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Mueller ER, Damaser MS, Mallampalli MP, Losada L. Women's Urological Health as a Priority to the Woman Well Visit. Womens Health Issues 2016; 26:476-7. [PMID: 27448751 DOI: 10.1016/j.whi.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Elizabeth R Mueller
- Departments of Urology & Obstetrics/Gynecology Loyola University Chicago, Stritch School of Medicine/Loyola University Medical Center, Maywood, Il
| | - Margot S Damaser
- Biomedical Engineering Department and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Research Service, Louis Stokes Cleveland Dept of Veterans Affairs Medical Center, Cleveland, OH
| | - Monica P Mallampalli
- Vice President, Scientific Affairs, Society for Women's Health Research, Washington D.C
| | - Liliana Losada
- Associate Director, Scientific Affairs, Society for Women's Health Research, Washington D.C
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Losada L, Amundsen CL, Ashton-Miller J, Chai T, Close C, Damaser M, DiSanto M, Dmochowski R, Fraser MO, Kielb SJ, Kuchel G, Mueller ER, Parker-Autry C, Wolfe AJ, Mallampalli MP. Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span. J Womens Health (Larchmt) 2016; 25:1086-1096. [PMID: 27285829 PMCID: PMC5116700 DOI: 10.1089/jwh.2016.5895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.
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Affiliation(s)
- Liliana Losada
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
| | - Cindy L Amundsen
- 2 Departments of Obstetrics and Gynecology and Surgery, Duke University , Durham, North Carolina
| | - James Ashton-Miller
- 3 Department of Biomechanical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Toby Chai
- 4 Department of Urology, Yale School of Medicine , New Haven, Connecticut
| | - Clare Close
- 5 Close Pediatric Urology , Las Vegas, Nevada
| | - Margot Damaser
- 6 Department of Biomedical Engineering, Cleveland Clinic and Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio
| | - Michael DiSanto
- 7 Department of Biomedical Sciences and Surgery, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Roger Dmochowski
- 8 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Matthew O Fraser
- 9 Department of Surgery, Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Stephanie J Kielb
- 10 Department of Urology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - George Kuchel
- 11 Department of Geriatrics and Gerontology, UConn Center on Aging , Farmington, Connecticut
| | - Elizabeth R Mueller
- 12 Department Obstetrics/Gynecology and Urology, Loyola University Medical Center, Loyola University Chicago , Maywood, Illinois
| | - Candace Parker-Autry
- 13 Department of Obstetrics and Gynecology, Wake Forest University , Baptist Medical Center, Winston-Salem, North Carolina
| | - Alan J Wolfe
- 14 Department of Microbiology and Immunology, Loyola University Chicago , Maywood, Illinois
| | - Monica P Mallampalli
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
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The Role of Chronic Mesh Infection in Delayed-Onset Vaginal Mesh Complications or Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg 2016; 22:166-71. [DOI: 10.1097/spv.0000000000000246] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schmid M, Krishna N, Ravi P, Meyer CP, Becker A, Dalela D, Sood A, Chun FKH, Kibel AS, Menon M, Fisch M, Trinh QD, Sun M. Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma. Urol Oncol 2016; 34:293.e1-293.e10. [PMID: 27033047 DOI: 10.1016/j.urolonc.2016.02.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/23/2016] [Accepted: 02/22/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the prevalence, temporal trends, and predictors of postoperative acute kidney injury (AKI) in a large cohort of patients with renal cell carcinoma treated with radical or partial nephrectomy. METHODS Between January 1998 and December 2010, patients who underwent radical or partial tumor nephrectomy were identified within the Nationwide Inpatient Sample. First, prevalence and temporal trends of AKI were analyzed. Second, predictors of AKI were identified using multivariable regression analyses. Third, associations between AKI and in-hospital complications, length of stay, hospital costs, and in-hospital mortality were evaluated using logistic regression models adjusted for clustering. RESULTS Of total 253,046 patients, 5.5% (14,303 in radical and 3,525 in partial nephrectomy) experienced AKI. Rates of AKI significantly increased from 2.0% in 1998 to 10.4% in 2010 (P<0.001). Predictors of AKI included male sex, radical nephrectomy, more contemporary years (2004-2010), older age, black race, higher comorbidities, higher preoperative chronic kidney disease stage, Medicare insurance status, and nephrectomy at urban hospitals (all P<0.01). Postoperative AKI during hospitalization was associated with an increased rate of in-hospital mortality, any complications, transfusion, prolonged length of stay, and higher hospital costs (all P<0.001). CONCLUSIONS Rising rates of in-hospital AKI after radical and partial nephrectomy were observed. Increasing awareness of AKI, identification of patients at risk before surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, long-term renal functional follow-up, and a well-designed prospective study, may be warranted.
