首页 > 最新文献

World Journal of Urology最新文献

英文 中文
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":"42 1","pages":"611"},"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
Clinical significance of stone culture during endourological procedures in predicting post-operative urinary sepsis: should it be a standard of care-evidence from a systematic review and meta-analysis from EAU section of Urolithiasis (EULIS). 尿道内镜手术期间结石培养在预测术后泌尿系统败血症方面的临床意义:是否应将其作为护理标准--来自欧洲泌尿系结石协会(EAU)泌尿系统结石病分会(EULIS)系统回顾和荟萃分析的证据。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1007/s00345-024-05319-0
Francesco Ripa, Clara Cerrato, Zafer Tandoğdu, Christian Seitz, Emanuele Montanari, Simon Choong, Alimuddin Zumla, Thomas Herrmann, Bhaskar Somani

Purpose: Urinary sepsis is the leading cause of mortality in the setting of endourological procedures for stone treatment such as URS and PCNL; renal stones themselves may be a source of infection. Aim of this study is to determine the diagnostic accuracy of stone cultures (SC) collected during URS and PCNL in predicting post-operative septic complications, compared to preoperative bladder urine culture (BUC).

Methods: We performed a systematic review (SR) of literature according to the PRISMA guidelines; Literature quality was evaluated according to The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. A univariate meta-analysis (MA) was used to estimate pooled log odds ratio of BUC and SC, respectively.

Results: Overall, 14 studies including 3646 patients met the inclusion criteria. Eight studies reported data from PCNL only; three from URS only; three from both URS and PCNL. Stone cultures showed a higher sensitivity (0.52 vs 0.32) and higher positive predictive value (0.28 vs 0.21) in predicting post-operative sepsis, compared to bladder urine cultures. The pool-weighted logarithmic odd risk (LOR) for BUC was 2.30 (95% CI 1.51-3.49, p < 0.001); the LOR for stone cultures (SC) in predicting post-operative sepsis was 5.79 (95% CI 3.58-9.38, p < 0.001).

Conclusion: The evidence from this SR and MA suggests that intraoperative SC from stone fragments retrieved during endourological procedures are better predictors of the likelihood of occurrence of post-operative sepsis compared to pre-operative BUC. Therefore, SC should be a standard of care in patients undergoing endourological interventions.

目的:泌尿系统败血症是尿路内镜手术(如 URS 和 PCNL)治疗结石时导致死亡的主要原因;肾结石本身也可能是感染源。本研究旨在确定与术前膀胱尿液培养(BUC)相比,在尿路造影术(URS)和PCNL术中收集的结石培养(SC)在预测术后脓毒症并发症方面的诊断准确性:我们根据 PRISMA 指南对文献进行了系统性回顾(SR);根据非随机干预研究中的偏倚风险(ROBINS-I)评估工具对文献质量进行了评估。采用单变量荟萃分析(MA)分别估算了BUC和SC的集合对数几率比:共有 14 项研究(包括 3646 名患者)符合纳入标准。八项研究仅报告了 PCNL 的数据;三项研究仅报告了 URS 的数据;三项研究同时报告了 URS 和 PCNL 的数据。与膀胱尿培养相比,结石培养在预测术后败血症方面显示出更高的灵敏度(0.52 对 0.32)和阳性预测值(0.28 对 0.21)。膀胱尿液培养的集合加权对数奇异风险(LOR)为 2.30(95% CI 1.51-3.49,P 结论:膀胱尿液培养可预测术后败血症:该SR和MA的证据表明,与术前BUC相比,从腔内造影术中取出的结石碎片的术中SC能更好地预测术后发生败血症的可能性。因此,SC 应成为接受腔内介入治疗的患者的标准护理方法。
{"title":"Clinical significance of stone culture during endourological procedures in predicting post-operative urinary sepsis: should it be a standard of care-evidence from a systematic review and meta-analysis from EAU section of Urolithiasis (EULIS).","authors":"Francesco Ripa, Clara Cerrato, Zafer Tandoğdu, Christian Seitz, Emanuele Montanari, Simon Choong, Alimuddin Zumla, Thomas Herrmann, Bhaskar Somani","doi":"10.1007/s00345-024-05319-0","DOIUrl":"https://doi.org/10.1007/s00345-024-05319-0","url":null,"abstract":"<p><strong>Purpose: </strong>Urinary sepsis is the leading cause of mortality in the setting of endourological procedures for stone treatment such as URS and PCNL; renal stones themselves may be a source of infection. Aim of this study is to determine the diagnostic accuracy of stone cultures (SC) collected during URS and PCNL in predicting post-operative septic complications, compared to preoperative bladder urine culture (BUC).</p><p><strong>Methods: </strong>We performed a systematic review (SR) of literature according to the PRISMA guidelines; Literature quality was evaluated according to The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. A univariate meta-analysis (MA) was used to estimate pooled log odds ratio of BUC and SC, respectively.</p><p><strong>Results: </strong>Overall, 14 studies including 3646 patients met the inclusion criteria. Eight studies reported data from PCNL only; three from URS only; three from both URS and PCNL. Stone cultures showed a higher sensitivity (0.52 vs 0.32) and higher positive predictive value (0.28 vs 0.21) in predicting post-operative sepsis, compared to bladder urine cultures. The pool-weighted logarithmic odd risk (LOR) for BUC was 2.30 (95% CI 1.51-3.49, p < 0.001); the LOR for stone cultures (SC) in predicting post-operative sepsis was 5.79 (95% CI 3.58-9.38, p < 0.001).</p><p><strong>Conclusion: </strong>The evidence from this SR and MA suggests that intraoperative SC from stone fragments retrieved during endourological procedures are better predictors of the likelihood of occurrence of post-operative sepsis compared to pre-operative BUC. Therefore, SC should be a standard of care in patients undergoing endourological interventions.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"614"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565032","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
A nomogram to predict "pure" vs. "mixed" uric acid urinary stones. 预测 "纯 "与 "混合 "尿酸性尿路结石的提名图。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.1007/s00345-024-05340-3
Liran Zieber, Gherman Creiderman, Muhammad Krenawi, Daniel Rothenstein, Dmitry Enikeev, Yaron Ehrlich, David Lifshitz

