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Artificial Intelligence–Generated Patient Information Videos for Partial Nephrectomy by Medical Students With Expert Validation: A Pilot Study 人工智能生成的医学生肾部分切除术患者信息视频与专家验证:试点研究
Pub Date : 2024-07-01 DOI: 10.1097/ju9.0000000000000165
W. Z. So, Collin Elijah Rui Hung Ho, Kenneth Leung, S. Ong, Hong Min Peng, Nicholas Hoi Pong Wong, Ho Yee Tiong
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引用次数: 0
Editorial Comment: Artificial Intelligence—Generated Patient Information Videos for Partial Nephrectomy by Medical Students With Expert Validation: A Pilot Study 编辑评论:人工智能生成的医学生肾部分切除术患者信息视频与专家验证:一项试点研究
Pub Date : 2024-07-01 DOI: 10.1097/ju9.0000000000000172
Natalie Mainland, Alyssa Lange, Firas G. Petros
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引用次数: 0
Dorsal Penile Artery Avulsion After Collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s Disease: A Case Report 胶原酶溶解梭菌(Xiaflex)治疗佩罗尼氏病后阴茎背动脉撕脱:病例报告
Pub Date : 2024-06-01 DOI: 10.1097/ju9.0000000000000159
Rajvi Goradia, Alexander J. Skokan, M. Hehemann
Collagenase Clostridium histolyticum (CCH) is frequently used as first-line therapy for patients with Peyronie’s disease. It was United States Food and Drug Administration approved in 2013 and since then, has been widely accepted as a safe and effective treatment option with most adverse effects being minor and amenable to conservative management. We report an unusual and previously unreported complication after CCH (Xiaflex) injection: avulsion of a dorsal penile artery, which required surgical exploration and ligation. This article seeks to inform urologists about an unexpected complication that should be considered in the differential diagnosis for severe penile hematoma after CCH injection and discusses our strategy for surgical management.
胶原酶溶解梭菌(CCH)经常被用作佩罗尼病患者的一线疗法。它于 2013 年获得美国食品和药物管理局批准,自此被广泛认为是一种安全有效的治疗方法,大多数不良反应轻微,可采取保守治疗。我们报告了注射 CCH(Xiaflex)后出现的一种不同寻常且之前未曾报道过的并发症:阴茎背动脉撕脱,需要进行手术探查和结扎。本文旨在向泌尿科医生介绍一种意想不到的并发症,这种并发症应在 CCH 注射后严重阴茎血肿的鉴别诊断中加以考虑,并讨论了我们的手术治疗策略。
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引用次数: 0
Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System 在 COVID-19 大流行期间,美国普遍参保的医疗系统减少了前列腺特异性抗原筛查率
Pub Date : 2024-06-01 DOI: 10.1097/ju9.0000000000000155
Vivitha Mani, Amanda Banaag, S. S. T. Miura, Satish Munigala, Christian L Coles, Andrew J. Schoenfeld, T. Koehlmoos
PSA testing is the primary method of screening for prostate cancer, although recommendations are varied. The COVID-19 pandemic diverted resources away from preventive screenings. We sought to examine alterations in PSA screening among TRICARE beneficiaries in the Military Health System (MHS) over the course of the pandemic. Using data from the MHS Data Repository, we executed a retrospective open cohort study of male TRICARE Prime beneficiaries aged 40 to 64 years during fiscal years 2018 to 2022. The study period was separated into 3 subperiods: prepandemic (October 1, 2017-February 28, 2020), early pandemic (March 1, 2020-September 30, 2020), and late pandemic (October 1, 2020-September 30, 2022). We found a 73% reduction in PSA screenings in the early pandemic and 14% decrease in the late pandemic compared with prepandemic rates. Compared with White men aged 50 to 54 years, men younger than 50 years in all racial groups were less likely to receive screening. In both pandemic periods, all racial groups, except for Black men, were overall more likely than White men to receive screening. Men were more likely to seek PSA screening in the private sector during the pandemic compared with prepandemic times (early pandemic: 1.21 RR, 1.20-1.22 95% confidence interval [CI]; late pandemic: 1.20 RR, 1.19-1.20 95% CI). We found significant reductions in PSA screening over the course of the COVID-19 pandemic among TRICARE beneficiaries. While disparities appear less pronounced when compared with other preventive testing, targeted outreach is still necessary for certain sociodemographic groups.
