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An in vitro study of irrigation rate, operator duty cycle and intrarenal temperature in superpulse fiber thulium laser lithotripsy. 超脉冲光纤铥激光碎石术中灌注率、操作员工作周期和肾内温度的体外研究。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00345-024-05289-3
Tianfu Ding, Zheng Xu, Zhongyue Huang, Bo Xiao, Weiguo Hu, Jianxing Li

Objective: The present study aimed to examine the relationship between irrigation velocity, operator duty cycle (ODC), and intrarenal temperature during retrograde intrarenal surgery with a superpulse fiber thulium laser.

Methods: Place the stones into the fresh isolated porcine kidneys, use puncture needle to place the temperature probe 2 mm around the stones, and place the pressure probes in the upper calyx, lower calyx, and renal pelvis. Place the entire setup in a 37 °C constant temperature water bath to simulate the human body environment. The laser power varies between 10 and 30 W, and the irrigation speed is 10-30 ml/min. Additionally, at a laser power of 20 W and an irrigation speed of 10 ml/min, different On-Duty Cycles (ODC) are set. Monitor the changes in temperature and pressure.

Results: A direct proportionality of temperature in the kidney to the rate of irrigation has been reported between 10 W and 30 W laser powers. The percentage ratio of the rate of irrigation and power in the laser is 1:1, which can keep the temperature in the kidney at a safe level. At a laser power of 20 W and irrigation of 10 ml/min, the temperature inside the kidney increases sharply with the increase in ODC. By decreasing the ratio of ODC, the increase of temperature inside the kidney can be brought to a great reduction.

Conclusion: Maintaining a 1:1 ratio between laser power and irrigation speed can effectively prevent thermal damage or injury to kidney tissue.Additionally, by adjusting the On-Duty Cycle (ODC) ratio, the intrarenal temperature can also be reduced.

目的:本研究旨在探讨超脉冲光纤铥激光逆行肾内手术中灌注速度、操作者工作周期(ODC)和肾内温度之间的关系:本研究旨在探讨超脉冲光纤铥激光逆行肾内手术中灌注速度、操作者占空比(ODC)和肾内温度之间的关系:将结石放入新鲜离体猪肾,用穿刺针将温度探头置于结石周围 2 毫米处,将压力探头置于上萼、下萼和肾盂。将整个装置置于 37 °C 恒温水浴中,以模拟人体环境。激光功率在 10 到 30 W 之间变化,灌洗速度为 10-30 毫升/分钟。此外,在激光功率为 20 W、冲洗速度为 10 ml/min 的情况下,设置了不同的开机周期 (ODC)。监测温度和压力的变化:结果:据报道,在 10 W 和 30 W 激光功率之间,肾脏温度与灌流速度成正比。灌洗速度与激光功率的比例为 1:1,可将肾脏温度控制在安全水平。当激光功率为 20 瓦,灌洗速度为 10 毫升/分钟时,肾脏内的温度会随着 ODC 的增加而急剧升高。通过降低 ODC 的比例,可以大大降低肾脏内温度的升高:结论:激光功率与灌洗速度保持 1:1 的比例可有效防止肾脏组织的热损伤。
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引用次数: 0
A new spectrum of neonatal urethral pathologies in the era of early vesicoamniotic shunting? 早期膀胱羊膜腔分流时代的新生儿尿道病变新谱?
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00345-024-05307-4
J Kohaut, G Holtkamp, J Fischer-Mertens, D Schulten, S Kohl, S Habbig, E C Weber, I Gottschalk, C Berg, M Dübbers

Purpose: Intrauterine vesicoamniotic shunting (VAS) was shown to affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO). Data on postnatal management are largely lacking. We aim to describe the pathologies diagnosed in children born after vesicoamniotic shunt placement in early pregnancy for megacystis.

Methods: All newborns with previous intrauterine VAS treated in our institution were analyzed retrospectively. We evaluated the clinical spectrum of urethral pathologies. We also compared patients who received a shunt before the 17th gestational week with those who received it later.

Results: Between 2014 and 2023, 26 patients (all male) with a history of VAS for suspected LUTO were treated in our institution postnatally. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in 14 patients. Seven patients received a Harrison® shunt whereas 19 received a Somatex® shunt. Twelve patients required surgical shunt removal under general anesthesia due to shunt migration/embedding. Posterior urethral valves were found in 10/26 patients, 10/26 patients showed a urethral hypoplasia [Fig. 1] and two patients had urethral duplications. In two patients, we identified a prune belly syndrome. One patient had posterior and anterior urethral valves. One patient had a high grade bilateral vesicoureteral reflux without LUTO. The 11 patients shunted early (before 17GW) showed a trend towards a higher proportion of urethral hypoplasia in the early shunt group (54% vs. 26%) without statistical significance.

Conclusion: In our observation, patients treated with VAS had a noticeable high proportion of complex urethral pathologies such as urethral hypoplasia. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.