Purpose: Uric acid stones (UAS) can be treated non-invasively by oral chemolysis. However, it is crucial to identify individuals who are most likely to benefit from this approach, specifically, patients with pure UAS. The aim of this study was to develop a nomogram that can differentiate between pure and mixed UAS.

Methods: A retrospective analysis of demographic, clinical and stone composition data of patients with a predominant UAS composition (≥ 50%) treated between 2014 and 2022.

Results: A total of 135 patients were included in the analysis, 37.8% had mixed UAS (50-90% UA) and 62.2% had pure UAS (≥ 95% UA). The mean stone density and the percentage of radiopaque stones in the pure UAS group were significantly lower than those in the mixed UAS group (450 Hounsfield Units [HU] vs. 600 HU, and 24% vs. 58%, respectively). A stepwise multivariate logistic regression revealed that lower stone density, bigger size, decreased stone opacity and older age are predictive variables for pure UAS. Accordingly, a nomogram was generated with a receiver operating characteristic (ROC) curve that showed an area under the curve (AUC) of 0.78. A patient with a total score of 156 has a probability of > 95% for pure UAS.

Conclusion: Imaging and demographic data can be used to identify patients with pure UAS. The nomogram may be useful for counseling patients regarding oral chemolysis. Future validation of the nomogram with a different data set is required to assess its efficacy.

目的:尿酸结石(UAS)可通过口服化学溶解剂进行无创治疗。然而,关键是要确定哪些人最有可能从这种方法中获益,特别是纯尿酸结石患者。本研究的目的是开发一种能区分纯合子和混合型 UAS 的提名图:对2014年至2022年间接受治疗的UAS成分占主导地位(≥50%)的患者的人口统计学、临床和结石成分数据进行回顾性分析:共有135名患者纳入分析,其中37.8%为混合型UAS(50%-90% UA),62.2%为纯UAS(≥ 95% UA)。纯 UAS 组的平均结石密度和不透射线结石的百分比明显低于混合 UAS 组(分别为 450 Hounsfield Units [HU] 对 600 HU,以及 24% 对 58%)。逐步多变量逻辑回归显示,较低的结石密度、较大的结石体积、较低的结石不透明度和较高的年龄是纯UAS的预测变量。因此,生成了一个提名图,其接收者操作特征曲线(ROC)显示曲线下面积(AUC)为 0.78。总分 156 分的患者患纯合子尿崩症的概率大于 95%:结论:影像学和人口统计学数据可用于识别纯UAS患者。该提名图可能有助于为患者提供有关口服化疗溶液的咨询。今后需要使用不同的数据集对提名图进行验证,以评估其有效性。
{"title":"A nomogram to predict \"pure\" vs. \"mixed\" uric acid urinary stones.","authors":"Liran Zieber, Gherman Creiderman, Muhammad Krenawi, Daniel Rothenstein, Dmitry Enikeev, Yaron Ehrlich, David Lifshitz","doi":"10.1007/s00345-024-05340-3","DOIUrl":"10.1007/s00345-024-05340-3","url":null,"abstract":"<p><strong>Purpose: </strong>Uric acid stones (UAS) can be treated non-invasively by oral chemolysis. However, it is crucial to identify individuals who are most likely to benefit from this approach, specifically, patients with pure UAS. The aim of this study was to develop a nomogram that can differentiate between pure and mixed UAS.</p><p><strong>Methods: </strong>A retrospective analysis of demographic, clinical and stone composition data of patients with a predominant UAS composition (≥ 50%) treated between 2014 and 2022.</p><p><strong>Results: </strong>A total of 135 patients were included in the analysis, 37.8% had mixed UAS (50-90% UA) and 62.2% had pure UAS (≥ 95% UA). The mean stone density and the percentage of radiopaque stones in the pure UAS group were significantly lower than those in the mixed UAS group (450 Hounsfield Units [HU] vs. 600 HU, and 24% vs. 58%, respectively). A stepwise multivariate logistic regression revealed that lower stone density, bigger size, decreased stone opacity and older age are predictive variables for pure UAS. Accordingly, a nomogram was generated with a receiver operating characteristic (ROC) curve that showed an area under the curve (AUC) of 0.78. A patient with a total score of 156 has a probability of > 95% for pure UAS.</p><p><strong>Conclusion: </strong>Imaging and demographic data can be used to identify patients with pure UAS. The nomogram may be useful for counseling patients regarding oral chemolysis. Future validation of the nomogram with a different data set is required to assess its efficacy.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"610"},"PeriodicalIF":2.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558976","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
A 3-arm randomized control trial to compare the efficacy of re-circulant hyperthermic intravesical chemotherapy versus conventional intravesical mitomycin C and BCG therapy for intermediate-risk non-muscle invasive bladder cancer. 一项三臂随机对照试验,比较再循环热疗膀胱内化疗与传统膀胱内丝裂霉素 C 和卡介苗治疗中危非肌浸润性膀胱癌的疗效。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.1007/s00345-024-05338-x
Ankit Sachan, Rishi Nayyar, Sahil Pethe, Prashant Singh, Amlesh Seth

Introduction: To evaluate the efficacy and side effects of re-circulant hyperthermic intravesical chemotherapy versus conventional treatments for intermediate risk non-muscle invasive bladder cancer (NMIBC).

