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Collecting duct renal cell carcinoma: a single centre series and review of the literature. 收集管肾细胞癌:单中心系列和文献回顾。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-09-06 DOI: 10.5173/ceju.2022.0143
Wies Vanderbruggen, Marc Claessens, Vincent De Coninck, Aline Duchateau, Thomas Gevaert, Steven Joniau, Robert Hente

Introduction: Collecting duct, or Bellini duct, renal cell carcinoma (CDRCC) is a rare tumour, comprising only 0.4-2% of all renal cell carcinoma. The goal of this study was to evaluate the cases in our institution and look at current available literature.

Material and methods: We searched all data on renal cell tumours in our institution between 2011 and 2021 and identified four cases with confirmed CDRCC pathology. Important features were listed and analysed. We also reviewed current available literature and compared it to our case series.

Results: All cases were men with a median age of 63.5 years. All were symptomatic at presentation. Two patients presented with flank pain and two with gross haematuria. Three patients had stage IV disease at time of presentation and one stage III disease. All cases had clear Bellini duct renal cell carcinoma appearance on microscopy with infiltrative tubular architecture and high-grade nuclear features. Immunohistochemic (IHC) staining was performed for diagnostic confirmation. Three patients underwent radical nephrectomy and received adjuvant chemotherapy. One case had kidney biopsy for diagnostic confirmation and received first line chemotherapy. Immunotherapy or tyrosine kinase inhibitor (TKI) were started for second, third or fourth line of treatment. Median overall survival after diagnosis was 11 months.

Conclusions: CDRCC is a rare subtype of renal cell carcinoma with poor prognosis, typically presenting in a more advanced or metastatic stage. Diagnosis can be challenging. Multimodality treatment should be considered using radical surgery and systemic treatment.

导言:收集管或贝利尼管肾细胞癌(CDRCC)是一种罕见的肿瘤,仅占所有肾细胞癌的0.4-2%。本研究的目的是评估我们机构的病例,并查看当前可用的文献。材料和方法:我们检索了我院2011年至2021年肾细胞肿瘤的所有数据,并确定了4例确诊的CDRCC病理。列举并分析了其重要特征。我们还回顾了当前可用的文献,并将其与我们的病例系列进行了比较。结果:所有病例均为男性,中位年龄63.5岁。所有患者在发病时均有症状。2例患者出现腹部疼痛,2例出现肉眼血尿。3例患者在发病时为IV期疾病,1例为III期疾病。所有病例镜检均有清晰的贝利尼管肾细胞癌表现,具有浸润性管状结构和高级别核征。免疫组织化学(IHC)染色进行诊断确认。3例患者行根治性肾切除术并辅助化疗。1例行肾活检确诊并行一线化疗。免疫疗法或酪氨酸激酶抑制剂(TKI)开始第二,第三或第四线治疗。诊断后的中位总生存期为11个月。结论:CDRCC是一种罕见的肾细胞癌亚型,预后较差,通常出现在较晚期或转移期。诊断可能具有挑战性。应考虑综合治疗,包括根治性手术和全身治疗。
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引用次数: 2
Perioperative and oncological outcomes of laparoscopic and open radical nephroureterectomy for locally advanced upper tract urothelial carcinoma: a single-center cohort study. 腹腔镜和开放式根治性肾输尿管切除术治疗局部晚期上尿路癌的围手术期和肿瘤预后:一项单中心队列研究
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-09-14 DOI: 10.5173/ceju.2022.103
Jorge Correia, Gonçalo Mendes, Bernardo Texeira, Mariana Madanelo, Avelino Fraga, Miguel Silva-Ramos

Introduction: Open radical nephroureterectomy (ONU) is the standard of care for treatment of upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LNU) is increasingly being used due to better perioperative outcomes. However, its oncological safety remains controversial, in particular for advanced disease.We aimed to compare perioperative and oncological outcomes between surgical approaches in locally advanced UTUC (≥pT3 and/or pN+).

Material and methods: This study was a retrospective analysis of all 48 patients submitted to radical nephroureterectomy for advanced UTUC between 2006 and 2020 in our center.Perioperative data were compared between groups. Bladder tumor-free survival (BTFS), metastasis-free survival (MFS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier curves and compared with log-rank p test. Multivariable Cox regression model was used to evaluate their association with surgical approach.

Results: Clinical and pathological characteristics were similar between groups. LNU had lower blood loss (p = 0.031), need for transfusion (p = 0.013) and length of hospital stay (p <0.001), with similar operative time (p = 0.860).LNU was associated with better MFS (hazard ratio [HR]: 0.43, 95% confidence interval [CI] 0.20-0.93, p = 0.033) and CSS (HR: 0.42, 95%CI 0.19-0.94, p = 0.036). Median time to cancer death was 41 months for LNU and 12 months for ONU (log-rank p = 0.029). BTFS was similar between groups (HR: 0.60, 95%CI 0.17-2.11, p = 0.427). On multivariable Cox regression model, surgical approach wasn't significantly associated with MFS (p = 0.202), CSS (p = 0.149) or BTFS (p = 0.586).

Conclusions: In our cohort of advanced UTUC, LNU did not result in inferior oncological control compared to ONU. The minimally invasive approach conferred an advantage in perioperative outcomes.

