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Prognostic implications and diagnostic significance of TFE3 rearrangement in renal cell carcinoma. 肾细胞癌中 TFE3 重排的预后影响和诊断意义。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s00345-024-05290-w
Carmina Muñoz Bastidas, Mario Tapia Tapia, Andrés Calva López, Vanessa Talavera Cobo, Juan Colombas Vives, Eduardo Miraval Wong, Cristina Gutiérrez Castané, Francisco Javier Ancizu Marckert, Marcos Torres Roca, Luis Labairu Huerta, Fernando Diez-Caballero Alonso, José Enrique Robles García, Felipe Villacampa Aubá, Daniel González Padilla, Bernardino Miñana López, Daniel Sánchez Zalabardo

Objectives: To investigate the impact of TFE3 rearrangement, analyzing clinicopathological features that influence renal cell carcinoma (RCC) recurrence, and clarify the role of immunohistochemistry (IHC) staining in diagnosis.

Methods: We screened patients diagnosed of clear cell RCC (ccRCC), fluorescence in situ hybridization (FISH) was performed on all TFE3 positive IHC tumors. Clinicopathological and survival features were collected for analysis.

Results: Out of 695 patients treated for renal tumors, 478 (68.7%) were ccRCC and 22 were suspected of TFE3 rearrangement based on IHC. Subsequent testing revealed 8 (1.15%) were positive in the FISH test (TFE3-rearranged-RCC) and 14 (2.01%) tested negative. No significant differences were noted in general characteristics among the three groups, except for age, TFE3-rearranged-RCC were younger than ccRCC (median age, 49 vs. 58 years, p=0.02). TFE3-rearranged-RCC exhibited a significant higher recurrence rate compared to ccRCC (50% vs 18.8%) and multivariate analysis revealed that TFE3 rearrangement, along with tumor size and metastasis, was an independent prognostic factor for recurrence (HR=4.6; 95% CI 1.1-21.2; p=0.05). Survival analysis demonstrated a significant shorter PFS (progression-free survival) for TFE3-rearranged-RCC compared to ccRCC.

Conclusions: TFE3 rearrangement is an independent prognostic factor for recurrence and contributes to a worse PFS, suggesting the necessity of careful follow-up. Diagnosis should be confirmed using FISH due to low specificity of IHC. Further studies are needed to confirm TFE3 IHC staining as a prognostic factor.

研究目的研究TFE3重排的影响,分析影响肾细胞癌(RCC)复发的临床病理特征,明确免疫组化(IHC)染色在诊断中的作用:我们筛查了被诊断为透明细胞肾细胞癌(ccRCC)的患者,对所有TFE3 IHC阳性肿瘤进行了荧光原位杂交(FISH)。收集临床病理和生存特征进行分析:结果:在接受肾肿瘤治疗的 695 例患者中,478 例(68.7%)为 ccRCC,22 例根据 IHC 怀疑有 TFE3 重排。随后的检测显示,8 例(1.15%)在 FISH 检测中呈阳性(TFE3 重排-RCC),14 例(2.01%)呈阴性。除年龄外,三组患者的一般特征无明显差异,TFE3重组-RCC患者比ccRCC患者年轻(中位年龄,49岁对58岁,P=0.02)。TFE3重排-RCC的复发率明显高于ccRCC(50% vs 18.8%),多变量分析显示,TFE3重排以及肿瘤大小和转移是复发的独立预后因素(HR=4.6;95% CI 1.1-21.2;P=0.05)。生存期分析表明,与ccRCC相比,TFE3重排-RCC的PFS(无进展生存期)明显较短:结论:TFE3重排是复发的独立预后因素,并导致较差的PFS,这表明有必要进行仔细的随访。由于 IHC 的特异性较低,应使用 FISH 进行确诊。还需要进一步的研究来证实TFE3 IHC染色是一个预后因素。
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引用次数: 0
Battle of the bots: a comparative analysis of ChatGPT and bing AI for kidney stone-related questions. 机器人之战:ChatGPT 和 bing AI 对肾结石相关问题的比较分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1007/s00345-024-05326-1
Amber K McMahon, Russell S Terry, Willian E Ito, Wilson R Molina, Bristol B Whiles

Objectives: To evaluate and compare the performance of ChatGPT™ (Open AI®) and Bing AI™ (Microsoft®) for responding to kidney stone treatment-related questions in accordance with the American Urological Association (AUA) guidelines and assess factors such as appropriateness, emphasis on consulting healthcare providers, references, and adherence to guidelines by each chatbot.

