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High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform. 高强度聚焦超声(HIFU)应用MRI-US融合平台治疗局限性前列腺癌。
IF 1.4 Q3 Medicine Pub Date : 2021-12-14 eCollection Date: 2021-01-01 DOI: 10.1155/2021/7157973
Chi-Hang Yee, Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Chi-Fai Ng, Chi-Kwok Chan, See-Ming Hou

Objective: The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery.

Methods: It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes.

Results: Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p=0.066). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p=0.035). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p=0.014).

Conclusion: In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.

目的:本研究旨在探讨利用MRI-US融合平台进行前列腺HIFU病灶治疗的定位和输送效果。方法:前瞻性设计HIFU治疗局限性前列腺癌的病例系列。纳入标准:临床肿瘤分期≤T2,多参数MRI可见病变指数直径小于20mm,前列腺活检未见Gleason 5型,PSA≤20ng /ml。在该系列的前50%采用传统方式进行HIFU局灶治疗,而随后的病例采用MRI-US融合平台进行治疗。主要结果是治疗失败率,这是由挽救性治疗的需要来定义的。次要结局包括随访活检中肿瘤复发、PSA变化、围手术期并发症和术后功能结局。结果:20例患者行HIFU局灶消融。MRI-US融合平台HIFU的总手术时间比常规HIFU的总手术时间更长(124.2 min vs 107.1 min, p=0.066)。两者的平均消融体积与病变体积之比无差异。常规组从基线到6个月的平均PSA百分比变化更为显著(63.3%比44.6%,p=0.035)。20例患者6个月mpMRI未见可疑病变。两名患者,每组一名,最终接受了根治性治疗,因为在随访活检期间以视野外复发的形式出现临床显著的前列腺癌。HIFU前后尿流测量、SF-12评分、EPIC-26评分无显著差异。我们观察到,每体积使用的能量与患者PSA密度呈正相关(r = 0.6364, p=0.014)。结论:总之,HIFU与传统或MRI-US融合平台提供相似的肿瘤和功能结果。
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引用次数: 7
Ultrasound Guided Percutaneous Nephrolithotomy in Mesh-Repaired Incisional Hernia. 超声引导下经皮肾镜取石术治疗网状修复切口疝。
IF 1.4 Q3 Medicine Pub Date : 2021-11-28 eCollection Date: 2021-01-01 DOI: 10.1155/2021/1537840
Seyed Hassan Inanloo, Mohammad Reza Nikoobakht, Hamed Akhavizadegan, Mojgan Karbakhsh

Objectives: To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure.

Materials and methods: Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected.

Results: Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography.

Conclusion: Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.

目的:探讨经皮肾镜取石术(PNL)治疗经网修复的腹侧切口疝的方法。聚丙烯补片在疝修补中用于筋膜强化,引起强烈的炎症反应,引起的纤维化改变了腹壁的特征。因此,先前的腹侧疝修补史可能导致经皮肾镜取石失败。材料与方法:收集2011年至2020年行PNL治疗且侧腹区域有补片的患者的人口学资料、肾结石特征、手术及随访中有无并发症。结果:8例患者均在超声引导下顺利行经皮肾镜取石术。结论:根据我们的经验,在这种情况下,超声引导下的PNL是可行的,并且假设优于透视。
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引用次数: 0
Microbiota, Prostatitis, and Fertility: Bacterial Diversity as a Possible Health Ally. 微生物群、前列腺炎和生育能力:细菌多样性是可能的健康盟友。
IF 1.4 Q3 Medicine Pub Date : 2021-09-28 eCollection Date: 2021-01-01 DOI: 10.1155/2021/1007366
Jenniffer Puerta Suárez, Walter D Cardona Maya

Background: In health, microorganisms have been associated with the disease, although the current knowledge shows that the microbiota present in various anatomical sites is associated with multiple benefits.

Objective: This study aimed to evaluate and compare the genitourinary microbiota of chronic prostatitis symptoms patients and fertile men.

