BJUI compass最新文献_第6页

Perioperative alpha blockers in voiding dysfunction secondary to prostate biopsy: A meta-analysis 围手术期α受体阻滞剂治疗前列腺活检继发的排尿功能障碍：荟萃分析

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-05-08 DOI: 10.1002/bco2.366

Sean Lim, Kylie Yen-Yi Lim, Liang Qu, Sanjeeva Ranasinha, Anthony Dat, Matthew Brown, Paul Manohar, Matthew Harper, Scott Donnellan, Weranja Ranasinghe

Introduction and Objectives

Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy-related voiding function.

Methods

A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta-analysis.

Results

A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre-existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58–5.84, p < 0.00001), PVR (mean difference 20.41 mL, 95% CI 3.44–37.39, p = 0.02), Qmax (mean difference 3.07 mL/s, 95% CI 2.55–3.59, p < 0.00001), QoL (weighted-mean difference 0.82, CI 0.17–1.48, p = 0.01) as well as overall risk of AUR (odds ratio 0.22, CI 0.09–0.55, p = 0.001). There was variable heterogeneity (I² = 0–86%) between outcomes.

Conclusions

This review highlights the potential role of alpha blockers in improving urinary function and reducing adverse voiding outcomes postprostate biopsy. The standard practice of incorporating the usage of perioperative alpha blockers may be considered to reduce the morbidity of voiding complications secondary to prostate biopsy.

排尿功能障碍仍然是前列腺活检术后常见的副作用，会导致严重的发病率。α受体阻滞剂已成为减轻这一风险的潜在治疗选择，许多中心已将其应用于实践中。尽管如此，有关其疗效的文献仍然没有定论。因此，我们进行了一项系统性综述，以量化围手术期α受体阻滞剂对前列腺活检相关排尿功能的影响。我们对1989年1月至2023年7月期间的MEDLINE、Embase和PubMed进行了系统性检索，以确定相关文章。两名独立审稿人分别独立筛选摘要、全文并进行数据提取。提取的数据包括国际前列腺症状评分（IPSS）、排尿流量（Qmax）、排尿后残余物（PVR）、急性尿潴留率（AUR）和生活质量（QoL）评分。六项随机对照试验（RCT）共纳入了808名患者，这些试验将α受体阻滞剂与对照组进行了比较。所有文章都排除了原有排尿功能障碍的患者。汇总结果表明，在所有客观和主观测量指标中，使用α受体阻滞剂均有显著统计学差异，包括IPSS（平均差异4.21，95% 置信区间[CI] 2.58-5.84，P < 0.00001）、PVR（平均差异20.41 mL，95% CI 3.44-37.39，p = 0.02）、Qmax（平均差异 3.07 mL/s，95% CI 2.55-3.59，p <0.00001）、QoL（加权平均差异 0.82，CI 0.17-1.48，p = 0.01）以及 AUR 的总体风险（几率比 0.22，CI 0.09-0.55，p = 0.001）。本综述强调了α受体阻滞剂在改善排尿功能和减少前列腺活检后不良排尿结果方面的潜在作用。可以考虑在围手术期使用α受体阻滞剂的标准做法，以降低前列腺活检术后排尿并发症的发病率。

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引用次数: 0

Ureteroenteric strictures after cystectomy: Side-specific risk factors and radiological assessment 膀胱切除术后输尿管狭窄：侧特异性风险因素和放射学评估

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-05-06 DOI: 10.1002/bco2.364

Simone Buchardt Brandt, Lotte Ibsen, Gitte Wrist Lam, Morten Bøttcher, Pernille Skjold Kingo, Jørgen Bjerggaard Jensen

Objective

To evaluate risk factors contributing to side-specific benign ureteroenteric strictures following radical cystectomy with an ileal conduit.

Materials and Methods

Data obtained from patients with bladder cancer who underwent radical cystectomy with ileal conduit surgery between 2015 and 2018 were retrospectively analysed. Imaging prior to surgery was analysed, regarding calcifications in the aorta, sarcopenia and postoperatively for length of remaining left ureter. Descriptive analyses were performed on preoperative and perioperative data, comparing patients who developed unilateral left- or right-sided strictures, bilateral strictures, to those who remained free of strictures. COX regression analysis was employed to calculate crude and adjusted hazard ratio for side-specific strictures.

