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Do High-Power Lasers Reduce Operative Time for Ureterorenoscopy? A Comparison of Holmium Lasers in An Australian Tertiary Centre 高功率激光能缩短输尿管镜手术时间吗?澳大利亚高等教育中心钬激光器的比较
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2021.2021.0104
R. Mondschein, Caitlin Ying Ming Louey, A. Ng, P. McCahy
There is some laboratory-based evidence that high-powered laser systems destroy stones more effectively than low-power laser systems. However, whether this translates clinically is unknown, as direct clinical comparisons are absent from the literature. This study provides a direct comparison of the two laser systems. Abstract Objective: Holmium lasers are an effective endoscopic treatment for renal stones. Although laboratory studies have demonstrated reduced destruction times for high-power lasers, clinical evidence is lacking. Operative times for ureterorenoscopy (URS) were investigated by comparing high- and low power lasers in a general hospital setting. Materials and Methods: An audited review was conducted of 354 patients who underwent URS over a two-year period at two hospital sites using high- or low power laser. Operative time, stone characteristics, disposable equipment, s use of dusting, complications and stone-free rates were recorded. Linear regression was used to model the relationship between laser type and theater time. Univariate analysis was performed to determine other factors associated with increased operative time. Results: Mean operative time was 61.9 minutes. No significant difference between sites [0.40, p=0.88, confidence interval (CI) -4.9-5.8] was found, including following the exclusion of large stones (>20 mm). Stone size categories analyzed separately showed reduced operative times for larger stones when using high-power laser. Basket use (8.4, p=0.002, CI 3.06-13.65) and increasing stone size (6.9, p<0.005, CI 3.4-10.4) were associated with increased operative time. Complications and stone-free rates did not vary between sites. Conclusion: High-power laser was not associated with reduced total operative time in this cohort, although there was a trend toward this for larger renal calculi. Further delineation by surgeon expertise would be useful to determine whether high power laser is generally advantageous in the clinical setting. In training hospitals, any differences may be obscured by other factors.
有一些基于实验室的证据表明,高功率激光系统比低功率激光系统更有效地破坏石头。然而,由于文献中没有直接的临床比较,这是否在临床上转化是未知的。本研究提供了两种激光系统的直接比较。摘要目的:钬激光是一种有效的内镜治疗肾结石的方法。虽然实验室研究已经证明高功率激光可以缩短破坏时间,但缺乏临床证据。通过比较在一般医院设置的高功率和低功率激光输尿管镜(URS)的手术时间。材料和方法:对354例在两家医院使用高功率或低功率激光接受URS治疗的患者进行了为期两年的审计审查。记录手术时间、结石特征、一次性器械的使用、并发症及结石清除率。采用线性回归方法对激光类型与作战时间之间的关系进行建模。进行单因素分析以确定与手术时间增加相关的其他因素。结果:平均手术时间61.9分钟。包括排除大结石(> ~ 20mm)后,各部位间无显著差异[0.40,p=0.88,置信区间(CI) -4.9 ~ 5.8]。单独分析的石头大小类别表明,使用高功率激光时,较大的石头减少了手术时间。使用手术篮(8.4,p=0.002, CI 3.06-13.65)和增大结石大小(6.9,p<0.005, CI 3.4-10.4)与延长手术时间相关。不同部位的并发症和无结石率没有差异。结论:在这个队列中,高功率激光与总手术时间的减少无关,尽管对于较大的肾结石有这种趋势。外科医生专业知识的进一步描述将有助于确定高功率激光在临床环境中是否普遍有利。在培训医院,任何差异都可能被其他因素所掩盖。
