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Robot-assisted, laparoscopic and open radical cystectomy for bladder cancer: A systematic review and network meta-analysis. 机器人辅助、腹腔镜和开放式膀胱癌根治术:系统综述和网络荟萃分析。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0191
Zhanpo Yang, Xinmeng Dou, Wenhui Zhou, Qian Liu

Objectives: To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer.

Methods: A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes.

Results: Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group.

Conclusion: LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

目的评估机器人辅助膀胱根治术(RARC)、腹腔镜膀胱根治术(LRC)和开放式膀胱根治术(ORC)治疗膀胱癌的安全性和有效性:利用截至 2024 年 2 月 29 日的国际数据库进行网络荟萃分析文献检索。研究结果包括基线特征、围手术期结果和肿瘤学结果:结果:最终筛选出 40 篇文章纳入网络荟萃分析。与 ORC 相比,LRC 和 RARC 的手术时间更长、估计失血量更少、输血率更低、规律饮食时间更短、并发症发生率更低、手术切缘阳性率更低。LRC 比 ORC 的排便时间更短,而 RARC 和 ORC 之间则无差异。考虑到淋巴结产量,LRC、RARC 和 ORC 之间没有差异。此外,输血率(OR=-0.15,95% CI=-0.47-0.17)、总并发症率(OR=-0.39,95% CI=-0.79-0.00)、轻微并发症率(OR=-0.23,95% CI=-0.48至0.02)、主要并发症发生率(OR=-0.23,95% CI=-0.68至0.21)、手术切缘阳性率(OR=0.22,95% CI=-0.27至0.68):结论:LRC 和 RARC 可被视为膀胱癌手术切除术的可行且安全的替代方案。值得注意的是,与 LRC 相比,RARC 可显著降低输血率,减少并发症,降低手术切缘阳性率。这些数据表明,RARC 可以改善对肌肉浸润性或高风险非肌肉浸润性膀胱癌患者的治疗。
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引用次数: 0
The atlas of supine single port extraperitoneal access. 仰卧单孔腹膜外入路图集。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0400
Luca Lambertini, Matteo Pacini, Luca Morgantini, Jhon Smith, Juan Ramon Torres-Anguiano, Simone Crivellaro

Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1-3). Nevertheless, a comprehensive description of different supine access options is still lacking (4-6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes.

Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space.

Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%.

Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning.

简介:单孔(SP)平台的问世为泌尿外科领域开辟了新的手术选择,可在腹膜外和患者仰卧位进行大型泌尿外科机器人辅助手术(1-3)。然而,目前仍缺乏对不同仰卧入路选择的全面描述(4-6)。有鉴于此,我们提供了腹腔镜腹膜外仰卧位入路选择的分步指南,并探讨了初步的手术效果:经膀胱入路是在耻骨上方 3 厘米处横向切口,在腹部前片切口后,用柔性膀胱镜对膀胱充气,并在膀胱穹隆水平切开逼尿肌。同样,腹膜外入路也是在耻骨上方切开一个 4 厘米的切口,在看到腹膜前间隙后,轻轻展开腹膜前脂肪。在麦克伯尼点处切开一个 3 厘米的切口,进行低位前方入路,然后展开腹部肌肉。结果:结果:总共为 623 名患者实施了 16 种不同的仰卧腹膜外入路手术。没有发生术中转换。经膀胱入路、腹膜外入路和低位前入路的中位入路时间分别为 16 分钟(IQR 12-21)、11 分钟(IQR 7-14)和 14 分钟(IQR 10-18)。值得注意的是,81.5% 的患者当天出院,术后无阿片类药物使用率为 73%:该图集提供了一个全面的分步指南,可帮助患者在腹膜外和仰卧位成功实施所有主要的泌尿外科 SP 手术。
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引用次数: 0
First impressions of Telesurgery robotic-assisted radical prostatectomy using the Edge medical robotic platform. 使用Edge医疗机器人平台的远程手术机器人辅助前列腺癌根治术初体验。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0458
Marcio Covas Moschovas, Travis Rogers, Wanhai Xu, Roshane Perera, Xu Zhang, Vipul Patel

Purpose: We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network.

