Asian Journal of Urology最新文献

Proposal and clinical validation of a perioperative algorithm enhancing antimicrobial stewardship in substitution urethroplasty 在替代尿道成形术中加强抗菌管理的围手术期算法建议与临床验证

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2024.01.003

Objective

To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.

Methods

Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile vs. non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum. The ability of the algorithm to improve antibiotic stewardship was tested by three endpoints: (a) immediate (UCx 2 days postoperatively), (b) short-term (21-day infectious complications), and (c) long-term (retreatment-free survival [RFS]). Statistical analyses included bivariate comparisons. The Kaplan–Meier estimators were used to compare RFS between the groups. The multivariable Cox regression was used to evaluate the independent effect of UCx status at the time of surgery on RFS.

Results

Of 374 men, 235 (63%) had a sterile and 139 (37%) a non-sterile culture at the time of surgery. The proportion of sterile cultures at the time of surgery (63%) was significantly improved to 82% 2 days postoperatively (p<0.001). There were 16 (4.3%) patients with infectious complications with no difference between patients with sterile versus non-sterile culture (p=0.6). At median follow-up of 29 months, there was no difference in RFS (84%) between patients with sterile versus non-sterile culture (p=0.3). Positive UCx was not a predictor of recurrence after multivariable adjustment (p=0.5).

Conclusion

A standardized protocol such as the one introduced improves antibiotic stewardship through frequent testing and culture-specific treatment. This is crucial in avoiding unnecessary antimicrobial treatment, and reducing infectious events and adverse effects of a positive UCx on long-term stricture recurrence.

方法对 2009 年 1 月至 2016 年 12 月间接受球部替代尿道成形术的男性患者按手术时的尿培养（UCx）进行分层（无菌与非无菌），并采用标准化算法进行尿液分析和抗菌治疗。我们对 UCx 结果和微生物谱进行了定量和定性研究。我们通过三个终点测试了该算法改善抗生素管理的能力：(a) 即时（术后 2 天的 UCx）、(b) 短期（21 天的感染并发症）和 (c) 长期（无再治疗生存率 [RFS]）。统计分析包括双变量比较。Kaplan-Meier 估计器用于比较组间的 RFS。结果在 374 名男性中，235 人（63%）在手术时进行了无菌培养，139 人（37%）未进行无菌培养。手术时的无菌培养比例（63%）在术后 2 天明显提高到 82%（p<0.001）。有 16 例（4.3%）患者出现感染并发症，无菌培养和非无菌培养的患者之间没有差异（p=0.6）。中位随访时间为 29 个月，无菌培养与非无菌培养患者的 RFS（84%）无差异（P=0.3）。经过多变量调整后，UCx 阳性并不是复发的预测因素（P=0.5）。这对于避免不必要的抗菌治疗、减少感染事件和 UCx 阳性对狭窄长期复发的不利影响至关重要。

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引用次数: 0

Anillin actin-binding protein expression correlates with poor prognosis for prostate cancer patients Anillin肌动蛋白结合蛋白表达与前列腺癌症患者预后不良的相关性

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.07.002

Objective

Octamer transcription factor 1 (OCT1), a transcription factor that interacts with androgen receptor, is involved in prostate cancer (PCa) progression. The OCT1 target gene, Anillin actin-binding protein (ANLN), is highly expressed in castration-resistant PCa tissue; however, it remains unclear whether ANLN expression in hormone-sensitive PCa tissue could be used as a predictive biomarker for poor prognosis of patients. We aimed to investigate ANLN expression in PCa tissue obtained via radical prostatectomy and its correlation with clinical parameters.

Methods

Immunohistochemical staining for ANLN was performed on 86 PCa specimens, followed by evaluation using immunoreactivity (IR) scores. Prognosis was analyzed by the log-rank test using the Kaplan–Meier method to generate a cancer-specific survival curve. The correlations between ANLN IR and clinical parameters as well as OCT1 IR were analyzed using the Chi-squared test.

Results

The median IR score was 0 for ANLN. Accordingly, given the low median IR score, an IR score of ≥3 was defined as positive. There were 17 (19.8%) ANLN-positive cases, and these cases had a significantly poorer prognosis. Multivariate analysis revealed that the Gleason score, pathological tumor and lymph node stages, and positive ANLN expression were significant predictors of poor prognosis. Notably, patients with both positive ANLN and high OCT1 expression had a significantly decreased overall survival (p=0.001).

Conclusion

ANLN, which is a OCT1 target gene especially in castration-resistant PCa, is expressed in a small number of hormone-sensitive PCa cases. Both positive ANLN expression and high OCT1 expression are significantly correlated with poor prognosis for PCa patients.

