To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible.
Patients and methods
This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed.
Results
The median intravesical prostatic protrusion was 19.3 mm (8.5–32.2). The median operative time was 100 min (75–140), and the median estimated blood loss was 100 mL (10–500). The median time to catheter removal was 7 days (5–7), with a median postoperative hospital stay of 2 days (2–4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7–52.4) and 15 mL (5–23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0–6.3) and 1 (0–3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15–1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function.
Conclusion
We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.
{"title":"Trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy: A case series","authors":"Xinnan Chen, Kangkang Zhao, Hao Wang, Chengwei Zhang, Lin Du, Wendi Wang, Tianyi Chen, Haixiang Qin, Xuefeng Qiu, Hongqian Guo, Gutian Zhang","doi":"10.1002/bco2.389","DOIUrl":"10.1002/bco2.389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median intravesical prostatic protrusion was 19.3 mm (8.5–32.2). The median operative time was 100 min (75–140), and the median estimated blood loss was 100 mL (10–500). The median time to catheter removal was 7 days (5–7), with a median postoperative hospital stay of 2 days (2–4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7–52.4) and 15 mL (5–23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0–6.3) and 1 (0–3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15–1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 8","pages":"776-782"},"PeriodicalIF":1.6,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Active Surveillance (AS) is an important management strategy for patients diagnosed with early prostate cancer. Current National Institute for Health and Care Excellence (NICE) guidelines recommend AS as first-line for patients in Cambridge Prognostic Group 1 (CPG1), as an equal option for CPG2 and an alternative for those with CPG3 who decline radical treatment (https://www.nice.org.uk/guidance/ng131). The elements of modern AS incorporate regular prostate-specific antigen (PSA) tests and MRI scans at defined timepoints. Early repeat or confirmatory biopsies, however, are not currently mandated in any modern guidance or protocol. Previous research has shown that first diagnostic biopsies can under-represent disease burden in men on AS and is improved if pre-biopsy MRI guidance is used.<span><sup>1, 2</sup></span> We have previously published that MRI pre-biopsy improves disease characterisation at diagnosis that can translate into lower rates of AS progression compared with benchmark series.<span><sup>3</sup></span> However, the value of confirmatory/early re-biopsy in addition to pre-MRI diagnostics remains unknown. This is particularly important if AS follow-up is to be individualised at its commencement based on predicted disease behaviour, progression risk and to minimise future use of protocol re-biopsies.<span><sup>4</sup></span></p><p>We have developed and implemented the Stratified Cancer Active Surveillance (STRATCANS) programme in our centre details of which we have reported and are in this webtool https://stratcans.com.<span><sup>4, 5</sup></span> In summary, STRATCANS defines three tiers of follow-up based on the risk of progression determined by diagnostic CPG, PSA density and MRI. In STRATCANS, men with the least burden of disease (STRATCANS tier-1, that is, CPG1 and a low PSA density) are managed primarily by PSA (which can be patient self-monitored) and may not need clinical review for up to 18 months. MRI repeat is based on daignostic PIRADS score and biopsies used only if there is a change. This light touch review mandates that the disease burden at the start of AS is very well characterised. Given this context the goal of this study was to assess the value of confirmatory re-biopsy in STRATCANS in confirming the disease burden at the start of AS and hence allocation to the correct STRATCANS tier.</p><p>A retrospective case notes review of men on STRATCANS who agreed to confirmatory re-biopsy (within 12 months of diagnosis) was performed as part of an ongoing service evaluation of STRATCANS in our unit (Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; registration number: PRN11857). Men were routinely offered early re-biopsy when selecting AS management unless unfit for another procedure. Data from all men who agreed are included here, and there were no other case selections applied. The only other exclusion was therefore if a patient declined based on their own preferences. Those with significant co-morbi