目的:研究表明,宫内膀胱羊膜分流术(VAS)会影响疑似下尿路梗阻(LUTO)的巨胱症男性胎儿的存活率。有关产后管理的数据基本缺失。我们的目的是描述因巨细胞畸形而在孕早期进行膀胱羊水分流术后出生的婴儿的病理诊断:方法:我们对本机构曾接受过宫内 VAS 治疗的所有新生儿进行了回顾性分析。我们评估了尿道病变的临床范围。我们还比较了在第17孕周之前和之后接受分流术的患者:结果:2014 年至 2023 年间,我院共收治了 26 例因疑似 LUTO 而有 VAS 病史的患者(均为男性)。5名分流管脱位的胎儿在宫内接受了再植入手术。共有 14 名患者在妊娠 38 周前早产。7 名患者接受了 Harrison® 分流术,19 名患者接受了 Somatex® 分流术。由于分流管移位/嵌顿,12 名患者需要在全身麻醉的情况下进行分流管移除手术。10/26例患者发现后尿道瓣膜,10/26例患者尿道发育不良[图1],2例患者尿道重复。在两名患者中,我们发现了葡萄胎综合征。一名患者患有后尿道瓣膜和前尿道瓣膜。一名患者双侧膀胱输尿管高度反流,但无 LUTO。在早期分流(17GW 之前)的 11 名患者中,早期分流组尿道发育不全的比例呈上升趋势(54% 对 26%),但无统计学意义:根据我们的观察,接受 VAS 治疗的患者出现尿道发育不良等复杂尿道病变的比例明显较高。在为父母提供产前咨询和规划产后管理时,应考虑到这些数据。
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引用次数: 0
Polish validation of the wisconsin stone quality of life questionnaire (POL-WISQoL). 威斯康星州结石生活质量问卷(POL-WISQoL)的波兰验证。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00345-024-05303-8
Wojciech Tomczak, Wojciech Krajewski, Joanna Chorbińska, Łukasz Nowak, Katarzyna Grunwald, Adam Chełmoński, Jan Łaszkiewicz, Bartosz Małkiewicz, Tomasz Szydełko

Purpose: Urolithiasis significantly affects patient quality of life, yet the global standard of care predominantly focuses on achieving a stone free status, often ignoring patient reported outcomes. Currently, there are no specific measures available to assess the quality of life in the Polish population suffering from kidney stones. Therefore, this study aimed to develop and validate the Polish version of the Wisconsin Stone Quality of Life Questionnaire.

Methods: The translation of WISQOL was carried out in accordance with the best available guidelines. Patients treated for kidney stones at a tertiary centre were recruited and completed both POL-WISQOL and SF36 questionnaires. Comprehensive analyses were conducted to assess internal consistency, inter-item and inter-domain correlations, as well as convergent and construct validity. Additionally, test-retest reliability was evaluated to ensure the accuracy and stability of the findings.

Results: A total of 102 participants fully completed both questionnaires and were included in the analysis. The translated survey demonstrated excellent internal consistency (Cronbach's coefficient 0.967) and significant convergent validity (Spearman's correlation = 0.847, p < 0.001). Furthermore, an ANOVA with Tukey's post hoc analysis revealed a significant decline in WISQOL scores between symptomatic and asymptomatic individuals, thereby confirming tool's construct validity.

Conclusion: POL-WISQoL turned out to be a valid disease specific health related quality of life measuring tool. Its widespread utilisation has the potential to shift the standard of care towards patient centered outcomes.

目的:泌尿系结石严重影响患者的生活质量,然而全球护理标准主要侧重于实现无结石状态,往往忽视了患者报告的结果。目前,还没有专门的方法来评估波兰肾结石患者的生活质量。因此,本研究旨在开发和验证波兰语版的威斯康星结石生活质量问卷:方法:WISQOL 的翻译是根据现有的最佳指南进行的。我们招募了在一家三级医院接受肾结石治疗的患者,他们填写了 POL-WISQOL 和 SF36 问卷。对问卷进行了综合分析,以评估内部一致性、项目间和领域间相关性,以及聚合效度和建构效度。此外,还评估了重复测试的可靠性,以确保研究结果的准确性和稳定性:共有 102 名参与者完整填写了两份问卷,并纳入了分析。翻译后的调查表显示出良好的内部一致性(克朗巴赫系数 0.967)和显著的聚合效度(斯皮尔曼相关性 = 0.847,p 结论:POL-WISQoL 结果表明,POL-WISQoL 具有良好的内部一致性(克朗巴赫系数 0.967)和显著的聚合效度:POL-WISQoL 是一种有效的疾病相关健康生活质量测量工具。它的广泛使用有可能将护理标准转向以患者为中心的结果。
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引用次数: 0
Short-term postoperative recovery for patients after Thulium Laser Vapoenucleation of Prostate: evaluation of the impact of lower urinary tract symptoms on quality of life. 铥激光前列腺汽化切除术后患者的术后短期恢复:评估下尿路症状对生活质量的影响。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00345-024-05293-7
Jiayan Luan, Chuqiao Song, Deng Li, Lei Chen, Di Cui, Yuyang Zhao, Yuan Ruan, Xiaohai Wang, Yifeng Jing, Wenhuan Guo, Shujie Xia, Yiping Zhu

Purpose: We evaluated short-term postoperative recovery in patients with benign prostatic hyperplasia (BPH), especially focusing on symptoms reduction and life quality enhancement.