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Affiliation(s)
- Marianne Schmid
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Nandita Krishna
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA
| | - Praful Ravi
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Christian P Meyer
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deepansh Dalela
- Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Akshay Sood
- Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Felix K-H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Kibel
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA
| | - Mani Menon
- Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA
| | - Maxine Sun
- Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA
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Ricke WA, Lee CW, Clapper TR, Schneider AJ, Moore RW, Keil KP, Abler LL, Wynder JL, López Alvarado A, Beaubrun I, Vo J, Bauman TM, Ricke EA, Peterson RE, Vezina CM. In Utero and Lactational TCDD Exposure Increases Susceptibility to Lower Urinary Tract Dysfunction in Adulthood. Toxicol Sci 2016; 150:429-40. [PMID: 26865671 DOI: 10.1093/toxsci/kfw009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Benign prostatic hyperplasia, prostate cancer, and changes in the ratio of circulating testosterone and estradiol often occur concurrently in aging men and can lead to lower urinary tract (LUT) dysfunction. To explore the possibility of a fetal basis for the development of LUT dysfunction in adulthood, Tg(CMV-cre);Nkx3-1(+/-);Pten(fl/+) mice, which are genetically predisposed to prostate neoplasia, were exposedin uteroand during lactation to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD, 1 μg/kg po) or corn oil vehicle (5 ml/kg) after a single maternal dose on 13 days post coitus, and subsequently were aged without further manipulation, or at 8 weeks of age were exposed to exogenous 17 β-estradiol (2.5 mg) and testosterone (25 mg) (T+E2) via slow release subcutaneous implants.In uteroand lactational (IUL) TCDD exposure in the absence of exogenous hormone treatment reduced voiding pressure in adult mice, but otherwise had little effect on mouse LUT anatomy or function. By comparison, IUL TCDD exposure followed by exogenous hormone treatment increased relative kidney, bladder, dorsolateral prostate, and seminal vesicle weights, hydronephrosis incidence, and prostate epithelial cell proliferation, thickened prostate periductal smooth muscle, and altered prostate and bladder collagen fiber distribution. We propose a 2-hit model whereby IUL TCDD exposure sensitizes mice to exogenous-hormone-induced urinary tract dysfunction later in life.
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Affiliation(s)
- William A Ricke
- *Molecular and Environmental Toxicology Center; Department of Urology; University of Wisconsin Carbone Cancer Center; George M. O'Brien Benign Urology Center of Research Excellence
| | | | | | | | | | - Kimberly P Keil
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Lisa L Abler
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | | | | | | | - Jenny Vo
- *Molecular and Environmental Toxicology Center
| | | | | | - Richard E Peterson
- *Molecular and Environmental Toxicology Center; University of Wisconsin Carbone Cancer Center; School of Pharmacy; and
| | - Chad M Vezina
- *Molecular and Environmental Toxicology Center; Department of Urology; University of Wisconsin Carbone Cancer Center; George M. O'Brien Benign Urology Center of Research Excellence; School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
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Hawken SR, Herrel LA, Ellimoottil C, Ye Z, Hollenbeck BK, Miller DC. Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs). Urology 2016; 90:76-80. [PMID: 26809069 DOI: 10.1016/j.urology.2015.12.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/14/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To understand the current role of urologists in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the organizational characteristics of ACOs with participating urologists. MATERIALS AND METHODS Using 2012-2013 Medicare data and the National Provider Identifier Database, we classified each urologist in the U.S. and Puerto Rico as either an MSSP ACO participant or nonparticipating provider. We then examined the distribution of ACO-participating urologists across the U.S. and among the first 220 MSSP ACOs. We also compared the characteristics of ACOs with and without participating urologists. RESULTS Among 11,084 identified urologists, 1118 (10%) were MSSP ACO participants. ACO-participating urologists practiced more frequently in the Northeast and Midwest (P < .001), and were more commonly female (10% vs 8%, P = .003). At an organizational level, only 110 (50%) of the initial MSSP ACOs included at least one urologist; among this group, the number of participating urologists ranged from 1 to 55. ACOs with one or more participating urologist were larger organizations, with respect to both the number of assigned beneficiaries and the number of providers per 1000 beneficiaries (P < .001 for each comparison). The patient populations served by ACOs with and without urologists were similar (P > .05 for each comparison). CONCLUSION A modest percentage of urologists participate in MSSP ACOs, although many of these organizations still lack any formal involvement by urological surgeons. Without such participation, improving the coordination, quality, and cost of urologic care for Medicare beneficiaries may be more challenging.