Results

The study included 395 patients. Strictures developed in 19% (75/395) of the patients, within a median period of 9 months: 57% (43/75) unilateral left sided, 20% (15/75) unilateral right sided and 23% (17/75) bilateral. Unilateral left-sided stricture was associated with higher body mass index (p = 0.077) and hypercholesterolemia (p = 0.007). Right-sided stricture was associated with a history of prior abdominal surgery (p = 0.029) and postoperative leakage (p = 0.004). Bilateral stricture was associated with smoking (p = 0.006) and high BMI (p = 0.015). The adjusted HR comparing patients with and without previous abdominal surgery was only significantly higher for right-sided ureteroenteric strictures (HR 3.18 [95% CI: 1.11; 9.05]) compared with patients without strictures. No association was identified between strictures and preoperative aortic calcification of the abdominal aorta or sarcopenia as estimated from imaging.

Conclusion

The aetiology of ureteroenteric strictures appears multifactorial. Our findings suggest that development of left-sided stricture is influenced by factors associated with metabolic syndrome, indicating a potential role of distal ureteric ischemia. On the other hand, right-sided stricture was more frequent in patients with previous abdominal surgery and postoperative leakage.

目的：评估回肠导管根治性膀胱切除术后导致侧特异性良性输尿管肠管狭窄的风险因素。我们对2015年至2018年间接受回肠导管根治性膀胱切除术的膀胱癌患者的数据进行了回顾性分析。对术前主动脉钙化、肌肉疏松以及术后剩余左输尿管长度的影像学进行了分析。对术前和围手术期的数据进行了描述性分析，将出现单侧左侧或右侧输尿管狭窄、双侧输尿管狭窄的患者与没有出现输尿管狭窄的患者进行比较。研究采用 COX 回归分析法计算一侧狭窄的粗危险比和调整后危险比。19%的患者（75/395）在中位 9 个月内出现了狭窄：57%（43/75）为单侧左侧，20%（15/75）为单侧右侧，23%（17/75）为双侧。单侧左侧狭窄与较高的体重指数（p = 0.077）和高胆固醇血症（p = 0.007）有关。右侧狭窄与之前的腹部手术史（p = 0.029）和术后渗漏（p = 0.004）有关。双侧狭窄与吸烟（p = 0.006）和高体重指数（p = 0.015）有关。与既往接受过腹部手术和未接受过腹部手术的患者相比，只有右侧输尿管肠管狭窄患者的调整后HR显著高于无狭窄患者（HR 3.18 [95% CI: 1.11; 9.05]）。输尿管肠管狭窄的病因似乎是多因素的。我们的研究结果表明，左侧输尿管狭窄的发生受代谢综合征相关因素的影响，这表明输尿管远端缺血可能起了作用。另一方面，右侧输尿管狭窄在曾接受腹部手术和术后漏尿的患者中更为常见。

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引用次数: 0

A systematic review and network meta-analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate 系统性综述和网络荟萃分析：比较 Rezūm 与经尿道针头消融术和微波热疗在治疗前列腺肥大方面的效果

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-29 DOI: 10.1002/bco2.361

Ansh Bhatia, Joao G. Porto, Renil S. Titus, Vishal Ila, Khushi Shah, Ankur Malpani, Diana M. Lopategui, Robert Marcovich, Thomas R. W. Herrmann, Hemendra N. Shah

Objectives

We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms.

Materials

PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included.

Results

At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score – Rezūm versus TUMT: 1.33 points (95% CI: −1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: −3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: −4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: −4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months – Rezūm versus TUMT: 11.20 mL (95% CI: −32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years – TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low).

Conclusions

Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.