PSA 测试是筛查前列腺癌的主要方法,但建议各不相同。COVID-19 大流行占用了预防性筛查的资源。我们试图研究大流行期间军事卫生系统(MHS)中 TRICARE 受益人 PSA 筛查的变化。 利用军事卫生系统数据存储库中的数据,我们对 2018 至 2022 财年期间 40 至 64 岁的男性 TRICARE Prime 受益人进行了一项回顾性开放队列研究。研究期间分为 3 个子期间:大流行前期(2017 年 10 月 1 日至 2020 年 2 月 28 日)、大流行早期(2020 年 3 月 1 日至 2020 年 9 月 30 日)和大流行后期(2020 年 10 月 1 日至 2022 年 9 月 30 日)。 我们发现,与大流行前相比,大流行早期的 PSA 筛查减少了 73%,大流行晚期减少了 14%。与 50 至 54 岁的白人男性相比,所有种族群体中 50 岁以下的男性接受筛查的可能性较低。在两次大流行期间,除黑人男性外,所有种族群体接受筛查的可能性总体上都高于白人男性。与大流行前相比,大流行期间男性更有可能在私营部门接受 PSA 筛查(大流行早期:1.21 RR,1.20-1.22 95% 置信区间 [CI];大流行后期:1.20 RR,1.19-1.20 95% CI)。 我们发现,在 COVID-19 大流行期间,TRICARE 受益人的 PSA 筛查率明显下降。虽然与其他预防性检测相比,差异似乎不那么明显,但仍有必要对某些社会人口群体进行有针对性的宣传。
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引用次数: 0
Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study 回复编辑评论:医生对有助于晚期前列腺癌治疗决策的非临床因素的看法:定性研究
Pub Date : 2024-06-01 DOI: 10.1097/ju9.0000000000000151
Jeremy Kurnot, Deborah R. Kaye
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引用次数: 0
Editorial Comment: Prone Split-Leg vs Galdakao-Modified Supine Valdivia Position During Endoscopic Combined Intrarenal Surgery: A Noninferiority Design Randomized Controlled Trial 编辑评论:内镜联合肾内手术中的俯卧分腿位与Galdakao-Modified Supine Valdivia体位:非劣效性设计随机对照试验
Pub Date : 2024-06-01 DOI: 10.1097/ju9.0000000000000144
Fernando J. Kim
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引用次数: 0
Impact of Androgen Deprivation Therapy on Lumbar Spine Bone Health Using Quantitative Computed Tomography in a Propensity-Matched Cohort of Patients With Prostate Cancer 在倾向匹配的前列腺癌患者队列中使用定量计算机断层扫描测量雄激素剥夺疗法对腰椎骨健康的影响
Pub Date : 2024-06-01 DOI: 10.1097/ju9.0000000000000158
Mototaka Sato, M. Kashii, Takahiro Maekawa, Shunsuke Mori, Shun Umeda, Yuma Kujime, Makoto Matsushita, Satoshi Kamido, Norichika Ueda, Jiro Nakayama, Norihide Tei, Osamu Miyake
Fragility fracture risk in patients with prostate cancer is an important issue. The purpose of this study was to accurately assess the impact of androgen deprivation therapy on lumbar spine bone loss using quantitative computed tomography in a propensity-matched cohort of patients with prostate cancer. Eighty-one patients with prostate cancer who underwent androgen deprivation therapy for 1 year were included. Thirty-nine of these patients were successfully propensity-matched with 39 of 68 patients from a control group who underwent robot-assisted radical prostatectomy without androgen deprivation therapy. Volumetric bone mineral density of trabecular bone in each vertebral body (L1-L4) was measured using quantitative computed tomography during staging and at 1 year after commencing treatment. The change in mean lumbar volumetric bone mineral density (L1-L4) was then calculated. Propensity score matching successfully achieved comparable baseline patient characteristics and radiological parameters between the androgen deprivation therapy and control groups. In the androgen deprivation therapy group, the decrease in lumbar volumetric bone mineral density (L1-L4) was significantly greater with confirmed testosterone deficiency (−17.9 ± 12.0%) compared with the control group (−8.5 ± 10.8%, P < .001). This study observed a 17.9% reduction in volumetric lumbar bone mineral density (g/cm3) after 1 year of androgen deprivation therapy, exceeding previously reported values (g/cm2) obtained using dual-energy X-ray absorptiometry. The potential overestimation of lumbar spine bone mineral density measured by dual-energy X-ray absorptiometry in older patients with prostate cancer because of concomitant lumbar degenerative disease is a possible reason for this discrepancy. Androgen deprivation therapy may decrease vertebral bone mass and increase the risk of vertebral fractures more than urologists realize.
