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Editorial Comment on “Social Vulnerability and Receipt of Neoadjuvant Chemotherapy in Patients Undergoing Radical Cystectomy for Bladder Cancer” 关于 "膀胱癌根治性膀胱切除术患者的社会脆弱性与接受新辅助化疗 "的编辑评论。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.024

引用次数: 0

Utilizing the Ex-Vivo Bovine Model in Retrograde Intrarenal Surgery Training 在逆行肾内手术培训中利用活体牛模型。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.053

Objective

To present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training.

Materials and Methods

The model was specifically developed for a pre-congress course organized as part of the National Pediatric Urology Congress. The course involved a 2-day online theoretical segment followed by hands-on training. Bovine kidneys were chosen for their anatomical resemblance to human kidneys. The kidneys were sourced from a local slaughterhouse, ensuring the intactness of the pelvis, ureters, and perirenal fat. A Modified Larssen solution was used for tissue preservation. The tissue was positioned within a cardboard box, with specific preparation techniques to ensure realism. During the hands-on training, participants utilized a flexible ureterorenoscope for practice. After the course, participants completed an 18-question survey assessing the model and training experience.

Results

Twenty-four participants completed the training and survey. Four out of 8 procured kidneys were suitable. The model's cost was 18 euros. Around 87.5% of participants reported increased RIRS confidence. Those with prior course experience rated the model's anatomical resemblance higher (P = .016). No significant difference was observed in feedback on the model's durability or tactile feedback based on prior experience (P >.05).

Conclusion

The ex-vivo bovine model provides a promising alternative for RIRS training. While further studies are needed to validate its widespread application, initial feedback suggests it offers a balance between cost-effectiveness and realistic training experience.

目的：介绍一种用于逆行肾内手术（RIRS）培训的体外牛模型：介绍一种用于逆行肾内手术（RIRS）培训的体外牛模型：该模型是专门为作为全国小儿泌尿学大会一部分的会前课程而开发的。课程包括为期两天的在线理论部分和实践培训。选择牛肾是因为其解剖结构与人类肾脏相似。肾脏来自当地屠宰场，确保肾盂、输尿管和肾周脂肪完好无损。使用改良拉尔森溶液保存组织。组织被放置在一个纸箱中，采用特定的制备技术以确保逼真。在实操培训期间，学员们使用柔性输尿管造影镜进行练习。课程结束后，学员们填写了一份包含 18 个问题的调查问卷，对模型和培训体验进行评估。在采购的 8 个肾脏中，有 4 个合适。模型成本为 18 欧元。87.5%的参与者表示增强了对RIRS的信心。有培训经验的学员对模型解剖相似度的评价更高（P=0.016）。对模型耐久性或触觉反馈的评价没有明显差异（p>0.05）：结论：牛体外模型为 RIRS 训练提供了一种很有前途的替代方法。虽然还需要进一步研究来验证其广泛应用，但初步反馈表明，它在成本效益和逼真的培训体验之间取得了平衡。

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引用次数: 0

Household Toilet and Sanitation Insecurity is Associated With Urinary Symptoms, Psychosocial Burden, and Compensatory Bladder Behaviors 家庭厕所和卫生设施不安全与泌尿系统症状、社会心理负担和膀胱补偿行为有关。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.071

Objective

To investigate whether being “at-risk” for toilet and sanitation insecurity in the United States is associated with urinary symptoms, voiding behaviors, and psychosocial burden. Based on census data, nearly 2 million people in the United States do not have access to adequate plumbing. More may have inconsistent access related to cost, inadequate facilities for the number of people in a home, or declining regional infrastructure. The effects of inadequate access in the United States are poorly characterized.

Methods

This is a secondary analysis of a community-based sample of adults electronically recruited to complete questionnaires on clinical and sociodemographic information, living situations, home toilets and plumbing, urinary symptoms, compensatory bladder behaviors, and psychosocial burden. Multivariable logistic regression was used to assess for associations between being at-risk for toilet and sanitation insecurity and urinary and psychosocial symptoms. Linear regression was used to assess for association with adopting compensatory bladder behaviors.

