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Evaluation of postoperative bleeding control employing Surgicel: a clinical trial. 外科手术对术后出血控制的评价:一项临床试验。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Mohsen Amjadi, Mahdi Hemmati-Ghavshough, Hamed DadashKarimi, Mohsen Mohammad-Rahimi

Introduction: Various techniques have been developed for the rapid control of bleeding as a potential surgical complication. Research shows that the Surgicel has a significant effect on reducing bleeding in most surgeries; however, in our experimental observations on patients undergoing open prostatectomy, not only no significant reduction was seen in the amount of bleeding, but in some cases, Surgicel led to infection. Therefore, in this study, the effect of the Surgicel on infection and bleeding in open prostatectomy was investigated.

Materials and methods: Thirty patients undergoing open prostatectomy were randomly divided into two groups. To control bleeding after suturing the bladder neck, the Surgicel was installed in the first group, while it was not in the second group. Hemoglobin, hematocrit, PT, PTT, INR, bleeding rate, and postoperative complications were evaluated in all patients.

Results: In the studied groups, hemoglobin level and hematocrit percentage before surgery and on the first and second days after surgery, along with coagulation status, were compared in terms of PT, PTT, and INR. There were no significant differences between the studied variables and baseline variables.

Conclusion: The present study revealed that the Surgicel in open prostatectomy was ineffective in controlling bleeding and can lead to infection.

导言:为了快速控制出血这种潜在的手术并发症,已经发展出了各种各样的技术。研究表明,在大多数手术中,Surgicel对减少出血有显著效果;然而,在我们对开放性前列腺切除术患者的实验观察中,不仅出血量没有明显减少,而且在某些情况下,外科手术导致了感染。因此,在本研究中,我们探讨了surgical对开放性前列腺切除术中感染和出血的影响。材料与方法:30例开放性前列腺切除术患者随机分为两组。为了控制膀胱颈缝合后出血,第一组安装了Surgicel,第二组不安装。评估所有患者的血红蛋白、红细胞压积、PT、PTT、INR、出血率和术后并发症。结果:比较两组患者术前、术后1、2 d血红蛋白水平、红细胞压积百分率及凝血状态的PT、PTT、INR。研究变量与基线变量之间无显著差异。结论:在开放性前列腺切除术中,外科手术不能有效地控制出血,并可能导致感染。
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引用次数: 0
Mechanistic review of sulforaphane as a chemoprotective agent in bladder cancer. 萝卜硫素作为化学保护剂治疗膀胱癌的机制综述。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Gabrielle E Kennelley, Tatiana Amaye-Obu, Barbara A Foster, Li Tang, Gyorgy Paragh, Wendy J Huss

Regular consumption of cruciferous vegetables has numerous health benefits, including reduced cancer risk and improved patient outcomes. Sulforaphane (SFN) is an isothiocyanate found in cruciferous vegetables with a chemoprotective role against epithelial cancers, particularly of the bladder. Epithelial cells have several functions, including secretion, absorption, filtration, and protection from environmental insults. The specialized stratified epithelium of the bladder has direct and frequent contact with carcinogenic agents, increasing the likelihood of cancer initiation at this site. Carcinogen exposure, particularly from cigarette smoke or occupational exposure to aromatic amines, are the most significant risk factors for bladder cancer due to their ability to activate inflammatory pathways, induce free radicals, and damage DNA. SFN acts as an antioxidant by activating phase II enzymes involved in carcinogen detoxification to prevent DNA damage and inhibit tumor initiation, modulates multiple signaling pathways to inhibit tumor growth and progression, and has anti-inflammatory and immune-modulating properties to help protect against cancer. Due to these chemoprotective mechanisms, SFN has been studied as both mono- and adjuvant therapy in several bladder cancer models. Here we present a review of the effects of SFN on carcinogen-induced bladder cancer to support the inclusion of cruciferous vegetables as a chemoprotective strategy.

经常食用十字花科蔬菜对健康有很多好处,包括降低癌症风险和改善患者的预后。萝卜硫素(SFN)是十字花科蔬菜中发现的一种异硫氰酸盐,对上皮癌,特别是膀胱癌具有化学保护作用。上皮细胞具有多种功能,包括分泌、吸收、过滤和保护免受环境损害。膀胱的特化层状上皮与致癌物有直接和频繁的接触,增加了在该部位发生癌症的可能性。致癌物质暴露,特别是来自香烟烟雾或职业接触芳香胺的致癌物质,是膀胱癌最重要的危险因素,因为它们能够激活炎症途径,诱导自由基,损伤DNA。SFN作为一种抗氧化剂,通过激活参与致癌物质解毒的II期酶来防止DNA损伤和抑制肿瘤的发生,调节多种信号通路来抑制肿瘤的生长和进展,并具有抗炎和免疫调节特性来帮助预防癌症。由于这些化学保护机制,SFN在几种膀胱癌模型中作为单一和辅助治疗进行了研究。在这里,我们回顾了SFN对致癌物质诱发的膀胱癌的影响,以支持十字花科蔬菜作为一种化学保护策略。
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引用次数: 0
Efficacy of botulinum toxin-A injection versus oral anticholinergic medications following transurethral resection of the prostate to manage bladder outlet obstruction with overactive bladder: a prospective randomized clinical trial study. 经尿道前列腺切除术后注射a型肉毒杆菌毒素与口服抗胆碱能药物治疗膀胱出口梗阻伴膀胱过度活动的疗效:一项前瞻性随机临床试验研究
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Farzad Allameh, Mohammad Hosseininia, Arian Karimi Rouzbahani, Behzad Narouie, Mehdi Dadpour