导读:开放式根治性肾输尿管切除术(ONU)是治疗上尿路上皮癌(UTUC)的标准护理方法,但腹腔镜根治性肾输尿管切除术(LNU)因其更好的围手术期疗效而越来越多地被采用。然而,其肿瘤安全性仍然存在争议,特别是对于晚期疾病。我们的目的是比较局部晚期UTUC(≥pT3和/或pN+)手术入路的围手术期和肿瘤预后。材料和方法:本研究回顾性分析了2006年至2020年在我中心接受根治性肾输尿管切除术治疗晚期UTUC的48例患者。比较两组围手术期资料。膀胱无肿瘤生存期(BTFS)、无转移生存期(MFS)和肿瘤特异性生存期(CSS)采用Kaplan-Meier曲线估计,并采用log-rank p检验进行比较。采用多变量Cox回归模型评价其与手术入路的关系。结果:两组临床及病理特征相似。LNU的失血量(p = 0.031)、输血需求(p = 0.013)和住院时间(p)较低。结论:在我们的晚期UTUC队列中,与ONU相比,LNU没有导致较差的肿瘤控制。微创入路在围手术期预后方面具有优势。
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引用次数: 2
Robotic-assisted, laparoscopic, and open radical cystectomy: surgical data of 1400 patients from The Italian Radical Cystectomy Registry on intraoperative outcomes. 机器人辅助、腹腔镜和开放式根治性膀胱切除术:来自意大利根治性膀胱切除术登记处的1400例患者术中结果的手术数据。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-05-04 DOI: 10.5173/ceju.2022.0284
Angelo Porreca, Luca Di Gianfrancesco, Walter Artibani, Gian Maria Busetto, Giuseppe Carrieri, Alessandro Antonelli, Lorenzo Bianchi, Eugenio Brunocilla, Aldo Massimo Bocciardi, Marco Carini, Antonio Celia, Giovanni Cochetti, Andrea Gallina, Ettore Mearini, Andrea Minervini, Riccardo Schiavina, Sergio Serni, Daniele D'Agostino, Erica Debbi, Paolo Corsi, Alessandro Crestani

Introduction: The Italian Radical Cystectomy Registry (Registro Italiano Cistectomie - RIC) aimed to analyse outcomes of a multicenter series of patients treated with radical cystectomy (RC) for bladder cancer.

Material and methods: An observational, prospective, multicenter, cohort study was performed to collect data from RC and urinary diversion via open (ORC), laparoscopic (LRC), or robotic-assisted (RARC) techniques performed in 28 Italian Urological Departments. The enrolment was planned from January 2017 to June 2020 (goal: 1000 patients), with a total of 1425 patients included. Chi-square and t-tests were used for categorical and continuous variables. All tests were 2-sided, with a significance level set at p <0.05.

Results: Overall median operative-time was longer in RARCs (390 minutes, IQR 335-465) than ORCs (250, 217-309) and LRCs (292, 228-350) (p <0.001). Lymph node dissection (LND) was performed more frequently in RARCs (97.1%) and LRCs (93.5%) than ORCs (85.6%) (p <0.001), with extended-LND performed 2-fold more frequently in RARCs (61.6%) (p <0.001). The neobladder rate was significantly higher (more than one-half) in RARCs. The median estimated blood loss (EBL) rate was lower in RARCs (250 ml, 165-400) than LRCs (330, 200-600) and ORCs (400, 250-600) (p <0.001), with intraoperative blood transfusion rates of 11.4%, 21.7% and 35.6%, respectively (p <0.001). The conversion to open rate was slightly higher in RARCs (6.8%) than LRCs (4.3%). Intraoperative complications occurred in 1.3% of cases without statistically significant differences among the approaches.

Conclusions: Data from the RIC confirmed the need to collect as much data as possible in a multicenter manner. RARCs proves to be feasible with perioperative complication rates that do not differ from the other approaches.

简介:意大利根治性膀胱切除术登记(Registro Italiano Cistectomie - RIC)旨在分析多中心系列接受根治性膀胱切除术(RC)治疗膀胱癌的患者的结果。材料和方法:一项观察性、前瞻性、多中心、队列研究收集了意大利28个泌尿科通过开放(ORC)、腹腔镜(LRC)或机器人辅助(RARC)技术进行的RC和尿转移的数据。计划于2017年1月至2020年6月入组(目标:1000例患者),共纳入1425例患者。分类变量和连续变量采用卡方检验和t检验。结果:rarc的总中位手术时间(390分钟,IQR 335-465)比ORCs(250、217-309)和lrc(292、228-350)更长(p)。结论:RIC的数据证实了以多中心方式收集尽可能多的数据的必要性。rarc被证明是可行的,其围手术期并发症发生率与其他方法没有什么不同。
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引用次数: 5
Sex-related differences in non-urothelial variant histology, non-muscle invasive bladder cancer. 非尿路上皮变异组织学、非肌肉浸润性膀胱癌的性别相关差异。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-07-18 DOI: 10.5173/ceju.2022.0053
Rocco Simone Flammia, Francesco Chierigo, Christoph Würnschimmel, Mike Wenzel, Benedikt Horlemann, Zhen Tian, Marco Borghesi, Costantino Leonardo, Derya Tilki, Shahrokh F Shariat, Umberto Anceschi, Felix K H Chun, Carlo Terrone, Fred Saad, Michele Gallucci, Pierre I Karakiewicz

Introduction: Non-urothelial variant histology (VH), non-muscle invasive bladder cancer (NMIBC) has received little attention in contemporary urologic literature. Specifically, the effect of female sex on stage at presentation, as well as on cancer-specific mortality (CSM) have not been previously examined in VH NMIBC. Our aim was to test the effect of female sex on stage at presentation and CSM in VH NMIBC.

