Pub Date : 2023-03-20DOI: 10.3389/fruro.2023.984967
N. M. G. D. de Queiroz, Fábio Mambelli, Bruno M. Silva, S. Oliveira
Bacillus Calmette–Guérin (BCG) immunotherapy for the treatment of bladder cancer (BC) depends on the recognition of bacteria by extracellular toll-like receptors (TLRs) or the detection of mycobacterial DNA by endosomal TLRs or the cGAS-STING pathway. Agonists related to these innate immune pathways have been developed as adjuvants to potentiate the effects of immunotherapy. As innate immune pathways are important for the action of BCG and other agonists proposed for BC therapy, we decided to investigate the presence of mutations in the main receptors of these pathways. The Cancer Genome Atlas (TCGA) database was screened to identify BC-related mutations (apart from oncogenes), targeting, in particular, TLRs, the adaptor molecule MyD88, and the cGAS-STING (cyclic GMP-AMP synthase-stimulator of interferon genes) immune pathway. Among 1,724 BC entries, 103 mutations were identified in 80 affected cases in the cohort. TLR9 and TLR10 ranked among the most frequent mutated genes observed in the affected cases in our search (13 mutations each). Through all analyzed data, the search for MYD88 gene recovered only 1 mutation input in the database. Mutations in the STING and cGAS genes were found in one and four cases, respectively. We also evaluated clinical data, including the pathologic stage of BC, and gene expression from 103 mutations entries. This article attempts to highlight the relevance of mutations in genes coding for innate immune molecules in BC samples as potential biomarkers to predict individual disease outcome, and specifically to help find the appropriate treatment for each person in the future.
{"title":"Mutations in genes encoding innate immune molecules identified in bladder cancer samples as potential biomarkers for immunotherapy with BCG and agonists","authors":"N. M. G. D. de Queiroz, Fábio Mambelli, Bruno M. Silva, S. Oliveira","doi":"10.3389/fruro.2023.984967","DOIUrl":"https://doi.org/10.3389/fruro.2023.984967","url":null,"abstract":"Bacillus Calmette–Guérin (BCG) immunotherapy for the treatment of bladder cancer (BC) depends on the recognition of bacteria by extracellular toll-like receptors (TLRs) or the detection of mycobacterial DNA by endosomal TLRs or the cGAS-STING pathway. Agonists related to these innate immune pathways have been developed as adjuvants to potentiate the effects of immunotherapy. As innate immune pathways are important for the action of BCG and other agonists proposed for BC therapy, we decided to investigate the presence of mutations in the main receptors of these pathways. The Cancer Genome Atlas (TCGA) database was screened to identify BC-related mutations (apart from oncogenes), targeting, in particular, TLRs, the adaptor molecule MyD88, and the cGAS-STING (cyclic GMP-AMP synthase-stimulator of interferon genes) immune pathway. Among 1,724 BC entries, 103 mutations were identified in 80 affected cases in the cohort. TLR9 and TLR10 ranked among the most frequent mutated genes observed in the affected cases in our search (13 mutations each). Through all analyzed data, the search for MYD88 gene recovered only 1 mutation input in the database. Mutations in the STING and cGAS genes were found in one and four cases, respectively. We also evaluated clinical data, including the pathologic stage of BC, and gene expression from 103 mutations entries. This article attempts to highlight the relevance of mutations in genes coding for innate immune molecules in BC samples as potential biomarkers to predict individual disease outcome, and specifically to help find the appropriate treatment for each person in the future.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47317803","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 : 2023-03-17DOI: 10.3389/fruro.2023.1159439
Yasmine S. Ghattas, David G. Gelikman, Kristen R. Ibanez, P. Ellsworth, A. Seth
Introduction Management of urachal anomalies in pediatric patients has historically lacked a clear consensus between conservative and surgical management. We aimed to review and summarize the literature on the diagnosis, symptoms, and evolution in the management of urachal anomalies in pediatric patients. Methods We performed a scoping literature review of PubMed/Medline and WebOfScience from January 2000 to February 2022. Results 32 publications were selected for inclusion in this analysis. 1,438 unique studies were identified with 32 studies meeting inclusion criteria. 15/32 studies discussed both conservative and surgical management, 14/32 studies discussed only surgical management outcomes, and 3/32 studies discussed diagnostic methods. The studies discussing conservative management supported the treatment of urachal anomalies with an initial conservative approach, which includes watchful waiting, repeated ultrasounds, lesion measurement, and antibiotic use. 5/32 of the included studies identified patients that were converted from conservative to surgical management with conversion rates ranging from 12.5% to 43.5% per study. 14/20 converted patients were identified to have a urachal cyst and 13/20 had a persistent infection. Conclusions Strong evidence exists that supports initial conservative management over surgical management of pediatric urachal anomalies. However, predictive factors for determining which patients will require surgical management remain elusive. Treatment algorithms can potentially be developed once carefully developed prospective studies delineate statistically significant patient factors which necessitate surgical management over observation.