Background: To compare the effect of botulinum toxin-A (BoNT-A) injection versus oral anticholinergic agents following transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and Overactive Bladder.

Materials and methods: In this randomized clinical trial from February 2021 till May 2022 data of patients with obstructive urinary symptoms and urgency incontinence were analyzed. The intervention group consisted of 35 patients who were injected with 300 units of BoNT-A (Dysport®) into the detrusor muscles at the same time as TURP. 38 participants in the control group were treated with solifenacin 5 mg (Urinacin®) daily after TURP.

Results: In the evaluation of 73 included patients (mean age: 67.54±6.3), IPSS score change (first month, P=0.777; 6th month, P=0.761) and storage irritative symptoms change score (first month, P=0.995; 6th month, P=0.962) were decreased and Qmax was increased (first month, P=0.195; 6th month, P=0.174) similarly in 2 groups. Lower number of patients experienced urgency incontinence during follow up time in intervention group, significantly (first month, 18 versus 5, P=0.002; 6th month, 20 versus 6, P=0.002). PVR was also decreased more in first month and 6th month follow up in patients of intervention group (1th month, P=0.012; 6th month, P=0.033).

Conclusion: Anticholinergic agents or intradetrusor BoNT-A injection would improve the storage symptoms in patients with BPH and detrusor overactivity following TURP. In contrast to IPSS score, storage irritative score and Qmax, which improve similarly in both groups, the PVR and urgency incontinence episodes will improve more in patients receive intradetrusor BoNT-A injection.

背景:比较经尿道前列腺切除术(TURP)后注射肉毒毒素a (BoNT-A)与口服抗胆碱能药物对良性前列腺增生(BPH)和膀胱过动症患者的疗效。材料与方法:本随机临床试验于2021年2月至2022年5月期间对有梗阻性尿失禁和急迫性尿失禁患者的资料进行分析。干预组由35例患者组成,在TURP的同时向逼尿肌注射300单位BoNT-A (Dysport®)。对照组38例患者在TURP术后每日给予索利那新5mg(尿苷酸®)治疗。结果:入选患者73例(平均年龄:67.54±6.3),IPSS评分变化(第1个月,P=0.777;第6个月,P=0.761)和储存刺激症状变化评分(第1个月,P=0.995;第6个月,P=0.962)下降,Qmax升高(第1个月,P=0.195;第6个月,P=0.174)。干预组在随访期间出现急迫性尿失禁的患者数量明显减少(第1个月,18例对5例,P=0.002;第6个月,20对6,P=0.002)。干预组患者随访第1个月和第6个月PVR下降幅度更大(第1个月,P=0.012;第6个月,P=0.033)。结论:抗胆碱能药物或肌内注射BoNT-A可改善前列腺增生和尿逼肌过度活动患者的储存症状。与IPSS评分、存储刺激评分和Qmax改善相似的两组相比,接受肌内注射BoNT-A的患者PVR和急迫性尿失禁发作改善更多。
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引用次数: 0
Urinary stone disease burden is increased in patients with cognitive impairment. 认知障碍患者的尿路结石疾病负担增加。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Ahmed Elshafei, Victor Chalfant, Mohammed Al-Toubat, Carlos Riveros, Allison Feibus, Soroush Bazargani, Seyed Behzad Jazayeri, Robert Marino, K C Balaji

Mental illness and brain disorders such as dementia are commonly encountered in patients with cognitive impairment in urology. In this cohort study, we assessed the prevalence and outcomes of inpatient admissions for stone disease in patients with cognitive impairment. Using the National Inpatient Sample database, we identified adults (>18 years) with stone disease between 2015 and 2019. The patients were dichotomized based on the presence or absence of cognitive impairment. The groups were compared for baseline differences in inpatient admissions and hospital complications. We evaluated the independent factors associated with urinary complications in the population using multivariate logistic regression. We identified 223,072 patients with stone disease. Patients with cognitive impairment were significantly (P<0.001) older (68 vs. 62 years), female (55.7% vs. 47.4%), had government-issued insurance (77.5% vs. 64.4%), and were discharged to a nursing facility (31.7% vs. 14.2%). Patients with cognitive impairment had significantly higher rates of urinary tract infection (29.7% vs. 21.5%, P<0.001), pneumonia (5.6% vs. 4.6%, P<0.001), systemic sepsis (4.3% vs. 3.8%, P<0.001), and acute renal failure (0.9% vs. 0.7%, P = 0.008). Female sex, low income, and cognitive impairment were all independently more likely to experience a urinary complication, with significant differences (P<0.001). Patients with cognitive impairment have a higher prevalence of stone disease and urinary complications associated with inpatient admissions than the rest of the population. Health care inequities among cognitively impaired patients should be a topic of further study.

