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A Vaginal Inlay for Reduction of Stress Urinary Incontinence: Outcome of a Randomized Clinical Trial and Four User Acceptance Studies. 阴道内嵌体减少压力性尿失禁:一项随机临床试验和四项用户接受研究的结果。
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2021-02-15 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8822186
Aino Fianu Jonasson, Karin Bryder, Elisabeth Sthengel

A multicenter, randomized, controlled clinical trial and four postmarket user acceptance investigations were carried out to document the safety, performance, and user acceptance of Efemia Bladder Support, a novel vaginal inlay for the temporary reduction of stress urinary incontinence (SUI). The clinical investigation enrolled 97 women diagnosed with SUI, randomized 3 : 1 to either treatment or standard care (control). The primary endpoint was reduction of urine leakage, measured as change in pad weight baseline week compared with treatment week. Secondary endpoints were treatment success, calculated as the percentage of subjects with >70% reduction in pad weight, reduction in incontinence episodes, and quality of life (QoL). 75 women (77%) completed the clinical investigation. No serious adverse events occurred. The treatment group reached a 55% (p < 0.001) mean reduction of total leakage compared to the control arm. A subanalysis, involving only leakage during provocation testing (coughing and jumping), showed a 67% (p < 0.001) mean reduction of leakage. No significant effect on QoL could be observed. 51% of the women answered "yes" to the question if they would use the device to reduce SUI. The user acceptance of the device was further investigated in four postmarket studies, using an improved device design with a slimmer centerpiece and a thinner handle, while keeping the effect achieving parts of the device unchanged. An average of 74% of the 102 participants in the postmarket studies reported that they were likely to continue using Efemia. The highest user satisfaction was seen in the two studies evaluating the use of Efemia during exercise, where 83% and 88% of the women were likely to continue using Efemia. It can be concluded that Efemia is a safe, well-tolerated, and effective alternative for reducing SUI, both in everyday life and during physical exercise.

一项多中心、随机、对照临床试验和四项上市后用户接受度调查进行了记录Efemia膀胱支持的安全性、性能和用户接受度,Efemia膀胱支持是一种用于暂时减少压力性尿失禁(SUI)的新型阴道植入物。临床研究纳入了97名诊断为SUI的女性,随机分为治疗组和标准护理组(对照组)。主要终点是尿漏的减少,以尿垫重量基线周与治疗周相比的变化来衡量。次要终点是治疗成功,以尿垫重量减轻>70%、尿失禁发作减少和生活质量(QoL)的受试者百分比计算。75名妇女(77%)完成了临床调查。未发生严重不良事件。与对照组相比,治疗组的总渗漏平均减少了55% (p < 0.001)。一项亚分析,仅涉及激发试验(咳嗽和跳跃)期间的渗漏,显示渗漏平均减少67% (p < 0.001)。未观察到对生活质量的显著影响。对于是否会使用该设备减少SUI的问题,51%的女性回答“是”。在四项上市后研究中,进一步调查了用户对该设备的接受程度,使用改进的设备设计,采用更薄的中心部件和更薄的手柄,同时保持设备实现效果的部分不变。在上市后研究的102名参与者中,平均有74%的人报告说他们可能会继续使用Efemia。在两项评估运动期间使用Efemia的研究中,用户满意度最高,其中83%和88%的女性可能会继续使用Efemia。由此可见,无论是在日常生活中还是在体育锻炼中,Efemia都是一种安全、耐受性良好且有效的减少SUI的替代方法。
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引用次数: 3
Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study. 布基纳法索产科和医源性泌尿生殖瘘管的特点:一项横断面研究。
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2021-01-20 eCollection Date: 2021-01-01 DOI: 10.1155/2021/8838146
Fasnéwindé Aristide Kabore, Stéphanie Dominique Amida Nama, Boureima Ouedraogo, Moussa Kabore, Adama Ouattara, Brahima Kirakoya, Gilles Karsenty

Objective: To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years' period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups.