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Affiliation(s)
- Scott R Hawken
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | | | - Zaojun Ye
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI.
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Adomaitis R, Vincel B, Eidukaite A, Ostaneviciute E, Kirka R, Bilius V, Malcius D, Verkauskas G, Hadziselimovic F. Consequences of bilateral cryptorchidism in adults. Andrologia 2016; 48:933-938. [DOI: 10.1111/and.12534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- R. Adomaitis
- Centre of Urology; Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - B. Vincel
- Children's Surgery Centre; Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - A. Eidukaite
- Centre for Innovative Medicine; State Research Institute; Vilnius Lithuania
| | - E. Ostaneviciute
- Centre of Laboratory Medicine; Vilnius University; Vilnius Lithuania
| | - R. Kirka
- Faculty of Mathematics and Informatics; Vilnius University; Vilnius Lithuania
| | - V. Bilius
- Department of Pediatrics; Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - D. Malcius
- Department of Pediatric Surgery; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - G. Verkauskas
- Children's Surgery Centre; Faculty of Medicine; Vilnius University; Vilnius Lithuania
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Patel P, Nayak JG, McGregor TB. The value of a core clinical rotation in urology for medical students. Can Urol Assoc J 2015; 9:392-6. [PMID: 26788227 DOI: 10.5489/cuaj.3297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In 2013, our institution underwent a change to the undergraduate medical curriculum whereby a clinical urology rotation became mandatory. In this paper, we evaluated the perceived utility and value of this change in the core curriculum. METHODS Third year medical students, required to complete a mandatory 1-week clinical urology rotation, were asked to complete a survey before and after their rotation. Fourth year medical students, not required to complete this rotation, were also asked to complete a questionnaire. Chi-squared and Fisher's exact test were used for data analysis. RESULTS In total, 108 third year students rotated through urology during the study period. Of these, 66 (61%) completed the pre-rotation survey and 54 (50%) completed the post-rotation survey. In total, there were 110 fourth year students. Of these, 44 (40%) completed the questionnaire. After completing their mandatory rotations, students felt more comfortable managing and investigating common urological problems, such as hematuria and renal colic. Students felt they had a better understanding of how to insert a Foley catheter and felt comfortable independently inserting a Foley catheter. Importantly, students felt they knew when to consult urology and were also more likely to consider a career in urology. Compared to fourth year students, third year students felt urology was an important component to a family medicine practice and felt they had a better understanding of when to consult urology. CONCLUSION The introduction of a mandatory urology rotation for undergraduate medical students leads to a perceived improvement in fundamental urological knowledge and skill set of rotating students. This mandatory rotation provides a valuable experience that validates its inclusion.