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引用次数: 0
The Effect of COVID-19 Phobia on the Time of Admission to the Hospital in Patients with Ureteral Stones COVID-19恐惧症对输尿管结石患者入院时间的影响
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2022.2021.0135
M. Değer, N. Akdoğan, M. Demirkol, Sümeyye Seday, Sevinç Püren Yüce, V. Izol, I. Aridogan
Objective: To investigate the effect of coronavirus disease-2019 (COVID-19) phobia in patients with ureteral stones. Materials and Methods: Between August 2020 and March 2021, patients over the age of 18 who were diagnosed with ureteral stones were included in this study. The COVID-19 Phobia scale (C19P-S) was used to measure the COVID-19 phobia levels of the patients. Demographic and patients' characteristics were recorded. The time between the onset of the patient's complaint and the time of admission to the hospital was recorded and grouped as group 1 (≤7 days), group 2 (7-21 days), group 3 (>21 days). Results: A total of 77 patients with a mean age of 45.8±14.8 years were eligible for analysis. Among these, 55 (71.4%) were male. According to the time between the onset of the patient's complaint and the time of admission to the hospital, there were 39 (50.6%) patients in group 1 (≤7 days), 17 (22.1%) patients in group 2 (7-21 days) and 21 (27.3%) patients group 3 (>21 days). The median C19P-S scores in these groups were 32.0 (15.0- 46.0), 37.0 (26.0-62.0) and 56.0 (37.0-80.0), respectively. There were significant differences in terms of C19P-S between groups of the time between the onset of the patient's complaint and the time of admission to the hospital (p≤0.001). Conclusion: COVID-19 phobia caused a delay in the hospital admission of patients with ureter stones. When patients have complaints, it is necessary to raise the awareness of society about applying to the hospital and to increase awareness of this issue.
目的:探讨新冠肺炎恐惧症对输尿管结石患者的影响。材料和方法:在2020年8月至2021年3月期间,本研究纳入了18岁以上被诊断为输尿管结石的患者。采用新冠肺炎恐惧症量表(C19P-S)测定患者的新冠肺炎恐惧症水平。记录人口统计学和患者特征。记录患者主诉发作与入院时间之间的时间,并将其分为第1组(≤7天)、第2组(7-21天)和第3组(>21天)。结果:共有77名患者符合分析条件,平均年龄为45.8±14.8岁。其中男性55例(71.4%)。从患者出现主诉到入院时间,第1组(≤7天)有39名患者(50.6%),第2组(7-21天)有17名患者(22.1%),第3组(>21天)21名患者(27.3%)。这些组的C19P-S得分中位数分别为32.0(15.0-46.0)、37.0(26.0-62.0)和56.0(37.0-80.0)。两组患者的C19P-S在发病时间与入院时间之间存在显著差异(p≤0.001)。结论:新冠肺炎恐惧症导致输尿管结石患者延迟入院。当患者有投诉时,有必要提高社会对申请医院的认识,并提高对这一问题的认识。
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引用次数: 0
Testicular Torsion: Not Just in Young Men 睾丸扭转:不只是年轻男性
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2021.2021.0085
J. Saad, R. Shanmugasundaram, Sean Heywood, C. Varol, M. Roberts
Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. It is a clinical diagnosis with assistance from a scrotal ultrasound or confirmation via scrotal exploration. Here we present an interesting case of a 67-year-old man with TT. This case demonstrates that medical professionals should have a high degree of clinical suspicion for men of all ages with unilateral scrotal pain.
