Pub Date : 2024-02-13DOI: 10.3389/fruro.2024.1348002
Zachary C. Danziger, Daniel Jaskowak
Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.
{"title":"On variability and detecting unreliable measurements in animal cystometry","authors":"Zachary C. Danziger, Daniel Jaskowak","doi":"10.3389/fruro.2024.1348002","DOIUrl":"https://doi.org/10.3389/fruro.2024.1348002","url":null,"abstract":"Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"64 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781543","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 : 2024-02-13DOI: 10.3389/fruro.2024.1348002
Zachary C. Danziger, Daniel Jaskowak
Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.
{"title":"On variability and detecting unreliable measurements in animal cystometry","authors":"Zachary C. Danziger, Daniel Jaskowak","doi":"10.3389/fruro.2024.1348002","DOIUrl":"https://doi.org/10.3389/fruro.2024.1348002","url":null,"abstract":"Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"461 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841460","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 : 2024-01-24DOI: 10.3389/fruro.2023.1198980
D. Draeger, O. W. Hakenberg
Triple-drug cisplatin- and taxane-based chemotherapy is the standard treatment for metastatic penile squamous cell cancer (PeSCC), with a moderate response rate of 30% to 38%. Relapse after first-line chemotherapy has a poor prognosis and there is no established second-line treatment. Mitomycin C (MMC) is used as an effective chemotherapy in squamous cell carcinoma of other localities. We therefore used MMC as a single agent for the second-line treatment for patients with advanced PeSCC.Nine patients [median age 63 years (range 31 years–81 years)], who, after inguinal and pelvic lymphadenectomy and progression after first-line chemotherapy, received second-line treatment with 20 mg of MMC administered intravenously and weekly, were included in this study. The median number of cycles of MMC was 6 (range 2–12 cycles) and the median cumulative dose was 120 mg absolute (range 40 mg absolute–240 mg absolute). The patients’ toxicity and treatment responses were evaluated, with the latter evaluated using 18F-FDG-PET/CT.Common Terminology Criteria for Adverse Events (CTCAE) grades 3 or 4 thrombocytopenia and grades 2 or 3 leukopenia occurred in all patients, as did anemia. In seven patients, the application interval had to be extended due to thrombocytopenia. Stable disease was achieved in two patients, and all others progressed under treatment. Seven patients died of the disease, with most patients dying 6 months after starting MMC therapy. Of the two patients who responded with disease stabilization, one died of progressive disease 14 months after MMC treatment. The other responding patient has been stable for over 1 year and is still receiving treatment, which he tolerates well, and has a good quality of life.MMC has only moderate efficacy as a second-line treatment in patients with metastatic PeSCC. With MMC treatment, hematological toxicity is marked.
{"title":"Feasibility and effectiveness of second-line chemotherapy with mitomycin C in patients with advanced penile cancer","authors":"D. Draeger, O. W. Hakenberg","doi":"10.3389/fruro.2023.1198980","DOIUrl":"https://doi.org/10.3389/fruro.2023.1198980","url":null,"abstract":"Triple-drug cisplatin- and taxane-based chemotherapy is the standard treatment for metastatic penile squamous cell cancer (PeSCC), with a moderate response rate of 30% to 38%. Relapse after first-line chemotherapy has a poor prognosis and there is no established second-line treatment. Mitomycin C (MMC) is used as an effective chemotherapy in squamous cell carcinoma of other localities. We therefore used MMC as a single agent for the second-line treatment for patients with advanced PeSCC.Nine patients [median age 63 years (range 31 years–81 years)], who, after inguinal and pelvic lymphadenectomy and progression after first-line chemotherapy, received second-line treatment with 20 mg of MMC administered intravenously and weekly, were included in this study. The median number of cycles of MMC was 6 (range 2–12 cycles) and the median cumulative dose was 120 mg absolute (range 40 mg absolute–240 mg absolute). The patients’ toxicity and treatment responses were evaluated, with the latter evaluated using 18F-FDG-PET/CT.Common Terminology Criteria for Adverse Events (CTCAE) grades 3 or 4 thrombocytopenia and grades 2 or 3 leukopenia occurred in all patients, as did anemia. In seven patients, the application interval had to be extended due to thrombocytopenia. Stable disease was achieved in two patients, and all others progressed under treatment. Seven patients died of the disease, with most patients dying 6 months after starting MMC therapy. Of the two patients who responded with disease stabilization, one died of progressive disease 14 months after MMC treatment. The other responding patient has been stable for over 1 year and is still receiving treatment, which he tolerates well, and has a good quality of life.MMC has only moderate efficacy as a second-line treatment in patients with metastatic PeSCC. With MMC treatment, hematological toxicity is marked.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"44 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139601012","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 : 2024-01-16DOI: 10.3389/fruro.2023.1335414
Pedro Amado, Shao-li Zheng, Dirk Lange, Dario Carugo, Sarah L. Waters, Dominik Obrist, Fiona Burkhard, F. Clavica
Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents.