{"title":"Current management strategies of urachal anomalies in pediatric patients: A scoping review","authors":"Yasmine S. Ghattas, David G. Gelikman, Kristen R. Ibanez, P. Ellsworth, A. Seth","doi":"10.3389/fruro.2023.1159439","DOIUrl":"https://doi.org/10.3389/fruro.2023.1159439","url":null,"abstract":"Introduction Management of urachal anomalies in pediatric patients has historically lacked a clear consensus between conservative and surgical management. We aimed to review and summarize the literature on the diagnosis, symptoms, and evolution in the management of urachal anomalies in pediatric patients. Methods We performed a scoping literature review of PubMed/Medline and WebOfScience from January 2000 to February 2022. Results 32 publications were selected for inclusion in this analysis. 1,438 unique studies were identified with 32 studies meeting inclusion criteria. 15/32 studies discussed both conservative and surgical management, 14/32 studies discussed only surgical management outcomes, and 3/32 studies discussed diagnostic methods. The studies discussing conservative management supported the treatment of urachal anomalies with an initial conservative approach, which includes watchful waiting, repeated ultrasounds, lesion measurement, and antibiotic use. 5/32 of the included studies identified patients that were converted from conservative to surgical management with conversion rates ranging from 12.5% to 43.5% per study. 14/20 converted patients were identified to have a urachal cyst and 13/20 had a persistent infection. Conclusions Strong evidence exists that supports initial conservative management over surgical management of pediatric urachal anomalies. However, predictive factors for determining which patients will require surgical management remain elusive. Treatment algorithms can potentially be developed once carefully developed prospective studies delineate statistically significant patient factors which necessitate surgical management over observation.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41572434","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 : 2023-03-14DOI: 10.3389/fruro.2023.1080856
Shane Kronstedt, A. Kaldany, Hiren V. Patel, S. Elsamra
The management of urinary tract stricture disease has evolved over the last several decades, with robotic surgery representing a bourgeoning method for urologic reconstruction. Conventionally, proximal and mid-ureteral strictures, as well as lengthy urethral strictures, have presented a challenge for surgeons to create tension-free repairs. Options for repair include endoscopic dilation, endopyelotomy, ureteroplasty or pyeloplasty, and urethroplasty. Small and large bowel can be incorporated into various urinary tract stricture repairs. Their use has proven successful in reconstructing both upper and lower urinary tract strictures and offers flexibility for complex cases such as lengthy or multifocal strictures. While the use of bowel, most notably the appendix, for stricture repair is not a novel concept, a growing body of evidence supports its use with minimally invasive robotic approaches. In addition, there has been a substantial amount of recent data suggesting low rates of postoperative complications and long progression-free survival after robotic stricture repair using small bowel or rectum. We present a comprehensive review of literature outlining the role of the small bowel, appendix, and rectum in the minimally invasive repair of urinary tract stricture disease, as well as a description of the various techniques employed.
