Pub Date : 2023-10-19DOI: 10.3389/fruro.2023.1257368
Ruijie Dai, Fan Jiang, Junjie Fan, Dalin He, Lei Li, Kaijie Wu
Zinner’s syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is characterized by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Cases are rarely reported in China since the incidence of the disease is low. Symptoms also vary widely among patients and its etiology is unclear. In this article, we described two patients with totally different cinicopathological and genetic features based on exon sequencing.
{"title":"Clinicopathological and genetic features of Zinner’s syndrome: two case reports and review of the literature","authors":"Ruijie Dai, Fan Jiang, Junjie Fan, Dalin He, Lei Li, Kaijie Wu","doi":"10.3389/fruro.2023.1257368","DOIUrl":"https://doi.org/10.3389/fruro.2023.1257368","url":null,"abstract":"Zinner’s syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is characterized by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Cases are rarely reported in China since the incidence of the disease is low. Symptoms also vary widely among patients and its etiology is unclear. In this article, we described two patients with totally different cinicopathological and genetic features based on exon sequencing.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135731779","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}
Aims To explore the feasibility of using pressure-volume (PV) catheters for cystometry. These catheters are well-established in cardiovascular research for simultaneous pressure and volume measurements in the left ventricle. Methods Urinary bladders with urethras were collected from domestic pigs for ex-vivo testing. Using a pump, bladders were filled up to 500ml at five different filling rates (15, 20, 25, 30, 35ml/min), and the resulting pressures and volumes were measured using a PV catheter. The bladder were compressed externally in three different areas (central, apex and outlet) to assess the PV catheter’s ability to detect local changes in bladder volume. Results Bladder pressure remained below 10cmH2O for all bladder filling rates. Volume measurements were compared with the volumes instilled by the pump (ground truth), proving high reproducibility and accuracy of the PV catheter measurements up to 400ml. Using the different sensing units of the PV catheter, local changes in bladder volumes could be identified and quantified. Conclusion The main advantage of PV catheters, compared to existing technology used in urology (e.g. conventional urodynamic testing), is the possibility to i) simultaneously measure bladder pressure and volumes and ii) identify local changes in bladder volume (e.g. caused by non-voiding contractions). Both could be useful in the clinical setting to improve the diagnosis and treatment of the Lower Urinary Tract Dysfunction (e.g. overactive/underactive bladder).
{"title":"Can cardiac pressure-volume catheters improve urodynamic assessment? an ex-vivo proof-of-concept","authors":"Silje Ekroll Jahren, Dominik Obrist, Matthias Haenggi, Fiona Burkhard, Francesco Clavica","doi":"10.3389/fruro.2023.1258649","DOIUrl":"https://doi.org/10.3389/fruro.2023.1258649","url":null,"abstract":"Aims To explore the feasibility of using pressure-volume (PV) catheters for cystometry. These catheters are well-established in cardiovascular research for simultaneous pressure and volume measurements in the left ventricle. Methods Urinary bladders with urethras were collected from domestic pigs for ex-vivo testing. Using a pump, bladders were filled up to 500ml at five different filling rates (15, 20, 25, 30, 35ml/min), and the resulting pressures and volumes were measured using a PV catheter. The bladder were compressed externally in three different areas (central, apex and outlet) to assess the PV catheter’s ability to detect local changes in bladder volume. Results Bladder pressure remained below 10cmH2O for all bladder filling rates. Volume measurements were compared with the volumes instilled by the pump (ground truth), proving high reproducibility and accuracy of the PV catheter measurements up to 400ml. Using the different sensing units of the PV catheter, local changes in bladder volumes could be identified and quantified. Conclusion The main advantage of PV catheters, compared to existing technology used in urology (e.g. conventional urodynamic testing), is the possibility to i) simultaneously measure bladder pressure and volumes and ii) identify local changes in bladder volume (e.g. caused by non-voiding contractions). Both could be useful in the clinical setting to improve the diagnosis and treatment of the Lower Urinary Tract Dysfunction (e.g. overactive/underactive bladder).","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135854249","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 : 2023-10-13DOI: 10.3389/fruro.2023.1173885