Methods: We developed 20 kidney stone evaluation and treatment-related questions based on the AUA Surgical Management of Stones guideline. Questions were asked to ChatGPT and Bing AI chatbots. We compared their responses utilizing the brief DISCERN tool as well as response appropriateness.

Results: ChatGPT significantly outperformed Bing AI for questions 1-3, which evaluate clarity, achievement, and relevance of responses (12.77 ± 1.71 vs. 10.17 ± 3.27; p < 0.01). In contrast, Bing AI always incorporated references, whereas ChatGPT never did. Consequently, the results for questions 4-6, which evaluated the quality of sources, were consistently favored Bing AI over ChatGPT (10.8 vs. 4.28; p < 0.01). Notably, neither chatbot offered guidance against guidelines for pre-operative testing. However, recommendations against guidelines were notable for specific scenarios: 30.5% for the treatment of adults with ureteral stones, 52.5% for adults with renal stones, and 20.5% for all patient treatment.

Conclusions: ChatGPT significantly outperformed Bing AI in terms of providing responses with clear aim, achieving such aim, and relevant and appropriate responses based on AUA surgical stone management guidelines. However, Bing AI provides references, allowing information quality assessment. Additional studies are needed to further evaluate these chatbots and their potential use by clinicians and patients for urologic healthcare-related questions.

目的评估并比较 ChatGPT™(Open AI®)和 Bing AI™(Microsoft®)在根据美国泌尿外科协会(AUA)指南回答肾结石治疗相关问题时的表现,并评估每个聊天机器人的适当性、对咨询医疗保健提供者的重视程度、参考文献以及对指南的遵守情况等因素:方法:我们根据 AUA 结石外科治疗指南开发了 20 个与肾结石评估和治疗相关的问题。我们向 ChatGPT 和 Bing AI 聊天机器人提出了问题。我们利用简短的 DISCERN 工具比较了它们的回答以及回答的适当性:结果:在评估回答的清晰度、成就感和相关性的 1-3 个问题上,ChatGPT 的表现明显优于 Bing AI(12.77 ± 1.71 vs. 10.17 ± 3.27;P 结论:ChatGPT 的表现明显优于 Bing AI:根据 AUA 手术结石管理指南,ChatGPT 在提供目标明确的回答、实现此类目标以及相关且适当的回答方面明显优于 Bing AI。不过,Bing AI 提供了参考文献,可以对信息质量进行评估。还需要进行更多的研究,以进一步评估这些聊天机器人及其在临床医生和患者遇到泌尿科医疗保健相关问题时的潜在用途。
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引用次数: 0
The relationship between neutrophil/lymphocyte ratio, platelet/neutrophil ratio, and risk of urosepsis in patients who present with ureteral stones and suspected urinary tract infection. 输尿管结石和疑似尿路感染患者的中性粒细胞/淋巴细胞比率、血小板/中性粒细胞比率与尿毒症风险之间的关系。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s00345-024-05229-1
Juliana Villanueva-Congote, David Hinojosa-Gonzalez, Michal Segall, Brian H Eisner

Purpose: Patients presenting with ureteral stones and concurrent urinary tract infections require prompt kidney drainage as per standard care guidelines. However, even in patients who are promptly drained and treated with appropriate antibiotics, the mortality rate due to urosepsis has been reported to be nearly 9%. Therefore, Predictive tools for early sepsis detection have become essential. The Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) are potential biomarkers for predicting infection risk in these patients.

Methods: A retrospective cohort analysis involving patients diagnosed with obstructing ureteral stones who underwent urgent stent placement due to suspected urinary tract infection (UTI) in the emergency room (ER) was conducted. The baseline characteristics of patients were age, sex, comorbidities, and urological history. Laboratory data collected during hospitalization included total leukocyte and platelet counts and blood cultures. Ratios were calculated from the serum studies obtained upon admission to the ER. A logistic regression model was utilized to predict the incidence of positive qSOFA score (sepsis prediction score), the need for vasopressors, intensive care unit (ICU) admission, and sepsis, using NLR and PLR as independent variables.

Results: Between January 2016 and December 2020, 143 patients with a diagnosis of obstructing ureteral stone were admitted to the ER with a suspected UTI. 11.9% showed a positive qSOFA score, 20.3% required vasopressor support for > 1 h after ureteral stent placement, 28.7% required ICU admission, and 16.8% met sepsis criteria. Sepsis was defined as patients who were qSOFA positive and vasopressors needed for more than 1 h following stent placement. Logistic regression analysis revealed that PLR and positive blood cultures correlated significantly with positive qSOFA scores. Using logistic regression analysis, PLR, NLR, and positive blood culture were each independent predictors of vasopressor requirements, ICU admission, and urosepsis.

