Urology最新文献

英文中文

Vessel-sparing Non-transecting Anastomotic Reconstruction of the Posterior Urethra: Single Center Experience with Long-term Follow-up 后尿道保全血管无交叉吻合重建术：单中心长期随访经验。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.059

Reynaldo G. Gómez, Laura G. Velarde, Rodrigo A. Campos, Víctor Barrientos

Objective

To discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe, and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future.

Methods

The bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and performs the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries.

Results

One hundred twenty-seven patients, median age 58 years (interquartile range [IQR] 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n = 48), pelvic fracture urethral injury (PFUI) (n = 61), prostate cancer treatment (n = 14) and instrumentation (n = 4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High-grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. Fourteen patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow-up of 36 months.

Conclusion

Sparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.

目的：讨论我们在后尿道进行吻合尿道成形术时采用的疏通血管非横断法（vspEPA）的长期效果。我们避免横切球部动脉，以保留尿道的前向血管。我们假设 vspEPA 是可行的、安全的，而且并不比传统的横切技术差。此外，如果将来需要植入人工尿道括约肌 (AUS)，vspEPA 可能会带来好处：方法：从海绵体上抬起球部尿道，向远端松解，向侧方牵开，在球-膜交界处向背侧靠近。这种暴露方式允许切除疤痕，并按照标准横切技术进行吻合重建，同时避免了球部动脉的分割：自 2008 年以来，127 名患者接受了吻合重建手术，中位年龄为 58 岁（IQR 35-67）。狭窄的病因包括良性前列腺增生手术（48 例）、骨盆骨折尿道损伤（61 例）、前列腺癌治疗（14 例）和器械治疗（4 例）。中位随访时间为 43 个月（IQR 17-74），121 名患者（95%）的狭窄修复手术获得成功。6例（5%）患者出现了高级并发症（Clavien ≥III），24例（19%）患者出现了整体压力性尿失禁。结论：在后尿道吻合重建过程中保留球动脉是可行且安全的。虽然手术略显繁琐，但不会影响手术效果，而且可能有助于避免将来出现与 AUS 袖带相关的侵蚀。

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引用次数: 0

Integrating a Virtual Reality Mask in Functional Urological Surgeries Under Local Anesthesia: A Prospective Cohort Study on Utility and Satisfaction 在局部麻醉下的功能性泌尿外科手术中整合虚拟现实面罩：关于实用性和满意度的前瞻性队列研究。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.007

Paolo Geretto , Sabrina De Cillis , Luigi Candela , Thibault Germain , Nicolas Vienney , Margaux Felber , Véronique Phé

Objective

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol.

Methods

This is a single-center prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VR virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, 2 questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient’s reported intraoperative pain and anxiety.

Results

Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (P = .01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (P = .12), respectively. Preoperative and postoperative STAI index were 34.8 + −10 and 32.8 + −10.3 (P = .88). Mean Likert anxiety scale value was 2.2 + −1.1, mean intraoperative VAS score was 5.3 + −2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative.

Conclusion

Virtual reality mask may play a role in reducing pain and anxiety in minimally invasive functional urological interventions.

目的评估虚拟现实（VR）面具作为局部麻醉方案的一部分，在微创功能性泌尿外科介入过程中作为分散注意力工具的安全性和有效性：这是一项单中心前瞻性观察试点队列研究，包括所有连续接受尿道内肉毒毒素注射、骶神经调控和尿道膨出剂注射的患者，联合麻醉方案包括局部麻醉和虚拟现实面罩（Hypno VRTM 虚拟现实面罩，法国斯特拉斯堡）。术前和术后评估包括状态-特质焦虑量表（STAI）指数。术中评估采用 4 点李克特焦虑评分量表和视觉模拟量表（VAS）疼痛评分。术前和术中均测量了生命体征。术后进行了两次患者满意度问卷调查。评估结果包括设备的耐受性以及患者报告的术中疼痛和焦虑：结果：共纳入 39 名患者。平均年龄为 64 岁。11名患者（28%）患有神经系统疾病。两名患者有主观不适感。术前和术中平均动脉压分别为 105 毫米汞柱和 111 毫米汞柱（P=0.01）。术前和术中平均心率分别为 72 和 75 bpm（P=0.12）。术前和术后STAI指数分别为34.8+-10和32.8+-10.3（P=0.88）。李克特焦虑量表平均值为 2.2+-1.1，术中 VAS 平均值为 5.3+-2.5。34名患者（87%）对手术过程表示满意，36名患者（92.3%）会向亲属推荐同样的手术：结论：虚拟现实面具可在微创功能性泌尿外科介入治疗中起到减轻疼痛和焦虑的作用。