Material and methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified patients aged ≥18 years, with histologically confirmed VH NMIBC. Logistic regression models addressed T1 stage at diagnosis after multivariable adjustments for tumor grade, age and race/ethnicity. Before Kaplan-Meier plots and Cox regression analyses, propensity score matched adjusting for histological variants, T-stage, tumor grade, age and race/ethnicity was performed.

Results: Overall, 2,205 VH NMIBC patients were identified. Of those, 28% (n = 607) were female. Females were older (77 vs 74 years, p <0.001) and more frequently harbored T1 stage (55 vs 45%, p <0.001). Female sex independently predicted T1 stage (odds ratio [OR] = 1.66, 95% Confidence Interval [CI] = 1.35-2.03, p <0.001). Female sex also exhibited higher CSM, after matching for all assessable variables, including stage (hazard ratio [HR] = 1.91, 95% CI = 1.45-2.54, p <0.001).

Conclusions: In VH NMIBC, female sex is an indicator of higher rate of T1 stage and, fully independently of stage, female sex also results in higher CSM.

简介:非尿路上皮变异组织学(VH),非肌肉浸润性膀胱癌(NMIBC)在当代泌尿学文献中很少受到关注。具体地说,女性对呈现阶段的影响,以及对癌症特异性死亡率(CSM)的影响,此前尚未在VH NMIBC中进行过研究。我们的目的是测试女性在VH NMIBC中对讲台和CSM的影响。材料和方法:在监测、流行病学和最终结果(SEER)数据库(2004-2016)中,我们确定了年龄≥18岁、组织学证实为VH NMIBC的患者。在对肿瘤分级、年龄和种族/民族进行多变量调整后,Logistic回归模型解决了T1阶段的诊断问题。在Kaplan-Meier图和Cox回归分析之前,对组织学变异、t分期、肿瘤分级、年龄和种族/民族进行倾向评分匹配调整。结果:总共有2205例VH NMIBC患者被确定。其中,28% (n = 607)是女性。结论:在VH NMIBC中,女性性别是T1期发生率较高的一个指标,并且完全独立于分期,女性性别也导致较高的CSM。
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引用次数: 1
Prospective long-term experience in the treatment of renal tumors with cryotherapy: follow-up with computed tomography scan and contrast-enhanced ultrasound. 肾肿瘤冷冻治疗的前瞻性长期经验:计算机断层扫描和增强超声随访。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-09-24 DOI: 10.5173/ceju.2022.125
Inés Laso-García, Fernando Arias-Fúnez, Marta Santiago-González, Enrique Sanz-Mayayo, Gema Duque-Ruiz, Manuel Hevia-Palacios, Victoria Gómez-Dos-Santos, Andreina Olavarria-Delgado, Ana Palomera-Rico, Francisco Javier Burgos-Revilla

Introduction: The aim of this article was to evaluate the oncological results and safety of cryotherapy for the treatment of renal tumors.

Material and methods: This study was a prospective review and follow-up of patients who underwent cryotherapy from January 2008 to May 2021. Cryotherapy was offered to patients with bilateral tumors, tumors in solitary kidneys, or comorbid patients. Follow-up consisted of a computed tomography (CT) scan and contrast-enhanced ultrasound (CEUS), with analysis of concordance (kappa index). Overall survival and kidney survival were analyzed (Kaplan-Meier).

Results: Cryotherapy was performed 71 times in 67 patients. A total of 74.6% of patients were men. The mean age of patients was 69.7 years (standard deviation (SD) 11.3]. Mean follow-up was 52.7 months (SD 36.2). Mean tumor size was 26.2 mm (SD 7.6). 90% were cT1a, 10% cT1b stage. Type of access was open in 1 patient, laparoscopic in 8, percutaneous US-guided in 8 and percutaneous CT-guided in 54 patients. Biopsy was taken in 60 patients (84.5%) and consisted of renal cell carcinoma (22), oncocytoma (9), papillary carcinoma (4), angiomyolipoma (1), sarcoma (1), and non-conclusive (23).There were 22 complications such as pain in 2 patients, hematoma in 8 and 2 cases of bleeding, all resolved conservatively except for one case of bleeding which required embolization.Recurrences occurred in 16 cases (22.5%). Management was cryotherapy in 25%, radical nephrectomy in 31.3% and surveillance in 43.8%. Concordance between contrast-enhanced ultrasound and CT was 0.8 (excellent).Mean glomerular filtration did not change. One patient developed metastasis.No cancer-specific mortality was found. Overall survival at 12, 24 and 48 months was 98.5%, 96.8% and 76.9% respectively. Kidney survival at 12, 24 and 48 months was 97%, 93.5% and 93.5% respectively.

Conclusions: Cryotherapy for renal tumors is a safe treatment for comorbid or solitary kidney patients, with rare major complications and good oncological outcome.

