Urine storage and excretion require a network of interactions in the urinary tract and the central nervous system (CNS), which is mediated by a reservoir of water in the bladder and the outlet to the bladder neck, urethra and external urethral sphincter. Through communicating and coordinating each other, micturition system eventually showed a switch-like activity pattern. At cervicothoracic and lumbosacral spine, the spinal reflex pathway of the lower urinary tract (LUT) received mechanosensory input from the urothelium to regulate the bladder contraction activity, thereby controlled urination voluntarily. Impairment of above-mentioned any level could result in lower urinary tract dysfunction (LUTD), placed a huge burden on patients and society. Specific expression of purinergic receptors and transient receptor potential (TRP) channels are thought to play an important role in urinary excretion in the lower urinary tract. This article reviewed the knowledge about the voiding reflex and described the role and function of TRP channels during voiding.
{"title":"Transient receptor potential channels in sensory mechanisms of the lower urinary tract.","authors":"Ruiqiang Gou, Yuanyuan Liu, Li Gou, Shengyan Mi, Xiaonan Li, Yichen Yang, Xiaorong Cheng, Yibao Zhang","doi":"10.1159/000538855","DOIUrl":"https://doi.org/10.1159/000538855","url":null,"abstract":"Urine storage and excretion require a network of interactions in the urinary tract and the central nervous system (CNS), which is mediated by a reservoir of water in the bladder and the outlet to the bladder neck, urethra and external urethral sphincter. Through communicating and coordinating each other, micturition system eventually showed a switch-like activity pattern. At cervicothoracic and lumbosacral spine, the spinal reflex pathway of the lower urinary tract (LUT) received mechanosensory input from the urothelium to regulate the bladder contraction activity, thereby controlled urination voluntarily. Impairment of above-mentioned any level could result in lower urinary tract dysfunction (LUTD), placed a huge burden on patients and society. Specific expression of purinergic receptors and transient receptor potential (TRP) channels are thought to play an important role in urinary excretion in the lower urinary tract. This article reviewed the knowledge about the voiding reflex and described the role and function of TRP channels during voiding.","PeriodicalId":509662,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662697","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}
Jakob Michaelis, Ruth Himmelsbach, Patrick Metzger, S. Lassmann, Melanie Börries, Martin Werner, C. Miething, Rouven Höfflin, A. Illert, J. Duyster, Heiko Becker, A. Sigle, Christian Gratzke, Markus Grabbert
PURPOSE Personalized medicine poses great opportunities and challenges. While therapeutic landscape markedly expands, descriptions about status, clinical implementation and real-world benefits of precision oncology and molecular tumor boards (MTB) remain sparse, particularly in the field of genitourinary (GU) cancer. Hence, this study characterized urological MTB cases to better understand the potential role of MTB in uro-oncology. METHODS We analyzed patients with complete data sets being reviewed at an MTB from January 2019 to October 2022, focusing on results of molecular analysis and treatment recommendations. RESULTS We evaluated 102 patients with GU cancer with a mean patient age of 61.7 years. Prostate cancer (PCa) was the most frequent entity with 52.9% (54/102), followed by bladder cancer (18.6%, 19/102) and renal cell carcinoma (14.7%, 15/102). On average, case presentation at MTB took place 54.9 months after initial diagnosis and after 2.7 previous lines of therapy. During the study period 49.0% (50/102) of patients deceased. Additional MTB-based treatment recommendations were achieved in a majority of 68.6% (70/102) of patients, with a recommendation for targeted therapy in 64.3% (45/70) of these patients. Only 6.7% (3/45) of patients - due to different reasons - received the recommended MTB-based therapy tough, with 33% (1/3) of patients reaching disease control. Throughout the MTB study period, GU cancer case presentations and treatment recommendations increased, while the time interval between initial presentation and final therapy recommendation were decreasing over time. CONCLUSION Presentation of uro-oncological patients at the MTB is a highly valuable measure for clinical decision-making. Prospectively, earlier presentation of patients at the MTB and changing legislative issues regarding comprehensive molecular testing and targeted treatment approval might further improve patients' benefits from comprehensive molecular diagnostics.