{"title":"The role of bowel for minimally invasive treatment of stricture disease","authors":"Shane Kronstedt, A. Kaldany, Hiren V. Patel, S. Elsamra","doi":"10.3389/fruro.2023.1080856","DOIUrl":"https://doi.org/10.3389/fruro.2023.1080856","url":null,"abstract":"The management of urinary tract stricture disease has evolved over the last several decades, with robotic surgery representing a bourgeoning method for urologic reconstruction. Conventionally, proximal and mid-ureteral strictures, as well as lengthy urethral strictures, have presented a challenge for surgeons to create tension-free repairs. Options for repair include endoscopic dilation, endopyelotomy, ureteroplasty or pyeloplasty, and urethroplasty. Small and large bowel can be incorporated into various urinary tract stricture repairs. Their use has proven successful in reconstructing both upper and lower urinary tract strictures and offers flexibility for complex cases such as lengthy or multifocal strictures. While the use of bowel, most notably the appendix, for stricture repair is not a novel concept, a growing body of evidence supports its use with minimally invasive robotic approaches. In addition, there has been a substantial amount of recent data suggesting low rates of postoperative complications and long progression-free survival after robotic stricture repair using small bowel or rectum. We present a comprehensive review of literature outlining the role of the small bowel, appendix, and rectum in the minimally invasive repair of urinary tract stricture disease, as well as a description of the various techniques employed.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48255116","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 : 2023-03-09DOI: 10.3389/fruro.2023.1132139
M. Zaliznyak, Rainey Horwitz, F. Davaro, Geoffrey H. Rosen, Katie S. Murray, Z. Hamilton
Purpose Prostate cancer (PCa) is a heterogeneous diagnosis, with a significant latency between diagnosis and risk of cancer specific mortality. During the COVID-19 pandemic, the need to balance the risk of COVID-19 exposure and resource allocation resulted in delays in non-emergent surgeries. We sought to assess if delays in surgical wait time (SWT) result in an increased risk of disease progression in the setting of clinically node positive PCa. Materials and methods The National Cancer Database was queried for patients with cT1-3N0-1M0 PCa who underwent radical prostatectomy with lymph node dissection from 2010 to 2016. Patients were grouped based on pathologic node status (pN0 versus pN1). Outcomes including clinical tumor characteristics, hospital readmissions, and survival was correlated with length of SWT prior to radical prostatectomy. Results A total of 218 patients with pN0 PCa and 805 patients with pN1 PCa met our inclusion criteria and were included in this study. Hospital length of stay and 30-day readmissions were similar between pN0 and pN1 patients. No significant association was detected between increased SWT and pN1 status among our patient population. Sensitivity multivariable analyses including only patients with Gleason 7-10 and excluding those who received androgen deprivation therapy prior to surgery showed similar findings that SWT was not associated with pN1 disease. With short term follow up, Kaplan-Meier analysis showed no significant difference in overall survival when stratified by SWT at 30-, 60-, 90-, or >90-day intervals. Conclusion With the impact of the recent pandemic on healthcare and hospital systems, it is important to understand the effect that likely delays in SWT can have on patient outcomes. The findings described in this study suggest that delays in SWT may not result in adverse nodal disease progression among patients diagnosed with pathological node positive PCa. These results will be important to share with patients and their families when discussing treatment options and can result in improved patient outcomes and satisfaction with treatment regimens.
{"title":"Increasing surgical wait time does not increase the risk of node positive prostate cancer: Implications for surgical planning during the COVID-19 pandemic and beyond","authors":"M. Zaliznyak, Rainey Horwitz, F. Davaro, Geoffrey H. Rosen, Katie S. Murray, Z. Hamilton","doi":"10.3389/fruro.2023.1132139","DOIUrl":"https://doi.org/10.3389/fruro.2023.1132139","url":null,"abstract":"Purpose Prostate cancer (PCa) is a heterogeneous diagnosis, with a significant latency between diagnosis and risk of cancer specific mortality. During the COVID-19 pandemic, the need to balance the risk of COVID-19 exposure and resource allocation resulted in delays in non-emergent surgeries. We sought to assess if delays in surgical wait time (SWT) result in an increased risk of disease progression in the setting of clinically node positive PCa. Materials and methods The National Cancer Database was queried for patients with cT1-3N0-1M0 PCa who underwent radical prostatectomy with lymph node dissection from 2010 to 2016. Patients were grouped based on pathologic node status (pN0 versus pN1). Outcomes including clinical tumor characteristics, hospital readmissions, and survival was correlated with length of SWT prior to radical prostatectomy. Results A total of 218 patients with pN0 PCa and 805 patients with pN1 PCa met our inclusion criteria and were included in this study. Hospital length of stay and 30-day readmissions were similar between pN0 and pN1 patients. No significant association was detected between increased SWT and pN1 status among our patient population. Sensitivity multivariable analyses including only patients with Gleason 7-10 and excluding those who received androgen deprivation therapy prior to surgery showed similar findings that SWT was not associated with pN1 disease. With short term follow up, Kaplan-Meier analysis showed no significant difference in overall survival when stratified by SWT at 30-, 60-, 90-, or >90-day intervals. Conclusion With the impact of the recent pandemic on healthcare and hospital systems, it is important to understand the effect that likely delays in SWT can have on patient outcomes. The findings described in this study suggest that delays in SWT may not result in adverse nodal disease progression among patients diagnosed with pathological node positive PCa. These results will be important to share with patients and their families when discussing treatment options and can result in improved patient outcomes and satisfaction with treatment regimens.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49283460","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 : 2023-02-24DOI: 10.3389/fruro.2023.1100386
