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Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes. 用于机器人辅助肾部分切除术的达芬奇和雨果 RAS 平台:初步前瞻性结果比较分析。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-17 DOI: 10.23736/S2724-6051.24.05623-4
Esther García Rojo, Vital Hevia Palacios, Ricardo Brime Menendez, Javier A Feltes Ochoa, Juan Justo Quintas, Fernando Lista Mateos, Karim Touijer, Javier Romero Otero

Background: Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system.

Methods: A prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses.

Results: The average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93).

Conclusions: Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.

背景:机器人辅助肾部分切除术(RAPN)已成为治疗T1肾细胞癌的首选方法。随着Hugo RAS等新型机器人平台的出现,我们试图了解它们在实现与成熟的达芬奇系统类似的RAPN结果方面的潜力:方法:我们进行了一项前瞻性单中心比较研究,共选取了50例RAPN患者(25例达芬奇Xi;25例雨果RAS)。机器人系统的选择完全基于医院的后勤标准。手术由专家外科医生实施。收集了人口统计学数据、肿瘤特征、手术细节和术后结果。统计分析采用 SPSS 22.0 版:患者的平均年龄为(62.52±9.47)岁,各组的中位年龄、性别和肾功能评分无明显差异。达芬奇组的对接时间明显更短(12.56 分钟对 20.08 分钟;PC 结论:初步研究结果表明,使用雨果RAS与达芬奇系统相比,RAPN的围手术期结果相似。有必要进一步开展长期随访研究,以评估肿瘤和功能方面的结果。
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引用次数: 0
Comparison of 24-hour urine composition prior to and after stone removal in nephrolithiasis: a prospective observational study. 肾炎患者排石前后 24 小时尿液成分的比较:一项前瞻性观察研究。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-06-01 Epub Date: 2023-02-13 DOI: 10.23736/S2724-6051.22.05164-3
Wei Zhu, Xin Zhang, Suilin Lu, Mehmet Özsoy, Zhen Zhou, Zhicong Huang, Guoyao Ai, Guohua Zeng

Background: To evaluate 24-hour urine composition prior to and after complete stone removal in nephrolithiasis patients to determine potential relationship between kidney stones and patient metabolic status.

Methods: A prospective observational study was performed with patient enrollment from March 2019 to August 2020. 24-hour urine samples were collected prior to stone removal and 4 weeks after double-J stent removal, and examined the following urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium, and pH value. For each parameter, pairwise t test was performed to compare samples prior to and after stone removal. The number of cases that changed from normal to abnormal or vice versa was also evaluated for each parameter. The study was registered at http://clinicaltrials.gov/ (NCT03846011).

Results: A total of 109 patients completed 24-hour urine collections prior to and after stone removal. The urinary calcium and phosphate levels increased significantly after stone removal, showing a mean difference of 0.55 mmol (P=0.015) and 2.35 mmol (P=0.001) respectively. None of the other urinary parameters demonstrated a statistically significant difference when means were compared. The percentage differences for all urinary parameters ranged from 5.4% to 14.1%. The percentages of patients that presented clinically significant changes in urinary parameter values from normal to abnormal or vice versa ranged from 4.6% to 20.1%.

Conclusions: Ideally, evaluation of 24-hour urine compositions should be undertaken after total stone removal, especially for patients with calcium stones. For patients who cannot achieve total stone removal, 24-hour urine samples should be thoroughly interpreted as urinary calcium and phosphate levels might be depleted in the presence of urinary stones.

