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Use of omentum during robotic-assisted reconstructive urological surgery: a systematic review of the current literature. 在机器人辅助泌尿外科整形手术中使用网膜:当前文献的系统性回顾。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-04 DOI: 10.1007/s00345-024-05335-0
Christopher Anderson, Theodoros Spinos, Evangelos Liatsikos, Panagiotis Kallidonis, Vasileios Tatanis, Anja Dietel, Toni Franz, Jens-Uwe Stolzenburg

Purpose: Due to its biological properties, the omentum is a very useful tool in the hands of reconstructive urologists. The purpose of this systematic review is to present all existing evidence regarding the use of omentum during different robotic-assisted reconstructive urological surgeries.

Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, three databases (PubMed, Scopus and Cochrane) were systematically screened. The following search string was used: (omentum OR omental) AND robotic. Retrospective studies and case-series were included, while case-reports were not included.

Results: 13 studies met all eligibility criteria and were included in final qualitative synthesis. Seven studies reported robotic vesicovaginal fistula repair, two studies reported robotic vesicouterine or vesicocervical fistula repair, one study reported robotic rectovesical fistula repair, one study reported robotic rectourethral fistula repair, one study reported ureterolysis with omental wrap and one study reported robotic repair of long ureteral strictures with omental wrap and autologous onlay flap or graft ureteroplasty. Recurrence rates ranged from 0% to 6.7%. The Grade I-II complications according to Clavien-Dindo Classification ranged from 0 to 40%, while no Grade III-IV were reported.

Conclusion: Robotic repair with the use of omentum is potentially a feasible, safe and efficient approach for complicated urological surgeries, such as vesicovaginal, vesicouterine, vaginocervical, rectovesical and rectourethral fistulas, idiopathic retroperitoneal fibrosis and long ureteral strictures. Because the evidence is based on small case series, further publications are needed to enhance confidence in omental harvesting and render it a routine component of reconstructive Urology.

目的:由于网膜的生物特性,它是泌尿外科整形专家手中非常有用的工具。本系统综述的目的是介绍在不同的机器人辅助泌尿外科重建手术中使用网膜的所有现有证据:方法:根据《系统综述和荟萃分析首选报告项目》(PRISMA)指南,对三个数据库(PubMed、Scopus 和 Cochrane)进行了系统筛选。搜索字符串如下(网膜或网膜)和机器人。结果:结果:13 项研究符合所有资格标准,并纳入最终定性综述。7项研究报告了机器人膀胱阴道瘘修补术,2项研究报告了机器人膀胱阴道瘘或膀胱宫颈瘘修补术,1项研究报告了机器人直肠瘘修补术,1项研究报告了机器人直肠尿道瘘修补术,1项研究报告了使用网膜包裹的输尿管溶解术,1项研究报告了使用网膜包裹和自体嵌顿皮瓣或移植输尿管成形术的机器人长输尿管狭窄修补术。复发率从0%到6.7%不等。根据Clavien-Dindo分类法,I-II级并发症的发生率为0-40%,没有III-IV级并发症的报道:结论:对于复杂的泌尿外科手术,如膀胱阴道瘘、膀胱阴道瘘、阴道宫颈瘘、直肠瘘和直肠尿道瘘、特发性腹膜后纤维化和长输尿管狭窄,使用网膜进行机器人修复是一种可行、安全和高效的方法。由于这些证据都是基于小型病例系列,因此需要更多的出版物来增强人们对网膜采集的信心,并使其成为泌尿外科整形手术的常规组成部分。
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引用次数: 0
Letter to the editor: transrectal versus transperineal prostate fusion biopsy-a pair-matched analysis to evaluate accuracy and complications. 致编辑的信:经直肠与经会阴前列腺融合活检--评估准确性和并发症的配对分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-04 DOI: 10.1007/s00345-024-05328-z
Kamil Malshy, Thomas Osinski, Trevor C Hunt, Jean Joseph
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引用次数: 0
Impact of weight loss on the risk of urinary incontinence: the role of sex and body type. 减肥对尿失禁风险的影响:性别和体型的作用。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 DOI: 10.1007/s00345-024-05333-2
Feng Chen, Hao Lin, Yuansi Zhang, Yu Zhang, Maoping Chu, Lulu Pan

Introduction: Although weight loss is known to alleviate urinary incontinence (UI) symptoms, the effects of sex and body size on this relationship remain insufficiently explored.

Materials and methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, comprising 28,161 participants. Weighted logistic regression analysis, fitted curves, and subgroup analysis were used to assess the association between the percentage of weight loss and UI. Propensity score matching (PSM) was performed to account for potential confounding factors.