泌尿科认知障碍患者常患精神疾病和脑障碍,如痴呆。在这项队列研究中,我们评估了认知障碍患者因结石疾病住院的患病率和结果。使用国家住院患者样本数据库,我们确定了2015年至2019年间患有结石疾病的成年人(>18岁)。根据是否存在认知障碍对患者进行分类。比较两组住院率和住院并发症的基线差异。我们使用多变量逻辑回归评估了人群中与泌尿系统并发症相关的独立因素。我们确定了223,072例结石患者。认知功能障碍患者有显著性差异(P
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引用次数: 0
Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years. 机器人辅助与传统开放肾移植:中位随访5年的倾向匹配比较。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Abhijit Patil, Arvind Ganpule, Abhishek Singh, Anshul Agrawal, Pratik Patel, Nitiraj Shete, Ravindra Sabnis, Mahesh Desai

Background: RAKT is a relatively newer approach for kidney transplant and has to be proven against the established approach, OKT. RAKT may be beneficial in obese patients as described in literature. Hence, we compared pre-, intra- and postoperative parameters with one year follow-up of both approaches by propensity matching similar characteristics patients.

Methods: Data of 28 OKT and 28 RAKT propensity matched patients was collected during 2014 to 2022 through the institutional transplant registry. OKT and RAKT patients were propensity matched for confounding factors like donor age, eGFR, side along with recipient age, BMI and comorbidities. All graft kidneys were harvested laparoscopically.

Results: Both the groups were comparable in terms of recipient age and BMI, donor age, creatinine, BMI, eGFR and comorbidities. Total ischemia time (P<0.001) and postoperative day (POD) 1 creatinine (P<0.001) was significantly more in RAKT. However, postoperative 1 month (P=0.12), 3 months (P=0.60) and 1 year (P=0.10) creatinine was comparable in both approaches. Postoperative complications (P=0.90) including hemoglobin drop (P=0.72) were comparable in both the groups. The days to half the creatinine from preoperative values was significantly less in OKT group (P=0.009). Serum Tacrolimus levels at day 3 (P=0.08) and day 7 (P=0.112) were also comparable in both the groups. Graft survival was 78.5% in OKT group and 82.14% in RAKT group with median follow-up of 60 months in both the groups.

Conclusion: In this comprehensive propensity matched analysis of RAKT with OKT, we conclude that RAKT has similar outcomes as OKT at 1 year and 5 years follow-up. CIT, TIT, time to half creatinine and POD 1 creatinine values were higher in RAKT group, but eventually have comparable outcomes at further follow-up. Thus, RAKT, a novel approach is non-inferior to established OKT approach. However, further larger trials are required.

