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Case - Giant primary retroperitoneal teratoma with neuroendocrine components. 病例-巨大原发性腹膜后畸胎瘤伴神经内分泌成分。
Nicholas Sellke, Kimberly Tay, Eric Zhou, Holly Harper, Amel Ahmed, Tsigab Hagos, Richard Hoehn, Shahrazad T Saab, Adam Calaway
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引用次数: 0
Existing trends and applications of artificial intelligence in urothelial cancer A scoping review. 人工智能在尿路上皮癌研究中的现状及应用综述。
Shamir Malik, Jeremy Wu, Nicole Bodnariuc, Krishnateja Narayana, Naveen Gupta, Mikail Malik, Jethro C C Kwong, Adree Khondker, Alistair E W Johnson, Girish S Kulkarni

Introduction: The use of artificial intelligence (AI) in urology is gaining significant traction. While previous reviews of AI applications in urology exist, there have been few attempts to synthesize existing literature on urothelial cancer (UC).

Methods: Comprehensive searches based on the concepts of "AI" and "urothelial cancer" were conducted in MEDLINE , EMBASE , Web of Science, and Scopus. Study selection and data abstraction were conducted by two independent reviewers. Two independent raters assessed study quality in a random sample of 25 studies with the prediction model risk of bias assessment tool (PROBAST) and the standardized reporting of machine learning applications in urology (STREAM-URO) framework.

Results: From a database search of 4581 studies, 227 were included. By area of research, 33% focused on image analysis, 26% on genomics, 16% on radiomics, and 15% on clinicopathology. Thematic content analysis identified qualitative trends in AI models employed and variables for feature extraction. Only 19% of studies compared performance of AI models to non-AI methods. All selected studies demonstrated high risk of bias for analysis and overall concern with Cohen's kappa (k)=0.68. Selected studies met 66% of STREAM-URO items, with k=0.76.

Conclusions: The use of AI in UC is a topic of increasing importance; however, there is a need for improved standardized reporting, as evidenced by the high risk of bias and low methodologic quality identified in the included studies.

导读:人工智能(AI)在泌尿外科的应用越来越受到重视。虽然之前有关于人工智能在泌尿外科应用的综述,但很少有人尝试综合现有的关于尿路上皮癌(UC)的文献。方法:基于“AI”和“尿路上皮癌”的概念在MEDLINE、EMBASE、Web of Science、Scopus中进行综合检索。研究选择和数据提取由两名独立审稿人进行。两名独立评估员使用预测模型偏倚风险评估工具(PROBAST)和机器学习在泌尿科应用的标准化报告(STREAM-URO)框架对25项研究的随机样本进行了研究质量评估。结果:从数据库检索的4581项研究中,纳入227项。按研究领域划分,33%专注于图像分析,26%专注于基因组学,16%专注于放射组学,15%专注于临床病理学。主题内容分析确定了所采用的人工智能模型和特征提取变量的定性趋势。只有19%的研究将人工智能模型的性能与非人工智能方法进行了比较。所有入选的研究均显示分析偏倚风险高,总体关注Cohen’s kappa (k)=0.68。所选研究满足66%的STREAM-URO项目,k=0.76。结论:人工智能在UC中的应用是一个越来越重要的话题;然而,有必要改进标准化报告,正如纳入研究中发现的高偏倚风险和低方法学质量所证明的那样。
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引用次数: 0
Urodynamic and urethral pressure profilometry findings in women with voiding phase dysfunction treated with surgical urethrolysis. 尿动力学和尿道压力谱分析在手术解尿治疗排尿期功能障碍的妇女中的发现。
Amy D Dobberfuhl, Craig V Comiter, Sayantan Deb

Introduction: Long-term urodynamic (UDS) and urethral pressure profilometry (UPP) parameters in women with voiding phase dysfunction following an anti-incontinence (AI) procedure have been poorly characterized. We report our 10-year UDS findings in women with voiding phase dysfunction after AI procedure, who underwent urethrolysis.

Methods: We identified sequential records containing urethrolysis current procedural terminology codes over a 10-year period. Records of women with preoperative UDS were reviewed for demographics, UDS tracing, and outcomes following urethrolysis.