V. Lorenzoni, I. Palla, G. Manenti, P. Ditonno, T. D. de Reijke, G. Turchetti
Introduction Benign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population over 60 years and it is associated with the development of lower urinary tract symptoms (LUTS): dysuria, nocturia, increased frequency of urination, etc. LUTS negatively affect the patient’s daily activities and the quality of life. Patients with severe and persisting symptoms, not responding to pharmacological therapy, are candidates for surgical intervention. Transurethral resection of the prostate (TURP) has been the gold standard for surgical approach despite it can be associated with significant complications. Indeed, laser vaporization or enucleation are today the most broadly used surgical techniques and other minimally invasive surgical therapies (MISTs) have been introduced to reduce some complications during- and post-surgery. Moreover, a new micro-invasive approach for LUTS is represented by EchoLaser SoracteLite™ transperineal laser ablation (TPLA), an innovative, safe and feasible approach that can be performed under local anaesthesia and in an outpatient setting. Objective The paper aims to analyse and discuss the economic implications of standard surgical techniques and innovative approaches with a focus on TPLA thought a literature review. Results The literature review highlights that at present there are few studies related to the economic implications of surgical therapies for LUTS. Preliminary results show that the TPLA is a promising technique in terms of clinical and economic benefit for the treatment of obstructive LUTS. Furthermore, TPLA can be performed in an outpatient setting implying an advantage from an economic and also organizational point of view, in particular in a health emergency situation. Conclusions Economic literature on minimally invasive techniques and surgical approaches for the treatment of BPH is still lacking. Multicentre and long-term economic studies are needed to assess the estimated disease burden. However, direct and indirect costs associated with TPLA are minimized vs TURP and laser vaporization/enucleation.
{"title":"Standard approach and future perspective for the management of benign prostatic hyperplasia from a health-economics point of view: the role of transperineal laser ablation","authors":"V. Lorenzoni, I. Palla, G. Manenti, P. Ditonno, T. D. de Reijke, G. Turchetti","doi":"10.3389/fruro.2023.1100386","DOIUrl":"https://doi.org/10.3389/fruro.2023.1100386","url":null,"abstract":"Introduction Benign prostatic hyperplasia (BPH) is a common diagnosis among the ageing male population over 60 years and it is associated with the development of lower urinary tract symptoms (LUTS): dysuria, nocturia, increased frequency of urination, etc. LUTS negatively affect the patient’s daily activities and the quality of life. Patients with severe and persisting symptoms, not responding to pharmacological therapy, are candidates for surgical intervention. Transurethral resection of the prostate (TURP) has been the gold standard for surgical approach despite it can be associated with significant complications. Indeed, laser vaporization or enucleation are today the most broadly used surgical techniques and other minimally invasive surgical therapies (MISTs) have been introduced to reduce some complications during- and post-surgery. Moreover, a new micro-invasive approach for LUTS is represented by EchoLaser SoracteLite™ transperineal laser ablation (TPLA), an innovative, safe and feasible approach that can be performed under local anaesthesia and in an outpatient setting. Objective The paper aims to analyse and discuss the economic implications of standard surgical techniques and innovative approaches with a focus on TPLA thought a literature review. Results The literature review highlights that at present there are few studies related to the economic implications of surgical therapies for LUTS. Preliminary results show that the TPLA is a promising technique in terms of clinical and economic benefit for the treatment of obstructive LUTS. Furthermore, TPLA can be performed in an outpatient setting implying an advantage from an economic and also organizational point of view, in particular in a health emergency situation. Conclusions Economic literature on minimally invasive techniques and surgical approaches for the treatment of BPH is still lacking. Multicentre and long-term economic studies are needed to assess the estimated disease burden. However, direct and indirect costs associated with TPLA are minimized vs TURP and laser vaporization/enucleation.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47870967","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 : 2023-02-21DOI: 10.3389/fruro.2023.1080410
D. Abramowitz, W. Claeys, C. Jamaer, C. Berquin, P. Hoebeke, A. Spinoit