Conclusions: NLR and PLR may be valuable prognostic markers for predicting urosepsis risk in urolithiasis patients who present with obstructing stones and concern for systemic infection. Their utility may be in helping clinicians in early risk stratification, prompt intervention, and resource allocation.

目的:根据标准护理指南,输尿管结石并发尿路感染的患者需要及时进行肾脏引流。然而,据报道,即使是及时引流并接受适当抗生素治疗的患者,因尿毒症导致的死亡率也接近 9%。因此,用于早期脓毒症检测的预测工具变得至关重要。中性粒细胞与淋巴细胞比率(NLR)和血小板与淋巴细胞比率(PLR)是预测这些患者感染风险的潜在生物标志物:研究人员对急诊室(ER)中因疑似尿路感染(UTI)而接受紧急支架置入手术的输尿管梗阻性结石患者进行了回顾性队列分析。患者的基线特征包括年龄、性别、合并症和泌尿科病史。住院期间收集的实验室数据包括白细胞和血小板总数以及血液培养。比率是根据急诊室入院时获得的血清检查结果计算得出的。以NLR和PLR为自变量,利用逻辑回归模型预测qSOFA评分(脓毒症预测评分)阳性、血管加压剂需求、重症监护室(ICU)入院和脓毒症的发生率:2016年1月至2020年12月期间,急诊室收治了143名诊断为梗阻性输尿管结石的疑似UTI患者。11.9%的患者qSOFA评分呈阳性,20.3%的患者在输尿管支架置入后需要血管加压支持超过1小时,28.7%的患者需要入住ICU,16.8%的患者符合败血症标准。脓毒症的定义是在支架置入后 qSOFA 阳性且需要使用血管加压药超过 1 小时的患者。逻辑回归分析表明,PLR 和血培养阳性与 qSOFA 阳性评分显著相关。通过逻辑回归分析,PLR、NLR 和血培养阳性分别是血管加压剂需求、入住 ICU 和尿毒症的独立预测因子:结论:NLR和PLR可能是预测患有梗阻性结石并担心全身感染的尿路结石患者发生尿毒症风险的重要预后指标。它们可以帮助临床医生进行早期风险分层、及时干预和资源分配。
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引用次数: 0
Effect of intrarenal pelvic pressure on pyelo-tubular backflow and renal cortical blood perfusion during mini-percutaneous nephrolithotomy. 肾盂内压对微型经皮肾镜碎石术中肾盂-肾小管回流和肾皮质血流灌注的影响
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s00345-024-05313-6
Lei Zhou, Chen Zhang, Xiao-Lin Zhan, Mian Li, Nan-Yan Luo, Wei-Wei Wu, Xiao-Ma Zhang

Purpose: To investigate the effects of intrarenal pelvic pressure (IPP) on pyelo-tubular backflow and renal cortical blood perfusion during mini-percutaneous nephrolithotomy (MPCNL).

Methods: Dynamic changes in pyelo-tubular backflow and renal cortical blood perfusion were studied in six patients undergoing MPCNL using dynamic contrast-enhanced ultrasonography (CEUS) and IPP monitoring.

Results: CEUS of intrarenal pelvic perfusion revealed that renal tubules began to exhibit contrast agent reflux when IPP exceeded 34 mmHg during the MPCNL procedure. There was a positive correlation between renal tubule contrast agent reflux and IPP (P < 0.05). Intravenous CEUS of renal cortical blood flow demonstrated that both intrarenal pelvic perfusion time and IPP during MPCNL significantly affected renal cortical blood perfusion. Intrarenal pelvic perfusion time and pressure were negatively correlated with contrast agent peak intensity (PI) and area under the curve (AUC) (P < 0.05). Longer intrarenal pelvic perfusion times and higher pressures resulted in decreased renal cortical blood perfusion.

Conclusion: This study directly confirmed through dynamic CEUS and real-time IPP monitoring that an increase in IPP above the threshold of approximately 34 mmHg during MPCNL in patients leads to reflux through the renal tubules and a significant decrease in renal cortical blood perfusion. The safe upper limit for intrarenal pelvic perfusion pressure during MPCNL is approximately 34 mmHg.