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引用次数: 0

Editorial Comment on “Indwelling Urological Devise Biofilm Composition and Characteristics in the Presence and Absence of Infection” 关于留置泌尿科器械生物膜的组成和特性（有感染和无感染）的编辑评论。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.016

Mitchell H. Bamberger

引用次数: 0

Drug-induced Uropathy 药物引起的尿病。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.039

André B. Silva, Bruno R. Lebani, Diego P. Resuto, Eduardo R. Pinto, Milton Skaff, Fernando G. Almeida

引用次数: 0

Editorial Comment on “HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020)” 《HoLEP在80岁老人中的安全性和有效性：ACS-NSQIP回顾性分析（2011-2020）》

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.045

Syed Muhammad Nazim, Muhammad Hummam Siddique

引用次数: 0

Editorial Comment on "Commercial Prices and Care for Medicare Beneficiaries With Prostate Cancer" 前列腺癌治疗的市场力量。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.12.010

Michael S. Leapman

引用次数: 0

The Effect of Listening to Music on Pain and Anxiety Scores During Office Based Transperineal Prostate Biopsy: A Prospective Study 听音乐对办公室经会阴前列腺活检中疼痛和焦虑评分的影响：一项前瞻性研究。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.064

Erdem Öztürk , Eriz Özden , Mustafa Işikdoğan , İsa Dagli , Tuncel Uzel , Mehmet Duvarci , Serhat Haluk Ünal , Nurullah Hamidi

Objective

To reduce the pain and anxiety during the transperineal prostate biopsy (TPBx), we aimed to evaluate the effect of listening to music on this condition.

Methods

This study included 97 patients, divided into a music group and a non-music group. Patients in the music group chose from classical, popular, or local folk music, played through speakers during the biopsy. Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory and the Beck Anxiety Inventory, while pain was measured using the Visual Analog Scale (VAS). Patients were also asked about their willingness to undergo another biopsy if needed.

Results

We showed that music significantly reduced pain and anxiety during TPBx. The music group had lower VAS scores for overall pain and pain during local anesthesia administration (P:.002 and P:.003, respectively). Post-biopsy anxiety scores were also significantly lower in the music group. These findings suggest that music enhances patient comfort and increases willingness to undergo repeat procedures.

Conclusion

Music is a cost-effective, safe, and proven approach for interventional procedures that is increasingly acknowledged for its ability to ease pain and lower anxiety. The study suggests adding music to TPBx to improve patient experience, reduce pain and anxiety, and boost future biopsy agreement.

目的：为了减少经会阴前列腺活检时的疼痛和焦虑，我们旨在评估听音乐对这种情况的影响。方法：97例患者分为音乐组和非音乐组。音乐组的患者在活检过程中通过扬声器播放古典音乐、流行音乐或当地民间音乐。使用Spielberger状态-特质焦虑量表（STAI）和Beck焦虑量表（BAI）评估焦虑，使用视觉模拟量表（VAS）测量疼痛。患者还被问及是否愿意在必要时接受另一次活检。结果：我们发现音乐显著减少了TPBx期间的疼痛和焦虑。音乐组整体疼痛和局部麻醉时疼痛的VAS评分较低（分别为p:0.002和p:0.003）。音乐组的活检后焦虑评分也明显较低。这些发现表明，音乐提高了患者的舒适度，并增加了接受重复手术的意愿。结论：音乐是一种经济、安全、可靠的介入治疗方法，因其缓解疼痛和降低焦虑的能力而日益得到认可。该研究建议在TPBx中加入音乐，以改善患者体验，减轻疼痛和焦虑，并提高未来活检的一致性。

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引用次数: 0

Accuracy of a ChatGPT in Diagnosing Urologic Conditions From Cross-sectional Imaging ChatGPT 通过横断面成像诊断泌尿系统疾病的准确性。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.036

Matthew W. Cole , Keavash D. Assani , Hunter S. Robinson , Mae Wimbiscus , Bryn M. Launer , Ryan J. Chew , Erin A. Cooke , Sam S. Chang , Amy N. Luckenbaugh , Daniel D. Joyce , Jeffrey J. Tosoian

Objective

To evaluate ChatGPT's effectiveness in medical imaging interpretation within urology, addressing the critical need for safe AI application in healthcare by identifying its strengths and limitations as a diagnostic and educational resource.

Material and Methods

Using publicly available cases from Radiopaedia.com, we entered 1-3 CT or MRI images into ChatGPT. A standard prompt instructed the model to provide a differential diagnosis ranked by probability. This task was repeated a second time with organ guidance (OG), which provided the organ of diagnostic interest to the model (eg, kidney). Primary outcomes included whether the model’s top or differential diagnosis correctly identified the underlying pathology.