背景:评估肾结石患者在结石完全排出之前和之后的 24 小时尿液成分:目的:评估肾结石患者在完全清除结石之前和之后的 24 小时尿液成分,以确定肾结石与患者代谢状况之间的潜在关系:从 2019 年 3 月至 2020 年 8 月对患者进行了前瞻性观察研究。在结石取出前和双 J 支架取出后 4 周收集 24 小时尿样,并检查以下尿液参数:尿量、肌酐、钠、钙、尿酸、柠檬酸盐、草酸盐、钾、磷、镁和 pH 值。对每个参数都进行了成对 t 检验,以比较取石前后的样本。此外,还评估了每项参数由正常变为异常或由异常变为正常的病例数。该研究已在 http://clinicaltrials.gov/(NCT03846011)上注册:共有 109 名患者在取石前后完成了 24 小时尿液采集。取石后,尿钙和磷酸盐水平明显升高,平均值分别为 0.55 mmol(P=0.015)和 2.35 mmol(P=0.001)。在比较平均值时,其他尿液参数均未显示出明显的统计学差异。所有尿液参数的百分比差异从 5.4% 到 14.1% 不等。尿液参数值从正常到异常或从异常到正常的临床显著变化的患者百分比从 4.6% 到 20.1% 不等:结论:理想情况下,在完全清除结石后,应评估 24 小时尿液成分,尤其是钙结石患者。结论:理想情况下,应在结石完全清除后对 24 小时尿液成分进行评估,尤其是钙结石患者。对于无法完全清除结石的患者,应全面解读 24 小时尿液样本,因为尿液中的钙和磷酸盐水平可能会因结石的存在而降低。
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引用次数: 0
URS for de-novo urolithiasis after kidney transplantation: a systematic review of the literature. 肾移植后新发尿路结石的尿路造影术:文献系统回顾。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-31 DOI: 10.23736/S2724-6051.24.05683-0
Clara Cerrato, Carlotta Nedbal, Victoria Jahrreiss, Francesco Ripa, Vincenzo DE Marco, Manoj Monga, Belthangady M Hameed, Peter Kronenberg, Amelia Pietropaolo, Nitesh Naik, Bhaskar Somani

Introduction: There is a gap in the available literature and guidelines concerning the optimal approach for treating allograft stones, which currently include external shockwave lithotripsy, ureteroscopy and laser lithotripsy, or percutaneous nephrolithotomy. The objective of this systematic review was to evaluate the safety and effectiveness of URS as a treatment option for patients in this scenario.

Evidence acquisition: A comprehensive search of the literature was conducted until August 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023451154).

Evidence synthesis: Eleven articles were included (122 patients). The mean age was 46.9±9.5 years, with a male-to-female ratio of 62:49. The preferred ureteral reimplantation technique was the Lich-Gregoire. The mean onset time was 48.24 months. Acute kidney injury, urinary tract infections and fever were the most frequent clinical presentations (18.3% each), followed by hematuria (10%). The mean stone size measured 9.84 mm (±2.42 mm). Flexible URS was preferred over semirigid URS. The stone-free rate stood at 83.35%, while the overall complication rate was 13.93%, with six (4.9%) major complications reported. Stones were mainly composed of calcium oxalate (42.6%) or uric acid (14.8%). Over an average follow-up period of 30.2 months, the recurrence rate was 2.46%. No significant changes in renal function or allograft loss were reported.

Conclusions: URS remains an efficient choice for addressing de-novo allograft urolithiasis, offering the advantage of treating urinary stones with a good SFR and a low incidence of complications. Procedures should be performed in an Endourology referral center.

导言:目前,治疗同种异体结石的最佳方法包括体外冲击波碎石、输尿管镜检查和激光碎石或经皮肾镜取石术。本系统性综述的目的是评估尿路碎石术作为这种情况下患者的治疗方案的安全性和有效性:对截至 2023 年 8 月的文献进行了全面检索。仅考虑纳入以英语撰写的原创文章。本综述已在 PROSPERO 注册(注册号为 CRD42023451154):共纳入 11 篇文章(122 名患者)。平均年龄为 46.9±9.5 岁,男女比例为 62:49。首选的输尿管再植技术是Lich-Gregoire技术。平均发病时间为 48.24 个月。急性肾损伤、尿路感染和发热是最常见的临床表现(各占18.3%),其次是血尿(10%)。结石的平均大小为 9.84 毫米(±2.42 毫米)。与半硬性尿路造影术相比,患者更倾向于采用软性尿路造影术。无结石率为 83.35%,总并发症率为 13.93%,其中主要并发症有 6 例(4.9%)。结石主要由草酸钙(42.6%)或尿酸(14.8%)组成。平均随访时间为 30.2 个月,复发率为 2.46%。肾功能和异体移植损失均无明显变化:结论:URS仍是治疗新发异体尿路结石的有效选择,其优势在于治疗尿路结石的SFR良好,并发症发生率低。手术应在内科转诊中心进行。
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引用次数: 0
Application of AI in urolithiasis risk of infection: a scoping review. 人工智能在泌尿系结石感染风险中的应用:范围综述。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-06-01 DOI: 10.23736/S2724-6051.24.05686-6
Davide Campobasso, Matteo Panizzi, Valentina Bellini, Stefania Ferretti, Daniele Amparore, Daniele Castellani, Cristian Fiori, Stefano Puliatti, Amelia Pietropaolo, Bhaskar K Somani, Salvatore Micali, Francesco Porpiglia, Umberto V Maestroni, Elena G Bignami

