Pub Date : 2022-12-20DOI: 10.3389/fruro.2022.1020215
D. Herchenhorn, V. Freire
The availability of new systemic therapies associated with better outcomes and survival for GU tumors is a major obstacle for most LMIC. Strategies to improve access are necessary and depend not only on drug availability, but from public health care system organization, discussion and priorities as well as strategies to decrease cost by rational treatment decision and individualize use of systemic therapies in limited resource countries. Efforts should be implemented to provide more real-world data coming from LMIC and studies focusing in strategies to decrease drug costs are urgently needed.
{"title":"Access of new systemic therapies for Genito-urinary cancers in low-middle income countries","authors":"D. Herchenhorn, V. Freire","doi":"10.3389/fruro.2022.1020215","DOIUrl":"https://doi.org/10.3389/fruro.2022.1020215","url":null,"abstract":"The availability of new systemic therapies associated with better outcomes and survival for GU tumors is a major obstacle for most LMIC. Strategies to improve access are necessary and depend not only on drug availability, but from public health care system organization, discussion and priorities as well as strategies to decrease cost by rational treatment decision and individualize use of systemic therapies in limited resource countries. Efforts should be implemented to provide more real-world data coming from LMIC and studies focusing in strategies to decrease drug costs are urgently needed.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43573119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-19DOI: 10.3389/fruro.2022.1001054
M. C. Suárez Arbeláez, Yasmine S. Ghattas, A. Raymo, Samantha Isern, A. Alam, D. Nassau, M. Castellan
Introduction Open surgery is considered the standard of care for pediatric urological procedures. Nonetheless, Robotic Assisted Laparoscopic Surgeries (RALS) have become increasingly popular in pediatrics as they allow for quicker recovery times, lower narcotic use, better cosmesis, and better intraoperative visibility. However, there are concerns regarding the usefulness of RALS in the infant population, as operating on smaller patients limits mobility of the robotic arms and can result in arm collisions. Objective The aim of this study was to compare the clinical and postoperative outcomes of infants undergoing robotic vs open pyeloplasty or ureteroureterostomy. Materials and Methods Retrospective study conducted between 2012 to 2022, 114 infants who underwent pyeloplasty (81 open pyeloplasty and 33 robotic pyeloplasty) and 21 who underwent ureteroureterostomy (9 open ureteroureterostomy and 12 robotic ureteroureterostomy) were included. Results Mean age at surgery in the pyeloplasty cohort was 4.81 ± 3.1 months in the open group, and 6.24 ± 2.6 months in the robotic group (p=0.13), and in the ureteroureterostomy cohort was 7.67 ± 3.16 months in the open group and 7.58 ± 2.75 months in the robotic group (p=0.95). Operative time was found to be shorter in robotic pyeloplasty and robotic ureteroureterostomy, when compared to the open approaches. Postoperative complications, its severity, and the surgical success were comparable among the pyeloplasty and ureteroureterostomy groups. Only 1(3%) complication related to the robotic technique was reported in the pyeloplasty cohort. The length of hospital stay was found to be similar between the ureteroureterostomy groups, while in the pyeloplasty cohort the robotic group showed a significant shorter hospital stay than the open group. Overall, the mean follow-up was greater than 12 months. Conclusion Our results demonstrated that robotic pyeloplasty and ureteroureterostomy performed in infants are feasible, safe, and durable procedures, with an additional benefit of reducing duration of operative time and hospital stay.