Results: 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05-3.1]), low level of education (OR = 5.4; CI = [2.3-12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7-6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1-4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1-20.5]).

Conclusion: OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.

目的:比较布基纳法索七个中心产科泌尿生殖瘘管(of)和医源性泌尿生殖瘘管(IF)治疗的社会人口学、临床和治疗特点。材料和方法。我们进行了一项为期七年的横断面研究(2010年1月1日至2016年12月31日)。我们认为所有泌尿生殖瘘管(UGF)发生在选择性剖腹产、妇科手术(子宫切除术、子宫肌瘤切除术和脱垂修复)或人工流产后。长时间分娩后阴道分娩的UGF没有产科手术或剖宫产被认为是产科。本研究排除了其他机制(紧急剖宫产、先天性和外伤性)引起的UGF。采用STATA软件第14版进行统计分析。采用logistic回归模型对两组进行比较。结果:共纳入UGF 310例。IF占25.8% (n = 80),而OF占74.2% (n = 230)。IF的中位年龄为35岁,OF的中位年龄为35.38岁。两组以膀胱阴道瘘为主(74.5%)。OF组均为环周瘘。OF常与居住在农村地区相关(OR = 1.8;CI =[1.05 - -3.1]),低水平的教育(OR = 5.4;CI =[2.3 - -12.9]),身高在158厘米(或= 3.4 CI =[1.7 - -6.6])。阴道硬化在IF组较少见(OR = 2.2;ci =[1-4.6])。3个月后手术治疗失败与of的相关性更高(OR = 4.7;ci =[1.1-20.5])。结论:OF是最常见的,多发生在农村、受教育程度低的矮个子妇女身上。OF组的瘘管也更为严重。IF术后修复效果较好。
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引用次数: 3
Risk Factors of Ureteral Stenosis in Kidney Transplant Recipients: A Retrospective Study in National Referral Hospital in Indonesia. 肾移植受者输尿管狭窄的危险因素:印度尼西亚国家转诊医院的回顾性研究
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2021-01-11 eCollection Date: 2021-01-01 DOI: 10.1155/2021/2410951
Gampo A Irdam, Bobby Sutojo, Putu A R Raharja

Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2-10% of patients and poses a significant problem to the patients as it may lead to permanent damage to renal damage. Identification of risk factors is important to prevent the incidence of ureteral stenosis. Thus, we aim to determine the risk factors of ureteral stenosis in the Indonesian population. This is a retrospective analysis of 487 kidney transplant patients performed in Cipto Mangunkusumo Hospital between 2014 and 2018. We collected and compared donor and recipient demography data in recipients who developed ureteral stenosis and recipients who did not develop ureteral stenosis. Ureteral stenosis was defined as the presence of hydronephrosis from ultrasound and increased number of serum creatinine. The overall incidence of ureteral stenosis post-kidney transplantation in our center is 6.6% (32 from 487 patients) from January 2014 until June 2018. We found that older donor and recipient age more frequent in developing ureteral stenosis post-kidney transplantation (p < 0.001). We also found that donors with number of arteries more than 2 (p < 0.001) and prolonged warm ischemic time (p < 0.05) are more frequently to develop ureteral stenosis post-kidney transplantation. There is no association between type II diabetes mellitus and hypertension with ureteral stenosis in this study. Donor age, recipient age, donor number of arteries more than 2, and prolonged warm ischemia time are associated with ureteral stenosis after kidney transplantation.