睾丸扭转(TT)是泌尿外科急症,需要及时诊断和处理。TT主要表现为严重,突然发作,单侧睾丸疼痛在21岁以下的男性。它是一种临床诊断,在阴囊超声的帮助下或通过阴囊探查证实。这里我们报告一个有趣的病例,一个67岁的男性与TT。本病例表明,医学专业人员对所有年龄的男性单侧阴囊疼痛应具有高度的临床怀疑。
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引用次数: 0
A Rational Solution for Megaureter in Infants with Solitary Kidney: Temporary Loop Cutaneous Ureterostomy 孤立肾患儿巨输尿管的合理治疗方法:临时环状皮肤输尿管切开术
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2022.2021.0087
S. Tekgül, B. Çıtamak, H. Doğan, T. Ceylan
Objective: To define and discuss the new concept which using loop cutaneous ureterostomy (LCU) in patients with obstructing megaureter and solitary kidney. Materials and Methods: Two patients with solitary kidney with obstructive pattern were included. Both patients underwent LCU within the 1 st month to reduce the obstruction and to relieve the pelvicaliceal system. Thereafter, parents were taught to dilate the ureter and irrigate the bladder with sterile saline by a disposable 6F catheter via antegrade fashion through the distal ureter. Initially, 10 cc saline was used once a day, then it was increased to 20 cc once a day after 2 months. When the bladder capacity was sufficient (50 mL capacity at the 6 th month or by cystoscopic evaluation intraoperatively), we performed undiversion with ureteroneocystostomy and Double-J-stent placement. Results: Ureterorenal dilatations were followed-up by ultrasonography and renal function tests. No bladder dysfunction and renal insufficiency were observed during follow-up. At the postoperative controls, patients’ renal function tests were compatible with their ages and they had no voiding dysfunction. Conclusion: Patients with solitary kidney and obstructing megaureter require urgent diversion. After diversion, bladder cycling is required to prevent bladder dysfunction by protecting and developing bladder capacity. Using this concept, the kidney can be protected from further damage and treatment can be finalized around 6 months of age with minimum morbidity.
目的:对输尿管环皮切开术(LCU)治疗梗阻性巨输尿管和孤立肾的新概念进行界定和探讨。材料与方法:纳入2例孤立性肾梗阻型患者。两名患者均在第1个月内接受了LCU,以减少梗阻并缓解盆腔系统。此后,父母被教导通过一次性6F导管通过输尿管远端顺行扩张输尿管并用无菌盐水冲洗膀胱。最初,每天使用一次10cc生理盐水,然后在2个月后增加到每天一次20cc。当膀胱容量足够时(第6个月时容量为50mL,或通过术中膀胱镜检查评估),我们进行了输尿管新膀胱造口术和双J形位置管的未翻复术。结果:超声检查和肾功能检查对输尿管肾扩张进行了随访。随访期间未观察到膀胱功能障碍和肾功能不全。在术后对照组中,患者的肾功能测试与他们的年龄相符,并且他们没有排尿功能障碍。结论:肾孤立性巨输尿管梗阻患者需要紧急分流。改道后,需要膀胱循环,通过保护和发展膀胱容量来预防膀胱功能障碍。利用这一概念,可以保护肾脏免受进一步损伤,并在6个月大左右以最低的发病率完成治疗。
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引用次数: 0
Emphysematous Pyelonephritis: A Twelve-year Review in A Regional Centre 肺气肿性肾盂肾炎:一个地区中心的12年回顾
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2022.2021.0008
B. Storey, S. Nalavenkata, S. Whitcher, A. Blatt
It is known that emphysematous pyelonephritis is a severe and life threatening illness that does not have a clearly defined treatment algorithm. This paper shows the experience of treating this disease over 12 years and reinforces that there remains a role for both minimally invasive therapy as well as extensive surgical intervention, but further research into this condition is Abstract Objective: To examine outcomes and prognostic features of patients admitted with emphysematous pyelonephritis (EPN) at a regional tertiary centre. Materials and Methods: Nineteen patients with EPN were identified between January 2007 and December 2019. Patients were grouped into two “mild” (grade I or II); and “severe” (grade III or IV) based on their Huang and Tseng classification. The two groups were compared using Fisher’s Exact tests to determine prognostic features associated with poor outcome, defined as extensive surgical intervention or death. Results: Thirteen patients had mild disease and six patients had severe disease. 69% of patients had ureteric obstruction, 58% were diabetic, 26% were thrombocytopaenic, and there was a female predominance (12:7). Poor outcomes were significantly more common in patients with severe disease (83%), versus mild disease (8%) (p<0.0001). Half of the patients managed with sole medical management died (two of four patients) and only two patients required escalation to extensive surgical management, both of whom survived. Overall mortality during admission was 19%; encompassing three of six patients with severe disease (50%) and one of thirteen patients with mild disease (8%). Conclusion: EPN is dangerous, requiring prompt recognition and intervention, and is of increasing importance given the aging population and increased prevalence of comorbidities associated with the disease. This study of the largest recorded cohort of patients with EPN in Australia it was found that poor outcomes were significantly more common in patients with high radiological-grade disease, and severe thrombocytopaenia.