{"title":"Safety and feasibility of performing robotic ureteroureterostomy and robotic pyeloplasty in infants","authors":"M. C. Suárez Arbeláez, Yasmine S. Ghattas, A. Raymo, Samantha Isern, A. Alam, D. Nassau, M. Castellan","doi":"10.3389/fruro.2022.1001054","DOIUrl":"https://doi.org/10.3389/fruro.2022.1001054","url":null,"abstract":"Introduction Open surgery is considered the standard of care for pediatric urological procedures. Nonetheless, Robotic Assisted Laparoscopic Surgeries (RALS) have become increasingly popular in pediatrics as they allow for quicker recovery times, lower narcotic use, better cosmesis, and better intraoperative visibility. However, there are concerns regarding the usefulness of RALS in the infant population, as operating on smaller patients limits mobility of the robotic arms and can result in arm collisions. Objective The aim of this study was to compare the clinical and postoperative outcomes of infants undergoing robotic vs open pyeloplasty or ureteroureterostomy. Materials and Methods Retrospective study conducted between 2012 to 2022, 114 infants who underwent pyeloplasty (81 open pyeloplasty and 33 robotic pyeloplasty) and 21 who underwent ureteroureterostomy (9 open ureteroureterostomy and 12 robotic ureteroureterostomy) were included. Results Mean age at surgery in the pyeloplasty cohort was 4.81 ± 3.1 months in the open group, and 6.24 ± 2.6 months in the robotic group (p=0.13), and in the ureteroureterostomy cohort was 7.67 ± 3.16 months in the open group and 7.58 ± 2.75 months in the robotic group (p=0.95). Operative time was found to be shorter in robotic pyeloplasty and robotic ureteroureterostomy, when compared to the open approaches. Postoperative complications, its severity, and the surgical success were comparable among the pyeloplasty and ureteroureterostomy groups. Only 1(3%) complication related to the robotic technique was reported in the pyeloplasty cohort. The length of hospital stay was found to be similar between the ureteroureterostomy groups, while in the pyeloplasty cohort the robotic group showed a significant shorter hospital stay than the open group. Overall, the mean follow-up was greater than 12 months. Conclusion Our results demonstrated that robotic pyeloplasty and ureteroureterostomy performed in infants are feasible, safe, and durable procedures, with an additional benefit of reducing duration of operative time and hospital stay.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45437715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.3389/fruro.2022.1005166
Brent Yelton, Shivam Patel, Andrew Shanholtzer, B. Walter, S. M. Jafri
Social media (SoMe) use within healthcare has changed significantly since the start of the COVID-19 pandemic. This project highlights recent changes in SoMe use within the field of urology and summarizes how they have impacted the urology residency application and match process. A literature review of the PubMed, Embase, Cochrane, Scopus, PsycINFO, and Web of Science databases was performed on March 19th, 2022 for relevant studies regarding the use of SoMe in the American urology residency application and match process. Articles not published in English, published prior to 2019, or focusing on residency matches outside of the United States were excluded. The initial search yielded 202 unique results, of which, after independent review, a total of nine texts were deemed appropriate for analysis. Of the nine sources, six were peer-reviewed articles, two were published conference abstracts which included data, and one was a research letter. These studies consistently found that both urology applicants and residency programs increased their SoMe use following the start of the COVID-19 pandemic as the percentage of programs (26-50% to 51-75%) and percentage of applicants (44% to 80%) participating in SoMe for professional purposes increased from 2018-2019 to 2021. Notably, Twitter was the most popular SoMe platform used. Among urology applicants, 43-61% found SoMe to have the greatest utility in providing information about specific programs. There was also consistency between studies in finding that SoMe use played a minimal role in whether or not a student matched, as only 3-6% of program directors reviewed applicants’ SoMe during the application and match process, while as many as 80% reported that SoMe had no role in the assessment of applicants. With programs continuing to see SoMe as a method of reaching out to applicants, increases in usage will likely continue even after the COVID-19 pandemic ends. In turn, it will become increasingly important for students to be mindful of how and what they post on SoMe. Continuing to analyze and reevaluate the benefits and drawbacks of these SoMe tools will remain important as virtual interactions become increasingly relevant to the field of urology.