Results: Twenty-five women (mean age 60 years) had voiding phase dysfunction and underwent urethrolysis at a mean of 47 months (interquartile range [IQR] 12-61) after AI procedure. Preoperatively, six (24%) women required intermittent catheterization. Free uroflowmetry revealed a mean maximum peak flow (Qmax) of 9.6 ml/s (IQR 7.0-11.0), voided volume of 137 ml (IQR 81-169), and postvoid residual of 167 ml (IQR 43-288). UDS revealed a mean UPP length of 24 mm (IQR 20-27), UPP closure pressure of 78 cmH2O (IQR 59-103), detrusor pressure at maximum flow (Pdet@Qmax) of 31 cmH2O (IQR 19-43), Qmax of 7.9 ml/s (IQR 5.0-12.0), bladder outlet obstruction index of 15 (IQR 0-34), and bladder contractility index of 71 (IQR 60-81). UPP length was significantly associated (Pearson correlation, p<0.05) with bladder outlet obstruction index (r=0.80), Pdet@Qmax (r=0.75), and time since AI procedure (r=-0.70). UPP closure pressure was significantly associated with age (r=-0.64), volume of first (r=-0.64) and strong (r=-0.78) desire, and capacity (r=-0.71). Following urethrolysis, spontaneous voiding was achieved in 23 (92%) women at followup (mean 308 days).

Conclusions: UPP may help characterize outlet parameters in women with voiding phase dysfunction following an AI procedure, who ultimately undergo urethrolysis.

导读:长期尿动力学(UDS)和尿道压力测量(UPP)参数在抗尿失禁(AI)手术后出现排尿期功能障碍的女性的特征尚不明确。我们报告了10年的UDS在人工智能手术后排尿期功能障碍的妇女中发现的结果,这些妇女接受了解尿术。方法:我们在10年的时间里确定了包含尿道溶解现行程序术语代码的顺序记录。回顾术前UDS患者的人口统计、UDS追踪和解尿后的结果。结果:25名女性(平均年龄60岁)在人工智能手术后平均47个月(四分位数间距[IQR] 12-61)出现排尿期功能障碍并进行了尿道溶解。术前,6名(24%)女性需要间歇性置管。自由尿流仪显示,平均最大峰流量(Qmax)为9.6 ml/s (IQR 7.0-11.0),空腔体积为137 ml (IQR 81-169),空腔后残留为167 ml (IQR 43-288)。UDS显示UPP平均长度为24 mm (IQR 20-27), UPP闭合压力为78 cmH2O (IQR 59-103),最大流量逼尿肌压力(Pdet@Qmax)为31 cmH2O (IQR 19-43), Qmax为7.9 ml/s (IQR 5.0-12.0),膀胱出口阻塞指数为15 (IQR 0-34),膀胱收缩指数为71 (IQR 60-81)。UPP长度显著相关(Pearson相关性,p)结论:UPP可能有助于确定AI手术后排尿期功能障碍的女性的出口参数,这些女性最终接受了解尿术。
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引用次数: 0
Postoperative events and complications of next-day stent removal following uncomplicated percutaneous nephrolithotomy compared to longer stenting. 无并发症经皮肾镜取石术后次日支架取出的事件和并发症与较长时间支架放置的比较。
Taylor Goodstein, Patrick Mershon, Tasha Posid, Aliza Khuhro, Mary Charleton, Amara Ndumele, Colin Kleinguetl, Chase Arnold, Bodo Knudsen, Michael Sourial

Introduction: Options for renal drainage after percutaneous nephrolithotomy (PCNL) vary and depend primarily on surgeon preference and case considerations. In our practice, patients traditionally returned one week postoperatively to remove the stents in the office via cystoscopy; however, following uncomplicated PCNL with no plans for second-look procedure, a ureteral stent on a tether is currently removed in tandem with the Foley catheter on postoperative day 1 (POD1) prior to patient discharge. This study compared the number of postoperative events between POD1 stent removal and their longer stented counterparts.

Methods: We conducted a retrospective chart review on all patients who had undergone PCNL at our institution from January 1, 2020, to June 31, 2021. Patient demographics, operative metrics, and postoperative events (telephone calls, emergency department [ED ]/clinic visits, and complications) were recorded and compared between the two groups.

Results: A total of 243 patients were included in final analysis: 46% (n=111) had their stent removed on POD1 and 54% (n=132) had longer indwelling stent times. Baseline demographics were similar between the two groups. Number of telephone calls (p=0.081), ED /clinic visits (p=0.093), and complications (p=0.647) were similar between groups. There were three (1.3%) unplanned second-look procedures: two (1.8%) in the POD1 stent removal group and one (0.8%, p=0.475) in the later stent removal group.