Results: After PSM, multivariate logistic regression showed an inverse relationship between weight loss percentage and UI risk (odds ratio [OR] = 0.97, 95% confidence interval [CI]: 0.94-0.99). Compared with weight loss percentages < 0%, the risk of UI significantly decreased with weight loss percentages > 5% (weight loss percentage 5.1-10%: OR = 0.83, 95% CI: 0.70-1.00; weight loss percentage 10.1-15%: OR = 0.73, 95% CI: 0.55-0.97; weight loss percentage > 15%: OR = 0.52, 95% CI: 0.39-0.70). Furthermore, subgroup analysis indicated that this relationship was more significant in males and non-overweight/non-obese populations.

Conclusion: There was an inverse relationship between weight loss percentage and UI risk, with noticeable differences based on sex and body size. However, these findings warrant further investigation.

简介:尽管减肥可以减轻尿失禁(UI)症状,但性别和体型对这种关系的影响仍未得到充分探讨:众所周知,减肥可减轻尿失禁(UI)症状,但性别和体型对这一关系的影响仍未得到充分探讨:我们分析了美国国家健康与营养调查(NHANES)2007-2018 年的数据,其中包括 28,161 名参与者。我们采用加权逻辑回归分析、拟合曲线和亚组分析来评估体重减轻百分比与 UI 之间的关系。进行倾向得分匹配(PSM)以考虑潜在的混杂因素:经过倾向得分匹配后,多变量逻辑回归显示,体重减轻百分比与尿失禁风险之间存在反向关系(几率比 [OR] = 0.97,95% 置信区间 [CI]:0.94-0.99)。与体重减轻百分比为 5%(体重减轻百分比为 5.1-10%:OR = 0.83,95% 置信区间 [CI]:0.70-1.00;体重减轻百分比 10.1-15%:OR = 0.73,95% CI:0.55-0.97;体重减轻百分比 > 15%:OR = 0.52,95% CI:0.39-0.70)。此外,亚组分析表明,这种关系在男性和非超重/非肥胖人群中更为显著:结论:减肥百分比与 UI 风险之间存在反向关系,性别和体型差异明显。不过,这些发现值得进一步研究。
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引用次数: 0
Oncological outcomes of organ-sparing cystectomy versus standard radical cystectomy in male patients diagnosed with bladder cancer. 在确诊为膀胱癌的男性患者中,保全器官膀胱切除术与标准根治性膀胱切除术的肿瘤学效果对比。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 DOI: 10.1007/s00345-024-05329-y
Zeyu Han, Yaxiong Tang, Xianyanling Yi, Jin Li, Jianzhong Ai

Purpose: To compare the oncological outcomes between standard radical cystectomy (SRC) and organ-sparing cystectomy (OSC) in male patients diagnosed with bladder cancer.

Methods: Patients with stage Ta-T3 bladder cancer who underwent OSC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The association between preoperative factors and the implementation of OSC was analyzed using logistic regression. Propensity score matching (PSM) was employed to balance baseline characteristics between the two groups. Patients' overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Subgroup analyses based on the T stage were also conducted.

Results: A total of 7264 patients were included, with 96.8% (7033 patients) receiving SRC and 3.2% (231 patients) receiving OSC. Patients with higher T stages and high-grade tumors were less likely to undergo OSC. After PSM, OSC was associated with significantly worse OS and CSS than SRC. Subgroup analysis revealed that OSC did not lead to worse OS and CSS in non-muscle invasive bladder cancer and T2 stage patients, but it resulted in significantly worse outcomes in T3 stage patients.

Conclusion: Our study indicates that OSC is associated with poorer oncological outcomes compared to SRC, particularly in patients with advanced-stage tumors. These findings suggest the need for stringent selection criteria for OSC in bladder cancer patients. Given the negative impact on prognosis, stage T3 should potentially be considered a contraindication for OSC. Further evidence is required to confirm these assertions.