Introduction: Artificial intelligence and machine learning are the new frontier in urology; they can assist the diagnostic work-up and in prognostication bring superior to the existing nomograms. Infectious events and in particular the septic risk, are one of the most common and in some cases life threatening complication in patients with urolithiasis. We performed a scoping review to provide an overview of the current application of AI in prediction the infectious complications in patients affected by urolithiasis.

Evidence acquisition: A systematic scoping review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) guidelines by screening Medline, PubMed, and Embase to detect pertinent studies.

Evidence synthesis: A total of 467 articles were found, of which nine met the inclusion criteria and were considered. All studies are retrospective and published between 2021 and 2023. Only two studies performed an external validation of the described models. The main event considered is urosepsis in four articles, urinary tract infection in two articles and diagnosis of infection stones in three articles. Different AI models were trained, each of which exploited several types and numbers of variables. All studies reveal good performance. Random forest and artificial neural networks seem to have higher AUC, specificity and sensibility and perform better than the traditional statistical analysis.

Conclusions: Further prospective and multi-institutional studies with external validation are needed to better clarify which variables and AI models should be integrated in our clinical practice to predict infectious events.

简介人工智能和机器学习是泌尿外科的新前沿;它们可以协助诊断工作,并在预后方面优于现有的提名图。感染事件,尤其是脓毒症风险,是泌尿系结石患者最常见的并发症之一,在某些情况下甚至危及生命。我们对人工智能在预测泌尿系结石患者感染并发症方面的应用进行了一次范围性综述:证据综述:我们根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews,PRISMA-ScR)指南,通过筛选 Medline、PubMed 和 Embase 来检测相关研究,对文献进行了系统的范围界定综述:共找到 467 篇文章,其中 9 篇符合纳入标准并被考虑。所有研究均为回顾性研究,发表于 2021 年至 2023 年之间。只有两项研究对所述模型进行了外部验证。四篇文章考虑的主要事件是尿毒症,两篇文章考虑的主要事件是尿路感染,三篇文章考虑的主要事件是感染结石的诊断。对不同的人工智能模型进行了训练,每个模型都利用了多种类型和数量的变量。所有研究都显示出良好的性能。随机森林和人工神经网络似乎具有更高的AUC、特异性和敏感性,比传统的统计分析方法表现更好:需要进一步开展具有外部验证的前瞻性多机构研究,以更好地明确哪些变量和人工智能模型应纳入我们的临床实践,用于预测感染性事件。
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引用次数: 0
Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group). 机器人远端输尿管切除术治疗高风险远端输尿管尿路上皮癌:回顾性多中心比较分析(ROBUUST 2.0协作组)。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-06-01 DOI: 10.23736/S2724-6051.24.05737-9
Francesco Ditonno, Antonio Franco, Alessandro Veccia, Eugenio Bologna, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio DE Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Andres Brönimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Chandru P Sundaram, Zhenjie Wu, Hooman Djaladat, Alessandro Antonelli, Riccardo Autorino

Background: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors.

Methods: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.

Results: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.

Conclusions: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.