Methods: We prospectively enrolled 160 BPH patients who underwent surgery and were followed up regularly for 12 weeks, collecting the International Prostate Symptom Score (IPSS), Quality of Life (QoL), and Qmax. Regression analysis and mixed effect models were used to evaluate the tendency of symptoms on recovery from the perspective of quality of life.

Results: At 12 weeks, all patients recovered well with conspicuous change in IPSS, QoL and Qmax, that were 4.80 ± 4.59, 1.34 ± 1.14,20.02 ± 8.61 mL/s respectively. Voiding symptoms were significantly reduced by 79.4% at 2 weeks, whereas storage symptoms recovered slowly until 12 weeks with residual lower urinary tract symptoms (LUTS), predominantly urinary frequency and nocturia. Improvements in incomplete emptying urination and urinary frequency were significantly associated with QoL.

Conclusions: With regards to the comprehensive full-cycle treatment of LUTS patients, in addition to the objective results, more attention should also be focused on the change in following symptoms, that is, incomplete emptying urination, urine frequency and urination difficulty, which play key roles in the enhancement of patients' quality of life.

目的:我们对良性前列腺增生症(BPH)患者的术后短期恢复情况进行了评估,尤其关注症状的减轻和生活质量的提高:我们对 160 名良性前列腺增生症患者进行了前瞻性手术,并定期随访 12 周,收集国际前列腺症状评分(IPSS)、生活质量(QoL)和 Qmax。采用回归分析和混合效应模型从生活质量的角度评估症状对康复的影响:12 周后,所有患者均恢复良好,IPSS、QoL 和 Qmax 均有明显变化,分别为 4.80 ± 4.59、1.34 ± 1.14、20.02 ± 8.61 mL/s。排尿症状在 2 周时明显减轻了 79.4%,而储尿症状在 12 周前恢复缓慢,下尿路症状(LUTS)残留,主要是尿频和夜尿。排空不完全排尿和尿频的改善与质量生活显著相关:结论:对于 LUTS 患者的全周期综合治疗,除了客观结果外,还应更加关注以下症状的变化,即排空不完全排尿、尿频和排尿困难,这对提高患者的生活质量起着关键作用。
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引用次数: 0
Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques. 机器人辅助根治性膀胱切除术后的皮肤输尿管造口术:经腹膜与腹膜后技术的多中心比较研究。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00345-024-05300-x
Yutaro Sasaki, Yasuyo Yamamoto, Kyotaro Fukuta, Kazuyoshi Izumi, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka, Junya Furukawa

Background: The aim of this study was to evaluate the differences in perioperative outcomes between transperitoneal and retroperitoneal techniques in cutaneous ureterostomy (CUS).

Methods: Between 2018 and 2023, 55 patients underwent CUS following robot-assisted radical cystectomy. Among the 55 patients, we compared 33 patients who underwent transperitoneal CUS (t-CUS) and 22 who underwent retroperitoneal CUS (r-CUS).

Results: Compared with the r-CUS group, the t-CUS group had significantly shorter operative times (p < 0.001); significantly less estimated blood loss (p < 0.001); and significantly lower incidence of complications (Clavien-Dindo classification grade ≤ 2) within 30 days (p = 0.005). Unexpectedly, the incidence of ileus within 30 days was lower, though the difference was not statistically significant (p = 0.064). During the median follow-up period of 24.3 months, no ileus was observed in either group after 30 days postoperatively. There was no significant difference in the stent-free rate between the groups (p = 0.449). There were also no significant differences in the rates of change in estimated glomerular filtration rate from preoperatively at 3, 6, 12, and 24 months postoperatively between the groups (p = 0.590, p = 0.627, p = 0.741, and p = 0.778, respectively).

Conclusions: Compared with r-CUS, t-CUS was associated with a shorter operative time and lower incidence of perioperative complications, including gastrointestinal complications. We believe that t-CUS can be performed safely and effectively.