{"title":"Primary results of patients with genitourinary malignancies presented at a Molecular Tumor Board.","authors":"Jakob Michaelis, Ruth Himmelsbach, Patrick Metzger, S. Lassmann, Melanie Börries, Martin Werner, C. Miething, Rouven Höfflin, A. Illert, J. Duyster, Heiko Becker, A. Sigle, Christian Gratzke, Markus Grabbert","doi":"10.1159/000538908","DOIUrl":"https://doi.org/10.1159/000538908","url":null,"abstract":"PURPOSE\u0000Personalized medicine poses great opportunities and challenges. While therapeutic landscape markedly expands, descriptions about status, clinical implementation and real-world benefits of precision oncology and molecular tumor boards (MTB) remain sparse, particularly in the field of genitourinary (GU) cancer. Hence, this study characterized urological MTB cases to better understand the potential role of MTB in uro-oncology.\u0000\u0000\u0000METHODS\u0000We analyzed patients with complete data sets being reviewed at an MTB from January 2019 to October 2022, focusing on results of molecular analysis and treatment recommendations.\u0000\u0000\u0000RESULTS\u0000We evaluated 102 patients with GU cancer with a mean patient age of 61.7 years. Prostate cancer (PCa) was the most frequent entity with 52.9% (54/102), followed by bladder cancer (18.6%, 19/102) and renal cell carcinoma (14.7%, 15/102). On average, case presentation at MTB took place 54.9 months after initial diagnosis and after 2.7 previous lines of therapy. During the study period 49.0% (50/102) of patients deceased. Additional MTB-based treatment recommendations were achieved in a majority of 68.6% (70/102) of patients, with a recommendation for targeted therapy in 64.3% (45/70) of these patients. Only 6.7% (3/45) of patients - due to different reasons - received the recommended MTB-based therapy tough, with 33% (1/3) of patients reaching disease control. Throughout the MTB study period, GU cancer case presentations and treatment recommendations increased, while the time interval between initial presentation and final therapy recommendation were decreasing over time.\u0000\u0000\u0000CONCLUSION\u0000Presentation of uro-oncological patients at the MTB is a highly valuable measure for clinical decision-making. Prospectively, earlier presentation of patients at the MTB and changing legislative issues regarding comprehensive molecular testing and targeted treatment approval might further improve patients' benefits from comprehensive molecular diagnostics.","PeriodicalId":509662,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698640","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}
Maximilian Reinhard Müller, Eva-Maria Prey, Philipp Julian Spachmann, C. Goßler, Maximilian Burger, M. Schnabel
Purpose To assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection (UTI) undergoing a ureterorenoscopy (URS) for stone removal. Patients and Methods A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship (ABS). Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for ureterorenoscopic stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis was standard of care. Analysis focused on postoperative complications. Results Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p= 0.589). Clavien 1-3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p= 0.159). No Clavien 4-5 complications were seen. We identified a residual stone (p=0.033) and an ASA-Score 3-4 (p=0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). Conclusion Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.
{"title":"Ureterorenoscopic stone removal without antibiotic prophylaxis.","authors":"Maximilian Reinhard Müller, Eva-Maria Prey, Philipp Julian Spachmann, C. Goßler, Maximilian Burger, M. Schnabel","doi":"10.1159/000538856","DOIUrl":"https://doi.org/10.1159/000538856","url":null,"abstract":"Purpose To assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection (UTI) undergoing a ureterorenoscopy (URS) for stone removal. Patients and Methods A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship (ABS). Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for ureterorenoscopic stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis was standard of care. Analysis focused on postoperative complications. Results Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p= 0.589). Clavien 1-3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p= 0.159). No Clavien 4-5 complications were seen. We identified a residual stone (p=0.033) and an ASA-Score 3-4 (p=0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). Conclusion Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.","PeriodicalId":509662,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697665","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}
INTRODUCTION To examine whether disinfection of Bacillus Calmette-Guerin -containing urine with etaprocohol® (Ethanol 76.9-81.4 vol % and isopropanol as an additive) is safer than disinfection with sodium hypochlorite. METHOD In prospective research, safety, and efficacy was analyzed in five patients in the etaprocohol® disinfection group and five patients in the sodium hypochlorite disinfection group. The primary endpoint was the temperature change after disinfection and the secondary endpoint was the unpleasantness of the odor caused by disinfection. Additionally, concentration of gas produced was also examined. Sensory tests were taken from staff who performed urine disinfection and the odor generated by disinfection was evaluated. As a safety protocol, post-BCG-treated urine is cultured to verify the negative for Mycobacteria. RESULTS Mycobacteria was disinfected in all cases. The temperature rise following disinfection was significantly higher in the sodium hypochlorite group. The sensory test outcomes were significantly worse in the group disinfected with sodium hypochlorite. The concentration of gas generated immediately after disinfection in both groups reached the maximum value and declined quickly. CONCLUSIONS Disinfection of Bacillus Calmette-Guerin -containing urine with etaprocohol® was safer than disinfection with sodium hypochlorite, and an equivalent disinfection effect was achieved.