导读:本文的目的是评价冷冻治疗肾肿瘤的肿瘤学结果和安全性。材料和方法:本研究对2008年1月至2021年5月接受冷冻治疗的患者进行前瞻性回顾和随访。冷冻疗法适用于双侧肿瘤、单侧肾脏肿瘤或合并症患者。随访包括计算机断层扫描(CT)和超声造影(CEUS),并分析一致性(kappa指数)。分析总生存期和肾生存期(Kaplan-Meier)。结果:67例患者共行冷冻治疗71次。74.6%的患者为男性。患者平均年龄为69.7岁(标准差为11.3)。平均随访52.7个月(SD 36.2)。平均肿瘤大小26.2 mm (SD 7.6)。90%为cT1a期,10%为cT1b期。开放方式1例,腹腔镜8例,经皮us引导8例,经皮ct引导54例。60例(84.5%)患者进行了活检,包括肾细胞癌(22例)、嗜瘤细胞瘤(9例)、乳头状癌(4例)、血管平滑肌脂肪瘤(1例)、肉瘤(1例)和不确定(23例)。术后出现疼痛2例,血肿8例,出血2例等22例并发症,除1例出血需栓塞外,其余均保守解决。复发16例(22.5%)。治疗方法为冷冻治疗占25%,根治性肾切除术占31.3%,监测占43.8%。超声造影与CT的符合率为0.8(优秀)。平均肾小球滤过没有改变。1例患者出现转移。没有发现癌症特异性死亡率。12、24和48个月的总生存率分别为98.5%、96.8%和76.9%。12个月、24个月和48个月肾脏存活率分别为97%、93.5%和93.5%。结论:肾肿瘤冷冻治疗对于合并症或单纯性肾患者是一种安全的治疗方法,主要并发症罕见,肿瘤预后良好。
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引用次数: 1
Definition of clinically insignificant residual fragments after percutaneous nephrolithotomy among urologists: a world-wide survey by EAU-YAU Endourology and Urolithiasis Working Group. 泌尿科医师经皮肾镜取石术后临床不显著残余碎片的定义:EAU-YAU泌尿外科和尿石症工作组的一项全球调查。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-08-18 DOI: 10.5173/ceju.2022.0115
Senol Tonyali, Esteban Emiliani, Tarik Emre Şener, Amelia Pietropaolo, Mehmet Ӧzsoy, Omar Aboumarzouk, Bhaskar Somani, Panagiotis Kallidonis, Vincent M J De Coninck, Michele Talso, Etienne Xavier Keller, Nicola Macchione, Thomas Tailly

Introduction: The aim of this article was to evaluate the current perception of urologists as to what size is considered as a clinically insignificant residual fragment (CIRF).

Material and methods: A survey was globally distributed to the members of the Endourological Society via SurveyMonkey.

Results: A total of 385 participants responded to the survey on CIRF. Most participants considered 2 mm (29%) as CIRF threshold, followed by 3 mm (24%), 4 mm (22%), 0 mm (14%), 5 mm (8%) and 1 mm (3%). North American urologists considered CIRF to be smaller than urologists from Asia, Eurasia and South America, (p-values ≤0.001, 0.037 and 0.015 respectively). European urologists identified smaller CIRF in comparison to Asian urologists (p-value = 0.001). Urologists mainly using a pneumatic lithotripter accepted larger fragments as CIRF, compared to urologists mainly using ultrasonic devices or a combination of ultrasonic and pneumatic devices (p-value = 0.026 and 0.005 respectively). Similarly, urologists mainly performing X-Ray and ultrasound as post-operative imaging accepted larger fragments as CIRF in comparison to urologists mainly performing non-contrast computed tomography (p-value = 0.001).

Conclusions: What is considered as CIRF varies between urologist from different continents and seems to be associated with the lithotripter used and the post-operative imaging modality of preference to assess treatment success.

简介:本文的目的是评估泌尿科医生目前对临床无关紧要的残余碎片(CIRF)大小的看法。材料和方法:通过SurveyMonkey在全球范围内向endourology Society成员分发调查。结果:共有385名参与者参与了CIRF调查。大多数参与者认为2毫米(29%)是CIRF阈值,其次是3毫米(24%)、4毫米(22%)、0毫米(14%)、5毫米(8%)和1毫米(3%)。北美泌尿科医师认为CIRF小于亚洲、欧亚大陆和南美泌尿科医师(p值分别≤0.001、0.037和0.015)。与亚洲泌尿科医师相比,欧洲泌尿科医师鉴定出较小的CIRF (p值= 0.001)。主要使用气动碎石机的泌尿科医师接受的碎片量比主要使用超声碎石机或超声与气动联合碎石机的泌尿科医师接受的碎片量更大(p值分别为0.026和0.005)。同样,与主要采用非对比计算机断层扫描的泌尿科医生相比,主要采用x线和超声作为术后成像的泌尿科医生接受的CIRF片段更大(p值= 0.001)。结论:不同大洲的泌尿科医生对CIRF的定义不同,似乎与使用的碎石机和评估治疗成功的首选术后成像方式有关。
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引用次数: 1
Demographics of men receiving vasectomies in Poland 2019-2020. 波兰2019-2020年接受输精管切除术的男性人口统计数据。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-05-18 DOI: 10.5173/ceju.2022.0086
Emilia Pawłowska-Krajka, Mateusz Bajkowski, Adam Dorobek, Bartosz Hnatowski, Piotr Radziszewski

Introduction: The demographics of men undergoing vasectomy in Poland has not been thoroughly evaluated. The objective of the study is to characterise patients who underwent vasectomy in 2019-2020 in terms of their motivation, the level of acceptance of the method, their social and health status and the way religion influenced their choice.

