Pub Date : 2024-09-16DOI: 10.1101/2024.09.14.24313693
Kshitij Pandit, Paul Riviere, Kylie Morgan, Aditya Bagrodia
Abstract: Testosterone and prostatic inflammation have been postulated to influence the development of benign prostatic hyperplasia (BPH). Our study aims to evaluate the incidence of BPH in Testicular Cancer (TCa) survivors, focusing on the impact of chemotherapy and post TCa diagnosed hypogonadism. We conducted a retrospective cohort analysis of US veterans diagnosed with TCa between 1990 to 2021, using the Veterans affairs database. BPH was defined using International Classification of Diseases (ICD) codes, Current Procedural Terminology (CPT) codes, or a 6-month prescription of medications. Associations with BPH were analysed, stratifying the cohort by receipt of chemotherapy and presence of hypogonadism. Multivariable cox regression models were used to determine statistical significance (p-value <0.05). Our cohort included 2038 TCa survivors with a median age at diagnosis of 41 years. On multivariable cox regression analysis, receipt of chemotherapy was not significantly associated with incidence of BPH (p-value= 0.13). When stratified by diagnosis of hypogonadism prior to BPH, no significant associations were found on univariable (p=0.81) as well as multivariable (p=0.65) analyses. In the multivariable model, age at diagnosis was significantly associated with an increased incidence of BPH (Hazard ratio: 1.06, p<0.001). Our findings demonstrate that age is a significant factor associated with development of BPH in this population, while suggesting that chemotherapy for TCa and hypogonadism might not substantially alter the development of BPH.
{"title":"INCIDENCE OF BENIGN PROSTATIC HYPERPLASIA IN TESTICULAR CANCER SURVIVORS IN THE VETERANS AFFAIRS HEALTH SYSTEM","authors":"Kshitij Pandit, Paul Riviere, Kylie Morgan, Aditya Bagrodia","doi":"10.1101/2024.09.14.24313693","DOIUrl":"https://doi.org/10.1101/2024.09.14.24313693","url":null,"abstract":"Abstract:\u0000Testosterone and prostatic inflammation have been postulated to influence the development of benign prostatic hyperplasia (BPH). Our study aims to evaluate the incidence of BPH in Testicular Cancer (TCa) survivors, focusing on the impact of chemotherapy and post TCa diagnosed hypogonadism. We conducted a retrospective cohort analysis of US veterans diagnosed with TCa between 1990 to 2021, using the Veterans affairs database. BPH was defined using International Classification of Diseases (ICD) codes, Current Procedural Terminology (CPT) codes, or a 6-month prescription of medications. Associations with BPH were analysed, stratifying the cohort by receipt of chemotherapy and presence of hypogonadism. Multivariable cox regression models were used to determine statistical significance (p-value <0.05). Our cohort included 2038 TCa survivors with a median age at diagnosis of 41 years. On multivariable cox regression analysis, receipt of chemotherapy was not significantly associated with incidence of BPH (p-value= 0.13). When stratified by diagnosis of hypogonadism prior to BPH, no significant associations were found on univariable (p=0.81) as well as multivariable (p=0.65) analyses. In the multivariable model, age at diagnosis was significantly associated with an increased incidence of BPH (Hazard ratio: 1.06, p<0.001). Our findings demonstrate that age is a significant factor associated with development of BPH in this population, while suggesting that chemotherapy for TCa and hypogonadism might not substantially alter the development of BPH.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide and the 5th leading cause of death from cancer for men in Taiwan. The incidence of synchronous metastatic PCa in Taiwan is higher than U.S. and Europe. We aim to present the latest life expectancy (LE), loss of LE, and lifetime cost associated with PCa in Taiwan. The PCa data are based on Taiwan Cancer Registry and National Health Insurance Database. Total 30,207 new cases of PCa were recorded during 2008-2019 nationwide. LE, estimated loss of LE and lifetime cost were stratified by age, cancer stage, Gleason score, grade group and serum PSA level at diagnosis. We compared LE and healthcare cost outcomes between synchronous metastatic PCa patients in 3 age groups. Among the 30,207 new cases, the low to intermediate risk groups, high-risk groups, and regional and metastatic PCa accounted for 54.1%, 13.2%, and 32.6% of cases, respectively. A considerable proportion of synchronous metastatic PCa was noted in Taiwan when compared with the U.S. For synchronous metastatic PCa, the highest LE is 9.22 years for ages 20-64 years, followed by ages 65-74 (8.29 years) and ages 75-89 years (4.58 years). The loss of LE in the three groups is 13.63, 6.75, and 3.87 years, respectively. The healthcare cost of synchronous metastatic PCa in all age groups is higher than the average cost for PCa patients in Taiwan. This study provides real-world evidence to support health care policy-making and clinical decisions regarding PCa. Due to the high proportion of synchronous metastatic PCa in Taiwan, the findings of this analysis emphasize the importance of early detection of PCa, which can save LE and decrease the total cost burden on the healthcare system.
