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Prostate cancer and solid organ transplantation: patient management and outcomes. 前列腺癌与实体器官移植:患者管理与疗效。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1111/bju.16558
Alon Lazarovich, Tanya W Kristof, Shavano Steadman, Aaron S Dahmen, Michelle A Josephson, Rolf Barth, Todd M Morgan, Marc-Olivier Timsit, Scott Eggener

Objective: To analyse the management and outcomes of individuals diagnosed with prostate cancer either before or after organ transplantation, as the impact of organ transplantation and associated immunosuppression on the incidence, progression, and mortality of prostate cancer remains an area of substantial clinical interest and uncertainty.

Patients and methods: We conducted a retrospective analysis of patients from two tertiary care centres who had solid organ transplantation and were diagnosed with prostate cancer before or after organ transplantation. Data collected included demographics and clinical information.

Results: The cohort consisted of 110 patients with a median (interquartile range [IQR]) age at prostate cancer diagnosis of 62 (56.6-67.2) years and a median (IQR) age at transplantation of 58.6 (52.7-65.3) years. Renal transplantation was the most common (54%). The median (IQR) prostate-specific antigen concentration at prostate cancer diagnosis was 6.2 (4.5-10) ng/mL, and the distribution of American Urological Association risk groups was: low risk, 36%; intermediate risk, 50%; and high risk, 14%. In all, 45 (41%) patients were diagnosed with prostate cancer prior to transplantation. Management included radical prostatectomy (RP; 62%), prostate radiotherapy (RT; 13%), and active surveillance (AS; 18%). During a median (IQR) follow-up of 5.8 (2.5-10) years from prostate cancer diagnosis, one (2%) patient developed metastatic disease. In all, 65 (59%) patients were diagnosed with prostate cancer subsequent to organ transplantation. Management included AS (29%), RT (45%), and RP (15%). During a median (IQR) follow-up of 5.3 (1-8.4) years, three patients (5%) developed metastatic disease. There were no deaths from prostate cancer.

Conclusion: A diagnosis of localised prostate cancer should not preclude solid organ transplantation, and the presence of a transplant does not appear to substantially impact risk of prostate cancer progression.

目的由于器官移植和相关免疫抑制对前列腺癌的发病率、进展和死亡率的影响仍然是临床上非常关注和不确定的领域,因此我们将对器官移植前或器官移植后确诊的前列腺癌患者的管理和结果进行分析:我们对两个三级医疗中心的患者进行了回顾性分析,这些患者接受了实体器官移植,并在器官移植前后被诊断出患有前列腺癌。收集的数据包括人口统计学和临床信息:队列中有110名患者,确诊前列腺癌时的中位(四分位距[IQR])年龄为62(56.6-67.2)岁,移植时的中位(IQR)年龄为58.6(52.7-65.3)岁。肾移植最为常见(54%)。确诊前列腺癌时的前列腺特异性抗原浓度中位数(IQR)为 6.2(4.5-10)纳克/毫升,美国泌尿协会风险组别分布为:低风险,36%;中度风险,50%;高度风险,14%。共有 45 名(41%)患者在移植前被诊断出患有前列腺癌。治疗方法包括根治性前列腺切除术(RP;62%)、前列腺放射治疗(RT;13%)和主动监测(AS;18%)。在前列腺癌确诊后5.8(2.5-10)年的中位数(IQR)随访期间,有一名(2%)患者出现了转移性疾病。共有 65 名(59%)患者在器官移植后确诊为前列腺癌。治疗方法包括AS(29%)、RT(45%)和RP(15%)。在中位数(IQR)为5.3(1-8.4)年的随访期间,3名患者(5%)出现了转移性疾病。没有人死于前列腺癌:结论:局部前列腺癌的诊断不应排除实体器官移植,移植的存在似乎不会对前列腺癌进展的风险产生重大影响。
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引用次数: 0
RE: urinary incontinence recovery and surgical techniques in endoscopic enucleation of the prostate. RE: 内窥镜前列腺去核术中的尿失禁恢复和手术技术。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1111/bju.16554
Yu-Hsiang Lin, Chih-Te Lin, Kuo-Jen Lin
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引用次数: 0
The LANDMARK project: providing summaries of key papers that have shaped urological practice LANDMARK 项目:提供影响泌尿外科实践的重要论文摘要。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1111/bju.16548
Kevin G. Byrnes, Cameron Alexander, Mariam Lami, Marie Edison, Aqua Asif, Alexander Ng, Quentin Mak, Bing Jie Chow, Mathew Smith, Kevin Keane, Kevin Gallagher, Arjun S. Nathan, Sinan Khadhouri, Nikita R. Bhatt, Veeru Kasivisvanathan
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引用次数: 0
Ureteric stenting outside of the operation theatre: challenges and opportunities. 手术室外的输尿管支架植入术:挑战与机遇。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1111/bju.16533
Patrick Gordon, Daryl Thompson, Oneel Patel, Ronald Ma, Damien Bolton, Joseph Ischia