Materials and methods: In this preliminary study, ten volunteers have included 5 volunteers with symptoms of chronic prostatitis (prostatitis group) and five fertile volunteers, asymptomatic for urogenital infections (control group) matched by age. Bacterial diversity analysis was performed using the 16S molecular marker to compare the microbiota present in urine and semen samples from chronic prostatitis symptoms and fertile volunteers. Seminal quality, nitric oxide levels, and seminal and serum concentration of proinflammatory cytokines were quantified.

Results: Fertile men present a greater variety of operational taxonomical units-OTUs in semen (67.5%) and urine (17.6%) samples than chronic prostatitis symptoms men. Chronic prostatitis symptoms men presented a higher concentration of IL-12p70 in seminal plasma. No statistically significant differences were observed in conventional and functional seminal parameters. The species diversity in semen samples was similar in healthy men than prostatitis patients, inverted Simpson index median 5.3 (5.0-10.7) vs. 4.5 (2.1-7.8, p=0.1508). Nevertheless, the microbiota present in the semen and urine samples of fertile men presents more OTUs. Less microbial diversity could be associated with chronic prostatitis symptoms. The presence of bacteria in the genitourinary tract is not always associated with the disease. Understanding the factors that affect the microbiota can implement lifestyle habits that prevent chronic prostatitis.

Conclusion: Chronic prostatitis does not seem to affect male fertility; however, studies with a larger sample size are required. Our preliminary results strengthen the potential role; the greater bacterial diversity is a protective factor for chronic prostatitis.

背景:在健康方面,微生物与疾病有关,尽管目前的知识表明,存在于不同解剖部位的微生物群与多种益处有关。目的:本研究旨在评价和比较慢性前列腺炎症状患者和育龄男性的泌尿生殖系统微生物群。材料与方法:在本初步研究中,10名志愿者,包括5名有慢性前列腺炎症状的志愿者(前列腺炎组)和5名有生育能力的志愿者,无症状的泌尿生殖系统感染(对照组),按年龄匹配。使用16S分子标记进行细菌多样性分析,比较慢性前列腺炎症状和有生育能力的志愿者尿液和精液样本中的微生物群。量化精液质量、一氧化氮水平、精液和血清促炎细胞因子浓度。结果:与有慢性前列腺炎症状的男性相比,有生育能力的男性在精液(67.5%)和尿液(17.6%)样本中表现出更多的操作分类单位——otus。慢性前列腺炎症状男性精浆中IL-12p70浓度较高。常规和功能性精液参数无统计学差异。健康男性和前列腺炎患者精液样本的物种多样性相似,倒辛普森指数中位数分别为5.3(5.0-10.7)和4.5 (2.1-7.8,p=0.1508)。然而,有生育能力的男性精液和尿液样本中的微生物群呈现出更多的otu。微生物多样性减少可能与慢性前列腺炎症状有关。泌尿生殖系统中细菌的存在并不总是与疾病有关。了解影响微生物群的因素可以实施预防慢性前列腺炎的生活习惯。结论:慢性前列腺炎似乎不影响男性生育能力;然而,研究需要更大的样本量。我们的初步结果加强了潜在的作用;更大的细菌多样性是慢性前列腺炎的保护因素。
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引用次数: 7
Dual-Tracer Positron-Emission Tomography Using Prostate-Specific Membrane Antigen and Fluorodeoxyglucose for Staging of Prostate Cancer: A Systematic Review. 使用前列腺特异性膜抗原和氟脱氧葡萄糖进行前列腺癌分期的双示踪正电子发射断层扫描:系统综述。
IF 1.4 Q3 Medicine Pub Date : 2021-08-18 eCollection Date: 2021-01-01 DOI: 10.1155/2021/1544208
Stephen McGeorge, Michael Kwok, Andrew Jiang, Louise Emmett, David A Pattison, Paul A Thomas, John W Yaxley, Matthew J Roberts