前列腺癌患者的脆性骨折风险是一个重要问题。本研究的目的是在一个倾向匹配的前列腺癌患者队列中,使用定量计算机断层扫描准确评估雄激素剥夺疗法对腰椎骨质流失的影响。 研究纳入了 81 名接受雄激素剥夺治疗一年的前列腺癌患者。其中39名患者与对照组68名患者中的39名成功进行了倾向匹配,后者接受了机器人辅助根治性前列腺切除术,但未接受雄激素剥夺治疗。在分期治疗期间和开始治疗一年后,使用定量计算机断层扫描测量了每个椎体(L1-L4)骨小梁的体积骨矿物质密度。然后计算平均腰椎体积骨矿物质密度(L1-L4)的变化。 倾向评分匹配成功实现了雄激素剥夺疗法组和对照组之间患者基线特征和放射学参数的可比性。在雄激素剥夺治疗组中,与对照组(-8.5 ± 10.8%,P < .001)相比,腰椎容积骨矿密度(L1-L4)的下降幅度在确诊睾酮缺乏时明显更大(-17.9 ± 12.0%)。 本研究观察到,雄激素剥夺疗法一年后,腰椎骨矿物质密度(克/立方厘米)体积减少了17.9%,超过了之前报道的使用双能X射线吸收测量法获得的数值(克/立方厘米)。在老年前列腺癌患者中,由于同时患有腰椎退行性疾病,通过双能 X 射线吸收测定法测量的腰椎骨矿物质密度可能会被高估,这可能是造成这一差异的原因之一。雄激素剥夺疗法可能会降低脊椎骨质量,增加脊椎骨折的风险,这一点比泌尿科医生意识到的要严重得多。
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引用次数: 0
Long-Term Trends in Decisional Regret Among Men with Localized Prostate Cancer 局部前列腺癌男性患者后悔决策的长期趋势
Pub Date : 2024-04-01 DOI: 10.1097/ju9.0000000000000131
Alexandria Spellman, Vishnukamal Golla, Li Lin, Aaron Katz, Ronald C. Chen, Leah L. Zullig
There are several evidence-based treatment options for localized prostate cancer (PCa). Decisional regret (DR), or regret based on the treatment a patient chooses, is poorly understood in patients with PCa. We describe long-term trends in DR for patients with localized PCa and factors associated with regret. We surveyed an established prospective cohort of patients with PCa in North Carolina who were diagnosed between 2011 and 2013. DR was assessed by a validated instrument at 12, 24, 36, 48, 60, 72, 84, and 120 months after treatment or active surveillance (AS). We estimated the overall trend of DR and examined how DR was associated with treatment and demographic data using generalized linear mixed-model regressions. The sample included 1456 men. At 12 months, 88% (n = 1100) of patients did not regret their treatment. With all time points included, DR increased slightly in early months and the speed of increase slowed over time (P = .003 for time, .02 for time-squared). Divorced men were more likely to have DR compared with married men (odds ratio [OR] = 1.5; 95% confidence interval [CI] 0.9-2.7). African Americans (OR = 1.5; 95% CI 1.0-2.1) and those who underwent surgery had significantly more regret (14.6%; 95% CI 11.3-18.0, P = .01) than patients of other racial groups or who underwent AS, respectively. Although DR is low overall in this cohort, being married and AS were associated with lower regret than those who were not married or who underwent surgery, respectively. Understanding factors that affect DR can guide urologists to more effectively direct resources and counseling.
针对局部前列腺癌(PCa)有多种循证治疗方案。人们对 PCa 患者的决策后悔(DR),即基于患者选择的治疗方案而产生的后悔,知之甚少。我们描述了局部 PCa 患者 DR 的长期趋势以及与遗憾相关的因素。 我们对北卡罗来纳州 2011 年至 2013 年期间确诊的 PCa 患者建立的前瞻性队列进行了调查。在治疗或主动监测(AS)后的 12、24、36、48、60、72、84 和 120 个月,我们使用一种经过验证的工具对 DR 进行了评估。我们估算了DR的总体趋势,并使用广义线性混合模型回归分析了DR与治疗和人口统计学数据之间的关联。 样本包括 1456 名男性。在 12 个月时,88% 的患者(n = 1100)不后悔接受治疗。在包含所有时间点的情况下,DR 在最初几个月略有上升,随着时间的推移,上升速度减慢(时间的 P = .003,时间平方的 P = .02)。与已婚男性相比,离婚男性更有可能患有DR(几率比[OR] = 1.5;95% 置信区间[CI] 0.9-2.7)。非裔美国人(OR = 1.5;95% 置信区间 [CI] 1.0-2.1)和接受过手术的患者的后悔率(14.6%;95% 置信区间 [CI] 11.3-18.0,P = .01)分别明显高于其他种族群体或接受过 AS 的患者。 虽然该队列中的后悔率总体较低,但已婚患者和接受过手术的患者的后悔率分别低于未婚患者和接受过手术的患者。了解影响DR的因素可以指导泌尿科医生更有效地引导资源和咨询。
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引用次数: 0
Evaluating the Prognostic Variables for Overall Survival in Patients with Metastatic Renal Cell Carcinoma: A Meta-Analysis Of 29,366 Patients 评估转移性肾细胞癌患者总生存期的预后变量:对 29,366 例患者的 Meta 分析
Pub Date : 2024-04-01 DOI: 10.1097/ju9.0000000000000127
Bruce Li, Swati Sood, Melissa J. Huynh, Nicholas E. Power