Methods: A randomized 3-arm, parallel group trial was conducted at a single tertiary care centre. 135 patients with low-grade intermediate-risk cancer, having undergone complete resection of bladder tumor were included. Patients were assigned 1:1:1, to receive intra-vesical chemo-hyperthermia (C-HT), mitomycin-C (MMC) or BCG therapy. There was no treatment crossover. Patients were followed up with check cystoscopy every 3 months for histopathological recurrence.

Results: The three arms were comparable in terms of age, gender, tumor size, number of tumors and clinical stage or grade of tumors. Mean tumor size was 2.58 (± 0.88) cm and the mean number of tumors resected was 2.04 (± 1.02) (Range 1-5). There was no significant difference between the various groups for tumor recurrence (χ2 = 1.96, p = 0.375) or time to recurrence (13.6 vs. 10.8 vs. 9.8 months, p = 0.844) though incidence of non-healing necrotic area was higher with C-HT (22.2% vs. 11.1% and 4.8%, χ2 = 6.093, p = 0.048). Median (IQR) follow up period was 26 (12-52) months. Treatment discontinuation or drug intolerance was significantly higher in BCG arm (p = 0.03).

Conclusions: Intravesical C-HT with MMC, conventional MMC and BCG are equally effective and comparable alternatives for intravesical therapy in low-grade intermediate-risk NMIBC. Higher incidence of non-healing resection site with C-HT and higher local symptoms with BCG are a concern.

简介:目的目的:评估中危非肌浸润性膀胱癌(NMIBC)膀胱内再循环热疗与传统疗法的疗效和副作用:在一家三级医疗中心进行了一项随机三臂平行分组试验。共纳入 135 名接受过膀胱肿瘤完全切除术的低级别中危癌症患者。患者按 1:1:1 的比例被分配接受膀胱内化疗热疗(C-HT)、丝裂霉素-C(MMC)或卡介苗治疗。治疗过程中没有交叉。患者每3个月接受一次膀胱镜检查,以观察组织病理学复发情况:结果:三组患者在年龄、性别、肿瘤大小、肿瘤数量、肿瘤临床分期或分级方面具有可比性。肿瘤平均大小为 2.58(± 0.88)厘米,切除肿瘤的平均数量为 2.04(± 1.02)个(范围 1-5)。各组间肿瘤复发率(χ2 = 1.96,P = 0.375)或复发时间(13.6 vs. 10.8 vs. 9.8个月,P = 0.844)无明显差异,但C-HT组无愈合坏死区的发生率更高(22.2% vs. 11.1%和4.8%,χ2 = 6.093,P = 0.048)。中位(IQR)随访时间为 26(12-52)个月。卡介苗治疗组的治疗中止率或药物不耐受率明显更高(p = 0.03):结论:膀胱内C-HT联合MMC、传统MMC和卡介苗都是低级别中危NMIBC膀胱内治疗的有效替代方案。C-HT 的切除部位不愈合发生率较高,而 BCG 的局部症状较重,这些都是值得关注的问题。
{"title":"A 3-arm randomized control trial to compare the efficacy of re-circulant hyperthermic intravesical chemotherapy versus conventional intravesical mitomycin C and BCG therapy for intermediate-risk non-muscle invasive bladder cancer.","authors":"Ankit Sachan, Rishi Nayyar, Sahil Pethe, Prashant Singh, Amlesh Seth","doi":"10.1007/s00345-024-05338-x","DOIUrl":"10.1007/s00345-024-05338-x","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the efficacy and side effects of re-circulant hyperthermic intravesical chemotherapy versus conventional treatments for intermediate risk non-muscle invasive bladder cancer (NMIBC).</p><p><strong>Methods: </strong>A randomized 3-arm, parallel group trial was conducted at a single tertiary care centre. 135 patients with low-grade intermediate-risk cancer, having undergone complete resection of bladder tumor were included. Patients were assigned 1:1:1, to receive intra-vesical chemo-hyperthermia (C-HT), mitomycin-C (MMC) or BCG therapy. There was no treatment crossover. Patients were followed up with check cystoscopy every 3 months for histopathological recurrence.</p><p><strong>Results: </strong>The three arms were comparable in terms of age, gender, tumor size, number of tumors and clinical stage or grade of tumors. Mean tumor size was 2.58 (± 0.88) cm and the mean number of tumors resected was 2.04 (± 1.02) (Range 1-5). There was no significant difference between the various groups for tumor recurrence (χ2 = 1.96, p = 0.375) or time to recurrence (13.6 vs. 10.8 vs. 9.8 months, p = 0.844) though incidence of non-healing necrotic area was higher with C-HT (22.2% vs. 11.1% and 4.8%, χ2 = 6.093, p = 0.048). Median (IQR) follow up period was 26 (12-52) months. Treatment discontinuation or drug intolerance was significantly higher in BCG arm (p = 0.03).</p><p><strong>Conclusions: </strong>Intravesical C-HT with MMC, conventional MMC and BCG are equally effective and comparable alternatives for intravesical therapy in low-grade intermediate-risk NMIBC. Higher incidence of non-healing resection site with C-HT and higher local symptoms with BCG are a concern.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"609"},"PeriodicalIF":2.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558975","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
Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy. 评估根治性前列腺切除术(超)扩大淋巴结清扫术后的并发症和生化复发率。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.1007/s00345-024-05321-6
Diederik J H Baas, Bas Israël, Joost M S de Baaij, Henricus J E J Vrijhof, Robert J Hoekstra, Heidi Kusters-Vandevelde, Peter F A Mulders, J P Michiel Sedelaar, Diederik M Somford, Jean-Paul A van Basten

Objective: To evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence.