目的:比较男性膀胱癌患者接受标准根治性膀胱切除术(SRC)和保器膀胱切除术(OSC)的肿瘤治疗效果:2004年至2015年期间,从监测、流行病学和最终结果(SEER)数据库中找到了接受OSC或SRC手术的Ta-T3期膀胱癌患者。采用逻辑回归分析了术前因素与实施OSC之间的关联。采用倾向评分匹配(PSM)来平衡两组患者的基线特征。患者的总生存期(OS)和癌症特异性生存期(CSS)采用 Kaplan-Meier 法进行估算。此外,还进行了基于T分期的亚组分析:共纳入 7264 例患者,其中 96.8%(7033 例)接受了 SRC 治疗,3.2%(231 例)接受了 OSC 治疗。T分期较高和肿瘤分级较高的患者接受卵巢癌手术的几率较低。PSM后,OSC的OS和CSS明显低于SRC。亚组分析显示,OSC不会导致非肌层浸润性膀胱癌和T2期患者的OS和CSS恶化,但会导致T3期患者的预后明显恶化:我们的研究表明,与SRC相比,OSC与较差的肿瘤预后相关,尤其是在晚期肿瘤患者中。这些研究结果表明,需要对膀胱癌患者进行严格的卵巢癌手术选择标准。考虑到对预后的负面影响,T3 期有可能被视为 OSC 的禁忌症。这些论断还需要进一步的证据来证实。
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引用次数: 0
Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women. 女性接受机器人辅助根治性膀胱切除术并植入新膀胱后的疗效。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 DOI: 10.1007/s00345-024-05339-w
Juhana Rautiola, Alberto Martini, Laura S Mertens, Viktor Skokic, Luca Di Gianfrancesco, Carlo Andrea Bravi, Julia Heinzelbecker, Mikolaj Mendrek, Stephan Buse, Guillaume Ploussard, Hubert John, Abdullah Erdem Canda, Mevlana Derya Balbay, Sebastian Edeling, Charles Van Praet, Sami-Ramzi Leyh-Bannurah, Alexander Mottrie, Frederiek D'Hondt, Hendrik van der Poel, Camille Berquin, Karel Dacaestecker, Richard Gaston, Peter Wiklund, Abolfazl Hosseini

Purpose: To investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.

Methods: From a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.

Results: The study involved 146 patients with the median age 60 years (IQR, 51-66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.

Conclusions: Robot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.

目的:研究接受机器人辅助膀胱切除术(RARC)和体外正位新膀胱术的女性患者的功能、肿瘤和并发症预后:我们从一个多机构数据库中筛选出了接受机器人辅助膀胱切除术(RARC)和体外正位新膀胱治疗的膀胱癌女性患者。我们评估了尿失禁率、短期肿瘤治疗效果和并发症发生率。我们根据保留妇科器官的情况进行了重复和分层分析:研究涉及 146 名患者,中位年龄为 60 岁(IQR,51-66 岁)。77名患者(53%)接受了盆腔器官保留手术(POP)。白天和夜间的总体尿失禁率分别为 54% 和 53%。就 POP 而言,日间和夜间尿失禁率均为 58%。在非 POP 患者组中,日间和夜间尿失禁率分别为 50%和 49%。两组患者的手术切缘阳性率相当(POP 为 5.3%,非 POP 为 4.7%)。在整个组别中,高级别(Clavien-Dindo ≥3)早期和晚期并发症的发生率分别为7.5%和7.5%:结论:女性机器人辅助根治性膀胱切除术与体腔内正位新膀胱术在功能和并发症方面都有很好的疗效。保留盆腔器官的膀胱切除术可提高尿失禁率,且不会对手术切缘造成不利影响。在保留盆腔器官的膀胱切除术的同时,对部分膀胱癌女性患者进行体外正位新膀胱治疗,可在不影响肿瘤治疗效果的前提下改善功能。
{"title":"Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women.","authors":"Juhana Rautiola, Alberto Martini, Laura S Mertens, Viktor Skokic, Luca Di Gianfrancesco, Carlo Andrea Bravi, Julia Heinzelbecker, Mikolaj Mendrek, Stephan Buse, Guillaume Ploussard, Hubert John, Abdullah Erdem Canda, Mevlana Derya Balbay, Sebastian Edeling, Charles Van Praet, Sami-Ramzi Leyh-Bannurah, Alexander Mottrie, Frederiek D'Hondt, Hendrik van der Poel, Camille Berquin, Karel Dacaestecker, Richard Gaston, Peter Wiklund, Abolfazl Hosseini","doi":"10.1007/s00345-024-05339-w","DOIUrl":"10.1007/s00345-024-05339-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.</p><p><strong>Methods: </strong>From a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.</p><p><strong>Results: </strong>The study involved 146 patients with the median age 60 years (IQR, 51-66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.</p><p><strong>Conclusions: </strong>Robot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Tumor regression after neoadjuvant hormonal therapy in high risk prostate cancer: pathological outcomes from a randomized phase II trial. 高危前列腺癌新辅助激素治疗后的肿瘤消退:一项随机 II 期试验的病理结果。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 DOI: 10.1007/s00345-024-05323-4
Leonardo Cardili, Diogo Assed Bastos, Eder Nisi Ilario, Marina Alessandra Pereira, Giuliano Bettoni Guglielmetti, Maurício Cordeiro, José Pontes, Rafael Ferreira Coelho, William Carlos Nahas, Katia Ramos Moreira Leite

Purpose: High-risk localized prostate cancer (HRLPC) commonly progresses to metastatic disease after local treatment. Neoadjuvant androgen deprivation therapy (nADT) before radical prostatectomy (RP) has recently been suggested to improve early oncological outcomes in HRLPC. We aimed to perform an exploratory analysis of the pathological outcomes from a prospective trial testing nADT before RP.

