相关的毒性是丰富的,持久的反应仍然罕见。免疫检查点抑制剂在一小部分前列腺癌患者中显示出适度的活性,对大多数晚期前列腺癌患者没有影响。前列腺特异性膜抗原(PSMA)的发现及其对前列腺癌特异性的理解,使其成为一种理想的肿瘤相关抗原,并重新激发了前列腺癌免疫治疗的热情。双特异性t细胞接合体(BiTEs)和嵌合抗原受体(CAR) t细胞疗法形式的t细胞免疫疗法在治疗各种血液系统恶性肿瘤方面取得了非凡的成功,现在正在前列腺癌患者中进行药物设计的测试,这些药物设计以各种靶配体为中心,不仅包括PSMA,还包括前列腺1的六跨膜上皮抗原(STEAP1)和前列腺干细胞抗原(PSCA)。这篇综述将重点关注围绕psma靶向t细胞治疗的数据。两类t细胞重定向疗法的早期临床研究都显示出抗肿瘤活性;然而,这类药物存在多重挑战,包括剂量限制性毒性,“靶标上,肿瘤外”免疫相关毒性,以及难以在复杂和明显免疫抑制的肿瘤微环境中维持持续的免疫反应。反思近期试验的经验是理解免疫逃逸机制和开发前列腺癌药物的局限性的关键。新一代的BiTE和CAR - t细胞结构,无论是单独治疗还是作为联合治疗的一部分,目前正在研究修改药物设计以克服这些障碍。药物开发的持续创新可能会促进t细胞免疫疗法的成功实施,为前列腺癌的治疗带来翻天覆地的变化。
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引用次数: 0
The role of mean corpuscular volume and red cell distribution width in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: the MARECAP retrospective study. 平均红细胞体积和红细胞分布宽度在接受酪氨酸激酶抑制剂治疗的转移性肾癌患者中的作用:MARECAP回顾性研究
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231187216
Chiara Tommasi, Giulia Scartabellati, Diana Giannarelli, Ugo De Giorgi, Nicole Brighi, Giuseppe Fornarini, Sara Elena Rebuzzi, Silvia Puglisi, Orazio Caffo, Stefania Kinspergher, Alessia Mennitto, Carlo Cattrini, Matteo Santoni, Elena Verzoni, Alessandro Rametta, Marco Stellato, Andrea Malgeri, Giandomenico Roviello, Matteo Brunelli, Sebastiano Buti

Background: Tyrosine-kinase inhibitors (TKIs) and immunotherapy represent the backbone treatment for metastatic renal cell carcinoma (mRCC) patients. The aim of the present study was to describe mean corpuscular volume (MCV) and red cell distribution width (RDW) in mRCC patients treated with pazopanib or cabozantinib, and to explore their potential impact on oncological outcomes.

Materials and methods: We conducted a multicenter retrospective observational study in mRCC patients treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Descriptive statistics, univariate, and multivariate analyses were performed.

Objectives: The primary endpoints were the incidence and trend over time of anemia, macrocytosis (elevated MCV), and anisocytosis (elevated RDW). The secondary endpoints were the correlations of MCV and RDW with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS).

Results: A total of 301 patients were enrolled; mean Hb value was 12.5 g/dl, a mean increase of 1 g/dl was observed at day 15 and maintained at 3 months. Most patients had baseline macrocytosis (MCV levels > 87 fl), with a significant mean increase after 3 months of treatment. At univariate analysis patients with macrocytosis had better ORR, longer PFS, and OS. About one third of patients had baseline anisocytosis (RDW > 16%), with a significant mean increase after 3 months of treatment. At univariate analysis, patients with RDW values ⩽ 16% had higher ORR, longer PFS, and OS. At multivariate analysis, baseline macrocytosis was significantly associated with better PFS in patients treated with pazopanib and baseline anisocytosis with shorter OS in all patients.