{"title":"The interplay between bacterial biofilms, encrustation, and wall shear stress in ureteral stents: a review across scales","authors":"Pedro Amado, Shao-li Zheng, Dirk Lange, Dario Carugo, Sarah L. Waters, Dominik Obrist, Fiona Burkhard, F. Clavica","doi":"10.3389/fruro.2023.1335414","DOIUrl":"https://doi.org/10.3389/fruro.2023.1335414","url":null,"abstract":"Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" 90","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618862","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 : 2024-01-08DOI: 10.3389/fruro.2023.1270509
Genevieve Baddoo, Adriana Ene, Zubia Merchant, Swarnali Banerjee, Alan J. Wolfe, C. Putonti
Continued efforts to isolate and sequence bacteria of the urinary tract has increased representation of these species in publicly available databases. This in turn has improved taxonomic classifications of the urinary microbiome (urobiome). Short-read sequencing targeting a variable region(s) of the 16S rRNA gene sequence has been fundamental in characterizing the urobiomes of males and females with and without lower urinary tract symptoms, as well as cancers of the urinary tract. Here, we have compiled a data set of full-length or near-full-length 16S rRNA gene sequences for the urobiome. To generate this data set, we first plated 203 isolates from the bladder on differential media and sequenced their full-length 16S rRNA gene sequence. We combined this data set with publicly available genomes from primarily the female urinary tract. The final data set includes 399 sequences representative of 160 different species from 73 genera. We assessed the ability of publicly available databases to correctly predict these sequences based on the V1-V3, V4, and V4-V6 variable regions. As expected, species designations based upon these variable regions is often not possible or incorrect. We also detected incorrect genus-level classifications. This data set can be used to supplement existing databases, by increasing urobiome species variation, and thus improve future studies characterizing urobiomes.
