JU open plus最新文献

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Editorial Comment: Metastatic Renal Cell Carcinoma to the Maxillary Sinus Presenting As Recurrent Epistaxis 社论评论：上颌窦转移性肾细胞癌表现为复发性鼻衄

JU open plus

Pub Date : 2023-12-01 DOI: 10.1097/ju9.0000000000000077

Jennifer Espinales, Firas G. Petros

引用次数: 0

Scrotum Apocrine Adenocarcinoma Mimicking Testicular Cancer with Infiltration to the Scrotum: A Case Report with Literature Review 模仿睾丸癌并向阴囊浸润的阴囊腺癌：病例报告与文献综述

JU open plus

Pub Date : 2023-12-01 DOI: 10.1097/ju9.0000000000000054

Evan Prakoso Gandakusuma, S. Pramod, H. Agustina

Apocrine carcinoma is a rare tumor of the skin that typically arises in areas rich in apocrine glands. In our report, a 64-year-old man came to the emergency department with a complaint of an enlarging, tender mass in the scrotum growing over the previous 3 months associated with discomfort. Tumor markers were checked, and elevation of lactate dehydrogenase (LDH) and beta-human chorionic gonadotropin (HCG) was found. The patient was initially diagnosed with testicular cancer with infiltration to the scrotum. Wide mass excision with bilateral orchidectomy was performed. Results from histopathological examination revealed an apocrine adenocarcinoma of the scrotum. We report a case of primary apocrine adenocarcinoma of the scrotum initially suspected as testicular cancer.

分泌腺癌是一种罕见的皮肤肿瘤，通常发生在分泌腺丰富的部位。在我们的报告中，一名 64 岁的男性来到急诊科就诊，主诉阴囊肿块增大、触痛，且在过去 3 个月中肿块不断增大，并伴有不适。对肿瘤标志物进行了检查，发现乳酸脱氢酶（LDH）和β-人绒毛膜促性腺激素（HCG）升高。患者被初步诊断为睾丸癌，并伴有阴囊浸润。患者接受了大范围肿块切除术和双侧睾丸切除术。组织病理学检查结果显示阴囊腺癌。我们报告了一例最初被怀疑为睾丸癌的原发性阴囊腺分泌性腺癌。

引用次数: 0

Editorial Comment: The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty 社论评论：肾盂成形术时分析输尿管肾盂连接组织的最小效用

JU open plus

Pub Date : 2023-12-01 DOI: 10.1097/ju9.0000000000000065

Alberto Benitez Cano, Karl-Dietrich Sievert

引用次数: 0

A Novel Partial Nephrectomy Technique Using Blunt Dissection, Clipping of Intrarenal Vessels, Followed by Closure Using a Fibrin Sealant and Sliding Clips 一种新颖的肾部分切除术技术，采用钝性剥离法，剪断肾内血管，然后使用纤维蛋白密封剂和滑动夹进行缝合

JU open plus

Pub Date : 2023-12-01 DOI: 10.1097/ju9.0000000000000055

F. J. Aschwanden, Dominic Ditsch, F. von Wallenberg, Andres Affentranger, Thomas Treumann, Agostino Mattei, C.D. Fankhauser

We describe a surgical technique for robotic-assisted partial nephrectomy, including 3 novel steps to facilitate resection and suturing. This approach minimizes positive surgical margins and the risk of postoperative bleeding. This article describes a retrospective study of a single-surgeon series, including 49 patients. The study approach includes descriptive analysis of the Intraoperative Adverse Incident Classification, analysis of postoperative complications using the Clavien-Dindo Classification, and description of pathological and oncological outcomes. The median operative time was 221 minutes (IQR: 196-263), and the median ischemia time was 20 minutes (IQR: 12-24). Intraoperative Adverse Incident Classification Grade 1 complications occurred in 2 patients (4%). Conversion to open partial nephrectomy was necessary in 1 patient (2%). Postoperative complications were reported in 7 patients (14%). Of these, 3 patients (6%) experienced a Clavien-Dindo Classification Grade 2 complication, 2 patients (4%) experienced a Grade 3a complication, 1 patient (2%) experienced a Grade 3b complication, and 1 patient (2%) experienced a Grade 4a complication. Endovascular coiling and blood transfusion were necessary in 2 patients (4%), and 2 patients (4%) were readmitted. A positive surgical margin was reported in 1 patient (2%). Metastatic relapse occurred in 1 patient (2%) 535 days after surgery who did not have a positive surgical margin. Our novel 3 surgical steps during robotic-assisted partial nephrectomy allow an oncologically safe resection with a low risk of postoperative complications.

