Vladimir Beloborodov, Vladimir Vorobev, Temirlan Hovalyg, Igor Seminskiy, Svetlana Sokolova, Ekaterina Lapteva, Aleksandr Mankov
Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, n = 25) and standard group (group I, n = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (p=0.004). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; p=0.870), as well as the likelihood of relapse within two years (p=0.512). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; p=0.002). The FTS protocol reduced the treatment period (p < 0.001) and decreased the severity of postoperative pain (p < 0.001). The use of the "fast track surgery" protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.
快速通道手术(FTS)以及ERAS(术后增强恢复/快速恢复计划)是最新的多模式治疗策略,旨在缩短残疾期并提高医疗质量。本研究旨在分析选择性尿道狭窄手术中增强恢复方案的有效性。一项前瞻性研究纳入了伊尔库茨克市第一临床医院泌尿科医院2019-2020年确诊为尿道狭窄的54例患者。所有54名患者都完成了研究。两组患者分为fts组(II组,n = 25)和标准组(I组,n = 29)。在术前参数方面,各组具有统计学上的同质性。根据本研究建立的标准对治疗进行组间疗效比较分析,I组5例(17.2%)、II组20例(80%)患者治疗效果良好(p=0.004)。无论治疗方案如何,输尿管成形术的总体疗效是相当的(86.2% vs 92%;P =0.870),以及2年内复发的可能性(P =0.512)。预测复发的因素是技术性并发症和尿道缝合失败(OR 4.36;95% ci 1.6;7.11;p = 0.002)。FTS方案缩短了治疗时间(p < 0.001),降低了术后疼痛的严重程度(p < 0.001)。在尿道成形术中使用“快速通道手术”方案,治疗效果大致相似,由于疼痛更少,导尿时间更短,住院时间更短,术后患者的功能和客观状况更好。
{"title":"Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty.","authors":"Vladimir Beloborodov, Vladimir Vorobev, Temirlan Hovalyg, Igor Seminskiy, Svetlana Sokolova, Ekaterina Lapteva, Aleksandr Mankov","doi":"10.1155/2023/2205306","DOIUrl":"https://doi.org/10.1155/2023/2205306","url":null,"abstract":"<p><p>Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, <i>n</i> = 25) and standard group (group I, <i>n</i> = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (<i>p</i>=0.004). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; <i>p</i>=0.870), as well as the likelihood of relapse within two years (<i>p</i>=0.512). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; <i>p</i>=0.002). The FTS protocol reduced the treatment period (<i>p</i> < 0.001) and decreased the severity of postoperative pain (<i>p</i> < 0.001). The use of the \"fast track surgery\" protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2023 ","pages":"2205306"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10195176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508532","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}
Pub Date : 2022-09-20eCollection Date: 2022-01-01DOI: 10.1155/2022/5185114
Ahmed S Zakaria, Amr Hodhod, Loay Abbas, Moustafa Fathy, Ruba Abdul Hadi, Waleed Shabana, Anastasia Alexandra MacDonald, Ahmed Gamaleldin, Mohamed Abdallah, Mohamed Elgharbawy, Abdulrahman Ahmad, Adam Roos, Ahmed Kotb, Walid Shahrour, Hazem Elmansy
Materials and methods: We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (Qmax), postvoid residual urine test (PVR), and continence status.
Results: Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25-200)) was not significantly longer than that for group II (60 min (19-165) (p=0.25)). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months' follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI.
Conclusions: For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.