背景:RAKT是一种相对较新的肾脏移植方法,并且必须与既定的方法OKT相比较。如文献所述,RAKT可能对肥胖患者有益。因此,我们通过倾向匹配相似特征的患者,比较了两种方法的术前、术中和术后一年随访参数。方法:通过机构移植登记处收集2014年至2022年28例OKT和28例RAKT倾向匹配患者的数据。OKT和RAKT患者在供体年龄、eGFR、受体年龄、BMI和合并症等混杂因素上倾向匹配。所有移植肾均在腹腔镜下摘取。结果:两组在受体年龄和BMI、供体年龄、肌酐、BMI、eGFR和合并症方面具有可比性。结论:在RAKT和OKT的综合倾向匹配分析中,我们得出结论,RAKT在1年和5年随访时的结果与OKT相似。在RAKT组中,CIT、TIT、到一半时间肌酐和POD 1肌酐值较高,但在进一步随访中最终具有相当的结果。因此,RAKT,一种新颖的方法是不逊色于既定的OKT方法。然而,还需要更大规模的试验。
{"title":"Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years.","authors":"Abhijit Patil,&nbsp;Arvind Ganpule,&nbsp;Abhishek Singh,&nbsp;Anshul Agrawal,&nbsp;Pratik Patel,&nbsp;Nitiraj Shete,&nbsp;Ravindra Sabnis,&nbsp;Mahesh Desai","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>RAKT is a relatively newer approach for kidney transplant and has to be proven against the established approach, OKT. RAKT may be beneficial in obese patients as described in literature. Hence, we compared pre-, intra- and postoperative parameters with one year follow-up of both approaches by propensity matching similar characteristics patients.</p><p><strong>Methods: </strong>Data of 28 OKT and 28 RAKT propensity matched patients was collected during 2014 to 2022 through the institutional transplant registry. OKT and RAKT patients were propensity matched for confounding factors like donor age, eGFR, side along with recipient age, BMI and comorbidities. All graft kidneys were harvested laparoscopically.</p><p><strong>Results: </strong>Both the groups were comparable in terms of recipient age and BMI, donor age, creatinine, BMI, eGFR and comorbidities. Total ischemia time (P<0.001) and postoperative day (POD) 1 creatinine (P<0.001) was significantly more in RAKT. However, postoperative 1 month (P=0.12), 3 months (P=0.60) and 1 year (P=0.10) creatinine was comparable in both approaches. Postoperative complications (P=0.90) including hemoglobin drop (P=0.72) were comparable in both the groups. The days to half the creatinine from preoperative values was significantly less in OKT group (P=0.009). Serum Tacrolimus levels at day 3 (P=0.08) and day 7 (P=0.112) were also comparable in both the groups. Graft survival was 78.5% in OKT group and 82.14% in RAKT group with median follow-up of 60 months in both the groups.</p><p><strong>Conclusion: </strong>In this comprehensive propensity matched analysis of RAKT with OKT, we conclude that RAKT has similar outcomes as OKT at 1 year and 5 years follow-up. CIT, TIT, time to half creatinine and POD 1 creatinine values were higher in RAKT group, but eventually have comparable outcomes at further follow-up. Thus, RAKT, a novel approach is non-inferior to established OKT approach. However, further larger trials are required.</p>","PeriodicalId":7438,"journal":{"name":"American journal of clinical and experimental urology","volume":"11 2","pages":"168-176"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10165225/pdf/ajceu0011-0168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9453371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ureteral stenting in the clinic: a safe and cost-effective alternative to the operating room. 输尿管支架置入术在临床:一个安全的和经济的替代手术室。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Zachary M Connelly, Ann Stolzle, Robert August Vanlangendonck, Wybra Joey Price, Kevin Morgan, Nazih Khater

Purpose: Ureteral stent placement is one of the most common procedures performed by urologists, and is typically done in the operating room. At Ochsner-LSU Health Shreveport, urologists have a unique setting allowing them to place ureteral stents for patients present in the outpatient ambulatory clinic without the need for nitrous oxide. This allows patients to avoid being admitted to the hospital and receiving subsequent general anesthesia in the operating room. Therefore, our novel study evaluates the feasibility, safety, and cost-effectiveness of ureteral stents insertion in the clinic.

Material and methods: In this study, we analyzed 240 patients with a total of 279 different ureteral stent insertion encounters to evaluate the safety and costs of stenting in the clinic compared to the operating room. Stents were placed in the outpatient clinic for 126 patients, which required either a new ureteral stent insertion or a scheduled stent exchange.

Results: Overall, there was an increased age and length of stent duration among those who were stented in the clinic. We did not observe any increase in narcotics use, pain, adverse injuries, or differences in stent length. The total cost of a stent insertion operating room was $16,349.91 whereas the clinic procedure cost $7,865.69, however: medicare reimbursement remained the same.

Conclusion: Our findings demonstrate a novel use of stenting in the clinic is feasible as an outpatient alternative. It is a safe alternative to the operating room, and more cost-effective.