目的:研究肾盂内压(IPP)对迷你经皮肾镜碎石术(MPCNL)中肾盂-肾小管回流和肾皮质血流灌注的影响:方法:使用动态对比增强超声成像(CEUS)和 IPP 监测对 6 名接受 MPCNL 的患者的肾盂-肾小管回流和肾皮质血流灌注的动态变化进行研究:结果:肾盂内血流灌注的 CEUS 显示,在 MPCNL 过程中,当 IPP 超过 34 mmHg 时,肾小管开始出现造影剂回流。肾小管造影剂回流与 IPP 呈正相关(P 结论:肾小管造影剂回流与 IPP 呈正相关:本研究通过动态 CEUS 和实时 IPP 监测直接证实,患者在 MPCNL 过程中 IPP 升高超过约 34 mmHg 的阈值时,会导致造影剂通过肾小管反流,并显著降低肾皮质血流灌注。MPCNL 期间肾盂内灌注压的安全上限约为 34 mmHg。
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引用次数: 0
Artificial intelligence versus human touch: can artificial intelligence accurately generate a literature review on laser technologies? 人工智能与人情味:人工智能能否准确生成激光技术文献综述?
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s00345-024-05311-8
Frédéric Panthier, Hugh Crawford-Smith, Eduarda Alvarez, Alberto Melchionna, Daniela Velinova, Ikran Mohamed, Siobhan Price, Simon Choong, Vimoshan Arumuham, Sian Allen, Olivier Traxer, Daron Smith

Purpose: To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser.

Methods: Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the "ground truth") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: "write a systematic review on pulsed-Thulium:YAG laser for lithotripsy" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 "checkpoint" proforma. A subjective assessment was recorded using a composite score including quality (0-10), clarity (0-10) and overall manuscript rank (1-5).

Results: The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively).

Conclusions: LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice.

目的:比较开源人工智能(AI)大语言模型(LLM)与人类作者就新型脉冲铥:YAG(p-Tm:YAG)激光生成系统综述(SR)的准确性:比较了五篇稿件。关于p-Tm:YAG的人类系统综述(被视为 "基本事实")由具有激光专业知识的独立认证内科医师撰写,已被同行评议的pubmed索引期刊接受(但尚未在线提供,因此LLM无法访问)。对人工智能 LLM 的要求是"撰写一篇关于脉冲铥:YAG 激光碎石的系统综述",该综述已提交给四位 LLM(ChatGPT3.5/Vercel/Claude/Mistral-7b)。对 LLM-SR 进行了统一,并对 Human-SR 进行了重新格式化,使其符合一般输出外观,以确保盲目性。九名具有不同程度内科专业知识的参与者(三名临床专科护士、泌尿科受训人员和顾问)使用定制的 10 个 "检查点 "表格对五个 SR 的准确性进行了客观评估。主观评估采用综合评分记录,包括质量(0-10 分)、清晰度(0-10 分)和稿件总体排名(1-5 分):结果:从客观和主观上看,Human-SR 比 LLM-SR 更准确(分别为 96 ± 7% 和 86.8 ± 8.2%;P 0.05)。质量和清晰度评估受到 SR 类型的显著影响,但不受专业知识水平的影响(分别为 p 0.05):结论:LLM 生成的关于高技术主题的数据准确性低于关键意见领袖。LLM,尤其是 ChatGPT3.5,在人工监督下可以改进我们的实践。
{"title":"Artificial intelligence versus human touch: can artificial intelligence accurately generate a literature review on laser technologies?","authors":"Frédéric Panthier, Hugh Crawford-Smith, Eduarda Alvarez, Alberto Melchionna, Daniela Velinova, Ikran Mohamed, Siobhan Price, Simon Choong, Vimoshan Arumuham, Sian Allen, Olivier Traxer, Daron Smith","doi":"10.1007/s00345-024-05311-8","DOIUrl":"10.1007/s00345-024-05311-8","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser.</p><p><strong>Methods: </strong>Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the \"ground truth\") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: \"write a systematic review on pulsed-Thulium:YAG laser for lithotripsy\" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 \"checkpoint\" proforma. A subjective assessment was recorded using a composite score including quality (0-10), clarity (0-10) and overall manuscript rank (1-5).</p><p><strong>Results: </strong>The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively).</p><p><strong>Conclusions: </strong>LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523249","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
Is it worth using the Comprehensive Complication Index over the Clavien-Dindo classification in elderly patients who underwent percutaneous nephrolithotomy? 对于接受经皮肾镜取石术的老年患者,是否值得使用综合并发症指数而非克拉维恩-丁多分类法?
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s00345-024-05318-1
Alexandre Danilovic, Gustavo Perrone, Lucas Dias, Giovanni Marchini, Fabio Torricelli, Carlos Batagello, Fabio Vicentini, William C Nahas, Eduardo Mazzucchi

Purpose: To compare the Comprehensive Complication Index (CCI) to the Clavien-Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population.

Methods: We conducted a retrospective cohort study involving patients 60 years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications.

Results: We included 244 patients with a median age of 65 [63-69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy's classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications.