目的八聚体转录因子 1（OCT1）是一种与雄激素受体相互作用的转录因子，它参与了前列腺癌（PCa）的进展。OCT1 的靶基因 Anillin 肌动蛋白结合蛋白（ANLN）在阉割耐药的 PCa 组织中高表达；然而，ANLN 在激素敏感的 PCa 组织中的表达是否可用作预测患者不良预后的生物标志物仍不清楚。我们的目的是研究通过根治性前列腺切除术获得的PCa组织中ANLN的表达及其与临床参数的相关性。方法对86例PCa标本进行ANLN免疫组织化学染色，然后使用免疫反应性（IR）评分进行评估。采用Kaplan-Meier法对预后进行对数秩检验分析，以生成癌症特异性生存曲线。采用Chi-squared检验分析了ANLN IR与临床参数以及OCT1 IR之间的相关性。因此，鉴于中位IR评分较低，IR评分≥3分为阳性。ANLN阳性病例有17例（19.8%），这些病例的预后明显较差。多变量分析显示，Gleason评分、肿瘤病理分期和淋巴结分期以及ANLN阳性表达是预后不良的重要预测因素。值得注意的是，ANLN阳性和OCT1高表达的患者总生存率明显下降（P=0.001）。ANLN阳性表达和OCT1高表达与PCa患者的不良预后显著相关。

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引用次数: 0

Dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture: Techniques and outcomes 背侧嵌体颊粘膜移植尿道成形术治疗女性尿道狭窄疾病：技术和结果

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2024.01.002

Objective

Female urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes.

Methods

Between January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Q_max) above 15 mL/s without the need for an additional instrumentation.

Results

The mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Q_max was 7.79 (SD 3.73) mL/s. However, the mean Q_max improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients.

Conclusion

Dorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.

目的女性尿道狭窄（FUS）约占女性膀胱出口梗阻病例的 4%-13%。过去和现在，女性尿道狭窄仍需通过反复扩张和/或直接可视内尿道切开术进行治疗。重建尿道的方法有很多，如口腔或阴道粘膜移植尿道成形术。我们的目的是描述背侧嵌体颊粘膜移植尿道成形术（BMG）治疗 FUS 的技术，并介绍其结果。方法在 2014 年 1 月至 2021 年 12 月期间，37 例接受背侧嵌体 BMG 尿道成形术的患者被纳入研究。他们的术前诊断均通过尿流率测定、膀胱尿道造影、尿道校准和台上膀胱镜检查得到确认。2 周后拔除膀胱导尿管。患者在 3 个月、6 个月、1 年后接受随访，之后每年接受尿液分析、尿流率测定和排尿后残余物评估。我们将成功定义为最大流速（Qmax）超过 15 mL/s，且无需额外器械。20 名患者曾接受过尿道扩张术。术前平均 Qmax 为 7.79（标准差 3.73）毫升/秒。然而，术后平均 Qmax 提高到了 23.20 (SD 8.25) mL/s。术后平均残余尿量为 30.50 毫升（标准差 10.70 毫升）。这比手术前的平均值 139.00（标准差 147.24）毫升有所减少。平均随访时间为 30.2 个月（标准差为 18.3 个月，范围为 18-44 个月）。术后未出现尿失禁。37 名患者中有 6 名（16.2%）在住院期间出现了克拉维恩-丁多一级并发症。结论女性背侧镶嵌式 BMG 尿道成形术是一种安全、有效的技术，可以避免反复扩张和多次尿道切开的痛苦。人们应始终考虑在 FUS 中进行重建，而不必担心尿失禁。

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引用次数: 0

Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer 前列腺特异性膜抗原-体层正电子发射断层扫描/磁共振成像和前列腺健康指数的组合与各自单独使用在前列腺癌早期诊断中的诊断价值比较

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.10.003

Objective

This study aimed to figure out whether the combination of the prostate health index (PHI) and prostate-specific membrane antigen (PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer (PCa) than that of each individual method used alone.

Methods

In this prospective, observational study, 41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled. Both the PHI test and ¹⁸F-PSMA-1007-PET/MR were performed prior to biopsies. The diagnostic accuracy of different models was compared by logistic regression, areas under the curve (AUCs) of the receiver operating characteristic, and net reclassification index (NRI).

Results

Among the 41 patients, 14 (34.1%) were pathologically diagnosed with PCa. The PHI in the PCa group was significantly higher than that in the benign group (44.4 vs. 35.0, p=0.048). Similarly, all the patients in the PCa group received positive results of ¹⁸F-PSMA-1007-PET/MR, of which the positive rate was significantly higher than that in benign group (100% vs. 62.96%, p=0.025). The ¹⁸F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI (AUC: 0.802 vs. 0.692, p=0.025). However, there was no significant difference between the combination model and the ¹⁸F-PSMA-1007-PET/MR alone (AUC 0.802 vs. 0.685, p=0.071). The optimal PHI cutoff of the combination model is 32, with which the model could significantly reduce unnecessary biopsies (NRI: 22.22%, 95% confidence interval: 6.54%–37.90%, p=0.005). However, among patients with the PHI of ≥43.5, there was no significant difference between the combination model and the PHI alone (NRI: 11.11%, 95% confidence interval: −0.74%–22.97%, p=0.066).

Conclusion

The combination of the PHI and ¹⁸F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa, especially in avoiding unnecessary biopsies. However, for patients with the PHI of ≥43.5, the addition of ¹⁸F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.