Conclusions: mRCC patients treated with pazopanib or cabozantinib may have baseline macrocytosis and anisocytosis. A significant increase of Hb, MCV, and RDW after TKIs start was observed. Baseline macrocytosis is positively correlated with PFS in patients treated with pazopanib and baseline anisocytosis affects survival of patients treated with TKIs.

背景:酪氨酸激酶抑制剂(TKIs)和免疫治疗是转移性肾细胞癌(mRCC)患者的主要治疗方法。本研究的目的是描述parazopanib或cabozantinib治疗的mRCC患者的平均红细胞体积(MCV)和红细胞分布宽度(RDW),并探讨它们对肿瘤预后的潜在影响。材料和方法:2012年1月至2020年12月,我们在意大利9个中心对接受帕唑帕尼或卡博赞替尼治疗的mRCC患者进行了一项多中心回顾性观察研究。进行描述性统计、单变量和多变量分析。目的:主要终点是贫血、巨噬细胞增多(MCV升高)和细胞异数增多(RDW升高)的发生率和随时间变化的趋势。次要终点是MCV和RDW与客观缓解率(ORR)、无进展生存期(PFS)和总生存期(OS)的相关性。结果:共入组301例患者;平均Hb值为12.5 g/dl,在第15天平均增加1 g/dl,并在3个月时保持不变。大多数患者有基线巨噬细胞增多(MCV水平> 87 fl),治疗3个月后显著增加。在单因素分析中,巨细胞增多症患者有更好的ORR,更长的PFS和OS。大约三分之一的患者有基线细胞异位(RDW > 16%),治疗3个月后显著增加。在单因素分析中,RDW值≥16%的患者有更高的ORR,更长的PFS和OS。在多变量分析中,在接受帕唑帕尼治疗的患者中,基线大量细胞增多与更好的PFS显著相关,而在所有患者中,基线细胞增多与更短的OS显著相关。结论:接受帕唑帕尼或卡博赞替尼治疗的mRCC患者可能出现大量细胞增多和细胞异数增多。观察到TKIs开始后Hb、MCV和RDW显著增加。在接受帕唑帕尼治疗的患者中,基线大量细胞增多与PFS呈正相关,基线细胞增多影响TKIs患者的生存。
{"title":"The role of mean corpuscular volume and red cell distribution width in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: the MARECAP retrospective study.","authors":"Chiara Tommasi,&nbsp;Giulia Scartabellati,&nbsp;Diana Giannarelli,&nbsp;Ugo De Giorgi,&nbsp;Nicole Brighi,&nbsp;Giuseppe Fornarini,&nbsp;Sara Elena Rebuzzi,&nbsp;Silvia Puglisi,&nbsp;Orazio Caffo,&nbsp;Stefania Kinspergher,&nbsp;Alessia Mennitto,&nbsp;Carlo Cattrini,&nbsp;Matteo Santoni,&nbsp;Elena Verzoni,&nbsp;Alessandro Rametta,&nbsp;Marco Stellato,&nbsp;Andrea Malgeri,&nbsp;Giandomenico Roviello,&nbsp;Matteo Brunelli,&nbsp;Sebastiano Buti","doi":"10.1177/17562872231187216","DOIUrl":"https://doi.org/10.1177/17562872231187216","url":null,"abstract":"<p><strong>Background: </strong>Tyrosine-kinase inhibitors (TKIs) and immunotherapy represent the backbone treatment for metastatic renal cell carcinoma (mRCC) patients. The aim of the present study was to describe mean corpuscular volume (MCV) and red cell distribution width (RDW) in mRCC patients treated with pazopanib or cabozantinib, and to explore their potential impact on oncological outcomes.</p><p><strong>Materials and methods: </strong>We conducted a multicenter retrospective observational study in mRCC patients treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Descriptive statistics, univariate, and multivariate analyses were performed.</p><p><strong>Objectives: </strong>The primary endpoints were the incidence and trend over time of anemia, macrocytosis (elevated MCV), and anisocytosis (elevated RDW). The secondary endpoints were the correlations of MCV and RDW with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS).</p><p><strong>Results: </strong>A total of 301 patients were enrolled; mean Hb value was 12.5 g/dl, a mean increase of 1 g/dl was observed at day 15 and maintained at 3 months. Most patients had baseline macrocytosis (MCV levels > 87 fl), with a significant mean increase after 3 months of treatment. At univariate analysis patients with macrocytosis had better ORR, longer PFS, and OS. About one third of patients had baseline anisocytosis (RDW > 16%), with a significant mean increase after 3 months of treatment. At univariate analysis, patients with RDW values ⩽ 16% had higher ORR, longer PFS, and OS. At multivariate analysis, baseline macrocytosis was significantly associated with better PFS in patients treated with pazopanib and baseline anisocytosis with shorter OS in all patients.</p><p><strong>Conclusions: </strong>mRCC patients treated with pazopanib or cabozantinib may have baseline macrocytosis and anisocytosis. A significant increase of Hb, MCV, and RDW after TKIs start was observed. Baseline macrocytosis is positively correlated with PFS in patients treated with pazopanib and baseline anisocytosis affects survival of patients treated with TKIs.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231187216"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/0c/10.1177_17562872231187216.PMC10363886.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10252089","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: 2
Diagnostic and therapeutic value of biomarkers in urosepsis. 生物标志物在尿脓毒症中的诊断和治疗价值。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231151852
Yuyun Wu, Guang Wang, Ziye Huang, Bowei Yang, Tongxin Yang, Jianhe Liu, Pei Li, Jiongming Li