Conclusion: Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and history of UTI as predictors of postoperative complications after this procedure in this population.

目的:在接受经皮肾镜取石术(PCNL)的老年人群中比较综合并发症指数(CCI)和克拉维恩-丁多分类法(CDC),并确定该人群术后并发症的预测因素:我们进行了一项回顾性队列研究,研究对象是 2009 年至 2020 年期间在本机构接受 PCNL 手术的 60 岁及以上患者。术后并发症被视为术后 30 天内的并发症。通过计算 CDC 和 CCI 来评估患者的预后。住院时间(LOS)和入住急诊室(ER)作为术后并发症的替代指标:我们共收治了 244 名患者,中位年龄为 65 [63-69] 岁。15.6%的患者出现术后并发症,2.5%的患者出现多种并发症。LOS的相关系数为0.29(P 结论:CDC和CCI同样与术后并发症相关:CDC 和 CCI 与老年 PCNL 患者的 LOS 和急诊室入院率同样相关。然而,与 CCI 相比,CDC 低估了住院费用。我们发现,在这一人群中,较高的 ASA 身体状况、Charlson 合并症指数、Guy 分类和尿毒症病史是该手术术后并发症的预测因素。
{"title":"Is it worth using the Comprehensive Complication Index over the Clavien-Dindo classification in elderly patients who underwent percutaneous nephrolithotomy?","authors":"Alexandre Danilovic, Gustavo Perrone, Lucas Dias, Giovanni Marchini, Fabio Torricelli, Carlos Batagello, Fabio Vicentini, William C Nahas, Eduardo Mazzucchi","doi":"10.1007/s00345-024-05318-1","DOIUrl":"https://doi.org/10.1007/s00345-024-05318-1","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the Comprehensive Complication Index (CCI) to the Clavien-Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving patients 60 years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications.</p><p><strong>Results: </strong>We included 244 patients with a median age of 65 [63-69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy's classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications.</p><p><strong>Conclusion: </strong>Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and history of UTI as predictors of postoperative complications after this procedure in this population.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523252","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
Incidence and mortality of prostate cancer in France from 2010 to 2021, using a real-life database (National Health Data System - SNDS) - the CaPCo Study. 利用真实生活数据库(国家健康数据系统 - SNDS)--CaPCo 研究,分析 2010 年至 2021 年法国前列腺癌的发病率和死亡率。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1007/s00345-024-05291-9
Hugo Crespin, Anne-Isabelle Lecuyer, Emeline Laurent, Franck Bruyere, Leslie Grammatico-Guillon

Background and objective: Prostate cancer (PCa) was the leading incident cancer and 3rd leading cause of cancer death in men in France in 2015 with inter-regional disparities. The objectives were to describe PCa incidence and mortality in France and by region, using real life data from the National Health Data System and to identify the factors associated with all-cause or PCa-specific mortality.

Methods: Men aged ≥ 18years hospitalized and/or on long-term care for PCa (ICD-10 code C61) in France between 2010 and 2021 were included. An incident case was defined by the absence of any cancer in the five years preceding the first coding. Incidence and mortality estimates were age-standardized: France 2018f standardized rates (FSR), all-cause mortality (SMR) and PCa-specific mortality (SMRspe). Factors associated with death were identified using cause-specific Cox models.

Results: The mean annual incidence was 47,081cases/year (FSR:179.6/100,000men), increasing over the period except 2020. All-cause mortality was 20,259 deaths/year (77.3/100,000men), and PCa-specific mortality was 7,265 deaths/year (27.7/100,000men). A PCa-specific mortality excess was found in Centre-Val-de-Loire (SMRspe = 1.21), Bretagne (1.18), Hauts-de-France (1.17) Normandie (1.15). After adjustment, significant PCa mortality excess was observed in Bretagne (HR = 1,29;95%IC[1.09-1.46]) and Hauts-de-France (HR = 1.19[1.03-1.34]). The other factors associated with death were an age ≥ 60years, an increasing comorbidity index, metastatic disease at onset (major weight in specific mortality with hazard ratio HR = 16.1[15.2-17.0]), precariousness, affiliation to the agricultural scheme, and the COVID period in all-cause mortality.

Conclusion: This study updated incidence and mortality data in France. It showed differences in mortality between regions in France. The adjustment moderates regional findings based on raw mortality data.

