Frontiers in urology最新文献

The advent of sensitive enhanced culture (metaculturomic) and culture-independent DNA-based (metagenomic) methods has revealed a rich collection of microbial species that inhabit the human urinary tract. Known as the urinary microbiome, this community of microbes consists of hundreds of distinct species that range across the entire phylogenetic spectrum. This new knowledge clashes with standard clinical microbiology laboratory methods, established more than 60 years ago, that focus attention on a relatively small subset of universally acknowledged uropathogens. Increasing reports support the hypothesis that this focus is too narrow. Single uropathogen reports are common in women with recurrent urinary tract infection (UTI), although wider disruption of their urinary microbiome is likely. Typical "UTI" symptoms occur in patients with "no growth" reported from standard culture and sometimes antibiotics improve these symptoms. Metaculturomic and metagenomic methods have repeatedly detected fastidious, slow growing, and/or anaerobic microbes that are not detected by the standard test in urine samples of patients with lower urinary tract symptoms. Many of these microbes are also detected in serious non-urinary tract infections, providing evidence that they can be opportunistic pathogens. In this review, we present a set of poorly understood, emerging, and suspected uropathogens. The goal is to stimulate research into the biology of these microbes with a focus on their life as commensals and their transition into pathogens.

Introduction: Zinner syndrome (ZS) is a rare condition characterized by a triad of seminal vesicle cyst (SVC), ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. The diagnosis is often delayed due to non-specific symptoms, such as lower urinary tract symptoms and infertility, typically appearing in the second and third decades of life.

Case presentation: We present the first published case of ZS in Palestine, involving a 53-year-old male patient who sought medical attention for right-sided hernia repair. Pre-operative imaging revealed a combination of findings, including a solitary left kidney with cysts, mild hydronephrosis, an enlarged prostate, suspicious soft tissue density, and abnormal lymph nodes. The diagnosis of ZS was confirmed through an abdominal ultrasound, identifying a dilated seminal vesicle and completing the criteria of ZS.

Discussion: The typical for ZS is to present in late second decade of life with nonspecific urogenital symptoms and infertility, However, our patient's incidental diagnosis during the preoperative evaluation of incisional hernia in a relatively old age with no previous complaints, the identification of a high aortic bifurcation at the level of the left kidney and a double Inferior Vena Cava (IVC) in this case of ZS represents novel and distinctive findings not commonly reported in previous cases.

Conclusion: Our patient's presentation and findings expand our understanding of the anatomical variations associated with ZS. This case report contributes to the advancement of knowledge in the field of ZS and provides valuable insights for future clinical management and research investigations.

Prostate cancer (PCa) risk assessment can incorporate clinical features, gene expression, protein 'biomarkers' or imaging. In this review the benefits of layering multiparametric magnetic resonance imaging (mpMRI) with other risk assessment methods is considered. mpMRI is an increasingly utilized risk assessment tool in prostate cancer. The European Association of Urology, National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) guidelines call for mpMRI utilization in the prostate cancer management pathway. As such, the NCCN Guidelines and AUA guidelines emphasize differing levels of reliance on mpMRI preceding prostate biopsy. However, like all risk assessment tools, mpMRI has strengths and limitations. This include dependencies on reader expertise and interpretation, equipment and process standardization, tumor size, tumor multifocality, tissue architecture, ethnic and racial disparity, and cost. Thus, layering complementary risk assessment methods to mitigate the limitations of each approach, enables the most informed clinical management. The goal of ongoing biomarker/mpMRI studies is to provide insight into the clinically helpful integration of the two approaches. For new technologies to be adapted or layered together synergistically, five specific competencies must be considered acceptable: (1) efficacy, (2) potential side effect levels, (3) ease of use of technology, (4) cost vs. clinical benefit, and (5) durability.

Diagnosis and treatment of urinary tract infections (UTIs) remains stagnant. The presumption that a patient either has a UTI or does not (binary choice) is inappropriately simplistic. Laboratory diagnostic tests have not advanced for decades. The goal of UTI treatment has not been rigorously defined and may increase the prescription of potentially harmful, inappropriate antibiotics. Despite the high incidence of UTI diagnoses, the high cost of UTI treatment, and increasing concerns associated with antimicrobial resistance, the development of novel and more accurate UTI tests has not been considered a priority, in part due to the general perception that current UTI care is already sufficient. In this review, we discuss the importance of improving UTI diagnostic testing to improve treatment outcomes. We discuss the problems associated with UTI diagnosis. Urinary microbes are alive and exist in both healthy and symptomatic individuals-urine is not sterile. We specifically outline the limitations of standard urine culture methods used by clinical microbiology laboratories, explaining clearly why such methods cannot be considered to be the "gold standard," as standard culture methods underreport most of the urinary tract microbes, including some acknowledged and many emerging uropathogens. We do not recommend abandonment of this test, as no universally accepted substitute yet exists. However, we strongly encourage the development of new and improved diagnostic tests that can both improve outcomes and preserve antibiotic stewardship.