Methods: Between January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up.

Results: The median LNI risk was 18% (IQR 9-31%). A median of 22 LN (IQR 16-28) were removed, with se-PLND yielding a higher number: 25 (IQR 20-32) compared to e-PLND: 17 (IQR 13-24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7-33), BCR incidence was comparable between the two groups.

Conclusion: Compared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.

目的通过研究淋巴结(LN)产量、并发症、LN转移和生化复发(BCR)发生率,评估机器人辅助根治性前列腺切除术(RARP)中扩展(e-PLND)和超扩展盆腔淋巴结清扫(se-PLND)的有效性:2016年1月至2020年1月期间,根据纪念斯隆-凯特琳癌症中心提名图预测,淋巴结受累(LNI)风险大于5%的354例连续患者在一家高容量中心接受了RARP加(s)e-PLND手术。e-PLND包括切除闭孔窝、髂内区和髂外血管周围的纤维脂肪淋巴组织。se-PLND由外科医生自行决定,也包括骶骨前和髂总部位的淋巴结。结果包括按解剖区域划分的组织病理学结果、并发症和随访期间的BCR发生率:LNI风险中位数为18%(IQR 9-31%)。切除的 LN 中位数为 22 个(IQR 16-28),与 e-PLND 的 17 个(IQR 13-24)相比,se-PLND 的切除数量更高:25 个(IQR 20-32)(p 结论:与标准扩展盆腔淋巴结切除术相比,se-PLND 的切除数量更多:与标准扩展盆腔淋巴结清扫术(PLND)相比,超扩展PLND提高了淋巴结的切除率和转移沉积物的清除率,但对中期无进展生存率无益。
{"title":"Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy.","authors":"Diederik J H Baas, Bas Israël, Joost M S de Baaij, Henricus J E J Vrijhof, Robert J Hoekstra, Heidi Kusters-Vandevelde, Peter F A Mulders, J P Michiel Sedelaar, Diederik M Somford, Jean-Paul A van Basten","doi":"10.1007/s00345-024-05321-6","DOIUrl":"10.1007/s00345-024-05321-6","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence.</p><p><strong>Methods: </strong>Between January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up.</p><p><strong>Results: </strong>The median LNI risk was 18% (IQR 9-31%). A median of 22 LN (IQR 16-28) were removed, with se-PLND yielding a higher number: 25 (IQR 20-32) compared to e-PLND: 17 (IQR 13-24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7-33), BCR incidence was comparable between the two groups.</p><p><strong>Conclusion: </strong>Compared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"605"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547936","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
Circular RNA circABCC4 as the ceRNA facilitates renal carcinoma progression. 环状 RNA circABCC4 作为 ceRNA 有助于肾癌的发展。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.1007/s00345-024-05279-5
Yongjie Yao, Tianchen Wang, Shilun Li, Qixiang Song, Kai Yuan

Purpose: This study explores the role of circular RNA derived from the Multidrug Resistance Protein 4 (MRP4/ABCC4) gene, which is markedly elevated in renal cell carcinoma (RCC). Our objective is to clarify how this circular RNA contributes to the progression and development of RCC.

Methods: We quantified the presence of circular ABCC4 RNA in tissue samples, plasma and urine from patients diagnosed with RCC. In addition, the impact of this circular RNA on RCC tumour growth was assessed through studies in RCC cell lines and in animal models mimicking the disease.

Results: Our findings reveal that circular ABCC4 RNA, specifically the variant containing exons 25-29 (circABCC4e), is upregulated in RCC cell lines and tissues. This upregulation correlates with advanced tumor stages in RCC patients, suggesting circABCC4e's potential as a biomarker for RCC progression. Furthermore, the reduction in circABCC4e levels following tumor resection indicates its potential utility in monitoring treatment response. The mechanism by which circABCC4e promotes RCC tumor growth through the antagonism of tumor-suppressive microRNAs highlights its significance in RCC pathogenesis. These insights may inform the development of diagnostic and therapeutic strategies for RCC.

Conclusion: This study demonstrates that circABCC4e accelerates RCC progression by inhibiting tumor-suppressive microRNAs. Its role as a diagnostic and prognostic biomarker for RCC underscores its potential value in improving RCC management.