{"title":"Comprehensive analysis of prostate cancer life expectancy, loss of life expectancy, and healthcare expenditures: Taiwan national cohort study spanning 2008 to 2019","authors":"Pin-Chun Liu, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Hsu, Min-Che Tung, Ying-Ming Chiu","doi":"10.1101/2024.09.05.24313122","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313122","url":null,"abstract":"Prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide and the 5th leading cause of death from cancer for men in Taiwan. The incidence of synchronous metastatic PCa in Taiwan is higher than U.S. and Europe. We aim to present the latest life expectancy (LE), loss of LE, and lifetime cost associated with PCa in Taiwan. The PCa data are based on Taiwan Cancer Registry and National Health Insurance Database. Total 30,207 new cases of PCa were recorded during 2008-2019 nationwide. LE, estimated loss of LE and lifetime cost were stratified by age, cancer stage, Gleason score, grade group and serum PSA level at diagnosis. We compared LE and healthcare cost outcomes between synchronous metastatic PCa patients in 3 age groups. Among the 30,207 new cases, the low to intermediate risk groups, high-risk groups, and regional and metastatic PCa accounted for 54.1%, 13.2%, and 32.6% of cases, respectively. A considerable proportion of synchronous metastatic PCa was noted in Taiwan when compared with the U.S. For synchronous metastatic PCa, the highest LE is 9.22 years for ages 20-64 years, followed by ages 65-74 (8.29 years) and ages 75-89 years (4.58 years). The loss of LE in the three groups is 13.63, 6.75, and 3.87 years, respectively. The healthcare cost of synchronous metastatic PCa in all age groups is higher than the average cost for PCa patients in Taiwan. This study provides real-world evidence to support health care policy-making and clinical decisions regarding PCa. Due to the high proportion of synchronous metastatic PCa in Taiwan, the findings of this analysis emphasize the importance of early detection of PCa, which can save LE and decrease the total cost burden on the healthcare system.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1101/2024.07.31.24311331
Takashi Yoshioka, Kenji Omae, Satoshi Funada, Tetsuji Minami, Rei Goto
Objectives: To determine the health utility values (HUVs) of overactive bladder (OAB) among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity. Methods: This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each gender and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≥5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol 5-Dimension 5-Level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB, with eight covariates selected based on previous studies. Results: Among the 998 participants (51.9% male; median age, 75 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs]) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066) and −0.0591 (−0.0844 to −0.0339), respectively. Conclusions: This study examined HUVs in older Japanese adults with and without OAB. The results demonstrate that increased OAB severity is associated with greater disutility.
{"title":"Health Utility Value of Overactive Bladder in Japanese Older Adults","authors":"Takashi Yoshioka, Kenji Omae, Satoshi Funada, Tetsuji Minami, Rei Goto","doi":"10.1101/2024.07.31.24311331","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311331","url":null,"abstract":"Objectives: To determine the health utility values (HUVs) of overactive bladder (OAB) among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity.\u0000Methods: This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each gender and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≥5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol 5-Dimension 5-Level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB, with eight covariates selected based on previous studies.\u0000Results: Among the 998 participants (51.9% male; median age, 75 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs]) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066) and −0.0591 (−0.0844 to −0.0339), respectively.\u0000Conclusions: This study examined HUVs in older Japanese adults with and without OAB. The results demonstrate that increased OAB severity is associated with greater disutility.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141883687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Micropenis, defined as a penile length more than 2.5 standard deviations below the mean for age and population, presents significant concerns for patients and parents. Despite current guidelines recommending multidisciplinary management, there is limited evidence on long-term outcomes, particularly in untreated patients. Methods: This retrospective cohort study involved 46 male children aged 7 to 9 years presenting with micropenis at the Ali Asghar Endocrine Clinic from 2015 to 2023. Initial penile size, BMI, and other growth parameters were measured, with biannual follow-ups extending three years post-bone fusion to evaluate growth rates and influential factors. Results: Initial mean stretched penile length (SPL) was 3.22 ± 0.21 cm. Significant increases in penile size were observed across all intervals, with the highest growth rates occurring between the first- and second-years post-fusion. BMI emerged as the most significant predictor of penile growth, while initial SPL was the least influential factor. By the third-year post-fusion, all subjects achieved penile lengths within the normal range. Conclusion: Our findings indicate that most untreated micropenis patients attain normal penile size by adulthood, highlighting the importance of monitoring growth rates rather than focusing solely on initial penile size. This study provides critical insights for developing guidelines and management strategies for micropenis, emphasizing the necessity of continued follow-up to ensure optimal outcomes.