Conclusions: In this limited, retrospective study, we did not detect a difference in postoperative events or short-term complications for POD1 vs. later stent removal after uncomplicated PCNL.

导读:经皮肾镜取石术(PCNL)后肾引流的选择不同,主要取决于外科医生的偏好和病例考虑。在我们的实践中,患者通常在术后一周返回办公室通过膀胱镜取出支架;然而,对于无并发症的PCNL患者,在术后第1天(POD1)出院前,将输尿管支架系绳与Foley导管一起取出。本研究比较了POD1支架移除与长时间支架移除之间的术后事件数量。方法:我们对2020年1月1日至2021年6月31日在我院接受PCNL的所有患者进行回顾性图表回顾。记录并比较两组患者的人口统计、手术指标和术后事件(电话呼叫、急诊科[ED]/门诊就诊和并发症)。结果:243例患者纳入最终分析:46% (n=111)患者在POD1移除支架,54% (n=132)患者延长支架留置时间。两组的基线人口统计数据相似。两组之间的电话次数(p=0.081)、急诊科/门诊就诊次数(p=0.093)和并发症(p=0.647)相似。有3例(1.3%)非计划的二次检查手术:2例(1.8%)在POD1支架移除组,1例(0.8%,p=0.475)在晚支架移除组。结论:在这项有限的回顾性研究中,我们没有发现POD1与无并发症PCNL术后支架取出的术后事件或短期并发症的差异。
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引用次数: 0
Current advances in pain regimens for percutaneous nephrolithotomy A comprehensive review. 经皮肾镜取石术疼痛治疗的最新进展综述。
Tomas Paneque, John Richey, Ahmad Abdelrazek, Kevin Morgan, Joseph Fitz-Gerald, Seth Swinney, Zachary M Connelly, Nazih Khater

Introduction: Percutaneous nephrolithotomy (PCNL) causes pain and discomfort after surgery. The primary causes of immediate postoperative pain after PCNL are visceral pain from the ureters and kidneys, and body surface discomfort from incisions. Acute, untreated pain has the potential to develop into chronic pain, which remains a considerable burden for the rehabilitation of patients. The goal of this review was to describe the current options for treating pain post-PCNL.

Methods: We conducted a literature review of all published manuscripts on pain protocols for patients undergoing PCNL and related topics; 50 published manuscripts were identified and reviewed.

Results: PCNL morbidity must be reduced by an appropriate management of postoperative pain. Opioids, multimodal therapy, tubeless PCNL, reduced size of nephrostomy tube, and regional anesthesia are currently available for reducing postoperative pain.

Conclusions: Implementing successful treatment strategies for postoperative pain after PCNL is key in reducing the morbidity and mortality of PCNL.

导读:经皮肾镜取石术(PCNL)术后会引起疼痛和不适。PCNL术后即刻疼痛的主要原因是输尿管和肾脏的内脏疼痛,以及切口引起的体表不适。急性,未经治疗的疼痛有可能发展成慢性疼痛,这仍然是患者康复的一个相当大的负担。本综述的目的是描述目前治疗pcnl后疼痛的选择。方法:我们对所有已发表的关于PCNL患者疼痛方案和相关主题的文献进行了综述;鉴定并审查了50篇已发表的手稿。结果:PCNL的发病率必须通过适当的术后疼痛管理来降低。目前,阿片类药物、多模式治疗、无管PCNL、缩小肾造口管尺寸和区域麻醉可用于减轻术后疼痛。结论:实施成功的PCNL术后疼痛治疗策略是降低PCNL发病率和死亡率的关键。
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引用次数: 0
Survey of the quality and origins of websites on penile low-intensity shockwave therapy in Canada. 加拿大阴茎低强度冲击波治疗网站质量及来源调查。
Taylor Remondini, Alexandra Millman, Keith Jarvi, Ethan Grober, Yonah Krakowsky

Introduction: The aim of this study was to establish the quality of patient-facing websites advertising low-intensity shockwave therapy (LISWT) for erectile dysfunction (ED) and Peyronie's disease (PD) patients in Canada.