输尿管狭窄是肾移植术后最常见的泌尿系统并发症之一。它发生在2-10%的患者中,对患者来说是一个严重的问题,因为它可能导致肾脏损害的永久性损害。识别危险因素对预防输尿管狭窄的发生具有重要意义。因此,我们的目的是确定印度尼西亚人群输尿管狭窄的危险因素。这是对2014年至2018年在Cipto Mangunkusumo医院接受肾移植手术的487名患者的回顾性分析。我们收集并比较输尿管狭窄受者和未发生输尿管狭窄受者的供者和受者的人口学数据。输尿管狭窄定义为超声显示肾积水和血清肌酐增高。2014年1月至2018年6月,我中心肾移植术后输尿管狭窄总发生率为6.6%(487例患者中32例)。我们发现,肾移植术后输尿管狭窄的发生率较高的供体和受体年龄(p p p
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引用次数: 3
Are Technology-Driven Mobile Phone Applications (Apps) the New Currency for Digital Stent Registries and Patient Communication: Prospective Outcomes Using Urostentz App. 技术驱动的移动电话应用程序(App)是数字支架注册和患者沟通的新货币:使用Urostentz App的前瞻性结果
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2021-01-06 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6612371
B M Zeeshan Hameed, Milap J Shah, Nithesh Naik, Mohan Amaresh, Padmaraj Hegde, Rahil Hussein Beary, Suraj Jayadeva, Bhaskar K Somani

Background: Forgotten ureteral stents (FUS) and stent-related symptoms (SRS) lead to increased postprocedural emergency department visits and add to the psychological and financial burden of the patients.

Purpose: To review the usage and benefits of ureteral stent tracking and symptom monitoring through a single smartphone-based application (App) platform with 2-way clinician-patient communication. This study also compared the features with other smartphone apps used for stent tracking.

Materials and methods: 100 patients were included in this single-center prospective study conducted between September 2019 and December 2019. Patients who had metallic or long-term indwelling stents, noncomprehensible patients, and those not willing to share their data were excluded from the study.

Results: Of 100 patients, 92 downloaded the Urostentz application, and 72 (78.2%) patients answered the pictorial symptom questionnaire. Symptom score analysis suggested that 62 patients (86.1%) had stent-related symptoms of which 3 required readmission and underwent early stent removal. The mean stent duration was 17.2 + 3.5 days (range: 11-23 days), with 69% of patients having their stent removed on the scheduled date and 25% of patients requesting a change of their appointment via the App.

Conclusion: In this study, there was no case of FUS encountered. The "Urostentz" App is a freely available patient safety stent tracking application that provides a secure and simplified interface, which can significantly reduce the incidence of FUS and provide digital remote assistance in the management of stent-related symptoms.

背景:遗忘输尿管支架(FUS)和支架相关症状(SRS)导致术后急诊就诊次数增加,增加了患者的心理和经济负担。目的:回顾通过基于智能手机的单一应用程序(App)平台进行输尿管支架跟踪和症状监测的临床-患者双向交流的使用情况和益处。这项研究还将其功能与其他用于支架跟踪的智能手机应用程序进行了比较。材料和方法:本研究于2019年9月至2019年12月进行,纳入了100例患者。有金属支架或长期留置支架的患者、难以理解的患者以及不愿意分享其数据的患者被排除在研究之外。结果:100例患者中,92例下载了Urostentz应用程序,72例(78.2%)患者回答了图像症状问卷。症状评分分析显示,62例(86.1%)患者出现支架相关症状,其中3例需要再入院并进行了早期支架取出。平均支架持续时间为17.2 + 3.5天(范围:11-23天),69%的患者在预定日期取出支架,25%的患者通过app要求更改预约。结论:在本研究中,没有发生FUS病例。“Urostentz”App是一款免费的患者安全支架跟踪应用程序,它提供了一个安全、简化的界面,可以显著降低FUS的发生率,并为支架相关症状的管理提供数字远程协助。
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引用次数: 6
Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life. 在出生后12个月的婴儿肾积水的影像学应用。
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2020-07-30 eCollection Date: 2020-01-01 DOI: 10.1155/2020/2108362
Anthony J Schaeffer, Patrick C Cartwright, Glen A Lau, Mark D Ebert, Nora F Fino, Flory L Nkoy, Rachel Hess

Purpose: The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. Study Design and Data Source. Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. Data Collection. Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. Primary Outcome. Sum of radiologic studies within the first year of life or prior to pyeloplasty. Statistical Analysis. Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade.