Objective: To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT).

Results: A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold.

Conclusion: Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.

目的:评估床旁或诊室输尿管支架插入的安全性、有效性、耐受性和成本效益:评估床旁或诊室输尿管支架植入的安全性、有效性、耐受性和成本效益:根据《系统综述和荟萃分析首选报告项目协议》(PRISMA-P)和《评估系统综述的评估工具》(AMSTAR)2 指南,我们检索了 PubMed/《医学文献分析和检索系统在线》(MEDLINE)、Excerpta Medica dataBASE(EMBASE)、谷歌学术、Cochrane 对照试验中央注册中心(CENTRAL)和 Dimensions 从 1978 年到 2023 年 4 月的英语研究。纳入标准侧重于手术室(OT)外的原发性输尿管支架置入:结果:共纳入 15 项研究,涉及 2072 个支架。在床旁或诊室正确放置支架的成功率从60%到95.8%不等,大多数研究报告的成功率≥80%。常见的失败原因包括结石撞击和难以识别输尿管口。疼痛和耐受性采用多种方法进行评估,有效工具显示疼痛程度适中,但大多数患者会在局部麻醉下再次接受手术。并发症发生率普遍较低,最常见的是血尿或术后发热等轻微并发症。非 OT 环境下的手术成本明显降低,估计可节省多达四倍的费用:结论:床旁或诊室输尿管支架植入术是手术室手术的可行替代方案,具有成功率高、疼痛程度可控、并发症发生率低和可节省大量费用等优点。这种方法在手术室条件有限的情况下尤其具有优势,因此有望在泌尿科临床中得到更广泛的应用。未来的研究应侧重于疼痛评估方法的标准化和随机研究。
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引用次数: 0
Bladder-centric benign prostatic hyperplasia management post-laser enucleation of the prostate. 前列腺激光去核术后以膀胱为中心的良性前列腺增生症治疗。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1111/bju.16544
Yu-Hsiang Lin, Chih-Te Lin, Kuo-Jen Lin
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引用次数: 0
Response to letter 'Bladder-centric benign prostatic hyperplasia management post-laser enucleation of the prostate'. 对 "激光前列腺去核术后以膀胱为中心的良性前列腺增生管理 "一信的回复。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1111/bju.16542
Cristina Cano Garcia, Andreas Becker
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引用次数: 0
Single-port robot-assisted nephroureterectomy via a supine anterior approach: step-by-step technique. 通过仰卧前路进行的单孔机器人辅助肾切除术:循序渐进的技术。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-03 DOI: 10.1111/bju.16537
Alessandro Izzo, Gianluca Spena, Giovanni Grimaldi, Giuseppe Quarto, Luigi Castaldo, Raffaele Muscariello, Dario Franzese, Francesco Passaro, Riccardo Autorino, Antonio Tufano, Sisto Perdonà
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引用次数: 0
The ‘balls’ of an ideal man? 理想男人的 "蛋蛋"?
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-03 DOI: 10.1111/bju.16538
Farrokh Habibzadeh
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引用次数: 0
Residual cancer at radical cystectomy with or without neoadjuvant chemotherapy: a pathological stage‐matched comparison 根治性膀胱切除术后残留癌与新辅助化疗的比较:病理分期比较
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-02 DOI: 10.1111/bju.16529
Leilei Xia, J. Everett Knudsen, Daniel S. Roberson, Erika L. Wood, Anosh Dadabhoy, Sofia Romano, Thomas J. Guzzo, Trinity J. Bivalacqua, Siamak Daneshmand
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引用次数: 0
Real-word outcomes for high-risk non-muscle-invasive bladder cancer: screened patients for the BRAVO trial. 高风险非肌层浸润性膀胱癌的实际疗效:BRAVO 试验筛选出的患者。
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-26 DOI: 10.1111/bju.16516