目的:输尿管支架置入是泌尿科医生最常见的手术之一,通常在手术室进行。在奥克斯纳-路易斯安那州立大学什里夫波特健康中心,泌尿科医生有一个独特的环境,允许他们为门诊门诊的病人放置输尿管支架,而不需要使用氧化亚氮。这使得患者可以避免住院并在手术室接受全身麻醉。因此,我们的新研究评估输尿管支架置入临床的可行性、安全性和成本效益。材料和方法:在本研究中,我们分析了240例患者共279种不同输尿管支架置入遭遇,以评估临床与手术室支架置入的安全性和成本。126例患者在门诊放置了支架,这些患者要么需要新的输尿管支架置入,要么需要预定的支架置换。结果:总体而言,在临床接受支架治疗的患者中,年龄和支架持续时间都有所增加。我们没有观察到麻醉剂使用、疼痛、不良损伤或支架长度的差异有任何增加。一间支架植入手术室的总费用为16349.91美元,而门诊手术的费用为7865.69美元,然而,医疗保险报销保持不变。结论:我们的研究结果表明,一种新型的支架植入术在临床上是可行的。这是一个安全的替代手术室,更具有成本效益。
{"title":"Ureteral stenting in the clinic: a safe and cost-effective alternative to the operating room.","authors":"Zachary M Connelly,&nbsp;Ann Stolzle,&nbsp;Robert August Vanlangendonck,&nbsp;Wybra Joey Price,&nbsp;Kevin Morgan,&nbsp;Nazih Khater","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Ureteral stent placement is one of the most common procedures performed by urologists, and is typically done in the operating room. At Ochsner-LSU Health Shreveport, urologists have a unique setting allowing them to place ureteral stents for patients present in the outpatient ambulatory clinic without the need for nitrous oxide. This allows patients to avoid being admitted to the hospital and receiving subsequent general anesthesia in the operating room. Therefore, our novel study evaluates the feasibility, safety, and cost-effectiveness of ureteral stents insertion in the clinic.</p><p><strong>Material and methods: </strong>In this study, we analyzed 240 patients with a total of 279 different ureteral stent insertion encounters to evaluate the safety and costs of stenting in the clinic compared to the operating room. Stents were placed in the outpatient clinic for 126 patients, which required either a new ureteral stent insertion or a scheduled stent exchange.</p><p><strong>Results: </strong>Overall, there was an increased age and length of stent duration among those who were stented in the clinic. We did not observe any increase in narcotics use, pain, adverse injuries, or differences in stent length. The total cost of a stent insertion operating room was $16,349.91 whereas the clinic procedure cost $7,865.69, however: medicare reimbursement remained the same.</p><p><strong>Conclusion: </strong>Our findings demonstrate a novel use of stenting in the clinic is feasible as an outpatient alternative. It is a safe alternative to the operating room, and more cost-effective.</p>","PeriodicalId":7438,"journal":{"name":"American journal of clinical and experimental urology","volume":"11 4","pages":"304-311"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461035/pdf/ajceu0011-0304.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Novel urinary tract obstruction marker discovery by multi-marker profiling of urinary extracellular vesicles derived from a rat UTO model. 通过大鼠UTO模型尿细胞外囊泡的多标记分析发现新的尿路阻塞标志物。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Nora M Haney, Chi-Ju Kim, Morgan D Kuczler, Cheng-Fan Lee, Kara Lombardo, Trinity J Bivalacqua, Kenneth J Pienta, Sarah R Amend

Introduction: Congenital urinary obstruction is a common cause of end-stage renal disease in the pediatric population. However, non-invasive diagnostics to predict which patients will benefit from early intervention are lacking.

Methods: Using a rat model of upper and lower urinary tract partial obstruction and the Nanostring nCounter Fibrosis V2 Panel, we evaluated the mRNA cargo of urinary small extracellular vesicles (sEVs) and mRNA expression patterns of kidney and bladder tissues from rats with lower tract urinary obstruction and upper tract urinary obstruction.

Results: While mRNA hierarchical clustering of urinary sEVs was unable to differentiate upper compared to lower tract urinary obstruction, clustering was able to detect overall disease state (UUTO or LUTO) versus healthy controls. Further, urinary sEVs carried genes unique to each treatment group (UUTO: 59 genes, LUTO: 17 genes), while only one gene was uniquely carried in the control group. Notable genes of interest found in urinary sEVs were VCAM-1 and NOS1 for UUTO, Egfr for LUTO, and Pck1 for healthy controls.

Conclusion: This study provides support that differential gene expression of urinary sEV mRNA has potential to act as biomarkers in the diagnosis and prognosis of UTO. Urinary sEVs demonstrated higher numbers of unique genes representative of injury to the kidney than that of injury to the bladder. Importantly, there were genes unique to UUTO sEVs, indicating the extent and reversibility of renal damage can be independent of the function, damage, and architecture of the bladder.