{"title":"Value of a confirmatory re-biopsy as part of a modern risk stratified cancer surveillance programme for early prostate cancer","authors":"Harry Gabb, Vincent J. Gnanapragasam","doi":"10.1002/bco2.406","DOIUrl":"10.1002/bco2.406","url":null,"abstract":"<p>Active Surveillance (AS) is an important management strategy for patients diagnosed with early prostate cancer. Current National Institute for Health and Care Excellence (NICE) guidelines recommend AS as first-line for patients in Cambridge Prognostic Group 1 (CPG1), as an equal option for CPG2 and an alternative for those with CPG3 who decline radical treatment (https://www.nice.org.uk/guidance/ng131). The elements of modern AS incorporate regular prostate-specific antigen (PSA) tests and MRI scans at defined timepoints. Early repeat or confirmatory biopsies, however, are not currently mandated in any modern guidance or protocol. Previous research has shown that first diagnostic biopsies can under-represent disease burden in men on AS and is improved if pre-biopsy MRI guidance is used.<span><sup>1, 2</sup></span> We have previously published that MRI pre-biopsy improves disease characterisation at diagnosis that can translate into lower rates of AS progression compared with benchmark series.<span><sup>3</sup></span> However, the value of confirmatory/early re-biopsy in addition to pre-MRI diagnostics remains unknown. This is particularly important if AS follow-up is to be individualised at its commencement based on predicted disease behaviour, progression risk and to minimise future use of protocol re-biopsies.<span><sup>4</sup></span></p><p>We have developed and implemented the Stratified Cancer Active Surveillance (STRATCANS) programme in our centre details of which we have reported and are in this webtool https://stratcans.com.<span><sup>4, 5</sup></span> In summary, STRATCANS defines three tiers of follow-up based on the risk of progression determined by diagnostic CPG, PSA density and MRI. In STRATCANS, men with the least burden of disease (STRATCANS tier-1, that is, CPG1 and a low PSA density) are managed primarily by PSA (which can be patient self-monitored) and may not need clinical review for up to 18 months. MRI repeat is based on daignostic PIRADS score and biopsies used only if there is a change. This light touch review mandates that the disease burden at the start of AS is very well characterised. Given this context the goal of this study was to assess the value of confirmatory re-biopsy in STRATCANS in confirming the disease burden at the start of AS and hence allocation to the correct STRATCANS tier.</p><p>A retrospective case notes review of men on STRATCANS who agreed to confirmatory re-biopsy (within 12 months of diagnosis) was performed as part of an ongoing service evaluation of STRATCANS in our unit (Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; registration number: PRN11857). Men were routinely offered early re-biopsy when selecting AS management unless unfit for another procedure. Data from all men who agreed are included here, and there were no other case selections applied. The only other exclusion was therefore if a patient declined based on their own preferences. Those with significant co-morbi","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 7","pages":"662-664"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We sought to define the degree of artefact caused by prostatic urethral lift (PUL) on multiparametric-magnetic resonance imaging (mp-MRI) to determine the location, size of artefact and if the device could potentially obscure a diagnosis of prostate cancer.
Methods
Ten patients were prospectively enrolled to undergo PUL for treatment of benign prostatic hyperplasia and follow-up imaging. A standard mp-MRI protocol using a 3.0 Tesla scanner was performed prior to and following Urolift insertion. Pre- and post-PUL images were compared to measure maximum artefact diameter around each implant in each MRI parameter. A transverse relaxation time weighted (T2) artefact reduction protocol was also evaluated. The location of each artefact was then compared to a separate database of 225 consecutive patients who underwent magnetic resonance guided prostate biopsies.
Results
Artefact occurred around the stainless steel urethral implant component only. Mean T2 artefact maximum diameter was 7.7 mm (sd = 1.71 mm), with an artefact reduction protocol reducing this to 5.4 mm (sd = 1.43). Mean dynamic-contrast-enhancement artefact was 10 mm (sd = 2.5 mm), and mean diffusion-weighted-imaging artefact was 28.2 mm (sd = 7.8 mm). All artefacts were confined to the posterior transition zone only. In the 225 consecutive patients who had undergone magnetic resonance guided prostate biopsies, there were 55 positive biopsies with prostate cancer, with 13 cases found in the transition zones and no cancer identified solely in the posterior transitional zone.
Conclusions
The stainless steel urethral component of the PUL does cause artefact, which is confined to the posterior transition zone only. PUL artefact occurs in an area of the prostate that has a very low incidence of a single focus of prostate cancer. If there is concern for prostate cancer in the posterior TZ (e.g. if every other area is clear with a high PSA), this area can undergo targeted biopsy.