Methods: Canadian websites offering LIWST for ED or PD were identified using online web searches. The characteristics of these websites were reviewed, along with examining the presence of HONCode certification, assigning a brief DISCERN score (a tool designed to evaluate health information online) and readability scores. We also examined the LIWST technology advertised, as well as benefits of LIWST cited by the websites.

Results: Twenty-five unique websites linked to 46 clinics were identified and reviewed. Twenty-four percent of websites were run by a urologist. Other specialties offering LISWT included general practitioners, anesthesiologists, naturopaths, nurse practitioners, physiotherapists, and registered massage therapists. Twenty-four percent of the websites advertised the use of a focused shockwave generator. Forty percent of the websites had peer-reviewed references. The average brief DISCERN score was 14 (standard deviation 3.4). There was no association between the physician-or non-physician-led websites and the use of peer-reviewed references, readability scores, the number of clinic locations, or higher brief discern scores.

Conclusions: LISWT is readily advertised online for ED and PD patients in Canada; however, only a minority use a focused shockwave generator. There is a wide diversity of practitioners offering LISWT. Websites offering LISWT are generally of poor quality and do not provide adequate information for patients to make educated treatment decisions.

简介:本研究的目的是建立面向患者的网站宣传低强度冲击波治疗(LISWT)在加拿大勃起功能障碍(ED)和佩罗尼氏病(PD)患者的质量。方法:加拿大网站提供LIWST为ED或PD使用在线网络搜索确定。审查了这些网站的特点,同时检查了HONCode认证的存在,分配了一个简短的DISCERN分数(旨在评估在线健康信息的工具)和可读性分数。我们还研究了广告中的LIWST技术,以及网站引用的LIWST的好处。结果:确定并审查了与46家诊所相关的25个独特网站。24%的网站是由泌尿科医生运营的。其他提供LISWT的专业包括全科医生、麻醉师、自然治疗师、护士、物理治疗师和注册按摩治疗师。24%的网站宣传使用聚焦冲击波发生器。40%的网站有同行评议的参考资料。平均简短的DISCERN得分为14(标准偏差3.4)。医生或非医生主导的网站与同行评议参考文献的使用、可读性分数、诊所地点的数量或更高的简短识别分数之间没有关联。结论:在加拿大,LISWT很容易在ED和PD患者的网上宣传;然而,只有少数人使用聚焦冲击波发生器。提供LISWT的从业者种类繁多。提供LISWT的网站通常质量较差,不能为患者提供足够的信息来做出明智的治疗决定。
{"title":"Survey of the quality and origins of websites on penile low-intensity shockwave therapy in Canada.","authors":"Taylor Remondini, Alexandra Millman, Keith Jarvi, Ethan Grober, Yonah Krakowsky","doi":"10.5489/cuaj.8303","DOIUrl":"10.5489/cuaj.8303","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to establish the quality of patient-facing websites advertising low-intensity shockwave therapy (LISWT) for erectile dysfunction (ED) and Peyronie's disease (PD) patients in Canada.</p><p><strong>Methods: </strong>Canadian websites offering LIWST for ED or PD were identified using online web searches. The characteristics of these websites were reviewed, along with examining the presence of HONCode certification, assigning a brief DISCERN score (a tool designed to evaluate health information online) and readability scores. We also examined the LIWST technology advertised, as well as benefits of LIWST cited by the websites.</p><p><strong>Results: </strong>Twenty-five unique websites linked to 46 clinics were identified and reviewed. Twenty-four percent of websites were run by a urologist. Other specialties offering LISWT included general practitioners, anesthesiologists, naturopaths, nurse practitioners, physiotherapists, and registered massage therapists. Twenty-four percent of the websites advertised the use of a focused shockwave generator. Forty percent of the websites had peer-reviewed references. The average brief DISCERN score was 14 (standard deviation 3.4). There was no association between the physician-or non-physician-led websites and the use of peer-reviewed references, readability scores, the number of clinic locations, or higher brief discern scores.</p><p><strong>Conclusions: </strong>LISWT is readily advertised online for ED and PD patients in Canada; however, only a minority use a focused shockwave generator. There is a wide diversity of practitioners offering LISWT. Websites offering LISWT are generally of poor quality and do not provide adequate information for patients to make educated treatment decisions.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":" ","pages":"E358-E363"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9944834","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
Predictors of postoperative urinary tract infection following holmium laser enucleation of the prostate. 钬激光前列腺摘除术后尿路感染的预测因素。
Mohamed Elsaqa, Katherine Dowd, Amr El Mekresh, Karen M Doersch, Marawan M El Tayeb

Introduction: Storage urinary symptoms and urinary tract infection (UTI) are among the most common complications following holmium laser enucleation of the prostate (HoLEP). We aimed to study the incidence and risk factors for storage urinary symptoms and early UTI following HoLEP.