Material and methods: This is a prospective observational study based on a survey taken before vasectomy. The surveys attached were collected in 2019-2020. A total number of 253 surveys were collected.

Results: A total of 43 men aged between 31 and 40 constituted 56.52% of all patients. Of the patients surveyed, 123 (48.62%) were in their first stable relationship. In total, 230 participants (90.91%) declared no intention of having children. A total of 128 patients surveyed (50.59%) showed no interest in the possibility of adoption, whereas 109 (43.08%) did consider adoption. Most of the patients - 150 (59.29%), had been considering vasectomy for 1-3 years. The most popular contraceptive methods were oral contraception - 68 surveyed (26.88%) and condoms - 66 (26.09%). Vasectomy did not collide with religion in 241 cases (95.26%). Seven patients (2.77%) chose vasectomy due to a genetic defect. A total of 46 out of 243 men (18.18%) chose this contraceptive method due to their partners' health.

Conclusions: Vasectomy in Poland has been performed for over 18 years, however, accessibility has been limited. Recently, the procedure has been gaining in popularity. Now the age structure and partnership status correspond with the data from other centres in the world. Our study showed positive trends of co-responsibility of both partners for procreation and family planning.

波兰接受输精管结扎术的男性人口统计数据尚未得到全面评估。该研究的目的是描述2019-2020年接受输精管结扎术的患者的动机、对该方法的接受程度、他们的社会和健康状况以及宗教影响他们选择的方式。材料和方法:这是一项基于输精管结扎前调查的前瞻性观察研究。所附调查于2019-2020年收集。共收集了253份调查问卷。结果:男性43例,年龄31 ~ 40岁,占全部患者的56.52%。在接受调查的患者中,123例(48.62%)是第一次稳定的恋爱关系。总共有230人(90.91%)表示不打算要孩子。共有128名(50.59%)患者表示对收养的可能性不感兴趣,109名(43.08%)患者考虑收养。大多数患者(150例,59.29%)考虑输精管结扎1-3年。最常用的避孕方法是口服避孕药(68人,占26.88%)和避孕套(66人,占26.09%)。输精管结扎术与宗教信仰不冲突241例(95.26%)。7例(2.77%)患者因遗传缺陷选择输精管切除术。243名男子中有46人(18.18%)由于其伴侣的健康状况选择了这种避孕方法。结论:输精管结扎术在波兰已经进行了超过18年,然而,可及性受到限制。最近,这种手术越来越受欢迎。现在,年龄结构和伙伴关系状况与世界上其他中心的数据一致。我们的研究表明,夫妻双方对生育和计划生育共同负责的趋势是积极的。
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引用次数: 0
A gynecological perspective of interstitial cystitis/bladder pain syndrome may offer cure in selected cases. 从妇科角度看间质性膀胱炎/膀胱疼痛综合征可能为某些病例提供治疗。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 DOI: 10.5173/ceju.2022.106
Peter Petros

Introduction: Recent publications of interstitial cystitis (IC)/bladder pain syndrome cure by a gynecological prolapse protocol, run counter to traditional treatments such as bladder installations which do not offer such cure. The prolapse protocol, uterosacral ligament (USL) repair, is based on the 'Posterior Fornix Syndrome' (PFS). PFS was described in the 1993 iteration of the Integral Theory. PFS comprises predictably co-occurring symptoms of frequency, urgency, nocturia, chronic pelvic pain, abnormal emptying and post-void residual urine, caused by USL laxity and cured or improved by repair thereof.

Material and methods: analysis and interpretation of published data showing cure of IC by USL repair.

Results: In many women, USL pathogenesis of IC can be explained by the effect of weak or loose USLs weakening two pelvic muscles which contract against them, levator plate (LP) and conjoint longitudinal muscle of the anus (LMA). The now weakened pelvic muscles cannot stretch the vagina sufficiently to prevent afferent impulses from urothelial stretch receptors 'N' reaching the micturition centre where they are interpreted as urge. The same unsupported USLs cannot support the visceral sympathetic/parasympathetic visceral autonomic nerve plexuses (VP). The pathway of multiple referred pelvic pains is explained as follows: groups of afferent VP axons stimulated by gravity or muscle movements fire off 'rogue' impulses, which are interpreted by the cortex as end-organ chronic pelvic pain (CPP) from several end organs; this explains how CPP is invariably perceived in several sites. Reports of cure of non-Hunner's and Hunner's IC are analysed with diagrams which explain co-occurrence of IC with urge and phenotypes of chronic pelvic pain from several different sites.

Conclusions: A gynecological schema cannot explain all IC phenotypes, especially male IC. However, for those women who obtain relief from the predictive speculum test, there is a significant possibility of cure of both the pain and the urge by uterosacral ligament repair. In this context, it may well be in such female patients' interests, at least in the exploratory diagnostic phase, for ICS/BPS to be subsumed into the PFS disease category. It would give such women a significant chance of cure, something denied to them for now.