{"title":"Outcomes of Top-Down Holmium Laser Enucleation of Prostate for Recurrent/Residual Benign Prostatic Hyperplasia: One-Year Follow-Up.","authors":"Ahmed S Zakaria, Amr Hodhod, Loay Abbas, Moustafa Fathy, Ruba Abdul Hadi, Waleed Shabana, Anastasia Alexandra MacDonald, Ahmed Gamaleldin, Mohamed Abdallah, Mohamed Elgharbawy, Abdulrahman Ahmad, Adam Roos, Ahmed Kotb, Walid Shahrour, Hazem Elmansy","doi":"10.1155/2022/5185114","DOIUrl":"https://doi.org/10.1155/2022/5185114","url":null,"abstract":"<p><strong>Materials and methods: </strong>We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (<i>Q</i> <sub>max</sub>), postvoid residual urine test (PVR), and continence status.</p><p><strong>Results: </strong>Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25-200)) was not significantly longer than that for group II (60 min (19-165) (<i>p</i>=0.25)). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months' follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI.</p><p><strong>Conclusions: </strong>For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2022 ","pages":"5185114"},"PeriodicalIF":1.4,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33516419","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}
Pub Date : 2022-08-29eCollection Date: 2022-01-01DOI: 10.1155/2022/1589040
Chen Mayer, Yasmin Abu-Ghanem, Zohar A Dotan, Iris Barshack, Eddie Fridman
Background: Oncocytoma is one of the most common benign kidney tumors, accounting for 3-7% of all solid renal masses. Diagnosing oncocytomas using renal biopsy remains a controversy in the uro-pathologic community. With the increasing use of biopsies for assessment of renal lesions, reaching this pathologically benign diagnosis may prevent further surgical measures and have significant clinical benefit.
Objective: To demonstrate our center's results using renal biopsy to diagnose oncocytomas and to suggest that this diagnosis can be made with high success rates.
Design: , Setting, and Participants. From our center's database, we retrospectively identified and retrieved all cases of oncocytoma diagnosed between the years 2011 and 2020 by renal biopsy. Medical records of those patients were then reviewed to view follow-up meetings and imaging of the lesions biopsied. Outcome Measurements and Statistical Analysis. In 21 biopsies performed on 19 patients, diagnosis was supported by subsequent follow-up averaging at 3.44 years per patient. Results and Limitations. The lesions exhibited benign behavior during follow-up after biopsy, consistent with the diagnosis of oncocytoma.
Conclusions: Our study demonstrates that with good patient selection and proficient cooperation between urologists, radiologists and dedicated uro-pathologists, correctly diagnosing oncocytomas using RCB is a viable task. Patient Summary. Oncocytomas are benign lesions of the kidney. In our study, we reviewed all cases of oncocytomas pathologically diagnosed using renal biopsy from our center's database. We found that in subsequent follow-up later to biopsy, the lesions displayed benign behavior consistent with oncocytoma. The use of percutaneous biopsies to reach this diagnosis could save patients more extensive surgeries.
{"title":"Diagnosing Oncocytoma by Core Needle Biopsy: A Single-Center Experience.","authors":"Chen Mayer, Yasmin Abu-Ghanem, Zohar A Dotan, Iris Barshack, Eddie Fridman","doi":"10.1155/2022/1589040","DOIUrl":"https://doi.org/10.1155/2022/1589040","url":null,"abstract":"<p><strong>Background: </strong>Oncocytoma is one of the most common benign kidney tumors, accounting for 3-7% of all solid renal masses. Diagnosing oncocytomas using renal biopsy remains a controversy in the uro-pathologic community. With the increasing use of biopsies for assessment of renal lesions, reaching this pathologically benign diagnosis may prevent further surgical measures and have significant clinical benefit.</p><p><strong>Objective: </strong>To demonstrate our center's results using renal biopsy to diagnose oncocytomas and to suggest that this diagnosis can be made with high success rates.</p><p><strong>Design: </strong>, <i>Setting</i>, <i>and Participants</i>. From our center's database, we retrospectively identified and retrieved all cases of oncocytoma diagnosed between the years 2011 and 2020 by renal biopsy. Medical records of those patients were then reviewed to view follow-up meetings and imaging of the lesions biopsied. <i>Outcome Measurements and Statistical Analysis</i>. In 21 biopsies performed on 19 patients, diagnosis was supported by subsequent follow-up averaging at 3.44 years per patient. <i>Results and Limitations</i>. The lesions exhibited benign behavior during follow-up after biopsy, consistent with the diagnosis of oncocytoma.</p><p><strong>Conclusions: </strong>Our study demonstrates that with good patient selection and proficient cooperation between urologists, radiologists and dedicated uro-pathologists, correctly diagnosing oncocytomas using RCB is a viable task. <i>Patient Summary</i>. Oncocytomas are benign lesions of the kidney. In our study, we reviewed all cases of oncocytomas pathologically diagnosed using renal biopsy from our center's database. We found that in subsequent follow-up later to biopsy, the lesions displayed benign behavior consistent with oncocytoma. The use of percutaneous biopsies to reach this diagnosis could save patients more extensive surgeries.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2022 ","pages":"1589040"},"PeriodicalIF":1.4,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9444412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33448055","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}