背景:本研究旨在评估经腹膜和腹膜后技术在皮下输尿管造口术(CUS)中围术期结果的差异:本研究旨在评估经腹膜和经腹膜后技术在经皮输尿管造口术(CUS)中围手术期结果的差异:2018年至2023年间,55名患者在机器人辅助根治性膀胱切除术后接受了CUS。在这55名患者中,我们比较了33名接受经腹膜CUS(t-CUS)的患者和22名接受腹膜后CUS(r-CUS)的患者:结果:与 r-CUS 组相比,t-CUS 组的手术时间明显更短(P与 r-CUS 相比,t-CUS 的手术时间更短,围手术期并发症(包括胃肠道并发症)的发生率更低。我们相信,t-CUS 可以安全有效地进行。
{"title":"Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques.","authors":"Yutaro Sasaki, Yasuyo Yamamoto, Kyotaro Fukuta, Kazuyoshi Izumi, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka, Junya Furukawa","doi":"10.1007/s00345-024-05300-x","DOIUrl":"https://doi.org/10.1007/s00345-024-05300-x","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the differences in perioperative outcomes between transperitoneal and retroperitoneal techniques in cutaneous ureterostomy (CUS).</p><p><strong>Methods: </strong>Between 2018 and 2023, 55 patients underwent CUS following robot-assisted radical cystectomy. Among the 55 patients, we compared 33 patients who underwent transperitoneal CUS (t-CUS) and 22 who underwent retroperitoneal CUS (r-CUS).</p><p><strong>Results: </strong>Compared with the r-CUS group, the t-CUS group had significantly shorter operative times (p < 0.001); significantly less estimated blood loss (p < 0.001); and significantly lower incidence of complications (Clavien-Dindo classification grade ≤ 2) within 30 days (p = 0.005). Unexpectedly, the incidence of ileus within 30 days was lower, though the difference was not statistically significant (p = 0.064). During the median follow-up period of 24.3 months, no ileus was observed in either group after 30 days postoperatively. There was no significant difference in the stent-free rate between the groups (p = 0.449). There were also no significant differences in the rates of change in estimated glomerular filtration rate from preoperatively at 3, 6, 12, and 24 months postoperatively between the groups (p = 0.590, p = 0.627, p = 0.741, and p = 0.778, respectively).</p><p><strong>Conclusions: </strong>Compared with r-CUS, t-CUS was associated with a shorter operative time and lower incidence of perioperative complications, including gastrointestinal complications. We believe that t-CUS can be performed safely and effectively.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509299","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
Efficacy of high-dose vitamin D supplementation vs. solifenacin or standard urotherapy for overactive bladder dry in children: a secondary analysis of a randomized clinical trial. 高剂量维生素 D 补充剂与索利那新或标准泌尿疗法治疗儿童干性膀胱过度活动症的疗效对比:随机临床试验的二次分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-22 DOI: 10.1007/s00345-024-05296-4
Hongsong Chen, Zhicheng Zhang, Qiang Zhang, Chong Wang, Zhenmin Liu, Zihan Ye, Xiao Wang, Yanxi Wang, Xing Liu, Guanghui Wei

Purpose: To investigate the efficacy of high-dose vitamin D supplementation (VDS) plus standard urotherapy (SU) in managing pediatric overactive bladder dry (OAB-dry), specifically in children with (1) vitamin D levels between 20 and 35 ng/mL and (2) heightened baseline symptom severity.

Methods: In this secondary analysis of a randomized controlled trial, eligible children (n = 303) were assigned to 8 weeks of VDS + SU group, solifenacin (SOL) + SU group, or SU alone group. The primary outcome was voiding frequency; secondary outcomes included urgency, nocturia, quality of life (QoL), pediatric lower urinary tract symptoms scores, and patient satisfaction.

Results: Among 303 participants, 197 (65%) had vitamin D levels between 20 and 35 ng/mL, and 119 (39%) exhibited heightened baseline symptom severity. In both subgroups, VDS + SU resulted in significantly greater improvements in voiding frequency compared to SOL + SU and SU alone. In the vitamin D subgroup (20-35 ng/mL), the median difference in voids/day between VDS + SU and SOL + SU was 2.0 (95% CI, 1.0 to 3.0; P = 0.003) and 3.2 compared to SU alone (P < 0.001). In the heightened symptom subgroup, the median difference was 3.0 (95% CI, 2.0 to 4.0; P < 0.001) vs. SOL + SU and 5.0 (95% CI, 4.0 to 6.0; P < 0.001) vs. SU alone. The VDS + SU group generally outperformed the other groups in various secondary outcome measures.

Conclusion: High-dose VDS plus SU has significant therapeutic benefit in children with OAB-dry in those with vitamin D levels between 20 and 35 ng/mL and with more severe symptoms, compared to SOL + SU or SU alone.