{"title":"A safer method for disinfection of Bacillus Calmette-Guerin-containing urine: a prospective, randomized study.","authors":"Tomohiro Kameda, Yoshimasa Kondo, Yasuko Fukataki, Shiro Hinotsu, Tetsuya Fujimura, Tatsuya Takayama","doi":"10.1159/000538758","DOIUrl":"https://doi.org/10.1159/000538758","url":null,"abstract":"INTRODUCTION\u0000To examine whether disinfection of Bacillus Calmette-Guerin -containing urine with etaprocohol® (Ethanol 76.9-81.4 vol % and isopropanol as an additive) is safer than disinfection with sodium hypochlorite.\u0000\u0000\u0000METHOD\u0000In prospective research, safety, and efficacy was analyzed in five patients in the etaprocohol® disinfection group and five patients in the sodium hypochlorite disinfection group. The primary endpoint was the temperature change after disinfection and the secondary endpoint was the unpleasantness of the odor caused by disinfection. Additionally, concentration of gas produced was also examined. Sensory tests were taken from staff who performed urine disinfection and the odor generated by disinfection was evaluated. As a safety protocol, post-BCG-treated urine is cultured to verify the negative for Mycobacteria.\u0000\u0000\u0000RESULTS\u0000Mycobacteria was disinfected in all cases. The temperature rise following disinfection was significantly higher in the sodium hypochlorite group. The sensory test outcomes were significantly worse in the group disinfected with sodium hypochlorite. The concentration of gas generated immediately after disinfection in both groups reached the maximum value and declined quickly.\u0000\u0000\u0000CONCLUSIONS\u0000Disinfection of Bacillus Calmette-Guerin -containing urine with etaprocohol® was safer than disinfection with sodium hypochlorite, and an equivalent disinfection effect was achieved.","PeriodicalId":509662,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711702","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}
Phirawat Phromprathum, S. Srinualnad, S. Leewansangtong, T. Taweemonkongsap, Kittipong Phinthusophon, S. Jitpraphai, Patkawat Ramart, V. Woranisarakul, C. Suk-ouichai, Thawatchai Mankongsrisuk, T. Hansomwong, Kantima Jongjitaree, E. Chotikawanich
INTRODUCTION Disposable (single-use) flexible ureteroscopes are alternatives to reusable ureteroscopes. With their superior surgical efficacy and safety in the presence of upper urinary calculi, disposable ureteroscopes aim to overcome the main limitations of conventional reusable ureteroscopes. However, studies on the performance of the most recently developed models of single-use flexible ureteroscopes are scarce. This study aimed to compare the in vitro performance of several recently introduced, single-use, flexible ureteroscopes. METHODS Five disposable flexible ureteroscopes were tested in vitro to evaluate their mechanical and optical characteristics. To this end, their degrees of deflection, irrigation flow rates, and image qualities were investigated. The models examined were Innovex US31-B12, OTU-100RR, Redpine RP-U-C12, Sciavita SUV-2A-B, and Seplou URS3016E. Their performance was also compared with that of a reusable flexible ureteroscope, Olympus URV-F. RESULTS The OTU device had the highest degrees of deflection and the smallest loop diameter of the disposable ureteroscopes. The single-use ureteroscopes had identical image resolutions at a distance of 1 cm. The Innovex and Redpine devices had the best color representation. CONCLUSIONS Of the tested disposable ureteroscopes, the OTU device had the best mechanical attributes, given its small loop diameter, high deflection angles, and low irrigation flow loss. As to their optical properties, the resolutions of all 5 single-use models were identical at an image distance of 1 cm.
{"title":"In vitro comparison of the mechanical and optical characteristics of 5 disposable flexible ureteroscopes.","authors":"Phirawat Phromprathum, S. Srinualnad, S. Leewansangtong, T. Taweemonkongsap, Kittipong Phinthusophon, S. Jitpraphai, Patkawat Ramart, V. Woranisarakul, C. Suk-ouichai, Thawatchai Mankongsrisuk, T. Hansomwong, Kantima Jongjitaree, E. Chotikawanich","doi":"10.1159/000538760","DOIUrl":"https://doi.org/10.1159/000538760","url":null,"abstract":"INTRODUCTION\u0000Disposable (single-use) flexible ureteroscopes are alternatives to reusable ureteroscopes. With their superior surgical efficacy and safety in the presence of upper urinary calculi, disposable ureteroscopes aim to overcome the main limitations of conventional reusable ureteroscopes. However, studies on the performance of the most recently developed models of single-use flexible ureteroscopes are scarce. This study aimed to compare the in vitro performance of several recently introduced, single-use, flexible ureteroscopes.\u0000\u0000\u0000METHODS\u0000Five disposable flexible ureteroscopes were tested in vitro to evaluate their mechanical and optical characteristics. To this end, their degrees of deflection, irrigation flow rates, and image qualities were investigated. The models examined were Innovex US31-B12, OTU-100RR, Redpine RP-U-C12, Sciavita SUV-2A-B, and Seplou URS3016E. Their performance was also compared with that of a reusable flexible ureteroscope, Olympus URV-F.\u0000\u0000\u0000RESULTS\u0000The OTU device had the highest degrees of deflection and the smallest loop diameter of the disposable ureteroscopes. The single-use ureteroscopes had identical image resolutions at a distance of 1 cm. The Innovex and Redpine devices had the best color representation.\u0000\u0000\u0000CONCLUSIONS\u0000Of the tested disposable ureteroscopes, the OTU device had the best mechanical attributes, given its small loop diameter, high deflection angles, and low irrigation flow loss. As to their optical properties, the resolutions of all 5 single-use models were identical at an image distance of 1 cm.","PeriodicalId":509662,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719170","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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