{"title":"Cataloging variation in 16S rRNA gene sequences of female urobiome bacteria","authors":"Genevieve Baddoo, Adriana Ene, Zubia Merchant, Swarnali Banerjee, Alan J. Wolfe, C. Putonti","doi":"10.3389/fruro.2023.1270509","DOIUrl":"https://doi.org/10.3389/fruro.2023.1270509","url":null,"abstract":"Continued efforts to isolate and sequence bacteria of the urinary tract has increased representation of these species in publicly available databases. This in turn has improved taxonomic classifications of the urinary microbiome (urobiome). Short-read sequencing targeting a variable region(s) of the 16S rRNA gene sequence has been fundamental in characterizing the urobiomes of males and females with and without lower urinary tract symptoms, as well as cancers of the urinary tract. Here, we have compiled a data set of full-length or near-full-length 16S rRNA gene sequences for the urobiome. To generate this data set, we first plated 203 isolates from the bladder on differential media and sequenced their full-length 16S rRNA gene sequence. We combined this data set with publicly available genomes from primarily the female urinary tract. The final data set includes 399 sequences representative of 160 different species from 73 genera. We assessed the ability of publicly available databases to correctly predict these sequences based on the V1-V3, V4, and V4-V6 variable regions. As expected, species designations based upon these variable regions is often not possible or incorrect. We also detected incorrect genus-level classifications. This data set can be used to supplement existing databases, by increasing urobiome species variation, and thus improve future studies characterizing urobiomes.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139444933","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 : 2023-12-18DOI: 10.3389/fruro.2023.1323444
Natalija Kovacevic, Larry Sirls, J. Gilleran, Kenneth Peters
Chronic pelvic pain conditions such as pudendal neuralgia pose significant treatment difficulty due to their elusive etiology and diverse symptomatology. Initially approved as a third or fourth-line treatment of non-obstructive urinary retention and fecal incontinence, neuromodulation has also proven effective for pelvic pain associated with urinary dysfunction. Recently, sacral and pudendal neuromodulation has demonstrated efficacy in managing a spectrum of chronic pelvic conditions including refractory pudendal neuralgia. The individualized approach of peripheral neuromodulation has opened new avenues for tailored medical interventions, extending its application to conditions such as pudendal neuralgia, post sling pain, and vulvodynia. New technologies leading to miniaturized neuromodulation devices such as Freedom® stimulators (Curonix), allows us to implant leads and modulate nerves at precise pain targets. Further experience and research is needed to assess the impact of targeted neuromodulation on managing complex pelvic pain conditions.
{"title":"Peripheral nerve stimulation for pudendal neuralgia and other pelvic pain disorders: current advances","authors":"Natalija Kovacevic, Larry Sirls, J. Gilleran, Kenneth Peters","doi":"10.3389/fruro.2023.1323444","DOIUrl":"https://doi.org/10.3389/fruro.2023.1323444","url":null,"abstract":"Chronic pelvic pain conditions such as pudendal neuralgia pose significant treatment difficulty due to their elusive etiology and diverse symptomatology. Initially approved as a third or fourth-line treatment of non-obstructive urinary retention and fecal incontinence, neuromodulation has also proven effective for pelvic pain associated with urinary dysfunction. Recently, sacral and pudendal neuromodulation has demonstrated efficacy in managing a spectrum of chronic pelvic conditions including refractory pudendal neuralgia. The individualized approach of peripheral neuromodulation has opened new avenues for tailored medical interventions, extending its application to conditions such as pudendal neuralgia, post sling pain, and vulvodynia. New technologies leading to miniaturized neuromodulation devices such as Freedom® stimulators (Curonix), allows us to implant leads and modulate nerves at precise pain targets. Further experience and research is needed to assess the impact of targeted neuromodulation on managing complex pelvic pain conditions.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995272","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 : 2023-12-12DOI: 10.3389/fruro.2023.1275334
Sara B. Papp, Philippe E. Zimmern
Type 2 diabetes mellitus is considered a risk factor for developing recurrent urinary tract infections. This review examined current knowledge on the incidence rates, bacterial strains, risk factors, treatments, and outcomes of recurrent urinary tract infections in type 2 diabetes, predominantly in women.A systematic review was conducted for all English language articles from inception to June 2022 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards in the databases PubMed, OVID Embase, and Cochrane Library. References were cross-examined for further articles. Data collected described the prevalence, characteristics, and management of recurrent urinary tract infections. Risk of bias assessments were performed for all studies.From 3342 identified articles, 597 met initial study criteria. Fifteen studies from 10 countries were included after full-text reviews. Four studies found higher recurrent urinary tract infection rates in diabetics versus non-diabetics meanwhile others reported recurrence rates from 23.4% to 37%. Four of five studies found diabetes to be a risk factor for recurrent urinary tract infection. E. coli was the most frequent causative pathogen. Antibiotic prescription results varied; however, multiple studies determined that longer treatment (≥ 5 days) did not correlate with lower recurrence rates. Risk of bias assessments found the most frequent study weakness to be identification of confounding variables.This review covered multiple subtopics, with few comprehensive or generalizable results, suggesting a need for more research on how recurrent urinary tract infections can be better evaluated and managed in women with type 2 diabetes.