目的本研究旨在探讨前列腺健康指数（PHI）和前列腺特异性膜抗原（PSMA）-PET/MR联合使用是否能比单独使用每种方法提高前列腺癌（PCa）的诊断准确性。方法在这项前瞻性观察研究中，共纳入了41名在2019年6月至2022年9月期间接受系统性前列腺活检的患者。活检前进行 PHI 检测和 18F-PSMA-1007-PET/MR 检测。通过逻辑回归、接收者操作特征曲线下面积（AUC）和净再分类指数（NRI）比较了不同模型的诊断准确性。PCa 组的 PHI 明显高于良性组（44.4 对 35.0，P=0.048）。同样，PCa 组所有患者的 18F-PSMA-1007-PET/MR 结果均为阳性，其中阳性率明显高于良性组（100% 对 62.96%，P=0.025）。18F-PSMA-1007-PET/MR为PHI提供了额外的诊断价值（AUC：0.802 vs. 0.692，p=0.025）。然而，组合模型与单独使用 18F-PSMA-1007-PET/MR 没有明显差异（AUC 0.802 vs. 0.685，p=0.071）。联合模型的最佳 PHI 临界值为 32，该模型可显著减少不必要的活检（NRI：22.22%，95% 置信区间：6.54%-37.90%，P=0.005）。结论 PHI 和 18F-PSMA-1007-PET/MR 的组合在预测 PCa 方面优于单用 PHI，尤其是在避免不必要的活检方面。然而，对于 PHI≥43.5 的患者，在 PHI 的基础上增加 18F-PSMA-1007-PET/MR 并不能带来额外的益处。

{"title":"Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer","authors":"","doi":"10.1016/j.ajur.2023.10.003","DOIUrl":"10.1016/j.ajur.2023.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to figure out whether the combination of the prostate health index (PHI) and prostate-specific membrane antigen (PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer (PCa) than that of each individual method used alone.</div></div><div><h3>Methods</h3><div>In this prospective, observational study, 41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled. Both the PHI test and <sup>18</sup>F-PSMA-1007-PET/MR were performed prior to biopsies. The diagnostic accuracy of different models was compared by logistic regression, areas under the curve (AUCs) of the receiver operating characteristic, and net reclassification index (NRI).</div></div><div><h3>Results</h3><div>Among the 41 patients, 14 (34.1%) were pathologically diagnosed with PCa. The PHI in the PCa group was significantly higher than that in the benign group (44.4 <em>vs.</em> 35.0, <em>p</em>=0.048). Similarly, all the patients in the PCa group received positive results of <sup>18</sup>F-PSMA-1007-PET/MR, of which the positive rate was significantly higher than that in benign group (100% <em>vs.</em> 62.96%, <em>p</em>=0.025). The <sup>18</sup>F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI (AUC: 0.802 <em>vs.</em> 0.692, <em>p</em>=0.025). However, there was no significant difference between the combination model and the <sup>18</sup>F-PSMA-1007-PET/MR alone (AUC 0.802 <em>vs.</em> 0.685, <em>p</em>=0.071). The optimal PHI cutoff of the combination model is 32, with which the model could significantly reduce unnecessary biopsies (NRI: 22.22%, 95% confidence interval: 6.54%–37.90%, <em>p</em>=0.005). However, among patients with the PHI of ≥43.5, there was no significant difference between the combination model and the PHI alone (NRI: 11.11%, 95% confidence interval: −0.74%–22.97%, <em>p</em>=0.066).</div></div><div><h3>Conclusion</h3><div>The combination of the PHI and <sup>18</sup>F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa, especially in avoiding unnecessary biopsies. However, for patients with the PHI of ≥43.5, the addition of <sup>18</sup>F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 4","pages":"Pages 555-562"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140463481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system: A retrospective study based on a tertiary hospital database in China 使用新型综合能量系统手术剪对腹腔镜前列腺癌根治术患者的疗效和经济效益：基于中国一家三级医院数据库的回顾性研究

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.08.010

Objective

This study aimed to demonstrate a new surgical shear with an integrated energy system (Harmonic ACE®+7) value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears (CUSs) in a real-world setting.

Methods

This was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE®+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital (the headquarters and Luwan Center in China). Demographic and diagnosis information, intraoperative and postoperative clinical outcomes, and total and categorical costs were collected. Propensity score matching was performed to form the study population for each clinical group. Data were compared between the two groups using t-test and Chi-squared test.

Results

The ACE®+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs (12.8 vs. 19.8, p<0.001), a moderate but not significant difference in mean postoperative drainage duration (6.6 [standard deviation, SD 2.2] days vs. 7.9 [SD 4.1] days, p=0.082), a reduction on mean total drainage volume (275.5 [SD 374.3 mL vs. 492.9 [SD 1495.0] mL, p=0.321), and a lower mean rate of postoperative hemostatic drug usage (16.0% vs. 52.0%, p<0.001). There was no significant difference in total costs between the ACE®+7 and CUS groups.

