JU open plus最新文献

{"title":"Editorial Comment: Pelvic Floor Dysfunction: A Common Cause of Chronic Orchialgia","authors":"Leo Puhalla, Scott D. Lundy","doi":"10.1097/ju9.0000000000000078","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000078","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292963","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}

{"title":"JU Open Plus: Beyond Borders","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000094","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000094","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"13 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294745","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}

{"title":"The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty","authors":"Jasper C. Bash, Solange Bassale, Sudhir Isharwal","doi":"10.1097/ju9.0000000000000059","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000059","url":null,"abstract":"Introduction: Ureteropelvic junction obstruction is a common cause of upper tract obstruction that often necessitates surgical intervention because of its severe implications. A high proportion of these surgeries include pathologic analysis of this tissue with unclear clinical value. We examined our institution's practices concerning sending the ureteropelvic junction (UPJ) specimens for pathology analysis, its clinical value, and the associated costs for both pediatric and adult cases. Methods: We performed retrospective chart review using Current Procedural Terminology codes for pyeloplasty over 8 years. Clinical variables were extracted from operative reports, path reports, and postoperative clinic notes. Pathology results were classified dichotomously as “benign” or “malignant” and subsequently assigned to 1 of 4 categories—inflammation, fibrosis, muscular hyperplasia, or no atypical findings. Results: Two hundred sixty-nine pyeloplasty surgeries were included, 68% of which were in children. Pathologic analysis was requested in most of the cases (91%), and this was slightly more common in adults (94%) than in pediatric patients (90%). All available pathology reports found benign findings in the UPJ specimen, mostly commonly categorized as “normal.” No cases of malignancy were noted. At the list price for pathologic analysis, $103,027 was spent over 8 years without the discovery of clinically significant pathology findings. Conclusions: There was a lack of clinically meaningful results from pathologic analysis of UPJ specimens excised during pyeloplasty. A UPJ specimen should not be routinely sent for pathologic analysis rather selectively if there is clinical concern for nonbenign etiology of UPJ obstruction.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663315","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}

{"title":"JU Open Plus: Section Meetings—Science, Practice Improvement, and Networking","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000075","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000075","url":null,"abstract":"SEPTEMBER 2023 ISSUE REVIEW We start our September issue review with the research communication from Takahara et al from Japan.1 The article reviews the needs for minimally invasive surgeons to offer partial nephrectomy, when indicated, and to achieve a trifecta of warm ischemia time <25 minutes, negative surgical margins, and no complications. They report on an early experience with a 3D workstation product called Atrena. I am sure you have to see it in person to appreciate its contribution. From the article's figure, the surgeon can have this program on a tablet nearby and rotate, zoom, and make some structures translucent. Images can then be pushed into the daVinci console with TilePro. They present an early experience of 15 cases, with 14 achieving the “trifecta.” Intraoperative navigation will certainly be a hot topic for the foreseeable future to augment the improvements realized thus far in surgical vision and ergonomics. JU Open Plus will have several articles types to publish research including reviews, hypothesis-generating study, clinical trials, and videos as manuscripts. We have 2 interesting case reports. Cohen et al2 report on a rare case of metastatic clear cell renal cell carcinoma within Birt-Hogg-Dube syndrome. The interests in the case are the genetic mutations identified that were common to bilateral renal lesions and a brain metastasis. The discussion emphasizes germline testing for multifocal or bilateral renal cell carcinoma and the possibility of clear cell histology with Birt-Hogg-Dube syndrome. Faber et al3 report on primary renal neuroendocrine tumor causing Zollinger-Ellison syndrome. Primary renal neuroendocrine tumors are very rare and generally treated surgically. The gastrin-secreting tumors will have gastrointestinal symptoms as described. With early detection, this lesion was amenable for partial nephrectomy. If you are in board review mode, see their figure 2 with an octreotide scan–positive lesion due to somatostatin receptor avidity. For original articles, Rasheed et al4 studied the emerging field of telemedicine: What are the barriers to successful connections? For our system, I see patients mostly struggling with how to turn on their camera or microphone. In this study, a volunteer medical student group was working with groups including geriatric and pediatric patients. They break it down into 4 themes: completing registration, familiarity and access to video conference software, proxy access for pediatric patients, and various technical questions. They present an algorithm and discussion on pathways to success. As a sign of the times, my institution is not only expanding telemedicine visits and access but also starting to credential the staff in multiple states to expand our reach. Norman et al5 pose a long-standing question in prostate cancer diagnostics—What to do with results that are not cancer but are not “not” cancer either. The tracked patients had high-grade prostatic intraepithelial neoplasm, atyp","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2021 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136054648","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}