Urosepsis is sepsis caused by urogenital tract infection and is one of the most common critical illnesses in urology. If urosepsis is not diagnosed early, it can rapidly progress and worsen, leading to increased mortality. In recent years, with the increase of urinary tract surgery, the incidence of urosepsis continues to rise, posing a serious threat to patients. Early diagnosis of urosepsis, timely and effective treatment can greatly reduce the mortality of patients. Biomarkers such as WBC, NLR, PCT, IL-6, CRP, lactate, and LncRNA all play specific roles in the early diagnosis or prognosis of urosepsis. In addition to the abnormal increase of WBC, we should be more alert to the rapid decline of WBC. NLR values were superior to WBC counts alone in predicting infection severity. Compared with several other biomarkers, PCT values can differentiate between bacterial and non-bacterial sepsis. IL-6 always has high sensitivity and specificity for the diagnosis of sepsis, and CRP also has high sensitivity and specificity for the diagnosis of urosepsis. Lactic acid is closely related to the prognosis of patients with urosepsis. LncRNAs may be potential biomarkers of urosepsis. This article summarizes the main biomarkers, hoping to provide a reference for the timely diagnosis and evaluation of urosepsis.

尿脓毒症是由泌尿生殖道感染引起的脓毒症,是泌尿外科最常见的危重疾病之一。如果尿脓毒症没有得到早期诊断,它可以迅速发展和恶化,导致死亡率增加。近年来,随着尿路手术的增多,尿脓毒症的发病率不断上升,对患者构成严重威胁。尿脓毒症的早期诊断、及时有效的治疗可大大降低患者的死亡率。WBC、NLR、PCT、IL-6、CRP、乳酸、LncRNA等生物标志物在尿脓毒症的早期诊断或预后中都有特定的作用。除了白细胞的异常升高外,我们更应该警惕白细胞的快速下降。NLR值在预测感染严重程度方面优于单纯白细胞计数。与其他几种生物标志物相比,PCT值可以区分细菌性和非细菌性脓毒症。IL-6对脓毒症的诊断始终具有较高的敏感性和特异性,CRP对尿脓毒症的诊断也具有较高的敏感性和特异性。乳酸与尿脓毒症患者的预后密切相关。lncrna可能是尿脓毒症的潜在生物标志物。本文就尿脓毒症的主要生物标志物进行综述,以期为尿脓毒症的及时诊断和评价提供参考。
{"title":"Diagnostic and therapeutic value of biomarkers in urosepsis.","authors":"Yuyun Wu,&nbsp;Guang Wang,&nbsp;Ziye Huang,&nbsp;Bowei Yang,&nbsp;Tongxin Yang,&nbsp;Jianhe Liu,&nbsp;Pei Li,&nbsp;Jiongming Li","doi":"10.1177/17562872231151852","DOIUrl":"https://doi.org/10.1177/17562872231151852","url":null,"abstract":"<p><p>Urosepsis is sepsis caused by urogenital tract infection and is one of the most common critical illnesses in urology. If urosepsis is not diagnosed early, it can rapidly progress and worsen, leading to increased mortality. In recent years, with the increase of urinary tract surgery, the incidence of urosepsis continues to rise, posing a serious threat to patients. Early diagnosis of urosepsis, timely and effective treatment can greatly reduce the mortality of patients. Biomarkers such as WBC, NLR, PCT, IL-6, CRP, lactate, and LncRNA all play specific roles in the early diagnosis or prognosis of urosepsis. In addition to the abnormal increase of WBC, we should be more alert to the rapid decline of WBC. NLR values were superior