Zhi Hong Sun, Xue Wei Ma, Wei Sun, Ying Ji Wei, Yi Zhen Li, Dan Wang, Chang Xi Zhou, Guo Gang Xu, Gui Zhi Zhang
Objective To analyze the effect of different types of disinfectants for perineum and urethral meatus cleaning in preventing catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI). Methods Chinese and English databases were searched to collect randomized controlled trials (RCTs) of different disinfectants for perineum and urethral meatus cleaning to prevent CAUTI, and the positive rates of urine culture with different cleaning methods were contrasted by network meta-analysis. Results A total of 18 RCTs were included in this study to analyze the effect of 10 disinfectants in preventing CAUTI. The disinfectants were 0.1% chlorhexidine (CHG), 0.5% CHG, 2% CHG, 0.1% benzalkonium bromide (DBDAB), 0.05% iodophor, 0.5% iodophor, acidic oxidizing potential water (EOW), normal saline (NS), Shehuang lotion, and sterile water. Meta-analysis showed that the positive rates of urine culture in the 0.5% CHG cluster, EOW cluster, 0.5% iodophor cluster, and Shehuang lotion cluster were remarkably lower than that in the 0.1% DBDAB cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster was remarkably lower than that in the 0.05% iodophor cluster (P < 0.05), whereas the positive rates of urine culture in the 0.5% CHG cluster, 0.5% iodophor cluster, Shehuang lotion cluster, and EOW were remarkably lower than that in the normal saline cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster and EOW cluster were remarkably lower than those in the sterile water cluster (P < 0.05). The results of the area under the cumulative ranking probability plot (SUCRA) analysis showed that the probability ranking of the preventive effect of different disinfectants was as follows: 0.5% CHG > Shehuang lotion > EOW > 0.5% Iodophor > 2% CHG > 0.1% CHG > 0.05% Iodophor > Sterile Water > 0.1% DBDAB > Saline. Conclusion 0.5% CHG, Shehuang lotion, EOW, and 0.5% iodophor can be used to clean the perineum and urethral meatus in patients with indwelling catheters. Systematic review registration Chinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2100052260.
{"title":"Effect of different disinfectants on preventing asymptomatic bacteriuria and catheter-related urinary tract infection: a network meta-analysis","authors":"Zhi Hong Sun, Xue Wei Ma, Wei Sun, Ying Ji Wei, Yi Zhen Li, Dan Wang, Chang Xi Zhou, Guo Gang Xu, Gui Zhi Zhang","doi":"10.3389/fruro.2023.1173885","DOIUrl":"https://doi.org/10.3389/fruro.2023.1173885","url":null,"abstract":"Objective To analyze the effect of different types of disinfectants for perineum and urethral meatus cleaning in preventing catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI). Methods Chinese and English databases were searched to collect randomized controlled trials (RCTs) of different disinfectants for perineum and urethral meatus cleaning to prevent CAUTI, and the positive rates of urine culture with different cleaning methods were contrasted by network meta-analysis. Results A total of 18 RCTs were included in this study to analyze the effect of 10 disinfectants in preventing CAUTI. The disinfectants were 0.1% chlorhexidine (CHG), 0.5% CHG, 2% CHG, 0.1% benzalkonium bromide (DBDAB), 0.05% iodophor, 0.5% iodophor, acidic oxidizing potential water (EOW), normal saline (NS), Shehuang lotion, and sterile water. Meta-analysis showed that the positive rates of urine culture in the 0.5% CHG cluster, EOW cluster, 0.5% iodophor cluster, and Shehuang lotion cluster were remarkably lower than that in the 0.1% DBDAB cluster (P &lt; 0.05). The positive rate of urine culture in the 0.5% CHG cluster was remarkably lower than that in the 0.05% iodophor cluster (P &lt; 0.05), whereas the positive rates of urine culture in the 0.5% CHG cluster, 0.5% iodophor cluster, Shehuang lotion cluster, and EOW were remarkably lower than that in the normal saline cluster (P &lt; 0.05). The positive rate of urine culture in the 0.5% CHG cluster and EOW cluster were remarkably lower than those in the sterile water cluster (P &lt; 0.05). The results of the area under the cumulative ranking probability plot (SUCRA) analysis showed that the probability ranking of the preventive effect of different disinfectants was as follows: 0.5% CHG &gt; Shehuang lotion &gt; EOW &gt; 0.5% Iodophor &gt; 2% CHG &gt; 0.1% CHG &gt; 0.05% Iodophor &gt; Sterile Water &gt; 0.1% DBDAB &gt; Saline. Conclusion 0.5% CHG, Shehuang lotion, EOW, and 0.5% iodophor can be used to clean the perineum and urethral meatus in patients with indwelling catheters. Systematic review registration Chinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2100052260.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852992","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 : 2023-10-12DOI: 10.3389/fruro.2023.1300741