PSMA PET is more accurate than conventional imaging (CT/bone scan) for staging of intermediate- or high-risk prostate cancer (PCa), but 5-10% of primary tumours have low PSMA ligand uptake. FDG PET has been used to further define disease extent in end-stage castrate-resistant PCa and may be beneficial earlier in the disease course for more accurate staging. The objective of this study was to review the available evidence for patients undergoing both FDG and PSMA PET for PCa staging at initial diagnosis and in recurrent disease. A systematic literature review was performed for studies with direct, intraindividual comparison of PSMA and FDG PET for staging of PCa. Assessment for radioligand therapy eligibility was not considered. Risk of bias was assessed. 543 citations were screened and assessed. 13 case reports, three retrospective studies, and one prospective study were included. FDG after PSMA PET improved the detection of metastases from 65% to 73% in high-risk early castration-resistant PCa with negative conventional imaging (M0). Positive FDG PET was found in 17% of men with negative PSMA PET for postprostatectomy biochemical recurrence. Gleason score ≥8 and higher PSA levels predicted FDG-avid metastases in BCR and primary staging. Variant histology (ductal and neuroendocrine) was common in case reports, resulting in PSMA-negative FDG-positive imaging for 3 patients. Dual-tracer PET for PCa may assist in characterising high-risk disease during primary staging and restaging. Further studies are required to determine the additive benefit of FDG PET and if the FDG-positive phenotype may indicate a poorer prognosis.

对于中高危前列腺癌(PCa)的分期,PSMA PET比传统成像(CT/骨扫描)更准确,但5-10%的原发性肿瘤具有低PSMA配体摄取。FDG PET已被用于进一步确定终末期去势抵抗性前列腺癌的疾病程度,并可能有助于在病程早期获得更准确的分期。本研究的目的是回顾接受FDG和PSMA PET的患者在初始诊断和复发疾病时的PCa分期的现有证据。我们对PSMA和FDG PET对前列腺癌分期的直接、个体间比较研究进行了系统的文献综述。没有考虑放射治疗资格的评估。评估偏倚风险。筛选和评估了543条引文。纳入13例病例报告、3项回顾性研究和1项前瞻性研究。PSMA PET后FDG将常规影像学阴性(M0)的高危早期去势抵抗性前列腺癌的转移检出率从65%提高到73%。前列腺切除术后生化复发,PSMA PET阴性的男性中,FDG PET阳性占17%。Gleason评分≥8和较高的PSA水平预测BCR和初级分期的FDG-avid转移。不同的组织学(导管和神经内分泌)在病例报告中很常见,导致3例患者psma阴性fdg阳性成像。前列腺癌的双示踪PET可能有助于在初级分期和再分期期间确定高危疾病。需要进一步的研究来确定FDG PET的附加效益,以及FDG阳性表型是否表明预后较差。
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引用次数: 11
Evaluation of the Extent of Primary Buccal Mucosal Graft Contracture in Augmentation Urethroplasty for Stricture Urethra: A Prospective Observational Study at a Tertiary Healthcare Centre. 评估尿道狭窄尿道成形术中初级颊粘膜移植挛缩程度:一项在三级医疗中心的前瞻性观察研究。
IF 1.4 Q3 Medicine Pub Date : 2021-07-23 eCollection Date: 2021-01-01 DOI: 10.1155/2021/9913452
A BhalaguruIyyan, P Puvai Murugan, Chandranaath C Alakhananda, B M Zeeshan Hameed

Introduction: Buccal mucosal graft (BMG) urethroplasty is considered as gold standard in the treatment of urethral stricture disease. The successful outcome after BMG urethroplasty varies between 66 and 99%. One of the possible causes for failure is BMG contracture. Primary BMG contracture rate is poorly understood and unreported. The present study aimed to evaluate the extent of contracture of buccal mucosa immediately after harvesting.

Materials and methods: This was a prospective observational study conducted in the Department of Urology at our institute between January 2016 and December 2019. All patients with urethral stricture disease undergoing BMG urethroplasty for the first time were enrolled in the study after obtaining informed consent. Demographic and patient clinical profile was noted. Based on the intraoperative urethral stricture size, the preharvest graft was marked on the buccal mucosa and the size was calculated. Postharvest unstretched size of the graft was measured immediately after graft removal from the oral cavity. Alteration in BMG size was analysed using paired t-test.

Results: Forty-four patients were included in the study. Mean age of the patient was 53.6 years. Mean stricture length was 7.45 cm (range 4-12 cm). Mean pre- and postharvest BMG size was 8.3 × 1.5 cm and 7.6 × 1.3 cm, respectively. There was a 8.4% decrease in length and 9.5% decrease in width of the buccal mucosal graft.