Introduction and aim of study The bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of congenital malformations with many variations. A never operated political refugee with BEEC was referred to our center for management upon arrival in Europe. Our aim is to report the technique and outcomes on a never operated on BEEC adult, highlighting the importance of transitional urologic care for congenital malformations in adult patients. Materials and methods A 27-year old female patient was referred to our center for complete incontinence since birth by the General practitioner from the refugee center who suspected BEEC. Upon further investigation, an exstrophic bladder with blind ending ureteral orifices and a urethral meatus caudal to the exstrophic bladder plate were highlighted. A second non-exstrophic bladder with two orthotopic ureters was demonstrated, thereby a bladder duplication in the sagittal plane was diagnosed, presenting a wide-open bladder neck and a 7 cm pubic diastasis, causing the incontinence she was initially referred for. With the patient in a supine position, laparotomy incision was done with excision of the umbilical scar. The exstrophic bladder plate is dissected caudally. As it presents good detrusor quality, decision is taken to use it as a ventral inlay to augment the non-exstrophic bladder. A Mitchell-type bladder neck reconstruction is performed with a classical fascia sling wrapped around the bladder neck to increase the continence mechanism given the very wide pubic diastasis. Given the risk for hyper-continence, interposition of a continent Mitrofanoff-type vesicostomy is additionally realized. Genital reconstruction is achieved. Results Over 1 year post operatively, the patient is completely dry, can holp up to 250ml between catheterization she performs five times per day and once at night. No post-operative complications were observed. Conclusion The case of one adult patient with a rare urological condition like bladder exstrophy with duplication is presented, illustrating challenges political refugees referred to Europe implicates in terms of surgery regarding congenital malformations in adult patients. A multidisciplinary approach is highly important, demonstrating the importance of transitional care.
{"title":"Complete bladder duplication presenting in adulthood: A case report on reconstructive technique and reflections on translational urology in refugees","authors":"D. Abramowitz, W. Claeys, C. Jamaer, C. Berquin, P. Hoebeke, A. Spinoit","doi":"10.3389/fruro.2023.1080410","DOIUrl":"https://doi.org/10.3389/fruro.2023.1080410","url":null,"abstract":"Introduction and aim of study The bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of congenital malformations with many variations. A never operated political refugee with BEEC was referred to our center for management upon arrival in Europe. Our aim is to report the technique and outcomes on a never operated on BEEC adult, highlighting the importance of transitional urologic care for congenital malformations in adult patients. Materials and methods A 27-year old female patient was referred to our center for complete incontinence since birth by the General practitioner from the refugee center who suspected BEEC. Upon further investigation, an exstrophic bladder with blind ending ureteral orifices and a urethral meatus caudal to the exstrophic bladder plate were highlighted. A second non-exstrophic bladder with two orthotopic ureters was demonstrated, thereby a bladder duplication in the sagittal plane was diagnosed, presenting a wide-open bladder neck and a 7 cm pubic diastasis, causing the incontinence she was initially referred for. With the patient in a supine position, laparotomy incision was done with excision of the umbilical scar. The exstrophic bladder plate is dissected caudally. As it presents good detrusor quality, decision is taken to use it as a ventral inlay to augment the non-exstrophic bladder. A Mitchell-type bladder neck reconstruction is performed with a classical fascia sling wrapped around the bladder neck to increase the continence mechanism given the very wide pubic diastasis. Given the risk for hyper-continence, interposition of a continent Mitrofanoff-type vesicostomy is additionally realized. Genital reconstruction is achieved. Results Over 1 year post operatively, the patient is completely dry, can holp up to 250ml between catheterization she performs five times per day and once at night. No post-operative complications were observed. Conclusion The case of one adult patient with a rare urological condition like bladder exstrophy with duplication is presented, illustrating challenges political refugees referred to Europe implicates in terms of surgery regarding congenital malformations in adult patients. A multidisciplinary approach is highly important, demonstrating the importance of transitional care.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46828457","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 : 2023-02-16DOI: 10.3389/fruro.2023.1098294
W. Whitman, M. Sandberg, P. Lee, S. Walker
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease that, based on the variable efficacy observed with most therapeutic options, is difficult to treat effectively. A more targeted patient selection process for current and emerging therapeutic options would likely help to improve outcomes. This narrative review explores small fiber polyneuropathy (SFPN) in IC/BPS as part of a larger widespread pain phenotype and as a potential therapeutic target. Because SFPN is becoming increasingly implicated in polysyndromic pain disorders (e.g., IC/BPS, chronic pelvic pain, and fibromyalgia) in which immune dysregulation is a suspected pathophysiologic etiology, continued consideration should be given to immunomodulatory therapies such as intravenous immunoglobulin (IVIg). Moreover, since the small fibers affected in SFPN continue to grow even as people age, targeted treatment may prevent further destruction and provide long-term benefits as the fibers are given time to repair. In addition to therapeutic potential, having a definitive SFPN diagnosis may provide psychological benefit in a patient population for which symptoms have historically been attributed to negative psychological factors. Finally, based on emerging data in this area, we propose consideration be given to include SFPN testing in the work-up of patients with IC/BPS that are refractory to treatments or have multiple comorbid pain syndromes since it may be an indicator of the need for alternative therapies. We believe that SFPN will play an increasingly larger role in the clinical evaluation and management of polysyndromic pain disorders, including IC/BPS.