Ł. Zapała, Aleksander Ślusarczyk
{"title":"Editorial: Recent advances in the treatment of upper urinary tract bladder cancers","authors":"Ł. Zapała, Aleksander Ślusarczyk","doi":"10.3389/fruro.2023.1300741","DOIUrl":"https://doi.org/10.3389/fruro.2023.1300741","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"181 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139320206","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 : 2023-10-12DOI: 10.3389/fruro.2023.1239328
Xianfu Cai, Chenguang Ding, Yang Li, Jin Zheng, Wujun Xue
Objective To utilize bibliometric analysis to examine the literature about immunotherapy for castration-resistant prostate cancer published within the past two decades. Through this method, we aim to visualize and analyze the research progress in this field and identify the most recent trends and developments. Methods This research conducted a comprehensive literature review on immunotherapy for castration-resistant prostate cancer. The time frame spanned from January 2003 to December 2022, and the data were extracted from the Web of Science Core Collection database. The application of various software tools, such as CiteSpace, Bibliometrix, and VOSviewer, facilitated the visualization and analysis of the gathered data. These technological utilities illustrated the progression of prominent focus areas within the field. Results After excluding irrelevant studies, 373 papers were selected for this study. The findings suggested that the field of immunotherapy for castration-resistant prostate cancer was rapidly developing. The USA was considered to have a significant early entrant advantage in this area and profoundly influenced the field. Similarly, China’s National Cancer center demonstrated notable advantages as a recent participant in this research domain. Major research institutions contributing to the field include the University of California, San Francisco; the University of Washington; and the Memorial Sloan Kettering Cancer Research Center. Notably, US authors James L. Gulley, Charles G. Drake, and Lawrence Fong had the largest number of publications in this area. The main research trends for immunotherapy of castration-resistant prostate cancer are membrane antigen expression, checkpoints T-lymphocyte-associated protein 4 (CTLA4) blockade, radium-223, and vaccines, and the refinement of establishing organoid models might fuel castration-resistant prostate cancer immunotherapy research in the ongoing development. Conclusion The key trends in immunotherapy research for castration-resistant prostate cancer are membrane antigen expression, CTLA4 blockade, radium-223, and vaccines. Exploring new immune pathways and combining different therapeutic approaches to enhance immune response will be a major trend in the field in the future.
目的运用文献计量学分析方法，对近20年来有关去势抵抗性前列腺癌免疫治疗的文献进行分析。通过这种方法，我们旨在可视化和分析该领域的研究进展，并确定最新的趋势和发展。方法对免疫治疗去势抵抗性前列腺癌的相关文献进行综述。时间跨度为2003年1月至2022年12月，数据提取自Web of Science Core Collection数据库。利用CiteSpace、Bibliometrix、VOSviewer等软件工具，对收集到的数据进行可视化分析。这些技术应用说明了该领域内突出的重点领域的进展。结果在剔除不相关研究后，共筛选出373篇论文。研究结果表明，去势抵抗性前列腺癌的免疫治疗领域正在迅速发展。美国被认为在这一领域具有显著的早期进入优势，并对该领域产生了深远的影响。同样，中国国家癌症中心作为这一研究领域的新参与者，也展示了显著的优势。对该领域做出贡献的主要研究机构包括加州大学旧金山分校;华盛顿大学;以及纪念斯隆·凯特琳癌症研究中心值得注意的是，美国作家James L. Gulley, Charles G. Drake和Lawrence Fong在这一领域的出版物数量最多。去势抵抗性前列腺癌免疫治疗的主要研究方向是膜抗原表达、检查点t淋巴细胞相关蛋白4 (CTLA4)阻断、放射-223和疫苗，建立的类器官模型的完善可能会推动正在进行的去势抵抗性前列腺癌免疫治疗研究。结论膜抗原表达、CTLA4阻断、镭-223和疫苗是去势抵抗性前列腺癌免疫治疗研究的关键方向。探索新的免疫途径，结合不同的治疗方法来增强免疫反应将是未来该领域的一个主要趋势。