{"title":"Carcinogenic Effects of Nitrosodimethylamine Contamination in Ranitidine: Defining the Relationship With Renal Malignancies","authors":"Richard E. Link","doi":"10.1097/ju9.0000000000000062","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000062","url":null,"abstract":"Patients with renal cell carcinoma (RCC) often feel struck by lightning. Unsatisfied by relatively modest associations of RCC with advancing age, male sex, tobacco exposure, and Western diets rich in red meat,1,2 patients reach for causative connections to occupational exposures and drugs. Exposure to trichloroethylene and chronic analgesic use has perhaps the most compelling association with RCC.3 However, many other drugs have been implicated in contributing to RCC without convincing proof. Urologists must be prepared to field these questions from their patients when they arise. The cautionary tale of the rise and fall of ranitidine, once the highest-selling drug on the planet, is fascinating and of particular interest to patients with RCC and their physicians. The downfall of ranitidine derived from the detection of a known carcinogen in the medication, nitrosodimethylamine (NDMA), linked to RCC and other tumors in animals. The authors describe the preclinical evidence for NDMA contamination in ranitidine, its connection to carcinogenesis in animals, and the challenges inherent in asking the critical clinical question: “Did ranitidine ingestion contribute to RCC tumorigenesis in humans?” The available population cohort data exploring this association are clouded by short follow-up, inhomogeneous data collection, the lack of screening imaging to detect subclinical tumors, and a range of other confounders. Moreover, NDMA levels were not actually measured in any of these studies. The story highlights the inherent difficulty in connecting an extremely pervasive drug exposure to a specific type of cancer unless the associated risk is exceptionally high. For practicing urologists, the take home message of this well-written review is that no clear association between ranitidine exposure and the development of RCC currently exists.4 However, the authors appropriately recommend that we view this conclusion, based entirely on observational studies with significant weaknesses, with caution when counseling our patients.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136117946","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}

{"title":"Carcinogenic Effects of Nitrosodimethylamine Contamination in Ranitidine: Defining the Relationship With Renal Malignancies","authors":"Nuphat Yodkhunnatham, Dhruv Puri, Kshitij Pandit, Aditya Bagrodia","doi":"10.1097/ju9.0000000000000063","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000063","url":null,"abstract":"Ranitidine, a common medication for gastric ulcers, was withdrawn from the market because of contamination with the likely carcinogen N-nitrosodimethylamine (NDMA). The Gold and Margulis article1 examines the clinical risks associated with ranitidine, reviewing its history, scientific evidence, and possible link to kidney cancer. The discovery of NDMA contamination has raised concerns about its safety, particularly its potential connection to kidney cancer. The authors examine the relationship between NDMA and kidney cancer, citing an array of animal studies that demonstrate NDMA's potential carcinogenicity. The article also explains how NDMA is formed and its DNA-damaging potential, shedding light on the inherent risks that categorize NDMA as a probable human carcinogen. Furthermore, the article examines available epidemiological data concerning the association between ranitidine use and kidney cancer risk. While acknowledging the inherent limitations of such data, the authors emphasize the need for further prospective clinical research to confirm the link between ranitidine and kidney cancer risk in humans. This editorial comment on the ranitidine controversy underscores the need for strict pharmaceutical quality control and reminds us of the balance between clinical research, regulations, and patient health. The article calls for continued vigilance in assessing the risks and benefits of ranitidine, especially concerning potential kidney cancer risk.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135922040","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}