背景:保肾手术在高风险上尿路尿路上皮癌患者中的作用存在争议。本研究旨在评估机器人辅助远端输尿管肿瘤切除术在高危远端输尿管肿瘤患者中的肿瘤学和功能预后:这项回顾性队列分析采用了ROBUUST 2.0多中心国际数据集(2015-2022年)。输尿管远端肿瘤高危患者根据手术类型分为:机器人辅助输尿管远端切除术或机器人辅助肾切除术。对无局部复发生存率、无远处转移生存率和总生存率进行了生存分析。在对高危预后组的临床特征进行调整后,绘制了Cox比例危险模型,以评估从时间到事件结果的重要预测因素:结果:总共有477名患者接受了机器人辅助远端尿道切除术,其中58人接受了机器人辅助肾切除术,419人接受了机器人辅助肾切除术,平均(±SD)随访时间为29.6个月(±2.6)。两组患者的基线特征相当。在生存率分析中,机器人辅助远端泌尿系切除术和机器人辅助肾切除术的无复发生存率(P=0.6)、无转移生存率(P=0.5)和总生存率(P=0.7)均无明显差异。在Cox回归分析中,手术类型从来都不是较差肿瘤预后的重要预测因素。在最后一次随访中,接受机器人辅助远端尿道切除术的患者术后肾功能明显更好:结论:机器人辅助远端尿道切除术和机器人辅助肾切除术患者的无复发生存率、无转移生存率和总生存率相当,前者术后肾功能保留更好。对于选定的高风险输尿管远端UTUC患者,应考虑将保肾手术作为一种可能的选择。
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引用次数: 0
A new alternative approach to management of acute phase Peyronie's disease: low intensity extracorporeal shockwave therapy and platelet-rich plasma. 治疗急性期佩罗尼氏病的另一种新方法:低强度体外冲击波疗法和富血小板血浆。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2023-12-13 DOI: 10.23736/S2724-6051.23.05458-7
Ayhan Karakose, Yasin Yitgin

Background: The aim of this study was to investigate the efficacy, safety, and outcomes of the combination of low ıntensity external shock wave therapy (Li-ESWT) and platelet-rich plasma (PRP) therapy in acute phase Peyronie's disease (PD).

Methods: The datas of patients admitted with acute phase Peyronie's between January 2014 and January 2022 were reviewed retrospectively. In total, we included total 159 patients who used combination of vitamin E 600 mg/day plus colchicine 1.5 mg/day plus oral daily 5 mg tadalafil (N.=77) in group 1 and received Li-ESWT+PRP combination therapy plus oral daily 5 mg tadalafil (N.=82) in group 2. We noted characteristics of fibrous plaques, pain status, penile curvature degree, and erectile function parameters. All patients were visited at the 3rd and 12th months after the treatment.

Results: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in the mean plaque size, penile curvature degree, IIEF-5 and VAS scores in the intervention group after the treatment. Ecchymosis and hematoma were not observed at the injection site and Li-ESWT application areas in the intervention group. No local or systemic drug reactions were noted in either group.

Conclusions: Combination of Li-ESWT and PRP are highly effective and safety to early treatment in the acute phase PD.

研究背景本研究旨在探讨低强度体外冲击波疗法(Li-ESWT)和富血小板血浆疗法(PRP)联合治疗急性期佩罗尼氏病(PD)的疗效、安全性和结果:回顾性分析2014年1月至2022年1月期间收治的急性期佩罗尼氏病患者的数据。我们共纳入了159名患者,其中第1组患者使用维生素E 600 mg/天+秋水仙碱1.5 mg/天+每日口服5 mg他达拉非(N=77)的组合疗法,第2组患者接受Li-ESWT+PRP组合疗法+每日口服5 mg他达拉非(N=82)的组合疗法,我们记录了纤维斑块的特征、疼痛状况、阴茎弯曲程度和勃起功能参数。所有患者均在治疗后第3个月和第12个月接受了回访:结果:两组患者术前的人口统计学特征相似。结果:两组患者术前人口统计学特征相似,治疗后干预组患者的平均斑块大小、阴茎弯曲度、IIEF-5 和 VAS 评分均有明显改善。干预组的注射部位和Li-ESWT应用区域未观察到瘀斑和血肿。两组均未发现局部或全身药物反应:结论:Li-ESWT和PRP联合疗法对急性期脊髓灰质炎的早期治疗非常有效和安全。
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引用次数: 0
Development and validation of a predictive model for post-percutaneous nephrolithotomy urinary sepsis: a multicenter retrospective study. 经皮肾取石术后尿路败血症预测模型的开发和验证:一项多中心回顾性研究。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-06-01 Epub Date: 2023-10-23 DOI: 10.23736/S2724-6051.23.05396-X
Leibo Wang, Daobing Li, Wei He, Guanyu Shi, Jianpo Zhai, Zhuangding Cen, Feng Xu, Hao Xie, Zhibing Yu, Guoqiang Zhao, Chishou Mo, Qi Lv, Wu Tian

Background: The objective of this retrospective, multicenter study was to analyze the factors associated with the development of urogenital sepsis after percutaneous nephrolithotomy (PCNL) and to establish a nomogram prediction model of urogenital sepsis after PCNL.