{"title":"Long-Term Outcomes of Untreated Micropenis: Growth Patterns and Predictive Factors","authors":"Davoud Amirkashani, Mostafa Abdollahi Sarvi, Mostafa Masoumi","doi":"10.1101/2024.07.21.24310773","DOIUrl":"https://doi.org/10.1101/2024.07.21.24310773","url":null,"abstract":"Background: Micropenis, defined as a penile length more than 2.5 standard deviations below the mean for age and population, presents significant concerns for patients and parents. Despite current guidelines recommending multidisciplinary management, there is limited evidence on long-term outcomes, particularly in untreated patients.\u0000Methods: This retrospective cohort study involved 46 male children aged 7 to 9 years presenting with micropenis at the Ali Asghar Endocrine Clinic from 2015 to 2023. Initial penile size, BMI, and other growth parameters were measured, with biannual follow-ups extending three years post-bone fusion to evaluate growth rates and influential factors.\u0000Results: Initial mean stretched penile length (SPL) was 3.22 ± 0.21 cm. Significant increases in penile size were observed across all intervals, with the highest growth rates occurring between the first- and second-years post-fusion. BMI emerged as the most significant predictor of penile growth, while initial SPL was the least influential factor. By the third-year post-fusion, all subjects achieved penile lengths within the normal range.\u0000Conclusion: Our findings indicate that most untreated micropenis patients attain normal penile size by adulthood, highlighting the importance of monitoring growth rates rather than focusing solely on initial penile size. This study provides critical insights for developing guidelines and management strategies for micropenis, emphasizing the necessity of continued follow-up to ensure optimal outcomes.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141740339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-07DOI: 10.1101/2024.07.06.24310031
Julian Yin Vieira Borges
Abstract Background: Erectile dysfunction (ED) has been suggested to be associated with an increased risk of cardiovascular disease (CVD), including coronary artery disease, stroke, and cardiovascular mortality This meta-analysis aims to investigate the relationship between ED and CVD risk using PRISMA 2020 guidelines for reporting systematic reviews and evaluate the risk of specific cardiovascular events such as coronary artery disease (CAD), myocardial infarction (MI), stroke, and cardiovascular mortality. Methods: A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases from January 2009 to December 2023. Studies were selected based on predefined inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I statistic and Q test. For the assessment of certainty were used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence for each outcome. The GRADE approach evaluates evidence based on five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Each domain can lead to downgrading the certainty of evidence by one or two levels. The overall certainty of evidence was classified as high, moderate, low, or very low. Results: This updated meta-analysis of prospective studies provides robust evidence that ED was found to be an independent risk factor for CVD outcomes, including coronary artery disease, stroke, and cardiovascular mortality. Clinicians should consider early identification and management of ED, such initiative has great potential to improve cardiovascular risk and using it as stratification criteria would help CVD prevention strategies in men. Keywords: erectile dysfunction, cardiovascular disease, coronary artery disease, stroke, cardiovascular mortality, risk factors, endothelial dysfunction, meta-analysis
摘要背景：勃起功能障碍（ED）被认为与心血管疾病（CVD）（包括冠状动脉疾病、中风和心血管疾病死亡率）风险的增加有关。本荟萃分析旨在采用PRISMA 2020系统综述报告指南研究ED与CVD风险之间的关系，并评估特定心血管事件（如冠状动脉疾病（CAD）、心肌梗死（MI）、中风和心血管疾病死亡率）的风险。研究方法从 2009 年 1 月到 2023 年 12 月，在 PubMed、Embase、Cochrane Library 和 Web of Science 数据库中进行了系统的文献检索。根据预先确定的纳入标准筛选研究。数据提取和质量评估由两名审稿人独立完成。采用随机效应模型计算汇总相对风险 (RR) 及 95% 置信区间 (CI)。异质性采用 I 统计量和 Q 检验进行评估。对于确定性的评估，我们采用 GRADE（建议评估、发展和评价分级）方法来评估每项结果的证据确定性。GRADE 方法根据五个方面对证据进行评估：偏倚风险、不一致性、间接性、不精确性和发表偏倚。每个领域都可能导致证据的确定性降低一个或两个等级。证据的总体确定性分为高、中、低或极低。结果：这项最新的前瞻性研究荟萃分析提供了强有力的证据，证明 ED 是导致心血管疾病（包括冠心病、中风和心血管疾病死亡率）的独立危险因素。临床医生应考虑早期识别和管理ED，这一举措具有改善心血管风险的巨大潜力，将其作为分层标准将有助于男性心血管疾病的预防策略。关键词：勃起功能障碍、心血管疾病、冠心病、中风、心血管疾病死亡率、风险因素、内皮功能障碍、荟萃分析