目的:研究高剂量维生素D补充剂(VDS)加标准尿路治疗(SU)在治疗小儿干性膀胱过度活动症(OAB-dry)方面的疗效,尤其是针对(1)维生素D水平介于20至35纳克/毫升之间和(2)基线症状严重程度升高的儿童:在这项随机对照试验的二次分析中,符合条件的儿童(n = 303)被分配到为期 8 周的 VDS + SU 组、索利非那新 (SOL) + SU 组或单用 SU 组。主要结果是排尿次数;次要结果包括尿急、夜尿、生活质量(QoL)、小儿下尿路症状评分和患者满意度:在303名参与者中,197人(65%)的维生素D水平介于20至35纳克/毫升之间,119人(39%)的基线症状严重程度较高。在这两个亚组中,VDS + SU 与 SOL + SU 和单独使用 SU 相比,排尿频率的改善幅度更大。在维生素 D 亚组(20-35 纳克/毫升)中,VDS + SU 与 SOL + SU 相比,排尿次数/天的中位数差异为 2.0(95% CI,1.0 至 3.0;P = 0.003),与单独使用 SU 相比,差异为 3.2(P 结论:在维生素 D 亚组中,VDS + SU 与 SOL + SU 相比,排尿次数/天的中位数差异为 2.0(95% CI,1.0 至 3.0;P = 0.003):与 SOL + SU 或单用 SU 相比,大剂量 VDS + SU 对维生素 D 水平在 20 至 35 纳克/毫升之间且症状较严重的干性 OAB 患儿有显著的治疗效果。
{"title":"Efficacy of high-dose vitamin D supplementation vs. solifenacin or standard urotherapy for overactive bladder dry in children: a secondary analysis of a randomized clinical trial.","authors":"Hongsong Chen, Zhicheng Zhang, Qiang Zhang, Chong Wang, Zhenmin Liu, Zihan Ye, Xiao Wang, Yanxi Wang, Xing Liu, Guanghui Wei","doi":"10.1007/s00345-024-05296-4","DOIUrl":"https://doi.org/10.1007/s00345-024-05296-4","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the efficacy of high-dose vitamin D supplementation (VDS) plus standard urotherapy (SU) in managing pediatric overactive bladder dry (OAB-dry), specifically in children with (1) vitamin D levels between 20 and 35 ng/mL and (2) heightened baseline symptom severity.</p><p><strong>Methods: </strong>In this secondary analysis of a randomized controlled trial, eligible children (n = 303) were assigned to 8 weeks of VDS + SU group, solifenacin (SOL) + SU group, or SU alone group. The primary outcome was voiding frequency; secondary outcomes included urgency, nocturia, quality of life (QoL), pediatric lower urinary tract symptoms scores, and patient satisfaction.</p><p><strong>Results: </strong>Among 303 participants, 197 (65%) had vitamin D levels between 20 and 35 ng/mL, and 119 (39%) exhibited heightened baseline symptom severity. In both subgroups, VDS + SU resulted in significantly greater improvements in voiding frequency compared to SOL + SU and SU alone. In the vitamin D subgroup (20-35 ng/mL), the median difference in voids/day between VDS + SU and SOL + SU was 2.0 (95% CI, 1.0 to 3.0; P = 0.003) and 3.2 compared to SU alone (P < 0.001). In the heightened symptom subgroup, the median difference was 3.0 (95% CI, 2.0 to 4.0; P < 0.001) vs. SOL + SU and 5.0 (95% CI, 4.0 to 6.0; P < 0.001) vs. SU alone. The VDS + SU group generally outperformed the other groups in various secondary outcome measures.</p><p><strong>Conclusion: </strong>High-dose VDS plus SU has significant therapeutic benefit in children with OAB-dry in those with vitamin D levels between 20 and 35 ng/mL and with more severe symptoms, compared to SOL + SU or SU alone.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476212","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
Optimizing risk stratification for intermediate-risk prostate cancer - the prognostic value of baseline health-related quality of life. 优化中危前列腺癌的风险分层--基线健康相关生活质量的预后价值。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-20 DOI: 10.1007/s00345-024-05298-2
Thilo Westhofen, Alexander Buchner, Simon Lennartz, Severin Rodler, Lennert Eismann, Can Aydogdu, Darjusch Askari-Motlagh, Elena Berg, Enya Feyerabend, Philipp Kazmierczak, Friedrich Jokisch, Armin Becker, Christian G Stief, Alexander Kretschmer

Objective: To investigate the prognostic value of baseline health-related quality of life (HRQOL) for patients with intermediate-risk localized prostate cancer (IR-PCa) undergoing radical prostatectomy (RP).

Methods: 4780 patients with IR-PCa according to NCCN risk stratification were identified from a prospectively maintained database. All patients were treated with RP and had prospectively assessed baseline HRQOL. Main outcomes were oncologic endpoints metastasis-free survival (MFS); biochemical recurrence free survival (BRFS) and overall survival (OS). Multivariable Cox regression models assessed prognostic significance of baseline global health status (GHS) on survival outcomes. Harrell's discrimination C-index was applied to calculate the predictive accuracy of the model. Decision curve analysis (DCA) tested the clinical net benefit associated with adding the GHS domain to our multivariable model (p < 0.05).

Results: Median follow-up was 51 months. Multivariable analysis confirmed baseline GHS as an independent predictor for increased MFS (HR 0.976, 95%CI 0.96-0.99; p < 0.001), increased BRFS (HR 0.993, 95%CI 0.99-1.00; p = 0.027) and increased OS (HR 0.969, 95%CI 0.95-0.99; p = 0.002), indicating a relative risk reduction of 2.4% for MFS, 0.7% for BRFS and 3.1% for OS per 1-point increase of baseline GHS. Baseline HRQOL improved discrimination in predicting MFS, BRFS and OS. DCA revealed a net benefit over all threshold probabilities.