Material and methods: We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer.

Results: We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days).

Conclusion: As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.

目的:作为前列腺癌转诊中心,我们报告了使用机器人手术和 5G 网络进行远程手术的观点和经验:我们描述并说明了远程手术的应用和结果,治疗了一名前列腺癌患者,患者距离外科医生(北京-哈尔滨)1300 公里。我们于 2023 年 11 月使用 Edge 医疗机器人(MP1000)对一名 71 岁的患者进行了治疗,该患者的 13 个癌核中有 8 个格雷森 6(ISUP 1),PSA 为 14 ng/dL,临床分期为 cT2a。核磁共振成像显示,患者左侧外周区底部有一个 PIRADS 5 结节,前列腺大小为 20gr。我们详细介绍了各中心之间的联系、围手术期的结果以及我们作为前列腺癌转诊中心的观点:结果:各中心之间的网络连接没有出现任何延误或问题。手术在60分钟内完成,术中和术后均无并发症。估计失血量为 100 毫升。麻醉恢复后,患者很快就能下地行走。最终病理结果显示,患者的左侧基底和左侧精囊受累,Gleason 6(ISUP 1),手术切缘阴性,无淋巴结受累(pT3bN0)。患者在拔除导管后不久(7 天)就能继续行走:随着技术的进步,引入了新型机器人平台和高速网络,远程手术的概念成为了切实可行的现实,而 5G 技术则解决了延迟和传输问题。然而,在取得这些进步的同时,伦理考虑和监管框架也应强调该领域负责任创新的透明度和患者安全的重要性。
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引用次数: 0
Single Port Robotic Nephrectomy via lower anterior retroperitoneal approach: feasible, safe and effective option in surgically complex patients. 经腹膜后下前方入路的单孔机器人肾切除术:手术复杂患者的可行、安全和有效选择。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0420
Angelo Orsini, Francesco Lasorsa, Gabriele Bignante, Jamie Yoon, Kyle Anna Dymanus, Edward E Cherullo, Riccardo Autorino

Purpose: Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases.

Materials and methods: We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m², had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m², had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video.

Results: Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues.

Conclusion: Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach.

目的:对于不适合进行肾部分切除术(1)的较大肾肿瘤,通常首选微创根治性肾切除术。最近的研究强调了影响手术效果的重要因素,包括预测因素(2)、节段动脉松解技术(3)和机器人技术比较(4)。这段视频显示,通过前下途径进行的SP机器人辅助根治性肾切除术(RARN)对具有挑战性的病例很有价值:我们采用腹膜后下前路为两名复杂患者实施了 SP-RARN 手术。第一例患者是一名 54 岁的女性,体重指数(BMI)为 36.8 kg/m²,有腹股沟疝和肠梗阻病史,右肾中段有一个 9 厘米的肿块。第二名患者是一名 58 岁的男性,体重指数为 31.19 kg/m²,患有 ESRD,腹膜透析 8 年,右上极有一个 3.4x3.7 厘米的肿块,怀疑是 RCC。手术技巧详见视频:两次手术都很成功,手术时间分别为173分钟和203分钟,失血量为150毫升。无并发症发生。患者分别在 31 小时和 38 小时后出院。组织病理学证实为 RCC。在三个月的随访中,没有报告并发症或再入院情况。第二名患者继续进行腹膜透析,未出现任何问题:结论:经腹膜后SP-RARN前下入路可避开腹腔,因此适合某些患者。对这些患者而言,这种手术比其他手术更可行、更安全,而且比标准多孔腹腔镜手术的发病率更低。
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引用次数: 0
Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials. 使用或不使用输尿管入路鞘的逆行肾内手术:随机对照试验的系统性回顾和荟萃分析。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0452
Lucas Guimarães Campos Roriz de Amorim, Marcelo Esteves Chaves Campos, Lígia Sant'Ana Dumont, José Augusto Rojas Peñafiel, Eliabe Silva de Abreu, Giovanni Scala Marchini, Manoj Monga, Eduardo Mazzucchi

Introduction: The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management.