{"title":"Erectile Dysfunction and Cardiovascular Disease Risk: An Updated 2024 Systematic Review Meta-Analysis of Prospective Studies","authors":"Julian Yin Vieira Borges","doi":"10.1101/2024.07.06.24310031","DOIUrl":"https://doi.org/10.1101/2024.07.06.24310031","url":null,"abstract":"Abstract\u0000Background: Erectile dysfunction (ED) has been suggested to be associated with an increased risk of cardiovascular disease (CVD), including coronary artery disease, stroke, and cardiovascular mortality This meta-analysis aims to investigate the relationship between ED and CVD risk using PRISMA 2020 guidelines for reporting systematic reviews and evaluate the risk of specific cardiovascular events such as coronary artery disease (CAD), myocardial infarction (MI), stroke, and cardiovascular mortality. Methods: A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases from January 2009 to December 2023. Studies were selected based on predefined inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I statistic and Q test. For the assessment of certainty were used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence for each outcome. The GRADE approach evaluates evidence based on five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Each domain can lead to downgrading the certainty of evidence by one or two levels. The overall certainty of evidence was classified as high, moderate, low, or very low. Results: This updated meta-analysis of prospective studies provides robust evidence that ED was found to be an independent risk factor for CVD outcomes, including coronary artery disease, stroke, and cardiovascular mortality. Clinicians should consider early identification and management of ED, such initiative has great potential to improve cardiovascular risk and using it as stratification criteria would help CVD prevention strategies in men. Keywords: erectile dysfunction, cardiovascular disease, coronary artery disease, stroke, cardiovascular mortality, risk factors, endothelial dysfunction, meta-analysis","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141568627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.03.24309902
Jashkaran G. Gadhvi, Parker R.M. Kenee, Kevin C. Lutz, Fatima Khan, Qiwei Li, Philippe E. Zimmern, Nicole J. De Nisco
Background. Antibiotic-recalcitrant recurrent urinary tract infection (rUTI) is has become increasingly observed in postmenopausal women. Therefore, when standard antibiotic therapies have failed, some elect electrofulguration (EF) of areas of chronic cystitis when detected on office cystoscopy. EF is thought to remove tissue-resident bacteria that have been previously detected in the bladder walls of postmenopausal women with rUTI. We hypothesized that increased bladder bacterial burden may be associated with incomplete rUTI resolution following EF. Methods. Following IRB approval, bladder biopsies were obtained from 34 consenting menopausal women electing EF for the advanced management of rUTI. 16S rRNA FISH was performed using both universal and Escherichia probes and tissue-resident bacterial load was quantified. Time to UTI relapse after EF was recorded during a six-month follow-up period and the association of bladder bacterial burden and clinical covariates with UTI relapse was assessed. Results. We observed bladder-resident Escherichia in 52% of all participants and in 92% of participants with recent E. coli UTI. Time-to-relapse analysis revealed that women with high bladder bacterial burden as detected by the universal probe had a significantly (p=0.035) higher risk of UTI within six months of EF (HR=3.15, 95% CI: 1.09-9.11). Interestingly, bladder-resident Escherichia was not significantly associated (p=0.26) with a higher risk of UTI relapse (HR= 2.14, 95% CI: 0.58-7.90). Conclusions. We observed that total bladder bacterial burden was associated with a 3.1x increased risk of rUTI relapse within six months. Continued analysis of the relationship between bladder bacterial burden and rUTI outcomes may provide insight into the management of these challenging patients.