我们描述了一种机器人辅助部分肾切除术的手术技术，包括3个新的步骤来促进切除和缝合。这种方法将阳性手术切缘和术后出血的风险降到最低。这篇文章描述了一项回顾性研究，包括49名患者的单外科医生系列。研究方法包括术中不良事件分类的描述性分析，使用Clavien-Dindo分类分析术后并发症，以及病理和肿瘤结果的描述。中位手术时间221分钟(IQR: 196 ~ 263)，中位缺血时间20分钟(IQR: 12 ~ 24)。术中不良事件分类1级并发症2例(4%)。1例(2%)患者需要转行开放式部分肾切除术。术后并发症7例(14%)。其中，3例患者(6%)出现Clavien-Dindo分级2级并发症，2例患者(4%)出现3a级并发症，1例患者(2%)出现3b级并发症，1例患者(2%)出现4a级并发症。2例(4%)患者需要进行血管内盘绕和输血，2例(4%)患者再次入院。1例(2%)患者报告手术切缘阳性。1例(2%)患者在手术后535天发生转移性复发，手术切缘不阳性。我们在机器人辅助部分肾切除术中新颖的3个手术步骤使肿瘤安全切除，术后并发症风险低。

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引用次数: 0

Editorial Comment: Utilization of Instagram by Urology Residency Programs for Applicant Recruitment 编辑评论：泌尿科住院医师项目利用 Instagram 招募申请人

JU open plus

Pub Date : 2023-12-01 DOI: 10.1097/ju9.0000000000000092

Huma K. Sadulla, Henry H. Woo

引用次数: 0

Reply by Authors: Carcinogenic Effects of Nitrosodimethylamine Contamination in Ranitidine: Defining the Relationship with Renal Malignancies 雷尼替丁中亚硝基二甲胺污染的致癌作用:确定与肾脏恶性肿瘤的关系

JU open plus

Pub Date : 2023-11-01 DOI: 10.1097/ju9.0000000000000067

Samuel A. Gold, Vitaly Margulis

We thank the reviewers for providing these editorial comments that highlight the question posed to urologists, the FDA, and patients as to whether ranitidine increases the risk of renal malignancies.1,2 We believe preclinical data and limited population data demonstrate an association between this now-recalled medication and kidney cancer but not causation.3 As this issue spills into the legal system and regulatory bodies, it is incumbent on all the parties involved to carefully evaluate the dynamic stream of information and seek out further answers on this topic.

我们感谢审稿人提供的这些评论，这些评论强调了泌尿科医生、FDA和患者对雷尼替丁是否会增加肾脏恶性肿瘤风险的问题。我们相信临床前数据和有限的人群数据证明了这种现已召回的药物与肾癌之间的关联，但不是因果关系随着这一问题进入法律体系和监管机构，有关各方都有责任仔细评估动态信息流，并就这一主题寻求进一步的答案。

引用次数: 0

Editorial Comment: Pelvic Floor Dysfunction: A Common Cause of Chronic Orchialgia 编辑评论：盆底功能障碍：慢性睾丸炎的常见病因

JU open plus

Pub Date : 2023-11-01 DOI: 10.1097/ju9.0000000000000081

Michel A. Pontari

引用次数: 0

EDITORIAL COMMENT for: The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty, Has Been Accepted for Publication in JU Open Plus 编辑评论肾盂成形术时分析输尿管盆腔交界处组织的最小效用》已被《JU Open Plus》接受发表

JU open plus

Pub Date : 2023-11-01 DOI: 10.1097/ju9.0000000000000064

A. Shukla

引用次数: 0

Underenrolled and Undertreated Advanced Bladder Cancer in Women: It is Time to Improve 未充分登记和治疗的晚期膀胱癌妇女:是时候改善了

