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The potential benefits of concomitant statins treatment in patients with non-muscle-invasive bladder cancer 非肌层浸润性膀胱癌患者同时服用他汀类药物的潜在益处
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-10 DOI: 10.1111/bju.16493
Kang Liu, Rossella Nicoletti, Hongda Zhao, Xuan Chen, Peter Ka-Fung Chiu, Chi-Fai Ng, Renate Pichler, Laura S. Mertens, Takafumi Yanagisawa, Luca Afferi, Andrea Mari, Satoshi Katayama, Juan Gomez Rivas, Riccardo Campi, Maria Carmen Mir, Michael Rink, Yair Lotan, Morgan Rouprêt, Shahrokh F. Shariat, Jeremy Yuen-Chun Teoh
To investigate the influence of statins on the survival outcomes of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adjuvant intravesical bacille Calmette-Guérin (BCG) immunotherapy.
研究他汀类药物对接受膀胱内卡介苗(BCG)免疫疗法辅助治疗的非肌层浸润性膀胱癌(NMIBC)患者生存结果的影响。
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引用次数: 0
Bridging the knowledge gap: past, present and future of antibiotic use for ureteral stents 缩小知识差距:输尿管支架抗生素使用的过去、现在和未来。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-04 DOI: 10.1111/bju.16515
Jasper Cornette, Dirk Lange, Ben H. Chew, Thomas Tailly

Objective

To evaluate the available literature on ureteric stent-related infections, the use of antibiotics and bacterial colonisation to identify the current incidence of stent-related infections, unveil knowledge gaps and generate potential hypotheses for future research.

Methods

A literature review was conducted using PubMed, Cochrane and urological association websites identifying relevant English literature published between 1983 and January 2024.

Results

There is a worldwide lack of guidelines for antibiotic prophylaxis for stent placement, exchange or extraction. In patients with a negative preoperative urine culture undergoing ureteroscopy and stent placement, it may be considered to only provide prophylaxis in presence of risk factors. However, in pre-stented patients a preoperative urine culture is important to guide prophylaxis during endourological surgery. During stent indwell time, antibiotic prophylaxis does not show any advantage in preventing urinary tract infections (UTIs). There is no strong evidence to support the use of antibiotics at time of stent removal. In the absence of any clear evidence, management strategies for treating UTIs in patients with ureteric stents vary widely. Stent exchange could be considered to remove the biofilm as a potential source of bacteria. Stent culture can help to guide treatment during infection as urine culture and stent culture can differ.

Conclusion

In terms of good antibiotic stewardship, urologists should be aware that unnecessary use of antibiotics provokes bacterial resistance. There is a great need for further research in the field of antibiotic prophylaxis and stent-related infections to develop evidence that can help shape clear guidelines for this very common urological practice.

目的:评估输尿管支架相关感染、抗生素使用和细菌定植方面的现有文献:评估有关输尿管支架相关感染、抗生素使用和细菌定植的现有文献,以确定目前支架相关感染的发生率,揭示知识差距,并为未来研究提出潜在假设:方法:利用PubMed、Cochrane和泌尿外科协会网站进行文献综述,确定1983年至2024年1月期间发表的相关英文文献:结果:全世界范围内都缺乏关于支架置入、更换或拔出时抗生素预防的指南。对于接受输尿管镜检查和支架置入术前尿液培养阴性的患者,可以考虑仅在存在风险因素的情况下进行预防。不过,对于支架置入前的患者,术前尿培养对于指导输尿管内手术的预防非常重要。在支架植入期间,抗生素预防在预防尿路感染(UTI)方面没有任何优势。没有有力的证据支持在移除支架时使用抗生素。在缺乏明确证据的情况下,治疗输尿管支架患者尿路感染的策略存在很大差异。可以考虑更换支架,以清除作为潜在细菌来源的生物膜。在感染期间,支架培养有助于指导治疗,因为尿液培养和支架培养可能有所不同:就抗生素管理而言,泌尿科医生应意识到不必要使用抗生素会引发细菌耐药性。我们亟需在抗生素预防和支架相关感染领域开展进一步研究,以获得有助于为这一泌尿外科常见病制定明确指南的证据。
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引用次数: 0
Robotic appendiceal ureteric interposition or replacement: the surgical technique. 机器人阑尾输尿管插管或置换:手术技术。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-03 DOI: 10.1111/bju.16523
Silu Chen, Shubo Fan, Kunlin Yang, Zhihua Li, Wenzhi Gao, Xiang Wang, Zhenyu Li, Bing Wang, Chen Huang, Hongjian Zhu, Yaming Gu, Xuesong Li
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引用次数: 0
Contemporary short-term peri-operative outcomes of open primary retroperitoneal lymph node dissection 开放式腹膜后原发淋巴结清扫术的当代短期围手术期疗效。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-03 DOI: 10.1111/bju.16506
Jacob D. McFadden, Timothy A. Masterson, Clint Cary

Objectives

To provide current peri-operative outcomes and short-term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications.