Results

ChatGPT correctly identified the pathologic condition as its top diagnosis in 14% of CT (7/50) and 28% (14/50) of MRI cases (P = .08). OG increased the model’s ability to recognize the top diagnosis by 18% (P = .03) when interpreting CT images, a benefit not shared when interpreting MRI images (P = .4). At baseline the differential diagnosis contained the final diagnosis for 30% and 56% of CT and MRI cases (P = .03). With the inclusion of OG, the model’s differential diagnosis was able to correctly identify the underlying condition in 62% of both CT and MRI cases (CT: P = .001, MRI: P = .31).

Conclusion

ChatGPT's effectiveness in medical imaging diagnostics is initially limited, yet it substantially benefits from the addition of user guidance. The study underscores AI's current shortcomings but also its considerable capacity to improve clinical operations when enriched with more data and expert direction.

目的评估 ChatGPT 在泌尿科医学影像解读中的有效性，通过确定其作为诊断和教育资源的优势和局限性，满足在医疗保健领域安全应用人工智能的迫切需求：利用 Radiopaedia.com 上的公开病例，我们向 ChatGPT 输入了 1-3 幅 CT 或 MRI 图像。标准提示指示模型提供按概率排序的鉴别诊断。在器官引导（OG）的情况下第二次重复这项任务，OG 会提供模型感兴趣的诊断器官（如肾脏）。主要结果包括模型的最高诊断或鉴别诊断是否正确识别了潜在病理：结果：在 14% 的 CT 病例（7/50）和 28% 的 MRI 病例（14/50）中，ChatGPT 将病理情况正确识别为其最高诊断（P=0.08）。在解读 CT 图像时，OG 将模型识别最高诊断的能力提高了 18% (p = 0.03)，但在解读 MRI 图像时，这一优势并不明显 (p=0.4)。基线时，分别有 30% 和 56% 的 CT 和 MRI 病例的鉴别诊断包含最终诊断（p = 0.03）。加入 OG 后，该模型的鉴别诊断能够正确识别 62% 的 CT 和 MRI 病例的潜在病症（CT：p=0.001，MRI：p=0.31）：结论：ChatGPT 在医学影像诊断中的有效性最初是有限的，但在增加了用户指导后，它将大大受益。这项研究强调了人工智能目前存在的不足，但如果有更多的数据和专家指导，它也有相当大的能力改善临床操作。

{"title":"Accuracy of a ChatGPT in Diagnosing Urologic Conditions From Cross-sectional Imaging","authors":"Matthew W. Cole , Keavash D. Assani , Hunter S. Robinson , Mae Wimbiscus , Bryn M. Launer , Ryan J. Chew , Erin A. Cooke , Sam S. Chang , Amy N. Luckenbaugh , Daniel D. Joyce , Jeffrey J. Tosoian","doi":"10.1016/j.urology.2024.11.036","DOIUrl":"10.1016/j.urology.2024.11.036","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate ChatGPT's effectiveness in medical imaging interpretation within urology, addressing the critical need for safe AI application in healthcare by identifying its strengths and limitations as a diagnostic and educational resource.</div></div><div><h3>Material and Methods</h3><div>Using publicly available cases from Radiopaedia.com, we entered 1-3 CT or MRI images into ChatGPT. A standard prompt instructed the model to provide a differential diagnosis ranked by probability. This task was repeated a second time with organ guidance (OG), which provided the organ of diagnostic interest to the model (eg, kidney). Primary outcomes included whether the model’s top or differential diagnosis correctly identified the underlying pathology.</div></div><div><h3>Results</h3><div>ChatGPT correctly identified the pathologic condition as its top diagnosis in 14% of CT (7/50) and 28% (14/50) of MRI cases (<em>P</em> = .08). OG increased the model’s ability to recognize the top diagnosis by 18% (<em>P</em> = .03) when interpreting CT images, a benefit not shared when interpreting MRI images (<em>P</em> = .4). At baseline the differential diagnosis contained the final diagnosis for 30% and 56% of CT and MRI cases (<em>P</em> = .03). With the inclusion of OG, the model’s differential diagnosis was able to correctly identify the underlying condition in 62% of both CT and MRI cases (CT: <em>P</em> = .001, MRI: <em>P</em> = .31).</div></div><div><h3>Conclusion</h3><div>ChatGPT's effectiveness in medical imaging diagnostics is initially limited, yet it substantially benefits from the addition of user guidance. The study underscores AI's current shortcomings but also its considerable capacity to improve clinical operations when enriched with more data and expert direction.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"196 ","pages":"Pages 27-31"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

The Diagnostic Efficacy of Rapid Urine Sediment Fluorescence Staining in Urinary Tract Infections: An Exploratory Study 尿沉渣快速荧光染色诊断尿路感染的初步研究。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.063

Xihui Ma , Binyu Li , Guangliang Bai , Zongwei Guo , Xueting Cao , Xiangrui Kong , Yong Han , Li Xiao

Objective

To investigate rapid and early diagnostic approaches for urinary tract infections (UTIs).