Results: Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42-1.73) and severe (RR: 2.09; 95% CI: 1.88-2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders.

Conclusions: In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.

目的:婴儿肾积水(HN)的检查和监测策略各不相同,尽管这可能是由于成像强度的分级依赖差异。我们的目的是描述在一个大型区域医疗保健系统中,HN在出生后第一年的影像学检查频率,按HN的初始级别分层。研究设计和数据来源。使用Intermountain医疗数据仓库的回顾性队列研究。纳入标准:(1)2005年1月1日至2013年12月31日出生,(2)CPT编码为HN,(3)出生4个月内超声(U/S)证实HN。数据收集。产后初始U/S的HN分级;hn相关放射学研究的数量(肾脏U/Ss、排尿膀胱输尿管图(VCUGs)和利尿肾扫描);人口统计和医学变量。主要的结果。生命第一年或肾盂成形术前的放射学研究的总和。统计分析。多变量泊松回归分析主要结局与初始HN分级之间的关系。结果:1380例(男性993例,女性387例)中,轻度、中度、重度HN患者分别为990例(72%)、230例(17%)、160例(12%)。与轻度HN患者相比,中度HN患者(RR: 1.57;95% CI: 1.42-1.73)和严重(RR: 2.09;95% CI: 1.88-2.32)在控制了潜在的混杂因素后,HN在12个月内(或手术前)的影像学使用率明显更高。结论:在大型区域医疗保健系统中,HN的影像学使用与其初始分级成正比。这表明,在我们的系统内,临床医生治疗这种情况正在使用风险分层的方法来成像。
{"title":"Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life.","authors":"Anthony J Schaeffer, Patrick C Cartwright, Glen A Lau, Mark D Ebert, Nora F Fino, Flory L Nkoy, Rachel Hess","doi":"10.1155/2020/2108362","DOIUrl":"10.1155/2020/2108362","url":null,"abstract":"<p><strong>Purpose: </strong>The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. <i>Study Design and Data Source</i>. Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. <i>Data Collection</i>. Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. <i>Primary Outcome</i>. Sum of radiologic studies within the first year of life or prior to pyeloplasty. <i>Statistical Analysis</i>. Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade.</p><p><strong>Results: </strong>Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42-1.73) and severe (RR: 2.09; 95% CI: 1.88-2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders.</p><p><strong>Conclusions: </strong>In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2020 ","pages":"2108362"},"PeriodicalIF":1.4,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2108362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10389260","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: 1
Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center. 外伤性膀胱破裂:一级创伤中心十年回顾。
IF 1.8 Q3 UROLOGY & NEPHROLOGY Pub Date : 2019-12-12 eCollection Date: 2019-01-01 DOI: 10.1155/2019/2614586
John Barnard, Tyler Overholt, Ali Hajiran, Chad Crigger, Morris Jessop, Jennifer Knight, Chad Morley
<p><p>Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. The present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008-January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. The primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m<sup>2</sup>, 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and all-terrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. The intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, <i>p</i>=0.46), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, <i>p</i>=0.80), and time from injury to repair (4.3 vs. 60.5 h, <i>p</i>=0.23) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. The complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. The present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional proto