Conclusions: We found baseline HRQOL to substantially improve risk stratification for the heterogeneous cohort of IR-PCa. Baseline HRQOL accurately predicts increased MFS, BRFS and OS. Our findings therefore support the role of preoperative HRQOL as an adjunct to established prognosticators for IR-PCa, potentially facilitating guidance of therapy.

目的研究接受根治性前列腺切除术(RP)的中危局部前列腺癌(IR-PCa)患者基线健康相关生活质量(HRQOL)的预后价值。所有患者均接受了前列腺癌根治术治疗,并对基线 HRQOL 进行了前瞻性评估。主要结果为肿瘤学终点无转移生存期(MFS)、无生化复发生存期(BRFS)和总生存期(OS)。多变量考克斯回归模型评估了基线全球健康状况(GHS)对生存结果的预后意义。哈雷尔分辨 C 指数用于计算模型的预测准确性。决策曲线分析(DCA)检验了在我们的多变量模型中加入全球健康状况域所带来的临床净效益(P 结果:中位随访时间为 51 个月。多变量分析证实基线 GHS 是 MFS 增加的独立预测因素(HR 0.976,95%CI 0.96-0.99;P 结论:我们发现基线 HRQOL 与 MFS 的增加密切相关:我们发现基线 HRQOL 能显著改善 IR-PCa 异质性队列的风险分层。基线 HRQOL 可准确预测 MFS、BRFS 和 OS 的增加。因此,我们的研究结果支持将术前 HRQOL 作为 IR-PCa 既定预后指标的辅助指标,这可能有助于指导治疗。
{"title":"Optimizing risk stratification for intermediate-risk prostate cancer - the prognostic value of baseline health-related quality of life.","authors":"Thilo Westhofen, Alexander Buchner, Simon Lennartz, Severin Rodler, Lennert Eismann, Can Aydogdu, Darjusch Askari-Motlagh, Elena Berg, Enya Feyerabend, Philipp Kazmierczak, Friedrich Jokisch, Armin Becker, Christian G Stief, Alexander Kretschmer","doi":"10.1007/s00345-024-05298-2","DOIUrl":"10.1007/s00345-024-05298-2","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prognostic value of baseline health-related quality of life (HRQOL) for patients with intermediate-risk localized prostate cancer (IR-PCa) undergoing radical prostatectomy (RP).</p><p><strong>Methods: </strong>4780 patients with IR-PCa according to NCCN risk stratification were identified from a prospectively maintained database. All patients were treated with RP and had prospectively assessed baseline HRQOL. Main outcomes were oncologic endpoints metastasis-free survival (MFS); biochemical recurrence free survival (BRFS) and overall survival (OS). Multivariable Cox regression models assessed prognostic significance of baseline global health status (GHS) on survival outcomes. Harrell's discrimination C-index was applied to calculate the predictive accuracy of the model. Decision curve analysis (DCA) tested the clinical net benefit associated with adding the GHS domain to our multivariable model (p < 0.05).</p><p><strong>Results: </strong>Median follow-up was 51 months. Multivariable analysis confirmed baseline GHS as an independent predictor for increased MFS (HR 0.976, 95%CI 0.96-0.99; p < 0.001), increased BRFS (HR 0.993, 95%CI 0.99-1.00; p = 0.027) and increased OS (HR 0.969, 95%CI 0.95-0.99; p = 0.002), indicating a relative risk reduction of 2.4% for MFS, 0.7% for BRFS and 3.1% for OS per 1-point increase of baseline GHS. Baseline HRQOL improved discrimination in predicting MFS, BRFS and OS. DCA revealed a net benefit over all threshold probabilities.</p><p><strong>Conclusions: </strong>We found baseline HRQOL to substantially improve risk stratification for the heterogeneous cohort of IR-PCa. Baseline HRQOL accurately predicts increased MFS, BRFS and OS. Our findings therefore support the role of preoperative HRQOL as an adjunct to established prognosticators for IR-PCa, potentially facilitating guidance of therapy.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476215","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
Enzalutamide versus abiraterone acetate in the development of new-onset or worsening type 2 diabetes mellitus in patients with metastatic castration-resistant prostate cancer: EVADE study. 恩杂鲁胺与醋酸阿比特龙治疗转移性耐受性前列腺癌患者新发或恶化的2型糖尿病:EVADE研究。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-18 DOI: 10.1007/s00345-024-05280-y
Amit Bahl, Hanna Sodatonou, Robert Snjider, Andrew Chilelli, Alessandra Pranzo, Karla Martins, Axel Merseburger, Nigel Rozario, Danielle Crawley

Purpose: To determine new-onset or worsening T2DM risk in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone acetate (AA) vs. enzalutamide (ENZA) in England.

Methods: Records of patients on AA and/or ENZA (2015-2021) were analysed retrospectively from UK- or England-wide databases and data sets. The primary endpoint was new-onset or worsening T2DM, analysed using a Cox model.