目的:本研究探讨了源自多药耐药蛋白4(MRP4/ABCC4)基因的环状RNA的作用,这种RNA在肾细胞癌(RCC)中明显升高。我们的目的是阐明这种环状 RNA 如何促进 RCC 的进展和发展:我们对确诊为 RCC 患者的组织样本、血浆和尿液中的环状 ABCC4 RNA 进行了量化。此外,我们还通过对 RCC 细胞系和模拟该疾病的动物模型进行研究,评估了这种环状 RNA 对 RCC 肿瘤生长的影响:我们的研究结果表明,环状 ABCC4 RNA,特别是包含 25-29 号外显子的变体(circABCC4e),在 RCC 细胞系和组织中上调。这种上调与 RCC 患者的肿瘤晚期相关,表明 circABCC4e 有可能成为 RCC 进展的生物标记物。此外,肿瘤切除后circABCC4e水平的降低表明它在监测治疗反应方面具有潜在的作用。circABCC4e通过拮抗抑制肿瘤的microRNA促进RCC肿瘤生长的机制凸显了它在RCC发病机制中的重要性。这些见解可为RCC诊断和治疗策略的开发提供参考:本研究表明,circABCC4e通过抑制肿瘤抑制性microRNA加速了RCC的进展。其作为 RCC 诊断和预后生物标志物的作用凸显了其在改善 RCC 管理方面的潜在价值。
{"title":"Circular RNA circABCC4 as the ceRNA facilitates renal carcinoma progression.","authors":"Yongjie Yao, Tianchen Wang, Shilun Li, Qixiang Song, Kai Yuan","doi":"10.1007/s00345-024-05279-5","DOIUrl":"https://doi.org/10.1007/s00345-024-05279-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study explores the role of circular RNA derived from the Multidrug Resistance Protein 4 (MRP4/ABCC4) gene, which is markedly elevated in renal cell carcinoma (RCC). Our objective is to clarify how this circular RNA contributes to the progression and development of RCC.</p><p><strong>Methods: </strong>We quantified the presence of circular ABCC4 RNA in tissue samples, plasma and urine from patients diagnosed with RCC. In addition, the impact of this circular RNA on RCC tumour growth was assessed through studies in RCC cell lines and in animal models mimicking the disease.</p><p><strong>Results: </strong>Our findings reveal that circular ABCC4 RNA, specifically the variant containing exons 25-29 (circABCC4e), is upregulated in RCC cell lines and tissues. This upregulation correlates with advanced tumor stages in RCC patients, suggesting circABCC4e's potential as a biomarker for RCC progression. Furthermore, the reduction in circABCC4e levels following tumor resection indicates its potential utility in monitoring treatment response. The mechanism by which circABCC4e promotes RCC tumor growth through the antagonism of tumor-suppressive microRNAs highlights its significance in RCC pathogenesis. These insights may inform the development of diagnostic and therapeutic strategies for RCC.</p><p><strong>Conclusion: </strong>This study demonstrates that circABCC4e accelerates RCC progression by inhibiting tumor-suppressive microRNAs. Its role as a diagnostic and prognostic biomarker for RCC underscores its potential value in improving RCC management.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"607"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547935","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
Optimal deflection techniques for flexible and navigable suction ureteral access sheaths (FANS): a comparative in vitro PEARLS analysis. 柔性和可导航抽吸输尿管通路鞘(FANS)的最佳偏转技术:体外 PEARLS 比较分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.1007/s00345-024-05297-3
Alex Lua, Lynnette R L Tan, Frédéric Panthier, Alba Sierra, Eugenio Ventimiglia, Catalina Solano, Vincent De Coninck, Steffi Kar Kei Yuen, Vineet Gauhar, Olivier Traxer, Etienne Xavier Keller, Jia-Lun Kwok

Purpose: Flexible and navigable suction ureteral access sheaths (FANS) have been introduced without current evidence on how to optimize deflection. Aim was to evaluate in vitro deflection angles with 2 different FANS techniques-sheath advancement and ureteroscope deflection; and effects of sheath size-ureteroscope combinations.

Methods: We evaluated in vitro deflection angles of 10/12Fr, 11/13Fr and 12/14Fr FANS (Hunan Reborn Medical Co. Ltd) with six single-use flexible ureteroscopes (Pusen Uscope 7.5Fr, OTU WiScope 7.5Fr, OTU WiScope 8.6Fr, Innovex EU-scope 8.7Fr, Red Pine RP-U-C12 8.7Fr and Boston Scientific Lithovue 9.5Fr). Two deflection techniques were tested: (1) sheath advancement-advancing the sheath forward over a maximally deflected ureteroscope, and (2) ureteroscope deflection-maximally deflecting the ureteroscope from various starting positions relative to tip of the sheath.

Results: Intra and inter-scope comparisons of maximum deflection angles were significantly different (all ANOVA p < 0.01). Largest maximum angles for all ureteroscopes were with the sheath advancement technique (range 218°-277°), and second largest for most scopes using the ureteroscope deflection technique at tip (range 111°-212°), mostly deviating from manufacturer specifications (range 270°-275°). 10/12Fr and 11/13Fr sheath sizes were more flexible than 12/14Fr. Largest angles were with 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations.

Conclusion: Optimal deflection with FANS is achieved using either a sheath advancement technique, or ureteroscope deflection technique at tip. Despite using these optimized techniques, deflection angles specified by manufacturers seem hardly achievable. The sheath advancement technique and 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations may be better suited for lower pole situations. Urologists should be aware of these differences and apply the findings to their FANS technique.