Conclusion

This study provides real-world data demonstrating that the ACE®+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems. Using the ACE®+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.

方法这是一项回顾性研究，研究对象是2019年8月至2021年4月期间在上海瑞金医院（中国总部和卢湾中心）接受腹腔镜前列腺癌根治术并使用ACE®+7剪或CUS的成人前列腺癌患者。收集了人口统计学和诊断信息、术中和术后临床结果、总费用和分类费用。对每个临床组的研究人群进行倾向评分匹配。结果 ACE®+7 与 CUSs 相比，每次手术使用的止血夹平均数量较少（12.8 对 19.8，p<0.001），术后平均引流时间差异不大（6.6 [标准差，SD 2.2] 天 vs. 7.9 [SD 4.1] 天，p=0.082），平均总引流容量减少（275.5 [SD 374.3 mL vs. 492.9 [SD 1495.0] mL，p=0.321），术后止血药平均使用率降低（16.0% vs. 52.0%，p<0.001）。结论本研究提供的实际数据表明，与 CUS 相比，带有集成能源系统的 ACE®+7 剪切术可改善临床疗效，并为医院和医疗系统节约成本。在腹腔镜根治性前列腺切除术中使用 ACE®+7 可以让医生帮助患者获得更好的治疗效果，而无需花费额外的金钱。

{"title":"Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system: A retrospective study based on a tertiary hospital database in China","authors":"","doi":"10.1016/j.ajur.2023.08.010","DOIUrl":"10.1016/j.ajur.2023.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to demonstrate a new surgical shear with an integrated energy system (Harmonic ACE®+7) value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears (CUSs) in a real-world setting.</div></div><div><h3>Methods</h3><div>This was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE®+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital (the headquarters and Luwan Center in China). Demographic and diagnosis information, intraoperative and postoperative clinical outcomes, and total and categorical costs were collected. Propensity score matching was performed to form the study population for each clinical group. Data were compared between the two groups using <em>t</em>-test and Chi-squared test.</div></div><div><h3>Results</h3><div>The ACE®+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs (12.8 <em>vs.</em> 19.8, <em>p</em><0.001), a moderate but not significant difference in mean postoperative drainage duration (6.6 [standard deviation, SD 2.2] days <em>vs.</em> 7.9 [SD 4.1] days, <em>p</em>=0.082), a reduction on mean total drainage volume (275.5 [SD 374.3 mL <em>vs.</em> 492.9 [SD 1495.0] mL, <em>p</em>=0.321), and a lower mean rate of postoperative hemostatic drug usage (16.0% <em>vs.</em> 52.0%, <em>p</em><0.001). There was no significant difference in total costs between the ACE®+7 and CUS groups.</div></div><div><h3>Conclusion</h3><div>This study provides real-world data demonstrating that the ACE®+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems. Using the ACE®+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 4","pages":"Pages 563-568"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Genitourinary toxicity after pelvic radiation: Prospective review of complex urological presentations 盆腔放射后泌尿生殖系统毒性:复杂泌尿学表现的前瞻性回顾

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.01.006

Objective

Recent randomised controlled trials underestimated the incidence of genitourinary (GU) complications occurring more than 5 years following pelvic radiotherapy. This study aimed to determine the burden of treatment at a single institution from late GU complications after pelvic radiotherapy.

Methods

A prospective study of all presentations for GU complications following pelvic radiotherapy at a tertiary urology department between November 2018 and November 2019 was performed. Subgroup analyses was performed on patients with prostate cancer (PCa) with late toxicity to compare patient demographics, radiotherapy, complications, and management factors.

Results

There were 117 hospital encounters involving 46 patients with a 56.4% repeat encounter rate. Patients with PCa were the predominant group (n=39, 84.8%). External beam radiotherapy was the most common treatment modality (n=41, 89.1%). The median time from radiotherapy to encounter was 8 (range 0–23) years. Radiation-induced haemorrhagic cystitis was the most common presentation (n=70, 59.8%). Forty-four (42.7%) encounters for GU toxicity were managed operatively and 33 (32.0%) involved a non-operative procedure. Nine patients required packed red cell transfusion, with a total of 154 units transfused. Patients with PCa who presented with late GU toxicity had higher median Radiotherapy Oncology Group grades (p=0.020), proportion of emergency admissions (p=0.047), and frequency of clot urinary retention (p<0.001).

Conclusion

There is a high burden of elective and emergency urology workload attributed to late pelvic radiation toxicity. Late GU toxicity occurring ≥5 years after radiotherapy is common and often more severe.