{"title":"Small fiber polyneuropathy: A new therapeutic target in patients with interstitial cystitis/bladder pain syndrome?","authors":"W. Whitman, M. Sandberg, P. Lee, S. Walker","doi":"10.3389/fruro.2023.1098294","DOIUrl":"https://doi.org/10.3389/fruro.2023.1098294","url":null,"abstract":"Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease that, based on the variable efficacy observed with most therapeutic options, is difficult to treat effectively. A more targeted patient selection process for current and emerging therapeutic options would likely help to improve outcomes. This narrative review explores small fiber polyneuropathy (SFPN) in IC/BPS as part of a larger widespread pain phenotype and as a potential therapeutic target. Because SFPN is becoming increasingly implicated in polysyndromic pain disorders (e.g., IC/BPS, chronic pelvic pain, and fibromyalgia) in which immune dysregulation is a suspected pathophysiologic etiology, continued consideration should be given to immunomodulatory therapies such as intravenous immunoglobulin (IVIg). Moreover, since the small fibers affected in SFPN continue to grow even as people age, targeted treatment may prevent further destruction and provide long-term benefits as the fibers are given time to repair. In addition to therapeutic potential, having a definitive SFPN diagnosis may provide psychological benefit in a patient population for which symptoms have historically been attributed to negative psychological factors. Finally, based on emerging data in this area, we propose consideration be given to include SFPN testing in the work-up of patients with IC/BPS that are refractory to treatments or have multiple comorbid pain syndromes since it may be an indicator of the need for alternative therapies. We believe that SFPN will play an increasingly larger role in the clinical evaluation and management of polysyndromic pain disorders, including IC/BPS.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44931582","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 : 2023-02-13DOI: 10.3389/fruro.2023.994540
Tara Bates, B. Spray, Stephen J. Canon
Purpose The COVID-19 pandemic dramatically changed the way many patients interacted with their healthcare providers, with many people being forced to use telemedicine out of necessity. Our study aimed to investigate if this increased usage of telemedicine impacted pediatric patient caregivers’ perception of telemedicine for pediatric urology visits. Materials and Methods A prospective survey was administered to the primary caregiver of all patients less than 18 years of age during either an in-person (IP) or a telemedicine (TM) encounter. The survey included questions regarding accessibility to and opinions toward telemedicine. Results Two hundred, thirty-nine total patient caregivers were surveyed: 209 IP and 30 TM. Most caregivers in both cohorts reported being more likely to use telemedicine now than before the pandemic: IP (125/209, 59.8%) and TM (23/30, 76.7%). Caregivers also reported that the severity of their child’s condition would impact their likelihood to utilize telemedicine for evaluation (IP 162/209 (77.5%) vs. TM 28/30 (93.3%) with caregivers in the TM group even more likely to be influenced by this factor (p = 0.045). Most caregivers in both groups reported that they would utilize telemedicine within 60 miles from the provider. Over 80% of families from both groups reported having both a laptop and a cellular phone in their home. A greater percentage of caregivers in the IP group reported having a desktop computer and a tablet in their home compared to the TM group (41.1% versus 20.0% and 27.3% versus 3.3%, respectively). Conclusions Living through the COVID-19 pandemic has increased the likelihood of caregivers to utilize telemedicine for care of their child’s pediatric urologic disorder. Factors such as severity of illness, distance from the provider, and the context of the evaluation influenced caregiver preferences for utilization of telemedicine. All families surveyed reported having a device at home to perform telemedicine. Laptops and cellular phones were the most commonly used devices.