N. Gadzhiev, I. Semeniakin, A. Morshnev, A. Alcaraz, V. Gauhar, Z. Okhunov
Objective To develop a software for mixed reality (MR) anatomical model creation and study its intraoperative clinical utility to facilitate laparoscopic partial nephrectomy. Materials and Methods After institutional review board approval, 47 patients were prospectively randomized for LPN into two groups: the control group (24 patients) underwent operation with an intraoperative ultrasound (US) control and the experimental group (23 patients) with smart glasses HoloLens 2 (Microsoft, Seattle, WA, USA). Our team has developed an open-source software package called “HLOIA,” utilization of which allowed to create and use during surgery the MR anatomical model of the kidney with its vascular pedicle and tumor. The study period extended from June 2020 to February 2021 where demographic, perioperative, and pathological data were collected for all qualifying patients. The objective was to assess the utility of a MR model during LPN and through a 5-point Likert scale questionnaire, completed by the surgeon, immediately after LPN. Patient characteristics were tested using the chi-square test for categorical variables and Student's t-test or Mann–Whitney test for continuous variables. Results Comparison of the variables between the groups revealed statistically significant differences only in the following parameters: the time for renal pedicle exposure and the time from the renal pedicle to the detection of tumor localization (p < 0.001), which were in favor of the experimental group. The surgeon's impression of the utility of the MR model by the proposed questionnaire demonstrated high scores in all statements. Conclusions Developed open-source software “HLOIA” allowed to create the mixed reality anatomical model by operating urologist which is when used with smart glasses has shown improvement in terms of time for renal pedicle exposure and time for renal tumor identification without compromising safety.
{"title":"Role and Utility of Mixed Reality Technology in Laparoscopic Partial Nephrectomy: Outcomes of a Prospective RCT Using an Indigenously Developed Software","authors":"N. Gadzhiev, I. Semeniakin, A. Morshnev, A. Alcaraz, V. Gauhar, Z. Okhunov","doi":"10.1155/2022/8992051","DOIUrl":"https://doi.org/10.1155/2022/8992051","url":null,"abstract":"Objective To develop a software for mixed reality (MR) anatomical model creation and study its intraoperative clinical utility to facilitate laparoscopic partial nephrectomy. Materials and Methods After institutional review board approval, 47 patients were prospectively randomized for LPN into two groups: the control group (24 patients) underwent operation with an intraoperative ultrasound (US) control and the experimental group (23 patients) with smart glasses HoloLens 2 (Microsoft, Seattle, WA, USA). Our team has developed an open-source software package called “HLOIA,” utilization of which allowed to create and use during surgery the MR anatomical model of the kidney with its vascular pedicle and tumor. The study period extended from June 2020 to February 2021 where demographic, perioperative, and pathological data were collected for all qualifying patients. The objective was to assess the utility of a MR model during LPN and through a 5-point Likert scale questionnaire, completed by the surgeon, immediately after LPN. Patient characteristics were tested using the chi-square test for categorical variables and Student's t-test or Mann–Whitney test for continuous variables. Results Comparison of the variables between the groups revealed statistically significant differences only in the following parameters: the time for renal pedicle exposure and the time from the renal pedicle to the detection of tumor localization (p < 0.001), which were in favor of the experimental group. The surgeon's impression of the utility of the MR model by the proposed questionnaire demonstrated high scores in all statements. Conclusions Developed open-source software “HLOIA” allowed to create the mixed reality anatomical model by operating urologist which is when used with smart glasses has shown improvement in terms of time for renal pedicle exposure and time for renal tumor identification without compromising safety.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46787693","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}
J. Forster, Petra Schulze, Claudia Burger, M. Krone, U. Vogel, Güzin Surat
Inappropriate diagnosis of urinary tract infections (UTI) contributes to antimicrobial overuse. A combined training intervention for medical and nursing staff mainly addressing the analytic process reduced UTI events (9.20 vs. 7.36 per 1000 PD, −20.0%, p = 0.003) and the utilization rate of ciprofloxacin (11.6 vs. 3.5, −69.6 p = 0.001) in a Bavarian University Hospital. Combined training intervention—as part of an antibiotic stewardship program—can be effective in avoiding unnecessary urinalysis and reducing antibiotic consumption.