{"title":"Knowledge mapping of immunotherapy in castration-resistant prostate cancer: a bibliometric and visualized study (2003–2022)","authors":"Xianfu Cai, Chenguang Ding, Yang Li, Jin Zheng, Wujun Xue","doi":"10.3389/fruro.2023.1239328","DOIUrl":"https://doi.org/10.3389/fruro.2023.1239328","url":null,"abstract":"Objective To utilize bibliometric analysis to examine the literature about immunotherapy for castration-resistant prostate cancer published within the past two decades. Through this method, we aim to visualize and analyze the research progress in this field and identify the most recent trends and developments. Methods This research conducted a comprehensive literature review on immunotherapy for castration-resistant prostate cancer. The time frame spanned from January 2003 to December 2022, and the data were extracted from the Web of Science Core Collection database. The application of various software tools, such as CiteSpace, Bibliometrix, and VOSviewer, facilitated the visualization and analysis of the gathered data. These technological utilities illustrated the progression of prominent focus areas within the field. Results After excluding irrelevant studies, 373 papers were selected for this study. The findings suggested that the field of immunotherapy for castration-resistant prostate cancer was rapidly developing. The USA was considered to have a significant early entrant advantage in this area and profoundly influenced the field. Similarly, China’s National Cancer center demonstrated notable advantages as a recent participant in this research domain. Major research institutions contributing to the field include the University of California, San Francisco; the University of Washington; and the Memorial Sloan Kettering Cancer Research Center. Notably, US authors James L. Gulley, Charles G. Drake, and Lawrence Fong had the largest number of publications in this area. The main research trends for immunotherapy of castration-resistant prostate cancer are membrane antigen expression, checkpoints T-lymphocyte-associated protein 4 (CTLA4) blockade, radium-223, and vaccines, and the refinement of establishing organoid models might fuel castration-resistant prostate cancer immunotherapy research in the ongoing development. Conclusion The key trends in immunotherapy research for castration-resistant prostate cancer are membrane antigen expression, CTLA4 blockade, radium-223, and vaccines. Exploring new immune pathways and combining different therapeutic approaches to enhance immune response will be a major trend in the field in the future.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136012883","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 : 2023-10-03DOI: 10.3389/fruro.2023.1100516
Claudia E. Pronk, Leonore F. Albers, Lothar D. J. Kuijper, Kees Hendricksen, Melianthe P. J. Nicolai
Introduction Little is known about the long-term effects on sexual function (SF) after radical cystectomy (RC) in bladder carcinoma (BC) patients. Aim To assess the course of SF in BC patients who underwent RC, and individual characteristics that influence the sexual outcome during a six-year follow-up. Methods In this longitudinal study, 62 BC patients treated with RC were included between 2008 and 2022. Patients filled out validated questionnaires as part of the regular care at baseline, three months, six months, 12 months and thereafter yearly post RC. Outcome measures To determine the sexual function, the International Index of Erectile Function questionnaire was filled in and a linear mixed model for repeated measures was conducted. The analysed clinical variables included sexual preserving cystectomy (SPC), age, type of diversion, treatment, comorbidities, tumour status, smoking habits, patient status and open- or robot-assisted RC. A Generalised Linear Mixed Model was used to evaluate the impact on Quality of Life with the QLQ-C30 questionnaire. Results After an initial decrease of sexual function post-RC, no change in SF was seen during the six years of follow-up. A statistically significant difference in sexual health was found between SPC and standard RC (p=0.015), which was time-dependent. Patients with an orthotopic ileal neobladder experienced a significantly better SF than those with a Bricker’s ileal conduit (p=<0.001). A younger age also seemed to yield beneficial outcomes regarding SF (p=0.004). Other analysed clinical variables did not influence the course of SF. A statistically significant positive correlation was found between Quality of Life- and SF scores (p=0.004). Robot-assisted RC resulted in higher Global Health scores than open RC (p=0.001). Conclusions RC has a severe impact on sexual function. Although SPC, collinear with the use of an orthotopic ileal neobladder and younger patient age show better outcomes in SF, erectile dysfunction post-RC is moderate to severe in the vast majority of patients.