Results: Of 1382 patients, 84 (6.1%) met the primary endpoint; 42 of 826 patients (5.1%) received ENZA and 42 of 556 patients (7.6%) received AA. Among patients without baseline T2DM (n = 1049), 50 developed new-onset T2DM: 24 (3.9%) on ENZA and 26 (5.9%) on AA. Among patients with baseline T2DM (n = 333), 34 (10.2%) had worsening T2DM: 18 (8.3%) on ENZA and 16 (13.8%) on AA. Patients on ENZA had longer median follow-up (445 vs. 408 days) and treatment duration (164 vs. 139 days) than those on AA, who were also more likely to have new-onset or worsening T2DM than those on ENZA (HR: 1.8; 95% CI: 1.4-2.7; P = 0.0101). The number needed to harm for an additional patient to experience new-onset or worsening T2DM when receiving AA instead of ENZA was 40 overall, 50 in patients without baseline T2DM, and 18 in patients with baseline T2DM.

Conclusion: Patients with mCRPC receiving AA were more likely to experience new-onset or worsening T2DM than those on ENZA, despite having a shorter treatment duration. Further research is required to substantiate these findings in earlier disease settings with longer treatment duration.

目的:确定英格兰接受醋酸阿比特龙(AA)与恩扎鲁胺(ENZA)治疗的转移性抗性前列腺癌(mCRPC)患者新发或恶化T2DM的风险:从英国或英格兰范围内的数据库和数据集中回顾性分析了接受 AA 和/或 ENZA 治疗的患者记录(2015-2021 年)。主要终点是新发或恶化的 T2DM,采用 Cox 模型进行分析:在1382名患者中,84人(6.1%)达到了主要终点;826名患者中有42人(5.1%)接受了ENZA治疗,556名患者中有42人(7.6%)接受了AA治疗。在没有基线 T2DM 的患者(n = 1049)中,有 50 例新发 T2DM:24 例(3.9%)接受 ENZA 治疗,26 例(5.9%)接受 AA 治疗。在基线 T2DM 患者(n = 333)中,34 人(10.2%)的 T2DM 病情恶化:18 人(8.3%)服用 ENZA,16 人(13.8%)服用 AA。ENZA患者的中位随访时间(445天 vs. 408天)和治疗时间(164天 vs. 139天)均长于AA患者,而AA患者比ENZA患者更有可能出现新发或恶化的T2DM(HR:1.8;95% CI:1.4-2.7;P = 0.0101)。接受AA治疗而非ENZA治疗的患者中,发生T2DM新发或恶化的新增伤害所需人数总体为40人,无基线T2DM的患者为50人,有基线T2DM的患者为18人:结论:与接受ENZA治疗的患者相比,接受AA治疗的mCRPC患者更有可能出现新发或恶化的T2DM,尽管治疗时间更短。需要进一步研究,以便在治疗时间较长的早期疾病中证实这些发现。
{"title":"Enzalutamide versus abiraterone acetate in the development of new-onset or worsening type 2 diabetes mellitus in patients with metastatic castration-resistant prostate cancer: EVADE study.","authors":"Amit Bahl, Hanna Sodatonou, Robert Snjider, Andrew Chilelli, Alessandra Pranzo, Karla Martins, Axel Merseburger, Nigel Rozario, Danielle Crawley","doi":"10.1007/s00345-024-05280-y","DOIUrl":"https://doi.org/10.1007/s00345-024-05280-y","url":null,"abstract":"<p><strong>Purpose: </strong>To determine new-onset or worsening T2DM risk in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone acetate (AA) vs. enzalutamide (ENZA) in England.</p><p><strong>Methods: </strong>Records of patients on AA and/or ENZA (2015-2021) were analysed retrospectively from UK- or England-wide databases and data sets. The primary endpoint was new-onset or worsening T2DM, analysed using a Cox model.</p><p><strong>Results: </strong>Of 1382 patients, 84 (6.1%) met the primary endpoint; 42 of 826 patients (5.1%) received ENZA and 42 of 556 patients (7.6%) received AA. Among patients without baseline T2DM (n = 1049), 50 developed new-onset T2DM: 24 (3.9%) on ENZA and 26 (5.9%) on AA. Among patients with baseline T2DM (n = 333), 34 (10.2%) had worsening T2DM: 18 (8.3%) on ENZA and 16 (13.8%) on AA. Patients on ENZA had longer median follow-up (445 vs. 408 days) and treatment duration (164 vs. 139 days) than those on AA, who were also more likely to have new-onset or worsening T2DM than those on ENZA (HR: 1.8; 95% CI: 1.4-2.7; P = 0.0101). The number needed to harm for an additional patient to experience new-onset or worsening T2DM when receiving AA instead of ENZA was 40 overall, 50 in patients without baseline T2DM, and 18 in patients with baseline T2DM.</p><p><strong>Conclusion: </strong>Patients with mCRPC receiving AA were more likely to experience new-onset or worsening T2DM than those on ENZA, despite having a shorter treatment duration. Further research is required to substantiate these findings in earlier disease settings with longer treatment duration.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476213","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
Impact of tumor dissecting technique on trifecta achievement in patients requiring extended warm ischemia during robot-assisted partial nephrectomy. 在机器人辅助肾部分切除术中,肿瘤剥离技术对需要延长热缺血时间的患者实现三连胜的影响。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-18 DOI: 10.1007/s00345-024-05299-1
Yudai Ishiyama, Tsunenori Kondo, Kazuhiko Yoshida, Junpei Iizuka, Toshio Takagi

Purpose: To clarify specific factors associated with surgical outcomes in robot-assisted partial nephrectomy (RAPN) that require extended warm ischemia time (WIT), which may have a negative impact, but cannot always be avoided.