to WBC counts alone in predicting infection severity. Compared with several other biomarkers, PCT values can differentiate between bacterial and non-bacterial sepsis. IL-6 always has high sensitivity and specificity for the diagnosis of sepsis, and CRP also has high sensitivity and specificity for the diagnosis of urosepsis. Lactic acid is closely related to the prognosis of patients with urosepsis. LncRNAs may be potential biomarkers of urosepsis. This article summarizes the main biomarkers, hoping to provide a reference for the timely diagnosis and evaluation of urosepsis.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231151852"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/85/10.1177_17562872231151852.PMC9893402.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215692","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: 3
Artificial intelligence and radiomics in evaluation of kidney lesions: a comprehensive literature review. 人工智能和放射组学在肾脏病变评估中的应用:综合文献综述。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231164803
Matteo Ferro, Felice Crocetto, Biagio Barone, Francesco Del Giudice, Martina Maggi, Giuseppe Lucarelli, Gian Maria Busetto, Riccardo Autorino, Michele Marchioni, Francesco Cantiello, Fabio Crocerossa, Stefano Luzzago, Mattia Piccinelli, Francesco Alessandro Mistretta, Marco Tozzi, Luigi Schips, Ugo Giovanni Falagario, Alessandro Veccia, Mihai Dorin Vartolomei, Gennaro Musi, Ottavio de Cobelli, Emanuele Montanari, Octavian Sabin Tătaru

Radiomics and artificial intelligence (AI) may increase the differentiation of benign from malignant kidney lesions, differentiation of angiomyolipoma (AML) from renal cell carcinoma (RCC), differentiation of oncocytoma from RCC, differentiation of different subtypes of RCC, to predict Fuhrman grade, to predict gene mutation through molecular biomarkers and to predict treatment response in metastatic RCC undergoing immunotherapy. Neural networks analyze imaging data. Statistical, geometrical, textural features derived are giving quantitative data of contour, internal heterogeneity and gray zone features of lesions. A comprehensive literature review was performed, until July 2022. Studies investigating the diagnostic value of radiomics in differentiation of renal lesions, grade prediction, gene alterations, molecular biomarkers and ongoing clinical trials have been analyzed. The application of AI and radiomics could lead to improved sensitivity, specificity, accuracy in detecting and differentiating between renal lesions. Standardization of scanner protocols will improve preoperative differentiation between benign, low-risk cancers and clinically significant renal cancers and holds the premises to enhance the diagnostic ability of imaging tools to characterize renal lesions.