Purpose: To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications.

Materials and methods: We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively.

Results: Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40).

Conclusion: UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

简介输尿管入路鞘(UAS)是一种医疗设备,可在逆行肾内手术(RIRS)中反复进入输尿管和集尿系统。它对无结石率、输尿管损伤、手术时间和术后并发症的影响仍存在争议。目的:比较使用或不使用输尿管通道鞘(UAS)进行逆行肾内手术(RIRS)取石的结果;评估无石率(SFR)、输尿管损伤、手术时间和术后并发症:我们在 2024 年 6 月对 PubMed、Embase 和 Cochrane 图书馆进行了系统检索,以寻找评估在 RIRS 中使用 UAS 治疗尿路结石的有效性和安全性的随机对照试验 (RCT)。研究纳入了 2014 年至 2024 年间发表的文章。分别计算了二元和连续结果的汇总风险比(RRs)和平均差(MDs):结果:共纳入了 5 项 RCT,包括 466 项手术。其中 246 例(52.7%)使用了 UAS。随访时间从 1 周到 1 个月不等。UAS 降低了术后发热(RR 0.49;95% 置信区间 [CI] 0.29-0.84;P=0.009)和术后感染(RR 0.50;95% CI 0.30-0.83;P=0.008)的发生率。在SFR(RR 1.05;95% CI 0.99-1.11;P=0.10)、输尿管损伤(RR 1.29;95% CI 0.95-1.75;P=0.11)、手术时间(MD 3.56分钟;95% CI -4.15至11.27分钟;P=0.36)或住院时间(MD 0.32天;95% CI -0.42至1.07天;P=0.40)方面,组间无明显差异:UAS可降低术后发热和感染率。结论:UAS 可降低术后发热和感染率,但 UAS 并未明显降低或增加 RIRS 期间尿石症患者的 SFR 或输尿管损伤率。应考虑使用 UAS 来降低感染并发症的风险,尤其是那些可能出现此类并发症的高危人群。
{"title":"Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lucas Guimarães Campos Roriz de Amorim, Marcelo Esteves Chaves Campos, Lígia Sant'Ana Dumont, José Augusto Rojas Peñafiel, Eliabe Silva de Abreu, Giovanni Scala Marchini, Manoj Monga, Eduardo Mazzucchi","doi":"10.1590/S1677-5538.IBJU.2024.0452","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0452","url":null,"abstract":"<p><strong>Introduction: </strong>The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management.</p><p><strong>Purpose: </strong>To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications.</p><p><strong>Materials and methods: </strong>We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively.</p><p><strong>Results: </strong>Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40).</p><p><strong>Conclusion: </strong>UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"670-682"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037518","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
Robotic versus open radical Prostatectomy: comparing automobiles and carriages in 2024. 机器人与开放式根治性前列腺切除术:2024 年汽车与马车的比较。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0470
Tomás Bernardo Costa Moretti, Leonardo Oliveira Reis
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引用次数: 0
Totally Intracorporeal Robot-Assisted Bilateral Ileal Ureter Replacement for the Treat-ment of Ureteral Strictures using Kangduo Surgical Robot 2000 Plus. 使用康道手术机器人2000 Plus进行体外机器人辅助双侧回肠输尿管置换术治疗输尿管狭窄。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.1590/S1677-5538.IBJU.2024.0360
Shubo Fan, Silu Chen, Xinfei Li, Zhihua Li, Kunlin Yang, Han Hao, Liqun Zhou, Xuesong Li

Purpose: Ureteroplasty using buccal or lingual mucosa graft Is feasible for complex proximal ureteral stricture (1, 2). Ileal ureter replacement is considered as the last resort for ureteral reconstruction. Totally intracorporeal robot-assisted ileal ureter replacement can be performed safely and effectively (3). In China, the KangDuo Surgical Robot 2000 Plus (KD-SR-2000 Plus) has been developed featuring two surgeon consoles and five robotic arms. This study aims to share our experience with totally intracorporeal robot-assisted bilateral ileal ureter replacement using KD-SR-2000 Plus.