Methods: A total of 2066 postoperative PCNL patients were included from three medical institutions: Zunyi Medical University Hospital, Beijing Jishuitan Hospital Guizhou Hospital, and Fenggang County People's Hospital. Clinical data of 1623 patients from the Department of Urology of Zunyi Medical University Hospital were randomized into a training cohort (Zunyi training cohort, N.=1139) and an internal validation cohort (Zunyi internal validation cohort, N.=484) using computer generated random numbers in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the compliance training cohort to identify risk factors for urogenital sepsis after PCNL and to develop a column line graph prediction model based on these risk factors. Finally, Zunyi internal validation cohort and two external validation cohorts (Guiyang external cohort, N.=306; Fenggang external cohort, N.=137) were used to validate the prognostic accuracy of the nomogram prediction model. R4.2.2 statistical software was used for all statistical data analyses.

Results: Multifactorial logistic regression analysis of the Zuiyi training cohort (N.=1139) identified five independent risk factors associated with urogenital sepsis after PCNL, including urine culture positivity (odds ratio [OR]=5.29, P<0.001), urine nitrite positivity (OR=5.97, P<0.001), operation time ≥60 min (OR=4.4, P=0.0037), residual stone (OR=5.18, P<0.001), and size ≥30 mm (OR=3.22, P=0.0086). Nomogram were constructed based on these independent risk factors. The area under the curve (AUC) of the nomogram model was 0.907 in the in-progress sample and 0.948 after internal validation. The AUC of the model was 0.855 and 0.804 after external validation of the Guiyang external validation cohort and the Fenggang validation cohort, respectively, indicating good discrimination ability. The calibration curves of the nomogram showed good agreement, and the decision curve analysis demonstrated high clinical utility.

Conclusions: Based on the clinical independent risk factors such as positive urine culture, positive urine nitrite, operation time ≥60min, stone residue, stone size ≥30mm, nomogram prediction model of urogenital sepsis after PCNL was established, which can provide reference for urologists to develop preoperative evaluation and treatment strategies for patients with percutaneous nephrolithotomy.

背景:本回顾性多中心研究的目的是分析经皮肾取石术(PCNL)后发生泌尿生殖道败血症的相关因素,并建立PCNL后泌尿生殖道脓毒症的列线图预测模型。方法:选择遵义医科大学医院、北京积水潭医院贵州医院、凤冈县人民医院三家医疗机构2066例术后PCNL患者。来自遵义医科大学医院泌尿外科的1623名患者的临床数据被随机分为训练队列(遵义训练队列,N=1139)和内部验证队列(遵义内部验证队列,N=484),使用计算机生成的随机数,按7:3的比例。对依从性训练队列进行单变量和多变量逻辑回归分析,以确定PCNL后泌尿生殖道败血症的风险因素,并基于这些风险因素建立柱线图预测模型。最后,遵义内部验证队列和两个外部验证队列(贵阳外部队列,N=306;凤岗外部队列,N=137)用于验证列线图预测模型的预后准确性。R4.2.2所有统计数据分析均使用统计软件。结果:醉医训练队列(N=1139)的多因素logistic回归分析确定了5个与PCNL后泌尿生殖道败血症相关的独立危险因素,包括尿液培养阳性(比值比[OR]=5.29,P结论:根据尿培养阳性、尿亚硝酸盐阳性、手术时间≥60min、结石残留、结石大小≥30mm等临床独立危险因素,建立PCNL后泌尿生殖道败血症的诺模图预测模型,为泌尿科医师制定经皮肾取石术前评估和治疗策略提供参考。
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引用次数: 0
Application of the ERAS guidelines in pediatric urological surgery: a systematic review. ERAS指南在小儿泌尿外科手术中的应用:系统回顾。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-06-01 DOI: 10.23736/S2724-6051.24.05511-3
Judith Stangl-Kremser, Laura Olivera, Sofia Giudici, Benjamin Pradere, Laura S Mertens, Simone Albisinni, Ekaterina Laukhtina, Francesco Del Giudice, Luca Afferi, Francesco Soria, Simone Sforza, Fardod O'Kelly, Rianne J Lammers, Mesrur S Silay, Andrea Minervini, Lorenzo Masieri, Ardavan Akhavan, Lisette A 't Hoen, Marco Moschini, Andrea Mari

Introduction: Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.