目的:柔性可导航抽吸式输尿管通路鞘(FANS)已经问世,但目前尚无如何优化偏转的证据。目的是评估 2 种不同 FANS 技术(鞘推进和输尿管镜偏转)的体外偏转角度,以及鞘尺寸和输尿管镜组合的影响:我们评估了 10/12Fr、11/13Fr 和 12/14Fr FANS(湖南雷邦医疗股份有限公司)与六种一次性使用柔性输尿管镜(Pusen Uscope 7.5Fr、OTU WiScope 7.5Fr、OTU WiScope 8.6Fr、Innovex EU-scope 8.7Fr、Red Pine RP-U-C12 8.7Fr 和 Boston Scientific Lithovue 9.5Fr)的体外偏转角度。测试了两种偏转技术:(1) 鞘推进--在最大偏转的输尿管镜上向前推进鞘;(2) 输尿管镜偏转--输尿管镜从相对于鞘尖的不同起始位置最大偏转:结果:最大偏转角度的镜内和镜间比较有显著差异(所有方差分析均为 p 结论:FANS输尿管镜的最佳偏转角度是在鞘尖位置:使用鞘推进技术或输尿管镜顶端偏转技术可实现 FANS 的最佳偏转。尽管使用了这些优化技术,但似乎仍难以达到制造商规定的偏转角度。鞘推进技术和 11/13Fr 鞘-OTU8.6Fr/Innovex8.7Fr 组合可能更适合低极情况。泌尿科医生应该意识到这些差异,并将研究结果应用到他们的 FANS 技术中。
{"title":"Optimal deflection techniques for flexible and navigable suction ureteral access sheaths (FANS): a comparative in vitro PEARLS analysis.","authors":"Alex Lua, Lynnette R L Tan, Frédéric Panthier, Alba Sierra, Eugenio Ventimiglia, Catalina Solano, Vincent De Coninck, Steffi Kar Kei Yuen, Vineet Gauhar, Olivier Traxer, Etienne Xavier Keller, Jia-Lun Kwok","doi":"10.1007/s00345-024-05297-3","DOIUrl":"https://doi.org/10.1007/s00345-024-05297-3","url":null,"abstract":"<p><strong>Purpose: </strong>Flexible and navigable suction ureteral access sheaths (FANS) have been introduced without current evidence on how to optimize deflection. Aim was to evaluate in vitro deflection angles with 2 different FANS techniques-sheath advancement and ureteroscope deflection; and effects of sheath size-ureteroscope combinations.</p><p><strong>Methods: </strong>We evaluated in vitro deflection angles of 10/12Fr, 11/13Fr and 12/14Fr FANS (Hunan Reborn Medical Co. Ltd) with six single-use flexible ureteroscopes (Pusen Uscope 7.5Fr, OTU WiScope 7.5Fr, OTU WiScope 8.6Fr, Innovex EU-scope 8.7Fr, Red Pine RP-U-C12 8.7Fr and Boston Scientific Lithovue 9.5Fr). Two deflection techniques were tested: (1) sheath advancement-advancing the sheath forward over a maximally deflected ureteroscope, and (2) ureteroscope deflection-maximally deflecting the ureteroscope from various starting positions relative to tip of the sheath.</p><p><strong>Results: </strong>Intra and inter-scope comparisons of maximum deflection angles were significantly different (all ANOVA p < 0.01). Largest maximum angles for all ureteroscopes were with the sheath advancement technique (range 218°-277°), and second largest for most scopes using the ureteroscope deflection technique at tip (range 111°-212°), mostly deviating from manufacturer specifications (range 270°-275°). 10/12Fr and 11/13Fr sheath sizes were more flexible than 12/14Fr. Largest angles were with 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations.</p><p><strong>Conclusion: </strong>Optimal deflection with FANS is achieved using either a sheath advancement technique, or ureteroscope deflection technique at tip. Despite using these optimized techniques, deflection angles specified by manufacturers seem hardly achievable. The sheath advancement technique and 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations may be better suited for lower pole situations. Urologists should be aware of these differences and apply the findings to their FANS technique.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"606"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547860","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
Prostate cancer lesions in transition zone exhibit a higher propensity for pathological upgrading in radical prostatectomy. 在根治性前列腺切除术中,过渡区的前列腺癌病灶显示出更高的病理升级倾向。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.1007/s00345-024-05294-6
Xin Chen, He Wang, Chaozhong Wang, Chengbo Qian, Yuxin Lin, Yuhua Huang, Xuedong Wei, Jianquan Hou

Background: The varying malignancy and lethality of different grades of prostate cancer (PCa) highlight the importance of accurate diagnosis. This study aims to evaluate the upgrading of transition zone (TZ) prostate cancer biopsies and identify factors to improve TZ biopsy accuracy.

Materials and methods: This retrospective study included 217 patients who underwent laparoscopic radical prostatectomy after 12 + X cores transperineal transrectal ultrasound-magnetic resonance imaging (MRI)-guided targeted prostate biopsy from 2018 to 2021 in our center.

Results: Patients with TZ lesions showed a higher incidence of International Society of Urological Pathology (ISUP) grade upgrading from 1 to higher grade compared to peripheral zone lesions (16.9% vs. 5.0%, p = 0.005). Multivariate analysis confirmed TZ lesions as an independent risk factor (OR: 4.594, 97.5% CI: 1.569-15.238, p = 0.008) for upgrading from 1 to higher. Additionally, the number of positive biopsy cores (OR: 0.586, 97.5% CI: 0.336-0.891, p = 0.029) and anterior TZ lesion location (OR: 10.797, 97.5% CI: 1.503-248.727, p = 0.048) were independent factors for the upgrading in TZ patients.

Conclusions: This study found that PCa lesions located in the TZ, particularly the anterior TZ, have a higher risk of ISUP grade upgrading. This elevated risk arises from the insufficient distribution of biopsy cores around the TZ lesion. The findings underscore the importance of having an adequate number of biopsy cores around the lesion area to improve the accuracy of ISUP grade assessments.

