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Moment of induction and duration of experimental varicocele in rats: effects on semen quality. 大鼠实验性精索静脉曲张的诱导时刻和持续时间:对精液质量的影响。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2023.0412
Renata Cristina de Carvalho, Rhayza Roberta Andretta, Jheysson Alfredo Cordeiro de Moura, Ricardo Pimenta Bertolla, Fatima Kazue Okada

Purpose: Varicocele is a condition known to cause damage to seminal parameters and sperm function. Furthermore, it has been hypothesized that the varicocele effect on fertility is time-dependent; however, little is known about the consequences of its establishment time on reproductive organs and/or sperm function. This study aimed to evaluate the effect of the duration of experimental varicocele on reproductive organs, sperm parameters, and sperm function.

Materials and methods: Varicocele induction surgeries were performed in Wistar rats aged 40 or 100 days old. At 160-day-old, analyses were performed, including biometry of reproductive organs (prostate, seminal vesicles, epididymis, and testis), sperm parameters (vitality, morphology, and motility), and sperm function tests (nuclear DNA integrity, acrosome integrity, and mitochondrial activity).

Results: The analysis of the biometry of reproductive organs showed no differences between distinct ages in which varicocele was induced. The total abnormal sperm morphology was bigger in animals with varicocele induced to 100 days old than in animals with varicocele induced to 40 days old. Regarding nuclear DNA integrity, animals of varicocele induced to 100 days old showed worse results compared to animals of varicocele induced to 40 days old. Other parameters analyzed showed no differences between varicocele groups.

Conclusion: In this study conducted on rats, we conclude that varicocele adversely affects sperm, particularly its function. However, we did not observe a negative progressive effect on sperm.

目的:众所周知,精索静脉曲张会损害精液参数和精子功能。此外,有人推测精索静脉曲张对生育力的影响与时间有关;然而,人们对精索静脉曲张形成时间对生殖器官和/或精子功能的影响知之甚少。本研究旨在评估实验性精索静脉曲张的持续时间对生殖器官、精子参数和精子功能的影响:对 40 或 100 日龄的 Wistar 大鼠进行精索静脉曲张诱导手术。160日龄时进行分析,包括生殖器官(前列腺、精囊、附睾和睾丸)的生物测量、精子参数(活力、形态和运动性)和精子功能检测(核DNA完整性、顶体完整性和线粒体活性):结果:对生殖器官生物测量的分析表明,诱发精索静脉曲张的不同年龄段之间没有差异。精索静脉曲张诱导至 100 天的动物的精子形态异常总数大于精索静脉曲张诱导至 40 天的动物。在核DNA完整性方面,诱导100天的精索静脉曲张动物比诱导40天的精索静脉曲张动物的结果更差。其他分析参数在精索静脉曲张组之间没有差异:在这项以大鼠为对象的研究中,我们得出结论,精索静脉曲张会对精子,尤其是精子的功能产生不利影响。然而,我们并未观察到精子的负面渐进影响。
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引用次数: 0
Single-Port Transvesical Vesico-Vaginal Fistula Repair: An Initial Experience. 单孔经膀胱阴道瘘修补术:初步经验
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.0146
Donato Cannoletta, Antony Pellegrino, Greta Pettenuzzo, Matteo Pacini, Ruben Calvo Sauer, Juan R Torres-Anguiano, Luca Morgantini, Simone Crivellaro

Introduction: Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2-5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access.

Materials and methods: Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure.

Results: Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up.

Conclusions: Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm).