尿路感染(UTI)诊断不当会导致抗生素过度使用。主要针对分析过程的医护人员联合培训干预减少了尿路感染事件(9.20 vs.7.36/1000 PD,−20.0%,p = 0.003)和环丙沙星的利用率(11.6对3.5,−69.6 p = 0.001)在巴伐利亚大学医院。作为抗生素管理计划的一部分,联合训练干预可以有效避免不必要的尿液分析和减少抗生素消耗。
{"title":"Combined Training Intervention Targeting Medical and Nursing Staff Reduces Ciprofloxacin Use and Events of Urinary Tract Infection","authors":"J. Forster, Petra Schulze, Claudia Burger, M. Krone, U. Vogel, Güzin Surat","doi":"10.1155/2022/2474242","DOIUrl":"https://doi.org/10.1155/2022/2474242","url":null,"abstract":"Inappropriate diagnosis of urinary tract infections (UTI) contributes to antimicrobial overuse. A combined training intervention for medical and nursing staff mainly addressing the analytic process reduced UTI events (9.20 vs. 7.36 per 1000 PD, −20.0%, p = 0.003) and the utilization rate of ciprofloxacin (11.6 vs. 3.5, −69.6 p = 0.001) in a Bavarian University Hospital. Combined training intervention—as part of an antibiotic stewardship program—can be effective in avoiding unnecessary urinalysis and reducing antibiotic consumption.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2022 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43928765","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}
L. Vale, A. Charrua, H. Cavaleiro, R. Ribeiro-Oliveira, A. Avelino, T. Antunes-Lopes, A. Albino-Teixeira, F. Cruz
Objectives To investigate, in initial phases of bladder outlet obstruction (BOO), the urinary ATP levels, the incidence of detrusor underactivity (DU), and if they change after deobstruction. Methods Adult female Wistar rats submitted to partial BOO (pBOO) and sham-obstruction were used. Cystometry was performed 3 or 15 days after pBOO and fluid was collected from the urethra for ATP determination. Bladders were harvested for morphological evaluation of the urothelium. DU was defined as the average of voiding contractions (VC) of sham-operated animals, with 3 SD at 15 days after the sham surgery. In another group of animals in which pBOO was relieved at 15 days and bladders were let to recover for 15 days, the incidence of DU and ATP levels were also accessed. The Kruskal–Wallis test was followed by Dunn's multiple comparisons test, and Spearman's correlation test was used. Results DU was present in 13% and 67% of the bladders at 3 and 15 days after pBOO, respectively, and in 20% of the bladders at 15 days after deobstruction. ATP levels were significantly lower in DU/pBOO versus sham and non-DU/pBOO rats. A strong positive correlation between ATP levels and VC/min was obtained (r = 0.63). DU bladders had extensive areas in which umbrella cells appeared stretched, the width exceeding that presented by sham animals. Conclusions Low urothelial ATP parallels with a high incidence of DU early after pBOO.