背景和目的:2015年,前列腺癌(PCa)是法国男性发病率最高的癌症,也是男性癌症死亡的第三大原因,但地区间存在差异。研究目的是利用国家健康数据系统(National Health Data System)提供的真实数据,按地区描述法国前列腺癌的发病率和死亡率,并确定与全因死亡率或前列腺癌特异性死亡率相关的因素:纳入2010年至2021年期间在法国因PCa(ICD-10代码C61)住院和/或接受长期治疗的年龄≥18岁的男性。首次编码前五年内未患任何癌症即为偶发病例。发病率和死亡率估计值已进行年龄标准化:法国2018六开彩开奖结果标准化率(FSR)、全因死亡率(SMR)和PCa特异性死亡率(SMRspe)。使用特定病因 Cox 模型确定了与死亡相关的因素:平均年发病率为 47,081 例/年(FSR:179.6/100,000 名男性),除 2020 年外,发病率一直在上升。全因死亡率为 20,259 例/年(77.3/100,000 人),PCa 特异死亡率为 7,265 例/年(27.7/100,000 人)。在卢瓦尔河中游省(SMRspe = 1.21)、布列塔尼省(1.18)、上法兰西省(1.17)和诺曼底省(1.15)发现 PCa 特异性死亡率超标。经调整后,布列塔尼省(HR = 1.29;95%IC[1.09-1.46])和上法兰西省(HR = 1.19[1.03-1.34])的 PCa 死亡率明显偏高。与死亡相关的其他因素包括:年龄≥60岁、合并症指数增加、发病时患有转移性疾病(在特定死亡率中占主要权重,危险比HR=16.1[15.2-17.0])、不稳定、隶属于农业计划以及全因死亡率中的COVID时期:这项研究更新了法国的发病率和死亡率数据。结论:这项研究更新了法国的发病率和死亡率数据,显示了法国不同地区之间的死亡率差异。调整结果缓和了基于原始死亡率数据的地区调查结果。
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引用次数: 0
Effect of standard urotherapy to children with overactive bladder on quality of life. 膀胱过度活动症儿童接受标准尿路治疗对生活质量的影响。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-25 DOI: 10.1007/s00345-024-05310-9
Rong Dai, Yue Chen, Shuangfeng Fan, Jingjie Xia, Shan Jiang, Yun Peng, Changkai Deng

Purpose: Overactive bladder (OAB) is a common syndrome in children, which may affect the patient's quality of life (QoL). This study aimed to evaluate the effect of standard urotherapy (SU) given on the quality of life for children diagnosed with OAB.

Methods: The study was conducted on 107 children aged 2 to 13 years who applied to the urology clinic of a hospital in China and were diagnosed with OAB. The QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). The QoL was evaluated before and 1 month later SU given.

Results: Of the 107 children, at baseline, the children with OAB revealed a total mean PINQ score of 27.40 ± 13.19, and the total mean PINQ score was 13.72 ± 9.63 at 1 month later. PINQ score showed a statistically significant difference between before and after 1 month treatment (P < 0.001).

Conclusions: The QoL of children with OAB increased may due to SU provided outpatient clinics. And it is important for children and their parents to investigate and monitor to what extent the QoL of children diagnosed with OAB is affected.

目的:膀胱过度活动症(OAB)是一种常见的儿童综合征,可能会影响患者的生活质量(QoL)。本研究旨在评估标准尿路治疗(SU)对确诊为膀胱过度活动症的儿童生活质量的影响:研究对象为中国某医院泌尿科门诊的 107 名确诊为 OAB 的 2-13 岁儿童。研究使用小儿尿失禁问卷(PINQ)对患儿的生活质量进行评估。结果显示,107 名患儿在接受 SU 治疗前和治疗 1 个月后的 QoL 均有所改善:结果:在 107 名患儿中,OAB 患儿基线时的 PINQ 平均总分为 27.40 ± 13.19,1 个月后的 PINQ 平均总分为 13.72 ± 9.63。治疗前后 1 个月的 PINQ 总分差异有统计学意义(P 结论:治疗前后 1 个月的 PINQ 总分差异有统计学意义(P):OAB 患儿的 QoL 可能因 SU 提供的门诊而有所提高。对于儿童及其家长来说,调查和监测确诊为 OAB 的儿童的 QoL 受影响的程度非常重要。
{"title":"Effect of standard urotherapy to children with overactive bladder on quality of life.","authors":"Rong Dai, Yue Chen, Shuangfeng Fan, Jingjie Xia, Shan Jiang, Yun Peng, Changkai Deng","doi":"10.1007/s00345-024-05310-9","DOIUrl":"https://doi.org/10.1007/s00345-024-05310-9","url":null,"abstract":"<p><strong>Purpose: </strong>Overactive bladder (OAB) is a common syndrome in children, which may affect the patient's quality of life (QoL). This study aimed to evaluate the effect of standard urotherapy (SU) given on the quality of life for children diagnosed with OAB.</p><p><strong>Methods: </strong>The study was conducted on 107 children aged 2 to 13 years who applied to the urology clinic of a hospital in China and were diagnosed with OAB. The QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). The QoL was evaluated before and 1 month later SU given.</p><p><strong>Results: </strong>Of the 107 children, at baseline, the children with OAB revealed a total mean PINQ score of 27.40 ± 13.19, and the total mean PINQ score was 13.72 ± 9.63 at 1 month later. PINQ score showed a statistically significant difference between before and after 1 month treatment (P < 0.001).</p><p><strong>Conclusions: </strong>The QoL of children with OAB increased may due to SU provided outpatient clinics. And it is important for children and their parents to investigate and monitor to what extent the QoL of children diagnosed with OAB is affected.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509301","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
Streamlined surgical approach for coexistent urethral stricture and benign prostatic enlargement: feasibility, safety and patency results. 尿道狭窄和良性前列腺增生并存时的简化手术方法:可行性、安全性和通畅性结果。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-25 DOI: 10.1007/s00345-024-05306-5
Jordán Scherñuk, Juan Diego Tinajero, Federico Tirapegui, Mariano Sebastián González, Carlos Roberto Giudice, Gabriel Andrés Favre