Scoring systems are a method of risk assessment used to stratify patients with metastatic renal cell carcinoma (mRCC) and guide systemic therapy. The variables are weighed equally when calculating total score. However, the difference of even 1 positive predictor can change one's risk category and therapy. To compare the relative strength of association between predictive variables and overall survival (OS) in mRCC. A search of Medical Literature Analysis and Retrieval System Online (MEDLINE) and Embase was conducted. Clinical studies, retrospective and prospective, were included if the association of at least 1 predictor and OS in patients with mRCC receiving first-line systemic therapy was evaluated. Meta-analysis was performed to generate pooled hazard ratios (HRs) and 95% CIs for OS for predictors with ≥ 5 included studies. Sensitivity analysis identified outlier heterogeneity and publication bias. Sixty-six studies containing 29,366 patients were included. Meta-analysis indicated lung metastases, bone metastases, thrombocytosis, time to systemic therapy < 1 year, liver metastases, hypercalcemia, anemia, elevated neutrophil-lymphocyte ratio, multiple metastatic sites, neutrophilia, poor Eastern Cooperative Oncology Group (ECOG) status, no previous nephrectomy, elevated lactate dehydrogenase, Fuhrman grade 3 or 4, central nervous system metastases, elevated C-reactive protein, and Karnofsky Performance Status < 80% were associated with significantly worse OS. The HRs varied from 1.34 to 2.76, representing heterogeneity in predictive strength. The effects of study heterogeneity and publication bias were minimal to moderate across all predictors. Based on the differences in pooled HRs, prognostic strength between the variables is likely not equivalent. Restructuring scoring models, through inclusion of other variables and usage of relative weighting, should be considered to improve accuracy of risk stratification.
评分系统是一种风险评估方法,用于对转移性肾细胞癌(mRCC)患者进行分层并指导系统治疗。在计算总分时,各变量的权重相同。然而,即使是一个阳性预测因子的差异也会改变患者的风险类别和治疗方法。 为了比较预测变量与 mRCC 总生存期(OS)之间的相对关联强度。 我们检索了医学文献分析与检索系统在线版(MEDLINE)和Embase。如果对接受一线系统治疗的 mRCC 患者中至少一个预测变量与 OS 的关系进行了评估,则纳入回顾性和前瞻性临床研究。对纳入研究≥5项的预测因子进行了元分析,以生成OS的集合危险比(HRs)和95% CIs。敏感性分析确定了离群异质性和发表偏倚。 共纳入 66 项研究,包含 29,366 名患者。Meta 分析表明,肺转移、骨转移、血小板增多、接受系统治疗时间小于 1 年、肝转移、高钙血症、贫血、中性粒细胞-淋巴细胞比率升高、多个转移部位、中性粒细胞增多、东部合作肿瘤学组(ECOG)状态不佳、既往未进行过肾切除术、乳酸脱氢酶升高、Fuhrman 3 级或 4 级、中枢神经系统转移、C 反应蛋白升高以及 Karnofsky 表 现状态 < 80% 与较差的 OS 显著相关。HRs从1.34到2.76不等,代表了预测强度的异质性。在所有预测因子中,研究异质性和发表偏倚的影响从最小到中等。 根据汇总 HRs 的差异,各变量之间的预后强度可能并不相同。应考虑通过纳入其他变量和使用相对权重来重组评分模型,以提高风险分层的准确性。
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引用次数: 1
Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study 回复编辑评论:医生对有助于晚期前列腺癌治疗决策的非临床因素的看法:定性研究
Pub Date : 2024-04-01 DOI: 10.1097/ju9.0000000000000130
Deborah R. Kaye, Karissa Tu, J. K. Davis, Ada Campagna, Sharron L. Docherty, Jeremy Kurnot, Tian Zhang, Daniel J. George, Peter A. Ubel
{"title":"Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study","authors":"Deborah R. Kaye, Karissa Tu, J. K. Davis, Ada Campagna, Sharron L. Docherty, Jeremy Kurnot, Tian Zhang, Daniel J. George, Peter A. Ubel","doi":"10.1097/ju9.0000000000000130","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000130","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"700 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140773047","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}
引用次数: 0
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