目的近期的随机对照试验低估了盆腔放疗后5年以上泌尿生殖系统（GU）并发症的发生率。本研究旨在确定盆腔放疗后晚期泌尿生殖系统并发症给单一机构带来的治疗负担。方法对2018年11月至2019年11月期间在一家三级泌尿科医院接受盆腔放疗后出现泌尿生殖系统并发症的所有病例进行了前瞻性研究。对有晚期毒性的前列腺癌（PCa）患者进行亚组分析，以比较患者的人口统计学、放疗、并发症和管理因素。结果共有117次住院治疗，涉及46名患者，重复就诊率为56.4%。PCa 患者是主要群体（39 人，占 84.8%）。体外放射治疗是最常见的治疗方式（41人，占89.1%）。从接受放疗到再次就诊的中位时间为 8 年（0-23 年不等）。放疗引起的出血性膀胱炎是最常见的表现（70人，59.8%）。44例（42.7%）泌尿系统毒性患者接受了手术治疗，33例（32.0%）接受了非手术治疗。九名患者需要输注红细胞，共输注了 154 个单位。出现晚期GU毒性的PCa患者的放疗肿瘤组分级中位数（p=0.020）、急诊入院比例（p=0.047）和血块性尿潴留频率（p<0.001）均较高。放疗后≥5 年发生的晚期泌尿系统毒性很常见，而且往往更为严重。

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引用次数: 0

An update on the use of stem cell therapy for erectile dysfunction 干细胞疗法治疗勃起功能障碍的最新进展

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.07.005

Objective

This systematic review aimed to analyze animal and human trial data to better understand the efficacy of stem cell therapy (SCT) for erectile dysfunction (ED) and the obstacles that may hinder its application in this field.

Methods

We searched electronic databases, including PubMed and Scopus, for published studies with the Medical Subject Heading terms of “erectile dysfunction” (AND) “stem cell therapy” (OR) “erectile dysfunction” (AND) “clinical trial of stem cell therapy” (OR) “stem cell therapy” (AND) “sexual dysfunction”. The search was limited to English-language journals and full papers only. The initial search resulted in 450 articles, of which 90 relevant to our aims were included in the analysis.

Results

ED is a multifactorial disease. Current treatment options rely on pharmacotherapy as well as surgical options. Patients may have side effects or unsatisfactory results following the use of these treatment options. SCT may restore pathophysiological changes leading to ED rather than treating the symptoms. It has been evaluated in animal models and shown promising results in humans. Results confirm that SCT does improve erectile function in animals with different types of SC use. In humans, evidence showed promising results, but the trials were heterogeneous and limited mainly by a lack of randomization and the small sample size. Many challenges could limit future research in this field, including ethical dilemmas, regulation, patient recruitment, the cost of therapy, and the lack of a standardized SCT regimen. Repairing and possibly replacing diseased cells, tissue, or organs and eventually retrieving normal function should always be the goals of any therapy, and this can only be guaranteed by SCT.

Conclusion

SCT is a potential and successful treatment for ED, particularly in patients who are resistant to the classic therapy. SCT may promote nerve regeneration and vascular cell regeneration, not only symptomatic treatment.

目的本系统综述旨在分析动物和人体试验数据，以更好地了解干细胞疗法（SCT）对勃起功能障碍（ED）的疗效，以及可能阻碍其在该领域应用的障碍。方法我们在电子数据库（包括PubMed和Scopus）中搜索了以 "勃起功能障碍"（或）"干细胞疗法"（或）"勃起功能障碍"（或）"干细胞疗法临床试验"（或）"干细胞疗法"（或）"性功能障碍 "为医学主题词的已发表研究。搜索仅限于英文期刊和论文全文。初步搜索结果为450篇文章，其中90篇与我们的目标相关，被纳入分析。目前的治疗方案主要依靠药物治疗和手术治疗。使用这些治疗方案后，患者可能会出现副作用或效果不理想。SCT可以恢复导致ED的病理生理变化，而不是治疗症状。该疗法已在动物模型中进行了评估，并在人体中显示出良好的效果。结果证实，在使用不同类型 SC 的动物身上，SCT 确实能改善勃起功能。在人体中，也有证据显示了良好的效果，但这些试验各不相同，而且主要受限于缺乏随机化和样本量较小。许多挑战可能会限制这一领域未来的研究，包括伦理困境、监管、患者招募、治疗成本以及缺乏标准化的 SCT 方案。修复并可能替代病变的细胞、组织或器官，最终恢复正常功能应始终是任何疗法的目标，而只有 SCT 才能保证这一点。SCT 可促进神经再生和血管细胞再生，而不仅仅是对症治疗。