目的我们旨在比较水蒸气疗法（Rezūm）、经尿道针消融术（TUNA）和经尿道微波疗法（TUMT）治疗中重度良性前列腺增生症（BPH）男性患者的疗效和安全性。材料我们对 PubMed/MEDLINE、EMBASE 和 Cochrane 图书馆进行了检索，检索时间从开始到 2023 年 7 月 30 日，然后进行了参考文献检索和双重独立研究筛选。我们仅分析了随机临床试验。证据质量（QoE）评估采用了 RoB-2、NIH 质量评估工具和 GRADE 指南。我们纳入了没有严重偏倚风险的相关前瞻性研究。结果 12个月后，Rezūm与TUNA和TUMT相比，在改善国际前列腺症状评分方面显示出相似的疗效--Rezūm与TUMT相比：1.33分（95% CI：-1.66至4.35），TUMT更胜一筹（QoE：中度）；Rezūm与TUNA相比：0.07分（95% CI：-3.64至3.88），TUNA更胜一筹（QoE：低度）。在最大峰值流速（Qmax）方面，Rezum 的结果与 TUNA 和 TUMT 相似：Rezūm 与 TUMT 相比：1.05 mL/s（95% CI：-4.88 至 2.82），Rezūm 更优（QoE：低）；Rezūm 与 TUNA 相比：0.37 mL/s（95% CI：-4.61 至 4.21），TUNA 更优（QoE：低）。此外，排卵后残余容积（PVR）比较显示，12 个月时，Rezūm 与其他技术相似或逊于其他技术--Rezūm 与 TUMT 相比：11.20 mL（95% CI：-32.40 至 10.30），TUMT 更胜一筹（QoE：低）；Rezūm 与 TUNA 相比：24.10 mL（95% CI：2.81 至 45.10），TUNA 更胜一筹（QoE：低）。Rezūm与TUMT和TUNA的3年手术再治疗率也相似--TUMT与Rezūm相比RR：1.21（95% CI：0.20至15.90）（QoE：低），TUNA与Rezūm相比RR：1.81（95% CI：0.2至24.60）（QoE：低）。在治疗后的头 12 个月，Rezūm 的严重不良事件发生率（Clavien-Dindo ≥ 3 级）高于 TUMT 和 TUNA。TUMT与Rezūm相比，RR=0.53（95% CI：0.13至3.14）（QoE：低）；TUNA与Rezūm相比，RR=0.38（95% CI：0.04至3.49）（QoE：低）。结论中度到微弱的证据表明，Rezūm 在所有研究领域均不优于 TUNA 和 TUMT。

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引用次数: 0

An international survey of contemporary practices towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy for testicular cancer 对因睾丸癌接受腹股沟睾丸根治术的患者进行生育力评估和保护的当代做法的国际调查

Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-26 DOI: 10.1002/bco2.356

Abi Kanthabalan, Anthony Emmanuel, Cameron Alexander, Nikita Bhatt, Vinson Chan, Odunayo Kalejaiye, Krishna Narahari, Veeru Kasivisvanathan, Majid Shabbir

Objective

The study aims to assess current international clinician attitudes, practices and barriers towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy (RIO) for testicular cancer.

Materials and methods

An international online survey of urologists and urologists in training who perform RIO for testicular cancer was developed by the British Association of Urological Surgeons (BAUS) Sections of Andrology and Oncology and the British Urology Researchers in Surgical Training (BURST). The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10/02/2021 and 31/05/2021 and stored using password-protected Research Electronic Data Capture (REDCap) database software. The primary outcome was the proportion of urologists who routinely offer semen cryopreservation prior to RIO. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys platform.

Results

A total of 393 respondents took part in the online survey; of these, the majority were from the United Kingdom (65.9%), with the remaining international respondents (34.1%) from six different continents, which included 45 different countries. Of the respondents, 57.1% reported that they would routinely offer semen cryopreservation to all patients undergoing RIO for testicular cancer. In addition, 36.0% of urologists routinely performed pre-operative semen analysis, and 22.1% routinely performed pre-operative testicular serum hormone profile. Of the respondents, 14.4% performed expedited RIO within 48 h; 31.2% of respondents reported that they considered no delay to RIO to allow for semen cryopreservation to be acceptable.

Conclusions

A significant proportion of international urologists do not offer pre-operative fertility assessment and preservation in men undergoing RIO for testicular cancer. Surgery is performed in an expedited fashion within 1 week in the majority of patients. Urologists perceive there to be a lack of access and availability to fertility services, and that delay to RIO to allow for fertility preservation is often not acceptable.