众所周知,肺气肿性肾盂肾炎是一种严重且危及生命的疾病,没有明确的治疗算法。本文展示了12年来治疗这种疾病的经验,并强调微创治疗和广泛的手术干预仍然有作用,但对这种情况的进一步研究是抽象的目的:检查在地区三级中心收治的肺气肿性肾盂肾炎(EPN)患者的结果和预后特征。材料和方法:在2007年1月至2019年12月期间,确认了19名EPN患者。患者被分为两组“轻度”(I级或II级);和“严重”(III或IV级)。使用Fisher精确检验对两组患者进行比较,以确定与不良预后相关的预后特征,不良预后定义为广泛的手术干预或死亡。结果:13例患者病情较轻,6例患者病情严重。69%的患者患有输尿管梗阻,58%的患者患有糖尿病,26%的患者患有血小板减少症,女性占主导地位(12:7)。与轻度疾病(8%)相比,严重疾病患者(83%)的不良结局更为常见(p<0.0001)。采用单一医疗管理的患者中有一半死亡(四名患者中有两名),只有两名患者需要升级到广泛的手术管理,两人都活了下来。入院期间的总死亡率为19%;包括6名重症患者中的3名(50%)和13名轻症患者中的1名(8%)。结论:EPN是危险的,需要及时识别和干预,鉴于人口老龄化和与该疾病相关的合并症患病率增加,EPN的重要性越来越大。这项针对澳大利亚有记录以来最大的EPN患者队列的研究发现,在患有高放射学级别疾病和严重血小板减少症的患者中,不良结局明显更常见。
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引用次数: 1
Primary Renal Synovial Sarcoma 原发性肾滑膜肉瘤
IF 0.3 Pub Date : 2022-09-14 DOI: 10.4274/jus.galenos.2022.2021.0094
Wyatt MacNevin, R. Rendon, B. Colwell, Cheng Wang, K. D. Haché, J. Merrimen, R. Mason
Primary renal synovial sarcoma is a rare malignancy that may present similarly to other renal neoplasms. The diagnosis of synovial sarcoma is performed through the identification of a SYT-SSX gene fusion. Here, we present a case of a primary renal synovial sarcoma in a patient who presented with renal mass initially thought to be renal cell carcinoma until further pathological characterization. After undergoing radical open nephrectomy, the patient developed pulmonary and psoas metastases and was treated with systemic therapy.
原发性肾滑膜肉瘤是一种罕见的恶性肿瘤,其表现可能与其他肾肿瘤相似。滑膜肉瘤的诊断是通过鉴定SYT-SSX基因融合进行的。在此,我们报告了一例原发性肾滑膜肉瘤患者,其肾脏肿块最初被认为是肾细胞癌,直到进一步的病理特征。在接受根治性开放性肾切除术后,患者出现肺和腰大肌转移,并接受了全身治疗。
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引用次数: 0
Protective Effects of Capsaicin on Experimental Testicular Torsion and Detorsion Injury 辣椒素对实验性睾丸扭脱损伤的保护作用
IF 0.3 Pub Date : 2022-07-04 DOI: 10.4274/jus.galenos.2022.2022.0011
Hilal Gören, Semih Öz, D. BURUKOĞLU DÖNMEZ, M. Üstüner, İhsan Hız, H. Özden, Ş. Kabay
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引用次数: 0
Iatrogenic Renal Rupture in Conduitoscopy - A Diagnostic Trauma 导管镜检查中的医源性肾破裂——一种诊断创伤
IF 0.3 Pub Date : 2022-06-10 DOI: 10.4274/jus.galenos.2021.2021.0089
J. Kovacic, E. Latif
Cite this article as: Kovacic J, Latif E. Iatrogenic Renal Rupture in Conduitoscopy A Diagnostic Trauma. J Urol Surg, 2022;9(2):143-145. Correspondence: James Kovacic MD, Gosford Hospital Ringgold Standard Institution, Department of Urology, Gosford, Australia Phone: +61 411 359 053 E-mail: james.kovacic@health.nsw.gov.au ORCID-ID: orcid.org/0000-0002-8615-4371 Received: 22.07.2021 Accepted: 10.09.202