Results

This sample included 4218 participants, of whom 17% were identified as being at-risk for toilet and sanitation insecurity. Being at-risk for toilet and sanitation insecurity was associated with worse overall urinary symptoms and greater bother from these symptoms, in addition to worse self-assessed mental and physical health, anxiety, stress, depression, and fewer social supports. Finally, those at-risk for toilet and sanitation insecurity were more likely to adopt burdensome and unhealthy compensatory bladder behaviors.

Conclusion

As with other social determinants of health, toilet and sanitation insecurity may be an under-appreciated contributor to urinary symptoms, unhealthy toileting behaviors, and psychosocial distress.

研究目的调查美国厕所和卫生设施不安全的 "高危人群 "是否与泌尿系统症状、排尿行为和社会心理负担有关。根据人口普查数据，美国有近 200 万人无法使用适当的管道。更多的人可能因为费用问题、家庭人口数量导致设施不足或地区基础设施衰退而无法使用适当的管道。在美国，水暖设施不足所造成的影响还没有得到很好的描述：这是对社区成人样本的二次分析，通过电子方式招募成人填写问卷，内容包括临床和社会人口信息、生活状况、家庭厕所和管道、排尿症状、膀胱代偿行为和社会心理负担。多变量逻辑回归用于评估厕所和卫生设施不安全风险与排尿症状和心理社会症状之间的关联。线性回归用于评估采用膀胱补偿行为的相关性：该样本包括 4,218 名参与者，其中 17% 的参与者被确认为面临厕所和卫生设施不安全的风险。除了自我评估的身心健康状况、焦虑、压力、抑郁和较少的社会支持外，厕所和卫生设施不安全的高危人群还伴有更严重的总体泌尿系统症状和这些症状带来的更大困扰。最后，厕所和卫生设施不安全的高危人群更有可能采取繁重和不健康的膀胱补偿行为：与其他健康的社会决定因素一样，厕所和卫生设施不安全可能是导致泌尿系统症状、不健康的如厕行为和社会心理困扰的一个未被充分重视的因素。

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引用次数: 0

Stomal Stenosis After Continent Urinary Diversion in Bladder Exstrophy: Risk Factors and Management 膀胱萎缩症患者持续性尿路转流术后的间质狭窄：风险因素与管理。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.07.003

Objective

To identify risk factors for stenosis and compare management strategies for stenosis etiology and to examine the efficacy of each approach. Patients with classic bladder exstrophy (CBE), a rare genitourinary malformation, may require construction of a continent urinary stoma (CUS) if incontinence persists. Stomal stenosis is a challenging complication as it is common, progressive, and recurrent.

Methods

CBE patients who underwent CUS were retrospectively reviewed for risk factors for stenosis including stoma type, prior midline laparotomy number, and umbilicoplasty suture material. Stenosis etiology and management strategies were further reviewed.

Results

A total of 260 CBE patients underwent CUS creation. Stenosis developed in 65 patients (25.0%) at a median interval of 1.9 years. Etiology included scar contracture (n = 41), keloid (n = 17), and hypertrophic scar (n = 7). Multifilament suture was the only variable associated with an increased risk of stenosis compared to monofilament suture (P = .009). Almost all patients required surgical intervention. Most scar contractures underwent stomal incision with success in 100%. Hypertrophic scars and keloids responded best to excision with local tissue rearrangement (66.7%). At last follow-up, all patients achieved success.

Conclusion

Stomal stenosis is common and challenging for the reconstructive surgeon. Strategies to prevent and effectively manage this are greatly desired. Use of multifilament suture for the umbilicoplasty increased stenosis perhaps from a greater inflammatory response and scarring, while monofilament suture may reduce its incidence. Stomal incision for treating scar contractures, and excision with local tissue rearrangement for hypertrophic scars and keloids may improve successful primary surgical intervention.