目的该研究旨在评估目前国际上临床医生对接受睾丸癌腹股沟根治性睾丸切除术（RIO）的患者进行生育力评估和保留的态度、做法和障碍。材料和方法英国泌尿外科医师协会（BAUS）泌尿学和肿瘤学分会以及英国泌尿外科培训研究人员协会（BURST）对实施睾丸癌根治性腹股沟睾丸切除术（RIO）的泌尿外科医师和接受培训的泌尿外科医师进行了一项国际在线调查。招募过程使用了社交媒体和各国泌尿外科学会的电子邮件列表。收集回复的时间为 2021 年 2 月 10 日至 2021 年 5 月 31 日，使用有密码保护的研究电子数据采集 (REDCap) 数据库软件进行存储。研究的主要结果是泌尿科医生在 RIO 之前常规提供精液冷冻保存服务的比例。研究报告按照互联网电子调查平台结果报告核对表进行报告。结果共有 393 名受访者参与了在线调查，其中大多数来自英国（65.9%），其余的国际受访者（34.1%）来自六大洲，包括 45 个不同的国家。在受访者中，57.1%的人表示他们会例行为所有接受睾丸癌冷冻术的患者提供精液冷冻服务。此外，36.0% 的泌尿科医生会常规进行术前精液分析，22.1% 的泌尿科医生会常规进行术前睾丸血清激素分析。在受访者中，14.4%的受访者在 48 小时内进行了快速 RIO；31.2%的受访者表示，他们认为不延迟 RIO 以进行精液冷冻保存是可以接受的。结论国际上有相当一部分泌尿科医生不对接受睾丸癌RIO手术的男性进行术前生育力评估和保存。大多数患者的手术都在一周内快速完成。泌尿科医生认为，生育服务缺乏途径和可用性，而且推迟睾丸切除术以保留生育能力往往是不可接受的。

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引用次数: 0

Evaluation of Botox treatment in patients with chronic scrotal pain: Protocol for a randomized double-blinded control trial 评估慢性阴囊疼痛患者的肉毒杆菌毒素治疗：随机双盲对照试验方案

Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-24 DOI: 10.1002/bco2.349

Nicolai Skov Schiellerup, Hanne Kobberø, Karin Andersen, Charlotte Aaberg Poulsen, Mads Hvid Poulsen

Background

Chronic scrotal pain is a common condition with a prevalence of 2.5–4.8% in male outpatients. Up to 40% of these patients report depressive symptoms and many feel isolated. Minimal invasive treatment is lacking, while spermatic cord injections of Botox® (BTX) have been proposed to offer long-term pain relief.

Study Design

This research protocol comprises a prospective multicentre, randomized, double-blinded clinical trial drawing patients from other urological departments in the region of Southern Denmark.

End Points

The primary end point will be reduction in pain evaluated by visual analogue score for pain at 3 months. Secondary end point will be length of effect of BTX injections along with changes in quality of life.

Patients and Methods

The study will include 50 patients for randomization to either spermatic cord block with 100 IE BTX or sterile saline. All patients will prior to randomization undergo physical examination and will be asked to fulfil multiple questionnaires regarding pain and impact in daily life, that is, (1) visual analogue score for pain, (2) quality of life (EQ-5D-5L), (3) Chronic Prostatitis Symptom Index (NIH-CPSI), (4) ICD-10 depression questionnaire (MDI), (5) Likert global assessment scale, and (6) International Index of Erectile Function questionnaire. Physical examination and fulfilment of the questionnaires will be repeated multiple times throughout the study period of 12 weeks. After this time point, patients will be unblinded, and the control arm will be given the opportunity of cross-over.

慢性阴囊疼痛是一种常见病，在男性门诊患者中的发病率为 2.5%-4.8%。多达 40% 的患者有抑郁症状，许多人感到孤独。本研究方案包括一项前瞻性多中心、随机、双盲临床试验，从丹麦南部地区的其他泌尿科部门抽取患者，主要终点是3个月后通过疼痛视觉模拟评分评估疼痛减轻情况。次要终点是 BTX 注射的效果持续时间以及生活质量的变化。该研究将包括 50 名患者，随机选择 100 IE BTX 或无菌生理盐水进行精索阻断。所有患者在随机分组前都将接受身体检查，并被要求填写有关疼痛和对日常生活影响的多份问卷，即：（1）疼痛视觉模拟评分；（2）生活质量（EQ-5D-5L）；（3）慢性前列腺炎症状指数（NIH-CPSI）；（4）ICD-10 抑郁症问卷（MDI）；（5）李克特总体评估量表；以及（6）国际勃起功能指数问卷。在为期 12 周的研究期间，将多次重复体检和填写问卷。在此时间点之后，患者将被取消盲法，对照组患者将有机会交叉接受治疗。

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引用次数: 0

Comparison of staging MRI to re-resection for localised bladder cancer: Narrative review 局部膀胱癌分期磁共振成像与再次切除术的比较：叙述性综述

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-24 DOI: 10.1002/bco2.365

Hugo Klempfner, Paul Anderson

Introduction

Bladder cancer (BCa) is characterised by high prevalence, multifocality, and frequent recurrence, imposing significant clinical and economic burdens. Accurate staging, particularly distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) disease, is crucial for guiding treatment decisions. This narrative review explores the potential implications of incorporating multiparametric magnetic resonance imaging (mpMRI) and the Vesical Imaging Reporting Data System (VI-RADS) into BCa staging, focusing on repeat transurethral resection of bladder tumour (re-TURBT).