Conclusion: Primary buccal mucosal graft contracture is around 8.4% in length and 9.5% in width. It would be better to mark wider than necessary while harvesting buccal mucosa so that tension-free anastomosis is performed.

口腔粘膜移植尿道成形术被认为是治疗尿道狭窄疾病的金标准。BMG尿道成形术的成功率在66%到99%之间。其中一个可能的失败原因是BMG挛缩。原发性BMG挛缩率了解甚少,未见报道。本研究的目的是评估口腔粘膜在收获后立即挛缩的程度。材料与方法:本研究为2016年1月至2019年12月在我院泌尿外科开展的前瞻性观察性研究。所有首次行BMG尿道成形术的尿道狭窄疾病患者均在获得知情同意后纳入研究。记录了人口统计学和患者临床资料。根据术中尿道狭窄大小,在颊黏膜上标记取前移植物并计算其大小。从口腔中取出移植物后,立即测量移植物的采后未拉伸大小。采用配对t检验分析BMG大小的变化。结果:44例患者纳入研究。患者平均年龄53.6岁。平均狭窄长度为7.45 cm(范围4-12 cm)。采前和采后BMG平均尺寸分别为8.3 × 1.5 cm和7.6 × 1.3 cm。颊粘膜移植物的长度减少8.4%,宽度减少9.5%。结论:一期颊黏膜移植挛缩的长度约为8.4%,宽度约为9.5%。在采集颊粘膜时,最好标记得比必要的宽,以便进行无张力吻合。
{"title":"Evaluation of the Extent of Primary Buccal Mucosal Graft Contracture in Augmentation Urethroplasty for Stricture Urethra: A Prospective Observational Study at a Tertiary Healthcare Centre.","authors":"A BhalaguruIyyan,&nbsp;P Puvai Murugan,&nbsp;Chandranaath C Alakhananda,&nbsp;B M Zeeshan Hameed","doi":"10.1155/2021/9913452","DOIUrl":"https://doi.org/10.1155/2021/9913452","url":null,"abstract":"<p><strong>Introduction: </strong>Buccal mucosal graft (BMG) urethroplasty is considered as gold standard in the treatment of urethral stricture disease. The successful outcome after BMG urethroplasty varies between 66 and 99%. One of the possible causes for failure is BMG contracture. Primary BMG contracture rate is poorly understood and unreported. The present study aimed to evaluate the extent of contracture of buccal mucosa immediately after harvesting.</p><p><strong>Materials and methods: </strong>This was a prospective observational study conducted in the Department of Urology at our institute between January 2016 and December 2019. All patients with urethral stricture disease undergoing BMG urethroplasty for the first time were enrolled in the study after obtaining informed consent. Demographic and patient clinical profile was noted. Based on the intraoperative urethral stricture size, the preharvest graft was marked on the buccal mucosa and the size was calculated. Postharvest unstretched size of the graft was measured immediately after graft removal from the oral cavity. Alteration in BMG size was analysed using paired <i>t</i>-test.</p><p><strong>Results: </strong>Forty-four patients were included in the study. Mean age of the patient was 53.6 years. Mean stricture length was 7.45 cm (range 4-12 cm). Mean pre- and postharvest BMG size was 8.3 × 1.5 cm and 7.6 × 1.3 cm, respectively. There was a 8.4% decrease in length and 9.5% decrease in width of the buccal mucosal graft.</p><p><strong>Conclusion: </strong>Primary buccal mucosal graft contracture is around 8.4% in length and 9.5% in width. It would be better to mark wider than necessary while harvesting buccal mucosa so that tension-free anastomosis is performed.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39269816","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
Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center. 腹腔镜与开放式根治性膀胱切除术的随机对照试验Naïve中心。
IF 1.4 Q3 Medicine Pub Date : 2021-07-07 eCollection Date: 2021-01-01 DOI: 10.1155/2021/4731013
Waleed Mohamed Fadlalla, Ayman Hanafy, Mahmoud Abdelhakim, Hatem Aboulkassem, El Sayed Ashraf, Ahmed Abdelbary