目的：确定膀胱狭窄的风险因素，比较针对狭窄病因的管理策略，并研究每种方法的疗效。典型膀胱外翻（CBE）是一种罕见的泌尿生殖系统畸形，如果尿失禁持续存在，患者可能需要修建尿道造口（CUS）。造口狭窄是一种具有挑战性的并发症，因为它很常见，而且是进行性和复发性的：方法：对接受 CUS 的 CBE 患者进行回顾性研究，以了解狭窄的风险因素，包括造口类型、之前的中线开腹手术次数和脐成形术的缝合材料。结果：共有 260 名 CBE 患者接受了 CUS 造口术。65名患者（25.0%）出现狭窄，中位间隔为1.9年。病因包括瘢痕挛缩（41 例）、瘢痕疙瘩（17 例）和增生性瘢痕（7 例）。与单丝缝合相比，多丝缝合是唯一与狭窄风险增加有关的变量（P=0.009）。几乎所有患者都需要手术治疗。大多数疤痕挛缩患者都接受了造口术，成功率为 100%。肥厚性疤痕和瘢痕疙瘩对局部组织重新排列的切除术反应最佳（66.7%）。最后一次随访时，所有患者都获得了成功：结论：对于整形外科医生来说，口腔狭窄是一种常见且具有挑战性的疾病。结论：对整形外科医生来说，肛门窦狭窄是一种常见且具有挑战性的疾病，预防和有效处理这种疾病的策略非常重要。在脐成形术中使用多丝缝合线会增加狭窄，这可能是由于炎症反应和瘢痕增生所致，而单丝缝合线可能会降低狭窄的发生率。用于治疗疤痕挛缩的缝合切口，以及用于增生性疤痕和瘢痕疙瘩的局部组织重新排列切除术，都可能提高初次手术干预的成功率。

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引用次数: 0

Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery 教学医院与泌尿系统癌症大手术后的教科书成果。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.007

Objective

To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers.

Methods

We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital’s workforce—defined as major, minor, and non teaching hospitals—was the primary exposure. A textbook outcome, measured at the patient level, was defined as the absence of in-hospital mortality and mortality within 30 days of surgery, no readmission 30 days following discharge, no postoperative complication, and no prolonged length of stay.

Results

Textbook outcomes were achieved in 51% (8564/16,786) of patients after bladder cancer surgery, 70% (39,938/57,300) of patients after kidney cancer surgery, and 82% (50,408/61,385) of patients after prostate cancer surgery. After adjusting for patient- and hospital-level characteristics, teaching hospitals had higher rates of textbook outcomes in those undergoing bladder (50.7% vs 44.0%; P = .001), kidney (72.0% vs 69.7%; P = .02), and prostate (85.3% vs 81.0%; P <.001) surgery. This effect was attenuated, but not eliminated, by surgical volume in additional sensitivity analyses for bladder (OR: 1.20, 95% CI: 1.00-1.42; P = .04) and prostate (OR: 1.15, 95% CI: 1.00-1.32; P = .04) surgery. There were no significant differences in kidney cancer surgery outcomes after adjusting for hospital volume (OR: 1.03, 95% CI: 0.93-1.14; P = .6).

Conclusion

Undergoing major cancer surgery at a teaching hospital was associated with an increased likelihood of achieving a textbook outcome. This effect was attenuated by volume but persisted for bladder and prostate surgery.

目的根据医院教学状况评估泌尿生殖系统恶性肿瘤大手术后的教科书结果：我们使用2017-2020年100%的全国医疗保险提供者分析和审查档案，评估接受膀胱（即根治性膀胱切除术）、肾（即根治性或部分肾切除术）和前列腺（即根治性前列腺切除术）手术治疗泌尿生殖系统恶性肿瘤的教科书结果率。学习者融入每家医院员工队伍的程度，即主要、次要和非教学人员，是主要的接触点。在患者层面衡量的教科书式结果被定义为无院内死亡和手术后 30 天内无死亡、出院后 30 天内无再入院、无术后并发症、无住院时间延长：51%（8,564/16,786 例）的膀胱癌手术患者、70%（39,938/57,300 例）的肾癌手术患者和 82%（50,408/61,385 例）的前列腺癌手术患者达到了教科书规定的治疗效果。在对患者和医院层面的特征进行调整后，教学医院的膀胱癌（50.7% vs 44.0%; p = 0.001）、肾癌（72.0% vs 69.7%; p = 0.02）和前列腺癌（85.3% vs 81.0%; p < 0.001）手术患者的教科书结果率更高。在膀胱（OR：1.20，95% CI：1.00-1.42；P = 0.04）和前列腺（OR：1.15，95% CI：1.00-1.32；P = 0.04）手术的额外敏感性分析中，手术量的影响有所减弱，但并未消除。调整医院规模后，肾癌手术结果无明显差异（OR：1.03，95% CI：0.93 - 1.14；P = 0.6）：结论：在教学医院接受大型癌症手术与获得教科书结果的可能性增加有关。结论：在教学医院接受大型癌症手术与获得 "教科书式 "结果的可能性增加有关，这种影响因医院规模而减弱，但在膀胱和前列腺手术中持续存在。