自新冠肺炎大流行开始以来，医疗保健领域的社交媒体（SoMe）使用发生了重大变化。该项目强调了泌尿外科领域SoMe使用的最新变化，并总结了它们如何影响泌尿外科住院申请和匹配过程。2022年3月19日，对PubMed、Embase、Cochrane、Scopus、PsycINFO和Web of Science数据库进行了文献综述，以了解有关SoMe在美国泌尿外科住院申请和匹配过程中使用的相关研究。未以英语发表、在2019年之前发表或关注美国境外居留权匹配的文章被排除在外。最初的搜索产生了202个独特的结果，经过独立审查，共有9个文本被认为适合分析。在九个来源中，六个是同行评审的文章，两个是包含数据的会议摘要，一个是研究信。这些研究一致发现，在新冠肺炎大流行开始后，泌尿外科申请者和住院治疗计划都增加了SoMe的使用，因为从2018-2019年到2021年，出于专业目的参与SoMe的计划百分比（26-50%到51-75%）和申请者百分比（44%到80%）都有所增加。值得注意的是，Twitter是最受欢迎的SoMe平台。在泌尿科申请人中，43-61%的人认为SoMe在提供特定项目的信息方面最有用。研究之间也存在一致性，发现SoMe的使用对学生是否匹配起到了最小的作用，因为只有3-6%的项目主管在申请和匹配过程中审查了申请人的SoMe，而多达80%的人表示SoMe在评估申请人中没有作用。随着项目继续将SoMe视为接触申请人的一种方法，即使在新冠肺炎大流行结束后，使用量也可能继续增加。反过来，对学生来说，注意他们在SoMe上发布的方式和内容将变得越来越重要。随着虚拟交互与泌尿外科领域的相关性越来越大，继续分析和重新评估这些SoMe工具的优点和缺点仍然很重要。
{"title":"Evaluating the effect of the COVID-19 pandemic on the use and impact of social media in the urology residency match: A review of the literature","authors":"Brent Yelton, Shivam Patel, Andrew Shanholtzer, B. Walter, S. M. Jafri","doi":"10.3389/fruro.2022.1005166","DOIUrl":"https://doi.org/10.3389/fruro.2022.1005166","url":null,"abstract":"Social media (SoMe) use within healthcare has changed significantly since the start of the COVID-19 pandemic. This project highlights recent changes in SoMe use within the field of urology and summarizes how they have impacted the urology residency application and match process. A literature review of the PubMed, Embase, Cochrane, Scopus, PsycINFO, and Web of Science databases was performed on March 19th, 2022 for relevant studies regarding the use of SoMe in the American urology residency application and match process. Articles not published in English, published prior to 2019, or focusing on residency matches outside of the United States were excluded. The initial search yielded 202 unique results, of which, after independent review, a total of nine texts were deemed appropriate for analysis. Of the nine sources, six were peer-reviewed articles, two were published conference abstracts which included data, and one was a research letter. These studies consistently found that both urology applicants and residency programs increased their SoMe use following the start of the COVID-19 pandemic as the percentage of programs (26-50% to 51-75%) and percentage of applicants (44% to 80%) participating in SoMe for professional purposes increased from 2018-2019 to 2021. Notably, Twitter was the most popular SoMe platform used. Among urology applicants, 43-61% found SoMe to have the greatest utility in providing information about specific programs. There was also consistency between studies in finding that SoMe use played a minimal role in whether or not a student matched, as only 3-6% of program directors reviewed applicants’ SoMe during the application and match process, while as many as 80% reported that SoMe had no role in the assessment of applicants. With programs continuing to see SoMe as a method of reaching out to applicants, increases in usage will likely continue even after the COVID-19 pandemic ends. In turn, it will become increasingly important for students to be mindful of how and what they post on SoMe. Continuing to analyze and reevaluate the benefits and drawbacks of these SoMe tools will remain important as virtual interactions become increasingly relevant to the field of urology.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48707501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-14DOI: 10.3389/fruro.2022.1064099
Jun Zhang, Ning Wang, Li-hong Chen, Wenjuan Wang, Ming Wang, Hao Liu, Han-guo Jiang, Y. Qi
Sporadic renal hemangioblastomas (RHBs) are a rare subgroup of extraneurologic hemangioblastomas. They are under-recognized renal tumours whose differential diagnosis remains challenging. Here, we describe a case of RHB in a 61-year-old man was admitted to the hospital two days after the discovery of a right kidney mass. Renal carcinoma was clinically considered, and a radical nephrectomy was performed. Follow-up showed no evidence of postoperative tumour recurrence. Histologically, the tumour boundary is clear and fibrous envelope is visible. The tumour issue was mainly composed of tumour cells and a dendritic capillary network, which consisted of multicellular and oligocellular areas. The tumour cells were polygonal, the cytoplasm was eosinophilic or transparent, and