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Affiliation(s)
- Premal Patel
- University of Manitoba, Section of Urology, Winnipeg, MB
| | - Jasmir G Nayak
- University of Washington, Department of Urology, Seattle, WA
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Jones P, Rai BP, Qazi HA, Somani BK, Nabi G. Perception, career choice and self-efficacy of UK medical students and junior doctors in urology. Can Urol Assoc J 2015; 9:E573-8. [PMID: 26425216 PMCID: PMC4581920 DOI: 10.5489/cuaj.2919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a growing concern about the reduced clinical exposure to urology at undergraduate level in the United Kingdom. As a consequence, the competencies of junior doctors are considered inadequate. The views of these doctors in training towards urology remain under reported. METHODS A modified Delphi method was employed to construct a questionnaire. Given the rise of social media as a platform for scientific discussion, participants were recruited via a social networking site. Outcomes assessed included career preference, exposure to urology, perceived male dominance, and confidence at core procedures. RESULTS In total, 412 and 66 responses were collected from medical students and junior doctors, respectively. Overall, 41% of participants felt that they had received a good level of clinical exposure to urology as part of their training and 15% were considering a career in this speciality. Female students were significantly less likely to consider urology as a career option (p < 0.01). Of these, 37% of the students felt confident at male catheterization and 46% of students regarded urology as a male-dominated speciality. CONCLUSIONS Urology is perceived as male dominated and is the least likely surgical speciality to be pursued as a career option according to our survey. Increased exposure to urology at the undergraduate level and dedicated workshops for core urological procedures are needed to address these challenges.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Ninewells Hospital, Dundee, UK
| | | | | | | | - Ghulam Nabi
- Department of Urology, Ninewells Hospital, Dundee, UK
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Meyer C, Sukumar S, Sood A, Hanske J, Vetterlein M, Elder JS, Fisch M, Trinh QD, Friedman AA. Inpatients hypospadias care: trends and outcomes from the American nationwide inpatient sample. Korean J Urol 2015; 56:594-600. [PMID: 26279829 PMCID: PMC4534434 DOI: 10.4111/kju.2015.56.8.594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. MATERIALS AND METHODS The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. RESULTS A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. CONCLUSIONS Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.
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Affiliation(s)
- Christian Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. ; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shyam Sukumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Julian Hanske
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Malte Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jack S Elder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. ; Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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The Influence of Race on Overall Survival in Patients with Newly Diagnosed Bladder Cancer. J Racial Ethn Health Disparities 2014; 2:124-31. [DOI: 10.1007/s40615-014-0055-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/29/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
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Walsh TJ, Hotaling JM, Smith A, Saigal C, Wessells H. Men with diabetes may require more aggressive treatment for erectile dysfunction. Int J Impot Res 2013; 26:112-5. [PMID: 24352244 DOI: 10.1038/ijir.2013.46] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/29/2013] [Accepted: 10/20/2013] [Indexed: 11/09/2022]
Abstract
Diabetes mellitus (DM) and erectile dysfunction (ED) are common health problems that markedly increase in prevalence and incidence with advancing age. DM is a known risk factor for developing ED; however, among men with ED it is unknown if DM alters the need for more invasive therapies. We sought to determine whether DM is associated with increased ED severity, reduced effectiveness of first-line (oral) therapies, and therefore higher utilization of second- and third-line therapies. The Inovus I3 database was queried to identify men with ED. Claims were followed for 48 months. Men with incomplete follow-up data and those diagnosed with DM after ED diagnosis were excluded from analysis. Rates of second-line (penile suppositories or injectables) and third-line (penile prostheses) ED therapies were compared between men with and without preexisting DM. Risk of progressing to second- and third-line therapies associated with DM was assessed with logistic regression and Kaplan-Meier analysis. From 1 January 2002 to 31 December 2006, 136 306 men were identified with prevalent and incident ED. Among this group, 19 236 men had DM that preceded their ED diagnosis. Men with DM were more than 50% more likely to be prescribed secondary ED treatments over the 2-year observation period, and more than twice as likely to undergo penile prosthesis surgery. Among a large population-based cohort of men with ED, those with DM are more likely to require more aggressive treatments. These data suggest that ED among men with diabetes may be less responsive to first-line treatments (oral agents), worsen more rapidly, or both.
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Affiliation(s)
- T J Walsh
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - J M Hotaling
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Smith
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - C Saigal
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - H Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
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Recent trends in the urology workforce in the United States. Urology 2013; 82:987-93. [PMID: 24055244 DOI: 10.1016/j.urology.2013.04.080] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 11/21/2022]
Abstract
The present study examines the current status of urology physician manpower in the United States, in the context of trends in the demographics, geographic distribution, and practice make-up of urologists. Physicians were identified as surgeons and classified into surgical groups using a combination of American Medical Association primary and secondary self-reported specialties and American Board of Medical Specialties certifications. From these groups, urologic surgeons were isolated for analysis. The supply of urologists per capita has declined since 1981 - most dramatically since 1991. With an average age of 52.5 years, urology is one of the oldest surgical specialties. Over 7% of urologists are older than 70 years and 44% are older than 55 years, suggesting an aging urology workforce. The number of female urologists has grown almost a 1000-fold and represents a growing and younger cohort of the workforce. The number of rural urologists and the number of international medical graduates have continued to decline since 1981. Over the past 10 years, an increasing number of urologists are now in group practices (over 60%), and these tended to be younger and in urban settings. In contrast to most other surgical specialties, there has been a decrease in the supply of urologists relative to population growth, which is expected to be exacerbated by an aging and relatively older urology physician workforce, particularly in rural areas, a slight increase in female urologists, and the gravitation of younger urologists toward group practice in urban areas.