膀胱破裂仅发生在 1.6% 的腹盆腔钝性创伤病例中。膀胱破裂虽然罕见,但如果未得到诊断或处理不当,会导致严重的发病率。AUA 泌尿创伤指南建议,无论是否需要手术修复,尿道导管引流都是腹膜外和腹膜内膀胱破裂的标准治疗方法。但是,对于导尿时间的长短并没有给出具体的指导。本研究旨在总结我们三级医疗中心对膀胱创伤的当代管理方法,评估导尿时间对膀胱损伤和并发症的影响,并制定从损伤到拔除导尿管的膀胱损伤管理方案。我们对 34,413 例钝性外伤病例进行了回顾性审查,以确定过去 10 年(2008 年 1 月至 2018 年 1 月)在我们的三级医疗机构发生的外伤性膀胱破裂。收集的患者数据包括年龄、性别、体重指数、损伤机制和损伤类型。此外,还评估了主要治疗方式(手术修复与仅导管引流)、导管插入时间以及伤后并发症。通过查阅本机构的创伤数据库,共发现 44 名膀胱创伤患者。平均年龄为 41 岁,平均体重指数为 24.8 kg/m2,95% 为白种人,55% 为女性。机动车碰撞(MVC)是最常见的受伤机制,占总受伤人数的45%。其他原因包括摔伤(20%)和全地形车(ATV)事故(13.6%)。31例患者为腹膜外损伤,13例为腹膜内损伤。93%的患者有骨盆骨折,39%的患者有其他实体器官损伤。59%的患者在就诊时进行了正式的膀胱造影,膀胱造影的平均时间为4小时。95%的病例出现毛细血尿。所有腹膜内损伤和35.5%的腹膜外损伤病例均接受了手术治疗。手术病例的膀胱闭合一般分为两层,采用可吸收缝合线进行缝合。对腹膜内和腹膜外损伤的手术处理进行了比较,结果发现导尿时间(28 d vs. 22 d,p=0.46)、从损伤到膀胱荧光造影正常的时间(19.8 d vs. 20.7 d,p=0.80)以及从损伤到修复的时间(4.3 h vs. 60.5 h,p=0.23)在不同组别之间没有统计学差异。与 14 天内拔除导尿管的患者相比,导尿管留置时间超过 14 天的患者初次膀胱造影时间较长(26.6 天 vs. 11.5 天)。导尿管留置时间超过 14 天的患者并发症发生率为 21%,而导尿管留置时间少于 14 天的患者没有并发症发生。本研究对我们一级创伤中心的膀胱创伤患者的发病、管理和随访情况进行了为期 10 年的回顾性分析。根据我们的研究结果,我们制定了一项机构协议,其中包括关于外伤性膀胱破裂后导尿时间长短的建议。我们希望通过为初始随访膀胱造影和气管插管拔除提供具体指导,降低患者因长时间导尿而导致的发病率。进一步的研究将使多学科创伤团队能够对膀胱外伤患者进行标准化管理、简化护理并将并发症降至最低。
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引用次数: 0
Nephrolithiasis and Polycystic Ovary Syndrome: A Case-Control Study Evaluating Testosterone and Urinary Stone Metabolic Panels 肾结石和多囊卵巢综合征:一项评估睾酮和尿石代谢组的病例对照研究
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2019-10-17 DOI: 10.1155/2019/3679493
Donald Fedrigon, Kareem Alazem, S. Sivalingam, M. Monga, Juan Calle
Introduction Both elevated testosterone and polycystic ovary syndrome (PCOS) have been speculated as possible risk factors for kidney stone formation; however, the details of this potential relationship with regards to 24-hour urine metabolic panels and stone composition have not previously been characterized. Methods A total of 74 PCOS patients were retrospectively identified and matched with a cohort of female stone formers at a 3 : 1 ratio (by age and BMI). All patients had 24-hour urinary metabolic panels and stone compositions. These groups were compared using Pearson chi-square and Student t-tests. Additionally, the PCOS group was differentiated based on free testosterone using multivariate analysis. Results The case-control cohort showed that PCOS patients had significantly lower sodium excretion (p=0.015) and hypernatriuria rates (28.9% vs 50.9%, p=0.009). The PCOS-testosterone cohort demonstrated that high testosterone patients had significantly higher citrate values (p=0.041) and significantly lower odds of hypocitraturia (36.7% vs 54.2%, OR = 0.2, p=0.042). The high testosterone group also had higher sodium excretion (p=0.058) with significantly higher odds of having hypernatriuria (40.0% vs 13.6%, OR = 13.3, p=0.021). No significant patterns were revealed based on stone composition analysis. Conclusions Compared to healthy stone formers, PCOS patients did not demonstrate significant differences in 24-hour urine and stone composition values. Elevated free testosterone in PCOS patients has a significant association with higher urinary citrate and sodium values: findings that in and of themselves do not confirm the hypothesized increased risk of stone formation. This patient cohort may provide deeper insight into the interplay between androgens and stone formation; however, further study is needed to fully characterize the possible relationship between PCOS and stone formation.