Methods: A prospectively maintained database was reviewed for patients who underwent HoLEP over a five-year period at a single tertiary center. Patient demographics, preoperative, operative, and postoperative characteristics, as well as infection rates, were obtained and analyzed using the appropriate statistical methods.

Results: Of a total 514 patients who underwent HoLEP, 473 patients with complete followup data were included. Mean (± standard deviation) age and median (interquartile range) prostate volume were 72±9.1 years and 89 (68-126) g, respectively. Preoperative positive urine culture and urine retention were seen in 28.5% (n=135) and 23.46 % (n=111) of patients, respectively. At six-week followup, irritative urinary symptoms were seen in 32.3% (n=153) of patients, while 13.5% (n= 64) of patients had positive urine culture. Bivariate and multivariate analysis showed that factors associated with significant higher rate of postoperative UTI at six weeks were high body mass index (BMI) (p= 0.023), weak grip strength within preoperative frailty assessment (p=0.042), positive preoperative urine culture (p=0.025), and postoperative incontinence (p=0.002).

Conclusions: Storage urinary symptoms are common complaints post-HoLEP; however, it may be caused by an inflammatory rather than infective process in a significant percentage of patients. Possible predictors of UTI after HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence.

导读:储尿症状和尿路感染(UTI)是钬激光前列腺摘除(HoLEP)后最常见的并发症。我们的目的是研究HoLEP后储尿症状和早期UTI的发生率和危险因素。方法:回顾了一个前瞻性维护的数据库,其中包括在单个三级中心接受HoLEP治疗超过五年的患者。采用适当的统计方法获取并分析患者人口统计学、术前、手术和术后特征以及感染率。结果:在514例接受HoLEP治疗的患者中,有473例患者有完整的随访资料。平均年龄(±标准差)为72±9.1岁,前列腺体积中位数(四分位间距)为89 (68-126)g。术前尿培养阳性135例(28.5%),尿潴留111例(23.46%)。在6周的随访中,32.3% (n=153)的患者出现刺激性尿路症状,13.5% (n= 64)的患者尿培养阳性。双因素和多因素分析显示,与术后6周尿路感染发生率显著升高相关的因素为高体重指数(BMI) (p= 0.023)、术前虚弱评估中握力弱(p=0.042)、术前尿培养阳性(p=0.025)和术后尿失禁(p=0.002)。结论:储尿症状是holep术后常见的主诉;然而,在很大比例的患者中,它可能是由炎症而不是感染过程引起的。HoLEP术后UTI的可能预测因素为高BMI、术前尿培养阳性、较高的虚弱量表和术后尿失禁。
{"title":"Predictors of postoperative urinary tract infection following holmium laser enucleation of the prostate.","authors":"Mohamed Elsaqa, Katherine Dowd, Amr El Mekresh, Karen M Doersch, Marawan M El Tayeb","doi":"10.5489/cuaj.8269","DOIUrl":"10.5489/cuaj.8269","url":null,"abstract":"<p><strong>Introduction: </strong>Storage urinary symptoms and urinary tract infection (UTI) are among the most common complications following holmium laser enucleation of the prostate (HoLEP). We aimed to study the incidence and risk factors for storage urinary symptoms and early UTI following HoLEP.</p><p><strong>Methods: </strong>A prospectively maintained database was reviewed for patients who underwent HoLEP over a five-year period at a single tertiary center. Patient demographics, preoperative, operative, and postoperative characteristics, as well as infection rates, were obtained and analyzed using the appropriate statistical methods.</p><p><strong>Results: </strong>Of a total 514 patients who underwent HoLEP, 473 patients with complete followup data were included. Mean (± standard deviation) age and median (interquartile range) prostate volume were 72±9.1 years and 89 (68-126) g, respectively. Preoperative positive urine culture and urine retention were seen in 28.5% (n=135) and 23.46 % (n=111) of patients, respectively. At six-week followup, irritative urinary symptoms were seen in 32.3% (n=153) of patients, while 13.5% (n= 64) of patients had positive urine culture. Bivariate and multivariate analysis showed that factors associated with significant higher rate of postoperative UTI at six weeks were high body mass index (BMI) (p= 0.023), weak grip strength within preoperative frailty assessment (p=0.042), positive preoperative urine culture (p=0.025), and postoperative incontinence (p=0.002).</p><p><strong>Conclusions: </strong>Storage urinary symptoms are common complaints post-HoLEP; however, it may be caused by an inflammatory rather than infective process in a significant percentage of patients. Possible predictors of UTI after HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":" ","pages":"E364-E368"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121126","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
The learning curve for pure retroperitoneoscopic donor nephrectomy by using cumulative sum analysis. 单纯后腹膜镜供肾切除术学习曲线的累积和分析。
Mehmet Necmettin Mercimek, Ender Ozden, Murat Gulsen, Onur Kalayci, Yarkin Kamil Yakupoglu, Yakup Bostanci, Saban Sarikaya