简介:最近发表的间质性膀胱炎(IC)/膀胱疼痛综合征通过妇科脱垂治疗方案,与传统的治疗方法,如膀胱安装,不提供这种治疗背道而驰。脱垂方案,子宫骶韧带(USL)修复,是基于“后穹窿综合征”(PFS)。PFS在1993年迭代的积分理论中被描述。PFS包括可预测的频率、尿急、夜尿、慢性盆腔疼痛、排空异常和空后残留尿等共同出现的症状,由USL松弛引起,通过修复USL松弛而治愈或改善。材料与方法:对USL修复治疗IC的已发表数据进行分析与解释。结果:在许多女性中,髂胫束的发病机制可以解释为弱或松散的USL削弱了对其收缩的盆腔肌肉,提肛板(LP)和肛门联合纵肌(LMA)。现在虚弱的骨盆肌肉不能充分拉伸阴道,以阻止来自尿路上皮拉伸受体'N'的传入冲动到达排尿中心,在那里它们被解释为冲动。同样的无支持usl不能支持内脏交感/副交感内脏自主神经丛(VP)。多发性盆腔疼痛的通路解释如下:重力或肌肉运动刺激的传入VP轴突群发出“流氓”脉冲,皮层将其解释为来自多个终末器官的慢性盆腔疼痛(CPP);这解释了为什么CPP在几个站点中总是被感知到。对非Hunner's和Hunner's IC的治疗报告进行了分析,并用图表解释了IC与冲动的共同发生以及来自不同部位的慢性盆腔疼痛的表型。结论:妇科模式不能解释所有IC表型,尤其是男性IC。然而,对于那些从预测镜试验中获得缓解的女性,子宫骶韧带修复有很大的可能性可以治愈疼痛和冲动。在这种情况下,至少在探索性诊断阶段,将ICS/BPS纳入PFS疾病类别可能符合这些女性患者的利益。这将给这些女性很大的治愈机会,这是她们目前无法获得的。
{"title":"A gynecological perspective of interstitial cystitis/bladder pain syndrome may offer cure in selected cases.","authors":"Peter Petros","doi":"10.5173/ceju.2022.106","DOIUrl":"https://doi.org/10.5173/ceju.2022.106","url":null,"abstract":"<p><strong>Introduction: </strong>Recent publications of interstitial cystitis (IC)/bladder pain syndrome cure by a gynecological prolapse protocol, run counter to traditional treatments such as bladder installations which do not offer such cure. The prolapse protocol, uterosacral ligament (USL) repair, is based on the 'Posterior Fornix Syndrome' (PFS). PFS was described in the 1993 iteration of the Integral Theory. PFS comprises predictably co-occurring symptoms of frequency, urgency, nocturia, chronic pelvic pain, abnormal emptying and post-void residual urine, caused by USL laxity and cured or improved by repair thereof.</p><p><strong>Material and methods: </strong>analysis and interpretation of published data showing cure of IC by USL repair.</p><p><strong>Results: </strong>In many women, USL pathogenesis of IC can be explained by the effect of weak or loose USLs weakening two pelvic muscles which contract against them, levator plate (LP) and conjoint longitudinal muscle of the anus (LMA). The now weakened pelvic muscles cannot stretch the vagina sufficiently to prevent afferent impulses from urothelial stretch receptors 'N' reaching the micturition centre where they are interpreted as urge. The same unsupported USLs cannot support the visceral sympathetic/parasympathetic visceral autonomic nerve plexuses (VP). The pathway of multiple referred pelvic pains is explained as follows: groups of afferent VP axons stimulated by gravity or muscle movements fire off 'rogue' impulses, which are interpreted by the cortex as end-organ chronic pelvic pain (CPP) from several end organs; this explains how CPP is invariably perceived in several sites. Reports of cure of non-Hunner's and Hunner's IC are analysed with diagrams which explain co-occurrence of IC with urge and phenotypes of chronic pelvic pain from several different sites.</p><p><strong>Conclusions: </strong>A gynecological schema cannot explain all IC phenotypes, especially male IC. However, for those women who obtain relief from the predictive speculum test, there is a significant possibility of cure of both the pain and the urge by uterosacral ligament repair. In this context, it may well be in such female patients' interests, at least in the exploratory diagnostic phase, for ICS/BPS to be subsumed into the PFS disease category. It would give such women a significant chance of cure, something denied to them for now.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/e3/CEJU-75-106.PMC9903172.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740121","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
Does Moses technology improve the efficiency and outcomes of standard holmium laser lithotripsy? A systematic review and meta-analysis. Moses技术是否提高了标准钬激光碎石术的效率和效果?系统回顾和荟萃分析。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 DOI: 10.5173/ceju.2022.156
Carlos A Riveros, Victor Chalfant, Thomas Melchart, Gurjot Singh, Ana M Forero, Braian Ledesma, Susan Harnett, Andrew A Stec, Michael Feloney, Joan C Delto, Dane E Klett

Introduction: Retrograde ureteroscopy with holmium laser lithotripsy (HLL) is a standard treatment for urolithiasis. Moses technology has been shown to improve fragmentation efficiency in vitro; however, it is still unclear how it performs clinically compared to standard HLL. We performed a systematic review and meta-analysis evaluating the differences in efficiency and outcomes between Moses mode and standard HLL.