Background: Laparoscopic radical cystectomy is a challenging surgical procedure; however, it has been largely abandoned in favor of the more intuitive robotic-assisted cystectomy. Due to the prohibitive cost of robotic surgery, the adoption of laparoscopic cystectomy is of relevance in low-resource institutes. Methodology. This is a randomized controlled trial comparing laparoscopic radical cystectomy (LRC) to open radical cystectomy (ORC) at a single institute. Each group included thirty patients. The trial was designed to compare both approaches regarding operative time, blood loss, transfusion requirements, length of hospital stay, time to oral intake, requirement of opioid analgesia, and complications.

Results: LRC was associated with less hospital stay (9.8 vs. 13.8 days, P=0.001), less time to oral solid intake (6 vs. 8.6 days, P=0.031), and lower opioid requirements (23.3% vs. 53.3%, P=0.033). There was a trend towards lower blood loss and transfusion requirements, but this did not reach statistical significance. Overall complication rates were comparable.

Conclusion: Laparoscopic radical cystectomy was associated with comparable postoperative outcomes when compared to ORC in the first laparoscopic cystectomy experience in our center. Benefitting from the assistance of an experienced laparoscopic surgeon is recommended to shorten the learning curve.

背景:腹腔镜根治性膀胱切除术是一项具有挑战性的手术;然而,由于更直观的机器人辅助膀胱切除术的青睐,这种方法在很大程度上已被放弃。由于机器人手术的成本过高,在资源匮乏的机构采用腹腔镜膀胱切除术是有意义的。方法。这是一项比较腹腔镜根治性膀胱切除术(LRC)和开放式根治性膀胱切除术(ORC)的随机对照试验。每组30例。该试验旨在比较两种方法在手术时间、出血量、输血要求、住院时间、口服时间、阿片类镇痛要求和并发症方面的差异。结果:LRC与更短的住院时间(9.8天对13.8天,P=0.001)、更短的口服固体摄入时间(6天对8.6天,P=0.031)和更低的阿片类药物需求(23.3%对53.3%,P=0.033)相关。有降低失血量和输血需求的趋势,但这没有达到统计学意义。总的并发症发生率比较。结论:在我们中心的第一例腹腔镜膀胱根治术中,腹腔镜根治术与ORC相比具有相当的术后结果。受益于经验丰富的腹腔镜外科医生的帮助,建议缩短学习曲线。
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引用次数: 2
Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study. 保留海绵体充气阴茎假体植入术后磷酸二酯酶V型抑制剂对阴茎血流动力学的反应:一项前瞻性随机、开放、盲法终点(PROBE)研究。
IF 1.4 Q3 Medicine Pub Date : 2021-06-28 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5548494
Adham Zaazaa, Michaela Bayerle-Eder, Ramzy Elnabarawy, Mahmoud Elbitar, Taymour Mostafa

Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5-344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.

阴茎假体植入过程中的强力下体扩张可能损伤阴茎海绵体动脉,危及阴茎血管系统。在这项研究中,我们的目的是比较传统的海绵体动脉保留技术和海绵体动脉保留技术。总共有33例患者接受了Coloplast Titan Touch®三件套充气阴茎假体植入。16例患者采用常规植入并进行连续剧烈扩张,而17例患者采用海绵体保留技术,包括术中海绵体内注射前列地尔(ICI)后进行一次最小的体扩张。术后行阴茎双多普勒超声检查。每当海绵体动脉被保留并成功探测时,在口服磷酸二酯酶5型抑制剂(PDE5i)前后,研究其血流动力学。海绵体保留组16/17(94%)的患者成功探查海绵体动脉,而常规组5/16(31%)的患者成功探查海绵体动脉,差异有统计学意义(P=0.001)。这表明海绵体保留技术在保留海绵体动脉方面优于传统入路(优势比35.2,95% ic3.5 -344.2;P = 0.0022)。无论何时,只要可以探测海绵体动脉,其血流动力学反应性也被保留。该试验注册号为NCT03733860。
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引用次数: 1
Understanding the Impact of Urinary Incontinence in Persons with Dementia: Development of an Interdisciplinary Service Model. 了解痴呆症患者尿失禁的影响:跨学科服务模式的发展。
IF 1.4 Q3 Medicine Pub Date : 2021-06-19 eCollection Date: 2021-01-01 DOI: 10.1155/2021/9988056
Patrick Juliebø-Jones, Elizabeth Coulthard, Elizabeth Mallam, Hilary Archer, Marcus J Drake