intranuclear pseudoinclusions were found. Immunohistochemically, vimentin, a-inhibin, neurogenic specific enolase (NSE), S-100, smooth muscle actin (SMA), and cluster of differentiation (CD)10 antibodies reacted strongly and were diffused, and Ki-67 was 2% positive. CD31 and CD34 showed vascular morphology. We also summarized related case reports (a total of 41 cases in the Chinese and English literature) to explore the clinicopathological characteristics of RHB and improve the diagnosis and treatment of this disease. RHB is a benign tumour with excellent prognosis; however, it is easily misdiagnosed as other common renal malignancies. Immunohistochemistry is vastly helpful in accurate diagnosis of RHB. Preoperative renal biopsy can effectively avoid misdiagnosis and overtreatment.
{"title":"Primary renal sporadic hemangioblastoma: A case report and literature review","authors":"Jun Zhang, Ning Wang, Li-hong Chen, Wenjuan Wang, Ming Wang, Hao Liu, Han-guo Jiang, Y. Qi","doi":"10.3389/fruro.2022.1064099","DOIUrl":"https://doi.org/10.3389/fruro.2022.1064099","url":null,"abstract":"Sporadic renal hemangioblastomas (RHBs) are a rare subgroup of extraneurologic hemangioblastomas. They are under-recognized renal tumours whose differential diagnosis remains challenging. Here, we describe a case of RHB in a 61-year-old man was admitted to the hospital two days after the discovery of a right kidney mass. Renal carcinoma was clinically considered, and a radical nephrectomy was performed. Follow-up showed no evidence of postoperative tumour recurrence. Histologically, the tumour boundary is clear and fibrous envelope is visible. The tumour issue was mainly composed of tumour cells and a dendritic capillary network, which consisted of multicellular and oligocellular areas. The tumour cells were polygonal, the cytoplasm was eosinophilic or transparent, and intranuclear pseudoinclusions were found. Immunohistochemically, vimentin, a-inhibin, neurogenic specific enolase (NSE), S-100, smooth muscle actin (SMA), and cluster of differentiation (CD)10 antibodies reacted strongly and were diffused, and Ki-67 was 2% positive. CD31 and CD34 showed vascular morphology. We also summarized related case reports (a total of 41 cases in the Chinese and English literature) to explore the clinicopathological characteristics of RHB and improve the diagnosis and treatment of this disease. RHB is a benign tumour with excellent prognosis; however, it is easily misdiagnosed as other common renal malignancies. Immunohistochemistry is vastly helpful in accurate diagnosis of RHB. Preoperative renal biopsy can effectively avoid misdiagnosis and overtreatment.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41444215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-12DOI: 10.3389/fruro.2022.1069045
R. Moreira, M. Fernandes, M. Monteiro, F. Luiz, Erika Simplicio Silva, P. Andrade, Mayara Batista Pinto, Letycia Lima, Astrid Silva, J. Nunez, D. Freitas, L. H. de Lima Araújo, Caio Vinícius Teles Rossini, P. Aguiar
Previous studies suggested that obesity pro-inflammatory state could improve immune checkpoint inhibitors (ICI) clinical efficacy. This is a retrospective, multicenter, and observational study that included patients treated in a private Brazilian Oncology Group. Primary outcomes were the association of body mass index (BMI) category with overall survival (OS) and progression free survival (PFS). Secondary outcomes were association between BMI and objective response rate (ORR). In the total cohort, 448 patients were classified as a normal weight (43%), overweight (36%), obese (17%) and underweight (4%). The patients were predominantly male gender (62%), with stage IV lung cancer (57%) and melanoma (19%). The obese group (BMI ≥ 30 kg/m2) had a not statistically significant longer median OS than the non-obese group (BMI < 30 kg/m2) - 21.8 months (95% CI NR - NR) versus 14.9 months (95% CI 8.3 - 21.5); HR = 0.82, (95% CI 0.57 - 1.18, P = 0.28). Obese patients treated with anti-CTLA4 did not reach the mOS, while the non-obese group had a mOS of 23.1 months (P = 0.04). PFS did not differ between subgroups. Obese patients had also lower ORR, but without reaching statistical significance. In conclusion, this study did not report an improved OS among high BMI patients treated with ICI.