JU open plus

Pub Date : 2023-11-01 DOI: 10.1097/ju9.0000000000000068

Jesse Persily, Katie S. Murray

Female exclusion from clinical trials has been a topic of debate and discussion for well over 30 years, with an ever-growing body of literature to support ongoing disparities related to female patient enrollment, along with concerns about downstream effects on treatment efficacy and health outcomes in this patient population.1-3 Awareness of this disparity is the first step in correction. In this edition of JU Open Plus, Miyagi et al4 took a multipronged approach to assess gender representation in major urologic clinical trials, focusing on advanced bladder cancer (BC). To assess the scope of the problem, the team reviewed all trials included as evidence in the National Comprehensive Cancer Network BC guidelines on systemic therapies and found a lower percentage of female participants (20%) than would be expected based on the proportion of female patients with BC in the Surveillance, Epidemiology, and End Results database (26.9%, P < .001). There was also lower female representation in later-stage trials and randomized controlled trials. They then looked at the National Cancer Database (NCDB) to assess how these findings translated to actual patient care and found a significant difference between the proportion of male and female patients who received systemic and immunotherapy for advanced BC (42.6% vs 46% and 1.9% vs 2.8%, respectively, both P < .001). We commend the group for tackling this important and timely topic. The advanced BC management landscape has begun to shift from an almost exclusively chemotherapy-focused treatment paradigm to one that includes immunotherapy, targeted therapy, and antibody-drug conjugate-based therapies.5 A proper understanding of the state of clinical trial recruitment will allow for proactive strategy development to ensure recruitment of under-represented groups, thus ensuring adequate access to these emerging therapies. This is even more important in BC clinical trials. The Bacillus Calmette-Guerin shortage in non–muscle-invasive disease and platinum ineligibility in advanced BC each result in a larger cohort of patients who could potentially benefit from early clinical trial enrollment.6 By outlining the details of the gender disparity in one disease cohort, the authors lay the groundwork for working toward gender equality in trial recruitment. We offer some additional thoughts to build upon their analysis and discussion. Although we agree that factors influencing patient decision to participate in clinical trials should be assessed, we feel that the gender discrepancy likely extends beyond individual patient choice. The consistent and persistent finding of gender, racial, and ethnic disparities in clinical trial enrollment suggests the need for a systematic correction.7 This may come in the form of explicit differential recruitment of female participants and racial minorities with a goal of over-representation to combat historic under-representation. More dramatic adjustments to predetermined secondary or ev

30多年来，女性被排除在临床试验之外一直是争论和讨论的话题，越来越多的文献支持与女性患者入组相关的持续差异，以及对该患者群体治疗疗效和健康结果的下游影响的担忧。意识到这种差异是改正的第一步。在本期的《JU Open Plus》中，Miyagi等人4采用了多管齐下的方法来评估主要泌尿外科临床试验中的性别代表性，重点是晚期膀胱癌(BC)。为了评估问题的范围，研究小组回顾了国家综合癌症网络BC系统治疗指南中作为证据的所有试验，发现女性参与者的比例(20%)低于基于监测、流行病学和最终结果数据库中女性BC患者比例(26.9%，P < 0.001)的预期。在后期试验和随机对照试验中，女性的代表性也较低。然后，他们查看了国家癌症数据库(NCDB)，以评估这些发现如何转化为实际的患者护理，并发现接受系统性和免疫治疗晚期BC的男性和女性患者比例之间存在显著差异(分别为42.6%对46%和1.9%对2.8%，P < 0.001)。我们赞扬工作组处理这一重要和及时的问题。先进的BC管理格局已经开始从几乎完全以化疗为中心的治疗范式转变为包括免疫治疗，靶向治疗和基于抗体-药物偶联治疗的治疗对临床试验招募状况的正确理解将有助于制定积极的战略，以确保招募代表性不足的群体，从而确保充分获得这些新兴疗法。这在BC临床试验中更为重要。在非肌肉侵袭性疾病中卡介苗芽孢杆菌的短缺和晚期BC中铂的不适合性都导致更大的患者队列可能从早期临床试验中获益通过概述一个疾病队列中性别差异的细节，作者为在试验招募中实现性别平等奠定了基础。在他们的分析和讨论的基础上，我们提供了一些额外的想法。虽然我们同意应该评估影响患者参与临床试验决定的因素，但我们认为性别差异可能超出了患者个人选择的范围。在临床试验入组中，性别、种族和民族差异的一致和持续的发现表明需要进行系统的纠正这可能会以明确的区别招募女性参与者和少数民族的形式出现，目的是增加代表性，以解决历史上代表性不足的问题。由于研究表明，在过去的20年里，这些人群的入学人数甚至没有上升的趋势，因此可能还需要对预定的中学甚至小学终点进行更大幅度的调整随着新药物在二线、三线和四线的应用，以及基于既往治疗暴露的不同纳入和排除标准，这些考虑将变得越来越重要。尽管绝对差异很小，但女性患者接受全身治疗的可能性较低这一发现既令人惊讶又意义重大。虽然缺乏数据，但考虑到各种假设及其含义将是减轻这种差异的关键，如果真的存在的话。在这方面缺失的关键数据包括这种差异是否反映了未能提供标准治疗化疗或不适合化疗。如果有更多的女性患者不符合条件，那么必须进行进一步的工作来了解为什么会出现这种情况。这一发现可能反映了先前的研究表明，女性BC患者的诊断延迟，并且可能更频繁地出现晚期疾病Marinaro等人在2021年发表的ndb分析提供了相互矛盾的结果。该小组没有发现显著的性别相关治疗差异，但确实发现女性90天死亡率较高，总体存活率较低。综上所述，显然必须开展更多的工作，也许可以使用更多样化的数据来源，以更好地评估这一潜在趋势。本研究仅关注BC的全身治疗范围是合适的，但仍有需要进一步研究的领域。关于临床试验招募的差异，我们所知甚少，因为它涉及到晚期BC的膀胱定向治疗。