背景:不同等级前列腺癌(PCa)的恶性程度和致死率各不相同,这凸显了准确诊断的重要性。本研究旨在评估过渡区(TZ)前列腺癌活检的升级情况,并找出提高TZ活检准确性的因素:这项回顾性研究纳入了2018年至2021年在本中心接受腹腔镜前列腺癌根治术的217例患者,这些患者在12+X核经会阴经直肠超声-磁共振成像(MRI)引导下接受了靶向前列腺活检:与外周区病变相比,TZ病变患者的国际泌尿病理学会(ISUP)分级从1级升至更高级别发生率更高(16.9% vs. 5.0%,P = 0.005)。多变量分析证实 TZ 病变是 1 级升至更高级别的独立风险因素(OR:4.594,97.5% CI:1.569-15.238,p = 0.008)。此外,阳性活检核的数量(OR:0.586,97.5% CI:0.336-0.891,p = 0.029)和前TZ病变位置(OR:10.797,97.5% CI:1.503-248.727,p = 0.048)也是TZ患者升级的独立因素:本研究发现,位于TZ,尤其是TZ前部的PCa病变有较高的ISUP分级升级风险。这种风险升高的原因是活检核心在TZ病变周围分布不足。这些发现强调了在病变区域周围放置足够数量的活检样本对提高 ISUP 等级评估准确性的重要性。
{"title":"Prostate cancer lesions in transition zone exhibit a higher propensity for pathological upgrading in radical prostatectomy.","authors":"Xin Chen, He Wang, Chaozhong Wang, Chengbo Qian, Yuxin Lin, Yuhua Huang, Xuedong Wei, Jianquan Hou","doi":"10.1007/s00345-024-05294-6","DOIUrl":"10.1007/s00345-024-05294-6","url":null,"abstract":"<p><strong>Background: </strong>The varying malignancy and lethality of different grades of prostate cancer (PCa) highlight the importance of accurate diagnosis. This study aims to evaluate the upgrading of transition zone (TZ) prostate cancer biopsies and identify factors to improve TZ biopsy accuracy.</p><p><strong>Materials and methods: </strong>This retrospective study included 217 patients who underwent laparoscopic radical prostatectomy after 12 + X cores transperineal transrectal ultrasound-magnetic resonance imaging (MRI)-guided targeted prostate biopsy from 2018 to 2021 in our center.</p><p><strong>Results: </strong>Patients with TZ lesions showed a higher incidence of International Society of Urological Pathology (ISUP) grade upgrading from 1 to higher grade compared to peripheral zone lesions (16.9% vs. 5.0%, p = 0.005). Multivariate analysis confirmed TZ lesions as an independent risk factor (OR: 4.594, 97.5% CI: 1.569-15.238, p = 0.008) for upgrading from 1 to higher. Additionally, the number of positive biopsy cores (OR: 0.586, 97.5% CI: 0.336-0.891, p = 0.029) and anterior TZ lesion location (OR: 10.797, 97.5% CI: 1.503-248.727, p = 0.048) were independent factors for the upgrading in TZ patients.</p><p><strong>Conclusions: </strong>This study found that PCa lesions located in the TZ, particularly the anterior TZ, have a higher risk of ISUP grade upgrading. This elevated risk arises from the insufficient distribution of biopsy cores around the TZ lesion. The findings underscore the importance of having an adequate number of biopsy cores around the lesion area to improve the accuracy of ISUP grade assessments.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"608"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547862","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
Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients. 在机器人肾部分切除术和机器人前列腺癌根治术中省去术中放置引流管是安全的:对18000名患者的分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s00345-024-05320-7
John Pfail, Jake Drobner, Alain Kaldany, Kevin Chua, Benjamin Lichtbroun, Rachel Passarelli, Hiren Patel, Arnav Srivastava, David Golombos, Thomas L Jang, Vignesh T Packiam, Saum Ghodoussipour

Purpose: Placement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications.

Methods: The NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication.

Results: We identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62-0.87]), infectious complication (OR 0.66 [0.49-0.89]), and LOS (β -0.30 [-0.37, -0.24]).

Conclusions: Using a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures.

目的:在机器人辅助肾部分切除术(RAPN)和机器人辅助前列腺癌根治术(RARP)中放置引流管是许多泌尿科医生的标准做法,有助于评估和处理尿漏、淋巴肿大或出血等并发症。然而,放置引流管可能会引起不适并延迟患者出院,其益处也值得怀疑。我们旨在评估引流管放置与术后并发症之间的相关性:方法:我们在 NSQIP 目标数据库中查询了 2019 年至 2021 年期间接受 RAPN 或 RARP 手术的患者。我们的主要结果包括根据术中引流管放置情况分层的 30 天并发症发生率。次要结果包括手术特异性并发症、住院时间(LOS)和再入院率。针对每种术后并发症进行了多变量回归分析,并进行了 Bonferroni 校正:我们发现分别有 4738 名和 13948 名患者接受了 RAPN 和 RARP 手术。分别有 2258 例(47.7%)和 6700 例(48%)患者未放置引流管。在对RAPN队列进行调整后的多变量分析后发现,未放置引流管与缩短LOS有关(β -0.45;99.58% CI [-0.59, -0.32]),但总体并发症发生率没有差异。在对RARP队列进行调整分析后发现,不放置引流管与任何并发症(OR 0.73 [0.62-0.87])、感染性并发症(OR 0.66 [0.49-0.89])和LOS(β -0.30 [-0.37,-0.24])风险的降低有关:本研究利用大型当代数据库证明,在 RAPN 和 RARP 术中不使用引流管是安全的,不会增加术后并发症的风险。尽管该队列存在固有的选择偏差,但我们的数据表明,在这些手术中不需要常规放置引流管。
{"title":"Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients.","authors":"John Pfail, Jake Drobner, Alain Kaldany, Kevin Chua, Benjamin Lichtbroun, Rachel Passarelli, Hiren Patel, Arnav Srivastava, David Golombos, Thomas L Jang, Vignesh T Packiam, Saum Ghodoussipour","doi":"10.1007/s00345-024-05320-7","DOIUrl":"10.1007/s00345-024-05320-7","url":null,"abstract":"<p><strong>Purpose: </strong>Placement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications.</p><p><strong>Methods: </strong>The NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication.</p><p><strong>Results: </strong>We identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62-0.87]), infectious complication (OR 0.66 [0.49-0.89]), and LOS (β -0.30 [-0.37, -0.24]).</p><p><strong>Conclusions: </strong>Using a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"601"},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547859","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
Implementation of surgical rehearsal utilizing patient specific hydrogel kidney phantoms prior to complex renal cancer surgery: a pilot study. 在复杂的肾癌手术前利用患者特定的水凝胶肾脏模型进行手术演练:一项试点研究。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s00345-024-05301-w
Ahmed Ghazi, Patrick Saba, Nathan Shuler, Lauren Shepard, Tyler Holler, Ahmed Radwan, Hani Rashid

Introduction: With the advancement of surgical technology, the opportunity to integrate novel surgical preparation is imperative to improve patient outcomes and enhance safety.