导言:膀胱阴道瘘(VVF)是最常见的先天性泌尿生殖道瘘,主要与妇科手术有关(1)。虽然保守治疗和手术治疗均可考虑,但最佳治疗方法仍不确定,已有多项研究采用了不同的技术(开腹、腹腔镜或机器人)和方法(膀胱外、经膀胱或经阴道)(2-5)。在此背景下,我们旨在报告使用单孔(SP)经膀胱(TV)入路修复 VVF 的初步经验:四名确诊为 VVF 的患者在 2022 年 5 月至 2023 年 12 月期间接受了 SP-TV VVF 修补术。诊断由膀胱镜检查和膀胱造影证实,其中两例由 CT 尿路造影证实。在机器人手术前,患者在全身麻醉的情况下取平卧位,进行初步膀胱镜检查。发现瘘管后,通过瘘管放置了一个 5fr 支架。放置了两个输尿管支架。然后,让患者仰卧,在耻骨上做一个 3 厘米的横向切口和 2 厘米的膀胱切开术,以便进入 SP。第一步是标记并切除通向阴道的瘘道。解剖阴道和膀胱的边缘,使闭合无张力,并创建三个不同的闭合层:阴道、膀胱肌肉层和膀胱粘膜层。置入膀胱导尿管,手术结束后取出两个输尿管支架:平均年龄为 53 岁,4 名患者中有 3 名在妇科手术后出现 VVF。两名患者分别在全子宫切除术后 6 个月和 8 个月接受了 VVF 修复术。一名患者在全子宫切除术和输卵管切除术后接受放射治疗,随后出现了 VVF。最后一名患者在接受泌尿外科手术后出现 VVF。瘘管直径在11至15毫米之间。手术时间为211分钟,包括初步膀胱镜检查、支架置入和SP入路。所有患者均在术后第 14-18 天膀胱造影阴性后,成功拔除膀胱导尿管,并于当天出院。只有一例患者因瘘管与输尿管口闭合而留置了输尿管支架,我们还报告了一例术后12天发生尿毒症的病例,患者在门诊接受了抗生素治疗。平均随访时间为 8 个月,患者被安排定期随访,无复发报告。所有患者术后都接受了至少 3 个月的随访:我们的经验表明,对于中小型瘘管(10-15 毫米),SP 经膀胱 VVF 修补术是一种安全可行的微创治疗方法。
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引用次数: 0
Experimental Model Exposed to Bisphenol and Submitted to a High-Fat Diet and Related Morphologic Testicular Parameters Alterations Analysis. 暴露于双酚并接受高脂饮食的实验模型及相关睾丸形态学参数变化分析。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.9911
Jorge Luiz Alves Pereira, Luiz Carlos Schrotke Pires, Eliete Dalla Corte Frantz, Dangelo Carlo Magliano, Luciano Alves Favorito

Purpose: To evaluate the morphological and stereological parameters of the testicles in mice exposed to bisphenol S and/or high-fat diet-induced obesity.

Material and methods: Forty adult male C57BL/6 mice were fed a standard diet (SC) or high-fat diet (HF) for a total of 12 weeks. The sample was randomly divided into 4 experimental groups with 10 mices as follows: a) SC - animals fed a standard diet; b) SC-B - animals fed a standard diet and administration of BPS (25 μg/kg of body mass/day) in drinking water; c) HF: animals fed a high-fat diet; d) HF-B - animals fed a high-fat diet and administration of BPS (25 μg/Kg of body mass/day) in drinking water. BPS administration lasted 12 weeks, following exposure to the SC and HF diets. BPS was diluted in absolute ethanol (0.1%) and added to drinking water (concentration of 25 μg/kg body weight/day). The animals were euthanized, and the testes were processed and stained with hematoxylin and eosin (H&E) for morphometric and stereological parameters, including density of seminiferous tubules per area, length density and total length of seminiferous tubules, height of the tunica albuginea and the diameter of the seminiferous tubules. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using ANOVA and the Holm-Sidak post-test (p<0.05).

Results: The seminiferous tubule density per area reduced in all groups when compared with SC samples (p<0.001): HF (40%), SC-B 3(2%), and HF-B (36%). Length density was reduced significantly (p<0.001) in all groups when compared with SC group: HF (40%), SC-B (32%), and HF-B (36%). The seminiferous tubule total length was reduced (p<0.001) when compared to f HF (28%) and SC-B (26%) groups. The tubule diameter increased significantly (p<0.001) only when we compared the SC group with SC (54%) an SC-B (25%) groups and the tunica thickness increased significantly only in HF group (117%) when compared with SC-B (20%) and HF-B 31%.

Conclusion: Animals exposed to bisphenol S and/or high-fat diet-induced obesity presented important structural alterations in testicular morphology.