{"title":"An update on the use of stem cell therapy for erectile dysfunction","authors":"","doi":"10.1016/j.ajur.2023.07.005","DOIUrl":"10.1016/j.ajur.2023.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aimed to analyze animal and human trial data to better understand the efficacy of stem cell therapy (SCT) for erectile dysfunction (ED) and the obstacles that may hinder its application in this field.</div></div><div><h3>Methods</h3><div>We searched electronic databases, including PubMed and Scopus, for published studies with the Medical Subject Heading terms of “erectile dysfunction” (AND) “stem cell therapy” (OR) “erectile dysfunction” (AND) “clinical trial of stem cell therapy” (OR) “stem cell therapy” (AND) “sexual dysfunction”. The search was limited to English-language journals and full papers only. The initial search resulted in 450 articles, of which 90 relevant to our aims were included in the analysis.</div></div><div><h3>Results</h3><div>ED is a multifactorial disease. Current treatment options rely on pharmacotherapy as well as surgical options. Patients may have side effects or unsatisfactory results following the use of these treatment options. SCT may restore pathophysiological changes leading to ED rather than treating the symptoms. It has been evaluated in animal models and shown promising results in humans. Results confirm that SCT does improve erectile function in animals with different types of SC use. In humans, evidence showed promising results, but the trials were heterogeneous and limited mainly by a lack of randomization and the small sample size. Many challenges could limit future research in this field, including ethical dilemmas, regulation, patient recruitment, the cost of therapy, and the lack of a standardized SCT regimen. Repairing and possibly replacing diseased cells, tissue, or organs and eventually retrieving normal function should always be the goals of any therapy, and this can only be guaranteed by SCT.</div></div><div><h3>Conclusion</h3><div>SCT is a potential and successful treatment for ED, particularly in patients who are resistant to the classic therapy. SCT may promote nerve regeneration and vascular cell regeneration, not only symptomatic treatment.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 4","pages":"Pages 530-544"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Prediction of recurrence risk in patients with non-muscle-invasive bladder cancer 预测非肌层浸润性膀胱癌患者的复发风险

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2023.04.007

Objective

Non-muscle-invasive bladder cancer (NMIBC) remains a common challenge in uro-oncology with conflicting reports on recurrence risk. This study aimed to elucidate the recurrence rate of NMIBC in the Cancer Clinic of Shahid Beheshti Hospital in Iran and to investigate related parameters affecting recurrence risk.

Methods

The data of 143 patients with NMIBC, who underwent treatment between January 2017 and January 2020 and were followed up from the initial transurethral resection of bladder tumor until November 30, 2020 in our institution, were retrospectively assessed. The Cox regression analysis and Kaplan–Meier plot of recurrence-free survival were used to determine independent contributing factors for tumor recurrence.

Results

Among patients with NMIBC, 83.9% were male, and 16.1% were female, with a mean age of 64.4 (standard deviation [SD] 12.9) years. During the follow-up, 71 (49.7%) patients showed tumor recurrence, with a mean recurrence time of 11.5 (SD 6.9) months. In the Chi-square test or Fisher's exact test, the age (≥65 years) (p=0.037), obesity (body mass index ≥30 kg/m²) (p=0.004), no diabetes mellitus (p=0.005), smoking (current or former smoker) (p=0.001), immediate perfusion therapy (p=0.035), number of tumors (>3) (p<0.001), and tumor stage (Ta, T1, and Tis) (p=0.001) had independent significant effects on the recurrence of NMIBC. The multivariate Cox regression analysis indicated that preoperative obesity (hazards ratio [HR] 7.90; 95% confidential interval [CI] 4.01–15.55; p<0.001), current or former smoking (HR 1.85; 95% CI 1.07–3.20; p=0.027), and a high-grade tumor (HR 4.03; 95% CI 1.59–10.25; p=0.003) were significant predictors of tumor recurrence. The Kaplan–Meier plot of recurrence-free survival showed that obesity (log-rank p<0.001), current or former smoking (log-rank p=0.001), and a high-grade tumor (log-rank p=0.006) were associated with a shorter time interval until the first tumor recurrence.

Conclusion

The study found a high recurrence rate of NMIBC in Iran from January 2017 to January 2020, with the obesity, smoking history, and the high-grade tumor as contributing factors.

目的非肌层浸润性膀胱癌（NMIBC）仍然是泌尿肿瘤学中的一个常见难题，有关其复发风险的报道相互矛盾。本研究旨在阐明伊朗沙希德-贝赫什提医院癌症诊所的非肌层浸润性膀胱癌复发率，并调查影响复发风险的相关参数。方法回顾性评估了我院在 2017 年 1 月至 2020 年 1 月期间接受治疗的 143 例非肌层浸润性膀胱癌患者的数据，这些患者从最初的经尿道膀胱肿瘤切除术开始随访，直至 2020 年 11 月 30 日。结果在NMIBC患者中，83.9%为男性，16.1%为女性，平均年龄为64.4（标准差[SD]12.9）岁。随访期间，71 例（49.7%）患者肿瘤复发，平均复发时间为 11.5 个月（标准差 6.9 个月）。在卡方检验或费雪精确检验中，年龄（≥65 岁）（P=0.037）、肥胖（体重指数≥30 kg/m2）（P=0.004）、无糖尿病（P=0.005）、吸烟（目前或曾经吸烟）（P=0.001）、立即灌注治疗（p=0.035）、肿瘤数目（>3）（p<0.001）和肿瘤分期（Ta、T1和Tis）（p=0.001）对NMIBC的复发有独立的显著影响。多变量 Cox 回归分析表明，术前肥胖（危险比 [HR] 7.90；95% 置信区间 [CI]4.01-15.55；p<0.001）、目前或曾经吸烟（HR 1.85；95% CI 1.07-3.20；p=0.027）和高级别肿瘤（HR 4.03；95% CI 1.59-10.25；p=0.003）是肿瘤复发的重要预测因素。无复发生存期的卡普兰-梅耶尔图显示，肥胖（对数秩p<0.001）、目前或曾经吸烟（对数秩p=0.001）和高级别肿瘤（对数秩p=0.006）与肿瘤首次复发前的时间间隔较短有关。结论该研究发现，从2017年1月至2020年1月，伊朗的NMIBC复发率较高，肥胖、吸烟史和高级别肿瘤是诱因。