Methods: Prospective, single-centered, phase II, randomized trial performed between October 2018 and July 2021. Random assignment (1:1) for nADT modalities: goserelin (10.8 mg) plus abiraterone acetate (1000 mg/d) plus prednisone (5 mg/d), with or without apalutamide (240 mg/d) for 12 weeks, followed by RP (within 30 days) and extended lymph node dissection. Baseline clinical and pathological variables were assessed in needle biopsies before nADT. Tumor regression was histologically evaluated in surgical specimens using the residual cancer burden index (RCB).

Results: Sixty-two patients reached the surgical phase. Good response (RCB ≤ 0.25 cm³) was achieved in 14 patients (22.5%). Overall stage migration rate between baseline status (MRI before nADT) and final status (after surgery) was 27.4%. Late stage detection (high tumor burden, perineural invasion) and altered PTEN/ERG immunostatus showed significant association with poor response in univariate analysis. Higher baseline tumor burden was the only independent factor related to poor response in multivariate analysis.

Conclusions: There are subgroups of patients, such as those with low baseline cancer burden and PTEN/ERG wild-type status, more likely to achieve good response with nADT. In the case of long term oncological benefit to be proven, nADT might be an additional therapeutic resource for these patients.

目的:高危局部前列腺癌(HRLPC)通常在局部治疗后发展为转移性疾病。最近有人提出,在根治性前列腺切除术(RP)前进行新辅助雄激素剥夺治疗(nADT)可改善HRLPC的早期肿瘤预后。我们的目的是对一项前瞻性试验的病理结果进行探索性分析,该试验测试了前列腺癌根治术前的 nADT:2018年10月至2021年7月期间进行的前瞻性、单一中心、II期随机试验。随机分配(1:1)nADT模式:戈舍瑞林(10.8毫克)加醋酸阿比特龙(1000毫克/天)加泼尼松(5毫克/天),加或不加阿帕鲁胺(240毫克/天),持续12周,然后进行RP(30天内)和扩大淋巴结清扫。在进行 nADT 之前,对针刺活检的临床和病理基线变量进行了评估。采用残留癌负担指数(RCB)对手术标本中的肿瘤消退情况进行组织学评估:结果:62 例患者进入手术阶段。结果:62 名患者进入了手术阶段,其中 14 名患者(22.5%)获得了良好反应(RCB ≤ 0.25 cm³)。基线状态(nADT前的磁共振成像)与最终状态(手术后)之间的总体分期迁移率为27.4%。在单变量分析中,晚期发现(高肿瘤负荷、神经周围侵犯)和PTEN/ERG免疫状态改变与不良反应有显著相关性。在多变量分析中,较高的基线肿瘤负荷是唯一与不良反应相关的独立因素:结论:有一些亚组患者,如基线肿瘤负荷低和PTEN/ERG野生型状态的患者,更有可能通过nADT获得良好反应。在长期肿瘤学获益有待证实的情况下,nADT 可能会成为这些患者的额外治疗资源。
{"title":"Tumor regression after neoadjuvant hormonal therapy in high risk prostate cancer: pathological outcomes from a randomized phase II trial.","authors":"Leonardo Cardili, Diogo Assed Bastos, Eder Nisi Ilario, Marina Alessandra Pereira, Giuliano Bettoni Guglielmetti, Maurício Cordeiro, José Pontes, Rafael Ferreira Coelho, William Carlos Nahas, Katia Ramos Moreira Leite","doi":"10.1007/s00345-024-05323-4","DOIUrl":"https://doi.org/10.1007/s00345-024-05323-4","url":null,"abstract":"<p><strong>Purpose: </strong>High-risk localized prostate cancer (HRLPC) commonly progresses to metastatic disease after local treatment. Neoadjuvant androgen deprivation therapy (nADT) before radical prostatectomy (RP) has recently been suggested to improve early oncological outcomes in HRLPC. We aimed to perform an exploratory analysis of the pathological outcomes from a prospective trial testing nADT before RP.</p><p><strong>Methods: </strong>Prospective, single-centered, phase II, randomized trial performed between October 2018 and July 2021. Random assignment (1:1) for nADT modalities: goserelin (10.8 mg) plus abiraterone acetate (1000 mg/d) plus prednisone (5 mg/d), with or without apalutamide (240 mg/d) for 12 weeks, followed by RP (within 30 days) and extended lymph node dissection. Baseline clinical and pathological variables were assessed in needle biopsies before nADT. Tumor regression was histologically evaluated in surgical specimens using the residual cancer burden index (RCB).</p><p><strong>Results: </strong>Sixty-two patients reached the surgical phase. Good response (RCB ≤ 0.25 cm³) was achieved in 14 patients (22.5%). Overall stage migration rate between baseline status (MRI before nADT) and final status (after surgery) was 27.4%. Late stage detection (high tumor burden, perineural invasion) and altered PTEN/ERG immunostatus showed significant association with poor response in univariate analysis. Higher baseline tumor burden was the only independent factor related to poor response in multivariate analysis.</p><p><strong>Conclusions: </strong>There are subgroups of patients, such as those with low baseline cancer burden and PTEN/ERG wild-type status, more likely to achieve good response with nADT. In the case of long term oncological benefit to be proven, nADT might be an additional therapeutic resource for these patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of metastatic sites and burden on oncological outcomes in patients progressing to metastatic castration resistant prostate cancer. 转移部位和负担对转移性去势抵抗性前列腺癌患者肿瘤治疗效果的影响。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 DOI: 10.1007/s00345-024-05341-2
Mike Wenzel, Benedikt Hoeh, Clara Humke, Florestan Koll, Cristina Cano Garcia, Carolin Siech, Thomas Steuber, Markus Graefen, Miriam Traumann, Luis Kluth, Felix K H Chun, Philipp Mandel