{"title":"Telemedicine preferences in pediatric urology following the COVID-19 pandemic: A caregiver survey","authors":"Tara Bates, B. Spray, Stephen J. Canon","doi":"10.3389/fruro.2023.994540","DOIUrl":"https://doi.org/10.3389/fruro.2023.994540","url":null,"abstract":"Purpose The COVID-19 pandemic dramatically changed the way many patients interacted with their healthcare providers, with many people being forced to use telemedicine out of necessity. Our study aimed to investigate if this increased usage of telemedicine impacted pediatric patient caregivers’ perception of telemedicine for pediatric urology visits. Materials and Methods A prospective survey was administered to the primary caregiver of all patients less than 18 years of age during either an in-person (IP) or a telemedicine (TM) encounter. The survey included questions regarding accessibility to and opinions toward telemedicine. Results Two hundred, thirty-nine total patient caregivers were surveyed: 209 IP and 30 TM. Most caregivers in both cohorts reported being more likely to use telemedicine now than before the pandemic: IP (125/209, 59.8%) and TM (23/30, 76.7%). Caregivers also reported that the severity of their child’s condition would impact their likelihood to utilize telemedicine for evaluation (IP 162/209 (77.5%) vs. TM 28/30 (93.3%) with caregivers in the TM group even more likely to be influenced by this factor (p = 0.045). Most caregivers in both groups reported that they would utilize telemedicine within 60 miles from the provider. Over 80% of families from both groups reported having both a laptop and a cellular phone in their home. A greater percentage of caregivers in the IP group reported having a desktop computer and a tablet in their home compared to the TM group (41.1% versus 20.0% and 27.3% versus 3.3%, respectively). Conclusions Living through the COVID-19 pandemic has increased the likelihood of caregivers to utilize telemedicine for care of their child’s pediatric urologic disorder. Factors such as severity of illness, distance from the provider, and the context of the evaluation influenced caregiver preferences for utilization of telemedicine. All families surveyed reported having a device at home to perform telemedicine. Laptops and cellular phones were the most commonly used devices.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47964377","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 : 2023-02-03DOI: 10.3389/fruro.2023.1119494
E. Faria, M. Moschovas, C. Vaz, A. Pompeo, A. Santos, A. Stievano, A. Berger, A. Carneiro, A. Dourado, J. R. Colombo, C. Passerotti, C. Andreoni, Clovis Fraga, G. Guglielmetti, G. Lemos, Gustavo Guimarães, L. Nogueira, M. Rocha, P. Melo, Paulo B O Arantes, P. Romanelli, R. Tourinho, R. Nishimoto, R. Machado, R. Reis, Rodrigo Frota, R. Guida, Victor T. Dubeux, R. Gualberto, M. Tobias-Machado
Objective Robotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus. Methods We implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed. Results We divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic. Conclusion RAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors’ assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.
{"title":"Recommendations and optimal approaches to robotic-assisted partial nephrectomy: A consensus of Brazilian experts","authors":"E. Faria, M. Moschovas, C. Vaz, A. Pompeo, A. Santos, A. Stievano, A. Berger, A. Carneiro, A. Dourado, J. R. Colombo, C. Passerotti, C. Andreoni, Clovis Fraga, G. Guglielmetti, G. Lemos, Gustavo Guimarães, L. Nogueira, M. Rocha, P. Melo, Paulo B O Arantes, P. Romanelli, R. Tourinho, R. Nishimoto, R. Machado, R. Reis, Rodrigo Frota, R. Guida, Victor T. Dubeux, R. Gualberto, M. Tobias-Machado","doi":"10.3389/fruro.2023.1119494","DOIUrl":"https://doi.org/10.3389/fruro.2023.1119494","url":null,"abstract":"Objective Robotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus. Methods We implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed. Results We divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic. Conclusion RAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors’ assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43075534","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 : 2023-02-01DOI: 10.3389/fruro.2023.1172271
F. V. van Veen, Stefan Den Hoedt, R. Coolen, Jessica Boekhorst, J. Scheepe, B. Blok