{"title":"Recurrent Urinary tract infections and type 2 diabetes mellitus: a systematic review predominantly in women","authors":"Sara B. Papp, Philippe E. Zimmern","doi":"10.3389/fruro.2023.1275334","DOIUrl":"https://doi.org/10.3389/fruro.2023.1275334","url":null,"abstract":"Type 2 diabetes mellitus is considered a risk factor for developing recurrent urinary tract infections. This review examined current knowledge on the incidence rates, bacterial strains, risk factors, treatments, and outcomes of recurrent urinary tract infections in type 2 diabetes, predominantly in women.A systematic review was conducted for all English language articles from inception to June 2022 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards in the databases PubMed, OVID Embase, and Cochrane Library. References were cross-examined for further articles. Data collected described the prevalence, characteristics, and management of recurrent urinary tract infections. Risk of bias assessments were performed for all studies.From 3342 identified articles, 597 met initial study criteria. Fifteen studies from 10 countries were included after full-text reviews. Four studies found higher recurrent urinary tract infection rates in diabetics versus non-diabetics meanwhile others reported recurrence rates from 23.4% to 37%. Four of five studies found diabetes to be a risk factor for recurrent urinary tract infection. E. coli was the most frequent causative pathogen. Antibiotic prescription results varied; however, multiple studies determined that longer treatment (≥ 5 days) did not correlate with lower recurrence rates. Risk of bias assessments found the most frequent study weakness to be identification of confounding variables.This review covered multiple subtopics, with few comprehensive or generalizable results, suggesting a need for more research on how recurrent urinary tract infections can be better evaluated and managed in women with type 2 diabetes.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009686","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 : 2023-12-08DOI: 10.3389/fruro.2023.1324696
Alireza Ghasemzadeh, Eric T. Wendt, Brendan Dolan, Juliana Craig, G. Allen, E. J. Abel, D. D. Shapiro
To describe the treatment and outcomes of patients who are medically immunosuppressed due to prior organ transplantation or autoimmune disease with clinical T1 renal cell carcinoma (cT1).An institutional database of patients treated for RCC was queried for patients with cT1 RCC and on chronic medical immunosuppression at the time of RCC diagnosis. The outcomes for patients undergoing (1) surgery, (2) ablation, or 3) active surveillance (AS) are described.Between 2010 and 2022, 74 medically immunosuppressed patients with RCC were identified and treated using surgery (n = 29), ablation (n = 33), or AS (n = 12). Seven (58%) AS patients underwent deferred treatment (six ablations and one nephrectomy) due to tumor growth. For surgery patients and ablation patients, the 30-day readmission rates [17% and 9%, respectively (p = 0.7)], and 90-day complication rates [24% and 21%, respectively (p = 0.9)] were similar. One (3%) surgical patient and two (6%) ablation patients recurred locally. Despite being immunosuppressed, only one (3%) surgical patient, one (3%) ablation patient, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence-free rates, metastasis-free rates, and overall survival for the three cohorts (p > 0.05 for all).Patients with stage one RCC with medical immunosuppression can be safely managed through surgery, thermal ablation, or active surveillance, with similar outcomes to historical series of non-immunosuppressed patients. Future prospective studies should investigate shared decision making in this patient cohort and include discussion of less aggressive options that minimize morbidity but preserve oncologic control.