Purpose: Metastatic castration-resistant prostate cancer (mCRPC) patients harbor reduced life expectancy after first-line treatment progression. Currently, no information is available regarding the influence of metastatic sites and osseous burden on progression-free (PFS) and overall survival (OS) of mCRPC patients.

Methods: We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to select patients progressing to mCRPC and stratified them according to lymph node vs. osseous vs. visceral metastatic sites. Moreover, we stratified osseous mCRPC patients regarding the number of metastatic lesions. Endpoints were PFS and OS in uni- and multivariable Cox regression models.

Results: Of 363 patients, 9.4% harbored M1a vs. 78% M1b vs. 12% M1c mCRPC with significantly higher PSA in M1b (9 vs. 22 vs. 8ng/ml). Rates of DeNovo (15% vs. 60% vs. 56%) were significantly lower in the M1a mCRPC group, compared to M1b and M1c (p < 0.001). In PFS analyses, a median of 12.7 vs. 10.1 vs. 15.9 months for M1a vs. M1b vs. M1c mCRPC was observed (p > 0.05). In multivariable Cox regression models, M1c mCRPC was independently at higher risk for progression (hazard ratio [HR]: 5.93, p = 0.048), relative to M1a. Regarding OS, significant differences were observed (p = 0.002), with median OS of 58 vs. 42 vs. 25 months for M1a vs. M1b vs. M1c mCRPC and corresponding HRs of 1.54 (p = 0.11) and 2.76 (p < 0.01). In multivariable models M1c mCRPC was associated with higher risk of death (HR: 3.56, p = 0.049), relative to M1a. No differences were observed after stratification according to number of bone lesions (all p ≥ 0.05).

Conclusion: M1c mCRPC patients are independently at higher risk for progression and death, while M1a patients harbor best cancer-control outcomes.

目的:转移性抗性前列腺癌(mCRPC)患者在一线治疗进展后预期寿命缩短。目前,还没有关于转移部位和骨性负担对mCRPC患者无进展生存期(PFS)和总生存期(OS)的影响的信息:我们依靠法兰克福前列腺癌转移数据库(FRAMCAP)筛选出进展为mCRPC的患者,并根据淋巴结转移部位、骨转移部位和内脏转移部位对他们进行了分层。此外,我们还根据转移病灶的数量对骨性 mCRPC 患者进行了分层。在单变量和多变量考克斯回归模型中,终点为PFS和OS:在363名患者中,9.4%患有M1a,78%患有M1b,12%患有M1c,其中M1b患者的PSA明显更高(9 vs. 22 vs. 8ng/ml)。与M1b和M1c相比,M1a mCRPC组的DeNovo率(15% vs. 60% vs. 56%)明显较低(P 0.05)。在多变量Cox回归模型中,相对于M1a,M1c mCRPC的进展风险更高(危险比[HR]:5.93,P = 0.048)。M1a与M1b与M1c mCRPC的中位OS分别为58个月与42个月与25个月,相应的HR分别为1.54(P = 0.11)和2.76(P 结论:M1a与M1b与M1c mCRPC的中位OS分别为58个月与42个月与25个月,相应的HR分别为1.54(P = 0.11)和2.76(P = 0.002):M1c型mCRPC患者的病情恶化和死亡风险较高,而M1a型患者的癌症控制效果最好。
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引用次数: 0
The infection post flexible UreteroreNoscopy (I-FUN) predictive model based on machine learning: a new clinical tool to assess the risk of sepsis post retrograde intrarenal surgery for kidney stone disease. 基于机器学习的柔性输尿管镜检查后感染(I-FUN)预测模型:评估肾结石逆行肾内手术后脓毒症风险的新临床工具。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1007/s00345-024-05314-5
Daniele Castellani, Virgilio De Stefano, Carlo Brocca, Giorgio Mazzon, Antonio Celia, Andrea Bosio, Claudia Gozzo, Eugenio Alessandria, Luigi Cormio, Runeel Ratnayake, Andrea Vismara Fugini, Tonino Morena, Yiloren Tanidir, Tarik Emre Sener, Simon Choong, Stefania Ferretti, Andrea Pescuma, Salvatore Micali, Nicola Pavan, Alchiede Simonato, Roberto Miano, Luca Orecchia, Giacomo Maria Pirola, Angelo Naselli, Esteban Emiliani, Pedro Hernandez-Peñalver, Michele Di Dio, Claudio Bisegna, Davide Campobasso, Emauele Serafin, Alessandro Antonelli, Emanuele Rubilotta, Deepak Ragoori, Emanuele Balloni, Marina Paolanti, Vineet Gauhar, Andrea Benedetto Galosi