简介:先天性尿路梗阻是儿童终末期肾脏疾病的常见原因。然而,预测哪些患者将从早期干预中受益的非侵入性诊断是缺乏的。方法:采用大鼠上、下尿路部分梗阻模型和Nanostring nCounter Fibrosis V2 Panel,对下尿路梗阻大鼠和上尿路梗阻大鼠的尿小细胞外囊(sev) mRNA的量和肾、膀胱组织mRNA的表达模式进行了评价。结果:虽然尿sev的mRNA分层聚类无法区分上尿路和下尿路梗阻,但聚类能够检测总体疾病状态(uto或LUTO)与健康对照。此外,尿sev携带每个治疗组独有的基因(UUTO: 59个基因,LUTO: 17个基因),而对照组仅携带1个基因。在尿sev中发现的值得注意的基因是uto的VCAM-1和NOS1, LUTO的Egfr和健康对照的Pck1。结论:本研究支持尿sEV mRNA差异基因表达可能作为UTO诊断和预后的生物标志物。尿液sev显示,与膀胱损伤相比,肾脏损伤的独特基因数量更多。重要的是,存在uto sev特有的基因,这表明肾脏损伤的程度和可逆性可能独立于膀胱的功能、损伤和结构。
{"title":"Novel urinary tract obstruction marker discovery by multi-marker profiling of urinary extracellular vesicles derived from a rat UTO model.","authors":"Nora M Haney,&nbsp;Chi-Ju Kim,&nbsp;Morgan D Kuczler,&nbsp;Cheng-Fan Lee,&nbsp;Kara Lombardo,&nbsp;Trinity J Bivalacqua,&nbsp;Kenneth J Pienta,&nbsp;Sarah R Amend","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital urinary obstruction is a common cause of end-stage renal disease in the pediatric population. However, non-invasive diagnostics to predict which patients will benefit from early intervention are lacking.</p><p><strong>Methods: </strong>Using a rat model of upper and lower urinary tract partial obstruction and the Nanostring nCounter Fibrosis V2 Panel, we evaluated the mRNA cargo of urinary small extracellular vesicles (sEVs) and mRNA expression patterns of kidney and bladder tissues from rats with lower tract urinary obstruction and upper tract urinary obstruction.</p><p><strong>Results: </strong>While mRNA hierarchical clustering of urinary sEVs was unable to differentiate upper compared to lower tract urinary obstruction, clustering was able to detect overall disease state (UUTO or LUTO) versus healthy controls. Further, urinary sEVs carried genes unique to each treatment group (UUTO: 59 genes, LUTO: 17 genes), while only one gene was uniquely carried in the control group. Notable genes of interest found in urinary sEVs were VCAM-1 and NOS1 for UUTO, Egfr for LUTO, and Pck1 for healthy controls.</p><p><strong>Conclusion: </strong>This study provides support that differential gene expression of urinary sEV mRNA has potential to act as biomarkers in the diagnosis and prognosis of UTO. Urinary sEVs demonstrated higher numbers of unique genes representative of injury to the kidney than that of injury to the bladder. Importantly, there were genes unique to UUTO sEVs, indicating the extent and reversibility of renal damage can be independent of the function, damage, and architecture of the bladder.</p>","PeriodicalId":7438,"journal":{"name":"American journal of clinical and experimental urology","volume":"11 2","pages":"136-145"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10165232/pdf/ajceu0011-0136.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9806441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corpus spongiosum flap: a unique technique in the management of urosymphyseal fistula. 海绵体皮瓣:治疗尿联合瘘的独特技术。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Jill S Patel, Sarah C Krzastek, John T Roseman, Adam P Klausner, Uzoma A Anele

Urosymphseal fistulas are a debilitating but treatable consequence of the combination of radiotherapy and endoscopic interventions in prostate cancer patients. Treatment includes fistula excision with a tissue flap to prevent communication of involved structures and provide structural and vascular support. We introduce a unique surgical approach of mobilizing and utilizing a corpus spongiosum flap in urosymphyseal fistula repair. A retrospective study identified two patients who underwent repair with a pedicled corpus spongiosum flap at our institution. The corpus spongiosum had adequate length and vascularization and limited the need for extra-pelvic muscle flaps, thus maintaining muscle integrity in the abdomen and thighs. Following extirpative surgery, both patients had durable fistula closure, decreased pelvic pain, and resolution of lower urinary tract symptoms and osteomyelitis. These cases highlight the potential of the corpus spongiosum to be a reasonable alternative interpositional flap in genitourinary reconstruction.

前列腺癌患者行放射治疗和内窥镜干预联合治疗后,尿神经管瘘是一种使人衰弱但可治疗的后果。治疗包括用组织瓣切除瘘管,以防止受累结构的沟通,并提供结构和血管支持。我们介绍一种独特的手术方法,动员和利用海绵体皮瓣修复尿联合瘘。一项回顾性研究确定了两例在我院接受带蒂海绵体皮瓣修复的患者。海绵体有足够的长度和血管化,限制了对骨盆外肌瓣的需求,从而保持了腹部和大腿的肌肉完整性。切除手术后,两名患者都有持久的瘘管闭合,盆腔疼痛减轻,下尿路症状和骨髓炎得到缓解。这些病例强调了海绵体作为一种合理的替代间置皮瓣在泌尿生殖系统重建中的潜力。
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引用次数: 0
EZH2 and matrix co-regulate phenotype and KCNB2 expression in bladder smooth muscle cells. EZH2和基质共同调控膀胱平滑肌细胞的表型和KCNB2表达。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Priyank Yadav, Tabina Ahmed, Suejean Park, Martin Sidler, Annette Schröder, Karen J Aitken, Darius Bägli

Background: Partial bladder outlet obstruction (PBO) is a widespread cause of urinary dysfunction and patient discomfort, resulting in immense health care costs. Previously, we found that obstruction is associated with altered regulation of epigenetic machinery and altered function. Here we examined if PBO and chronic bladder obstructive disease (COBD) affect epigenetic marks in a proof of principle gene and explored mechanisms of its epigenetic regulation using in vitro models.

