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Morin JP, Srinivas S, Wood RJ, Dajusta DG, Fuchs ME. Bladder Management and Continence in Girls With Cloacal Malformation After 3 Years of Age. J Pediatr Surg 2024; 59:1647-1651. [PMID: 38734497 DOI: 10.1016/j.jpedsurg.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Multiple factors impact ability to achieve urinary continence in cloacal malformation including common channel (CC) and urethral length and presence of spinal cord abnormalities. Few publications describe continence rates and bladder management in this population. We evaluated our cohort of patients with cloacal malformation to describe the bladder management and continence outcomes. METHODS We reviewed a prospectively collected database of patients with cloacal malformation managed at our institution. We included girls ≥3 years (y) of age and evaluated their bladder management methods and continence. Dryness was defined as <1 daytime accident per week. Incontinent diversions with both vesicostomy and enterovesicostomy were considered wet. RESULTS A total of 152 patients were included. Overall, 93 (61.2%) are dry. Nearly half (47%) voided via urethra, 65% of whom were dry. Twenty patients (13.1%) had incontinent diversions. Over 40% of the cohort performed clean intermittent catheterization (CIC), approximately half via urethra and half via abdominal channel. Over 80% of those performing CIC were dry. In total, 12.5% (n = 19) required bladder augmentation (BA). CC length was not associated with dryness (p = 0.076), need for CIC (p = 0.253), or need for abdominal channel (p = 0.497). The presence of a spinal cord abnormality was associated with need for CIC (p = 0.0117) and normal spine associated with ability to void and be dry (p = 0.004) CONCLUSIONS: In girls ≥ 3 y of age with cloacal malformation, 61.2% are dry, 65% by voiding via urethra and 82% with CIC. 12.5% require BA. Further investigation is needed to determine anatomic findings associated with urinary outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jacqueline P Morin
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shruthi Srinivas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel G Dajusta
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly E Fuchs
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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152
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Sibbald RG, Geng RSQ, Slomovic J, Stacey M. The muscle pump activator device: From evidence to lived experiences. Int Wound J 2024; 21:e14949. [PMID: 39072891 DOI: 10.1111/iwj.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024] Open
Abstract
A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life.
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Affiliation(s)
- R Gary Sibbald
- Dalla Lana School of Public Health & Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan S Q Geng
- Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Slomovic
- Temerty School of Medicine, Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Stacey
- Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada
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153
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Fleischmann N, Chughtai B, Plair A, Hurtado E, Jacobson N, Segal S, Panza J, Cichowski SB. Urethral Bulking. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:667-682. [PMID: 39051928 DOI: 10.1097/spv.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI). METHODS We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications. RESULTS One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened. CONCLUSIONS Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.
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Affiliation(s)
| | | | - Andre Plair
- Stony Brook Medicine University Hospital, Stony Brook, NY
| | | | - Nina Jacobson
- Hackensack Meridian School of Medicine/Jersey Shore University Medical Center, Neptune, NJ
| | - Saya Segal
- Weill Cornell Medical College, New York, NY
| | - Joseph Panza
- University of Rochester Medical Center, Rochester, NY
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Stroomberg HV, Larsen SB, Kjær Nielsen T, Helgstrand JT, Brasso K, Røder A. Outcomes of Biopsy Grade Group 1 Prostate Cancer Diagnosis in the Danish Population. Eur Urol Oncol 2024; 7:770-777. [PMID: 37884421 DOI: 10.1016/j.euo.2023.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Debate regarding a nomenclature change for grade group 1 (GG 1) prostate cancer to noncancer has been revived, as this could be a powerful tool in reducing the overtreatment of indolent disease. OBJECTIVE To describe outcomes for all men diagnosed with GG 1 prostate cancer in the Danish population, with a focus on men followed conservatively. DESIGN, SETTING, AND PARTICIPANTS This was a population-based observational study using data from the Danish Prostate Registry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We measured the cumulative incidence of curative treatment, endocrine treatment, and cause-specific mortality. RESULTS AND LIMITATIONS The cumulative incidence of endocrine therapy at 10 yr was 5.3% (95% confidence interval [CI] 4.3-6.3%) for men with initial active surveillance and 21% (95% CI 19-23%) for men with initial watchful waiting for localized GG 1. In the GG1 cohort, the prostate cancer-specific mortality rate at 15 yr was 14% (95 CI% 11-16%) for men on watchful waiting, 10% (95 CI% 6.7-14%) for men with prostate-specific antigen <10 ng/ml on watchful waiting, and 16% (95 CI% 13-19%) for men who did not receive curative-intent treatment or histological assessment. The study is limited by the historic nature of the observations over a period during which diagnostic procedures and treatments have evolved. CONCLUSIONS GG 1 cancer can lead to disease-specific mortality in men with localized prostate cancer, and changing the nomenclature for all men may lead to undertreatment. PATIENT SUMMARY Key opinion leaders have suggested that prostate cancers of Gleason grade group 1 (GG 1) should be renamed as noncancer to reduce overtreatment. The argument is that low-grade cancer does not metastasize. However, our nationwide population-based study showed that death from prostate cancer can occur in some men diagnosed with GG 1 disease. These men should be considered in discussions on changing the name for GG 1 prostate cancer.