Introduction: This study aimed to identify a precise learning curve for pure retroperitoneoscopic donor nephrectomy (RDN).

Methods: Data from 172 consecutive kidney donors who underwent pure RDN between January 2010 and July 2019 were prospectively collected and evaluated. Cumulative sum (CUSUM) analysis was used for testing the operation time. Changepoints were determined by using the r program and BINSEG method. The cohort was divided into three groups - group 1: competence, including the first 10 cases; group 2: 11-48 cases as proficiency; and group 3: the subsequent 124 cases as expert level. Continuous variables were evaluated using one-way ANOVA, and categorical data were evaluated using the Chi-squared test.

Results: Right RDN was performed in 39 (22.7%) donors. The eighth patient was converted to open surgery due to vena cava injury and excluded from the CUSUM analysis. Depending on experience in pure RDN, a significant decrease was detected in operative time (p<0.001), warm ischemia time (p=0.006), and blood loss (p<0.001). Recipient complications and graft function were found to be statistically comparable.

Conclusions: In our study, the attainment of expertise in pure RDN was observed after performing 50 cases. The transperitoneal technique, which is a feasible alternative, is far more widely used than pure RDN. We believe that understanding the learning curve associated with pure RDN could facilitate the adoption of this approach as a viable alternative to the transperitoneal approach.

本研究旨在确定纯后腹膜镜供体肾切除术(RDN)的精确学习曲线。方法:前瞻性收集和评估2010年1月至2019年7月期间接受纯RDN的172名连续肾供者的数据。采用累积和(CUSUM)分析法对手术时间进行检验。使用r程序和BINSEG方法确定变化点。该队列分为三组:第一组:胜任,包括前10例;第二组:熟练11-48例;第三组:后续124例为专家级。使用单因素方差分析评估连续变量,使用卡方检验评估分类数据。结果:39例(22.7%)供者进行了正确的RDN。第8例患者因腔静脉损伤转入开放手术,排除在CUSUM分析之外。根据纯RDN的经验,手术时间明显减少(p结论:在我们的研究中,在执行了50例纯RDN后观察到专业知识的获得。经腹膜技术是一种可行的替代方法,其应用范围远比纯RDN广泛。我们相信,了解与纯RDN相关的学习曲线可以促进采用这种方法作为经腹膜入路的可行替代方法。
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引用次数: 0
Quantitative and qualitative impact of physician assistants in a Canadian urology setting. 加拿大泌尿外科环境中医生助理的数量和质量影响。
James Misurka, Katherine Lajkosz, Miran Kenk, Antonio Finelli, Neil E Fleshner

Introduction: Physician assistants (PAs) are healthcare professionals who act as physician extenders. PAs are being used more and more in a wide variety of clinic settings throughout Canada to increase access to healthcare and reduce cost. We set out to determine the impact of PAs on a tertiary care center urologic oncology practice.

Methods: We reviewed Ontario Health Insurance Plan (OHIP) billing codes since the introduction of PAs for two attending urologists at Princess Margaret Cancer Centre. Data were grouped into early experience and established experience. In addition, questionnaires were electronically distributed among nurses, physicians, residents, and fellows who work with PAs in clinic. Patient visits conducted by PAs were tracked for one quarter to estimate the amount of annual patients seen by PAs. The costs associated with PAs are presented as recommendations for a new graduate PA hire.