Material and methods: We searched the MEDLINE, EMBASE, and CENTRAL databases for randomized clinical trials and cohort studies comparing Moses mode and standard HLL in adults with urolithiasis. Outcomes of interest included operative (operation, fragmentation, and lasing times; total energy used; and ablation speed) and perioperative parameters (stone-free rate and overall complication rate).

Results: The search identified six studies eligible for analysis. Compared to standard HLL, Moses was associated with significantly shorter average lasing time (mean difference [MD] -0.95, 95% confidence interval [CI] -1.22 to -0.69 minutes), faster stone ablation speed (MD 30.45, 95% CI 11.56-49.33 mm3/min), and higher energy used (MD 1.04, 95% CI 0.33-1.76 kJ). Moses and standard HLL were not significantly different in terms of operation (MD -9.89, 95% CI -25.14 to 5.37 minutes) and fragmentation times (MD -1.71, 95% CI -11.81 to 8.38 minutes), as well as stone-free (odds ratio [OR] 1.04, 95% CI 0.73-1.49) and overall complication rates (OR 0.68, 95% CI 0.39-1.17).

Conclusions: While perioperative outcomes were equivalent between Moses and standard HLL, Moses was associated with faster lasing time and stone ablation speeds at the expense of higher energy usage.

导读:逆行输尿管镜钬激光碎石术(HLL)是治疗尿石症的标准方法。Moses技术已被证明可以提高体外破碎效率;然而,与标准HLL相比,其临床表现尚不清楚。我们进行了系统回顾和荟萃分析,评估Moses模式和标准HLL之间的效率和结果差异。材料和方法:我们检索了MEDLINE、EMBASE和CENTRAL数据库中比较Moses模式和标准HLL在成人尿石症患者中的随机临床试验和队列研究。关注的结果包括手术(手术、碎片和激光时间);使用的总能源;消融速度)和围手术期参数(结石游离率和总并发症发生率)。结果:检索确定了6项符合分析条件的研究。与标准HLL相比,Moses与较短的平均激光时间(平均差[MD] -0.95, 95%可信区间[CI] -1.22至-0.69分钟)、更快的结石消融速度(MD 30.45, 95% CI 11.56-49.33 mm3/min)和较高的能量消耗(MD 1.04, 95% CI 0.33-1.76 kJ)相关。Moses和标准HLL在手术(MD -9.89, 95% CI -25.14至5.37分钟)、碎裂时间(MD -1.71, 95% CI -11.81至8.38分钟)、无结石(优势比[OR] 1.04, 95% CI 0.73-1.49)和总并发症发生率(OR 0.68, 95% CI 0.39-1.17)方面无显著差异。结论:虽然Moses和标准HLL的围手术期结果相当,但Moses与更快的激光时间和更快的结石消融速度相关,但以更高的能量消耗为代价。
{"title":"Does Moses technology improve the efficiency and outcomes of standard holmium laser lithotripsy? A systematic review and meta-analysis.","authors":"Carlos A Riveros,&nbsp;Victor Chalfant,&nbsp;Thomas Melchart,&nbsp;Gurjot Singh,&nbsp;Ana M Forero,&nbsp;Braian Ledesma,&nbsp;Susan Harnett,&nbsp;Andrew A Stec,&nbsp;Michael Feloney,&nbsp;Joan C Delto,&nbsp;Dane E Klett","doi":"10.5173/ceju.2022.156","DOIUrl":"https://doi.org/10.5173/ceju.2022.156","url":null,"abstract":"<p><strong>Introduction: </strong>Retrograde ureteroscopy with holmium laser lithotripsy (HLL) is a standard treatment for urolithiasis. Moses technology has been shown to improve fragmentation efficiency in vitro; however, it is still unclear how it performs clinically compared to standard HLL. We performed a systematic review and meta-analysis evaluating the differences in efficiency and outcomes between Moses mode and standard HLL.</p><p><strong>Material and methods: </strong>We searched the MEDLINE, EMBASE, and CENTRAL databases for randomized clinical trials and cohort studies comparing Moses mode and standard HLL in adults with urolithiasis. Outcomes of interest included operative (operation, fragmentation, and lasing times; total energy used; and ablation speed) and perioperative parameters (stone-free rate and overall complication rate).</p><p><strong>Results: </strong>The search identified six studies eligible for analysis. Compared to standard HLL, Moses was associated with significantly shorter average lasing time (mean difference [MD] -0.95, 95% confidence interval [CI] -1.22 to -0.69 minutes), faster stone ablation speed (MD 30.45, 95% CI 11.56-49.33 mm<sup>3</sup>/min), and higher energy used (MD 1.04, 95% CI 0.33-1.76 kJ). Moses and standard HLL were not significantly different in terms of operation (MD -9.89, 95% CI -25.14 to 5.37 minutes) and fragmentation times (MD -1.71, 95% CI -11.81 to 8.38 minutes), as well as stone-free (odds ratio [OR] 1.04, 95% CI 0.73-1.49) and overall complication rates (OR 0.68, 95% CI 0.39-1.17).</p><p><strong>Conclusions: </strong>While perioperative outcomes were equivalent between Moses and standard HLL, Moses was associated with faster lasing time and stone ablation speeds at the expense of higher energy usage.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/e9/CEJU-75-156.PMC9903166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9852041","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: 2
Does power setting impact surgical outcomes of holmium laser enucleation of the prostate? A systematic review and meta-analysis. 功率设置是否影响钬激光前列腺摘除的手术效果?系统回顾和荟萃分析。
IF 1.2 Q3 Medicine Pub Date : 2022-01-01 Epub Date: 2022-06-22 DOI: 10.5173/ceju.2022.0104
Giacomo Maria Pirola, Daniele Castellani, Martina Maggi, Ee Jean Lim, Vinson Wai Shun Chan, Angelo Naselli, Jeremy Yuen Chun Teoh, Vineet Gauhar