Methods: Archival obstruction tissues from COBD had been created in 200-250 g female Sprague-Dawley rats by surgical ligation of the urethra for 6 weeks, followed by removal of the suture and following animals for 6 more weeks. Obstruction (PBO) is the 6-week ligation only. Sham ligations comprise passing the suture behind the urethra. Histone3 lysine27 trimethylation (H3K27me3) was studied by immunostaining and Chromatin immunoprecipitation (ChIP)/PCR. The interaction of matrix with KCNB2 regulation was studied in human bladder SMC plated on damaged matrix and native collagen and treated with vehicle or UNC1999. Cells were analyzed by immunostaining for cell phenotype, and western blotting for KCNB2, H3K27me3 and EZH2. Effects of conditioned media from these cells were also examined on cell phenotype. siRNA against KCNB2 was examined for effects on cell phenotype and gene expression by RT-qPCR.

Results: H3K27me3 increased by immunofluorescence during PBO, and by ChIP/PCR during COBD in the CpG Island (CGI) as well as 350 bp upstream. Obstruction vs. sham also showed an increase in H3K27me3 deposition. In SMC in vitro, EZH2 inhibition restored KCNB2 expression and partially restored SMC phenotype.

Conclusions: Regulation of KCNB2 at the promoter demonstrated dynamic changes in H3K27me3 during COBD and obstruction. In vitro models suggest that matrix plays a role in regulation of EZH2, H3K27me3 and KCNB2, which may play a role in the regulation of smooth muscle phenotype in vivo.

背景:部分膀胱出口梗阻(PBO)是泌尿功能障碍和患者不适的普遍原因,导致巨大的医疗费用。先前,我们发现梗阻与表观遗传机制的调节改变和功能改变有关。在这里,我们研究了PBO和慢性膀胱阻塞性疾病(COBD)是否影响一个原理证明基因的表观遗传标记,并利用体外模型探讨了其表观遗传调控机制。方法:取200 ~ 250 g雌性Sprague-Dawley大鼠,结扎尿道6周,拆除缝线,再随访6周,形成COBD的闭塞组织。梗阻(PBO)仅为6周结扎。假结扎包括通过尿道后面的缝合线。通过免疫染色和染色质免疫沉淀(ChIP)/PCR研究组蛋白3赖氨酸27三甲基化(H3K27me3)。研究了基质与KCNB2调控在人膀胱SMC上的相互作用。通过免疫染色检测细胞表型,western blotting检测KCNB2、H3K27me3和EZH2。这些细胞的条件培养基对细胞表型的影响也进行了检测。RT-qPCR检测siRNA对KCNB2细胞表型和基因表达的影响。结果:PBO期间免疫荧光显示H3K27me3升高,COBD期间CpG岛(CGI)及上游350 bp的ChIP/PCR显示H3K27me3升高。梗阻组与假手术组也显示H3K27me3沉积增加。在体外SMC中,EZH2抑制恢复了KCNB2的表达,部分恢复了SMC的表型。结论:在COBD和梗阻期间,KCNB2启动子处的调控显示H3K27me3的动态变化。体外模型显示基质对EZH2、H3K27me3和KCNB2有调控作用,可能在体内对平滑肌表型有调控作用。
{"title":"EZH2 and matrix co-regulate phenotype and KCNB2 expression in bladder smooth muscle cells.","authors":"Priyank Yadav,&nbsp;Tabina Ahmed,&nbsp;Suejean Park,&nbsp;Martin Sidler,&nbsp;Annette Schröder,&nbsp;Karen J Aitken,&nbsp;Darius Bägli","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Partial bladder outlet obstruction (PBO) is a widespread cause of urinary dysfunction and patient discomfort, resulting in immense health care costs. Previously, we found that obstruction is associated with altered regulation of epigenetic machinery and altered function. Here we examined if PBO and chronic bladder obstructive disease (COBD) affect epigenetic marks in a proof of principle gene and explored mechanisms of its epigenetic regulation using <i>in vitro</i> models.</p><p><strong>Methods: </strong>Archival obstruction tissues from COBD had been created in 200-250 g female Sprague-Dawley rats by surgical ligation of the urethra for 6 weeks, followed by removal of the suture and following animals for 6 more weeks. Obstruction (PBO) is the 6-week ligation only. Sham ligations comprise passing the suture behind the urethra. Histone3 lysine27 trimethylation (H3K27me3) was studied by immunostaining and Chromatin immunoprecipitation (ChIP)/PCR. The interaction of matrix with KCNB2 regulation was studied in human bladder SMC plated on damaged matrix and native collagen and treated with vehicle or UNC1999. Cells were analyzed by immunostaining for cell phenotype, and western blotting for KCNB2, H3K27me3 and EZH2. Effects of conditioned media from these cells were also examined on cell phenotype. siRNA against KCNB2 was examined for effects on cell phenotype and gene expression by RT-qPCR.</p><p><strong>Results: </strong>H3K27me3 increased by immunofluorescence during PBO, and by ChIP/PCR during COBD in the CpG Island (CGI) as well as 350 bp upstream. Obstruction vs. sham also showed an increase in H3K27me3 deposition. In SMC <i>in vitro</i>, EZH2 inhibition restored KCNB2 expression and partially restored SMC phenotype.</p><p><strong>Conclusions: </strong>Regulation of KCNB2 at the promoter demonstrated dynamic changes in H3K27me3 during COBD and obstruction. <i>In vitro</i> models suggest that matrix plays a role in regulation of EZH2, H3K27me3 and KCNB2, which may play a role in the regulation of smooth muscle phenotype <i>in vivo</i>.</p>","PeriodicalId":7438,"journal":{"name":"American journal of clinical and experimental urology","volume":"11 4","pages":"293-303"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461034/pdf/ajceu0011-0293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of exercise on continence in prostate cancer patients post robotic assisted radical prostatectomy: a systematic review. 运动对机器人辅助根治性前列腺切除术后前列腺癌患者尿失禁的影响:一项系统综述。
IF 1.2 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01
Shirin Razdan, Krunal Pandav, Joshua Altschuler, Kate Moody, Lily Martin, Hiten D Patel, Nihal Mohamed, Zachary Dovey, Ashutosh K Tewari