Evidence acquisition: A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.

Evidence synthesis: Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.

Conclusions: There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.

导言:新生儿肠道手术已就儿科术后加强恢复(ERAS)达成共识,但在小儿泌尿外科尚未广泛应用。我们调查了ERAS指南在小儿泌尿外科中的应用情况,并根据支持儿童ERAS方案的现有证据水平确定了其效果:我们进行了一项系统性文献综述,其中包括在小儿泌尿外科手术中采用快速恢复方案的系列研究。主要结果指标包括研究特点、ERAS 19 个项目的遵守情况、并发症发生率和住院时间。根据手术类型(尿道下裂与大手术)进行了分组分析:共纳入了9个系列的1272例儿科手术数据。67.3%的报告采用了强化恢复路径。有两个系列研究包括尿道下裂修补术患者,ERAS项目报告不足。包括接受大型手术的儿童在内的研究提到的 ERAS 项目中位数为 15 个,但应用的项目中位数为 11 个。符合率中位数为88.9%(范围为50-100)。最近发表的研究报告(应用或提及)了更多的ERAS指南项目:结论:ERAS指南在泌尿外科手术,尤其是尿道下裂修补术中的报道和使用有限;而在儿童大手术中,遵守率和符合率差异很大。在最近的系列研究中,提及和应用ERAS的项目有所增加。未来的研究需要找出障碍并加以克服,以便全面采用ERAS途径并从中受益。
{"title":"Application of the ERAS guidelines in pediatric urological surgery: a systematic review.","authors":"Judith Stangl-Kremser, Laura Olivera, Sofia Giudici, Benjamin Pradere, Laura S Mertens, Simone Albisinni, Ekaterina Laukhtina, Francesco Del Giudice, Luca Afferi, Francesco Soria, Simone Sforza, Fardod O'Kelly, Rianne J Lammers, Mesrur S Silay, Andrea Minervini, Lorenzo Masieri, Ardavan Akhavan, Lisette A 't Hoen, Marco Moschini, Andrea Mari","doi":"10.23736/S2724-6051.24.05511-3","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05511-3","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children.</p><p><strong>Evidence acquisition: </strong>A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed.</p><p><strong>Evidence synthesis: </strong>Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies.</p><p><strong>Conclusions: </strong>There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 3","pages":"271-277"},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review. 机器人辅助腹股沟淋巴结切除术治疗阴茎癌和外阴癌:范围界定综述。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-06-01 DOI: 10.23736/S2724-6051.24.05532-0
Aldo Brassetti, Giuseppe Chiacchio, Umberto Anceschi, Alfredo Bove, Mariaconsiglia Ferriero, Simone D'Annunzio, Leonardo Misuraca, Salvatore Guaglianone, Gabriele Tuderti, Riccardo Mastroianni, Francesco Tedesco, Loris Cacciatore, Flavia Proietti, Simone R Flammia, Cosimo De Nunzio, Gabriele Cozzi, Costantino Leonardo, Andrea B Galosi, Giuseppe Simone

Introduction: Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL).

Evidence acquisition: On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement.

Evidence synthesis: Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients.

Conclusions: The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.