{"title":"Prediction of recurrence risk in patients with non-muscle-invasive bladder cancer","authors":"","doi":"10.1016/j.ajur.2023.04.007","DOIUrl":"10.1016/j.ajur.2023.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>Non-muscle-invasive bladder cancer (NMIBC) remains a common challenge in uro-oncology with conflicting reports on recurrence risk. This study aimed to elucidate the recurrence rate of NMIBC in the Cancer Clinic of Shahid Beheshti Hospital in Iran and to investigate related parameters affecting recurrence risk.</div></div><div><h3>Methods</h3><div>The data of 143 patients with NMIBC, who underwent treatment between January 2017 and January 2020 and were followed up from the initial transurethral resection of bladder tumor until November 30, 2020 in our institution, were retrospectively assessed. The Cox regression analysis and Kaplan–Meier plot of recurrence-free survival were used to determine independent contributing factors for tumor recurrence.</div></div><div><h3>Results</h3><div>Among patients with NMIBC, 83.9% were male, and 16.1% were female, with a mean age of 64.4 (standard deviation [SD] 12.9) years. During the follow-up, 71 (49.7%) patients showed tumor recurrence, with a mean recurrence time of 11.5 (SD 6.9) months. In the Chi-square test or Fisher's exact test, the age (≥65 years) (<em>p</em>=0.037), obesity (body mass index ≥30 kg/m<sup>2</sup>) (<em>p</em>=0.004), no diabetes mellitus (<em>p</em>=0.005), smoking (current or former smoker) (<em>p</em>=0.001), immediate perfusion therapy (<em>p</em>=0.035), number of tumors (>3) (<em>p</em><0.001), and tumor stage (Ta, T1, and Tis) (<em>p</em>=0.001) had independent significant effects on the recurrence of NMIBC. The multivariate Cox regression analysis indicated that preoperative obesity (hazards ratio [HR] 7.90; 95% confidential interval [CI] 4.01–15.55; <em>p</em><0.001), current or former smoking (HR 1.85; 95% CI 1.07–3.20; <em>p</em>=0.027), and a high-grade tumor (HR 4.03; 95% CI 1.59–10.25; <em>p</em>=0.003) were significant predictors of tumor recurrence. The Kaplan–Meier plot of recurrence-free survival showed that obesity (log-rank <em>p</em><0.001), current or former smoking (log-rank <em>p</em>=0.001), and a high-grade tumor (log-rank <em>p</em>=0.006) were associated with a shorter time interval until the first tumor recurrence.</div></div><div><h3>Conclusion</h3><div>The study found a high recurrence rate of NMIBC in Iran from January 2017 to January 2020, with the obesity, smoking history, and the high-grade tumor as contributing factors.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 4","pages":"Pages 625-632"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Correlation analysis between urinary crystals and upper urinary calculi 尿结晶与上尿路结石的相关性分析

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2024.04.003

Objective

This study aimed to analyze the correlation between urinary crystals and urinary calculi.

Methods

Clinical data, including urinary crystal types, were collected from 237 patients with urinary calculi. The detection rate of urine crystals and their correlation with stone composition were analyzed. The receiver operating characteristic curve analysis was used to determine the best cut-off value for predicting stone formation risk based on calcium oxalate crystals in urine.

Results

Calcium oxalate was the most common component in 237 patients. Among them, 201 (84.81%) patients had stones containing calcium oxalate. In these patients, calcium oxalate crystals were detected in 45.77% (92/201) of cases. In different groups of calcium oxalate stones, calcium oxalate crystals accounted for more than 90% of the total number of crystals detected in each group. The detection rate of calcium oxalate crystals was higher in first-time stone formers than in recurrent patients. The receiver operating characteristic curve analysis suggested a cut-off value of 110 crystals/μL for predicting stone formation, validated with 65 patients and 100 normal people.

Conclusion

Calcium oxalate crystals in urine can predict the composition of calcium oxalate stones and indicate a higher risk of stone formation when the number exceeds 110 crystals/μL. This non-invasive method may guide clinical treatment and prevention strategies.

