Urology最新文献

Objective: To investigate the association between the use of proton pump inhibitors (PPIs) and overactive bladder (OAB) in adults.

Methods: This study adopts a cross-sectional approach to scrutinize data derived from the National Health and Nutrition Examination Survey (NHANES), spanning from 2007 to 2018. It employs multivariable logistic regression along with restricted cubic splines (RCS) to investigate the relationship between the use of PPI and the incidence of OAB. Additionally, through interaction and stratification analyses, the study delves into how specific factors may influence this correlation.

Results: A total of 24,458 adults participated in this study. Individuals using PPIs exhibited higher rates of nocturia, urge incontinence, and OAB compared to non-users. After full adjustment, PPI users had a significantly increased risk of developing OAB (OR=1.36, 95%CI: 1.17-1.60). Moreover, with each year of continued PPI usage, the frequency of OAB symptoms escalated by 3% (P = .01). Further examinations within various subgroups maintained a uniform direction in these effect estimates.

Conclusion: The findings of this research highlight a noteworthy positive link between the use of PPIs and the emergence of OAB among adults. Moreover, it was observed that an extended period of using PPIs correlates with a heightened likelihood of encountering OAB.

Objective: To analyze the temporal trends and perioperative and long-term outcomes of living donor kidney nephrectomy in the United States.

Methods: The PearlDiverTM Mariner database (Pearl-Diver Technologies, Colorado Springs, CO, USA) was used for our retrospective analysis. The data were identified using ICD-9/10 codes, as well as CPT codes. Continuous and categorical variables were compared using 2-sided tests. Multivariate logistic regression analysis was conducted to identify predictors of 5-year ESRD.

Results: A total of 6333 patients were identified (median age 54, IQR 46-62 years) from 2010 to April 2022. A greater percentage of living donor nephrectomies were performed by general surgeons (56.1%), followed by transplant surgeons (16.5%) and urologists (14.7%). Unfortunately, physician specialty was not reported for the remaining patients. The MIS exceeded open surgery in each specialty group and inpatient setting. The significant predictors of ESRD were male, preoperative DM and hypertension, tobacco smoking, perioperative AKI and younger age at the time of kidney donation.

Conclusion: MIS represents the main surgical approach for organ procurement. A meticulous selection process for donors and subsequent close monitoring are necessary to minimize the putative consequences of donor nephrectomy.

Objective: To elucidate the application of HF approaches within urology to improve clinical work-system function via a systematic scoping review. Human Factors (HF) plays an integral role to improving safety, efficiency, and well-being by optimizing work-system interactions. Despite its established application across various high-risk industries, the systematic exploration of HF methods applied within urology remains limited.

Methods: A scoping review of HF interventions implemented within urologic care from 1980 to 2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Web of Science, PubMed, and OVID Medline databases were searched. Database searching resulted in 10,850 articles, after systematic review, 22 studies were included.

Results: The included studies predominantly originated from the United States and covered diverse areas of urology, including surgical procedures, diagnostics, and patient care. Interventions varied widely from ergonomic equipment implementations to modifications in clinical processes and team dynamics. Most studies utilized predetermined interventions based on prior literature or experiential anecdotes (15, 65.22%), while a smaller subset employed data-driven strategies to tailor interventions (8, 34.7%). The HF methods employed included questionnaires, retrospective reviews, observations, and physical measurements, targeting improvements in patient experiences, operational efficiencies, and clinical outcomes.

Conclusion: This review underscores the emergent role of HF in urology, highlighting a broad spectrum of interventions and methodological approaches that contribute to system optimization. Future endeavors should focus on collaborative efforts to develop standardized HF applications in urology, promoting a safer, more efficient, and clinician-friendly environment.

Objective: To evaluate the effectiveness and safety of a home-based, physiologic closed-loop wearable tibial neuromodulation system in comparison to a sham control for the treatment of overactive bladder (OAB).

Methods: This multicenter, prospective, randomized, double-blind, sham-controlled trial included 125 adult subjects with OAB who were randomized 1:1 to receive either active therapy with the Vivally System or sham therapy. Patients were allowed to continue concomitant OAB medications if therapy was stable and the remained on a consistent regimen throughout the study. The primary efficacy endpoint was a responder rate, defined as ≥50% reduction in daily urgency leaks or a ≥30% reduction in daily voids from baseline recorded on an electronic voiding diary. Safety was evaluated through adverse event (AE) reporting and patient satisfaction with the system was recorded.

Results: In the modified Intent-to-Treat (mITT) population (n = 107), the responder rate was significantly higher in the active therapy arm (83.6%) compared to the sham arm (57.7%; P = .032). The system demonstrated a favorable safety profile with no serious AE. Patient satisfaction with the device and mobile application was high with 90/92 (97.8%) reporting they were moderately to extremely satisfied and therapy compliance was above 92% for both therapy and sham groups.

Conclusion: The Vivally System showed significant improvement in OAB symptoms compared to sham therapy, demonstrating a high responder rate and excellent safety profile. The combination of physiologic closed-loop neuromodulation and a behavior-tracking application may offer an effective and user-friendly option for OAB management.

Lyndon Baines Johnson, the 36th president of the United States, was troubled with kidney stones for most of his adult life. Three times during his political career, he required either endoscopic or open surgical removal of stones. This review will highlight the symptomatic presentation of his stones, his nephrolithiasis' effect on his political career, and the methods used and reasoning for treating his nephrolithiasis.

Objective: To scrutinize the progression of clinical reasoning and theoretical knowledge by comparing the impact of Clinical Reasoning-Based Learning (CRBL) sessions with interactive lectures (IL).

Methods: In this experimental study conducted from November 15, 2021, to May 7, 2022, we focused on second-year students in the second cycle of medical studies. Four specific urologic emergency scenarios (nephritic colic, macroscopic hematuria, acute scrotal pain, and urinary incontinence in men) were selected for interactive teaching sessions. Four groups were studied. One urology item was taught via CRBL, the rest via IL. Each item was taught once with CRBL and thrice with IL. After instruction, learners took a 10-point evaluative test with multiple-choice questions and clinical scenarios.

Results: Four groups of 14 learners attended our department, for a total number of 56 participants. Each student attended 4 learning sessions (1 CRBL session and 3 ILs) with a number of tests completed at 4 for each. The total number of tests taken was 224. The scoring of each test was out of 10 with theoretical scores between 0 and 10. The overall median score was 7/10. We noted better ratings after the CRBL sessions (n = 56) with a median of 8/10 [4-10] compared to the IL sessions (n = 168) whose median was 6 [3-10] with a significant difference between the 2 learning methods (P <.001).

Conclusion: The CRBL sessions were significantly better than the ILs at developing the clinical reasoning and theoretical knowledge in urology of our medical students.