Introduction: Urinary incontinence is one of the most common long term side effects after robotic prostatectomy (RALP), and significantly impacts patient quality of life. Pelvic floor muscle training (PFMT) has been a standard part of the urologist's armamentarium for maximizing continence outcomes post-op. Recently, aerobic and resistance exercises have been described as improving functional outcomes post RALP. We performed a systematic review to determine the influence of exercise, in the form of PFMT, aerobic exercise, and resistance training, on incontinence post-RALP.

Materials and methods: This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with database searches performed on January 14, 2022 and again on August 10, 2022 to account for any new publications. The search identified 1675 papers. Of the 1675 papers, 1007 were found to be duplicates, leaving 668 total studies for screening. Of the 668 papers, nine met all inclusion criteria. Of the nine, four studies presented data from patients who had undergone RALP and were included in the final descriptive systematic review.

Results: Sayilan et al. and Milios et al. showed postoperative PFMT and physical activity resulted in significantly improved continence outcomes at 1 and 6 months and 2, 6, and 12 weeks postoperatively, respectively. Heydenreich et al. combined PFMT with an oscillating rod therapy, which was found to significantly improve both postoperative urinary continence and health related quality of life compared to PFMT and relaxation techniques alone. On the contrary, Goode et al. examined delivery of exercise information and demonstrated no difference in continence outcomes between focused telehealth PFMT program and generic prostate cancer education.

Conclusion: Pelvic floor muscle training, with or without adjunct therapies, results in improved continence outcomes post RALP. Supervised training programs may or may not accelerate this finding. There is no recent literature to support or refute the benefit of aerobic exercise or resistance training on reducing post-prostatectomy incontinence after RALP.

导读:尿失禁是机器人前列腺切除术(RALP)后最常见的长期副作用之一,严重影响患者的生活质量。盆底肌肉训练(PFMT)已经成为泌尿科医生的标准设备的一部分,以最大限度地提高术后的控制效果。最近,有氧和阻力运动被描述为改善RALP后的功能结果。我们进行了一项系统综述,以确定运动(以PFMT、有氧运动和阻力训练的形式)对ralp后尿失禁的影响。材料和方法:本系统评价根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行,数据库检索于2022年1月14日进行,并于2022年8月10日再次进行,以解释任何新的出版物。搜索确定了1675篇论文。在1675篇论文中,1007篇被发现是重复的,总共有668篇研究需要筛选。在668篇论文中,有9篇符合所有纳入标准。在9项研究中,4项研究提供了接受RALP的患者的数据,并被纳入最终的描述性系统评价。结果:Sayilan等人和Milios等人分别在术后1个月和6个月以及2周、6周和12周显示,术后PFMT和身体活动可显著改善尿失禁结果。Heydenreich等人将PFMT与振荡棒疗法相结合,发现与单独的PFMT和放松技术相比,前者显著改善了术后尿失禁和健康相关的生活质量。相反,Goode等人检查了运动信息的传递,并证明集中远程医疗PFMT项目和普通前列腺癌教育在失禁结果上没有差异。结论:骨盆底肌肉训练,有或没有辅助治疗,可以改善RALP后的尿失禁结果。有监督的培训项目可能会加速这一发现,也可能不会。最近没有文献支持或反驳有氧运动或阻力训练对减少RALP后前列腺切除术后尿失禁的益处。
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American journal of clinical and experimental urology
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