Introduction: The aim of this article was to enumerate the differences in immediate and postoperative outcomes for holmium laser enucleation of the prostate (HoLEP) performed with low-power (LP) or high-power (HP) laser settings through a systematic review of comparative studies.

Material and methods: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Potential clinical differences among LP and HP HoLEP were determined using the PICOS (Patient Intervention Comparison Outcome Study type) model, where outcomes were surgical time, operative efficiency, postoperative catheterization time, length of hospital stay, blood transfusion, incontinence rate, maximum urinary flow rate (QMax) and International Prostatic Symptom score (IPSS). Retrospective, prospective nonrandomized, randomized studies, and meeting abstracts were considered.

Results: A total of five studies were included for meta-analysis. No significant differences between LP and HP HoLEP were evidenced in terms of intraoperative variables (surgical time, surgical efficiency); postoperative outcomes (length of stay, length of catheterization); postoperative complications; functional results (IPSS; Qmax). Urinary incontinence rate did not differ between the two groups (OR 0.95, 95% CI 0.362.47, p = 0.91).

Conclusions: The study shows equal outcomes in outcomes from HoLEP performed with LP or HP energy settings. Even if further comparative studies are still needed to increase the level of evidence, those results encourage a further clinical adoption of LP HoLEP.

前言:本文的目的是通过对比较研究的系统回顾,列举低功率(LP)或高功率(HP)激光设置进行钬激光前列腺去核(HoLEP)的即时和术后结果的差异。材料和方法:我们使用MEDLINE、EMBASE和Cochrane Central Controlled Register of Trials进行了系统的文献综述。采用PICOS(患者干预比较结果研究类型)模型确定LP和HP HoLEP的潜在临床差异,其中结果包括手术时间、手术效率、术后置管时间、住院时间、输血、失禁率、最大尿流率(QMax)和国际前列腺症状评分(IPSS)。我们考虑了回顾性、前瞻性、非随机、随机研究和会议摘要。结果:共纳入5项研究进行meta分析。在术中变量(手术时间、手术效率)方面,LP与HP之间无显著差异;术后结果(住院时间、置管时间);术后并发症;功能结果(IPSS;Qmax)。两组尿失禁率无差异(OR 0.95, 95% CI 0.362.47, p = 0.91)。结论:该研究显示,在LP或HP能量设置下进行HoLEP的结果相同。即使还需要进一步的比较研究来增加证据水平,这些结果也鼓励了LP HoLEP的进一步临床应用。
{"title":"Does power setting impact surgical outcomes of holmium laser enucleation of the prostate? A systematic review and meta-analysis.","authors":"Giacomo Maria Pirola,&nbsp;Daniele Castellani,&nbsp;Martina Maggi,&nbsp;Ee Jean Lim,&nbsp;Vinson Wai Shun Chan,&nbsp;Angelo Naselli,&nbsp;Jeremy Yuen Chun Teoh,&nbsp;Vineet Gauhar","doi":"10.5173/ceju.2022.0104","DOIUrl":"https://doi.org/10.5173/ceju.2022.0104","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this article was to enumerate the differences in immediate and postoperative outcomes for holmium laser enucleation of the prostate (HoLEP) performed with low-power (LP) or high-power (HP) laser settings through a systematic review of comparative studies.</p><p><strong>Material and methods: </strong>We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Potential clinical differences among LP and HP HoLEP were determined using the PICOS (Patient Intervention Comparison Outcome Study type) model, where outcomes were surgical time, operative efficiency, postoperative catheterization time, length of hospital stay, blood transfusion, incontinence rate, maximum urinary flow rate (QMax) and International Prostatic Symptom score (IPSS). Retrospective, prospective nonrandomized, randomized studies, and meeting abstracts were considered.</p><p><strong>Results: </strong>A total of five studies were included for meta-analysis. No significant differences between LP and HP HoLEP were evidenced in terms of intraoperative variables (surgical time, surgical efficiency); postoperative outcomes (length of stay, length of catheterization); postoperative complications; functional results (IPSS; Qmax). Urinary incontinence rate did not differ between the two groups (OR 0.95, 95% CI 0.362.47, p = 0.91).</p><p><strong>Conclusions: </strong>The study shows equal outcomes in outcomes from HoLEP performed with LP or HP energy settings. Even if further comparative studies are still needed to increase the level of evidence, those results encourage a further clinical adoption of LP HoLEP.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/f3/CEJU-75-0104.PMC9326704.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40677239","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: 2
期刊
Central European Journal of Urology
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