{"title":"Body mass index and immune checkpoint inhibitor efficacy in metastatic cancer patients: A Brazilian retrospective study","authors":"R. Moreira, M. Fernandes, M. Monteiro, F. Luiz, Erika Simplicio Silva, P. Andrade, Mayara Batista Pinto, Letycia Lima, Astrid Silva, J. Nunez, D. Freitas, L. H. de Lima Araújo, Caio Vinícius Teles Rossini, P. Aguiar","doi":"10.3389/fruro.2022.1069045","DOIUrl":"https://doi.org/10.3389/fruro.2022.1069045","url":null,"abstract":"Previous studies suggested that obesity pro-inflammatory state could improve immune checkpoint inhibitors (ICI) clinical efficacy. This is a retrospective, multicenter, and observational study that included patients treated in a private Brazilian Oncology Group. Primary outcomes were the association of body mass index (BMI) category with overall survival (OS) and progression free survival (PFS). Secondary outcomes were association between BMI and objective response rate (ORR). In the total cohort, 448 patients were classified as a normal weight (43%), overweight (36%), obese (17%) and underweight (4%). The patients were predominantly male gender (62%), with stage IV lung cancer (57%) and melanoma (19%). The obese group (BMI ≥ 30 kg/m2) had a not statistically significant longer median OS than the non-obese group (BMI < 30 kg/m2) - 21.8 months (95% CI NR - NR) versus 14.9 months (95% CI 8.3 - 21.5); HR = 0.82, (95% CI 0.57 - 1.18, P = 0.28). Obese patients treated with anti-CTLA4 did not reach the mOS, while the non-obese group had a mOS of 23.1 months (P = 0.04). PFS did not differ between subgroups. Obese patients had also lower ORR, but without reaching statistical significance. In conclusion, this study did not report an improved OS among high BMI patients treated with ICI.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.3389/fruro.2022.1017069
M. Taratkin, E. Checcucci, A. Androsov, Camilla Azilgareeva, B. Brill, A. Morozov, S. Puliatti, I. R. Belenchon, K. Kowalewski, S. Rodler, J. Rivas, G. Cacciamani, D. Enikeev
Introduction The Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures. Materials and Methods We conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis. Results In terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT. Conclusion TFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.