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Penson D, Krishnaswami S, Jules A, McPheeters ML. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics 2013; 131:e1897-907. [PMID: 23690511 PMCID: PMC4074661 DOI: 10.1542/peds.2013-0072] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism. METHODS We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria. RESULTS Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare. CONCLUSIONS The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.
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Affiliation(s)
- David Penson
- Center for Surgical Quality and Outcomes Research, Nashville, TN 37203-1738, USA.
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health
| | | | - Melissa L. McPheeters
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health,,Obstetrics and Gynecology, Vanderbilt Medical Center, Nashville, Tennessee
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Krishnaswami S, Fonnesbeck C, Penson D, McPheeters ML. Magnetic resonance imaging for locating nonpalpable undescended testicles: a meta-analysis. Pediatrics 2013; 131:e1908-16. [PMID: 23690512 PMCID: PMC4074662 DOI: 10.1542/peds.2013-0073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Preoperative imaging techniques may guide management of nonpalpable, cryptorchid testicles. We evaluated conventional MRI for identifying and locating nonpalpable testicles in prepubescent boys via meta-analysis. METHODS Databases including Medline were searched from 1980 to February 2012. Eligible studies included ≥10 boys with cryptorchidism/suspected cryptorchidism and reported data on testicular presence/absence and position (abdominal, inguinal, or scrotal) as determined by imaging and surgery. Two investigators independently reviewed studies against inclusion criteria. We captured the number of testicles that were correctly and incorrectly identified and located, relative to surgically verified status, and estimated sensitivity and specificity by using a random-effects model. RESULTS Eight unique prospective case series included 171 boys with 193 nonpalpable testicles (22 with bilateral testicles). Surgery identified 158 testicles (81.9%) present and 35 absent. MRI correctly identified testicles with an estimated median sensitivity of 0.62 (95% Bayesian credible interval [BCI]: 0.47-0.77) and a specificity of 1.0 (95% BCI: 0.99-1.0). MRI located intraabdominal testicles with a sensitivity of 0.55 (95% BCI: 0.09-1.0) and inguino-scrotal testicles with a sensitivity of 0.86 (95% BCI: 0.67-1.0). We were not able to obtain estimates for MRI sensitivity or specificity for locating atrophied testicles. The estimated specificity for location-specific testicles reached almost 100%. CONCLUSIONS Conventional MRI has low sensitivity for estimating the population sensitivity for identifying the presence of nonpalpable cryptorchid testicles. When testicles are identified, MRI is poor at locating both atrophied and intraabdominal testicles but performs modestly well in locating those in the inguino-scrotal regions.
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Affiliation(s)
| | | | - David Penson
- Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, and,Departments of Urology and
| | - Melissa L. McPheeters
- Vanderbilt Evidence-based Practice Center and,Obstetrics and Gynecology, Vanderbilt Medical Center, Nashville, Tennessee; and
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66
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Affiliation(s)
- Keith Rourke
- Associate Professor, Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
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Kovanecz I, Rivera S, Nolazco G, Vernet D, Segura D, Gharib S, Rajfer J, Gonzalez-Cadavid NF. Separate or combined treatments with daily sildenafil, molsidomine, or muscle-derived stem cells prevent erectile dysfunction in a rat model of cavernosal nerve damage. J Sex Med 2012; 9:2814-26. [PMID: 22974131 DOI: 10.1111/j.1743-6109.2012.02913.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Long-term daily administration of phosphodiesterase type 5 (PDE5) inhibitors in the rat prevents or reverses corporal veno-occlusive dysfunction (CVOD) and smooth muscle cell (CSMC) loss and fibrosis, in both aging and bilateral cavernosal nerve resection (BCNR) models for erectile dysfunction. In the aging rat model, corporal implantation of skeletal muscle-derived stem cells (MDSC) reverses CVOD. Nitric oxide (NO) and cyclic guanosine monophosphate can modulate stem cell lineage. AIM To investigate in the BCNR model the effects of sildenafil at lower doses, alone or in combination with MDSC or the NO donor molsidomine, on CVOD and the underlying corporal histopathology. MAIN OUTCOMES MEASURES CVOD, histological, and biochemical markers in rat corporal tissue. Methods. Rats subjected to BCNR were maintained for 45 days either untreated, or received sildenafil in the