引用这篇文章:Kovacic J,Latif E.导管镜检查中的医源性肾破裂一种诊断性创伤。泌尿外科杂志,2022;9(2):143-145。通讯:James Kovacic医学博士,Gosford Hospital Ringgold Standard Institution,泌尿外科,Gosfford,Australia电话:+61 411 359 053电子邮件:james.kovacic@health.nsw.gov.auORCID-ID:ORCID.org/0000-0002-8615-4371收到日期:2021年7月22日接受日期:2002年9月10日
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引用次数: 1
A Large Bladder Tumor During Pregnancy: Twin Challenge 妊娠期膀胱大肿瘤:双胞胎挑战
IF 0.3 Pub Date : 2022-06-10 DOI: 10.4274/jus.galenos.2022.2021.0074
G. Singh, Sunil Chawla, P. Nandy, Meenakshi Rajput
Malignant tumors during pregnancy are a rarity with the overall incidence being approximately 2.35/10,000 (1) and the commonest are malignant melanomas (2.8/1,000), cervix (1/2,200), breast (1/3,000) and lymphomas (1/6,000) (2,3). Urological malignancies during pregnancy are extremely rare, affecting about 13 in 1,000,000 pregnancies (4). Common signs of urological malignancies especially bladder tumors such as hematuria, urgency, lower abdominal pain, may be attributed to the pregnancy. Combined with the hesitancy to undergo imaging, these overlapping symptoms may result in delayed diagnosis.
妊娠期间的恶性肿瘤非常罕见,总发病率约为2.35/10000(1),最常见的是恶性黑色素瘤(2.8/1000)、宫颈(1/2200)、乳腺(1/3000)和淋巴瘤(1/6000)(2,3)。妊娠期泌尿系统恶性肿瘤极为罕见,约有13/1000000妊娠受到影响(4)。泌尿系统恶性肿瘤的常见症状,尤其是膀胱肿瘤,如血尿、尿急、下腹疼痛,可能归因于妊娠。再加上对接受成像的犹豫,这些重叠的症状可能会导致诊断延迟。
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引用次数: 1
Correlation of Acute Flank Pain with the Number of Pregnancies and Hydronephroses; An Observational Study 急性腰痛与妊娠和肾积水次数的相关性;观察性研究
IF 0.3 Pub Date : 2022-06-10 DOI: 10.4274/jus.galenos.2022.2021.0071
A. Böyük, L. Özbek, Raşit İlhan, S. Verep, M. Ören, S. Erdem, T. Tefik
1Beylikdüzü Kolan Hospital, Clinic of Urology, İstanbul, Turkiye 2Private Atasam Hospital Samsun, Clinic of Urology, Samsun, Turkiye 3Iğdır State Hospital, Clinic of Gynecology and Obstetrics, Iğdır, Turkiye 4Özalp State Hospital, Clinic of Urology, Van, Turkiye 5İstanbul University-İstanbul Faculty of Medicine, Department of Public Health, İstanbul, Turkiye 6İstanbul University-İstanbul Faculty of Medicine, Department of Urology, İstanbul, Turkiye ORIGINAL RESEARCH Functional
1BeylikdüzüKolan医院,泌尿外科诊所,伊斯坦布尔,土耳其2私立阿塔萨姆医院,泌尿科诊所,Samsun,土耳其3Iğdır州立医院,妇产科诊所,Iğr,土耳其4Özalp州立医院,泌尿内科诊所,Van,土耳其5伊斯坦布尔大学-伊斯坦布尔医学院,公共卫生部,伊斯坦布尔,土耳其6伊斯坦布尔大学-伊斯坦布尔医学院泌尿系,伊斯坦布尔,土耳其原创研究功能
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引用次数: 0
期刊
Journal of Urological Surgery
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