方法收集 237 名尿路结石患者的临床数据，包括尿路结石类型。分析了尿液结晶的检出率及其与结石成分的相关性。根据尿液中的草酸钙结晶，采用接收者操作特征曲线分析法确定预测结石形成风险的最佳临界值。其中，201 名患者（84.81%）的结石中含有草酸钙。在这些患者中，45.77%（92/201）的病例检测出草酸钙结晶。在不同组别的草酸钙结石中，草酸钙结晶占每组检出结晶总数的 90%以上。首次结石患者的草酸钙结晶检出率高于复发患者。结论尿液中的草酸钙结晶可预测草酸钙结石的成分，当结晶数量超过 110 个/μL 时，结石形成的风险较高。这种无创方法可为临床治疗和预防策略提供指导。

{"title":"Correlation analysis between urinary crystals and upper urinary calculi","authors":"","doi":"10.1016/j.ajur.2024.04.003","DOIUrl":"10.1016/j.ajur.2024.04.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to analyze the correlation between urinary crystals and urinary calculi.</div></div><div><h3>Methods</h3><div>Clinical data, including urinary crystal types, were collected from 237 patients with urinary calculi. The detection rate of urine crystals and their correlation with stone composition were analyzed. The receiver operating characteristic curve analysis was used to determine the best cut-off value for predicting stone formation risk based on calcium oxalate crystals in urine.</div></div><div><h3>Results</h3><div>Calcium oxalate was the most common component in 237 patients. Among them, 201 (84.81%) patients had stones containing calcium oxalate. In these patients, calcium oxalate crystals were detected in 45.77% (92/201) of cases. In different groups of calcium oxalate stones, calcium oxalate crystals accounted for more than 90% of the total number of crystals detected in each group. The detection rate of calcium oxalate crystals was higher in first-time stone formers than in recurrent patients. The receiver operating characteristic curve analysis suggested a cut-off value of 110 crystals/μL for predicting stone formation, validated with 65 patients and 100 normal people.</div></div><div><h3>Conclusion</h3><div>Calcium oxalate crystals in urine can predict the composition of calcium oxalate stones and indicate a higher risk of stone formation when the number exceeds 110 crystals/μL. This non-invasive method may guide clinical treatment and prevention strategies.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 4","pages":"Pages 596-603"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 and safety of platelet-rich plasma intracavernous injection for patients with erectile dysfunction: A systematic review, meta-analysis, and meta-regression 富血小板血浆鞘膜内注射治疗勃起功能障碍患者的有效性和安全性：系统回顾、荟萃分析和荟萃回归

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology

Pub Date : 2024-10-01 DOI: 10.1016/j.ajur.2024.01.001

Objective

Intracavernous injection might be offered to patients with erectile dysfunction (ED) who did not respond to the first-line oral treatment. Platelet-rich plasma (PRP) might offer improvement in erectile function since it contains numerous growth factors. This study aimed to evaluate the efficacy and safety of PRP intracavernous injection for patients with ED.

Methods

We conducted relevant literature searches on Cochrane Library, Medline, Scopus, and ClinicalTrials.gov databases using specific keywords. The results of continuous variables were pooled into the mean difference (MD) and dichotomous variables into the odds ratio along with 95% confidence interval (95% CI).

Results

A total of six studies were included. Our pooled analysis revealed that PRP intracavernous injection was associated with a significant increase in the erectile function domain of the International Index of Erectile Function at 1 month (MD 3.47 [95% CI 2.62–4.32], p<0.00001, I²=7%), 3 months (MD 3.19 [95% CI 2.25–4.12], p<0.00001, I²=0%), and 6 months (MD 3.21 [95% CI 2.30–4.13], p<0.00001, I²=0%) after the intervention when compared with baseline values. PRP was also superior to a placebo in terms of improvement in erectile function domain of the International Index of Erectile Function score at 1 month (MD 2.83, p<0.00001), 3 months (MD 2.87, p<0.00001), and 6 months (MD 3.20, p<0.00001) post-intervention. The adverse events from PRP injection were only mild without any serious adverse events.

Conclusion

PRP intracavernous injection may offer benefits in improving erectile function in patients with ED with a relatively good safety profile.

目的对于口服一线治疗无效的勃起功能障碍（ED）患者，可进行阴茎海绵体内注射。富血小板血浆（PRP）含有多种生长因子，可改善勃起功能。本研究旨在评估PRP海绵体内注射治疗ED患者的有效性和安全性。方法我们使用特定关键词在Cochrane Library、Medline、Scopus和ClinicalTrials.gov数据库中进行了相关文献检索。结果共纳入六项研究。我们的汇总分析表明，PRP鞘膜内注射与一个月后国际勃起功能指数（International Index of Erectile Function）中勃起功能域的显著增加有关（MD 3.47 [95% CI 2.62-4.32]，p<0.00001，I2=7%）、3个月（MD 3.19 [95% CI 2.25-4.12]，p<0.00001，I2=0%）和6个月（MD 3.21 [95% CI 2.30-4.13]，p<0.00001，I2=0%）后与基线值相比均有明显提高。在干预后 1 个月（MD 2.83，p<0.00001）、3 个月（MD 2.87，p<0.00001）和 6 个月（MD 3.20，p<0.00001）的国际勃起功能指数评分中，PRP 在勃起功能改善方面也优于安慰剂。结论 PRP 海绵体内注射可改善 ED 患者的勃起功能，且安全性相对较好。

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引用次数: 0