Purpose: To evaluate the technical feasibility, safety, and patency results of a simultaneous surgical approach to repair urethral stricture and treat benign prostatic enlargement endoscopically in a highly selected group of patients at a tertiary referral center. We hypothesize that this is technically feasible, safe, and does not affect urethroplasty outcomes.

Methods: A retrospective review of adult men who underwent simultaneous urethroplasty and endoscopic prostatic surgery between May 2017 and May 2024 at our institution was conducted. Patients with strictures < 15 French and prostates with adverse prognostic features of response to medical treatment were included. The primary outcome was technical feasibility and safety. The secondary outcome was stricture-free survival.

Results: Twenty men were treated during the study period. The median length of the urethral stricture was 3.0 cm (IQR 2.0-5.0), and the median size of the prostate was 95.0 cc (IQR 63.3-128.3). All patients were treated successfully with a median operative time of 194.5 min (IQR 180.0-246.8), and no procedures required conversion to a staged procedure or open prostatectomy. There were seven Clavien-Dindo I-II complications and one Clavien-Dindo IIIb complication (hematuria requiring endoscopic clot evacuation). At 22 months follow-up, two cases of urethral re-stricture were diagnosed, with one case requiring redo urethroplasty, though none had previous major complications.

Conclusion: The combination of urethroplasty and endoscopic surgery for benign prostatic enlargement at the same stage appears to be technically viable and safe, and it does not compromise medium-term urethral patency results in a carefully selected group of patients.

目的:在一家三级转诊中心,对经过严格筛选的一组患者进行尿道狭窄修复和良性前列腺增生内窥镜治疗的同时手术方法的技术可行性、安全性和通畅效果进行评估。我们假设这种方法在技术上可行、安全,并且不会影响尿道成形术的效果:我们对 2017 年 5 月至 2024 年 5 月期间在我院接受尿道成形术和内窥镜前列腺手术的成年男性进行了回顾性研究。狭窄患者 结果:研究期间有 20 名男性接受了治疗。尿道狭窄的中位长度为 3.0 厘米(IQR 2.0-5.0),前列腺的中位大小为 95.0 cc(IQR 63.3-128.3)。所有患者都得到了成功治疗,手术时间中位数为 194.5 分钟(IQR 180.0-246.8),没有患者需要转为分期手术或开放式前列腺切除术。共有七例克拉维恩-丁多 I-II 并发症和一例克拉维恩-丁多 IIIb 并发症(血尿,需要内镜下血块排出)。在 22 个月的随访中,诊断出两例尿道再狭窄,其中一例需要重新进行尿道成形术,但之前都没有出现过重大并发症:结论:在同一阶段结合尿道成形术和内窥镜手术治疗良性前列腺增生似乎在技术上是可行和安全的,而且在精心挑选的患者群体中不会影响中期尿道通畅效果。
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引用次数: 0
Development of a multivariate model predictive of post-adrenalectomy renal function decline in patients with primary aldosteronism: a large-cohort single-center study. 建立预测原发性醛固酮增多症患者肾上腺切除术后肾功能下降的多变量模型:一项大型队列单中心研究。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-25 DOI: 10.1007/s00345-024-05308-3
Wenhao Lin, Juping Zhao, Chen Fang, Wei He, Xin Huang, Fukang Sun, Jun Dai

Purpose: To develop a multivariate liniear model for predicting long-term (> 3 months) post-adrenalectomy renal function decline in patients with primary aldosteronism (PA). The model aims to help identify patients who may experience a significant decline in renal function after surgery.