Introduction: Prevalence of urinary symptoms such as incontinence (UI) in patients with dementia is estimated to exceed 50%. The resultant psychological and socio-economic burden can be substantial. Our aim was to develop a dedicated urology service within a cognitive impairment clinic in order to treat and better understand the bothersome urinary symptoms suffered by persons with dementia.

Methods: Patients attending this clinic were invited to be assessed and interviewed by urologist, together with their family and/or carer. In addition, formal history, examination and relevant investigations, themes of importance such as quality of life, and select question items were drawn from validated questionnaires. Multidisciplinary team (MDT) meeting was carried out on the same day. Outcomes of the first 75 patients with UI and dementia have been reported.

Results: Average age was 70 years (range 58-98). Majority of persons had a diagnosis of Alzheimer's disease (n = 43, 57%). Average score for how much urine leakage interferes with everyday life was 7.7/10 (range 2-10). 58.7% (n = 44) revealed some degree of sleep disturbance due to UI. 83% (n = 62) stated daily activities were limited due to UI. Two-thirds of persons with dementia (n = 50) stated their bladder problem makes them feel anxious. 88% (n = 67) felt the topic was socially embarrassing. All carers stated that the person's continence issues affect the care they provide. Less than one-third of carers (30.7%, n = 23) were aware of or had been in contact with any bladder and bowel community service. More than half of the carers (n = 46, 65%) were concerned incontinence may be a principal reason for future nursing home admission.

Conclusion: UI can be distressing for persons with dementia. Care partners were concerned about loss of independence and early nursing home admission. Awareness of bladder and bowel services should be increased.

导读:痴呆患者尿失禁(UI)等泌尿系统症状的患病率估计超过50%。由此产生的心理和社会经济负担可能是巨大的。我们的目标是在一个认知障碍诊所内开发一个专门的泌尿科服务,以治疗和更好地了解痴呆症患者所遭受的令人烦恼的泌尿系统症状。方法:邀请来门诊就诊的患者,由泌尿科医生及其家人和/或护理人员进行评估和访谈。此外,正式的历史,考试和相关调查,重要的主题,如生活质量,并从有效的问卷中选择问题项。多学科小组(MDT)会议也在同一天举行。报道了首批75例尿失禁和痴呆患者的结局。结果:平均年龄70岁(58 ~ 98岁)。大多数人被诊断为阿尔茨海默病(n = 43, 57%)。尿漏干扰日常生活的平均得分为7.7/10(范围2-10)。58.7% (n = 44)有不同程度的睡眠障碍。83% (n = 62)的患者表示,由于UI,他们的日常活动受到限制。三分之二的痴呆症患者(n = 50)表示他们的膀胱问题使他们感到焦虑。88% (n = 67)的人认为这个话题在社交上令人尴尬。所有护理人员都表示,患者的自制问题影响了他们提供的护理。不到三分之一的护理人员(30.7%,n = 23)知道或曾经接触过任何膀胱和肠道社区服务。超过一半的护理人员(n = 46,65 %)担心尿失禁可能是未来入住养老院的主要原因。结论:尿失禁对痴呆患者来说是痛苦的。护理伙伴关心的是丧失独立性和过早入住养老院。应该提高对膀胱和肠道服务的认识。
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引用次数: 2
Efficacy of Neoadjuvant Targeted Therapy in Treatment of Patients with Localised Clear-Cell Renal Cell Carcinoma. 新辅助靶向治疗局部透明细胞肾细胞癌的疗效观察。
IF 1.4 Q3 Medicine Pub Date : 2021-04-30 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6674637
O A Voylenko, O E Stakhovsky, I V Vitruk, O A Kononenko, M V Pikul, S L Semko, E O Stakhovsky

Aim: This study aimed to evaluate the efficacy of neoadjuvant targeted therapy (TT) in patients with localised clear-cell renal cell carcinoma (RCC).