Patients and Methods

Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018–2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi-squared, Fisher's exact and unpaired t-tests in our analyses.

Results

A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m2. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m2; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30-day period. The study was limited by its retrospective design and short-term follow-up.

Conclusions

We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.

目的提供目前开放式原发性腹膜后淋巴结清扫术(RPLND)的围手术期结果和短期并发症发生率,并分析并发症的风险因素:利用印第安纳大学睾丸癌数据库,我们对研究期间(2018-2021 年)接受开放式原发性 RPLND 的所有患者进行了回顾性分析。我们关注的主要结果是接受手术患者的术前概况、并发症发生率以及与并发症相关的风险因素的识别。我们在分析中使用了卡方检验、费雪精确检验和非配对 t 检验:结果:共确定了 165 名患者。体重指数(BMI)中位数为 28.6 kg/m2。患者多为临床 IIA 期(39%)或 IIB 期(36%)睾丸癌。估计失血量中位数为 150 毫升,无需输血。出现任何并发症的患者的体重指数高于恢复正常的患者(34.95 vs 28 kg/m2;P = 0.0042)。住院时间中位数为 3 天。总体并发症发生率较低(8.48%),术后有两例主要并发症,其中一例为乳糜腹水(0.6%),30 天内无死亡病例。该研究因其回顾性设计和短期随访而受到限制:我们发现,即使是在超重人群中,开放式初级 RPLND 的发病率也是可以接受的。失血少、住院时间短、乳糜腹水风险小、术后主要并发症少,这应成为腹膜后淋巴结清扫术的基准。
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引用次数: 0
Cumulative re-operation rates during follow-up after hypospadias repair 尿道下裂修补术后随访期间的累积再手术率。
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-09-03 DOI: 10.1111/bju.16519
Annaleena Anttila, Tuija Lahdes-Vasama, Niklas Pakkasjärvi, Seppo Taskinen

Objective

To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre.

Patients and Methods

Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan–Meier methods were used to evaluate the re-operation data.

Results

The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards.

Conclusion

There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.