背景。在绝经后妇女中，越来越多地观察到抗生素复发性尿路感染（rUTI）。因此，当标准抗生素疗法无效时，一些妇女会选择在诊室膀胱镜检查时对慢性膀胱炎区域进行电灌洗（EF）。EF 被认为可以清除之前在患有急性膀胱炎的绝经后妇女的膀胱壁上检测到的组织驻留细菌。我们假设，膀胱细菌负担的增加可能与 EF 后 rUTI 未完全消退有关。方法。在获得 IRB 批准后，我们从 34 名更年期女性中获得了膀胱活检样本，她们均同意选择 EF 作为 rUTI 的晚期治疗方法。使用通用探针和埃希氏探针进行 16S rRNA FISH 检测，并对组织中的细菌量进行量化。在为期 6 个月的随访期间，记录了 EF 后 UTI 复发的时间，并评估了膀胱细菌负荷和临床协变量与 UTI 复发的关系。结果。我们在 52% 的参与者和 92% 近期感染过大肠埃希氏菌尿毒症的参与者中观察到了膀胱驻留埃希氏菌。对复发时间的分析表明，通过通用探针检测到膀胱细菌负荷较高的女性在 EF 后六个月内患尿毒症的风险明显较高（P=0.035）（HR=3.15，95% CI：1.09-9.11）。有趣的是，膀胱驻留埃希氏菌与 UTI 复发风险较高并无明显关联（P=0.26）（HR=2.14，95% CI：0.58-7.90）。结论我们观察到，膀胱细菌总负荷与六个月内尿路感染复发风险增加 3.1 倍有关。继续分析膀胱细菌负荷与 rUTI 结果之间的关系可为管理这些具有挑战性的患者提供启示。
{"title":"Bladder-resident bacteria associated with increased risk of recurrence after electrofulguration in women with antibiotic-recalcitrant urinary tract infection","authors":"Jashkaran G. Gadhvi, Parker R.M. Kenee, Kevin C. Lutz, Fatima Khan, Qiwei Li, Philippe E. Zimmern, Nicole J. De Nisco","doi":"10.1101/2024.07.03.24309902","DOIUrl":"https://doi.org/10.1101/2024.07.03.24309902","url":null,"abstract":"<strong>Background</strong>. Antibiotic-recalcitrant recurrent urinary tract infection (rUTI) is has become increasingly observed in postmenopausal women. Therefore, when standard antibiotic therapies have failed, some elect electrofulguration (EF) of areas of chronic cystitis when detected on office cystoscopy. EF is thought to remove tissue-resident bacteria that have been previously detected in the bladder walls of postmenopausal women with rUTI. We hypothesized that increased bladder bacterial burden may be associated with incomplete rUTI resolution following EF. <strong>Methods</strong>. Following IRB approval, bladder biopsies were obtained from 34 consenting menopausal women electing EF for the advanced management of rUTI. 16S rRNA FISH was performed using both universal and <em>Escherichia</em> probes and tissue-resident bacterial load was quantified. Time to UTI relapse after EF was recorded during a six-month follow-up period and the association of bladder bacterial burden and clinical covariates with UTI relapse was assessed. <strong>Results</strong>. We observed bladder-resident <em>Escherichia</em> in 52% of all participants and in 92% of participants with recent <em>E. coli</em> UTI. Time-to-relapse analysis revealed that women with high bladder bacterial burden as detected by the universal probe had a significantly (p=0.035) higher risk of UTI within six months of EF (HR=3.15, 95% CI: 1.09-9.11). Interestingly, bladder-resident <em>Escherichia</em> was not significantly associated (p=0.26) with a higher risk of UTI relapse (HR= 2.14, 95% CI: 0.58-7.90). <strong>Conclusions</strong>. We observed that total bladder bacterial burden was associated with a 3.1x increased risk of rUTI relapse within six months. Continued analysis of the relationship between bladder bacterial burden and rUTI outcomes may provide insight into the management of these challenging patients.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141568629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1101/2024.06.30.24309735
Rahma Menshawey, Esraa Menshawey
Abstract Background: Testicular torsion is a true urological emergency that occurs when the testes twists around the spermatic cord, cutting off its blood supply. The failure to diagnose testicular torsion is a common medicolegal pitfall due to the uncertainty and urgency of the diagnosis and the potential for testicular loss. In this study, we examined the current medicolegal cases that involved testicular torsion using the LexisNexis database for all cases from 2014 to 2022, using the search terms testicular torsion and medical malpractice. Our final examination included a total of 20 cases. Results: Trends reveal that Emergency doctors and urologists are the most commonly named defendants. Adults and incarcerated persons are common plaintiffs. The average time from presentation to diagnosis of testicular torsion was 8+/-13 days. The right testicle was the most commonly implicated, and a misdiagnosis was a commonly cited. The average time from testicular torsion diagnosis to filing a case was 4.35 years. Conclusions: Trends reaffirm that testicular torsion remains a high risk of litigation diagnosis, and continued training and education may be needed to remedy the medicolegal pitfalls for this emergency condition. Keywords: Testicular Torsion, Litigation, Pediatric, Emergency, Malpractice, Medicolegal
{"title":"Knot Guilty? An Examination of Testicular Torsion Litigation Trends from 2014 to 2022","authors":"Rahma Menshawey, Esraa Menshawey","doi":"10.1101/2024.06.30.24309735","DOIUrl":"https://doi.org/10.1101/2024.06.30.24309735","url":null,"abstract":"Abstract Background: Testicular torsion is a true urological emergency that occurs when the testes twists around the spermatic cord, cutting off its blood supply. The failure to diagnose testicular torsion is a common medicolegal pitfall due to the uncertainty and urgency of the diagnosis and the potential for testicular loss. In this study, we examined the current medicolegal cases that involved testicular torsion using the LexisNexis database for all cases from 2014 to 2022, using the search terms testicular torsion and medical malpractice. Our final examination included a total of 20 cases. Results: Trends reveal that Emergency doctors and urologists are the most commonly named defendants. Adults and incarcerated persons are common plaintiffs. The average time from presentation to diagnosis of testicular torsion was 8+/-13 days. The right testicle was the most commonly implicated, and a misdiagnosis was a commonly cited. The average time from testicular torsion diagnosis to filing a case was 4.35 years.