Methods: We retrospectively analyzed the clinical data of 357 patients who were diagnosed with PA and underwent adrenalectomy between September 2012 and February 2023. LASSO and multivariate linear regression analyses were used to identify significant risk factors for model construction. The models were further internally validated using bootstrap method.

Results: Age (P < 0.001), plasma aldosterone concentration (PAC) measured in the upright-position (PACU, P = 0.066), PAC measured after saline infusion (PACafterNS, P = 0.010), preoperative blood adrenocorticotropic-hormone level (ACTH, P = 0.048), preoperative estimated glomerular filtration rate (eGFR, P < 0.001) and immediate postoperative eGFR (P < 0.001) were finally included in a multivariate model predictive of post-adrenalectomy renal function decline and the coefficients were adjusted by internal validation. The final model is: predicted postoperative long-term (> 3 months) eGFR decline =-70.010 + 0.416*age + 6.343*lg PACU+4.802*lg ACTH + 7.424*lg PACafterNS+0.637*preoperative eGFR-0.438*immediate postoperative eGFR. The predicted values are highly related to the observed values (adjusted R = 0.63).

Conclusion: The linear model incorporating perioperative clinical variables can accurately predict long-term (> 3 months) post-adrenalectomy renal function decline.

目的:建立一个多变量线性模型,用于预测原发性醛固酮增多症(PA)患者肾上腺切除术后长期(大于 3 个月)肾功能下降的情况。该模型旨在帮助识别术后肾功能可能显著下降的患者:我们回顾性分析了 2012 年 9 月至 2023 年 2 月期间确诊为 PA 并接受肾上腺切除术的 357 例患者的临床数据。我们使用 LASSO 和多变量线性回归分析来识别重要的风险因素,从而构建模型。采用引导法对这些模型进行了进一步的内部验证:年龄(P U,P = 0.066)、生理盐水输注后测量的 PAC(PACafterNS,P = 0.010)、术前血液促肾上腺皮质激素水平(ACTH,P = 0.048)、术前估计肾小球滤过率(eGFR,P 3 个月)eGFR 下降 =-70.010 + 0.416*age + 6.343*lg PACU+4.802*lg ACTH + 7.424*lg PACafterNS+0.637*preoperative eGFR-0.438*immediate postoperative eGFR。预测值与观察值高度相关(调整 R = 0.63):结论:包含围手术期临床变量的线性模型可准确预测肾上腺切除术后长期(大于 3 个月)的肾功能下降。
{"title":"Development of a multivariate model predictive of post-adrenalectomy renal function decline in patients with primary aldosteronism: a large-cohort single-center study.","authors":"Wenhao Lin, Juping Zhao, Chen Fang, Wei He, Xin Huang, Fukang Sun, Jun Dai","doi":"10.1007/s00345-024-05308-3","DOIUrl":"https://doi.org/10.1007/s00345-024-05308-3","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a multivariate liniear model for predicting long-term (> 3 months) post-adrenalectomy renal function decline in patients with primary aldosteronism (PA). The model aims to help identify patients who may experience a significant decline in renal function after surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 357 patients who were diagnosed with PA and underwent adrenalectomy between September 2012 and February 2023. LASSO and multivariate linear regression analyses were used to identify significant risk factors for model construction. The models were further internally validated using bootstrap method.</p><p><strong>Results: </strong>Age (P < 0.001), plasma aldosterone concentration (PAC) measured in the upright-position (PAC<sub>U</sub>, P = 0.066), PAC measured after saline infusion (PAC<sub>afterNS</sub>, P = 0.010), preoperative blood adrenocorticotropic-hormone level (ACTH, P = 0.048), preoperative estimated glomerular filtration rate (eGFR, P < 0.001) and immediate postoperative eGFR (P < 0.001) were finally included in a multivariate model predictive of post-adrenalectomy renal function decline and the coefficients were adjusted by internal validation. The final model is: predicted postoperative long-term (> 3 months) eGFR decline =-70.010 + 0.416*age + 6.343*lg PAC<sub>U</sub>+4.802*lg ACTH + 7.424*lg PAC<sub>afterNS</sub>+0.637*preoperative eGFR-0.438*immediate postoperative eGFR. The predicted values are highly related to the observed values (adjusted R = 0.63).</p><p><strong>Conclusion: </strong>The linear model incorporating perioperative clinical variables can accurately predict long-term (> 3 months) post-adrenalectomy renal function decline.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509300","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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