{"title":"Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group","authors":"M. Taratkin, E. Checcucci, A. Androsov, Camilla Azilgareeva, B. Brill, A. Morozov, S. Puliatti, I. R. Belenchon, K. Kowalewski, S. Rodler, J. Rivas, G. Cacciamani, D. Enikeev","doi":"10.3389/fruro.2022.1017069","DOIUrl":"https://doi.org/10.3389/fruro.2022.1017069","url":null,"abstract":"Introduction The Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures. Materials and Methods We conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis. Results In terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT. Conclusion TFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45278129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-23DOI: 10.3389/fruro.2022.990499
I. Yusim, E. Mazor, Nimer Elsaraya, R. Gat, V. Novack, N. Mabjeesh
Purpose The outcome of the present study is to determine variables available at the time of diagnosis able to predict disease reclassification in prostate cancer (PCa) patients on active surveillance (AS). Materials and methods From January 2014 to December 2018, 114 consecutive low-risk PCa patients were enrolled in AS protocol according to inclusion criteria: PSA ≤ 10 ng/ml, Gleason score (GS) ≤ 6 or International Society of Urological Pathology (ISUP) Gleason grade group (GG) 1, maximum cancer core length (MCCI) < 50%, and ≤ 2 positive cores on biopsy. Patients were followed with confirmatory and yearly prostate biopsy, semi-annually with prostate-specific antigen (PSA), and digital rectal examination (DRE). Disease reclassification was defined as upgrading biopsy: GS ≥ 3 + 4 = 7 or ISUP GG ≥ 2, more than two positive cores, MCCI > 50%, or changes in serum PSA > 10 ng/ml. Uni- and multivariate Cox proportional hazards regression models, receiver performance curves (ROC), and Kaplan-Meier analysis were performed to characterize AS criteria and identify variables that predict disease reclassification. Finally, decision curve analysis (DCA) was performed to evaluate the net benefit of using PV in addition to standard variables to predict disease reclassification. Results PCa was diagnosed by systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx). The mean (range) follow-up was 32.7 (12-126) months. Disease reclassification occurred in 46 patients (40%). On univariate statistical analysis prostate specific antigen (PSA) (p = 0.05), prostate volume (PV) (p = 0.022), PSA density (PSAD) (p < 0.001) and number of positive cores (p = 0.021) were significant factors for disease reclassification. On the multivariate analysis, PSAD (p < 0.001) and PV (p = 0.003) were the only statistically significant independent variables to predict disease reclassification. A PSAD cut-off of 0.16 ng/ml² and a PV cut-off of 44 ml gave a maximal area under the curve, 0.69 and 0.63, respectively. Kaplan-Meier analysis showed that the median survival free from disease reclassification during AS was almost doubled in patients with PSAD < 0.16 ng/ml2 or PV > 44 ml. DCA showed a positive net benefit and clinical usefulness of the model, including PV, to predict disease reclassification between threshold probabilities of 20-50%. Conclusions PV and PSAD significantly predicted failure from AS in our patients. Patients with a baseline PV of fewer than 44 ml would be more likely to have disease reclassification and unsuitable for acceptable AS protocols. Therefore, we believe that PV may help to select PCa patients for AS, especially in populations where the use of mpMRI is limited.