{"title":"DU Is Induced by Low Levels of Urinary ATP in a Rat Model of Partial Bladder Outlet Obstruction: The Incidence of Both Events Decreases after Deobstruction","authors":"L. Vale, A. Charrua, H. Cavaleiro, R. Ribeiro-Oliveira, A. Avelino, T. Antunes-Lopes, A. Albino-Teixeira, F. Cruz","doi":"10.1155/2022/6292457","DOIUrl":"https://doi.org/10.1155/2022/6292457","url":null,"abstract":"Objectives To investigate, in initial phases of bladder outlet obstruction (BOO), the urinary ATP levels, the incidence of detrusor underactivity (DU), and if they change after deobstruction. Methods Adult female Wistar rats submitted to partial BOO (pBOO) and sham-obstruction were used. Cystometry was performed 3 or 15 days after pBOO and fluid was collected from the urethra for ATP determination. Bladders were harvested for morphological evaluation of the urothelium. DU was defined as the average of voiding contractions (VC) of sham-operated animals, with 3 SD at 15 days after the sham surgery. In another group of animals in which pBOO was relieved at 15 days and bladders were let to recover for 15 days, the incidence of DU and ATP levels were also accessed. The Kruskal–Wallis test was followed by Dunn's multiple comparisons test, and Spearman's correlation test was used. Results DU was present in 13% and 67% of the bladders at 3 and 15 days after pBOO, respectively, and in 20% of the bladders at 15 days after deobstruction. ATP levels were significantly lower in DU/pBOO versus sham and non-DU/pBOO rats. A strong positive correlation between ATP levels and VC/min was obtained (r = 0.63). DU bladders had extensive areas in which umbrella cells appeared stretched, the width exceeding that presented by sham animals. Conclusions Low urothelial ATP parallels with a high incidence of DU early after pBOO.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45468775","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}
Objective To examine the effects of ERAS protocol application on hospital stay, postoperative antibiotic use, and gastrointestinal recovery time in radical cystectomy patients with ileal conduit. Materials and Methods This retrospective study included 182 patients (112 traditional vs. 72 ERAS) who underwent radical cystectomy (RC) with ileal conduit between November 2017 and December 2020. Patients were compared in terms of time to start enteral feeding (SEF), length of hospital stay (LOS), time to first stool, duration of postoperative intravenous antibiotic use, postoperative ileus rate, and serum albumin levels. Results The traditional and ERAS groups contained 112 and 72 patients, respectively. LOS (14.79 ± 6.44 vs. 10.44 ± 4.64 days, p=0.003), first stool time (4.43 ± 2.39 vs. 2.89 ± 1.81 days, p=0.011), and duration of postoperative intravenous antibiotic use (8.79 ± 5.17 vs. 4.61 ± 4.90, p=0.004) were to be found significantly shorter in the ERAS group. Conclusion According to the results of this study, the ERAS protocol shortened the length of hospital stay, duration of antibiotic use, and time of first stool in patients who underwent RC with ileal conduit.
{"title":"ERAS vs. Traditional Protocol in Patients Who Had Radical Cystectomy with Ileal Conduit: A Retrospective Comparative Analysis of 182 Cases","authors":"A. S. Guleser, Yasar Basaga","doi":"10.1155/2022/7335960","DOIUrl":"https://doi.org/10.1155/2022/7335960","url":null,"abstract":"Objective To examine the effects of ERAS protocol application on hospital stay, postoperative antibiotic use, and gastrointestinal recovery time in radical cystectomy patients with ileal conduit. Materials and Methods This retrospective study included 182 patients (112 traditional vs. 72 ERAS) who underwent radical cystectomy (RC) with ileal conduit between November 2017 and December 2020. Patients were compared in terms of time to start enteral feeding (SEF), length of hospital stay (LOS), time to first stool, duration of postoperative intravenous antibiotic use, postoperative ileus rate, and serum albumin levels. Results The traditional and ERAS groups contained 112 and 72 patients, respectively. LOS (14.79 ± 6.44 vs. 10.44 ± 4.64 days, p=0.003), first stool time (4.43 ± 2.39 vs. 2.89 ± 1.81 days, p=0.011), and duration of postoperative intravenous antibiotic use (8.79 ± 5.17 vs. 4.61 ± 4.90, p=0.004) were to be found significantly shorter in the ERAS group. Conclusion According to the results of this study, the ERAS protocol shortened the length of hospital stay, duration of antibiotic use, and time of first stool in patients who underwent RC with ileal conduit.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512097","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 : 2022-02-03eCollection Date: 2022-01-01DOI: 10.1155/2022/7367851
Angelo J Cambio, Richard M Roach, Paul Arnold, Joseph Cambio, Clifford D Gluck, Sean P Heron
Purpose: This US FDA investigational device exemption (IDE) study evaluated the extended use of The Spanner® Temporary Prostatic Stent in catheter-dependent men with urinary retention who were not deemed candidates for corrective surgery but demonstrated bladder contractility.