Purpose: To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis.

Methods: All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023).

Inclusion criteria: adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days).

Exclusion criteria: concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds.

Results: 1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.

目的:建立一个机器学习模型,用于估计逆行肾内手术(RIRS)后发生败血症的可能性:纳入标准:成人、仅肾结石、CT扫描(3个月内)、中段尿培养(10天内);排除标准:合并输尿管结石、双侧手术。如果出现无症状感染/无症状菌尿症,患者将根据药敏谱接受为期六天的抗生素治疗。所有患者均接受了抗生素预防治疗。模型所选变量:年龄、性别、年龄调整后的夏尔森综合指数、结石体积、术前留置的膀胱导尿管、尿培养、单个/多个结石、术前留置的支架/肾造瘘术、输尿管通道鞘、手术时间。分析使用 Python 编程语言和 Pandas 库进行,机器学习模型使用 Scikit-learn 库实现。测试的机器学习算法包括决策树、随机森林、梯度提升。总体性能通过 K-Fold 交叉验证进行了精确估算:共纳入 1552 名患者。共有 20 例(1.3%)败血症病例,16 例(1.0%)脓毒性休克病例,另有 3 例(0.2%)败血症相关死亡病例。随机森林模型表现最佳(精确度=1.00;召回率=0.86;F1得分=0.92;准确度=0.92)。该预测模型的网络界面已建成,可在 https://emabal.pythonanywhere.com/ 网站上查阅:我们的模型可以高度准确地预测 RIRS 后脓毒症,有助于选择日间手术患者,并识别脓毒症风险较高的患者,这些患者值得高度重视,以便及时发现和治疗。
{"title":"The infection post flexible UreteroreNoscopy (I-FUN) predictive model based on machine learning: a new clinical tool to assess the risk of sepsis post retrograde intrarenal surgery for kidney stone disease.","authors":"Daniele Castellani, Virgilio De Stefano, Carlo Brocca, Giorgio Mazzon, Antonio Celia, Andrea Bosio, Claudia Gozzo, Eugenio Alessandria, Luigi Cormio, Runeel Ratnayake, Andrea Vismara Fugini, Tonino Morena, Yiloren Tanidir, Tarik Emre Sener, Simon Choong, Stefania Ferretti, Andrea Pescuma, Salvatore Micali, Nicola Pavan, Alchiede Simonato, Roberto Miano, Luca Orecchia, Giacomo Maria Pirola, Angelo Naselli, Esteban Emiliani, Pedro Hernandez-Peñalver, Michele Di Dio, Claudio Bisegna, Davide Campobasso, Emauele Serafin, Alessandro Antonelli, Emanuele Rubilotta, Deepak Ragoori, Emanuele Balloni, Marina Paolanti, Vineet Gauhar, Andrea Benedetto Galosi","doi":"10.1007/s00345-024-05314-5","DOIUrl":"https://doi.org/10.1007/s00345-024-05314-5","url":null,"abstract":"<p><strong>Purpose: </strong>To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis.</p><p><strong>Methods: </strong>All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023).</p><p><strong>Inclusion criteria: </strong>adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days).</p><p><strong>Exclusion criteria: </strong>concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds.</p><p><strong>Results: </strong>1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic. COVID-19 大流行期间门诊良性前列腺阻塞手术的趋势。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1007/s00345-024-05343-0
Zhiyu Qian, Dejan Filipas, Edoardo Beatrici, Jamie Ye, Mansoo Cho, Filippo Dagnino, Hanna Zurl, Daniel Stelzl, David F Friedlander, Quoc-Dien Trinh, Stuart R Lipsitz, Alexander P Cole, Lori B Lerner

Introduction: Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak.

Methods: We identified BPO surgeries from the California State Inpatient and State Ambulatory Surgery Databases between 2018 and 2020. Our primary outcome was the proportion of procedures performed in ambulatory settings with a length of stay of zero days. Univariable and multivariable analyses were performed to analyze factors associated with ambulatory surgery around the COVID-19 outbreak. Spline regression with a knot at the pandemic outbreak was performed to compare time trends pre- and post-pandemic.