Results: On average, PAs increased clinic volume by 11.3 patient visits per day. Furthermore, they individually care for an average of 24 patients per day. PAs did not represent a financial burden on the urology practice plan (revenue gain of $16 800). Our questionnaire demonstrated that PAs were capable healthcare professionals, who decreased workload and contributed to resident/fellow education.

Conclusions: PAs in a Canadian urology practice allow for more patient visits, decrease in physician workload, and positively impact trainee education. PAs saw more patients in clinic than clinic growth, thereby decreasing physician, fellow, and resident workload. The offset of the increase in patient visits made the PAs a cost-neutral investment.

简介:医师助理(PA)是作为医师延伸者的医疗保健专业人员。PA在加拿大各地的各种诊所中越来越多地被使用,以增加获得医疗保健的机会并降低成本。我们着手确定PA对三级护理中心泌尿肿瘤实践的影响。方法:我们回顾了自癌症公主中心为两名泌尿科主治医师引入PA以来,安大略省健康保险计划(OHIP)的账单代码。数据分为早期经验和既定经验。此外,问卷以电子方式分发给护士、医生、住院医师和在诊所与PA合作的同事。对私人助理进行的患者就诊进行了四分之一的跟踪,以估计私人助理每年就诊的患者数量。与PA相关的费用作为新毕业生PA招聘的建议。结果:PA平均每天增加11.3名患者的就诊量。此外,他们平均每天单独照顾24名患者。PA并不代表泌尿外科实践计划的财务负担(收入增加16800美元)。我们的问卷调查表明,PA是有能力的医疗保健专业人员,他们减少了工作量,并为住院医师/同事的教育做出了贡献。结论:加拿大泌尿外科实践中的PA允许更多的患者就诊,减少医生工作量,并对受训人员的教育产生积极影响。PA在临床上看到的患者比在临床上更多,从而减少了医生、同事和住院医生的工作量。患者就诊次数的增加抵消了PA的成本中性投资。
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引用次数: 0
Genetic testing practices among specialist physicians who treat prostate cancer A Canadian, cross-sectional survey. 治疗前列腺癌症的专科医生的基因检测实践加拿大的一项横断面调查。
Steven M Yip, Christopher Morash, Michael P Kolinsky, Anil Kapoor, Michael Ong, Shamini Selvarajah, Jennifer Nuk, Katie Compton, Frederic Pouliot, Luke T Lavallée, Daniel J Khalaf, Robert J Hamilton, Geoffrey T Gotto, Ricardo A Rendon, Elie Antebi, Sebastien J Hotte, Shawn Malone, Kim N Chi, Darrel E Drachenberg, Fred Saad, Jonathan Chan, Cristiano Ferrario, Jenny Ko, Bobby Shayegan, Sunil Parimi, Alan I So, Andrew Feifer, Kenneth Jansz, Daygen Finch, Joseph L Chin, Brendan Osborne, Kai Fai Ho, Corine Demanga Galamo, Anousheh Zardan, Tamim Niazi

Introduction: In patients with prostate cancer (PCa), the identification of an alteration in genes associated with homologous recombination repair (HRR) has implications for prognostication, optimization of therapy, and familial risk mitigation. The aim of this study was to assess the genomic testing landscape of PCa in Canada and to recommend an approach to offering germline and tumor testing for HRR-associated genes.

Methods: The Canadian Genitourinary Research Consortium (GURC) administered a cross-sectional survey to a largely academic, multidisciplinary group of investigators across 22 GURC sites between January and June 2022.

Results: Thirty-eight investigators from all 22 sites responded to the survey. Germline genetic testing was initiated by 34%, while 45% required a referral to a genetic specialist. Most investigators (82%) reported that both germline and tumor testing were needed, with 92% currently offering germline and 72% offering tissue testing to patients with advanced PCa. The most cited reasons for not offering testing were an access gap (50%), uncertainties around who to test and which genes to test, (33%) and interpreting results (17%). A majority reported that patients with advanced PCa (74-80%) should be tested, with few investigators testing patients with localized disease except when there is a family history of PCa (45-55%).

Conclusions: Canadian physicians with academic subspecialist backgrounds in genitourinary malignancies recognize the benefits of both germline and somatic testing in PCa; however, there are challenges in accessing testing across practices and specialties. An algorithm to reduce uncertainty for providers when ordering genetic testing for patients with PCa is proposed.