放射组学和人工智能(AI)可能会增加肾脏良性病变与恶性病变的分化,血管平滑肌脂肪瘤(AML)与肾细胞癌(RCC)的分化,癌细胞瘤与RCC的分化,RCC不同亚型的分化,预测Fuhrman分级,通过分子生物标志物预测基因突变,预测转移性RCC接受免疫治疗的治疗反应。神经网络分析成像数据。统计、几何、纹理特征给出了病灶轮廓、内部异质性和灰色地带特征的定量数据。在2022年7月之前进行了全面的文献综述。研究放射组学在肾脏病变鉴别、分级预测、基因改变、分子生物标志物和正在进行的临床试验中的诊断价值进行了分析。人工智能和放射组学的应用可以提高肾脏病变检测和鉴别的敏感性、特异性和准确性。扫描仪方案的标准化将提高术前良性、低风险癌症与临床显著肾癌的鉴别,并为提高成像工具对肾脏病变特征的诊断能力奠定基础。
{"title":"Artificial intelligence and radiomics in evaluation of kidney lesions: a comprehensive literature review.","authors":"Matteo Ferro,&nbsp;Felice Crocetto,&nbsp;Biagio Barone,&nbsp;Francesco Del Giudice,&nbsp;Martina Maggi,&nbsp;Giuseppe Lucarelli,&nbsp;Gian Maria Busetto,&nbsp;Riccardo Autorino,&nbsp;Michele Marchioni,&nbsp;Francesco Cantiello,&nbsp;Fabio Crocerossa,&nbsp;Stefano Luzzago,&nbsp;Mattia Piccinelli,&nbsp;Francesco Alessandro Mistretta,&nbsp;Marco Tozzi,&nbsp;Luigi Schips,&nbsp;Ugo Giovanni Falagario,&nbsp;Alessandro Veccia,&nbsp;Mihai Dorin Vartolomei,&nbsp;Gennaro Musi,&nbsp;Ottavio de Cobelli,&nbsp;Emanuele Montanari,&nbsp;Octavian Sabin Tătaru","doi":"10.1177/17562872231164803","DOIUrl":"https://doi.org/10.1177/17562872231164803","url":null,"abstract":"<p><p>Radiomics and artificial intelligence (AI) may increase the differentiation of benign from malignant kidney lesions, differentiation of angiomyolipoma (AML) from renal cell carcinoma (RCC), differentiation of oncocytoma from RCC, differentiation of different subtypes of RCC, to predict Fuhrman grade, to predict gene mutation through molecular biomarkers and to predict treatment response in metastatic RCC undergoing immunotherapy. Neural networks analyze imaging data. Statistical, geometrical, textural features derived are giving quantitative data of contour, internal heterogeneity and gray zone features of lesions. A comprehensive literature review was performed, until July 2022. Studies investigating the diagnostic value of radiomics in differentiation of renal lesions, grade prediction, gene alterations, molecular biomarkers and ongoing clinical trials have been analyzed. The application of AI and radiomics could lead to improved sensitivity, specificity, accuracy in detecting and differentiating between renal lesions. Standardization of scanner protocols will improve preoperative differentiation between benign, low-risk cancers and clinically significant renal cancers and holds the premises to enhance the diagnostic ability of imaging tools to characterize renal lesions.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231164803"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/f7/10.1177_17562872231164803.PMC10126666.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9369286","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: 13
The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series. 神经系统患者阴茎假体的结果:一个多中心回顾性系列。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231194921
Marco Falcone, Paolo Capogrosso, Lorenzo Cirigliano, Paolo Geretto, Mirko Preto, Massimiliano Timpano, Carlo Ceruti, Federica Peretti, Ilaria Ferro, Natalia Plamadeala, Federico Dehò, Carlo Bettocchi, Celeste Manfredi, Lorenzo Spirito, Alessandro Palmieri, Alberto Manassero, Gideon Blecher, Paolo Gontero