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引用次数: 0

Postoperative Oral Care Pathways Are Not Required at the Time of Buccal Mucosa Harvest 术后口腔护理路径在口腔粘膜收获时不需要

JU open plus

Pub Date : 2023-11-01 DOI: 10.1097/ju9.0000000000000069

Kevin Krughoff, Jordan Foreman, Thomas Dvergsten, Andrew C. Peterson

Purpose: For patients undergoing urethroplasty with buccal mucosa grafting, the impact of oral care pathways on infection and pain control remains unstudied. We hypothesize that the elimination of dietary restrictions and mouthwash regimens from the oral care pathway would not alter the rate of donor site complications. Materials and Methods: One hundred urethroplasty cases using buccal mucosa were retrospectively reviewed for donor site and perineal wound complications. No preoperative or intraoperative antibiotic oral cleanses were used in any case. Records were categorized by use of postoperative dietary restrictions and mouthwash regimens. Graft harvest size, preexisting oral issues, baseline comorbidities, dental assessments, perioperative antibiotics, and postoperative pain control regimens were accounted for. Results: Forty patients were included in the oral care pathway and 60 in the nonoral care pathway. Baseline demographics, dental assessment, and graft harvest details were similar between groups. There were no cases of graft site infection, with a median follow-up of 226 days. All graft site issues resolved in 3 to 4 weeks or less. Perineal wound infections for oral care pathway 2 (5%), and no oral care pathway 4 (6.7%), P = .6. Urinary tract infections for oral care pathway 7 (17.5%), and no oral care pathway 2 (3.3%), P = .027. Conclusions: Postoperative oral complications remain low without the use of oral cleanses, dietary restrictions, or mouthwash regimens. Routine use of donor site care pathways is likely unnecessary in this patient population.

目的:对于尿道成形术合并颊黏膜移植的患者，口腔护理途径对感染和疼痛控制的影响尚不清楚。我们假设，从口腔护理途径中消除饮食限制和漱口方案不会改变供体部位并发症的发生率。材料与方法:回顾性分析100例颊粘膜尿道成形术的供区及会阴伤口并发症。在任何情况下，术前或术中均未使用抗生素口腔洗液。记录按术后饮食限制和漱口方案进行分类。移植的大小，先前存在的口腔问题，基线合并症，牙科评估，围手术期抗生素和术后疼痛控制方案被考虑在内。结果:40例患者采用口腔护理途径，60例患者采用非口腔护理途径。基线人口统计、牙科评估和移植手术细节在两组之间相似。无移植物感染病例，中位随访226天。所有移植物部位问题在3 - 4周或更短时间内解决。会阴创面感染有口腔护理途径2者(5%)，无口腔护理途径4者(6.7%)，P = 0.6。口腔护理途径7泌尿系感染(17.5%)，无口腔护理途径2泌尿系感染(3.3%)，P = 0.027。结论:在没有使用口腔清洁、饮食限制或漱口方案的情况下，术后口腔并发症仍然很低。在这一患者群体中，常规使用供体部位护理途径可能是不必要的。

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