简介:高危阴茎癌(PC)或外阴癌(VC)患者建议进行腹股沟淋巴结清扫术(ILND)。然而,由于其预期的发病率,这种手术方法的使用率并不高。为了最大限度地减少与开放手术相关的并发症,人们提出了微创方法。在这篇综述中,我们分析了探讨机器人辅助ILND(RAIL)术中和围手术期结果的现有数据:2023 年 4 月 9 日,我们使用 PubMed 和 Scopus 数据库进行了文献检索。检索采用了以下术语组合:("机器人辅助 "或 "机器人辅助 "或 "机器人")和("腹股沟淋巴结清扫术 "或 "淋巴结切除术")和("阴茎癌 "或 "外阴癌")。在确定的 404 篇文章中,有 18 篇用于本次范围界定综述,其结果按照 PRISMA 声明进行了报告:获得了 171 名患者的数据,患者年龄从 32 岁到 85 岁不等。其中大部分患者(90.6%)患有阴茎鳞状细胞癌,且无可触及的结节(85%)。手术时间(OT)从 45 分钟到 300 分钟不等。估计失血量从 10 毫升到 300 毫升不等。报告了一起术中并发症,记录了一起转为开放手术的病例。腹股沟淋巴结(LNs)数量从3到26个不等,其中17项研究报告的中位数大于7个。住院时间为 1-7 天,引流时间为 4-72 天。术后并发症包括淋巴肿(22.2%;0-100%)、淋巴水肿(13.4%;0-40%)、蜂窝组织炎(11.1%;0-25%)、皮肤坏死(8.7%;0-15.4%)、血清肿(3.5%;0-20%)和伤口破裂/伤口感染(2.9%;0-10%)。在纳入的研究中,有7项提供了至少12个月的随访,阴茎癌患者的无复发率从50%到100%不等,外阴癌患者的无复发率从92%到100%不等:关于 RAIL 治疗 PC 和 VC 的现有证据有限。结论:RAIL 治疗 PC 和 VC 的现有证据有限,但这种方法似乎安全有效,因为它既能获得足够的淋巴结,又能确保术后病程短、住院时间短。
{"title":"Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review.","authors":"Aldo Brassetti, Giuseppe Chiacchio, Umberto Anceschi, Alfredo Bove, Mariaconsiglia Ferriero, Simone D'Annunzio, Leonardo Misuraca, Salvatore Guaglianone, Gabriele Tuderti, Riccardo Mastroianni, Francesco Tedesco, Loris Cacciatore, Flavia Proietti, Simone R Flammia, Cosimo De Nunzio, Gabriele Cozzi, Costantino Leonardo, Andrea B Galosi, Giuseppe Simone","doi":"10.23736/S2724-6051.24.05532-0","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05532-0","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL).</p><p><strong>Evidence acquisition: </strong>On April 9<sup>th</sup>, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: (\"robotic assisted\" OR \"robot-assisted\" OR \"robotic\") AND (\"inguinal lymph node dissection\" OR \"lymphadenectomy\") AND (\"penile cancer\" OR \"vulvar cancer\"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement.</p><p><strong>Evidence synthesis: </strong>Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients.</p><p><strong>Conclusions: </strong>The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"76 3","pages":"278-285"},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes. 用于机器人辅助肾部分切除术的达芬奇和雨果 RAS 平台:初步前瞻性结果比较分析。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.23736/S2724-6051.24.05623-4
Esther García Rojo, Vital Hevia Palacios, R. Brime Menéndez, J. F. Feltes Ochoa, J. Justo Quintas, F. Lista Mateos, Karim Touijer, J. Romero Otero
BACKGROUNDRobot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system.METHODSA prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses.RESULTSThe average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93).CONCLUSIONSInitial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.
背景机器人辅助肾部分切除术(RAPN)已成为治疗T1肾细胞癌的首选方法。随着新机器人平台(如 Hugo RAS)的出现,我们试图了解它们在实现与已有的达芬奇系统类似的 RAPN 结果方面的潜力。机器人系统的选择完全基于医院的后勤标准。手术由专家外科医生实施。收集了人口统计学数据、肿瘤特征、手术细节和术后结果。结果患者的平均年龄为(62.52±9.47)岁,组间在中位年龄、性别和肾功能评分方面无明显差异。达芬奇组对接时间明显更短(12.56 分钟对 20.08 分钟;P<0.01),而其他术中指标,如控制台时间和热缺血时间相似。雨果RAS组的肾造影时间更短(14.33分钟对18.84分钟;P=0.024)。术后结果和手术边缘阳性率无显著差异。每组均有一名患者(4%)出现主要手术并发症(Clavien IIIa)。结论初步研究结果表明,与达芬奇系统相比,使用Hugo RAS进行RAPN手术的围手术期结果相似。有必要进一步开展长期随访研究,以评估肿瘤和功能方面的结果。
{"title":"Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes.","authors":"Esther García Rojo, Vital Hevia Palacios, R. Brime Menéndez, J. F. Feltes Ochoa, J. Justo Quintas, F. Lista Mateos, Karim Touijer, J. Romero Otero","doi":"10.23736/S2724-6051.24.05623-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.24.05623-4","url":null,"abstract":"BACKGROUND\u0000Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system.\u0000\u0000\u0000METHODS\u0000A prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses.\u0000\u0000\u0000RESULTS\u0000The average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93).\u0000\u0000\u0000CONCLUSIONS\u0000Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"2011 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Minerva Urology and Nephrology
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