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Affiliation(s)
- Hein V Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Signe Benzon Larsen
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Torben Kjær Nielsen
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hoebeke P, Hittelman A, Jenkins B, Geib T, Titanji W, Bogaert G. Results of a study examining the use of onabotulinumtoxinA in pediatric patients with overactive bladder. J Pediatr Urol 2024; 20:600.e1-600.e8. [PMID: 38906707 DOI: 10.1016/j.jpurol.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND There is a lack of approved treatments for pediatric patients with overactive bladder (OAB) with inadequate response to anticholinergic therapy. OnabotulinumtoxinA 100U is approved to treat OAB in adults based on data from randomized, pivotal trials. OBJECTIVE To investigate the efficacy and safety of onabotulinumtoxinA treatment of OAB in children aged 12-17 years who were not adequately managed with anticholinergics. STUDY DESIGN In this multinational, multicenter, randomized, double-blind, parallel-group, multiple-dose study (NCT02097121), pediatric patients with OAB were randomized 1:1:1 to receive onabotulinumtoxinA 25U, 50U, or 100U (≤6 U/kg). Patients could request retreatment starting at week 12. The primary endpoint was change from baseline to week 12 after treatment 1 in daily frequency of daytime urinary incontinence (UI) episodes. Safety assessments evaluated treatment-emergent adverse events (TEAEs). RESULTS Of 68 screened patients, 55 received ≥1 treatment. Mean age was 14 years; 85.5% of patients were female. At week 12 after treatment 1, least squares mean change from baseline in daily frequency of daytime UI episodes showed a numerically greater reduction in the 100U arm (-2.4) versus the 25U arm (-1.4; P = 0.38), with a significant within-group change from baseline in the 100U arm (P = 0.0027). Achievement of treatment response was significantly greater with onabotulinumtoxinA 100U vs 25U (Figure). Median time to request retreatment was ≥16 weeks in all groups. The most frequently reported TEAEs were nasopharyngitis (10.9%) and urinary tract infection (UTI; 10.9%). Urinary retention was observed in 1 patient during treatment cycle 2; there were no serious TEAEs of UTI or urinary retention. Throughout 2 additional treatment cycles continued efficacy for the 100U dose arm was observed along with a consistent safety profile. DISCUSSION Change in daily frequency of UI episodes at week 12 in treatment cycle 1 was not significantly different between arms. However, ≥50% response rate was significantly higher with onabotulinumtoxinA 100U versus 25U. Enrollment challenges that lowered the sample size could have reduced statistical power. Also, the lack of a placebo arm and the observed benefit with the 25U comparator limited interpretation. CONCLUSIONS OnabotulinumtoxinA injections were well tolerated in children with OAB at all doses studied. Although the primary endpoint was not met, the significantly greater treatment response rate observed with onabotulinumtoxinA 100U versus 25U suggests additional benefit of the higher dose, without additional safety concerns.
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Affiliation(s)
- Piet Hoebeke
- Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| | - Adam Hittelman
- Yale School of Medicine, 330 Cedar Street, #208058, New Haven, CT, USA.
| | - Brenda Jenkins
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Till Geib
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Wilson Titanji
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Guy Bogaert
- Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Masoumi-Ravandi K, Mason RJ, Rendon RA. Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy A single-site, two-surgeon, retrospective cohort study. Can Urol Assoc J 2024; 18:245-250. [PMID: 38587976 PMCID: PMC11326722 DOI: 10.5489/cuaj.8585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. METHODS In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. RESULTS A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN REN AL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complication rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs. 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). CONCLUSIONS Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure times and LOS compared with OPN and LPN despite similar REN AL scores compared to OPN and greater scores than LPN.