Materials and methods: A special randomised trial was planned and conducted by the Research Department of Plastic and Reconstructive Oncology in the National Cancer Institute of Ukraine for testing the clinical efficacy of neoadjuvant TT in the treatment of clear-cell localised RCC, and the primary endpoint was tumour response evaluation after TT. The secondary endpoints included evaluation of dependence between the use of neoadjuvant TT and the probability of partial nephrectomy and the correlation between tumour size, stage, remaining functioning parenchyma volume, and response to systemic therapy.

Results: Overall, 118 patients met the inclusion criteria and were randomly assigned to receive combined treatment or surgery alone. The percentage of tumour regression ranged from 0% to 60%, and the median was (95% confidence interval) 20.5 ± 14.3 (16.8-24.3%). Most of the patients had a slightly positive response to TT (3%-29% decrease in tumour size); n = 44 (76.9%) cases. Partial response by the Response Evaluation Criteria in Solid Tumours, version 1.1, was observed in 14 (24.1%) patients and reached a maximum of 60% regression. Tumour reduction in the neoadjuvant TT group allowed kidney preservation in 53 (91.4%) patients. In the control group, the number of organ-sparing procedures was significantly lower (n = 20, 33.3%). The statistical difference was relevant (x 2 = 42.1; p < 0.001).

Conclusion: The positive results of neoadjuvant TT obtained in our study indicate the clinical validity of combined treatment in patients with localised RCC.