{"title":"Multiparametric-magnetic resonance imaging (mp-MRI) of the prostate and Urolift: Identifying artefact size, location and clinical implications","authors":"Cameron James Parkin, Rajeev Jyoti, Peter Chin","doi":"10.1002/bco2.392","DOIUrl":"https://doi.org/10.1002/bco2.392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We sought to define the degree of artefact caused by prostatic urethral lift (PUL) on multiparametric-magnetic resonance imaging (mp-MRI) to determine the location, size of artefact and if the device could potentially obscure a diagnosis of prostate cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten patients were prospectively enrolled to undergo PUL for treatment of benign prostatic hyperplasia and follow-up imaging. A standard mp-MRI protocol using a 3.0 Tesla scanner was performed prior to and following Urolift insertion. Pre- and post-PUL images were compared to measure maximum artefact diameter around each implant in each MRI parameter. A transverse relaxation time weighted (T2) artefact reduction protocol was also evaluated. The location of each artefact was then compared to a separate database of 225 consecutive patients who underwent magnetic resonance guided prostate biopsies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Artefact occurred around the stainless steel urethral implant component only. Mean T2 artefact maximum diameter was 7.7 mm (sd = 1.71 mm), with an artefact reduction protocol reducing this to 5.4 mm (sd = 1.43). Mean dynamic-contrast-enhancement artefact was 10 mm (sd = 2.5 mm), and mean diffusion-weighted-imaging artefact was 28.2 mm (sd = 7.8 mm). All artefacts were confined to the posterior transition zone only. In the 225 consecutive patients who had undergone magnetic resonance guided prostate biopsies, there were 55 positive biopsies with prostate cancer, with 13 cases found in the transition zones and no cancer identified solely in the posterior transitional zone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The stainless steel urethral component of the PUL does cause artefact, which is confined to the posterior transition zone only. PUL artefact occurs in an area of the prostate that has a very low incidence of a single focus of prostate cancer. If there is concern for prostate cancer in the posterior TZ (e.g. if every other area is clear with a high PSA), this area can undergo targeted biopsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 8","pages":"770-775"},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141994112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to assess whether urethral preservation can be performed safely using frozen section analysis (FSA) of the urethral stump on urethral recurrence after radical cystectomy.
Methods
Between June 2012 and July 2022, we investigated consecutive male patients who underwent urethral FSA during radical cystectomy for urothelial carcinoma. For FSA-abnormal cases, urethrectomy was performed, and for FSA-normal cases, the urethra was preserved. The diagnostic accuracy of FSA was assessed in comparison with the pathological findings of the permanent sections of the same tissue. Postoperatively, computed tomography and urinary cytology were performed as routine surveillance of recurrence.
Results
Of the 77 patients included in this study, three patients with abnormal FSA underwent concurrent urethrectomy. The negative predictive value of urethral FSA was 100%. With a median postoperative follow-up of 38 months (interquartile ranges 21–71), no urethral recurrence was observed.
Conclusions
FSA may be useful in determining the indication for urethrectomy.
{"title":"Safety of urethral preservation using urethral frozen section analysis in radical cystectomy","authors":"Yuto Hattori, Akihiko Nagoshi, Tasuku Fujiwara, Takanari Kambe, Yuta Mine, Hiroki Hagimoto, Yohei Abe, Daisuke Yamashita, Naofumi Tsutsumi, Noboru Shibasaki, Toshinari Yamasaki, Mutsushi Kawakita","doi":"10.1002/bco2.377","DOIUrl":"https://doi.org/10.1002/bco2.377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The objective of this study is to assess whether urethral preservation can be performed safely using frozen section analysis (FSA) of the urethral stump on urethral recurrence after radical cystectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between June 2012 and July 2022, we investigated consecutive male patients who underwent urethral FSA during radical cystectomy for urothelial carcinoma. For FSA-abnormal cases, urethrectomy was performed, and for FSA-normal cases, the urethra was preserved. The diagnostic accuracy of FSA was assessed in comparison with the pathological findings of the permanent sections of the same tissue. Postoperatively, computed tomography and urinary cytology were performed as routine surveillance of recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 77 patients included in this study, three patients with abnormal FSA underwent concurrent urethrectomy. The negative predictive value of urethral FSA was 100%. With a median postoperative follow-up of 38 months (interquartile ranges 21–71), no urethral recurrence was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FSA may be useful in determining the indication for urethrectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 8","pages":"806-810"},"PeriodicalIF":1.6,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141994059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hille J. Torenvlied, Evelien Trip, Wouter Olthuis, Loes I. Segerink, Rob C. M. Pelger, Jack J. H. Beck
Objectives
The observational ‘Feeling Hot’ study aims to evaluate the feasibility of employing overnight penile temperature measurements for the detection of nocturnal erections, thereby contributing to the advancement and modernization of a non-invasive diagnostic system for erectile dysfunction.