Methods

A comprehensive search of PubMed, EMBASE, and MEDLINE databases identified studies published from 2018 to 2023 discussing mpMRI or VI-RADS in the context of re-TURBT for BCa staging. Studies meeting inclusion criteria underwent qualitative analysis.

Results

Six recent studies met inclusion criteria. VI-RADS scoring, accurately predicted muscle invasion, aiding in NMIBC/MIBC differentiation. VI-RADS scores of ≥3 indicated MIBC with high sensitivity and specificity. VI-RADS potentially identified patients benefiting from re-TURBT and those for whom it could be safely omitted.

Discussion

mpMRI and VI-RADS offer promising prospects for BCa staging, potentially correlating more closely with re-TURBT and radical cystectomy histopathology than initial TURBT. However, validation and careful evaluation of clinical integration are needed. Future research should refine patient selection and optimise mpMRI's role in BCa management.

Conclusion

VI-RADS scoring could revolutionise BCa staging, especially regarding re-TURBT. There is potential that VI-RADS correlates more with the histopathology of re-TURBT and radical cystectomy than initial TURBT. While promising, ongoing research is essential to validate utility, refine selection criteria, and address economic considerations. Integration of VI-RADS into BCa staging holds potential benefits for patients and health care systems.

摘要膀胱癌（BCa）具有发病率高、多发性和复发频繁的特点，给临床和经济造成了巨大负担。准确的分期，尤其是区分非肌层浸润性膀胱癌（NMIBC）和肌层浸润性膀胱癌（MIBC）疾病，对于指导治疗决策至关重要。本叙述性综述探讨了将多参数磁共振成像（mpMRI）和膀胱成像报告数据系统（VI-RADS）纳入膀胱癌分期的潜在影响，重点关注重复经尿道膀胱肿瘤切除术（re-TURBT）。对PubMed、EMBASE和MEDLINE数据库进行了全面检索，发现了2018年至2023年发表的在膀胱癌分期的re-TURBT背景下讨论mpMRI或VI-RADS的研究。符合纳入标准的研究进行了定性分析。VI-RADS评分能准确预测肌肉侵犯情况，有助于区分NMIBC/MIBC。VI-RADS评分≥3分表示MIBC，具有较高的灵敏度和特异性。mpMRI和VI-RADS为BCa分期提供了广阔的前景，与初次TURBT相比，它们与再次TURBT和根治性膀胱切除术组织病理学的相关性更强。不过，还需要对临床整合进行验证和仔细评估。未来的研究应完善患者选择，优化 mpMRI 在 BCa 管理中的作用。VI-RADS 评分可彻底改变 BCa 分期，尤其是在再次 TURBT 方面。与初次TURBT相比，VI-RADS有可能与再次TURBT和根治性膀胱切除术的组织病理学更相关。尽管VI-RADS前景广阔，但持续的研究对于验证其实用性、完善选择标准和解决经济问题至关重要。将VI-RADS纳入BCa分期可为患者和医疗系统带来潜在的益处。

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引用次数: 0

Targeting genomic receptors in voided urine for confirmation of benign prostatic hyperplasia 以排出的尿液中的基因组受体为目标，确认良性前列腺增生症

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-22 DOI: 10.1002/bco2.362

Mathew Thakur, Vivek S. Tomar, Emma Dale, Leonard G. Gomella, Charalambos Solomides, Oleksandr Kolesnikov, Scott W. Keith, Hector T. Navarro, Olivia Dahlgren, Michael Chaga, Edouard J. Trabulsi

Objectives

The objective of this study is to validate a hypothesis that a non-invasive optical imaging assay targeting genomic VPAC receptors on malignant cells shed in voided urine will represent either benign prostatic hyperplasia (BPH) or prostatic cancer (PCa). Risk for BPH in men 50–70 years old is 50–70% and PCa is 17%. BPH and PCa can coexist in 20% of men with BPH. Most commonly practiced methods to diagnose BPH do not distinguish BPH from PCa.