Results: Among 37,148 patients who underwent BPO procedures, 30,067 (80.9%) were ambulatory. Before COVID-19, 80.1% BPO procedures were performed ambulatory, which increased to 83.4% after COVID-19 outbreak (p < 0.001). In multivariable model, BPO procedures performed after COVID-19 outbreak were 1.26 times more likely to be ambulatory (OR 1.26, 95% CI 1.14-1.40, p < 0.0001). Spline curve analysis indicated significantly different trend of change pre- and post-pandemic (p = 0.006).

Conclusions: We observed a rising trend of BPO surgeries performed in ambulatory setting post-pandemic. It remains to be seen if the observed ambulatory transition remains as we continue to recover from the pandemic.

导言:良性前列腺梗阻(BPO)是导致男性下尿路症状的最常见原因之一。一些医疗机构通常在门诊环境下进行良性前列腺梗阻手术,而另一些则选择住院治疗。由于COVID-19大流行限制了用于择期手术的资源和医院空间,我们对COVID-19爆发前后门诊BPO手术的时间趋势进行了调查:我们从加利福尼亚州住院病人和州非住院手术数据库中确定了 2018 年至 2020 年期间的 BPO 手术。我们的主要结果是在非住院环境中进行的手术中住院时间为零天的比例。我们进行了单变量和多变量分析,以分析 COVID-19 爆发前后非住院手术的相关因素。以大流行爆发时为结点进行了样条回归,以比较大流行前后的时间趋势:在接受 BPO 手术的 37,148 名患者中,30,067 人(80.9%)为非住院患者。在COVID-19爆发前,80.1%的BPO手术是在门诊进行的,而在COVID-19爆发后,这一比例上升至83.4%(p 结论:我们观察到BPO手术呈上升趋势:我们观察到,大流行后在非住院环境中进行的 BPO 手术呈上升趋势。随着我们从大流行中继续恢复,观察到的门诊转变是否会继续,我们拭目以待。
{"title":"Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic.","authors":"Zhiyu Qian, Dejan Filipas, Edoardo Beatrici, Jamie Ye, Mansoo Cho, Filippo Dagnino, Hanna Zurl, Daniel Stelzl, David F Friedlander, Quoc-Dien Trinh, Stuart R Lipsitz, Alexander P Cole, Lori B Lerner","doi":"10.1007/s00345-024-05343-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05343-0","url":null,"abstract":"<p><strong>Introduction: </strong>Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak.</p><p><strong>Methods: </strong>We identified BPO surgeries from the California State Inpatient and State Ambulatory Surgery Databases between 2018 and 2020. Our primary outcome was the proportion of procedures performed in ambulatory settings with a length of stay of zero days. Univariable and multivariable analyses were performed to analyze factors associated with ambulatory surgery around the COVID-19 outbreak. Spline regression with a knot at the pandemic outbreak was performed to compare time trends pre- and post-pandemic.</p><p><strong>Results: </strong>Among 37,148 patients who underwent BPO procedures, 30,067 (80.9%) were ambulatory. Before COVID-19, 80.1% BPO procedures were performed ambulatory, which increased to 83.4% after COVID-19 outbreak (p < 0.001). In multivariable model, BPO procedures performed after COVID-19 outbreak were 1.26 times more likely to be ambulatory (OR 1.26, 95% CI 1.14-1.40, p < 0.0001). Spline curve analysis indicated significantly different trend of change pre- and post-pandemic (p = 0.006).</p><p><strong>Conclusions: </strong>We observed a rising trend of BPO surgeries performed in ambulatory setting post-pandemic. It remains to be seen if the observed ambulatory transition remains as we continue to recover from the pandemic.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exposure to the herbicide 2,4-dichlorophenoxyacetic acid and prostate cancer among U.S. adult men. 美国成年男性接触除草剂 2,4-二氯苯氧乙酸与前列腺癌。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1007/s00345-024-05336-z
Frank Glover, Michael Eisenberg, Francesco Del Giudice, Federico Belladelli, Albert Ha, Michael Scott, Christopher Filson

Purpose: Prostate cancer is the second most diagnosed male malignancy in the U.S. 2,4-Dichlorophenoxyacetic acid (2,4-D) is a commonly used herbicide and potential carcinogen. The researchers evaluated the association between prostate cancer and 2,4-D.

Methods: Data was leveraged from the National Health and Nutrition Examination Survey (NHANES), a population-based, cross-sectional study of men and women in the U.S. Our cohort of interest was men aged 50 years and over. Urinary 2,4-D served as the measure of exposure. Our primary outcome was history of prostate cancer based on an individual's reply of "yes" to either ever having been diagnosed with prostate cancer and/or having received treatment for prostate cancer. Chi-square, one-way analysis of variance (ANOVA), and multivariable, weighted logistic regression were used to analyze the relationship between 2,4-D and prostate cancer.