Subjects/Patients and Methods
In this proof-of-concept study, 10 healthy men aged 20–25 were recruited, following the methodology outlined in the ‘Staying Hot’ study by Torenvlied et al. Participants underwent ambulatory overnight penile temperature measurements concurrent with RigiScan recordings. Key outcome measures included baseline and peak penile temperatures during RigiScan-annotated nocturnal erections. Reference measurements of the thigh temperature were also taken to assess nocturnal temperature variations.
Results
Statistically significant penile temperature increases (p = 0.008, n = 9) were observed during nocturnal erections, with an average elevation of 1.47°C noted during the initial erections. This underscores the practical utility of penile temperature measurements in detecting erection onset. Challenges arose in accurately determining erection duration and subsequent erection onsets due to the persistence of elevated temperatures following initial erections, termed the ‘Staying Hot effect’. Reference thigh temperature measurements aided in addressing this challenge.
Conclusion
Examining overnight penile temperature alongside simultaneous RigiScan recordings has yielded valuable insights into the viability of using the temperature methodology for detecting nocturnal erections. The ‘Feeling Hot’ study findings demonstrate significant penile temperature elevation during nocturnal erections in healthy young men, highlighting the potential of integrating this measurement methodology into the design of a modernized tool for ambulatory erectile dysfunction diagnostics. Further development of an advanced sensor system to comprehensively assess erection duration and quality is essential for enhancing clinical applicability.
{"title":"‘Feeling Hot’: Exploring the feasibility of nocturnal erection detection through penile temperature measurements","authors":"Hille J. Torenvlied, Evelien Trip, Wouter Olthuis, Loes I. Segerink, Rob C. M. Pelger, Jack J. H. Beck","doi":"10.1002/bco2.372","DOIUrl":"https://doi.org/10.1002/bco2.372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The observational ‘Feeling Hot’ study aims to evaluate the feasibility of employing overnight penile temperature measurements for the detection of nocturnal erections, thereby contributing to the advancement and modernization of a non-invasive diagnostic system for erectile dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects/Patients and Methods</h3>\u0000 \u0000 <p>In this proof-of-concept study, 10 healthy men aged 20–25 were recruited, following the methodology outlined in the ‘Staying Hot’ study by Torenvlied et al. Participants underwent ambulatory overnight penile temperature measurements concurrent with RigiScan recordings. Key outcome measures included baseline and peak penile temperatures during RigiScan-annotated nocturnal erections. Reference measurements of the thigh temperature were also taken to assess nocturnal temperature variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Statistically significant penile temperature increases (<i>p</i> = 0.008, <i>n</i> = 9) were observed during nocturnal erections, with an average elevation of 1.47°C noted during the initial erections. This underscores the practical utility of penile temperature measurements in detecting erection onset. Challenges arose in accurately determining erection duration and subsequent erection onsets due to the persistence of elevated temperatures following initial erections, termed the ‘Staying Hot effect’. Reference thigh temperature measurements aided in addressing this challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Examining overnight penile temperature alongside simultaneous RigiScan recordings has yielded valuable insights into the viability of using the temperature methodology for detecting nocturnal erections. The ‘Feeling Hot’ study findings demonstrate significant penile temperature elevation during nocturnal erections in healthy young men, highlighting the potential of integrating this measurement methodology into the design of a modernized tool for ambulatory erectile dysfunction diagnostics. Further development of an advanced sensor system to comprehensively assess erection duration and quality is essential for enhancing clinical applicability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 7","pages":"668-674"},"PeriodicalIF":1.6,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141631164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.
Patients and methods
From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed.
Results
The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.
Conclusion
Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.
{"title":"Characteristics and management of post-circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon","authors":"Landry Oriole Mbouche, Achille Aurèle Mbassi, Junior Barthelemy Mekeme Mekeme, Dorcas Nyanit Bob, Joseph Lionel Ndjock, Emmanuel Njuma Tamufor, Faustin Mouafo Tambo","doi":"10.1002/bco2.391","DOIUrl":"10.1002/bco2.391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 7","pages":"681-690"},"PeriodicalIF":1.6,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to identify the effect of cribriform pattern 4 carcinoma/intraductal carcinoma of the prostate (CC/IDCP) on persistent prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer (PCa).