Methods

Coincidence rates, sensitivities, and specificities of fungal fluorescence staining for fungal detection were calculated. Additionally, the positive rate of cellular fluorescence staining was compared with bacterial urine culture, with a focus on the increasing correlation between fluorescently stained bacteria proportions and the concordance between methods. Furthermore, diagnostic performance for detecting cocci and bacilli via histocyte fluorescence staining was evaluated. Receiver Operating Characteristic (ROC) curve analyses were conducted to determine the diagnostic accuracy of urine sediment fluorescence staining for fungal and bacterial UTIs.

Results

Fungal fluorescence staining of urine sediment demonstrated a coincidence rate of 95.90%, sensitivity of 94.44%, and specificity of 96.05%. The positivity of cellular fluorescence staining exceeded that of bacterial culture (P = .014), and an enhanced agreement between the 2 methods was observed with a rise in the proportion of stained bacteria. For histocyte fluorescence staining in identifying cocci and bacilli, coincidence rates were 76.92% and 74.36%, sensitivities were 51.85% and 73.85%, and specificities reached 82.43% and 88.18%, respectively. The ROC curve areas for diagnosing fungal and bacterial UTIs using urine sediment fluorescence staining were 0.952 and 0.87, respectively.

Conclusion

Urine sediment fluorescence staining offers promise as a rapid diagnostic tool for UTIs, demonstrating high sensitivity and specificity for fungal detection and a competitive performance in bacterial identification when compared to standard culture methods. These findings highlight the potential utility of this technique in clinical settings for prompt and accurate UTI diagnosis.

目的：探讨尿路感染的早期快速诊断方法。方法：计算真菌荧光染色检测真菌的符合率、灵敏度和特异性。此外，将细胞荧光染色的阳性率与细菌尿培养进行比较，重点关注荧光染色的细菌比例与方法之间的一致性之间的相关性增加。此外，对组织细胞荧光染色检测球菌和杆菌的诊断性能进行了评价。采用受试者工作特征（ROC）曲线分析，确定尿沉积物荧光染色对真菌和细菌uti的诊断准确性。结果：尿沉渣真菌荧光染色符合率为95.90%，灵敏度为94.44%，特异性为96.05%。细胞荧光染色的阳性率高于细菌培养（P=0.014），随着染色细菌比例的增加，两种方法的一致性增强。组织细胞荧光染色鉴定球菌和杆菌的符合率分别为76.92%和74.36%，敏感性分别为51.85%和73.85%，特异性分别为82.43%和88.18%。尿沉积物荧光染色诊断真菌和细菌uti的ROC曲线面积分别为0.952和0.87。结论：与标准培养方法相比，尿液沉积物荧光染色在真菌检测方面具有较高的敏感性和特异性，在细菌鉴定方面具有竞争力，有望成为尿路感染的快速诊断工具。这些发现强调了该技术在临床环境中对尿路感染的快速和准确诊断的潜在效用。

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引用次数: 0

Management of an Incidentally Discovered Ovarian Teratoma in an Adolescent Patient 如何处理一名青少年患者意外发现的卵巢畸胎瘤？

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.029

Jate Bernard , Joon Kyung Kim , Jacqueline Morin , Spencer Larkin , Timothy Stark , Amanda F. Buchanan

Mature ovarian teratomas are a benign subset of germ cell tumors (GCT) often diagnosed during reproductive years and are the most common GCT among children and adolescents. Many are found incidentally on unrelated imaging. There are no definitive guidelines on the management of these teratomas, particularly in the pediatric population. This case presents the management of an adolescent patient with an incidentally found ovarian teratoma. A discussion of contemporary literature also identifies a significant gap in the literature for definitive guidelines in pediatric patients with mature teratomas.

成熟卵巢畸胎瘤是生殖细胞瘤（GCT）的一个良性亚群，通常在育龄期诊断出来，是儿童和青少年中最常见的 GCT。许多畸胎瘤是在不相关的影像学检查中偶然发现的。对于这些畸胎瘤的治疗，尤其是儿童患者的治疗，目前还没有明确的指南。本病例介绍了对一名偶然发现卵巢畸胎瘤的青少年患者的治疗。通过对当代文献的讨论，我们还发现了文献中关于成熟畸胎瘤儿科患者明确治疗指南的重大空白。

引用次数: 0

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