Samantha Conroy,Ibrahim Jubber,Aidan P Noon,Derek J Rosario,Jon Griffin,Susan Morgan,Rachel Hubbard,Steve Kennish,Stephen Mitchell,Suresh Venugopal,Kate Linton,Ramanan Rajasundaram,Syed A Hussain,James W F Catto
OBJECTIVETo report real-world outcomes for high-risk non-muscle-invasive bladder cancer (HRNMIBC), including bacillus Calmette-Guérin (BCG) and radical cystectomy (RC), as randomised comparisons of these have not been possible.METHODSWe detail consecutive participants screened for the BRAVO randomised controlled trial comparing RC with BCG (International Standard Randomised Controlled Trial Number [ISRCTN]12509361). Patients were prospectively registered and case-note review used for outcomes. The primary outcome was overall survival. Secondary outcomes included recurrence, progression, metastasis, and bladder cancer-specific survival.RESULTS AND LIMITATIONSA total of 193 patients were screened, including 106 (54.9%) who received BCG, 43 (22.3%) primary RC, 37 (19.2%) 'other' treatment and seven (3.6%) hyperthermic intravesical mitomycin C. All-cause death occurred in 55 (28.5%) patients at median (interquartile range [IQR]) of 29.0 (19.5-42.0) months. In multivariable analysis, overall mortality was more common in older patients (hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.35-5.13; Cox P = 0.004 for age >70 years), those recruited from district hospitals (HR 0.53, 95% CI 0.3-0.95; P = 0.032) and those who did not undergo RC as their first treatment (HR 2.16, 95% CI 1.17-3.99; P = 0.014). In all, 17 (8.8%) patients died from bladder cancer (BC) at median (IQR) of 22.5 (19-36.25) months. In multivariable analysis, BC-specific mortality was more common in older patients (HR 4.87, 95% CI 1.1-21.6; P = 0.037) and those with Tis/T1 disease (HR 2.26, 95% CI 1.23-4.16; P = 0.008) but did not vary with initial treatment.CONCLUSIONSPatients with HRNMIBC are at high-risk of mortality. Those choosing RC as their initial treatment have lower risks of mortality than others, although this may reflect fitness and selection.
目的报告高危非肌层浸润性膀胱癌(HRNMIBC)的实际治疗效果,包括卡介苗(BCG)和根治性膀胱切除术(RC),因为无法对这些治疗方法进行随机比较。方法我们详细记录了BRAVO随机对照试验(国际标准随机对照试验编号 [ISRCTN]12509361 )筛选出的连续参与者,对RC和BCG进行了比较。对患者进行了前瞻性登记,并采用病例记录回顾法对结果进行分析。主要结果是总生存期。共有 193 名患者接受了筛查,其中 106 人(54.9%)接受了卡介苗治疗,43 人(22.3%)接受了原发性膀胱癌治疗,37 人(22.3%)接受了膀胱癌治疗。55例(28.5%)患者在中位(四分位间距 [IQR])29.0(19.5-42.0)个月时因各种原因死亡。在多变量分析中,老年患者(危险比 [HR] 2.63,95% 置信区间 [CI] 1.35-5.13;年龄大于 70 岁,Cox P = 0.004)、从地区医院招募的患者(HR 0.53,95% CI 0.3-0.95;P = 0.032)和首次治疗未接受 RC 的患者(HR 2.16,95% CI 1.17-3.99;P = 0.014)的总死亡率更高。共有 17 名(8.8%)患者在中位(IQR)22.5(19-36.25)个月时死于膀胱癌(BC)。在多变量分析中,BC特异性死亡率更常见于年龄较大的患者(HR 4.87,95% CI 1.1-21.6;P = 0.037)和患有Tis/T1疾病的患者(HR 2.26,95% CI 1.23-4.16;P = 0.008),但与初始治疗方法无关。选择 RC 作为初始治疗方法的患者的死亡风险低于其他患者,尽管这可能反映了患者的体质和选择。
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