睾丸激素升高和多囊卵巢综合征(PCOS)被推测为肾结石形成的可能危险因素;然而,关于24小时尿液代谢组和结石组成的这种潜在关系的细节以前没有被描述过。方法回顾性分析74例PCOS患者,并将其与女性结石患者按3:1的比例(按年龄和BMI)进行匹配。所有患者均有24小时尿代谢组和结石组成。这些组使用Pearson卡方检验和学生t检验进行比较。此外,采用多变量分析,根据游离睾酮水平对PCOS组进行区分。结果PCOS患者的钠排泄量(p=0.015)和高钠尿率(28.9% vs 50.9%, p=0.009)明显低于PCOS患者。pcos -睾酮队列显示,高睾酮患者的柠檬酸盐值显著升高(p=0.041),低尿率显著降低(36.7% vs 54.2%, OR = 0.2, p=0.042)。高睾酮组的钠排泄量也较高(p=0.058),高钠尿的发生率明显较高(40.0% vs 13.6%, OR = 13.3, p=0.021)。根据岩石成分分析,没有发现明显的图案。结论与健康结石患者相比,PCOS患者24小时尿液和结石组成值无显著差异。PCOS患者游离睾酮水平升高与尿中柠檬酸盐和钠值升高有显著相关性:研究结果本身并不能证实结石形成风险增加的假设。该患者队列可能为雄激素与结石形成之间的相互作用提供更深入的见解;然而,需要进一步的研究来充分表征多囊卵巢综合征和结石形成之间的可能关系。
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引用次数: 5
Insights into the Regulatory Roles of E3 Ubiquitin Ligases Associated with VHL-HIF Axis in Clear Cell Renal Cell Carcinoma 与VHL-HIF轴相关的E3泛素连接酶在透明细胞肾细胞癌中的调节作用
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2019-09-26 DOI: 10.1155/2019/2967183
Wuping Yang, Zhi Li, B. Hong, Y. Gong, K. Gong
Renal cell carcinoma (RCC) accounts for up to 85% to 90% of all kidney cancers. Clear cell RCC (ccRCC), the major subtype of RCC, is mainly characterized by the inactivation of the tumor suppressor gene VHL. pVHL as an E3 ubiquitin ligase targets the hydroxylated form of HIF-α for proteasomal degradation. The loss of VHL function leads to HIF-α aggregation as the main mechanism of ccRCC. Recently, the regulations of ccRCC through other E3 ubiquitin ligases are emerging. Moreover, most of them are associated with the VHL-HIF axis. In this review, we mainly focus on seven E3 ubiquitin ligases JADE1, SIAH1, CHIP, FBXW7, MDM2, SPOP, and HAF. Based on reported researches of these ligases on ccRCC, they are divided into two groups: JADE1, SIAH1, CHIP, and FBXW7 that negatively regulate the growth of ccRCC; MDM2, SPOP, and HAF that promote ccRCC progression. In addition, we further verify these possible links between these E3 ligases and VHL-HIF axis in ccRCC based on The Cancer Genome Atlas RNA-seq and Clinical data. Understanding the mechanisms by which these ligases regulate ccRCC, especially the interplay between these ligases and VHL-HIF axis may enable the development of novel therapeutic approaches for ccRCC. Overall, the present review reveals the potential mechanism by which seven ligases (JADE1, SIAH1, CHIP, FBXW7, MDM2, SPOP, and HAF) regulate ccRCC progression in detail, especially their relationship to VHL-HIF axis.
肾细胞癌(RCC)占所有肾癌的85%至90%。透明细胞RCC (Clear cell RCC, ccRCC)是RCC的主要亚型,其主要特征是肿瘤抑制基因VHL失活。pVHL作为E3泛素连接酶靶向HIF-α的羟基化形式进行蛋白酶体降解。VHL功能丧失导致HIF-α聚集是ccRCC的主要机制。近年来,通过其他E3泛素连接酶调控ccRCC的研究不断出现。此外,它们大多与VHL-HIF轴有关。本文主要综述了7种E3泛素连接酶JADE1、SIAH1、CHIP、FBXW7、MDM2、SPOP和HAF。根据已报道的ccRCC连接酶的研究,将其分为两组:JADE1、SIAH1、CHIP和FBXW7,它们负调控ccRCC的生长;MDM2、SPOP和HAF促进ccRCC进展。此外,我们基于The Cancer Genome Atlas RNA-seq和临床数据进一步验证了这些E3连接酶与ccRCC中VHL-HIF轴之间的可能联系。了解这些连接酶调节ccRCC的机制,特别是这些连接酶与VHL-HIF轴之间的相互作用,可能有助于开发新的ccRCC治疗方法。总之,本综述揭示了7种连接酶(JADE1、SIAH1、CHIP、FBXW7、MDM2、SPOP和HAF)详细调控ccRCC进展的潜在机制,特别是它们与VHL-HIF轴的关系。