Materials and methods: The Spanner was placed for 3 cycles of 30 days in catheter-dependent men with comorbid conditions, confirmed detrusor contractility, and catheter-associated discomfort. At each visit, postvoid residual, maximum flow rate, international prostate symptom score, quality of life, and adverse events were assessed. Voiding success was defined as PVR ≤ 150 ml at all visits.
Results: One hundred seven men were enrolled at 8 US sites; 82/107 (76.6%) completed the trial, and 79/107 (73.8%) successfully maintained PVR ≤ 150 ml for the trial duration. Patients were 77.1 ± 10.6 years old; 63/107 (58.9%) were dependent on Foley and 40/107 (37.4%) on intermittent catheterization for 36.0 ± 39.3 days and 30.2 ± 45.8 days, respectively. 25/107 (23.4%) discontinuations were primarily due to voluntary patient withdrawal 9/107 (8.4%), investigator-initiated withdrawal 8/107 (7.5%), or lack of effectiveness 4/107 (3.7%). During Spanner use, the mean Qmax was 11.2 ± 6.6, mean IPSS was 7.5 ± 6.4, and mean QOL was 2.0 ± 1.6. The most prevalent device-related adverse events were asymptomatic bacteriuria 25/107 (23.4%), discomfort 10/107 (9.4%), and urinary urgency 8/107 (7.5%). No device-related serious AEs were reported.
Conclusions: This study demonstrates that catheter-dependent men with sufficient bladder contractility can achieve volitional voiding and successful bladder drainage using The Spanner Temporary Prostatic Stent for extended periods of time.
{"title":"Extended Use of The Spanner® Temporary Prostatic Stent in Catheter-Dependent Men with Comorbidities.","authors":"Angelo J Cambio, Richard M Roach, Paul Arnold, Joseph Cambio, Clifford D Gluck, Sean P Heron","doi":"10.1155/2022/7367851","DOIUrl":"https://doi.org/10.1155/2022/7367851","url":null,"abstract":"<p><strong>Purpose: </strong>This US FDA investigational device exemption (IDE) study evaluated the extended use of The Spanner® Temporary Prostatic Stent in catheter-dependent men with urinary retention who were not deemed candidates for corrective surgery but demonstrated bladder contractility.</p><p><strong>Materials and methods: </strong>The Spanner was placed for 3 cycles of 30 days in catheter-dependent men with comorbid conditions, confirmed detrusor contractility, and catheter-associated discomfort. At each visit, postvoid residual, maximum flow rate, international prostate symptom score, quality of life, and adverse events were assessed. Voiding success was defined as PVR ≤ 150 ml at all visits.</p><p><strong>Results: </strong>One hundred seven men were enrolled at 8 US sites; 82/107 (76.6%) completed the trial, and 79/107 (73.8%) successfully maintained PVR ≤ 150 ml for the trial duration. Patients were 77.1 ± 10.6 years old; 63/107 (58.9%) were dependent on Foley and 40/107 (37.4%) on intermittent catheterization for 36.0 ± 39.3 days and 30.2 ± 45.8 days, respectively. 25/107 (23.4%) discontinuations were primarily due to voluntary patient withdrawal 9/107 (8.4%), investigator-initiated withdrawal 8/107 (7.5%), or lack of effectiveness 4/107 (3.7%). During Spanner use, the mean <i>Q</i> <sub>max</sub> was 11.2 ± 6.6, mean IPSS was 7.5 ± 6.4, and mean QOL was 2.0 ± 1.6. The most prevalent device-related adverse events were asymptomatic bacteriuria 25/107 (23.4%), discomfort 10/107 (9.4%), and urinary urgency 8/107 (7.5%). No device-related serious AEs were reported.</p><p><strong>Conclusions: </strong>This study demonstrates that catheter-dependent men with sufficient bladder contractility can achieve volitional voiding and successful bladder drainage using The Spanner Temporary Prostatic Stent for extended periods of time.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2022 ","pages":"7367851"},"PeriodicalIF":1.4,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39611298","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}