目的在一家三级儿科泌尿外科中心评估尿道下裂修复术后再次手术的累积率,并评估长期手术效果:对 1991 年至 2003 年间出生的 293 名接受尿道下裂手术的男孩进行了回顾性分析。研究包括 274 名患者:其中远端尿道下裂 165 例,中轴尿道下裂 34 例,近端尿道下裂 75 例。采用卡普兰-梅耶法评估再次手术数据:结果:初次手术的中位年龄为1.3岁,中位随访时间为14.4年。总的再手术率为 48.2%,其中约有一半的问题是在术后 3 个月内发现的。再次手术的风险与尿道下裂的严重程度相关,5年和15年再次手术的风险分别为39.3%和51.8%。该研究的局限性包括其回顾性和手术技术与现行标准的差异:结论:尿道下裂修复术后计划外再次手术的风险很大,而且随着原发病的严重程度而增加。结论:尿道下裂修复术后计划外再次手术的风险很大,且随着原发病的严重程度而增加。这突出表明需要延长随访时间,并与患者及其家属进行有效沟通,使其了解需要进行多次手术以获得最佳治疗效果的可能性。
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引用次数: 0
Variant genital gender‐affirming surgery: a systematic review 变异生殖器性别确认手术:系统综述
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 DOI: 10.1111/bju.16513
Wietse Claeys, Dylan T. Wolff, Alexandra Zachou, Piet Hoebeke, Nicolaas Lumen, Anne‐Françoise Spinoit
ObjectiveTo review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.MethodsA systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.ResultsIn total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.ConclusionThis review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.
目的综述有关变异生殖器性别确认手术(GGAS)的现有文献,包括实施手术的原因、手术本身及其结果。方法对变异生殖器性别确认手术的实施情况进行系统综述(系统综述国际前瞻性注册[PROSPERO]标识符:CRD42022306684):对 PubMed、Embase、Web of Science 和 Cochrane 数据库进行了研究(国际前瞻性系统综述注册[PROSPERO]标识符:CRD42022306684),研究时间从开始至 2023 年 12 月 31 日。研究遵循了系统综述和荟萃分析首选报告项目(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,并使用五项标准质量评估清单对每项研究的偏倚风险进行了评估。患者选择这些手术主要是出于个人意愿,以避免并发症的风险,或者是因为他们对自己生殖器的某些部位没有恐惧感。男性化手术的并发症主要来自尿道的延长,这可以通过初级会阴尿道前列腺切除术来缓解。在保留阴道的情况下,阴茎成形术和阴道成形术出现尿道并发症的风险较高。在女性化手术中,如果外阴成形术不创建阴道管,则可避免内脏损伤和终生自行扩张的风险。结论本综述强调了变性 GGAS 的重要性,并承认了变性者和性别多样化者的偏好。患者应了解这些手术每个步骤的风险和益处。
{"title":"Variant genital gender‐affirming surgery: a systematic review","authors":"Wietse Claeys, Dylan T. Wolff, Alexandra Zachou, Piet Hoebeke, Nicolaas Lumen, Anne‐Françoise Spinoit","doi":"10.1111/bju.16513","DOIUrl":"https://doi.org/10.1111/bju.16513","url":null,"abstract":"ObjectiveTo review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.MethodsA systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.ResultsIn total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.ConclusionThis review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"6 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Varying the intensity of cystoscopic surveillance for high‐risk non‐muscle‐invasive bladder cancer 改变高风险非肌层浸润性膀胱癌的膀胱镜监测强度
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 DOI: 10.1111/bju.16521
Zhuo Tony Su, Isabella S. Florissi, Katherine M. Mahon, Taibo Li, Michael E. Rezaee, Nirmish Singla, Sunil H. Patel, Jeffrey P. Townsend, Max R. Kates
ObjectivesTo compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).Patients and MethodsWe performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.ResultsThe guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.ConclusionIn microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients.
患者和方法 我们对由 10 万名 70 岁确诊为 HRNMIBC 的患者组成的假定队列进行了真实世界临床数据驱动的微观模拟。模拟人群接受了五项指南推荐的替代监测方案,以及两种假定方案--监测强度升级和降级--其监测强度分别比指南推荐的方案略高和略低。我们从美国医疗支付方的角度评估了肌层浸润性膀胱癌(MIBC)的 10 年累积发病率、癌症特异性生存率(CSS)、总生存率(OS)和成本效益。结果指南推荐的监测方案导致的 MIBC 10 年累积发病率估计为 11.0% 到 11.6%,CSS 为 95.0% 到 95.2%,OS 为 69.7% 到 69.8%。监测强度升级后,MIBC 的 10 年累计发病率为 10.5%(95% 置信区间 [CI] 10.3-10.7%),CSS 为 95.4%(95% CI 95.2-95.5%),OS 为 69.9%(95% CI 69.6-70.1%),而监测强度降级后分别为 11.9%(95% CI 11.7-12.1%)、94.9%(95% CI 94.8-95.1%)和 69.6%(95% CI 69.3-69.9%)。通过提高监测强度,在10年内防止多发生一次MIBC进展所需的治疗人数≥80人,避免多发生一次癌症相关死亡所需的治疗人数≥257人。与监测强度降级相比,高强度治疗方案每获得一个增量质量调整生命年的增量成本≥336 000 美元,远高于传统的支付意愿阈值;每预防一次额外的 MIBC 病变进展的增量成本≥686 000 美元;每避免一次额外的癌症相关死亡率的增量成本≥220 万美元。结论在对新诊断为 HRNMIBC 患者的各种膀胱镜监测强度进行微观模拟测试时,适度降低监测强度似乎与 10 年生存率的微小变化有关,而且与高强度监测方案相比具有成本效益。这些结果表明,适度降低监测强度可以降低医疗成本,而不会影响许多患者的预期寿命。