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引用次数: 0
Treatment of Priapism Secondary to Drugs for Erectile Dysfunction 药物治疗勃起功能障碍继发性勃起障碍
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2019-08-22 DOI: 10.1155/2019/6214921
José Pablo Saffon Cuartas, C. Sandoval-Salinas, Juan M. Martínez, H. Corredor
Priapism may present as a side effect in patients treated with medications for erectile dysfunction, in which it should be controlled in a timely manner to avoid complications. There is little information regarding the use of local measures for the treatment of this condition. This study was done with the objective to describe the management of priapism secondary to erectile dysfunction drugs in a cohort of men. Records of emergencies and adverse events were reviewed by two researchers to identify patients diagnosed with erectile dysfunction who received oral or intracavernosal drugs for their illness and presented priapism. Sociodemographic data, clinical background, and information on the duration, management, and evolution of the priapism were extracted. Priapism incidence, percentage of improvement by type of treatment subgroups, and frequency of complications were estimated. 698 patients were treated with PDE-5 inhibitors and 2,135 with intracavernosal drugs. Thirty-one patients (1.4%) reported at least one priapism event during treatment, all with intracavernosal drugs. Treatment with local measures was effective for 10 (32.2%) patients, 1 (3.2%) required terbutaline, 19 (61.2%) used intracavernosal etilefrine, and 1 (3.2%) required drainage and flushing of cavernous bodies. After the priapism episode, 3 (9.6%) patients required an increased dose of the drug in order to achieve satisfactory erection. The results suggest that in men treated for priapism secondary to the use of sexual impotence drugs, initial treatment with local measures and etilefrine can achieve detumescence, decreasing the need for invasive procedures or surgery as a first-line therapy alternative. It is necessary to carry out research studies to confirm this hypothesis.
勃起功能障碍可能是接受药物治疗的患者的副作用,应及时控制以避免并发症。关于使用当地措施治疗这种情况的信息很少。这项研究的目的是描述在一组男性中治疗勃起功能障碍药物继发的阴茎异常勃起。两名研究人员对紧急情况和不良事件的记录进行了审查,以确定被诊断为勃起功能障碍的患者,这些患者接受了口服或腔内药物治疗,并出现了阴茎异常勃起。提取了社会形态数据、临床背景以及关于阴茎异常勃起的持续时间、管理和演变的信息。对阴茎勃起异常的发生率、治疗亚组的改善百分比和并发症的频率进行了估计。698例患者接受PDE-5抑制剂治疗,2135例患者接受腔内药物治疗。31名患者(1.4%)在治疗期间报告了至少一次阴茎异常勃起事件,均使用了腔内药物。局部措施治疗对10名(32.2%)患者有效,1名(3.2%)患者需要特布他林,19名(61.2%)患者使用腔内依替林,1名患者(3.2%)需要引流和冲洗海绵状体。阴茎异常勃起发作后,3名(9.6%)患者需要增加药物剂量才能达到令人满意的勃起。研究结果表明,对于因使用性阳痿药物而继发性勃起异常的男性,采用局部措施和依替芬进行初步治疗可以实现消肿,减少了作为一线治疗替代方案的侵入性手术或手术的需要。有必要进行研究来证实这一假设。
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引用次数: 4
Initial Evaluation of Computer-Assisted Radiologic Assessment for Renal Mass Edge Detection as an Indication of Tumor Roughness to Predict Renal Cancer Subtypes. 计算机辅助放射学评估对肾肿块边缘检测作为肿瘤粗糙度指标预测肾癌亚型的初步评价。
IF 1.4 Q3 UROLOGY & NEPHROLOGY Pub Date : 2019-04-23 eCollection Date: 2019-01-01 DOI: 10.1155/2019/3590623
Rahul Rajendran, Kevan Iffrig, Deepak K Pruthi, Allison Wheeler, Brian Neuman, Dharam Kaushik, Ahmed M Mansour, Karen Panetta, Sos Agaian, Michael A Liss