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Affiliation(s)
| | - Ross J Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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157
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Mookerji N, Pfanner T, Hui A, Huang G, Albers P, Mittal R, Broomfield S, Dean L, St. Martin B, Jacobsen NE, Evans H, Gao Y, Hung R, Abele J, Dromparis P, Lima JF, Bismar T, Michelakis E, Sutendra G, Wuest F, Tu W, Adam BA, Fung C, Tamm A, Kinnaird A. Fluorine-18 Prostate-Specific Membrane Antigen-1007 PET/CT vs Multiparametric MRI for Locoregional Staging of Prostate Cancer. JAMA Oncol 2024; 10:1097-1103. [PMID: 38949926 PMCID: PMC11217889 DOI: 10.1001/jamaoncol.2024.3196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/17/2024] [Indexed: 07/03/2024]
Abstract
Importance Prostate-specific membrane antigen (PSMA) demonstrates overexpression in prostate cancer and correlates with tumor aggressiveness. PSMA positron emission tomography (PET) is superior to conventional imaging for the metastatic staging of prostate cancer per current research but studies of second-generation PSMA PET radioligands for locoregional staging are limited. Objective To determine the accuracy of fluorine-18 PSMA-1007 PET/computed tomography (18F-PSMA-1007 PET/CT) compared to multiparametric magnetic resonance imaging (MRI) in the primary locoregional staging of intermediate-risk and high-risk prostate cancers. Design, Setting, and Participants The Next Generation Trial was a phase 2 prospective validating paired cohort study assessing the accuracy of 18F-PSMA-1007 PET/CT and MRI for locoregional staging of prostate cancer, with results of histopathologic examination as the reference standard comparator. Radiologists, nuclear medicine physicians, and pathologists were blinded to preoperative clinical, pathology, and imaging data. Patients underwent all imaging studies and radical prostatectomies at 2 tertiary care hospitals in Alberta, Canada. Eligible participants included men with intermediate-risk or high-risk prostate cancer who consented to radical prostatectomy. Participants who underwent radical prostatectomy were included in the final analysis. Patients were recruited between March 2022 and June 2023, and data analysis occurred between July 2023 and December 2023. Exposures All participants underwent both 18F-PSMA-1007 PET/CT and MRI within 2 weeks of one another and before radical prostatectomy. Main Outcomes and Measures The primary outcome was the correct identification of the prostate cancer tumor stage by each imaging test. The secondary outcomes were correct identification of the dominant nodule, laterality, extracapsular extension, and seminal vesical invasion. Results Of 150 eligible men with prostate cancer, 134 patients ultimately underwent radical prostatectomy (mean [SD] age at prostatectomy, 62.0 [5.7] years). PSMA PET was superior to MRI for the accurate identification of the final pathological tumor stage (61 [45%] vs 38 [28%]; P = .003). PSMA PET was also superior to MRI for the correct identification of the dominant nodule (126 [94%] vs 112 [83%]; P = .01), laterality (86 [64%] vs 60 [44%]; P = .001), and extracapsular extension (100 [75%] vs 84 [63%]; P = .01), but not for seminal vesicle invasion (122 [91%] vs 115 [85%]; P = .07). Conclusions and Relevance In this phase 2 prospective validating paired cohort study, 18F-PSMA-1007 PET/CT was superior to MRI for the locoregional staging of prostate cancer. These findings support PSMA PET in the preoperative workflow of intermediate-risk and high-risk tumors.