Patients (or Materials) and Methods

Males with BPH (N = 97, 60.8 ± 6.3 years, prostate-specific antigen 0.7 ± 0.4 ng/mL) and without oncologic disease (N = 35, 63.4 ± 5.8 years, prostate-specific antigen < 1.5 ng/mL) signed informed consent form and provided voided urine. Urine was cytocentrifuged, cells collected on glass slide, fixed, treated with VPAC specific fluorophore TP4303 (Kd 3.1 × 10⁻⁸M), washed, incubated with DAPI and observed using a fluorescence microscope. Cells with no VPAC did not fluoresce (BPH) and those with VPAC had red-orange fluorescence (PCa). Real-time polymerase chain reaction analyses for VPAC and NKX3.1 assay for cell origin were performed.

Results

Eighty-seven subjects were negative for VPAC expression. Positive VPAC expression was noted in 10 subjects. Patient chart review for clinical data on these 10 VPAC positive subjects showed five had nephrolithiasis, three had renal cysts, one had prostatitis and one was being treated with finasteride. Real-time polymerase chain reaction analysis-VPAC expressions for 7 normal and 12 BPH subjects were 1.31 ± 1.26 and 0.94 ± 0.89, respectively (P = 0.46). NKX3.1 showed cells of prostate origin for finasteride-treated patient. Specificity for VPAC urine assay for excluding prostate cancer in this BPH cohort was 88.5%, positive predictive value 0.00% and negative predictive value 100%.

Conclusion

VPAC assay may contribute extensively for BPH diagnosis and warrant continued investigation.

本研究的目的是验证一个假设，即针对排出的尿液中脱落的恶性细胞上的基因组 VPAC 受体的非侵入性光学成像检测将代表良性前列腺增生症（BPH）或前列腺癌（PCa）。50-70 岁男性患良性前列腺增生症的风险为 50-70%，患 PCa 的风险为 17%。20%的良性前列腺增生男性可同时患有良性前列腺增生和前列腺癌。患有良性前列腺增生症的男性（97 人，60.8 ± 6.3 岁，前列腺特异性抗原 0.7 ± 0.4 纳克/毫升）和无肿瘤疾病的男性（35 人，63.4 ± 5.8 岁，前列腺特异性抗原小于 1.5 纳克/毫升）签署了知情同意书，并提供了排空的尿液。将尿液进行细胞离心，收集细胞到玻璃载玻片上，固定，用 VPAC 特异性荧光团 TP4303（Kd 3.1 × 10-8M）处理，洗涤，用 DAPI 孵育，用荧光显微镜观察。不含 VPAC 的细胞不发出荧光（BPH），含 VPAC 的细胞发出橘红色荧光（PCa）。对 VPAC 进行了实时聚合酶链反应分析，对细胞来源进行了 NKX3.1 检测。有 87 名受试者的 VPAC 表达呈阴性，10 名受试者的 VPAC 表达呈阳性。对这 10 名 VPAC 阳性受试者的临床数据进行病历审查后发现，其中 5 人患有肾结石，3 人患有肾囊肿，1 人患有前列腺炎，1 人正在接受非那雄胺治疗。实时聚合酶链反应分析显示，7 名正常受试者和 12 名良性前列腺增生受试者的 VPAC 表达量分别为 1.31 ± 1.26 和 0.94 ± 0.89（P = 0.46）。非那雄胺治疗患者的 NKX3.1 显示细胞来源于前列腺。在该前列腺增生症队列中，VPAC尿液检测排除前列腺癌的特异性为88.5%，阳性预测值为0.00%，阴性预测值为100%。

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引用次数: 0

Understanding symptom contribution to sex inequality in bladder and renal cancer stage at diagnosis 了解症状对膀胱癌和肾癌诊断阶段性别不平等的影响

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-19 DOI: 10.1002/bco2.360

Yin Zhou, Georgios Lyratzopoulos, Prabhakar Rajan, Fiona M. Walter, Jianhua Wu

Background

Understanding sex-specific factors contributing to advanced-stage diagnosis can guide interventions to reduce sex inequality in patients with urological cancers.

Method

We used linked primary care and cancer registry data to examine associations between symptoms and advanced-stage in 1151 bladder cancer and 440 renal cancer patients diagnosed between January 2012 and December 2015 in England. We performed logistic regression, adjusting for sex, age, deprivation and routes to diagnosis, including interaction terms between symptoms and sex and symptoms and age.