Introduction: Neurological disease is a known entity for causing erectile dysfunction (ED). Pharmacological therapies are not always effective these patients – penile prosthesis implant (PPI) is an established surgical treatment option. For a variety of reasons, neurological patients may experience differing outcomes of PPI compared to those whose ED arises from other causes. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses [Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED)]. Methods: Patients undergoing PPI were investigated via the INSIST-ED registry, from 2014 to 2021. Data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and reviewed by a data manager. We subselected patients with neurological disease undergoing PPI for ED, and these patients were reviewed at 3, 6, and 12 months, and annually thereafter. Postoperative complications and functional outcomes were evaluated through validated questionnaires [International Index of Erectile Function-5 (IIEF-5), Sexual Encounter Profile 2–3, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)]. A nonvalidated questionnaire was administered to assess patient satisfaction. Results: A total of 33 patients were included with a median age of 49 [interquartile range (IQR) 41–55]. Median follow-up was 83 months (IQR 67–99.5). A penoscrotal approach for PPI was performed in most cases (90.9%), while infrapubic was used in three cases (9.1%). Inflatable and malleable devices were implanted in 30 (90.9%) and 3 cases (9.1%), respectively. Intraoperative complications occurred in one case (3%). Early postoperative complications (<90 days) were observed in three cases (9.1%): two wound dehiscence (Clavien-Dindo G1 and G3a respectively) and one device infection requiring prosthesis explant (Clavien-Dindo G3a). Mechanical failures of inflatable devices were not observed during the follow-up period. Median IIEF-5 before surgery was 8 (IQR 7–9). At the latest follow-up, IIEF-5 was 22 (IQR 19–23.5), and median EDITS was 79 (IQR 64–88). A total of 28 patients (84.8%) self-reported to be fully satisfied with the PPI. Conclusion: Although PPI in the neurological population has been historically considered to be at increased risk, in our study, PPI complications and infections rates in this cohort did not differ from general population.
简介:神经系统疾病是引起勃起功能障碍(ED)的已知实体。药物治疗并不总是有效的这些患者-阴茎假体植入(PPI)是一种既定的手术治疗选择。由于各种原因,与其他原因引起ED的患者相比,神经系统患者可能经历不同的PPI结果。我们使用意大利多机构阴茎假体国家注册表[意大利全国ED手术治疗系统发明化(坚持-ED)]调查了神经系统患者PPI的结果。方法:从2014年到2021年,通过persist - ed登记对接受PPI的患者进行调查。数据由45名外科医生在一个专门的网站(www.registro.andrologiaitaliana.it)上进行前瞻性记录,并由数据管理员进行审查。我们亚选择了接受PPI治疗ED的神经系统疾病患者,并在3、6和12个月时对这些患者进行了回顾,此后每年一次。通过有效问卷[国际勃起功能指数-5 (IIEF-5),性接触概况2-3和勃起功能障碍治疗满意度量表(EDITS)]评估术后并发症和功能结局。采用一份未经验证的问卷来评估患者满意度。结果:共纳入33例患者,中位年龄49岁[四分位间距(IQR) 41-55]。中位随访83个月(IQR 67-99.5)。大多数病例(90.9%)采用耻骨下入路进行PPI, 3例(9.1%)采用耻骨下入路。可充气装置30例(90.9%),可延展装置3例(9.1%)。术中出现并发症1例(3%)。结论:尽管既往认为神经系统人群的PPI风险增加,但在我们的研究中,该队列的PPI并发症和感染率与一般人群没有差异。
{"title":"The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series.","authors":"Marco Falcone,&nbsp;Paolo Capogrosso,&nbsp;Lorenzo Cirigliano,&nbsp;Paolo Geretto,&nbsp;Mirko Preto,&nbsp;Massimiliano Timpano,&nbsp;Carlo Ceruti,&nbsp;Federica Peretti,&nbsp;Ilaria Ferro,&nbsp;Natalia Plamadeala,&nbsp;Federico Dehò,&nbsp;Carlo Bettocchi,&nbsp;Celeste Manfredi,&nbsp;Lorenzo Spirito,&nbsp;Alessandro Palmieri,&nbsp;Alberto Manassero,&nbsp;Gideon Blecher,&nbsp;Paolo Gontero","doi":"10.1177/17562872231194921","DOIUrl":"https://doi.org/10.1177/17562872231194921","url":null,"abstract":"Introduction: Neurological disease is a known entity for causing erectile dysfunction (ED). Pharmacological therapies are not always effective these patients – penile prosthesis implant (PPI) is an established surgical treatment option. For a variety of reasons, neurological patients may experience differing outcomes of PPI compared to those whose ED arises from other causes. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses [Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED)]. Methods: Patients undergoing PPI were investigated via the INSIST-ED registry, from 2014 to 2021. Data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and reviewed by a data manager. We subselected patients with neurological disease undergoing PPI for ED, and these patients were reviewed at 3, 6, and 12 months, and annually thereafter. Postoperative complications and functional outcomes were evaluated through validated questionnaires [International Index of Erectile Function-5 (IIEF-5), Sexual Encounter Profile 2–3, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)]. A nonvalidated questionnaire was administered to assess patient satisfaction. Results: A total of 33 patients were included with a median age of 49 [interquartile range (IQR) 41–55]. Median follow-up was 83 months (IQR 67–99.5). A penoscrotal approach for PPI was performed in most cases (90.9%), while infrapubic was used in three cases (9.1%). Inflatable and malleable devices were implanted in 30 (90.9%) and 3 cases (9.1%), respectively. Intraoperative complications occurred in one case (3%). Early postoperative complications (<90 days) were observed in three cases (9.1%): two wound dehiscence (Clavien-Dindo G1 and G3a respectively) and one device infection requiring prosthesis explant (Clavien-Dindo G3a). Mechanical failures of inflatable devices were not observed during the follow-up period. Median IIEF-5 before surgery was 8 (IQR 7–9). At the latest follow-up, IIEF-5 was 22 (IQR 19–23.5), and median EDITS was 79 (IQR 64–88). A total of 28 patients (84.8%) self-reported to be fully satisfied with the PPI. Conclusion: Although PPI in the neurological population has been historically considered to be at increased risk, in our study, PPI complications and infections rates in this cohort did not differ from general population.","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"15 ","pages":"17562872231194921"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/43/10.1177_17562872231194921.PMC10472821.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153739","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: 1
Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes 机器人辅助的简单前列腺切除术:基于三效和五效的长期功能结果分析
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872221147104
A. Bove, A. Brassetti, Mario Ochoa, U. Anceschi, M. Ferriero, G. Tuderti, L. Misuraca, R. Mastroianni, Silvia Cartolano, S. D'annunzio, Giulia Torreggiani, G. Simone
Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p < 0.01). RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.
机器人辅助简易前列腺切除术(RASP)被证明是缓解膀胱出口梗阻症状的一种可靠有效的方法。通常,进行经膀胱(Freyer)或经囊(Millin)技术。最近介绍了一种新的近红外荧光成像(NIFI)引导的尿道保留机器人辅助前列腺切除术(Madigan)。我们研究的目的是评估Millin、Freyer和Madigan RASP之间的长期功能结果。这是对前瞻性维护的机构审查委员会批准的数据库进行的单中心回顾性评估。前瞻性地收集了在我们中心接受RASP的患者的数据。评估了人口学、前列腺大小和术前流量测量参数。术前和随访期间,对每位患者进行国际勃起功能指数(IIEF)、国际失禁咨询问卷(ICIQ)、国际前列腺症状评分(IPSS)及其生活质量(QoL)、男性性健康问卷(MSHQ)、膀胱过度活动问卷(OABQ)等问卷调查。我们测试了复合结果(三联),定义为术后Q-max>15 ml/s、IPSS评分的组合  0)和勃起功能维持(∆IEEF < 6) 。中位随访时间为36个月。Millin、Madigan和Freyer手术分别在37例(51%)、18例(25%)和17例(24%)中进行。在43名(60%)患者中实现了Trifecta。术前ICIQ、术后IPSS、术后OABQ和生活质量在各组之间有显著差异(均p < 0.02)。14名(20%)患者获得了Pentaffecta。Pentaffecta组在术后IPSS和MSHQ方面显示出统计学上显著的优势(p < 0.01)。RASP在长期随访中对梗阻症状提供了有效和持久的缓解,无论采用何种技术,在大多数患者中都实现了三重切除。Madigan技术与pentafecta的成就有很大关系。
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引用次数: 0
Patterns of use of medications used to treat urinary incontinence and potentially inappropriate prescriptions. 用于治疗尿失禁的药物的使用模式和可能不适当的处方。
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.1177/17562872231179104
Luis Fernando Valladales-Restrepo, Hugo Alejandro Bedoya-Arias, Brayan Stiven Aristizábal-Carmona, Jorge Enrique Machado-Alba