Materials and methods: A 59-year-old female patient underwent a complete intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. The surgical procedure involved dissecting the proximal ends of the bilateral ureteral strictures, harvesting the ileal ureter, restoring intestinal continuity, and performing an anastomosis between the ileum and the ureteral end as well as the bladder. The data were prospectively collected and analyzed.

Results: The surgery was successfully completed with single docking without open conversion. The length of the harvested ileal ureter was 25 cm. The docking time, operation time and console time were 3.4 min., 271 min and 231 min respectively. The estimated blood loss was 50 mL. The postoperative hospitalization was 6 days. No perioperative complications occurred.

Conclusions: It is technically feasible to perform totally intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. A longer follow-up and a larger sample size are required to evaluate its safety and effectiveness.

目的:使用颊粘膜或舌粘膜移植物进行输尿管成形术对于复杂的输尿管近端狭窄是可行的(1, 2)。回肠输尿管置换被认为是输尿管重建的最后手段。完全体腔内机器人辅助回肠输尿管置换术可以安全有效地进行(3)。在中国,康多手术机器人 2000 Plus(KD-SR-2000 Plus)已经研制成功,它具有两个外科医生控制台和五个机械臂。本研究旨在分享我们使用 KD-SR-2000 Plus 进行完全体腔内机器人辅助双侧回输尿管置换术的经验:一名 59 岁的女性患者接受了完全体外机器人辅助双侧回肠输尿管置换术,使用 KD-SR-2000 Plus 治疗输尿管狭窄。手术过程包括剖开双侧输尿管狭窄的近端,获取回肠输尿管,恢复肠道连续性,并在回肠和输尿管端以及膀胱之间进行吻合。对数据进行了前瞻性收集和分析:结果:手术成功地完成了一次对接,没有进行开放式转换。收获的回肠输尿管长度为 25 厘米。对接时间、手术时间和控制台时间分别为 3.4 分钟、271 分钟和 231 分钟。估计失血量为 50 毫升。术后住院 6 天。无围手术期并发症发生:结论:使用KD-SR-2000 Plus进行完全体腔内机器人辅助双侧回肠输尿管置换术治疗输尿管狭窄在技术上是可行的。需要更长时间的随访和更大的样本量来评估其安全性和有效性。
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引用次数: 0
Role of Gubernaculum testis inervation during the process of testicular migration in human fetuses. 在人类胎儿的睾丸迁移过程中,Gubernaculum睾丸神经的作用。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1590/S1677-5538.IBJU.2024.9914
Luciano A Favorito, Laura M M Favorito, Ana R M Morais, Francisco J B Sampaio

Purpose: The gubernaculum seems to be the most important anatomical structure in the testicular migration process. The objective of this paper is to review current literature regarding the role of gubernaculum testis nerves in testicular migration. We conducted a comprehensive literature review about the gubernaculum testis innervation. A PubMed database search was performed in April 2024, focusing on gubernaculum testis and cryptorchidism and genitofemoral nerve (GFN) and calcitonin gene-related peptide (CGRP) gene. The gubernaculum has its own nerve supply, the GFN, descending on the anteromedial surface of the psoas muscle from L1-L2 segments. The second phase of testicular descent is regulated by androgens and CGRP, released from the sensory nucleus of the GFN. The GFN doesn't directly play a role in testicular migration but there is a theory that shows a regulatory function of this nerve in hormonal action during this process. The gubernaculum testis has important structural alterations during the testicular migration and the genitofemoral nerve and CGRP gene are of great importance in this process. The genitofemoral nerve provides motor innervation to the cremaster muscle and gubernaculum, which helps regulate the position of the testes within the scrotum.