{"title":"Sexual function after radical cystectomy in males with bladder carcinoma: a six-year longitudinal single-centre study","authors":"Claudia E. Pronk, Leonore F. Albers, Lothar D. J. Kuijper, Kees Hendricksen, Melianthe P. J. Nicolai","doi":"10.3389/fruro.2023.1100516","DOIUrl":"https://doi.org/10.3389/fruro.2023.1100516","url":null,"abstract":"Introduction Little is known about the long-term effects on sexual function (SF) after radical cystectomy (RC) in bladder carcinoma (BC) patients. Aim To assess the course of SF in BC patients who underwent RC, and individual characteristics that influence the sexual outcome during a six-year follow-up. Methods In this longitudinal study, 62 BC patients treated with RC were included between 2008 and 2022. Patients filled out validated questionnaires as part of the regular care at baseline, three months, six months, 12 months and thereafter yearly post RC. Outcome measures To determine the sexual function, the International Index of Erectile Function questionnaire was filled in and a linear mixed model for repeated measures was conducted. The analysed clinical variables included sexual preserving cystectomy (SPC), age, type of diversion, treatment, comorbidities, tumour status, smoking habits, patient status and open- or robot-assisted RC. A Generalised Linear Mixed Model was used to evaluate the impact on Quality of Life with the QLQ-C30 questionnaire. Results After an initial decrease of sexual function post-RC, no change in SF was seen during the six years of follow-up. A statistically significant difference in sexual health was found between SPC and standard RC (p=0.015), which was time-dependent. Patients with an orthotopic ileal neobladder experienced a significantly better SF than those with a Bricker’s ileal conduit (p=&lt;0.001). A younger age also seemed to yield beneficial outcomes regarding SF (p=0.004). Other analysed clinical variables did not influence the course of SF. A statistically significant positive correlation was found between Quality of Life- and SF scores (p=0.004). Robot-assisted RC resulted in higher Global Health scores than open RC (p=0.001). Conclusions RC has a severe impact on sexual function. Although SPC, collinear with the use of an orthotopic ileal neobladder and younger patient age show better outcomes in SF, erectile dysfunction post-RC is moderate to severe in the vast majority of patients.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135696607","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 : 2023-09-28DOI: 10.3389/fruro.2023.1275276
Darren Ha, Kelly T. Harris, Megan A. Brockel, Kyle O. Rove
Enhanced Recovery After Surgery (ERAS) is a set of evidence-based, multidisciplinary protocols that aim to improve the perioperative experience for patients by optimizing factors before, during, and after surgery. Originally developed for adult colorectal surgery, these protocols have expanded and been adopted into the pediatric surgical realm, including pediatric urology. Preoperative interventions are directed toward reducing physiologic and emotional stress prior to surgery, including preoperative education and decreased duration of fasting. Intraoperative interventions are designed to support physiologic homeostasis through maintenance of normothermia and euvolemia, use of regional anesthesia, and minimizing placement of drains. Postoperative interventions seek to reduce the physiologic burden of surgery and restore patients to their functional baseline through early oral intake, early mobilization, and opioid-sparing, multimodal analgesia. ERAS has demonstrated efficacy and safety across a wide variety of surgical subspecialties. In pediatric urology, ERAS has led to earlier return of bowel function, decreased opioid utilization, and shorter hospital length of stay, without an increase in complications compared to prior standard of care. ERAS can thus be seen as a system through which quality improvement (QI) initiatives can be designed and tailored to particular settings and patient populations. This review aims to summarize current data in pediatric urology regarding ERAS elements in the context of QI and patient safety. It will discuss the barriers and future directions of this field, including collaboration with implementation science to facilitate adoption of these protocolized measures more widely.
{"title":"The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology","authors":"Darren Ha, Kelly T. Harris, Megan A. Brockel, Kyle O. Rove","doi":"10.3389/fruro.2023.1275276","DOIUrl":"https://doi.org/10.3389/fruro.2023.1275276","url":null,"abstract":"Enhanced Recovery After Surgery (ERAS) is a set of evidence-based, multidisciplinary protocols that aim to improve the perioperative experience for patients by optimizing factors before, during, and after surgery. Originally developed for adult colorectal surgery, these protocols have expanded and been adopted into the pediatric surgical realm, including pediatric urology. Preoperative interventions are directed toward reducing physiologic and emotional stress prior to surgery, including preoperative education and decreased duration of fasting. Intraoperative interventions are designed to support physiologic homeostasis through maintenance of normothermia and euvolemia, use of regional anesthesia, and minimizing placement of drains. Postoperative interventions seek to reduce the physiologic burden of surgery and restore patients to their functional baseline through early oral intake, early mobilization, and opioid-sparing, multimodal analgesia. ERAS has demonstrated efficacy and safety across a wide variety of surgical subspecialties. In pediatric urology, ERAS has led to earlier return of bowel function, decreased opioid utilization, and shorter hospital length of stay, without an increase in complications compared to prior standard of care. ERAS can thus be seen as a system through which quality improvement (QI) initiatives can be designed and tailored to particular settings and patient populations. This review aims to summarize current data in pediatric urology regarding ERAS elements in the context of QI and patient safety. It will discuss the barriers and future directions of this field, including collaboration with implementation science to facilitate adoption of these protocolized measures more widely.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"392 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135420587","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 : 2023-09-26DOI: 10.3389/fruro.2023.1287189