{"title":"Management of stage 1 renal cell cancer in patients immunosuppressed for organ transplantation or autoimmune disease","authors":"Alireza Ghasemzadeh, Eric T. Wendt, Brendan Dolan, Juliana Craig, G. Allen, E. J. Abel, D. D. Shapiro","doi":"10.3389/fruro.2023.1324696","DOIUrl":"https://doi.org/10.3389/fruro.2023.1324696","url":null,"abstract":"To describe the treatment and outcomes of patients who are medically immunosuppressed due to prior organ transplantation or autoimmune disease with clinical T1 renal cell carcinoma (cT1).An institutional database of patients treated for RCC was queried for patients with cT1 RCC and on chronic medical immunosuppression at the time of RCC diagnosis. The outcomes for patients undergoing (1) surgery, (2) ablation, or 3) active surveillance (AS) are described.Between 2010 and 2022, 74 medically immunosuppressed patients with RCC were identified and treated using surgery (n = 29), ablation (n = 33), or AS (n = 12). Seven (58%) AS patients underwent deferred treatment (six ablations and one nephrectomy) due to tumor growth. For surgery patients and ablation patients, the 30-day readmission rates [17% and 9%, respectively (p = 0.7)], and 90-day complication rates [24% and 21%, respectively (p = 0.9)] were similar. One (3%) surgical patient and two (6%) ablation patients recurred locally. Despite being immunosuppressed, only one (3%) surgical patient, one (3%) ablation patient, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence-free rates, metastasis-free rates, and overall survival for the three cohorts (p > 0.05 for all).Patients with stage one RCC with medical immunosuppression can be safely managed through surgery, thermal ablation, or active surveillance, with similar outcomes to historical series of non-immunosuppressed patients. Future prospective studies should investigate shared decision making in this patient cohort and include discussion of less aggressive options that minimize morbidity but preserve oncologic control.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"78 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586742","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 : 2023-11-24DOI: 10.3389/fruro.2023.1296349
Karl-Axel Jönsson, Edvin Andersson, Tryggve Nevéus, Torbjörn Gärdenfors, Christian Balkenius
Bedwetting, also known as enuresis, is the second most common chronic health problem among children and it affects their everyday life negatively. A first-line treatment option is the enuresis alarm. This method entails the child being awoken by a detector and alarm unit upon urination at night, thereby changing their arousal mechanisms and potentially curing them after 6–8 weeks of consistent therapy. The enuresis alarm treatment has a reported success rate above 50% but requires significant effort from the families involved. Additionally, there is a challenge in identifying early indicators of successful treatment.The alarm treatment has been further developed by the company Pjama AB, which, in addition to the alarm, offers a mobile application where users provides data about the patient and information regarding each night throughout the treatment. The wet and dry nights are recorded, in addition to the actual timing of the bedwetting incidents. We used the machine learning model random forest to see if predictions of treatment outcome could be made in early stages of treatment and shorten the evaluation time based on data from 611 patients. This was carried out by using and analyzing data from patients who had used the Pjama application. The patients were split into training and testing groups to evaluate to what extent the algorithm could make predictions every day about whether a patient’s treatment would be successful, partially successful, or unsuccessful.The results show that a large number of patient outcomes can already be predicted accurately in the early stages of treatment.Accurate predictions enable the correct measures to be taken earlier in the treatment, including increasing motivation, adding pharmacotherapy, or terminating treatment. This has the potential to shorten the treatment in general, and to detect patients who will not respond to the treatment early on, which in turn can improve the lives of children suffering from enuresis. The results show great potential in making the treatment of enuresis more efficient.