简介:在癌症(PCa)患者中,识别与同源重组修复(HRR)相关的基因改变对预后、治疗优化和家族风险减轻具有重要意义。本研究的目的是评估加拿大前列腺癌的基因组检测情况,并推荐一种为HRR相关基因提供种系和肿瘤检测的方法。方法:2022年1月至6月,加拿大泌尿生殖研究联合会(GURC)对22个研究点的一个以学术为主的多学科研究小组进行了横断面调查。结果:来自所有22个研究地点的38名研究人员对调查做出了回应。34%的人开始进行种系基因检测,45%的人需要转诊给基因专家。大多数研究人员(82%)报告说,需要进行种系和肿瘤检测,92%的研究人员目前提供种系检测,72%的研究人员为晚期前列腺癌患者提供组织检测。不提供检测的最常见原因是获取差距(50%)、检测对象和检测基因的不确定性(33%)和解释结果(17%)。大多数报告称,晚期前列腺癌患者(74-80%)应该接受检测,很少有研究人员对局部疾病患者进行检测,除非有前列腺癌家族史(45-55%);然而,在跨实践和专业访问测试方面存在挑战。提出了一种算法,以减少提供者在为前列腺癌患者进行基因检测时的不确定性。
{"title":"Genetic testing practices among specialist physicians who treat prostate cancer A Canadian, cross-sectional survey.","authors":"Steven M Yip,&nbsp;Christopher Morash,&nbsp;Michael P Kolinsky,&nbsp;Anil Kapoor,&nbsp;Michael Ong,&nbsp;Shamini Selvarajah,&nbsp;Jennifer Nuk,&nbsp;Katie Compton,&nbsp;Frederic Pouliot,&nbsp;Luke T Lavallée,&nbsp;Daniel J Khalaf,&nbsp;Robert J Hamilton,&nbsp;Geoffrey T Gotto,&nbsp;Ricardo A Rendon,&nbsp;Elie Antebi,&nbsp;Sebastien J Hotte,&nbsp;Shawn Malone,&nbsp;Kim N Chi,&nbsp;Darrel E Drachenberg,&nbsp;Fred Saad,&nbsp;Jonathan Chan,&nbsp;Cristiano Ferrario,&nbsp;Jenny Ko,&nbsp;Bobby Shayegan,&nbsp;Sunil Parimi,&nbsp;Alan I So,&nbsp;Andrew Feifer,&nbsp;Kenneth Jansz,&nbsp;Daygen Finch,&nbsp;Joseph L Chin,&nbsp;Brendan Osborne,&nbsp;Kai Fai Ho,&nbsp;Corine Demanga Galamo,&nbsp;Anousheh Zardan,&nbsp;Tamim Niazi","doi":"10.5489/cuaj.8403","DOIUrl":"10.5489/cuaj.8403","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with prostate cancer (PCa), the identification of an alteration in genes associated with homologous recombination repair (HRR) has implications for prognostication, optimization of therapy, and familial risk mitigation. The aim of this study was to assess the genomic testing landscape of PCa in Canada and to recommend an approach to offering germline and tumor testing for HRR-associated genes.</p><p><strong>Methods: </strong>The Canadian Genitourinary Research Consortium (GURC) administered a cross-sectional survey to a largely academic, multidisciplinary group of investigators across 22 GURC sites between January and June 2022.</p><p><strong>Results: </strong>Thirty-eight investigators from all 22 sites responded to the survey. Germline genetic testing was initiated by 34%, while 45% required a referral to a genetic specialist. Most investigators (82%) reported that both germline and tumor testing were needed, with 92% currently offering germline and 72% offering tissue testing to patients with advanced PCa. The most cited reasons for not offering testing were an access gap (50%), uncertainties around who to test and which genes to test, (33%) and interpreting results (17%). A majority reported that patients with advanced PCa (74-80%) should be tested, with few investigators testing patients with localized disease except when there is a family history of PCa (45-55%).</p><p><strong>Conclusions: </strong>Canadian physicians with academic subspecialist backgrounds in genitourinary malignancies recognize the benefits of both germline and somatic testing in PCa; however, there are challenges in accessing testing across practices and specialties. An algorithm to reduce uncertainty for providers when ordering genetic testing for patients with PCa is proposed.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":" ","pages":"326-336"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10581730/pdf/cuaj-10-326.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873266","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}
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Canadian Urological Association journal = Journal de l'Association des urologues du Canada
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