Results: We identified 1,788 eligible men, representing an estimated 691,709 men after survey weighting. The median 2,4-D level was 0.28 µg/L (IQR: 0.26-0.53), and the geometric mean was 0.38 µg/L. Increasing exposure of 2,4-D was associated with prostate cancer (OR 1.72, 95% CI [1.2,2.4]). Individuals in the highest quartile of 2,4-D exposure had a higher odds of a prostate cancer diagnosis compared to the lowest quartile (OR = 3.46 95% CI [1.11,10.72]). Age stratification revealed statistically significant associations between 2,4-D and prostate cancer in men age 70 + who were in the highest quartile of exposure (OR = 3.79 95% CI [1.51,9.52]).

Conclusions: These findings implicate 2,4-D exposure in the risk of prostate cancer. Future studies are warranted to corroborate these findings and elucidate potential mechanisms underlying these associations.

目的:前列腺癌是美国第二大男性恶性肿瘤。2,4-二氯苯氧乙酸(2,4-D)是一种常用的除草剂,也是潜在的致癌物质。研究人员评估了前列腺癌与 2,4-D 之间的关联:我们感兴趣的人群是 50 岁及以上的男性。尿液中的 2,4-D 是衡量暴露量的指标。我们的主要研究结果是前列腺癌病史,根据个人对曾被诊断为前列腺癌和/或接受过前列腺癌治疗的回答 "是"。我们采用卡方、单因素方差分析(ANOVA)和多变量加权逻辑回归分析 2,4-D 与前列腺癌之间的关系:我们确定了 1,788 名符合条件的男性,经过调查加权后,估计有 691,709 名男性符合条件。2,4-D水平的中位数为0.28微克/升(IQR:0.26-0.53),几何平均数为0.38微克/升。2,4-D暴露量的增加与前列腺癌有关(OR 1.72,95% CI [1.2,2.4])。与最低四分位数的人相比,2,4-D 暴露量最高四分位数的人确诊前列腺癌的几率更高(OR = 3.46 95% CI [1.11,10.72])。年龄分层显示,在接触2,4-D最高四分位数的70岁以上男性中,2,4-D与前列腺癌之间存在显著的统计学关联(OR = 3.79 95% CI [1.51,9.52]):这些研究结果表明,暴露于 2,4-D 会增加患前列腺癌的风险。今后有必要开展研究,以证实这些发现并阐明这些关联的潜在机制。
{"title":"Exposure to the herbicide 2,4-dichlorophenoxyacetic acid and prostate cancer among U.S. adult men.","authors":"Frank Glover, Michael Eisenberg, Francesco Del Giudice, Federico Belladelli, Albert Ha, Michael Scott, Christopher Filson","doi":"10.1007/s00345-024-05336-z","DOIUrl":"https://doi.org/10.1007/s00345-024-05336-z","url":null,"abstract":"<p><strong>Purpose: </strong>Prostate cancer is the second most diagnosed male malignancy in the U.S. 2,4-Dichlorophenoxyacetic acid (2,4-D) is a commonly used herbicide and potential carcinogen. The researchers evaluated the association between prostate cancer and 2,4-D.</p><p><strong>Methods: </strong>Data was leveraged from the National Health and Nutrition Examination Survey (NHANES), a population-based, cross-sectional study of men and women in the U.S. Our cohort of interest was men aged 50 years and over. Urinary 2,4-D served as the measure of exposure. Our primary outcome was history of prostate cancer based on an individual's reply of \"yes\" to either ever having been diagnosed with prostate cancer and/or having received treatment for prostate cancer. Chi-square, one-way analysis of variance (ANOVA), and multivariable, weighted logistic regression were used to analyze the relationship between 2,4-D and prostate cancer.</p><p><strong>Results: </strong>We identified 1,788 eligible men, representing an estimated 691,709 men after survey weighting. The median 2,4-D level was 0.28 µg/L (IQR: 0.26-0.53), and the geometric mean was 0.38 µg/L. Increasing exposure of 2,4-D was associated with prostate cancer (OR 1.72, 95% CI [1.2,2.4]). Individuals in the highest quartile of 2,4-D exposure had a higher odds of a prostate cancer diagnosis compared to the lowest quartile (OR = 3.46 95% CI [1.11,10.72]). Age stratification revealed statistically significant associations between 2,4-D and prostate cancer in men age 70 + who were in the highest quartile of exposure (OR = 3.79 95% CI [1.51,9.52]).</p><p><strong>Conclusions: </strong>These findings implicate 2,4-D exposure in the risk of prostate cancer. Future studies are warranted to corroborate these findings and elucidate potential mechanisms underlying these associations.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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World Journal of Urology
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