Introduction Catheter-associated urinary tract infection (CAUTI) is a common complication among patients with urinary catheters and is often treated with antibiotics. With increasing rates of antibiotic resistance, it is necessary to explore alternative treatment options for CAUTIs. The aims of this study were 1) to assess the efficacy and treatment satisfaction of bladder irrigation (BI) with tap water to prevent and treat CAUTIs, 2) and to evaluate the current use of BI for CAUTIs among Dutch clinicians. Methods The first part of this study consisted of a cross-sectional study among patients with intermittent or indwelling catheters who performed BI with tap water between March 2020 and May 2021. Efficacy, treatment satisfaction, and Patient Global Impression of Improvement (PGI-I) were assessed using questionnaires. Outcomes were compared between neurogenic lower urinary tract dysfunction (NLUTD) and non-NLUTD patients. Factors associated with overall treatment satisfaction were determined using logistic regression analysis. Second, a nationwide survey of Dutch clinicians was conducted to evaluate the current use of BI for CAUTIs. Results A total of 99 patients who were performing BI for at least three months were included. The median age was 61.9 years, 41.4% had NLUTD, and 72.2% performed BI >1 year. The majority of both NLUTD (65.9%) and non-NLUTD patients (68.4%) were (very) satisfied with BI. Women had higher odds of reporting higher satisfaction and each additional CAUTI decreased the odds. Most NLUTD (85.4%) and non-NLUTD (65.5%) patients reported an improvement on the PGI-I with a difference in favour of NLUTD patients (p=0.002). In addition, 40.4% of the patients had no CAUTI, and 59.6% reported 1.39 (SD 2.06) CAUTIs. Only half of these self-reported CAUTIs were treated with antibiotics. In addition, 33 (58.9%) clinicians used BI for CAUTIs, of which ten used tap water as irrigation agent. Discussion This study provides first evidence supporting the efficacy of BI with tap water in the treatment of CAUTIs and reducing the use of antibiotics. Patients are overall satisfied and experience improvement in their condition with BI. In addition, the majority of the surveyed Dutch clinicians use BI for CAUTIs. However, irrigation with tap water is still not widely used.
{"title":"Bladder irrigation with tap water to reduce antibiotic treatment for catheter-associated urinary tract infections: an evaluation of clinical practice","authors":"F. V. van Veen, Stefan Den Hoedt, R. Coolen, Jessica Boekhorst, J. Scheepe, B. Blok","doi":"10.3389/fruro.2023.1172271","DOIUrl":"https://doi.org/10.3389/fruro.2023.1172271","url":null,"abstract":"Introduction Catheter-associated urinary tract infection (CAUTI) is a common complication among patients with urinary catheters and is often treated with antibiotics. With increasing rates of antibiotic resistance, it is necessary to explore alternative treatment options for CAUTIs. The aims of this study were 1) to assess the efficacy and treatment satisfaction of bladder irrigation (BI) with tap water to prevent and treat CAUTIs, 2) and to evaluate the current use of BI for CAUTIs among Dutch clinicians. Methods The first part of this study consisted of a cross-sectional study among patients with intermittent or indwelling catheters who performed BI with tap water between March 2020 and May 2021. Efficacy, treatment satisfaction, and Patient Global Impression of Improvement (PGI-I) were assessed using questionnaires. Outcomes were compared between neurogenic lower urinary tract dysfunction (NLUTD) and non-NLUTD patients. Factors associated with overall treatment satisfaction were determined using logistic regression analysis. Second, a nationwide survey of Dutch clinicians was conducted to evaluate the current use of BI for CAUTIs. Results A total of 99 patients who were performing BI for at least three months were included. The median age was 61.9 years, 41.4% had NLUTD, and 72.2% performed BI >1 year. The majority of both NLUTD (65.9%) and non-NLUTD patients (68.4%) were (very) satisfied with BI. Women had higher odds of reporting higher satisfaction and each additional CAUTI decreased the odds. Most NLUTD (85.4%) and non-NLUTD (65.5%) patients reported an improvement on the PGI-I with a difference in favour of NLUTD patients (p=0.002). In addition, 40.4% of the patients had no CAUTI, and 59.6% reported 1.39 (SD 2.06) CAUTIs. Only half of these self-reported CAUTIs were treated with antibiotics. In addition, 33 (58.9%) clinicians used BI for CAUTIs, of which ten used tap water as irrigation agent. Discussion This study provides first evidence supporting the efficacy of BI with tap water in the treatment of CAUTIs and reducing the use of antibiotics. Patients are overall satisfied and experience improvement in their condition with BI. In addition, the majority of the surveyed Dutch clinicians use BI for CAUTIs. However, irrigation with tap water is still not widely used.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"47 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41267418","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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