Results

Female sex (OR vs. men 1.89 [1.28–2.79]; p = 0.001) and patients presenting with urinary tract infections (OR 2.22 [1.34–3.69]) and abdominal symptoms (OR 2.19 [1.30–3.70]) were associated with increased odds of advanced-stage bladder cancer (vs. haematuria, p = 0.016 for both). Women with haematuria and men with abdominal symptoms (compared with the opposite sex with the same presenting symptom) were more likely to have advanced-stage bladder cancer. Neither sex nor symptom associations were observed for renal cancer.

Conclusion

Non-haematuria symptoms are associated with higher risk of advanced-stage bladder cancer. Greater risk of advanced-stage bladder cancer in women may reflect biological differences in haematuria onset and sex differences during diagnostic process. Identifying higher risk women with haematuria may reduce sex inequalities in bladder cancer outcomes.

了解导致晚期诊断的性别特异性因素可以为减少泌尿系统癌症患者性别不平等的干预措施提供指导。我们利用关联的初级保健和癌症登记数据，研究了英格兰在 2012 年 1 月至 2015 年 12 月期间确诊的 1151 名膀胱癌患者和 440 名肾癌患者的症状与晚期之间的关联。我们进行了逻辑回归，调整了性别、年龄、贫困程度和诊断途径，包括症状与性别、症状与年龄之间的交互项。001）以及出现尿路感染（OR 2.22 [1.34-3.69] ）和腹部症状（OR 2.19 [1.30-3.70] ）的患者罹患晚期膀胱癌的几率增加（与血尿相比，两者的 P = 0.016）。出现血尿的女性和出现腹部症状的男性（与出现相同症状的异性相比）更有可能罹患晚期膀胱癌。非血尿症状与晚期膀胱癌的高风险相关。女性罹患晚期膀胱癌的风险更高，这可能反映了血尿发病的生理差异和诊断过程中的性别差异。识别血尿的高危女性可减少膀胱癌结果中的性别不平等。

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引用次数: 0

Optimal Management for Primary High Grade Ta Bladder Cancer: Role of re-staging TURBT and Intravesical Adjuvant Therapy 原发性高级别 Ta 膀胱癌的最佳治疗方法：TURBT再分期和膀胱内辅助治疗的作用

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-17 DOI: 10.1002/bco2.363

Tarek Ajami, Sunwoo Han, Ruben Blachman-Braun, Helen Y. Hougen, Yuval Avda, Mark L. Gonzalgo, Bruno Nahar, Sanoj Punnen, Dipen J. Parekh, Isildinha M. Reis, Chad R. Ritch

Objective

This study aims to investigate the impact of risk group classification, restaging transurethral resection (re-TURBT), and adjuvant treatment intensity on recurrence and progression risks in high-grade Ta tumours in patients with non-muscle invasive bladder cancer (NMIBC).

Materials and methods

Data from a comprehensive bladder cancer database were utilized for this study. Patients with primary high-grade Ta tumours were included. Risk groups were classified according to AUA/SUO criteria. Tumour characteristics and patient demographics were analysed using descriptive statistics. Cox proportional hazard regression models were used to assess the effect of re-TURBT and other clinical/treatment-related predictors on recurrence- and progression-free survivals. The survivals by selected predictors were estimated using Kaplan–Meier method, and groups were compared by the log-rank test.

Results

Among 218 patients with high-grade Ta bladder cancer, those who underwent re-TURBT had significantly better 5-year recurrence-free survival (71.1% vs. 26.8%, p = 0.0009) and progression-free survival (98.6% vs. 73%, p = 0.0018) compared with those with initial TURBT alone. Full BCG treatment (induction and maintenance) showed lower recurrence risk, especially in high-risk patients. However, residual disease at re-TURBT did not significantly affect recurrence risk.

Conclusions

This study highlights the significance of risk group classification, the role of re-TURBT, and the intensity of adjuvant treatment in the management of high-grade Ta tumours. A risk-adapted model is crucial to reduce the burden of unnecessary intravesical treatment and endoscopic procedures.