{"title":"Prostate volume is an independent predictive factor in selecting low-risk prostate patients for active surveillance","authors":"I. Yusim, E. Mazor, Nimer Elsaraya, R. Gat, V. Novack, N. Mabjeesh","doi":"10.3389/fruro.2022.990499","DOIUrl":"https://doi.org/10.3389/fruro.2022.990499","url":null,"abstract":"Purpose The outcome of the present study is to determine variables available at the time of diagnosis able to predict disease reclassification in prostate cancer (PCa) patients on active surveillance (AS). Materials and methods From January 2014 to December 2018, 114 consecutive low-risk PCa patients were enrolled in AS protocol according to inclusion criteria: PSA ≤ 10 ng/ml, Gleason score (GS) ≤ 6 or International Society of Urological Pathology (ISUP) Gleason grade group (GG) 1, maximum cancer core length (MCCI) < 50%, and ≤ 2 positive cores on biopsy. Patients were followed with confirmatory and yearly prostate biopsy, semi-annually with prostate-specific antigen (PSA), and digital rectal examination (DRE). Disease reclassification was defined as upgrading biopsy: GS ≥ 3 + 4 = 7 or ISUP GG ≥ 2, more than two positive cores, MCCI > 50%, or changes in serum PSA > 10 ng/ml. Uni- and multivariate Cox proportional hazards regression models, receiver performance curves (ROC), and Kaplan-Meier analysis were performed to characterize AS criteria and identify variables that predict disease reclassification. Finally, decision curve analysis (DCA) was performed to evaluate the net benefit of using PV in addition to standard variables to predict disease reclassification. Results PCa was diagnosed by systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx). The mean (range) follow-up was 32.7 (12-126) months. Disease reclassification occurred in 46 patients (40%). On univariate statistical analysis prostate specific antigen (PSA) (p = 0.05), prostate volume (PV) (p = 0.022), PSA density (PSAD) (p < 0.001) and number of positive cores (p = 0.021) were significant factors for disease reclassification. On the multivariate analysis, PSAD (p < 0.001) and PV (p = 0.003) were the only statistically significant independent variables to predict disease reclassification. A PSAD cut-off of 0.16 ng/ml² and a PV cut-off of 44 ml gave a maximal area under the curve, 0.69 and 0.63, respectively. Kaplan-Meier analysis showed that the median survival free from disease reclassification during AS was almost doubled in patients with PSAD < 0.16 ng/ml2 or PV > 44 ml. DCA showed a positive net benefit and clinical usefulness of the model, including PV, to predict disease reclassification between threshold probabilities of 20-50%. Conclusions PV and PSAD significantly predicted failure from AS in our patients. Patients with a baseline PV of fewer than 44 ml would be more likely to have disease reclassification and unsuitable for acceptable AS protocols. Therefore, we believe that PV may help to select PCa patients for AS, especially in populations where the use of mpMRI is limited.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42164602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.3389/fruro.2022.1044639
A. Haffar, Christian C. Morrill, Adelaide Garcia, Zachary Werner, Chad B. Crigger, J. Gearhart
Purpose Classic bladder exstrophy (CBE), is a complex congenital malformation affecting formation of the lower abdominal wall and bladder. This study evaluates the readability of common online resources regarding CBE and its treatment. We hypothesize that high levels of reading comprehension are reflected in these resources, which may not be suitable to the general population for understanding this condition. Methods The search terms “bladder exstrophy” and “bladder exstrophy treatment” were reviewed on the Google search engine. The first 100 search results for each search query were collected. The readability of each webpage was assessed using a combination of four independent validated formulae: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG). Results A total of 200 search results were examined using the two search queries, yielding 72 unique webpages that fit the inclusionary criteria. The mean readability scores across all websites were a GFI of 14.3, SMOG score of 10, DCI of 9.06, and a FKG of 11.6. These scores correlate to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade respectively. There was no significant difference of readability between website categories across GFI (p = 0.32), SMOG (p = 0.38), DCI (p = 0.33), and FKG (p = 0.36). Conclusion This study demonstrates that online health information regarding CBE and its treatment is written at least the 11th grade reading level or above. This highlights the necessity to simplify online resources pertaining to CBE.