Introduction: Elective aspects of surgical management of pediatric differences of sex development (DSD) are associated with controversy. We examined North American pediatric urologist and endocrinologist perspectives regarding recommended and existing informed consent elements for written consent documents prior to pediatric genital surgery.

Methods: Focus groups with pediatric urologist and endocrinologist members of the Societies for Pediatric Urology (SPU, n=8) or Pediatric Endocrine Society (PES, n=8) were held to identify elements of informed consent for DSD-related urogenital surgery. Elements were subsequently included in web-based surveys in 2003 and 2020 (SPU: n=121 and 143; PES: n=287 and 111, respectively). Participants rated their level of agreement with including each element in informed consent documents. In 2020, participants reported whether documents they use in clinical practice incorporate these elements.

Results: Focus groups identified four elements of informed consent: on-going debate over pediatric genital surgery; potential needs for multiple procedures; possible gender change and surgical reversal; and non-surgical alternatives. Across both years and both specialties, a majority (79% to 98%) endorsed the four elements, with significant between-group differences. Significantly more PES than SPU participants reported not knowing whether specific elements were included in current written informed consent; of those who knew, the majority (66% to 91%) reported inclusion.

Discussion: Specialists agree with including these four elements in written informed consent documents. Endocrinologists are not always familiar with the exact elements included. The degree to which non-surgeon members of the care team should be involved in the written informed consent process is an open question.

Background: To our knowledge, no formal training combining didactic learning, simulation, and hands-on performance is available for practitioners performing neonatal circumcision. The absence of structured training may result in avoidable complications such as bleeding and penile injury. Herein, we present the results of a pilot neonatal circumcision training platform, offered either virtually or in person.

Material and methods: CIRCLES (CIRCumcision Learning Experience using Simulation) consist of 1. online didactic learning; 2. live simulation practice (in person or virtual coaching), and 3. clinical performance. Outcome measures included pre- and post-knowledge scores, self-efficacy questionnaires, and skill assessments of simulation and clinical performance (Likert rating). Face validity for training success was determined by an 80% passing score on the knowledge test and > 75% (mostly independent) performance.

Results: For this pilot, we restricted enrolment to seven pediatric residents and one nurse practitioner. Wilcoxon Sum Rank test for non-parametric paired samples for pre-and post-knowledge tests showed a median increase of 20 points in post-knowledge tests (p=0.011). Upon completion of the simulation training, all participants (8/8) have chosen to perform circumcision with the GOMCO clamp. Both in-person (4/4) and virtual participants (4/4) performed >75% of simulation and clinical circumcision independently. Post-training self-efficacy Z scores were higher than pre-training scores, except for the management of bleeding.

Conclusion: The pilot CIRCLES learning shows face validity for both in-person and virtual training for neonatal circumcision. We plan to extend this platform to include more trainees and to offer them to established practitioners. The availability of formal training may ultimately reduce adverse outcomes.

Objective: To evaluate the use of rectal mucosal cleansings before transrectal ultrasound-guided prostate biopsy with a transrectal approach, comparing the safety profile of chlorhexidine and povidone-iodine.

Methods: We conducted a retrospective analysis of our prospectively maintained database between August 2019 to September 2020 in a high-volume hospital in Cali, Colombia. 428 consecutive patients who underwent TRUS-PB with a transrectal approach were included in this study. 117 patients received povidone-iodine and 311 patients received chlorhexidine for rectal mucosa cleansings. After the procedure, we conducted telephone follow-ups at 48 hours, 7 days, and 30 days. The complications were registered in our database. Analysis was performed using STATA 15.

Results: There was a statistically significant increased risk of hematuria, urinary retention, and rectal bleeding in those patients exposed to Chlorhexidine (p <0.001, <0.001, and 0.01 respectively). We did not find any differences in sepsis (p 0.18) or urinary tract infection (p 0.77) rates between the groups. Rectal antisepsis with chlorhexidine significantly increased the risk of non-infectious complications.

Conclusions: In terms of infectious complications, there were no differences between the use of povidone-iodine and chlorhexidine for rectal mucosal cleansing prior to TRUS-PB. Povidone iodine appeared to be a safer option, as it is associated with fewer risks of hematuria, rectal bleeding, and urine retention.