Patients and Methods
This retrospective study included 730 consecutive patients with localized PCa who underwent RARP at Mie University (n = 392) and Aichi Medical University (n = 338) between 2015 and 2021. Patients with clinically metastatic PCa (cN1 and cM1) and those who received neoadjuvant and/or adjuvant therapy before biochemical recurrence were excluded. We evaluated the effects of CC/IDCP on persistent PSA levels after RARP. Persistent PSA was defined as PSA level ≥0.2 ng/mL at 1 month postoperatively and consecutively thereafter. Using factors from logistic regression analysis, models were developed to predict persistent PSA levels.
Results
Approximately 6.3% (n = 46) of the patients had persistent PSA levels. Patients with biopsy CC/IDCP (bCC/IDCP) and pathological CC/IDCP (pCC/IDCP) based on RARP specimens were 11.6% (85/730) and 36.5% (267/730), respectively. Multivariate analysis of the prediction of persistent PSA levels using preoperative factors revealed that PSA density, percentage of positive cancer cores, biopsy grade group and bCC/IDCP were independent prognostic factors. Furthermore, multivariate analysis of the prediction of persistent PSA levels using postoperative factors, excluding pN1, revealed that pathological grade group, pCC/IDCP, seminal vesicle invasion and lymphovascular invasion were independent prognostic factors. In the receiver operating characteristic curve analysis for predicting persistent PSA after RARP, areas under the receiver operating characteristic curve for the model with preoperative factors, postoperative factors, including pN1, and postoperative factors, excluding pN1, were 0.827, 0.833 and 0.834, respectively.
Conclusions
bCC/IDCP predicted persistent PSA after RARP in the overall population, while pCC/IDCP predicted persistent PSA only when the pN1 population was excluded. This may be useful for predicting susceptible patients with worse outcomes.
{"title":"Cribriform pattern 4/intraductal carcinoma of the prostate and persistent prostate-specific antigen after radical prostatectomy","authors":"Takeshi Sasaki, Ikuo Kobayashi, Katsunori Uchida, Shinichiro Higashi, Satoru Masui, Kouhei Nishikawa, Toyonori Tsuzuki, Masatoshi Watanabe, Naoto Sassa, Takahiro Inoue","doi":"10.1002/bco2.367","DOIUrl":"10.1002/bco2.367","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to identify the effect of cribriform pattern 4 carcinoma/intraductal carcinoma of the prostate (CC/IDCP) on persistent prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer (PCa).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This retrospective study included 730 consecutive patients with localized PCa who underwent RARP at Mie University (<i>n</i> = 392) and Aichi Medical University (<i>n</i> = 338) between 2015 and 2021. Patients with clinically metastatic PCa (cN1 and cM1) and those who received neoadjuvant and/or adjuvant therapy before biochemical recurrence were excluded. We evaluated the effects of CC/IDCP on persistent PSA levels after RARP. Persistent PSA was defined as PSA level ≥0.2 ng/mL at 1 month postoperatively and consecutively thereafter. Using factors from logistic regression analysis, models were developed to predict persistent PSA levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 6.3% (<i>n</i> = 46) of the patients had persistent PSA levels. Patients with biopsy CC/IDCP (bCC/IDCP) and pathological CC/IDCP (pCC/IDCP) based on RARP specimens were 11.6% (85/730) and 36.5% (267/730), respectively. Multivariate analysis of the prediction of persistent PSA levels using preoperative factors revealed that PSA density, percentage of positive cancer cores, biopsy grade group and bCC/IDCP were independent prognostic factors. Furthermore, multivariate analysis of the prediction of persistent PSA levels using postoperative factors, excluding pN1, revealed that pathological grade group, pCC/IDCP, seminal vesicle invasion and lymphovascular invasion were independent prognostic factors. In the receiver operating characteristic curve analysis for predicting persistent PSA after RARP, areas under the receiver operating characteristic curve for the model with preoperative factors, postoperative factors, including pN1, and postoperative factors, excluding pN1, were 0.827, 0.833 and 0.834, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>bCC/IDCP predicted persistent PSA after RARP in the overall population, while pCC/IDCP predicted persistent PSA only when the pN1 population was excluded. This may be useful for predicting susceptible patients with worse outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 7","pages":"709-717"},"PeriodicalIF":1.6,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Veronika S. Christensen, Marius Skow, Signe A. Flottorp, Hilde Strømme, Ibrahimu Mdala, Odd Martin Vallersnes
Objective
To compare the success of establishing spontaneous micturition following immediate trial without catheter (TWOC) to delayed TWOC in males catheterized for acute urinary retention.