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Affiliation(s)
- Nikhile Mookerji
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Pfanner
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Amaris Hui
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Guocheng Huang
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Albers
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Rohan Mittal
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Stacey Broomfield
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Lucas Dean
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Alberta, Canada
| | - Blair St. Martin
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Alberta, Canada
| | - Niels-Erik Jacobsen
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Alberta, Canada
| | - Howard Evans
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Alberta, Canada
| | - Yuan Gao
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Ryan Hung
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Abele
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Dromparis
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Joema Felipe Lima
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tarek Bismar
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Prostate Cancer Research Initiative (APCaRI), Alberta, Canada
| | | | - Gopinath Sutendra
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Cancer Research Institute of Northern Alberta (CRINA), Edmonton, Alberta, Canada
| | - Frank Wuest
- Cancer Research Institute of Northern Alberta (CRINA), Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Tu
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin A. Adam
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Fung
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Tamm
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
- Alberta Prostate Cancer Research Initiative (APCaRI), Alberta, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Alberta Centre for Urologic Research and Excellence (ACURE), Alberta, Canada
- Alberta Prostate Cancer Research Initiative (APCaRI), Alberta, Canada
- Cancer Research Institute of Northern Alberta (CRINA), Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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158
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Yao X, Zhang G, Xiong Q, Feng S, Liu X. Plastic Clamp Versus Conventional Surgical Dissection Technique in Pediatric Circumcision: A Systematic Review and Meta-Analysis. Curr Urol Rep 2024; 25:173-180. [PMID: 38769228 DOI: 10.1007/s11934-024-01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Phimosis is a common condition of the urinary system in children and often requires surgical treatment. However, the optimal method of circumcision for children has not been determined. We conducted a systematic review and meta-analysis to compare the safety and effectiveness of plastic clamp with conventional surgical circumcision in pediatric circumcision. METHODS A literature search was carried out to compare the plastic clamp and conventional dissection technique in the pediatric population. The following search terms were used: "circumcision", "plastic clamp", "conventional", "plastibell", "children" and etc. Meta-analysis was used to pool and evaluate variables such as operative time, blood loss, wound infection, bleeding, edema, and total postoperative complications. RESULTS The plastic clamp technique (PCT) was used in 10,412 of the 17,325 participants in the nine studies, while the conventional surgical dissection technique (CST) was used on 6913 patients. When compared to the CST approach, the PCT approach resulted in shorter operative times (mean difference (MD) -17.48, 95% CI -22 to -12.96; P < 0.001), less blood loss (MD -4.25, 95% CI -7.75 to -0.77; P = 0.02), and a higher incidence of postoperative edema (OR 2.33, 95% CI 1.34 to 4.08; P = 0.003). However, no significant difference was found in the incidence of postoperative complications, including wound infection and bleeding between PCT and CST. CONCLUSIONS PCT is a safe and time-saving option in the pediatric population. However, this method appeared to have a significant greater rate of postoperative edema.
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Affiliation(s)
- Xianming Yao
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Gang Zhang
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - Qianwei Xiong
- Department of Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Xian Liu
- Department of Critical Care Medicine, Anji County People's Hospital, Huzhou, Zhejiang, 313300, China.
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159
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Sannala CKR, MacLean C, Larsen F, van Os S, Jadhav P, Shore N, Morgans AK, Okwuosa T, Gobburu J. A Model-Informed Drug Development Approach to Design a Phase 3 Trial of Teverelix Drug Product in Advanced Prostate Cancer Patients with Increased Cardiovascular Risk. Clin Pharmacol Drug Dev 2024; 13:915-929. [PMID: 38757461 DOI: 10.1002/cpdd.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Teverelix drug product (DP) is a parenteral gonadotropin-releasing hormone (GnRH) antagonist that has been successfully tested in phase 2 trials for hormone-sensitive advanced prostate cancer (APC) and benign prostatic hyperplasia (BPH). In previous APC trials, teverelix DP was administered as intramuscular (IM) and subcutaneous (SC) injections, using a loading dose and (in a single trial) a maintenance dose. Our objective was to derive an optimal dosing regimen for phase 3 clinical development, using a pharmacometrics modeling approach. Data from 9 phase 2 studies (229 patients) was utilized to develop a population pharmacokinetic (PK) model that described the concentration profile accommodating both IM and SC routes of administration. A 2-compartment model with sequential first-order absorption (slow and fast) and lag times best described the PK profiles of teverelix following SC and IM administration. An indirect response model with inhibition of production rate was fit to describe testosterone (T) concentrations based on physiological relevance. The final population PK-pharmacodynamic model was used to conduct simulations of various candidate dosing regimens to select the optimal dosing regimen to achieve clinical castration (T < 0.5 ng/mL by day 28) and to sustain clinical castration for 26 weeks. Model simulation showed that a loading dose of 360 mg SC and 180 mg IM with a maintenance dose of 360 mg SC 6-weekly (Q6W) starting at day 28 can achieve a ≥95% castration rate up to 52 weeks. This dose regimen was selected for phase 3 clinical development, which includes cardiovascular safety assessment in comparison to a GnRH agonist.