目的:评估暴露于双酚 S 和/或高脂饮食诱发肥胖的小鼠睾丸的形态学和立体学参数:对 40 只成年雄性 C57BL/6 小鼠进行为期 12 周的标准饮食(SC)或高脂饮食(HF)喂养。将样本随机分为以下 4 个实验组,每组 10 只小鼠:a) SC - 标准饮食组;b) SC-B - 标准饮食组,同时在饮用水中添加 BPS(25 μg/kg 体重/天);c) HF:高脂饮食组;d) HF-B - 高脂饮食组,同时在饮用水中添加 BPS(25 μg/kg 体重/天)。在接触 SC 和 HF 食物后,BPS 给药持续 12 周。用绝对乙醇(0.1%)稀释 BPS 并将其加入饮用水中(浓度为 25 微克/公斤体重/天)。对动物实施安乐死,用苏木精和伊红(H&E)对睾丸进行处理和染色,以测定形态学和立体学参数,包括单位面积的曲细精管密度、曲细精管的长度密度和总长度、白膜高度和曲细精管直径。图像由奥林巴斯 BX51 显微镜和奥林巴斯 DP70 相机拍摄。使用 Image Pro 和 Image J 程序进行立体分析。采用方差分析和 Holm-Sidak 后检验(pResults)对平均数进行统计比较:暴露于双酚 S 和/或高脂饮食诱发肥胖的动物的睾丸形态发生了重要的结构性改变。
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引用次数: 0
International Brazilian Journal of Urology highlights experimental studies in Infertility in this number. 巴西国际泌尿学杂志》在本期中重点介绍了不孕不育方面的实验研究。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.04.01
Luciano A Favorito
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引用次数: 0
A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy. 机器人辅助腹腔镜前列腺切除术现状全面回顾
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.0126
Parth U Thakker, Maxwell Sandberg, Ashok K Hemal, Alejandro R Rodriguez

Background and objective: Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP.

Materials and methods: We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively.

Conclusions: Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.

背景和目的:抢救性机器人辅助前列腺癌根治术(sRARP)适用于经生化或活检证实、放疗或消融治疗后局部复发的前列腺癌患者。传统上,由于技术要求和并发症发生率较高,手术量较少的外科医生都会避免进行前列腺癌根治术(sRARP)。放射治疗后的 sRARP 结果研究虽然存在,但数量仍然很少。随着全腺体和病灶消融疗法的使用越来越多,需要对这种情况下的 sRARP 进行更新。本叙述性综述旨在概述近期关于放疗后和烧蚀后 sRARP 的肿瘤学结果、功能结果和并发症的研究。本文还提供了一些技巧和窍门,为可能实施 sRARP 的外科医生提供指导:我们对 PubMed 和 MEDLINE 进行了非系统性文献检索,以查找 2010-2022 年间与概述主题相关的最重要文章,且不限制研究设计。仅排除了病例报告、编辑评论、信件和非英语稿件。主要内容和研究结果:挽救性机器人前列腺癌根治术适用于放疗或消融治疗后出现生化复发的病例。与初次手术(pRARP)相比,机器人前列腺癌根治术后的肿瘤治疗效果较差,但与开放式挽救性前列腺切除术相比,机器人前列腺癌根治术后的肿瘤治疗效果有所改善。前列腺癌根治术前 PSA 水平越高、病理分期越晚,预示着肿瘤治疗效果越差。与高危 BCR 患者相比,符合低危 EAU 生化复发标准的患者的肿瘤治疗效果更好。虽然sRARP的并发症发生率比pRARP高,但Retzius疏散方法可降低并发症发生率,尤其是直肠损伤。与传统的开放式方法相比,sRARP 的膀胱颈挛缩率较低。就功能结果而言,sRARP术后的有效率较低,尿失禁率也较低,但Retzius疏通法在术后1年内的尿失禁恢复情况是可以接受的:结论:机器人平台的进步和机器人经验的提高使得 sRARP 术后的并发症发生率可以接受。然而,与 pRARP 相比,sRARP 术后在放疗后和消融术后的肿瘤学和功能预后较差。因此,在与患者就局部前列腺癌的初始治疗进行共同决策时,应让患者了解生化复发前列腺癌可能需要进行 sRARP 时的肿瘤学和功能预后及并发症。
{"title":"A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy.","authors":"Parth U Thakker, Maxwell Sandberg, Ashok K Hemal, Alejandro R Rodriguez","doi":"10.1590/S1677-5538.IBJU.2024.0126","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0126","url":null,"abstract":"<p><strong>Background and objective: </strong>Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP.</p><p><strong>Materials and methods: </strong>We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively.</p><p><strong>Conclusions: </strong>Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"398-414"},"PeriodicalIF":3.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853058","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
Treatment of erectile dysfunction by intracavernosal administration of mesenchymal stem cells in patients with diabetes mellitus. 通过海绵体内注射间充质干细胞治疗糖尿病患者的勃起功能障碍。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.0100
Yerbol Iskakov, Rustam Omarbayev, Rinat Nugumanov, Timur Turgunbayev, Yerkebulan Yermaganbetov

Erectile dysfunction is observed in about 50% of men. It has been found that diabetes mellitus increases its prevalence to 19-86.3%, necessitating attention to a therapeutic strategy. Among the available treatment methods, intracavernosal injections of mesenchymal stem cells have proven to be particularly effective.