{"title":"Improving the efficacy of enuresis alarm treatment through early prediction of treatment outcome: a machine learning approach","authors":"Karl-Axel Jönsson, Edvin Andersson, Tryggve Nevéus, Torbjörn Gärdenfors, Christian Balkenius","doi":"10.3389/fruro.2023.1296349","DOIUrl":"https://doi.org/10.3389/fruro.2023.1296349","url":null,"abstract":"Bedwetting, also known as enuresis, is the second most common chronic health problem among children and it affects their everyday life negatively. A first-line treatment option is the enuresis alarm. This method entails the child being awoken by a detector and alarm unit upon urination at night, thereby changing their arousal mechanisms and potentially curing them after 6–8 weeks of consistent therapy. The enuresis alarm treatment has a reported success rate above 50% but requires significant effort from the families involved. Additionally, there is a challenge in identifying early indicators of successful treatment.The alarm treatment has been further developed by the company Pjama AB, which, in addition to the alarm, offers a mobile application where users provides data about the patient and information regarding each night throughout the treatment. The wet and dry nights are recorded, in addition to the actual timing of the bedwetting incidents. We used the machine learning model random forest to see if predictions of treatment outcome could be made in early stages of treatment and shorten the evaluation time based on data from 611 patients. This was carried out by using and analyzing data from patients who had used the Pjama application. The patients were split into training and testing groups to evaluate to what extent the algorithm could make predictions every day about whether a patient’s treatment would be successful, partially successful, or unsuccessful.The results show that a large number of patient outcomes can already be predicted accurately in the early stages of treatment.Accurate predictions enable the correct measures to be taken earlier in the treatment, including increasing motivation, adding pharmacotherapy, or terminating treatment. This has the potential to shorten the treatment in general, and to detect patients who will not respond to the treatment early on, which in turn can improve the lives of children suffering from enuresis. The results show great potential in making the treatment of enuresis more efficient.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139241418","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 : 2023-11-08DOI: 10.3389/fruro.2023.1289421
Chidimma A. Omeke, Charles E. Azuka
Urinary Incontinence, the uncontrolled or involuntary loss of urine, is a prevalent condition among women that is frequently underdiagnosed and underreported, particularly in sub-Saharan Africa (SSA). The social stigma attached to urinary incontinence contributes to low presentation rates for care, and the help-seeking behavior of SSA women with urinary incontinence in this region. Thus, the occurrence of urinary incontinence imposes a considerable burden on women in SSA, leading to physical, social, and psychological complications. A multitude of challenges, such as limited availability of urogynaecological facilities, corruption, etc, have collectively contributed to the scarcity of information on how to manage urinary incontinence in this region. The commonplace management of urinary incontinence is the use of adult diapers, mostly among older women in this region. While it is essential to carry out more research to comprehend the impact of urinary incontinence on women in Sub-Saharan Africa and to promote awareness of medical and surgical interventions; It is recommended that the governing bodies of these regions enhance their endeavors to provide essential facilities and training a skilled workforce to manage this condition at a subsidized cost.
{"title":"Urinary incontinence among women in sub-Saharan Africa – an overview","authors":"Chidimma A. Omeke, Charles E. Azuka","doi":"10.3389/fruro.2023.1289421","DOIUrl":"https://doi.org/10.3389/fruro.2023.1289421","url":null,"abstract":"Urinary Incontinence, the uncontrolled or involuntary loss of urine, is a prevalent condition among women that is frequently underdiagnosed and underreported, particularly in sub-Saharan Africa (SSA). The social stigma attached to urinary incontinence contributes to low presentation rates for care, and the help-seeking behavior of SSA women with urinary incontinence in this region. Thus, the occurrence of urinary incontinence imposes a considerable burden on women in SSA, leading to physical, social, and psychological complications. A multitude of challenges, such as limited availability of urogynaecological facilities, corruption, etc, have collectively contributed to the scarcity of information on how to manage urinary incontinence in this region. The commonplace management of urinary incontinence is the use of adult diapers, mostly among older women in this region. While it is essential to carry out more research to comprehend the impact of urinary incontinence on women in Sub-Saharan Africa and to promote awareness of medical and surgical interventions; It is recommended that the governing bodies of these regions enhance their endeavors to provide essential facilities and training a skilled workforce to manage this condition at a subsidized cost.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"361 16","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135392167","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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