Objective: To develop software to assess the potential aggressiveness of an incidentally detected renal mass using images.

Methods: Thirty randomly selected patients who underwent nephrectomy for renal cell carcinoma (RCC) had their images independently reviewed by engineers. Tumor "Roughness" was based on image algorithm of tumor topographic features visualized on computed tomography (CT) scans. Univariant and multivariant statistical analyses are utilized for analysis.

Results: We investigated 30 subjects that underwent partial or radical nephrectomy. After excluding poor image-rendered images, 27 patients remained (benign cyst = 1, oncocytoma = 2, clear cell RCC = 15, papillary RCC = 7, and chromophobe RCC = 2). The mean roughness score for each mass is 1.18, 1.16, 1.27, 1.52, and 1.56 units, respectively (p < 0.004). Renal masses were correlated with tumor roughness (Pearson's, p=0.02). However, tumor size itself was larger in benign tumors (p=0.1). Linear regression analysis noted that the roughness score is the most influential on the model with all other demographics being equal including tumor size (p=0.003).

Conclusion: Using basic CT imaging software, tumor topography ("roughness") can be quantified and correlated with histologies such as RCC subtype and could lead to determining aggressiveness of small renal masses.

目的:开发一种软件来评估偶然发现的肾脏肿块的潜在侵袭性。方法:随机选择30例接受肾细胞癌(RCC)切除术的患者,由工程师独立审查其图像。肿瘤“粗糙度”是基于计算机断层扫描(CT)上可视化的肿瘤地形特征的图像算法。采用单变量和多变量统计分析进行分析。结果:我们调查了30例接受部分或根治性肾切除术的患者。排除图像渲染不良的图像后,剩余27例患者(良性囊肿1例,嗜瘤细胞瘤2例,透明细胞RCC 15例,乳头状RCC 7例,憎色RCC 2例)。每个质量的平均粗糙度评分分别为1.18、1.16、1.27、1.52和1.56个单位(p < 0.004)。肾肿块与肿瘤粗糙度相关(Pearson’s, p=0.02)。而良性肿瘤本身的肿瘤大小更大(p=0.1)。线性回归分析指出,在包括肿瘤大小在内的所有其他人口统计数据相等的情况下,粗糙度评分对模型的影响最大(p=0.003)。结论:使用基本的CT成像软件,可以量化肿瘤的地形(“粗糙度”),并与RCC亚型等组织学相关联,从而确定肾小肿块的侵袭性。
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引用次数: 2
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Advances in Urology
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