Alex Siu Wing Chan, Steve Wai Hee Chan, E. Yan
{"title":"Editorial: Healthy aging, mental health, and sexuality","authors":"Alex Siu Wing Chan, Steve Wai Hee Chan, E. Yan","doi":"10.3389/fruro.2023.1287189","DOIUrl":"https://doi.org/10.3389/fruro.2023.1287189","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"2015 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335838","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}
Objectives Recurrent UTI (rUTI) is a debilitating health condition that is associated with persistent mental, physical, and social burdens. People living with rUTI face inconsistencies in diagnostic testing and fragmented treatment pathways alongside their symptoms, which are likely to add considerably to their illness-related burdens. This study aimed to characterize the factors negatively impacting this population using the qualitative perspectives of people living with the condition. Methods Qualitative data were collected via free-text responses using an online survey hosted by an rUTI patient advocacy website. Female participants with self-reported rUTI ( n = 1,983) described the factors that were most salient to their experience of living with the condition. Data were analyzed using a coding reliability approach to thematic analysis. Results Two overarching themes were identified: (1) the patient burden of rUTI, which describes the multifaceted biopsychosocial impact of the illness, and (2) healthcare disillusionment, which describes patient dissatisfaction with healthcare received, both in terms of the treatments offered and communication with healthcare professionals. The patient burden of rUTI encompassed four subordinate themes: facing ongoing uncertainty; symptom salience; sex is not simple anymore; and perceived UTI stigma. Healthcare disillusionment included three subordinate themes: discomfort with frequent antibiotic use; fragmented treatment pathways; and devalued patient perspectives. Conclusions The findings demonstrated that ambiguity in the diagnosis of rUTI and inconsistencies in the subsequent treatment pathway are exacerbated by poor patient–clinician communication. The extent of the female-specific burden of rUTI symptoms confirmed the harmful effects of illness-related stigma. This novel qualitative reporting of rUTI symptom burden and life impact highlights the urgent need for increased patient-centered care for those living with rUTI. More effective rUTI management could have a major impact on treatment outcomes and patient-reported psychosocial wellbeing.
{"title":"Psychosocial burden and healthcare disillusionment in recurrent UTI: a large-scale international survey of patient perspectives","authors":"Kayleigh Maxwell, Lindsey Roberts, Melissa Kramer, Jessica Price, Abigail Newlands, Katherine A. Finlay","doi":"10.3389/fruro.2023.1264299","DOIUrl":"https://doi.org/10.3389/fruro.2023.1264299","url":null,"abstract":"Objectives Recurrent UTI (rUTI) is a debilitating health condition that is associated with persistent mental, physical, and social burdens. People living with rUTI face inconsistencies in diagnostic testing and fragmented treatment pathways alongside their symptoms, which are likely to add considerably to their illness-related burdens. This study aimed to characterize the factors negatively impacting this population using the qualitative perspectives of people living with the condition. Methods Qualitative data were collected via free-text responses using an online survey hosted by an rUTI patient advocacy website. Female participants with self-reported rUTI ( n = 1,983) described the factors that were most salient to their experience of living with the condition. Data were analyzed using a coding reliability approach to thematic analysis. Results Two overarching themes were identified: (1) the patient burden of rUTI, which describes the multifaceted biopsychosocial impact of the illness, and (2) healthcare disillusionment, which describes patient dissatisfaction with healthcare received, both in terms of the treatments offered and communication with healthcare professionals. The patient burden of rUTI encompassed four subordinate themes: facing ongoing uncertainty; symptom salience; sex is not simple anymore; and perceived UTI stigma. Healthcare disillusionment included three subordinate themes: discomfort with frequent antibiotic use; fragmented treatment pathways; and devalued patient perspectives. Conclusions The findings demonstrated that ambiguity in the diagnosis of rUTI and inconsistencies in the subsequent treatment pathway are exacerbated by poor patient–clinician communication. The extent of the female-specific burden of rUTI symptoms confirmed the harmful effects of illness-related stigma. This novel qualitative reporting of rUTI symptom burden and life impact highlights the urgent need for increased patient-centered care for those living with rUTI. More effective rUTI management could have a major impact on treatment outcomes and patient-reported psychosocial wellbeing.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313051","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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