{"title":"Metastasis-Directed Therapy for Metachronous Lung Metastases in Prostate Cancer","authors":"Ahmed M. Mahmoud, Robert W. Gao, Mohamed E. Ahmed, Jacob J. Orme, Miguel Muñiz Rincón, William S. Harmsen, Geoffrey B. Johnson, Stephen D. Cassivi, Eugene D. Kwon, Ryan M. Phillips, Jack R. Andrews, Daniel S. Childs","doi":"10.1097/ju9.0000000000000057","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000057","url":null,"abstract":"Introduction: As interest in metastasis-directed therapy (MDT) for prostate cancer (PCa) grows, exploring indications and patient selection is increasingly more important. Thus far, few studies have described long-term outcomes after surgical MDT in those with disease recurrence involving the lung. The objective of our study was to compare the cumulative incidence of cancer-related death by treatment modality in men with metachronous pulmonary metastases from PCa. Methods: In a single-institution retrospective study, we identified 75 men from the prospectively maintained Mayo Clinic C-11 Positron Emission Tomography Choline PCa registry with recurrent prostate cancer involving the lung but no other visceral organs. Patients were categorized into 3 groups based on treatment modalities: wedge resection ± hormonal therapy, chemohormonal therapy, and hormonal therapy alone. The risk of cancer-related death after treatment at the time of lung metastases was reported as cumulative incidence estimates. Non–cancer-related deaths were treated as a competing risk of death. A univariate Cox regression model was conducted to assess the impact of treatment modality on the risk of cancer-related death. Results: At the time of lung metastasis, the median age was 69.5 years, and the median (IQR) prostate-specific antigen was 4 (1.3-8.6) ng/ml. Forty-seven patients (62.7%) had hormone-sensitive disease, and 28 patients (37.3%) had hormone-resistant disease. A total of 26 patients (34.7%) were treated with wedge resection ± hormonal therapy, 27 (36%) with chemohormonal therapy, and 22 (29.3%) with hormonal therapy alone. The median (IQR) follow-up time was 50.3 (31.1-78.4) months, and 21 patients (28%) died. Patients who were treated with wedge resection ± hormonal therapy had lower rated of cancer-related death compared with those who received chemohormonal therapy (Hazard Ratio [HR]: 4.14, 95% CI: 1.01-16.96, P = .048) or hormonal therapy alone (HR: 6.37, 95% CI: 1.72-23.54, P = .005). Conclusion: This exploratory analysis supports the safety and feasibility of surgical metastasis-directed therapy in select patients with recurrent prostate cancer involving the lung. Favorable long-term survival provides justification for further evaluation of this approach.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135605305","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}

{"title":"A Novel Approach to Intraluminal Mitomycin C Instillation for Treatment of High Grade Nonmuscle Invasive Upper Tract Urothelial Carcinoma","authors":"Elizabeth Ellis, Edward Messing","doi":"10.1097/ju9.0000000000000056","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000056","url":null,"abstract":"Abstract Introduction and Objective: We present a novel technique for intrapelvicalyceal mitomycin C (MMC) instillation mixed with a contrast agent for treatment of high-grade nonmuscle invasive upper tract urothelial carcinoma in patients in whom nephroureterectomy would render them dialysis-dependent. Methods: After incomplete endoscopic resection, the patient underwent 3 intrapelvicalyceal instillations of MMC mixed with iopamidol, each 2 weeks apart. Results: Treatment has had a durable response for over 2 years after treatment. Conclusions: Intraluminal MMC mixed with iopamidol is an approach which helps to avoid pyelovenous backflow and provides visual confirmation that the drug is in adequate contact with the tumor.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135606663","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}