Methods: Patient specific perfused kidney phantoms including the tumor, parenchyma, artery, vein, and calyx were fabricated using 3D-printing and hydrogel injection molding from scans of 25 patients scheduled for robotic partial-nephrectomy (RAPN). Models are validated for anatomical accuracy, mechanical, functional properties and surrounded by the other models of relevant anatomy in a body cast for a simulated surgical rehearsal. We investigated the impact of these preoperative rehearsals preceding complex RAPN by analyzing changes in surgeons' decisions following review of both axial-imaging and following rehearsal simulation. Predictive ability of these rehearsal platforms was compared to live surgery outcomes and trifecta of cases as an outcome was calculated.

Results: 25 patients with complex renal tumors, average 9.8 nephrometry score and 4.9 cm mean tumor diameter were consented. Mean blood loss and WIT were 193.2 ml and 19.8 min. Two Clavien 2 complications were reported at 30-day postoperative. Trifecta was achieved in 17 (68%) of surgical cases. Surgeons' confidence in their ability to complete a partial nephrectomy and ability to predict WIT significantly increased from initial viewing the axial imaging to after the rehearsal. The correlation coefficient between the procedural clinical data collected during the rehearsals and live surgery were calculated.

Conclusion: The application of this versatile method for creating authentic perfused kidney phantoms can result in increased confidence in surgical plan and thus improved surgical performance and outcomes.

简介:随着外科技术的进步,整合新型手术准备的机会势在必行:随着外科技术的发展,为改善患者预后和提高安全性,整合新型手术准备势在必行:方法:根据 25 名计划接受机器人肾部分切除术(RAPN)的患者的扫描图像,使用三维打印和水凝胶注射成型技术制作了患者专用的灌注肾模型,包括肿瘤、实质、动脉、静脉和肾萼。对模型的解剖准确性、机械和功能特性进行了验证,并将其与其他相关解剖模型一起放在人体铸模中进行模拟手术演练。我们通过分析外科医生在回顾轴向成像和模拟演练后的决策变化,研究了这些术前演练对复杂 RAPN 手术的影响。将这些演练平台的预测能力与现场手术结果进行比较,并计算出作为结果的三连胜病例。结果:25 名患有复杂肾肿瘤、平均肾功能评分 9.8 分、平均肿瘤直径 4.9 厘米的患者同意接受手术。平均失血量和WIT分别为193.2毫升和19.8分钟。术后30天报告了2例Clavien 2并发症。17例(68%)手术实现了三连胜。从最初观看轴向成像到演练后,外科医生对完成肾部分切除术的信心和预测WIT的能力明显增强。计算了演练期间收集的手术临床数据与现场手术之间的相关系数:应用这种多功能方法创建真实的灌注肾脏模型可增强对手术计划的信心,从而改善手术表现和结果。
{"title":"Implementation of surgical rehearsal utilizing patient specific hydrogel kidney phantoms prior to complex renal cancer surgery: a pilot study.","authors":"Ahmed Ghazi, Patrick Saba, Nathan Shuler, Lauren Shepard, Tyler Holler, Ahmed Radwan, Hani Rashid","doi":"10.1007/s00345-024-05301-w","DOIUrl":"https://doi.org/10.1007/s00345-024-05301-w","url":null,"abstract":"<p><strong>Introduction: </strong>With the advancement of surgical technology, the opportunity to integrate novel surgical preparation is imperative to improve patient outcomes and enhance safety.</p><p><strong>Methods: </strong>Patient specific perfused kidney phantoms including the tumor, parenchyma, artery, vein, and calyx were fabricated using 3D-printing and hydrogel injection molding from scans of 25 patients scheduled for robotic partial-nephrectomy (RAPN). Models are validated for anatomical accuracy, mechanical, functional properties and surrounded by the other models of relevant anatomy in a body cast for a simulated surgical rehearsal. We investigated the impact of these preoperative rehearsals preceding complex RAPN by analyzing changes in surgeons' decisions following review of both axial-imaging and following rehearsal simulation. Predictive ability of these rehearsal platforms was compared to live surgery outcomes and trifecta of cases as an outcome was calculated.</p><p><strong>Results: </strong>25 patients with complex renal tumors, average 9.8 nephrometry score and 4.9 cm mean tumor diameter were consented. Mean blood loss and WIT were 193.2 ml and 19.8 min. Two Clavien 2 complications were reported at 30-day postoperative. Trifecta was achieved in 17 (68%) of surgical cases. Surgeons' confidence in their ability to complete a partial nephrectomy and ability to predict WIT significantly increased from initial viewing the axial imaging to after the rehearsal. The correlation coefficient between the procedural clinical data collected during the rehearsals and live surgery were calculated.</p><p><strong>Conclusion: </strong>The application of this versatile method for creating authentic perfused kidney phantoms can result in increased confidence in surgical plan and thus improved surgical performance and outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"42 1","pages":"602"},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547937","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
期刊
World Journal of Urology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1