{"title":"Complicating the already complex? Readability scores in bladder exstrophy and its treatment","authors":"A. Haffar, Christian C. Morrill, Adelaide Garcia, Zachary Werner, Chad B. Crigger, J. Gearhart","doi":"10.3389/fruro.2022.1044639","DOIUrl":"https://doi.org/10.3389/fruro.2022.1044639","url":null,"abstract":"Purpose Classic bladder exstrophy (CBE), is a complex congenital malformation affecting formation of the lower abdominal wall and bladder. This study evaluates the readability of common online resources regarding CBE and its treatment. We hypothesize that high levels of reading comprehension are reflected in these resources, which may not be suitable to the general population for understanding this condition. Methods The search terms “bladder exstrophy” and “bladder exstrophy treatment” were reviewed on the Google search engine. The first 100 search results for each search query were collected. The readability of each webpage was assessed using a combination of four independent validated formulae: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG). Results A total of 200 search results were examined using the two search queries, yielding 72 unique webpages that fit the inclusionary criteria. The mean readability scores across all websites were a GFI of 14.3, SMOG score of 10, DCI of 9.06, and a FKG of 11.6. These scores correlate to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade respectively. There was no significant difference of readability between website categories across GFI (p = 0.32), SMOG (p = 0.38), DCI (p = 0.33), and FKG (p = 0.36). Conclusion This study demonstrates that online health information regarding CBE and its treatment is written at least the 11th grade reading level or above. This highlights the necessity to simplify online resources pertaining to CBE.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42046406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-08DOI: 10.3389/fruro.2022.1042689
G. Aiello, A. Morlacco, M. Bianco, M. Soligo, D. Meneghesso, E. Vidal, W. Rigamonti, F. Dal Moro
Purpose Endoscopic treatment with high-pressure balloon dilatation (HPBD) has been proposed as a feasible, safe and minimally invasive procedure for primary obstructive megaureter, but the level of evidence is still low. This systematic review aims to evaluate the efficacy and safety of HPBD and its long-term results in paediatric population. Methods The review was conducted following the PRISMA guidelines. Systematic research of available literature in the English language from 1995 until June 2022 was conducted through EMBASE, MEDLINE, Cochrane Library and NIH Registry of Clinical Trials. For each relevant study, information was gathered regarding the study design, the inclusion/exclusion criteria, the indications for treatment, the success rate and the complications. Results The final set included 13 studies. Median age of the patients ranged from 4 months to 7 years (full range 15 days-15 years). The indications for HPBD varied in different studies, however most authors included patients with increasing dilation, obstructive patterns found at diuretic renogram scan, decreased renal function or symptoms. All the studies analysed reported a success rate ranging from 69 to 100% for the treatment of POM with HPBD. This approach may avoid surgery in up to 77% of cases and is thought to be a less invasive, definitive and safe treatment for this disorder. The complication rate ranged from 0 to 50% and it was mostly infectious or associated to the stent placement or both. Conclusion HPBD demonstrated to be safe for the treatment of POM in infants, with effective long-term results and can be a definitive treatment in a considerable subset of patients. Nevertheless, the overall level of evidence for HPBD is still low and further comparative studies or randomized clinical trials are needed.
{"title":"Efficacy and safety of high-pressure balloon dilatation for primary obstructive megaureter in children: A systematic review","authors":"G. Aiello, A. Morlacco, M. Bianco, M. Soligo, D. Meneghesso, E. Vidal, W. Rigamonti, F. Dal Moro","doi":"10.3389/fruro.2022.1042689","DOIUrl":"https://doi.org/10.3389/fruro.2022.1042689","url":null,"abstract":"Purpose Endoscopic treatment with high-pressure balloon dilatation (HPBD) has been proposed as a feasible, safe and minimally invasive procedure for primary obstructive megaureter, but the level of evidence is still low. This systematic review aims to evaluate the efficacy and safety of HPBD and its long-term results in paediatric population. Methods The review was conducted following the PRISMA guidelines. Systematic research of available literature in the English language from 1995 until June 2022 was conducted through EMBASE, MEDLINE, Cochrane Library and NIH Registry of Clinical Trials. For each relevant study, information was gathered regarding the study design, the inclusion/exclusion criteria, the indications for treatment, the success rate and the complications. Results The final set included 13 studies. Median age of the patients ranged from 4 months to 7 years (full range 15 days-15 years). The indications for HPBD varied in different studies, however most authors included patients with increasing dilation, obstructive patterns found at diuretic renogram scan, decreased renal function or symptoms. All the studies analysed reported a success rate ranging from 69 to 100% for the treatment of POM with HPBD. This approach may avoid surgery in up to 77% of cases and is thought to be a less invasive, definitive and safe treatment for this disorder. The complication rate ranged from 0 to 50% and it was mostly infectious or associated to the stent placement or both. Conclusion HPBD demonstrated to be safe for the treatment of POM in infants, with effective long-term results and can be a definitive treatment in a considerable subset of patients. Nevertheless, the overall level of evidence for HPBD is still low and further comparative studies or randomized clinical trials are needed.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45996986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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