Materials and methods
In this systematic review, we included studies reporting success rates of immediate TWOC or delayed TWOC (≤30 days) among males ≥18 years of age catheterized for acute urinary retention. We excluded studies on suprapubic catheterization, postoperative/perioperative catheterization and urinary retention related to trauma. We searched the following databases: MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey and Clinicaltrials.gov. The search was concluded on 30 November 2022. There were no restrictions on language or publication date. Risk of bias was assessed using the ROB 2.0 and ROBINS-I tools. We did random-effects restricted maximum likelihood model meta-analyses. Certainty of evidence was assessed using GRADE.
Results
We included 61 studies. In two randomized controlled trials (RCTs), both with some concerns for risk of bias, including in total 174 participants, the relative success rate was 1.22 (95% CI 0.84–1.76) favouring delayed TWOC. In two comparative cohort studies, both with serious risk of bias, including 642 participants, the relative success rate was 1.18 (0.94–1.47) favouring delayed TWOC. One study was excluded from this meta-analysis because of critically low quality. Four studies reporting success rates for cohorts with immediate TWOC, all with serious risk of bias, including 409 participants, had an overall success rate of 47% (29–66). Fifty-two studies reporting success rates for cohorts with delayed TWOC, all with serious risk of bias, including 12 489 participants, had an overall success rate of 53% (49–56). The certainty of the evidence was considered low for the RCTs and very low for the rest.
Conclusion
There was a limited number of appropriately designed studies addressing the research question directly. The evidence favours neither approach.
{"title":"Immediate or delayed trial without catheter in acute urinary retention in males: A systematic review","authors":"Veronika S. Christensen, Marius Skow, Signe A. Flottorp, Hilde Strømme, Ibrahimu Mdala, Odd Martin Vallersnes","doi":"10.1002/bco2.369","DOIUrl":"10.1002/bco2.369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the success of establishing spontaneous micturition following immediate trial without catheter (TWOC) to delayed TWOC in males catheterized for acute urinary retention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>In this systematic review, we included studies reporting success rates of immediate TWOC or delayed TWOC (≤30 days) among males ≥18 years of age catheterized for acute urinary retention. We excluded studies on suprapubic catheterization, postoperative/perioperative catheterization and urinary retention related to trauma. We searched the following databases: MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey and Clinicaltrials.gov. The search was concluded on 30 November 2022. There were no restrictions on language or publication date. Risk of bias was assessed using the ROB 2.0 and ROBINS-I tools. We did random-effects restricted maximum likelihood model meta-analyses. Certainty of evidence was assessed using GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 61 studies. In two randomized controlled trials (RCTs), both with some concerns for risk of bias, including in total 174 participants, the relative success rate was 1.22 (95% CI 0.84–1.76) favouring delayed TWOC. In two comparative cohort studies, both with serious risk of bias, including 642 participants, the relative success rate was 1.18 (0.94–1.47) favouring delayed TWOC. One study was excluded from this meta-analysis because of critically low quality. Four studies reporting success rates for cohorts with immediate TWOC, all with serious risk of bias, including 409 participants, had an overall success rate of 47% (29–66). Fifty-two studies reporting success rates for cohorts with delayed TWOC, all with serious risk of bias, including 12 489 participants, had an overall success rate of 53% (49–56). The certainty of the evidence was considered low for the RCTs and very low for the rest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a limited number of appropriately designed studies addressing the research question directly. The evidence favours neither approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 8","pages":"732-747"},"PeriodicalIF":1.6,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David G. Gelikman, Stephanie A. Harmon, Alexander P. Kenigsberg, Yan Mee Law, Enis C. Yilmaz, Maria J. Merino, Bradford J. Wood, Peter L. Choyke, Peter A. Pinto, Baris Turkbey