目的:本研究旨在评价新辅助靶向治疗(TT)在局部透明细胞肾细胞癌(RCC)患者中的疗效。材料与方法:乌克兰国家癌症研究所整形与重建肿瘤学研究部计划并开展了一项特殊的随机试验,以检测新辅助TT治疗透明细胞局限性RCC的临床疗效,主要终点为TT后肿瘤反应评价。次要终点包括评估新辅助TT的使用与部分肾切除术的可能性之间的依赖性,以及肿瘤大小、分期、剩余功能实质体积和对全身治疗反应之间的相关性。结果:总体而言,118例患者符合纳入标准,随机分配接受联合治疗或单独手术。肿瘤消退的百分比范围为0% ~ 60%,中位数为(95%可信区间)20.5±14.3(16.8 ~ 24.3%)。大多数患者对TT有轻微的阳性反应(肿瘤大小减少3%-29%);N = 44例(76.9%)。根据实体肿瘤反应评价标准(1.1版),在14例(24.1%)患者中观察到部分缓解,最大退行率达到60%。新辅助TT组肿瘤减少,使53例(91.4%)患者的肾脏得以保存。在对照组中,保留器官的手术次数明显较低(n = 20, 33.3%)。统计学差异具有相关性(x2 = 42.1;P < 0.001)。结论:本研究获得的新辅助TT阳性结果表明联合治疗局部肾细胞癌的临床有效性。
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引用次数: 1
Epidemiological and Diagnostic Aspects of Bladder Bilharziomas in the Urology Department of Idrissa Pouye General Hospital (HOGIP) 德国普耶总医院泌尿外科膀胱腺瘤的流行病学及诊断
IF 1.4 Q3 Medicine Pub Date : 2021-03-25 DOI: 10.1155/2021/4536381
O. Gaye, M. Jalloh, N. M. Thiam, M. Ndoye, Khadidiatou Dansokho, Youssef Bellamine, S. Kouka, C. Dial, M. Mbodji, Ayun Kotokai Cassell III, I. Labou, L. Niang, S. Gueye
Objective The aim of our study is to assess the diagnostic aspects of bladder bilharzioma in the Urology Department of Idrissa Pouye General Hospital (Senegal). Materials and Methods It is a descriptive study from January 2013 to December 2018. The patients included in the study were those who had anatomopathological examination of bladder biopsy that showed a schistosomiasis pseudotumor of the bladder. The variables studied were sociodemographic, clinical symptoms, imaging findings, histology, and treatment. The data have been saved and analyzed by the 2013 Excel software. Results Thirteen patients were included in our study. The average age was 27 ± 12.1 years. Sex ratio was 1.6. The majority of the patients were from the northern part of Senegal. Hematuria was the main symptom for all the patients. Cystoscopy was performed for all the patients and showed 5 granulomas and 8 fibrocalcic polyps. A transurethral resection of the bladder was performed, and treatment with praziquantel (40 mg/kg of bodyweight) has been carried out. One patient presented precancerous lesions such as metaplasia and dysplasia of the bladder mucosa. After a median follow-up of 40 months (6–57 months), ten patients had a favorable clinical and endoscopic outcome. Conclusion Granulomas and fibrocalcic polyps of the bladder mucosa are, respectively, confused with squamous cell carcinoma and bladder lithiasis in endemic areas of schistosomiasis. Good cystoscopy interpretation can provide the diagnosis of bladder bilharzioma and start the treatment.
目的我们研究的目的是评估Idrissa Pouye综合医院泌尿科膀胱血吸虫病的诊断方面。材料与方法这是一项2013年1月至2018年12月的描述性研究。纳入研究的患者是那些进行了膀胱活检的解剖病理检查,显示为血吸虫病膀胱假瘤的患者。研究的变量包括社会人口学、临床症状、影像学表现、组织学和治疗。数据已通过2013 Excel软件进行保存和分析。结果13例患者纳入本研究。平均年龄27岁 ± 12.1年。性别比为1.6。大多数患者来自塞内加尔北部。血尿是所有患者的主要症状。所有患者均行膀胱镜检查,结果显示5个肉芽肿和8个纤维钙化息肉。经尿道膀胱切除术,并用吡喹酮(40 mg/kg体重)。一名患者出现癌前病变,如膀胱粘膜的化生和异型增生。中位随访40个月(6–57个月)后,10名患者的临床和内镜结果良好。结论血吸虫病流行区膀胱黏膜肉芽肿和纤维钙化息肉分别与鳞状细胞癌和膀胱结石混淆。良好的膀胱镜检查解释可以提供膀胱血吸虫病的诊断和开始治疗。
{"title":"Epidemiological and Diagnostic Aspects of Bladder Bilharziomas in the Urology Department of Idrissa Pouye General Hospital (HOGIP)","authors":"O. Gaye, M. Jalloh, N. M. Thiam, M. Ndoye, Khadidiatou Dansokho, Youssef Bellamine, S. Kouka, C. Dial, M. Mbodji, Ayun Kotokai Cassell III, I. Labou, L. Niang, S. Gueye","doi":"10.1155/2021/4536381","DOIUrl":"https://doi.org/10.1155/2021/4536381","url":null,"abstract":"Objective The aim of our study is to assess the diagnostic aspects of bladder bilharzioma in the Urology Department of Idrissa Pouye General Hospital (Senegal). Materials and Methods It is a descriptive study from January 2013 to December 2018. The patients included in the study were those who had anatomopathological examination of bladder biopsy that showed a schistosomiasis pseudotumor of the bladder. The variables studied were sociodemographic, clinical symptoms, imaging findings, histology, and treatment. The data have been saved and analyzed by the 2013 Excel software. Results Thirteen patients were included in our study. The average age was 27 ± 12.1 years. Sex ratio was 1.6. The majority of the patients were from the northern part of Senegal. Hematuria was the main symptom for all the patients. Cystoscopy was performed for all the patients and showed 5 granulomas and 8 fibrocalcic polyps. A transurethral resection of the bladder was performed, and treatment with praziquantel (40 mg/kg of bodyweight) has been carried out. One patient presented precancerous lesions such as metaplasia and dysplasia of the bladder mucosa. After a median follow-up of 40 months (6–57 months), ten patients had a favorable clinical and endoscopic outcome. Conclusion Granulomas and fibrocalcic polyps of the bladder mucosa are, respectively, confused with squamous cell carcinoma and bladder lithiasis in endemic areas of schistosomiasis. Good cystoscopy interpretation can provide the diagnosis of bladder bilharzioma and start the treatment.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44199020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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Advances in Urology
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