water or retrolingually at 10, 2.5, and 1.25 mg/kg/day (medium, low, and very low doses), or intraperitoneal molsidomine, or MDSC implantation into the corpora cavernosa separately or in combination. Cavernosometry evaluated CVOD. Histopathology was assessed on penile sections by Masson trichrome, immunohistochemistry for α-smooth muscle actin (ASMA), or immunofluorescence for neuronal nitric oxide synthase (nNOS)/neurofilament 70, and in fresh tissue by Western blot for various markers and picrosirius red for collagen. RESULTS All treatments normalized erectile function (drop rate), and most increased the CSMC/collagen ratio and ASMA expression in corporal tissue sections, and reduced collagen content in the penile shaft. MDSC also increased nNOS and brain-derived neurotrophic factor. The combination treatment was not superior to MDSC or sildenafil given alone, and upregulated PDE5. CONCLUSIONS Lowering the dose of a continuous long-term sildenafil administration still maintained the prevention of CVOD in the BCNR rat previously observed, but it was less effective on the underlying histopathology. As in the aging rat model, MDSC also counteracted CVOD, but supplementation with very low-dose sildenafil did not improve the outcome.
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Affiliation(s)
- Istvan Kovanecz
- Department of Surgery, Division of Urology, Los Angeles Biomedical Research Institute (LABioMed) at Harbor-UCLA Medical Center, Torrance, CA, USA
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Toivanen R, Taylor RA, Pook DW, Ellem SJ, Risbridger GP. Breaking through a roadblock in prostate cancer research: an update on human model systems. J Steroid Biochem Mol Biol 2012; 131:122-31. [PMID: 22342674 DOI: 10.1016/j.jsbmb.2012.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/12/2012] [Accepted: 01/15/2012] [Indexed: 12/11/2022]
Abstract
Prostate cancer is a prevalent disease that affects the aging male population. Whilst there have been significant advances of our biological understanding of the disease, clinical translation of promising agents continues to lag behind. In part, this is due to a paucity of relevant experimental and pre-clinical models required to further develop effective prevention and therapeutic strategies. Genetically modified cell lines fail to entirely represent the genetic and molecular diversity of primary human specimens, particularly from localised disease. Furthermore, primary prostate cancer tissues are extremely difficult to grow in the laboratory and virtually all human models, whether they grow as xenografts in immune-deficient animals or as cell cultures, are genetically modified by the investigator or derived from patients with advanced metastatic disease. In this review, we discuss the latest advances and improvements to current methods of xenografting human primary prostate cancer, and their potential application to translational research.
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Affiliation(s)
- R Toivanen
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3800, Australia
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69
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Hubertus J, Plieninger S, Martinovic V, Heinrich M, Schuster T, Bürst M, Schröder A, Beetz R, Dietz HG, Stehr M. Children and adolescents with ureteropelvic junction obstruction: is an additional voiding cystourethrogram necessary? Results of a multicenter study. World J Urol 2012; 31:683-7. [DOI: 10.1007/s00345-012-0918-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022] Open
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Guzzo TJ, Hockenberry MS, Mucksavage P, Bivalacqua TJ, Schoenberg MP. Smoking Knowledge Assessment and Cessation Trends in Patients With Bladder Cancer Presenting to a Tertiary Referral Center. Urology 2012; 79:166-71. [DOI: 10.1016/j.urology.2011.06.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/26/2011] [Accepted: 06/04/2011] [Indexed: 10/15/2022]
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Katsumi HK, Rutman MP. Can we predict if overactive bladder symptoms will resolve after sling surgery in women with mixed urinary incontinence? Curr Urol Rep 2010; 11:328-37. [PMID: 20632135 DOI: 10.1007/s11934-010-0133-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Persistent overactive bladder and urgency urinary incontinence after sling surgery (pubovaginal sling or midurethral sling) in women with mixed urinary incontinence (MUI) is devastating to patients and frustrating to surgeons who perform anti-incontinence surgery. To better predict the outcomes of sling surgery in women with MUI, preoperative parameters need to be examined to accurately predict postsurgical outcomes. In this review article, we will explore recent literature exploring possible preoperative predictors of persistent overactive bladder and urgency urinary incontinence after sling surgery in women with MUI.