\u0000Conclusions: Trends reaffirm that testicular torsion remains a high risk of litigation diagnosis, and continued training and education may be needed to remedy the medicolegal pitfalls for this emergency condition. Keywords: Testicular Torsion, Litigation, Pediatric, Emergency, Malpractice, Medicolegal","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141516779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1101/2024.06.30.24309719
Syed Rohan Ali, Moosa Abdur Raqib, Shahida Kashif, Muhammad Ashir Shafique, Abdul Haseeb, Kainat Athar, Aisha Anis
Background: Catheter-associated urinary tract infections (CAUTIs) are a prevalent healthcare-associated infection, accounting for significant morbidity, mortality, and increased healthcare costs. Method: This is a cross-sectional study of patients diagnosed with UTI associated with catheter use. The sample was collected from November 2023 to June 2024, consisting of 200 patients admitted to the surgical, medical, and trauma wards of tertiary hospitals in Karachi, namely Jinnah Postgraduate Medical Centre Karachi and Dr. Ruth K. M. Pfau Civil Hospital Karachi. Data is analyzed using SPSS Version 22 and P-value of 0.05 considered significant. Result: The majority of respondents (59.5%) had their catheters changed since insertion, predominantly by trained nurses (93.0%). There were notable associations with underlying conditions such as hypertension (56.5%) and diabetes (44.5%). Gender differences were significant, with females leading in medical cases and males in surgical and trauma cases (p-value 0.017). Age-related trends showed the 55+ age group dominated medical cases, while surgical and trauma cases varied by age group. There was a significant relationship between bleeding during catheterization and UTI (p-value: 0.000). Conclusion: The study revealed a minimal incidence of CAUTI in Karachi's tertiary care hospitals, indicating effective practices. However, further research is needed to explore the potential risk factors identified, such as female gender and comorbidities, to develop targeted interventions for reducing CAUTI incidence and improving patient outcomes.
{"title":"Prevalence of catheter associated Urinary Tract Infection (UTI) in hospitalized patient in Karachi","authors":"Syed Rohan Ali, Moosa Abdur Raqib, Shahida Kashif, Muhammad Ashir Shafique, Abdul Haseeb, Kainat Athar, Aisha Anis","doi":"10.1101/2024.06.30.24309719","DOIUrl":"https://doi.org/10.1101/2024.06.30.24309719","url":null,"abstract":"Background: Catheter-associated urinary tract infections (CAUTIs) are a prevalent healthcare-associated infection, accounting for significant morbidity, mortality, and increased healthcare costs. Method: This is a cross-sectional study of patients diagnosed with UTI associated with catheter use. The sample was collected from November 2023 to June 2024, consisting of 200 patients admitted to the surgical, medical, and trauma wards of tertiary hospitals in Karachi, namely Jinnah Postgraduate Medical Centre Karachi and Dr. Ruth K. M. Pfau Civil Hospital Karachi. Data is analyzed using SPSS Version 22 and P-value of 0.05 considered significant.\u0000Result: The majority of respondents (59.5%) had their catheters changed since insertion, predominantly by trained nurses (93.0%). There were notable associations with underlying conditions such as hypertension (56.5%) and diabetes (44.5%). Gender differences were significant, with females leading in medical cases and males in surgical and trauma cases (p-value 0.017). Age-related trends showed the 55+ age group dominated medical cases, while surgical and trauma cases varied by age group. There was a significant relationship between bleeding during catheterization and UTI (p-value: 0.000).\u0000Conclusion: The study revealed a minimal incidence of CAUTI in Karachi's tertiary care hospitals, indicating effective practices. However, further research is needed to explore the potential risk factors identified, such as female gender and comorbidities, to develop targeted interventions for reducing CAUTI incidence and improving patient outcomes.