Pub Date : 2022-01-10eCollection Date: 2022-01-01DOI: 10.1155/2022/7149467
Patrick Juliebø-Jones, Karin M Hjelle, Jannike Mohn, Gigja Gudbrandsdottir, Ingunn Roth, Adeel Asghar Chaudhry, Anne Kvåle Bergesen, Christian Beisland
Bladder pain syndrome (BPS) is a prevalent and pervasive disease. The physical and psychological sequelae can be very burdensome for the patient, and the condition represents a real challenge for the clinician as well. With no simple pathognomonic test, finding harmony in navigating patient care can be demanding. Diagnosis and management rely upon a multidisciplinary and holistic approach. Treatment options include conservative measures and pharmacotherapies as well as bladder instillation therapies. Ultimately, surgery may be offered but only in cases of refractory disease. This article offers a pragmatic guide for clinicians managing this challenging disease.
{"title":"Management of Bladder Pain Syndrome (BPS): A Practical Guide.","authors":"Patrick Juliebø-Jones, Karin M Hjelle, Jannike Mohn, Gigja Gudbrandsdottir, Ingunn Roth, Adeel Asghar Chaudhry, Anne Kvåle Bergesen, Christian Beisland","doi":"10.1155/2022/7149467","DOIUrl":"https://doi.org/10.1155/2022/7149467","url":null,"abstract":"<p><p>Bladder pain syndrome (BPS) is a prevalent and pervasive disease. The physical and psychological sequelae can be very burdensome for the patient, and the condition represents a real challenge for the clinician as well. With no simple pathognomonic test, finding harmony in navigating patient care can be demanding. Diagnosis and management rely upon a multidisciplinary and holistic approach. Treatment options include conservative measures and pharmacotherapies as well as bladder instillation therapies. Ultimately, surgery may be offered but only in cases of refractory disease. This article offers a pragmatic guide for clinicians managing this challenging disease.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2022 ","pages":"7149467"},"PeriodicalIF":1.4,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834016","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}
Pub Date : 2021-12-31eCollection Date: 2021-01-01DOI: 10.1155/2021/5569254
Syed Ali Ehsanullah, Abida Sultana, Brian Kelly, Charlotte Dunford, Zaheer Shah
Introduction: To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time.
Methods: A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size.
Results: Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30-250), and mean estimated blood loss was 608 mls (range 100-2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian-Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%).
Conclusion: Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.
{"title":"Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses.","authors":"Syed Ali Ehsanullah, Abida Sultana, Brian Kelly, Charlotte Dunford, Zaheer Shah","doi":"10.1155/2021/5569254","DOIUrl":"https://doi.org/10.1155/2021/5569254","url":null,"abstract":"<p><strong>Introduction: </strong>To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time.</p><p><strong>Methods: </strong>A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12<sup>th</sup> rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size.</p><p><strong>Results: </strong>Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30-250), and mean estimated blood loss was 608 mls (range 100-2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian-Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%).</p><p><strong>Conclusion: </strong>Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2021 ","pages":"5569254"},"PeriodicalIF":1.4,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8741386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39661860","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}