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Affiliation(s)
- Hiroshi K Katsumi
- Department of Urology, Columbia University, Herbert Irving Pavilion, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
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Hollingsworth JM, Birkmeyer JD, Zhang YS, Zhang L, Hollenbeck BK. Imaging use among employed and self-employed urologists. J Urol 2010; 184:2480-4. [PMID: 20952030 DOI: 10.1016/j.juro.2010.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Compared to physicians paid on salary (ie employed), those who own their practice (ie self-employed) derive financial benefit from providing more care. Whether the volume based incentives of ownership influence physician use of other ancillary services, like diagnostic imaging, remains unknown. We explored this possibility among urologists. MATERIALS AND METHODS We used data from the National Ambulatory Medical Care Survey (2006 to 2007) to identify outpatient urology visits. We determined whether the urologist who was responsible for the encounter was employed or self-employed. We calculated the proportion of visits at which imaging was ordered, and we evaluated for a difference between visits directed by employed vs self-employed urologists. We used multivariable logistic regression to measure the relationship between urologist employment status and imaging use, adjusting for patient, provider and practice level characteristics. RESULTS More than 1 in 5 urology visits resulted in imaging. While imaging use did not vary by measurable patient or practice level characteristics, self-employed urologists ordered imaging more often than employed urologists (24.2% vs 13.2%, respectively, p<0.001). In fact, the odds of a patient receiving imaging were almost 2-fold greater if seen by a self-employed urologist (OR 1.84, 95% CI 1.18-2.87). On stratified analysis an independent association between employment status and imaging use was observed for urolithiasis (OR 4.76, 95% CI 1.30-17.4) and hematuria visits (OR 5.52, 95% CI 1.23-24.8). CONCLUSIONS Compared with employed urologists, those who are self-employed have more resource intense practice styles with respect to imaging use.
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Affiliation(s)
- John M Hollingsworth
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan 48105-2967, USA
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Watson RA, Suchak N, Steel K. A doctor in the house: rationale for providing on-site urological consultation to geriatric patients in nursing health care facilities. Urology 2010; 76:277-81. [PMID: 20451975 DOI: 10.1016/j.urology.2010.01.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/04/2010] [Accepted: 01/07/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish a rationale for providing on-site urological care on a regular basis in the nursing health care center setting and to share "lessons learned," which we have garnered in providing that care over a 5-year experience. METHODS We have reviewed and assessed our experiences in providing urological outreach to nursing health care center patients. RESULTS Our outreach program has been well received both by patients and by health care center personnel. Over this time, we have capitalized on many advantages that this initiative offers, and we have gained, through this experience, several "lessons learned," not only regarding what to do, but also what to avoid. CONCLUSIONS Advantages to on-site urological care include: (1) timely, targeted clinical intervention; (2) significant disease prevention; (3) expedition of treatment; (4) health care provider education; and (5) rich opportunities for clinical investigation. In addition, the on-site urologist can provide the health care center with helpful advice and validation in meeting federal and state health care requirements. Unfortunately, to date, remuneration for such programs has been discouraging. Federal and state regulations continue to impede innovative change.
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Affiliation(s)
- Richard A Watson
- Department of Urology and Geriatrics, Hackensack University Medical Center, Hackensack, NJ 07601-8554, USA.
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Gacci M, Simonato A, Masieri L, Gore JL, Lanciotti M, Mantella A, Rossetti MA, Serni S, Varca V, Romagnoli A, Ambruosi C, Venzano F, Esposito M, Montanaro T, Carmignani G, Carini M. Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health Qual Life Outcomes 2009; 7:94. [PMID: 19912640 PMCID: PMC2784440 DOI: 10.1186/1477-7525-7-94] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 11/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP). METHODS 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA <or= 0.2 ng/mL) at the follow up >or= 5 years were recruited.Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT).We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration. RESULTS Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).Higher stage PCa negatively affected UB, SF, and SB (all: p <or= 0.05). NS was associated with better UB, SF and SB (all: p <or= 0.05); conversely, HT was associated with worse UF, SF and SB (all: p <or= 0.05).More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time. CONCLUSION Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Nationally representative data in urology. Nat Rev Urol 2009; 6:354-5. [DOI: 10.1038/nrurol.2009.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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