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引用次数: 0

Reply to Editorial Comment on “Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy” 对 "根治性前列腺切除术后经括约肌修补直肠尿道瘘并结合达托斯肌皮瓣插植术 "的编辑评论的回复。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.07.007

引用次数: 0

Reply to Editorial Comment on “Incidence and Management of Radiation Cystitis After Pelvic Radiotherapy for Prostate Cancer: Analysis From a National Database" 对 "前列腺癌盆腔放疗后放射性膀胱炎的发病率和管理：来自全国数据库的分析"。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.027

引用次数: 0

Reply to Editorial Comment on “Intraprostatic Injection of Tranexamic Acid Decrease Blood Loss During Monopolar Transurethral Resection of the Prostate: A Randomized Controlled Clinical Trial” 对 "前列腺内注射氨甲环酸可减少单极 TURP 术中的失血量：一项随机对照临床试验 "的编辑评论的回复。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.062

引用次数: 0

The Prevalence of Urinary Incontinence, Knowledge and Practice of Pelvic Floor Muscle Training Among Female Recruits in Basic Training 基础训练中女兵尿失禁的发生率、盆底肌肉训练的知识和实践。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.07.016

Objective

To describe the prevalence, and severity of urinary incontinence (UI) among female recruits during basic training and their knowledge and practice of pelvic floor muscle training (PFMT). Furthermore, to determine if there is a relationship between the severity of UI and PFMT knowledge and practice.

Methods

This correlational study utilized a demographic and health questionnaire, a UI questionnaire (International Consultation on Incontinence Questionnaire Short Form [ICIQ-SF]), and a PFMT questionnaire-Short version of the Patient-reported Outcome Measures [PFMT-P]).

Results

The study included 349 female recruits with a mean age of 18.17 ( ± 0.390). The prevalence of UI was 26.7%, with a low mean of 2.03 ( ± 3.893) on the ICIQ-SF. PFMT knowledge level was moderate, 1.46 ( ± 0.790), and the mean practice of PFMT was low, 2.51( ± 1.180). No significant correlation was found between the ICIQ-SF score and the level of knowledge, r_s = −0.09, P = .092. There was a weak but significant correlation between the ICIQ-SF score and PFMT practice, r_s = 0.170, P = .003.

Conclusion

A little more than a quarter of the female recruits reported UI with a low severity. A relationship was found between UI and PFMT practice.

目的描述基础训练期间女兵尿失禁（UI）的发生率和严重程度，以及她们对盆底肌肉训练（PFMT）的了解和实践。此外，还要确定尿失禁的严重程度与盆底肌肉训练的知识和实践之间是否存在关系：这项相关研究采用了人口统计学和健康问卷、尿失禁问卷[国际尿失禁咨询问卷简表（ICIQ-SF）]和盆底肌肉训练问卷--患者报告结果测量简表（PFMT-P）]：研究包括 349 名女性新兵，平均年龄为 18.17（± 0.390）岁。UI 患病率为 26.7%，ICIQ-SF 平均值为 2.03（± 3.893）。PFMT知识水平中等，为1.46（± 0.790）分，PFMT实践平均水平较低，为2.51（± 1.180）分。ICIQ-SF得分与知识水平无明显相关性，rs=-0.09，P=0.092。ICIQ-SF 评分与 PFMT 实践之间存在微弱但明显的相关性，rs=0.170，p=0.003：略多于四分之一的女兵报告了严重程度较低的尿崩症。结论：超过四分之一的女兵报告的尿频症状严重程度较低，尿频症状与 PFMT 实践之间存在一定关系。

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引用次数: 0

Editorial Comment on “Eulogy for B&O Suppositories: A Resident’s Remembrance of Rectal Relief” 为 B&O 栓剂讴歌》的社论评论：一位居民对直肠舒缓的回忆"。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.017

引用次数: 0

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