{"title":"Varying the intensity of cystoscopic surveillance for high‐risk non‐muscle‐invasive bladder cancer","authors":"Zhuo Tony Su, Isabella S. Florissi, Katherine M. Mahon, Taibo Li, Michael E. Rezaee, Nirmish Singla, Sunil H. Patel, Jeffrey P. Townsend, Max R. Kates","doi":"10.1111/bju.16521","DOIUrl":"https://doi.org/10.1111/bju.16521","url":null,"abstract":"ObjectivesTo compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).Patients and MethodsWe performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.ResultsThe guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.ConclusionIn microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"23 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Observational study on screen‐detected prostate cancer: case series of empirical clinical practice 筛查出前列腺癌的观察研究:经验性临床实践案例系列
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 DOI: 10.1111/bju.16525
Takeshi Takahashi
{"title":"Observational study on screen‐detected prostate cancer: case series of empirical clinical practice","authors":"Takeshi Takahashi","doi":"10.1111/bju.16525","DOIUrl":"https://doi.org/10.1111/bju.16525","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"22 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate 经尿道前列腺切除术中两种直接口服抗凝剂围手术期出血风险的比较
IF 4.5 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 DOI: 10.1111/bju.16478
Lu Yu Kuo, Jenny Kuo, Joshua Silverman, Jason Jae Yeun Kim, Caitlin Letch, Scott McClintock
ObjectivesTo evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP).Patients and MethodsThis was a single‐centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no‐AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic‐related morbidity were captured within a 3‐month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no‐AC, and DOAC groups were analysed with two‐sided t‐test, and chi‐square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability‐weighted treatment effect analysis to evaluate bleeding risk.ResultsThere were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no‐AC vs AC: 0.4% vs 2.7%, P = 0.01).ConclusionThis is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding‐related complications than rivaroxaban.
目的评估接受经尿道前列腺切除术(TURP)的患者使用直接口服抗凝药(DOAC)和华法林的围术期发病率和死亡率。患者和方法这是一项单中心回顾性队列分析,分析对象是2019年4月至2023年12月期间因良性前列腺增生接受TURP手术的患者。主要目的是评估抗凝(AC)与无抗凝患者的围手术期出血和血栓栓塞风险。次要目标是评估不同配方 DOACs 的围手术期出血和血栓栓塞风险。研究人员收集了患者的人口统计学资料、既往治疗情况、前列腺大小、基线出血风险和手术细节。采集了术后 3 个月内出血和血栓栓塞相关的发病率。记录了AC治疗的围手术期管理情况,所有患者都暂停了AC治疗。使用双侧 t 检验和卡方检验分析了 AC 组与无 AC 组和 DOAC 组之间的队列特征。还进行了进一步的逻辑回归分析,以确定组间的重要变量。结果队列中有 629 名患者,其中 113 名(18%)患者接受了 AC 治疗。据统计,接受阿昔单抗治疗的患者发生急性出血的风险增加了1.6倍,血尿时间延长14天的风险增加了11倍。与阿哌沙班相比,接受利伐沙班治疗的患者急性出血的风险在统计学上显著增加了2.21倍。接受 AC 治疗的患者在围手术期发生中风的风险有统计学意义的显著增加(无 AC vs AC:0.4% vs 2.7%,P = 0.01)。尽管暂停了治疗,但接受 AC 治疗的患者在围手术期更有可能出现血尿和中风。阿哌沙班引起的出血相关并发症似乎少于利伐沙班。
{"title":"Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate","authors":"Lu Yu Kuo, Jenny Kuo, Joshua Silverman, Jason Jae Yeun Kim, Caitlin Letch, Scott McClintock","doi":"10.1111/bju.16478","DOIUrl":"https://doi.org/10.1111/bju.16478","url":null,"abstract":"ObjectivesTo evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP).Patients and MethodsThis was a single‐centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no‐AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic‐related morbidity were captured within a 3‐month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no‐AC, and DOAC groups were analysed with two‐sided <jats:italic>t</jats:italic>‐test, and chi‐square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability‐weighted treatment effect analysis to evaluate bleeding risk.ResultsThere were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for &gt;14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no‐AC vs AC: 0.4% vs 2.7%, <jats:italic>P</jats:italic> = 0.01).ConclusionThis is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding‐related complications than rivaroxaban.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"20 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ureteroscopy vs laparoscopic ureterolithotomy: equal treatments? 输尿管镜检查与腹腔镜输尿管结石切开术:同等治疗?
IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-08-28 DOI: 10.1111/bju.16522
Øyvind Ulvik