Objective: The purpose of study is to assess and analyse the effectiveness of their use in the treatment of erectile dysfunction in patients with diabetes mellitus.

Materials and methods: The literature search was conducted using systematic methods and analysis in databases such as Web of Science, Scopus, PubMed, Elsevier, and Springer, with 41 sources included for further review.

Results: The study highlights microangiopathic and neuropathic links as key factors in erectile dysfunction development in diabetic patients, stemming from endothelial dysfunction and conductivity disturbances. Mesenchymal stem cell therapy from bone marrow, adipose tissue, and umbilical cord mitigates pathogenic impact through regenerative and anti-apoptotic effects. Due to this, most studies indicate high efficacy of the treatment and rapid therapeutic action through intracavernosal administration. Some studies suggest an increase in the body's receptor sensitivity to other drugs, such as sildenafil.

Conclusion: From the perspective of further research on this issue, standardising the preparation of stem cells and the treatment method using a large sample size is essential to introduce such a method as an extremely promising therapy for this delicate issue in men into practical medicine. The practical value of the study lies in the systematisation of information on different sources of mesenchymal stem cells for treating erectile dysfunction.

约 50%的男性会出现勃起功能障碍。研究发现,糖尿病会使勃起功能障碍的发病率增加到 19-86.3%,因此有必要关注治疗策略。在现有的治疗方法中,间充质干细胞海绵体内注射被证明特别有效:本研究旨在评估和分析间充质干细胞用于治疗糖尿病患者勃起功能障碍的有效性:采用系统的方法在Web of Science、Scopus、PubMed、Elsevier和Springer等数据库中进行文献检索和分析,共纳入41篇文献进行进一步审查:研究强调微血管病变和神经病变是糖尿病患者勃起功能障碍发生的关键因素,源于内皮功能障碍和传导性障碍。来自骨髓、脂肪组织和脐带的间充质干细胞疗法可通过再生和抗凋亡作用减轻致病影响。因此,大多数研究表明,这种疗法疗效显著,而且通过海绵体内给药可快速发挥治疗作用。一些研究表明,人体受体对其他药物(如西地那非)的敏感性会增加:从进一步研究这个问题的角度来看,要将这种极有前景的治疗男性这一棘手问题的方法引入实用医学,就必须使用大量样本对干细胞的制备和治疗方法进行标准化。这项研究的实用价值在于系统化了治疗勃起功能障碍的间充质干细胞不同来源的信息。
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引用次数: 0
Editorial Comment: Proximal Urethrostomy Versus Urethroplasty for Complex Urethral Strictures 巴西国际泌尿学杂志》在本期中重点介绍了不孕不育方面的实验研究。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/S1677-5538.IBJU.2024.9912
Luciano A Favorito
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引用次数: 0
Editorial Comment: What Adults Teach Urologists About Hypospadias? 社论评论:成人如何向泌尿科医生传授尿道下裂知识?
IF 3.7 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-05-01 DOI: 10.1590/S1677-5538.IBJU.2024.9910
Luciano A Favorito
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引用次数: 0
Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors. COVID-19幸存者前瞻性队列中的下尿路症状。
IF 3.7 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-05-01 DOI: 10.1590/S1677-5538.IBJU.2023.0546
Cristiano M Gomes, Marcelo Hisano, Julia D Souza, João Victor T Henriques, Jose de Bessa, Julyana Moromizato, Thulio Bosi, Rachel Mazoni, João Gismondi, Bruno Camargo, Zein M Sammour, Homero Bruschini, Linamara R Battistella, William C Nahas

Purpose: To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization.

Materials and methods: In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation.

Results: Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS.

Conclusions: LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.

