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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
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。
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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":null,"pages":null},"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
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。
{"title":"Development and validation of a predictive model for post-percutaneous nephrolithotomy urinary sepsis: a multicenter retrospective study.","authors":"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","doi":"10.23736/S2724-6051.23.05396-X","DOIUrl":"10.23736/S2724-6051.23.05396-X","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693837","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":null,"pages":null},"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
The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer. 非肌层浸润性膀胱癌患者静脉注射卡介苗前使用纯化蛋白衍生物的影响。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.23736/S2724-6051.23.05515-5
M. Zawky, Asmaa Elsayed, Amira Awadallah, Ahmed Abdelhalim, Hassan Abolenein, Ahmed Shokeir
BACKGROUNDThe aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG.METHODSThe study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated.RESULTSThere were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions.CONCLUSIONSThe intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.
背景本研究旨在探讨经尿道膀胱肿瘤切除术(TURBT)和膀胱内卡介苗辅助治疗的非肌层浸润性膀胱癌(NMIBC)患者皮内注射纯化蛋白衍生物(PPD)和 PPD 皮试反应对其肿瘤预后的影响。方法:该研究包括 100 名连续的 NMIBC 患者,他们在开始卡介苗治疗前 1-2 周接受了皮内 PPD 前瞻性治疗。另选 100 名在开始卡介苗治疗前未给予皮内 PPD 的 NMIBC 患者作为历史对照。对照组的基线特征与研究组相匹配。研究组分为 PPD 皮试反应阳性和阴性两个亚组。结果接受和未接受PPD的患者在2年无复发生存率(RFS)、无进展生存率(PFS)和免疫指标变化方面无显著差异。阳性反应患者的两年无复发生存率(RFS)和无进展生存率(PFS)明显更高。所有患者诱导后的免疫标志物值均有所增加,阳性反应患者的免疫标志物值明显增加。结论膀胱内卡介苗注射前皮内注射 PPD 对接受 TURBT 和膀胱内卡介苗治疗的 NMIBC 患者的肿瘤预后没有影响。但是,卡介苗治疗前的 PPD 皮试反应可以预测患者的肿瘤预后、卡介苗副作用和免疫预后。
{"title":"The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer.","authors":"M. Zawky, Asmaa Elsayed, Amira Awadallah, Ahmed Abdelhalim, Hassan Abolenein, Ahmed Shokeir","doi":"10.23736/S2724-6051.23.05515-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.23.05515-5","url":null,"abstract":"BACKGROUND\u0000The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG.\u0000\u0000\u0000METHODS\u0000The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated.\u0000\u0000\u0000RESULTS\u0000There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions.\u0000\u0000\u0000CONCLUSIONS\u0000The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056506","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
Applications of augmented reality in urology: expanding its potentials and fields of usage. 增强现实技术在泌尿外科中的应用:拓展其潜力和使用领域。
IF 4.9 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05888-9
Francesco Esperto, Antonio Testa, Angelo Territo, Eliodoro Faiella, Rocco Papalia, Roberto M Scarpa
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引用次数: 0
Urological surgery with the Hugo RAS™ System: insights into system adaptability. 使用 Hugo RAS™ 系统进行泌尿外科手术:对系统适应性的深入了解。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-04-01 DOI: 10.23736/S2724-6051.24.05879-8
Marco Paciotti, Carlo A Bravi, Federico Piramide, Angelo Mottaran, Luca Sarchi, Paolo Dell'oglio, Filippo Turri, Fabrizio DI Maida, Nikolaos Liakos, Iulia Andras, Marcio Covas Moschovas, Mike Wenzel, Gabriele Sorce, Christoph Wurnschimmel, Edward Lambert, Ruben DE Groote, Alessandro Larcher
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引用次数: 0
ZSI-375 artificial urinary sphincter: efficacy, safety, and long-term outcomes. ZSI-375 人工尿道括约肌:疗效、安全性和长期结果。
IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-04-01 Epub Date: 2024-01-17 DOI: 10.23736/S2724-6051.23.05693-8
Carlo Bettocchi, Anna Ricapito, Ugo Falagario, Oscar Selvaggio, Pasquale Annese, Vito Mancini, Gian Maria Busetto, Luigi Cormio, Giuseppe Carrieri
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引用次数: 0
期刊
Minerva Urology and Nephrology
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