<p>In this issue of the <i>BJUI</i>, Torricelli et al. [<span>1</span>] report results from a randomised trial of participants who underwent treatment for large proximal ureteric stones with flexible ureteroscopy (URS) and holmium:yttrium-aluminium-garnet (Ho:YAG) lithotripsy or retroperitoneal laparoscopic ureterolithotomy (RLU). In total, 64 patients were included and randomised. Stone-free rates (SFRs) were 84.3% for URS and 93.7% for RLU (<i>P</i> = 0.23). There were no differences in complication rates, operative time or hospital stay. The authors conclude that both URS and RLU demonstrate high efficiency and low morbidity in the treatment of large proximal ureteric stones.</p><p>Since the reporting of the first experiences in the early 1980s, the evolution in URS has been extraordinary. High SFRs and few minor complications have made URS for ureteric stones the preferred treatment option [<span>2</span>]. SFRs of 100% after day-case surgery procedures have been reported in randomised trials using either Ho:YAG or thulium fibre lasers [<span>3, 4</span>]. In special circumstances with large, impacted stones or challenging anatomy, other treatment options may still be an alternative. However, European Association of Urology guidelines state laparoscopic or open stone surgery to be a valid option in complicated cases only when multiple endourological approaches have failed [<span>2</span>].</p><p>Torricelli et al. [<span>1</span>] should be commended for performing a randomised trial comparing URS and RLU treating large proximal stones. However, a randomised design alone is no guarantee for scientific quality, and the authors are correct in their suspicion of the study being underpowered. The power analysis made prior to study start returned a sample size of 49 patients in each group to detect a significant difference between the treatment arms. Despite this, only 64 patients were included in total. The authors advocate a lower sample size than calculated pointing out the SFR for RLU may be higher than anticipated. On the other hand, the authors’ assumption of SFR for URS being 75% is probably too low and in contrast to reports in other randomised studies [<span>3, 4</span>]. A higher and more realistic estimate for SFR in the URS group would in fact return a need for an even larger sample size. Lack of patients prevent detection of potential differences between the treatment groups as demonstrated in the present study. It is therefore still not known which treatment is better. On the other hand, given the reported results in the Torricelli et al. study [<span>1</span>], the differences between the two treatments may not be as large as anticipated after all.</p><p>Interesting to note, one in three of the patients had persistent hydronephrosis on CT scan at 3 months after surgery, and ureteric stricture was detected in one. The authors suggest longstanding obstruction prior to surgery as an explanation. This might well be true, but the signific
在本期 BJUI 杂志上,Torricelli 等人[1]报告了一项随机试验的结果,试验对象是接受输尿管软镜(URS)和钬钇铝石榴石(Ho:YAG)碎石术或腹膜后腹腔镜输尿管碎石术(RLU)治疗输尿管近端大结石的患者。共有64名患者被随机纳入。URS的无结石率(SFR)为84.3%,RLU为93.7%(P = 0.23)。并发症发生率、手术时间或住院时间均无差异。作者总结说,URS 和 RLU 在治疗大块输尿管近端结石方面都表现出高效率和低发病率。高SFR率和极少的轻微并发症使输尿管结石的URS成为首选治疗方案[2]。在使用 Ho:YAG 或铥纤维激光的随机试验中,日间手术程序后的 SFR 率达到了 100%[3,4]。在结石较大、有冲击力或解剖结构复杂的特殊情况下,其他治疗方案仍不失为一种选择。然而,欧洲泌尿外科协会指南指出,只有在多种腔内治疗方法均无效的情况下,腹腔镜或开放结石手术才是复杂病例的有效选择[2]。不过,随机设计本身并不能保证科学质量,而且作者怀疑研究动力不足也是正确的。研究开始前进行的功率分析表明,每组样本量为49名患者,才能检测出治疗组之间的显著差异。尽管如此,总共只纳入了 64 名患者。作者主张样本量低于计算结果,并指出 RLU 的 SFR 可能高于预期。另一方面,作者假设 URS 的 SFR 为 75%,这一假设可能过低,与其他随机研究的报告[3, 4]形成鲜明对比。如果 URS 组的 SFR 估计值更高、更符合实际情况,则需要更大的样本量。本研究显示,由于缺乏患者,无法发现治疗组之间的潜在差异。因此,目前还不清楚哪种治疗方法更好。另一方面,考虑到托里切利等人的研究结果[1],两种治疗方法之间的差异可能并不像预期的那么大。值得注意的是,每三名患者中就有一人在术后三个月的 CT 扫描中发现持续性肾积水,其中一人还发现了输尿管狭窄。作者认为,手术前长期存在的梗阻是一种解释。这很可能是真的,但大量持续扩张的患者也可能隐藏着未被发现的输尿管狭窄。在本研究中,对这些患者进行了动态闪烁扫描以排除梗阻。然而,同位素肾图检测明显梗阻的能力可能并不可靠[5]。由于大块输尿管结石的嵌顿是输尿管狭窄形成的一个已知风险因素,因此建议所有治疗后仍有肾积水的患者最好进行第二次尿路造影检查[6]。不过,还需要更大规模的研究来突出这些治疗方法之间的差异。作者的结论是,对于无法使用激光或柔性输尿管镜的泌尿科医生来说,RLU 是一种很有吸引力的尿路结石治疗替代方法,与此相反,我更建议将这些患者送到具备所需专业知识的转诊中心。不过,我同意逆行尿路造影术仍是首选,即使是对于近端输尿管的大块、有影响的结石也是如此。
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