<p>Advancements in artificial intelligence (AI) have shown promise in standardizing medical imaging evaluations, particularly in detecting prostate cancer (PCa) on MRI.<span><sup>1</sup></span> Though MRI-based AI algorithms have been developed to detect PCa in untreated glands,<span><sup>2, 3</sup></span> little research exists on the efficacy of such models after prostate ablation. While focal therapy (FT) targets and destroys localized PCa, it usually distorts prostate anatomy, making it difficult to evaluate on MRI.<span><sup>4</sup></span> Our study investigates the efficacy of a biparametric MRI (bpMRI)-based deep learning algorithm for post-FT PCa identification.</p><p>This retrospective cohort study utilized post-FT prostate bpMRIs from an IRB-approved clinical trial (NCT03354416). MRIs were evaluated with a previously developed AI model, a 3D U-Net-based deep neural network that can detect suspicious lesions on untreated prostate bpMRIs based on T2-weighted images, apparent diffusion coefficient maps and high b-value diffusion-weighted images (Figure 1A–C).<span><sup>5</sup></span> This algorithm was originally trained using a diverse MRI dataset obtained from treatment-naïve patients.</p><p>AI output consisted of PCa-suspicious lesion prediction maps overlayed on T2-weighted MRI (Figure 1D). Predictions were compared to MRI/transrectal ultrasound fusion-guided and systematic prostate biopsies. A patient-level analysis was performed where if at least one location containing Gleason Grade ≥1 disease was detected by the AI, this was a true positive. If an AI prediction was made in an area that turned out to be benign on biopsy, this was a false positive, even if biopsy revealed malignancy in a different region of the prostate. Patients with biopsy-proven PCa lesions that were not predicted by AI were false negatives. If AI made no predictions in a patient with a fully benign prostate biopsy, this was a true negative. AI performance metrics included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy.</p><p>Of the 40 included patients, the median time to post-FT MRI was 2.5 years, and 25 patients had PCa at biopsy. AI made 33 unique lesion predictions across 24 patients. Of these, 16 patients (67%) had one lesion prediction, 7 patients (29%) had two lesion predictions and 1 patient (4%) had three lesion predictions. Across all AI predictions in this cohort, 9 patients (22.5%) had true positives, 15 patients (37.5%) had false positives, 10 patients (25%) had false negatives and 6 patients (15%) had true negatives. The AI's overall sensitivity was 47.4% with a specificity of 28.6%. The PPV and NPV were both 37.5%. Overall, the AI achieved an accuracy of 37.5%. The performance characteristics of this model are listed in Table 1.</p><p>Our AI reached a moderate level of sensitivity. Despite low specificity and overall accuracy, this is a noteworthy finding, as this AI algorithm was tra
{"title":"Evaluating a deep learning AI algorithm for detecting residual prostate cancer on MRI after focal therapy","authors":"David G. Gelikman, Stephanie A. Harmon, Alexander P. Kenigsberg, Yan Mee Law, Enis C. Yilmaz, Maria J. Merino, Bradford J. Wood, Peter L. Choyke, Peter A. Pinto, Baris Turkbey","doi":"10.1002/bco2.373","DOIUrl":"10.1002/bco2.373","url":null,"abstract":"<p>Advancements in artificial intelligence (AI) have shown promise in standardizing medical imaging evaluations, particularly in detecting prostate cancer (PCa) on MRI.<span><sup>1</sup></span> Though MRI-based AI algorithms have been developed to detect PCa in untreated glands,<span><sup>2, 3</sup></span> little research exists on the efficacy of such models after prostate ablation. While focal therapy (FT) targets and destroys localized PCa, it usually distorts prostate anatomy, making it difficult to evaluate on MRI.<span><sup>4</sup></span> Our study investigates the efficacy of a biparametric MRI (bpMRI)-based deep learning algorithm for post-FT PCa identification.</p><p>This retrospective cohort study utilized post-FT prostate bpMRIs from an IRB-approved clinical trial (NCT03354416). MRIs were evaluated with a previously developed AI model, a 3D U-Net-based deep neural network that can detect suspicious lesions on untreated prostate bpMRIs based on T2-weighted images, apparent diffusion coefficient maps and high b-value diffusion-weighted images (Figure 1A–C).<span><sup>5</sup></span> This algorithm was originally trained using a diverse MRI dataset obtained from treatment-naïve patients.</p><p>AI output consisted of PCa-suspicious lesion prediction maps overlayed on T2-weighted MRI (Figure 1D). Predictions were compared to MRI/transrectal ultrasound fusion-guided and systematic prostate biopsies. A patient-level analysis was performed where if at least one location containing Gleason Grade ≥1 disease was detected by the AI, this was a true positive. If an AI prediction was made in an area that turned out to be benign on biopsy, this was a false positive, even if biopsy revealed malignancy in a different region of the prostate. Patients with biopsy-proven PCa lesions that were not predicted by AI were false negatives. If AI made no predictions in a patient with a fully benign prostate biopsy, this was a true negative. AI performance metrics included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy.</p><p>Of the 40 included patients, the median time to post-FT MRI was 2.5 years, and 25 patients had PCa at biopsy. AI made 33 unique lesion predictions across 24 patients. Of these, 16 patients (67%) had one lesion prediction, 7 patients (29%) had two lesion predictions and 1 patient (4%) had three lesion predictions. Across all AI predictions in this cohort, 9 patients (22.5%) had true positives, 15 patients (37.5%) had false positives, 10 patients (25%) had false negatives and 6 patients (15%) had true negatives. The AI's overall sensitivity was 47.4% with a specificity of 28.6%. The PPV and NPV were both 37.5%. Overall, the AI achieved an accuracy of 37.5%. The performance characteristics of this model are listed in Table 1.</p><p>Our AI reached a moderate level of sensitivity. Despite low specificity and overall accuracy, this is a noteworthy finding, as this AI algorithm was tra","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 7","pages":"665-667"},"PeriodicalIF":1.6,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charles Carey, Gerard Gurumurthy, Richard Napier-Hemy, Bachar Zelhof
Introduction and aims
Retroperitoneal fibrosis (RPF) is a fibroinflammatory disease in which patients may suffer obstructive uropathy (OU). The optimum treatment strategy for RPF with secondary OU is currently unclear, and the aim of this literature review is to assess the methods used to treat this patient cohort.
Methods
Medline, Embase, Cinahl, the Cochrane Library and PubMed were systematically searched to find studies assessing treatment outcomes in this patient cohort. After reviewing the studies' titles, abstracts and full texts, 12 were found that matched our search aims. Data from these publications were analysed and reported.
Results
The demographic and symptomatic features of patients across the 12 studies were representative of the general RPF population. No randomised control trials (RCTs) were found, and just one study formally compared outcomes between patients who underwent different treatment strategies. Many of the studies concluded that using medical and surgical methods in combination led to positive outcomes; whereas, others found positive outcomes following a variety of regimens. Many studies also highlighted, however, that significant minorities required further treatment after initial therapy. Conclusions regarding optimum treatment methods were limited as most publications did not formally compare outcomes following different strategies and had an observational study design.
Conclusion
Although positive outcomes were commonly seen following medical, surgical and a combination of treatments, the literature currently lacks research formally comparing outcomes after assigning specific treatment protocols to groups of RPF patients. More research is therefore required to determine how to best manage RPF leading to secondary OU.
{"title":"A review of the current treatment methods for retroperitoneal fibrosis with obstructive uropathy","authors":"Charles Carey, Gerard Gurumurthy, Richard Napier-Hemy, Bachar Zelhof","doi":"10.1002/bco2.371","DOIUrl":"10.1002/bco2.371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction and aims</h3>\u0000 \u0000 <p>Retroperitoneal fibrosis (RPF) is a fibroinflammatory disease in which patients may suffer obstructive uropathy (OU). The optimum treatment strategy for RPF with secondary OU is currently unclear, and the aim of this literature review is to assess the methods used to treat this patient cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medline, Embase, Cinahl, the Cochrane Library and PubMed were systematically searched to find studies assessing treatment outcomes in this patient cohort. After reviewing the studies' titles, abstracts and full texts, 12 were found that matched our search aims. Data from these publications were analysed and reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The demographic and symptomatic features of patients across the 12 studies were representative of the general RPF population. No randomised control trials (RCTs) were found, and just one study formally compared outcomes between patients who underwent different treatment strategies. Many of the studies concluded that using medical and surgical methods in combination led to positive outcomes; whereas, others found positive outcomes following a variety of regimens. Many studies also highlighted, however, that significant minorities required further treatment after initial therapy. Conclusions regarding optimum treatment methods were limited as most publications did not formally compare outcomes following different strategies and had an observational study design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although positive outcomes were commonly seen following medical, surgical and a combination of treatments, the literature currently lacks research formally comparing outcomes after assigning specific treatment protocols to groups of RPF patients. More research is therefore required to determine how to best manage RPF leading to secondary OU.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 8","pages":"721-731"},"PeriodicalIF":1.6,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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