目的:睾丸鞘膜似乎是睾丸移位过程中最重要的解剖结构。本文旨在综述有关网膜睾丸神经在睾丸移行中作用的现有文献。我们对脐带睾丸神经支配进行了全面的文献综述。我们于 2024 年 4 月在 PubMed 数据库中进行了检索,重点是咽鼓膜睾丸和隐睾、股生殖神经(GFN)和降钙素基因相关肽(CGRP)基因。睾丸鞘膜有自己的神经供应,即 GFN,从 L1-L2 节段下降到腰肌的前内侧表面。睾丸下降的第二阶段受雄激素和 CGRP 的调节,CGRP 由 GFN 的感觉核释放。GFN 并不直接参与睾丸的迁移,但有一种理论认为,在这一过程中,该神经对激素的作用具有调节功能。在睾丸迁移过程中,睾丸鞘膜发生了重要的结构变化,而股生殖神经和 CGRP 基因在这一过程中具有重要作用。股生殖神经为绉肌和睾丸鞘膜提供运动神经支配,有助于调节睾丸在阴囊内的位置。
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引用次数: 0
Transperineal versus Transrectal MRI/TRUS fusion-guided prostate biopsy in a large, ethnically diverse, and multiracial cohort. 经会阴与经直肠 MRI/TRUS 融合引导的前列腺活检在一个大型、种族多元化和多种族队列中的应用。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1590/S1677-5538.IBJU.2024.0354
Lorenzo Storino Ramacciotti, David Strauss, Francesco Cei, Masatomo Kaneko, Daniel Mokhtar, Jie Cai, Delara Jadvar, Giovanni E Cacciamani, Manju Aron, Pierre B Halteh, Vinay Duddalwar, Inderbir Gill, Andre Luis Abreu

Purpose: To compare transperineal (TP) vs transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion-guided prostate biopsy (PBx) in a large, ethnically diverse and multiracial cohort.

Materials and methods: Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05.

Results: A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders.

Conclusions: In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.

目的:在一个大型、种族多样化和多种族队列中,比较经会阴(TP)与经直肠(TR)磁共振成像(MRI)和经直肠超声(TRUS)融合引导的前列腺活检(PBx):从前瞻性数据库(IRB #HS-13-00663)中确定了接受多参数(mp)磁共振成像(MRI)后在TP或TR TRUS融合引导下进行前列腺活检的连续患者。所有患者都接受了 mpMRI 检查,然后进行了 12-14 次核心系统 PBx。每个PIRADS≥3病变至少再取两个靶活检核心。终点是检测出有临床意义的前列腺癌(CSPCa;分级组,GG≥2)。统计学意义定义为 p结果:共有 1491 名患者符合纳入标准,其中 480 人接受了前列腺癌根治术,1011 人接受了前列腺癌根治术。总体而言,11%的患者为亚洲人,5%为非裔美国人,14%为西班牙裔,14%为其他族裔,56%为白人,TP和TR的情况相似(P=0.4)。在 PIRADS 3-5 中,TP PBx 的 CSPCa 检出率(61% vs 54%,p=0.03)明显高于 TR PBx,但在 PIRADS 1-2 中却不尽相同(13% vs 13%,p=1.0)。在多变量分析中对混杂因素进行调整后,黑人种族是 CSPCa 检测的独立预测因素,而不是 PBx 方法(TP vs TR)。最大癌芯长度的中位数(11 mm vs 8 mm; p结论:在一个庞大而多样化的队列中,黑人种族而非活检方法是CSPCa检测的独立预测因素。TP和TR活组织切片检查的CSPCa检出率相似,但TP活组织切片检查的组织学信息量更大。
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引用次数: 0
Editorial Comment: Comparative Analysis of Super-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Management of Renal Calculi ≤2 cm Among Somali Population. 编辑评论:超微型经皮肾镜碎石术与逆行肾内手术治疗≤2厘米肾结石的索马里人口比较分析。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1590/S1677-5538.IBJU.2023.0354.1
Luciano A Favorito
{"title":"Editorial Comment: Comparative Analysis of Super-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Management of Renal Calculi ≤2 cm Among Somali Population.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2023.0354.1","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0354.1","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 5","pages":"655-656"},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898714","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
期刊
International Braz J Urol
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