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Prostate cancer is one of the most common malignant tumors and poses a substantial threat to human health. The PSA test is commonly used in prostate cancer screening, however its high rate of false-positive results causes unnecessary mental suffering, expensive examination costs, physical injury and other adverse consequences. Therefore, there is an urgent need to find a convenient, cost-effective and non-invasive diagnostic method to reduce the false-positive rate of PSA. This study aimed to assess the diagnostic value of YiDiXie™-SS in PSA-positive patients. Patients and methods: The study finally included 465 subjects with positive PSA test (prostate cancer group, n=292; BPH group, n=173). Remaining serum samples from the subjects were collected and tested with YiDiXie™ all-cancer detection kit. The sensitivity and specificity of YiDiXie™-SS were evaluated respectively. Results: The sensitivity of YiDiXie™-SS for the malignant group was 100% (95% CI: 98.7% - 100%; 292/292), with a false negative rate of 0 (95% CI: 0 - 1.3%; 0/292). The specificity of YiDiXie™-SS for the benign group was 57.2% (95% CI: 49.8% - 64.4%; 99/173), with a false positive rate of 42.8% (95% CI: 35.6% - 50.2%; 74/173). This means that YiDiXie™-SS reduces the false positive rate by 57.2% (95% CI: 49.8% - 64.4%; 99/173) with essentially no increase in malignancy leakage. Conclusion: YiDiXie™-SS significantly reduces the false-positive rate of PSA-positive patients without increasing the number of underdiagnosed malignant tumors. YiDiXie™-SS has vital diagnostic value in PSA-positive patients, and is expected to solve the problem of "high false-positive rate of PSA". Clinical trial number: ChiCTR2200066840. Key words: Prostate cancer, PSA, False-positive, YiDiXie™-SS
{"title":"Evaluation of the diagnostic value of YiDiXie™-SS in PSA-positive patients","authors":"Xutai Li, Zhenjian Ge, Qingshan Yang, Yutong Wu, Huimei Zhou, Chen Sun, Wenkang Chen, Yingqi Li, Shengjie Lin, Pengwu Zhang, Wuping Wang, Siwei Chen, Wei Li, Lingzhi Tao, Rong Huang, Liangchao Ni, Yongqing Lai","doi":"10.1101/2024.06.26.24309554","DOIUrl":"https://doi.org/10.1101/2024.06.26.24309554","url":null,"abstract":"Background: Prostate cancer is one of the most common malignant tumors and poses a substantial threat to human health. The PSA test is commonly used in prostate cancer screening, however its high rate of false-positive results causes unnecessary mental suffering, expensive examination costs, physical injury and other adverse consequences. Therefore, there is an urgent need to find a convenient, cost-effective and non-invasive diagnostic method to reduce the false-positive rate of PSA. This study aimed to assess the diagnostic value of YiDiXie™-SS in PSA-positive patients.\u0000Patients and methods: The study finally included 465 subjects with positive PSA test (prostate cancer group, n=292; BPH group, n=173). Remaining serum samples from the subjects were collected and tested with YiDiXie™ all-cancer detection kit. The sensitivity and specificity of YiDiXie™-SS were evaluated respectively.\u0000Results: The sensitivity of YiDiXie™-SS for the malignant group was 100% (95% CI: 98.7% - 100%; 292/292), with a false negative rate of 0 (95% CI: 0 - 1.3%; 0/292). The specificity of YiDiXie™-SS for the benign group was 57.2% (95% CI: 49.8% - 64.4%; 99/173), with a false positive rate of 42.8% (95% CI: 35.6% - 50.2%; 74/173). This means that YiDiXie™-SS reduces the false positive rate by 57.2% (95% CI: 49.8% - 64.4%; 99/173) with essentially no increase in malignancy leakage. Conclusion: YiDiXie™-SS significantly reduces the false-positive rate of PSA-positive patients without increasing the number of underdiagnosed malignant tumors. YiDiXie™-SS has vital diagnostic value in PSA-positive patients, and is expected to solve the problem of \"high false-positive rate of PSA\". Clinical trial number: ChiCTR2200066840.\u0000Key words: Prostate cancer, PSA, False-positive, YiDiXie™-SS","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1101/2024.06.14.24308947
Amador C Lagunas, Po-Ju Chen, Luis Ruiz, Amolak S Jhand, Nystha Baishya, Scott F Lempka, Priyanka Gupta, Tim M Bruns
Introduction: The factors that impact external anal sphincter (EAS) recruitment in clinical pudendal neuromodulation are not well understood. Therefore, the goal of this study was to identify and quantify physiological, demographic, and stimulation factors that significantly affect EAS recruitment in participants receiving pudendal neuromodulation for treatment of lower urinary tract symptoms. Methods: Demographic and diagnostic information were collected from participants upon entry to the study. MRI and CT were used to capture patient pudendal nerve anatomy and register the location of the implanted lead. EAS activation by pudendal nerve stimulation at different amplitudes and pulse widths was recorded during neurostimulator lead implantation in the operating room. Linear mixed modeling was used to quantify the impact each variable had on EAS recruitment in the sixteen enrolled participants. Results: Participant sex, age, and BMI did not significantly affect EAS recruitment with pudendal nerve stimulation. Participant diagnoses had significant relationships to EAS recruitment, likely due to unbalanced group sizes. A pulse width of 210 μs required significantly less current than 60 μs (p = 0.005) to activate the EAS at threshold and significantly less charge than 450 μs (p = 0.02) to activate the EAS at threshold. Increased distance between the stimulating electrode and the pudendal nerve decreased the magnitude of the EAS response (p = 0.0011) and increased EAS activation threshold (p < 0.001). Conclusions: Of the three tested pulse widths, 210 μs requires the least charge and is a good choice for stimulation. The distance between the electrode and pudendal nerve plays an important role in EAS and pudendal nerve recruitment and minimizing this distance should be a priority during lead implantation.