目的:分析中度和重度COVID-19存活患者的下尿路症状(LUTS)发生率以及住院6个月后出现LUTS的风险因素:在这项前瞻性队列研究中,对因COVID-19住院六个月后的患者进行了评估。采用国际前列腺症状评分法评估 LUTS。一般健康状况通过医院焦虑抑郁量表和EQ5D-L5量表进行评估,其中EQ5D-L5量表评估活动能力、日常活动能力、疼痛和不适,并完成自我感觉健康评估:在255名参与者中,54.1%为男性,年龄中位数为57.3 [44.3 - 66.6]岁。既往合并症包括糖尿病(35.7%)、高血压(54.5%)、肥胖(30.2%)和缺乏运动(65.5%)。124名患者(48.6%)住院时间超过15天,181名患者(71.0%)入住重症监护室,124名患者(48.6%)需要机械通气。IPSS 中位数为 6 [3-11],无性别差异。108例(42.4%)患者患有中度至重度尿失禁(男性40.6%,女性44.4%;P=0.610)。夜尿(58.4%)和尿频(45.9%)是最普遍的症状,尿急是唯一对男性(29.0%)和女性(44.4%)产生不同影响的症状(P=0.013)。60名(23.5%)患者的生活质量受到了 LUTS 的影响,其中女性患者受到的影响更为严重(P=0.004)。糖尿病、高血压和自我感觉总体健康状况较差与 LUTS 相关:结论:COVID-19导致的LUTS在住院6个月后非常普遍且令人烦恼。对 LUTS 进行评估有助于确保对这些患者进行适当的诊断和治疗。
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引用次数: 0
A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI 泌尿学知识和工具在深浸润性子宫内膜异位症诊断和手术中的应用——叙述性综述。
IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-05-01 DOI: 10.1590/S1677-5538.IBJU.2024.0084
Masatomo Kaneko, Atsuko Fujihara, Tsuyoshi Iwata, Lorenzo Storino Ramacciotti, Suzanne L Palmer, Masakatsu Oishi, Manju Aron, Giovanni E Cacciamani, Vinay Duddalwar, Go Horiguchi, Satoshi Teramukai, Osamu Ukimura, Inderbir S Gill, Andre Luis Abreu

Purpose: To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx).

Materials and methods: We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC.

Results: Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75.

Conclusions: Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.

目的:本综述利用当前泌尿学知识和技术讨论深浸润性子宫内膜异位症(DIE)的诊断和手术。材料和方法:导致泌尿系统问题的深浸润性子宫内膜异位症的叙述性综述。我们使用以下MeSH术语检查了Pubmed、Embase和Scielo数据库中的手稿:(“子宫内膜异位症”)and(“妇科”或“泌尿科”或“泌尿科医生”)and。我们的记录中的样本图像被拿来支持这一发现。结果:从105篇相关文章中选出34篇。死亡可能影响52.6%的患者的泌尿系统。下尿路症状可能需要进行尿动力学检查。超声检查为检测尿路病变或畸变提供了强大的统计结果,但磁共振将证实诊断。膀胱镜检查可以发现活动性病变,尽管任何肉眼可见的吸引力都是病理性的。尿道内窥镜检查用于术中膀胱和输尿管的评估,但经尿道内镜下膀胱病变切除术的复发率较高。腹腔镜是治疗的首选途径;膀胱部分切除术和膀胱刮除术是膀胱子宫内膜异位症最常见的外科治疗方法。关于输尿管的治疗,大多数论文都描述了简单的输尿管松解术和复杂的重建技术。使用解剖标志或神经导航,骨盆手术系统化允许术中神经结构识别。结论:泌尿系统DIE很常见,但具有高证据水平的出版物数量有限。最初的诊断工具是超声波和膀胱镜检查,但磁共振是最可靠的工具。当患者出现排尿症状时,尿动力学检查至关重要。腹腔镜提高了病变的检测和解剖学理解。这种方法必须由具有高度专业知识的专业人员进行,因为手术不仅仅是切除病变,还包括保存神经结构和尿路重建技术。
{"title":"A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI","authors":"Masatomo Kaneko, Atsuko Fujihara, Tsuyoshi Iwata, Lorenzo Storino Ramacciotti, Suzanne L Palmer, Masakatsu Oishi, Manju Aron, Giovanni E Cacciamani, Vinay Duddalwar, Go Horiguchi, Satoshi Teramukai, Osamu Ukimura, Inderbir S Gill, Andre Luis Abreu","doi":"10.1590/S1677-5538.IBJU.2024.0084","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0084","url":null,"abstract":"<p><strong>Purpose: </strong>To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx).</p><p><strong>Materials and methods: </strong>We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC.</p><p><strong>Results: </strong>Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75.</p><p><strong>Conclusions: </strong>Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"49 5","pages":"319-334"},"PeriodicalIF":3.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176619","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}
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International Braz J Urol
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