本研究旨在探讨非肌层浸润性膀胱癌（NMIBC）患者中，危险组别分类、重新分期经尿道切除术（re-TURBT）和辅助治疗强度对高级别Ta肿瘤复发和进展风险的影响。本研究利用了综合膀胱癌数据库中的数据，纳入了原发性高级别Ta肿瘤患者。根据AUA/SUO标准划分了风险组别。采用描述性统计对肿瘤特征和患者人口统计学特征进行了分析。Cox比例危险回归模型用于评估再次TURBT和其他临床/治疗相关预测因素对复发和无进展生存率的影响。在218例高级别Ta膀胱癌患者中，与单纯初次TURBT相比，接受再次TURBT的患者5年无复发生存率（71.1% vs. 26.8%，p = 0.0009）和无进展生存率（98.6% vs. 73%，p = 0.0018）明显更高。全面卡介苗治疗（诱导和维持）降低了复发风险，尤其是在高危患者中。这项研究强调了风险组别分类、再TURBT的作用以及辅助治疗的强度在治疗高级别Ta肿瘤中的重要性。风险适应模型对于减少不必要的膀胱内治疗和内镜手术负担至关重要。

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引用次数: 0

Urology consultants versus large language models: Potentials and hazards for medical advice in urology 泌尿外科顾问与大型语言模型：泌尿外科医疗建议的潜力与危害

Q3 UROLOGY & NEPHROLOGY

BJUI compass

Pub Date : 2024-04-03 DOI: 10.1002/bco2.359

Johanna Eckrich, Jörg Ellinger, Alexander Cox, Johannes Stein, Manuel Ritter, Andrew Blaikie, Sebastian Kuhn, Christoph Raphael Buhr

Background

Current interest surrounding large language models (LLMs) will lead to an increase in their use for medical advice. Although LLMs offer huge potential, they also pose potential misinformation hazards.

Objective

This study evaluates three LLMs answering urology-themed clinical case-based questions by comparing the quality of answers to those provided by urology consultants.

Methods

Forty-five case-based questions were answered by consultants and LLMs (ChatGPT 3.5, ChatGPT 4, Bard). Answers were blindly rated using a six-step Likert scale by four consultants in the categories: ‘medical adequacy’, ‘conciseness’, ‘coherence’ and ‘comprehensibility’. Possible misinformation hazards were identified; a modified Turing test was included, and the character count was matched.

Results

Higher ratings in every category were recorded for the consultants. LLMs' overall performance in language-focused categories (coherence and comprehensibility) was relatively high. Medical adequacy was significantly poorer compared with the consultants. Possible misinformation hazards were identified in 2.8% to 18.9% of answers generated by LLMs compared with <1% of consultant's answers. Poorer conciseness rates and a higher character count were provided by LLMs. Among individual LLMs, ChatGPT 4 performed best in medical accuracy (p < 0.0001) and coherence (p = 0.001), whereas Bard received the lowest scores. Generated responses were accurately associated with their source with 98% accuracy in LLMs and 99% with consultants.

Conclusions

The quality of consultant answers was superior to LLMs in all categories. High semantic scores for LLM answers were found; however, the lack of medical accuracy led to potential misinformation hazards from LLM ‘consultations’. Further investigations are necessary for new generations.

目前人们对大型语言模型（LLMs）的关注将使其在医疗咨询中的使用越来越多。虽然 LLM 具有巨大的潜力，但它们也会带来潜在的错误信息隐患。本研究通过比较回答质量与泌尿科顾问提供的回答质量，对回答泌尿科主题临床病例问题的三个 LLM 进行了评估。顾问和 LLM（ChatGPT 3.5、ChatGPT 4、Bard）回答了 45 个基于病例的问题。由四名顾问使用六级李克特量表对答案进行盲评，评分类别包括 "医学充分性"、"简洁性"、"连贯性 "和 "可理解性"。在每个类别中，顾问的评分都较高。法律硕士在以语言为重点的类别（连贯性和可理解性）中的总体表现相对较高。与顾问相比，法律硕士的医学充分性明显较差。2.8%至18.9%的法律硕士的答案可能存在信息错误的隐患，而顾问的答案中这一比例小于1%。本地语言管理员提供的答案简洁率较低，字符数较多。在单个 LLM 中，ChatGPT 4 在医疗准确性（p < 0.0001）和连贯性（p = 0.001）方面表现最佳，而 Bard 的得分最低。生成的回答与其来源的准确关联度在 LLMs 中为 98%，在顾问中为 99%。我们发现，法律工作者的回答语义得分较高；但是，由于缺乏医学准确性，法律工作者的 "咨询 "可能会造成误导。有必要对新一代人进行进一步调查。

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引用次数: 0