导言：在临床阴部神经调控中，影响肛门外括约肌（EAS）募集的因素尚不十分清楚。因此，本研究的目的是确定并量化对接受阴部神经调控治疗下尿路症状的参与者的肛门外括约肌募集有显著影响的生理、人口统计学和刺激因素：方法： 在参与者进入研究时收集其人口统计学和诊断信息。采用核磁共振成像（MRI）和计算机断层扫描（CT）捕捉患者的阴部神经解剖结构，并记录植入导线的位置。在手术室植入神经刺激器导线时，记录了不同振幅和脉宽的阴部神经刺激对 EAS 的激活情况。研究人员使用线性混合模型来量化每个变量对 16 名入选者 EAS 招募的影响：结果：参与者的性别、年龄和体重指数对阴部神经刺激的 EAS 招募没有显著影响。参与者的诊断与 EAS 招募有显著关系，这可能是由于不平衡的小组规模造成的。脉冲宽度为 210 μs 激活阈值 EAS 所需的电流明显少于 60 μs (p = 0.005)，激活阈值 EAS 所需的电荷明显少于 450 μs (p = 0.02)。刺激电极与阴部神经之间的距离增加会降低 EAS 反应的幅度（p = 0.0011）并提高 EAS 激活阈值（p < 0.001）：结论：在测试的三种脉冲宽度中，210 μs 所需的电荷最少，是刺激的良好选择。电极与阴部神经之间的距离在 EAS 和阴部神经募集中起着重要作用，因此在导联植入过程中应优先考虑最小化这一距离。
{"title":"Factors affecting anal sphincter recruitment during intraoperative pudendal nerve stimulation","authors":"Amador C Lagunas, Po-Ju Chen, Luis Ruiz, Amolak S Jhand, Nystha Baishya, Scott F Lempka, Priyanka Gupta, Tim M Bruns","doi":"10.1101/2024.06.14.24308947","DOIUrl":"https://doi.org/10.1101/2024.06.14.24308947","url":null,"abstract":"Introduction: The factors that impact external anal sphincter (EAS) recruitment in clinical pudendal neuromodulation are not well understood. Therefore, the goal of this study was to identify and quantify physiological, demographic, and stimulation factors that significantly affect EAS recruitment in participants receiving pudendal neuromodulation for treatment of lower urinary tract symptoms.\u0000Methods: Demographic and diagnostic information were collected from participants upon entry to the study. MRI and CT were used to capture patient pudendal nerve anatomy and register the location of the implanted lead. EAS activation by pudendal nerve stimulation at different amplitudes and pulse widths was recorded during neurostimulator lead implantation in the operating room. Linear mixed modeling was used to quantify the impact each variable had on EAS recruitment in the sixteen enrolled participants.\u0000Results: Participant sex, age, and BMI did not significantly affect EAS recruitment with pudendal nerve stimulation. Participant diagnoses had significant relationships to EAS recruitment, likely due to unbalanced group sizes. A pulse width of 210 μs required significantly less current than 60 μs (p = 0.005) to activate the EAS at threshold and significantly less charge than 450 μs (p = 0.02) to activate the EAS at threshold. Increased distance between the stimulating electrode and the pudendal nerve decreased the magnitude of the EAS response (p = 0.0011) and increased EAS activation threshold (p < 0.001).\u0000Conclusions: Of the three tested pulse widths, 210 μs requires the least charge and is a good choice for stimulation. The distance between the electrode and pudendal nerve plays an important role in EAS and pudendal nerve recruitment and minimizing this distance should be a priority during lead implantation.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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