Background: The pharmacological treatment of urinary incontinence (UI) may involve bladder antimuscarinics, which can generate risks in the elderly.

Objective: The aim was to determine the treatment patterns of a group of patients with UI and possible potentially inappropriate prescriptions.

Design and methods: This was a cross-sectional study that identified prescription patterns of medications for outpatient use in patients with UI between December 2020 and November 2021 based on a population database of members of the Colombian Health System. Patients were identified based on the codes of the international classification of diseases, version-10. Sociodemographic and pharmacological variables were considered.

Results: A total of 9855 patients with UI were identified, with a median age of 72 years, and 74.6% were women. Unspecified UI was the most frequent form (83.2%), followed by specified UI (7.9%), stress UI (6.7%), and UI associated with an overactive bladder (2.2%). A total of 37.2% received pharmacological treatment, mainly with bladder antimuscarinics (22.6%), mirabegron (15.6%), and topical estrogens (7.9%). Pharmacological management predominated in UI associated with overactive bladder, in women and in patients between 50 and 79 years of age. Of the patients who received bladder antimuscarinics, 54.5% were 65 years old or older, and 21.5% also had benign prostatic hyperplasia, sicca syndrome, glaucoma, constipation, or dementia. A total of 2.0% of women had been prescribed systemic estrogens and 1.7% had been prescribed peripheral α-adrenergic antagonists.

Conclusion: Differences in the prescriptions were found according to the type of UI, sex, and age group. Potentially inappropriate or risky prescriptions were common.

背景:尿失禁(UI)的药物治疗可能涉及膀胱抗尿毒药物,这在老年人中可能产生风险。目的:目的是确定一组尿失禁患者的治疗模式和可能不适当的处方。设计和方法:这是一项横断面研究,根据哥伦比亚卫生系统成员的人口数据库,确定了2020年12月至2021年11月期间UI患者门诊用药的处方模式。病人是根据国际疾病分类第10版的代码确定的。考虑了社会人口学和药理学变量。结果:共确诊尿失禁患者9855例,中位年龄72岁,女性占74.6%。未明确的尿失禁是最常见的形式(83.2%),其次是明确的尿失禁(7.9%)、应激性尿失禁(6.7%)和伴有膀胱过度活动的尿失禁(2.2%)。37.2%的患者接受了药物治疗,主要是膀胱抗蛇毒素(22.6%)、米拉贝隆(15.6%)和外用雌激素(7.9%)。在50 - 79岁的女性和患者中,与膀胱过度活动相关的尿失禁以药物治疗为主。在接受膀胱抗毒蕈素治疗的患者中,54.5%的患者年龄在65岁及以上,21.5%的患者同时患有良性前列腺增生、干燥综合征、青光眼、便秘或痴呆。总共有2.0%的女性服用了全身性雌激素,1.7%的女性服用了外周α-肾上腺素能拮抗剂。结论:根据尿失禁类型、性别、年龄组不同,处方存在差异。可能不合适或有风险的处方很常见。
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引用次数: 0
期刊
Therapeutic Advances in Urology
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