{"title":"Carcinogenic Effects of Nitrosodimethylamine (NDMA) Contamination in Ranitidine: Defining the Relationship With Renal Malignancies","authors":"Samuel A. Gold, Vitaly Margulis","doi":"10.1097/ju9.0000000000000058","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000058","url":null,"abstract":"Purpose: Ranitidine, a medication used to treat gastric ulcers and reflux, was once the highest selling drug in the world with over $1 billion in annual sales. However, in 2020, ranitidine, known more commonly by the brand name Zantac, virtually vanished from the market after multiple regulatory bodies including the US Food and Drug Administration recommended withdrawal. Their concern was based on detection of nitrosodimethylamine (NDMA), a known animal carcinogen, in ranitidine samples. NDMA has been shown to induce multiple tumor types, including renal tumors. The effects of human exposure, however, are not completely understood. This review aims to clarify what is known about NDMA contamination in ranitidine, the carcinogenic mechanisms of NDMA, and possible associations between ranitidine consumption and renal cancers. Materials and Methods: A comprehensive literature review was performed regarding ranitidine and NDMA, carcinogenesis, and associations with malignancy. Data were considered from environmental, preclinical, and clinical studies from various disciplines. Publications from governmental bodies, including the Food and Drug Administration and International Agency for Research on Cancer, were reviewed and included for analysis. Results: Multiple preclinical studies have demonstrated the carcinogenic effects of NDMA in animals with high rates of renal tumor development. NDMA has been detected in industrial, dietary, and pharmacologic sources. Regarding NDMA levels in ranitidine, evidence points to associations with storage conditions at elevated temperatures and/or prolonged duration as well as endogenous production facilitated by physiologic gastric conditions. Once metabolized, NDMA by-products form DNA adducts with established roles in carcinogenesis. Human data on ranitidine consumption and cancer development are derived from large population studies limited by their observational nature and inconsistent measure of NDMA exposure. To date, NDMA associations with renal malignancies—although evident in animal studies—is not clearly delineated in humans. Conclusions: Detection of NDMA in ranitidine has prompted governmental regulatory bodies to recommend withdrawal of ranitidine from US markets. Classification of NDMA as a “probable human carcinogen” is based on decades of animal studies with a notable rate of renal malignancies. Human observational studies do not clearly demonstrate an association with renal malignancies, but the available data have significant limitations and any conclusions drawn from these observational studies, whether supporting or challenging associations between ranitidine use and renal cancer, should be interpreted with caution.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135948523","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}

{"title":"Oncological Surveillance After Radical Cystectomy: a Narrative Review of the Enhanced Recovery After Surgery Cystectomy Committee","authors":"Ernest Kaufmann, Peter C. Black, James W.F. Catto, Hooman Djaladat, Saum Ghodoussipour, Jill M. Hamilton-Reeves, Bente Thoft Jensen, Wassim Kassouf, Susanne Vahr Lauridsen, Seth P. Lerner, Carlos Llorente, Katherine Loftus, Ilaria Lucca, Alberto Martini, Mark A. Preston, Sarah P. Psutka, John P. Sfakianos, Jay Shah, Marian Severin Wettstein, Stephen B. Williams, Siamak Daneshmand, Christian D. Fankhauser","doi":"10.1097/ju9.0000000000000046","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000046","url":null,"abstract":"Purpose: Follow-up after cystectomy aims to detect relapse, but there are discrepancies in recommendations among guidelines. Routine follow-up for asymptomatic recurrences in urothelial cancer is primarily based on nonvalidated risk factors from retrospective cohort studies in single institutions. This review provides an overview of follow-up investigations, schedules, and potential risk factors of recurrence. Materials and methods: We conducted a narrative literature search on PubMed and reviewed guidelines (European Society for Medical Oncology, European Association of Urology, National Comprehensive Cancer Network, American Urology Association, and National Institute for Health and Care Excellence) and institutional protocols for cystectomy patients. Results: Our analysis included 29 studies with 23,218 patients. Most relapses occurred within 2 years, either locally or as distant recurrences in the chest, liver, bones, or brain. Factors increasing relapse risk included higher tumor stage, nodal involvement, histological subtypes, and lymphovascular invasion. Surveillance protocols varied in frequency and type of investigation. Limited recommendations were available for patients with ypT0, pT0, or non–muscle-invasive bladder cancer. Conclusions: Further research is needed to evaluate the impact of postcystectomy follow-up protocols on oncological outcomes and establish optimal surveillance procedures.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"156 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135606830","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}