Methods: We included 1,182 patients who had RAPN performed between January 2016 and December 2022 from a prospectively generated multi-institutional RAPN database, divided into normal WIT (nWIT) (≤ 20 min; 843 patients) and extended WIT (eWIT) (> 20 min; 339 patients) groups. Primary outcome measures were WIT and the Surface-Intermediate-Base (SIB) margin score, which contribute to postoperative trifecta achievement. Results were compared between the two groups using logistic regression.

Results: Patients in the eWIT group had larger tumors, higher RENAL nephrometry scores, and lower SIB scores than those of the nWIT group. The trifecta achievement rate was significantly different between the two groups (nWIT: 70.1 vs. 49.0%, p < 0.001). In the nWIT group, WIT (coefficient: -0.105 [standard error 0.020], p < 0.001) and SIB score (coefficient: -0.107 [0.053], p = 0.045) were significant predictors of trifecta achievement. In the eWIT group, the SIB score (coefficient - 0.216 [0.082], p = 0.008) was significantly associated with trifecta attainment, whereas WIT only showed a trend toward significance. Limitations included a lack of long-term survival, renal function, and chronic complications data.

Conclusions: For patients with eWIT during RAPN, the tumor dissection technique may be more important than WIT in predicting postoperative outcomes. Further prospective studies are required to confirm our results.

目的:明确与机器人辅助肾部分切除术(RAPN)手术结果相关的特定因素,这些因素需要延长温热缺血时间(WIT),WIT可能会产生负面影响,但并非总能避免:我们从前瞻性生成的多机构 RAPN 数据库中纳入了 1,182 名在 2016 年 1 月至 2022 年 12 月期间接受 RAPN 手术的患者,分为正常 WIT (nWIT) 组(≤ 20 分钟;843 名患者)和延长 WIT (eWIT) 组(> 20 分钟;339 名患者)。主要结果指标是WIT和表面-中间-基底(SIB)边缘评分,这两项指标有助于术后三连胜的实现。采用逻辑回归对两组结果进行比较:结果:与nWIT组相比,eWIT组患者的肿瘤更大、RENAL肾测量评分更高、SIB评分更低。两组患者的三联征达标率有显著差异(nWIT:70.1% 对 49.0%,P 结论:eWIT 组患者的三联征达标率高于 nWIT 组:对于 RAPN 期 eWIT 患者,肿瘤解剖技术在预测术后预后方面可能比 WIT 更重要。需要进一步的前瞻性研究来证实我们的结果。
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引用次数: 0
The efficacy and safety of three different single-use ureteroscopes in retrograde intrarenal surgery: a comparative analysis of a single surgeon's experience in a single center. 三种不同的一次性输尿管镜在逆行肾内手术中的有效性和安全性:对一个中心的一名外科医生经验的比较分析。
IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-18 DOI: 10.1007/s00345-024-05283-9
Mehmet Fatih Şahin, Erdem Can Topkaç, Serkan Şeramet, Çağrı Doğan, Cenk Murat Yazıcı

Purpose: To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS).

Materials and methods: RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022 A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared.

Results: The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient's demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively).

Conclusion: In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences.

目的:评估和比较逆行肾内手术(RIRS)中使用的不同一次性柔性输尿管镜(su-fURS)的临床效果:回顾性分析了 2022 年至 2023 年期间由一名经验丰富的外科医生在一个中心实施的相同 RIRS 病例。这些手术使用了三种su-fURS(Redpine RP-U-C12、Hugemed HU30和Pusen Uscope 3022 A)。研究比较了患者的年龄、性别、体重指数、Charlson 合并症指数以及他们的临床细节,如结石大小、体积、密度、位置、肾积水或双 J 支架或 SWL 病史。此外,还比较了手术时间、无结石率(SFR)、围手术期和术后并发症以及住院时间:研究共纳入 208 例患者。Pusen有63例,Hugemed有62例,Redpine有83例。两组患者的人口统计学和临床特征与结石相关变量的比较结果相似。各组的 SFR 相似(p = 0.056)。三组患者的围手术期、术后和总并发症发生率以及第二次介入治疗的需求均无显著差异(p = 0.324、0.088、0.061 和 0.052):结论:在第一项比较使用不同su-fURS的病例临床结果的研究中,尽管这些设备的技术特点不同,但在手术结果和并发症方面没有观察到差异。泌尿科医生应根据临床要求、经济限制和个人经验选择 su-fURS。
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引用次数: 0
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World Journal of Urology
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