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Affiliation(s)
| | | | | | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
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160
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Arita Y, Woo S, Kwee TC, Shigeta K, Ueda R, Nalavenkata S, Edo H, Miyai K, Das J, Andrieu PIC, Vargas HA. Pictorial review of multiparametric MRI in bladder urothelial carcinoma with variant histology: pearls and pitfalls. Abdom Radiol (NY) 2024; 49:2797-2811. [PMID: 38847848 DOI: 10.1007/s00261-024-04397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 08/06/2024]
Abstract
Bladder cancer (BC), predominantly comprising urothelial carcinomas (UCs), ranks as the tenth most common cancer worldwide. UCs with variant histology (variant UC), including squamous differentiation, glandular differentiation, plasmacytoid variant, micropapillary variant, sarcomatoid variant, and nested variant, accounting for 5-10% of cases, exhibit more aggressive and advanced tumor characteristics compared to pure UC. The Vesical Imaging-Reporting and Data System (VI-RADS), established in 2018, provides guidelines for the preoperative evaluation of muscle-invasive bladder cancer (MIBC) using multiparametric magnetic resonance imaging (mpMRI). This technique integrates T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE)-MRI, and diffusion-weighted imaging (DWI) to distinguish MIBC from non-muscle-invasive bladder cancer (NMIBC). VI-RADS has demonstrated high diagnostic performance in differentiating these two categories for pure UC. However, its accuracy in detecting muscle invasion in variant UCs is currently under investigation. These variant UCs are associated with a higher likelihood of disease recurrence and require precise preoperative assessment and immediate surgical intervention. This review highlights the potential value of mpMRI for different variant UCs and explores the clinical implications and prospects of VI-RADS in managing these patients, emphasizing the need for careful interpretation of mpMRI examinations including DCE-MRI, particularly given the heterogeneity and aggressive nature of variant UCs. Additionally, the review addresses the fundamental MRI reading procedures, discusses potential causes of diagnostic errors, and considers future directions in the use of artificial intelligence and radiomics to further optimize the bladder MRI protocol.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, USA
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Sunny Nalavenkata
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Hiromi Edo
- Department of Radiology, National Defense Medical Collage, Saitama, Japan
| | - Kosuke Miyai
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Jeeban Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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161
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Fagan M, Janes WCI, Andrews M, Harvey DR, Warden GM, Organ MK, Johnston P. Restricted access and advanced disease in post-pandemic testicular cancer. Can Urol Assoc J 2024; 18:262-267. [PMID: 38587978 PMCID: PMC11326728 DOI: 10.5489/cuaj.8648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Urologists observed reduced cancer consultations and surgeries during the SARS-CoV-2 pandemic, raising concern about treatment delays. Testicular cancer serves as a particularly sensitive marker of this phenomenon, as the clinical stage of testicular cancer at presentation is predictive of cancer-specific survival. We aimed to investigate whether COVID-related restrictions to primary care access resulted in increased incidence of metastatic germ cell testis cancer. METHODS A retrospective chart review was conducted on all cases of testicular cancer managed surgically at our center from March 1, 2018, to February 28, 2023. Patients were categorized into temporal cohorts, representing before, during, and following the implementation of COVID-19 public health restrictions in the province of Newfoundland and Labrador. RESULTS Forty-one cases of testicular germ cell tumors were identified during the study period. The mean age at diagnosis was 40.8 years (standard deviation ±13.7). Demographics did not vary across the cohorts. Clinical stage 3 disease remained stable before and during the pandemic at 10.5% and 9.1% of cases, respectively. In the post-pandemic period, there was an increase to 27.3% (p=0.617). Surgical wait times remained stable across the pandemic (p=0.151). CONCLUSIONS There was a 16.8% rise in clinical stage 3 disease from the pre-pandemic to post-pandemic period. Our study failed to identify a statistically significant increase in metastatic testis cancer incidence upon lifting of pandemic restrictions. Further study is necessary to confirm suspicions that pandemic restrictions contributed to increased incidence of metastatic testis cancer.
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Affiliation(s)
- Mitchell Fagan
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - W C Ian Janes
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Matthew Andrews
- Department of Urology, Memorial University, St. John's, NL, Canada
| | - David R Harvey
- Department of Urology, Memorial University, St. John's, NL, Canada
| | - Geoff M Warden
- Discipline of Anesthesia, Memorial University, St. John's, NL, Canada
| | - Michael K Organ
- Department of Urology, Memorial University, St. John's, NL, Canada
| | - Paul Johnston
- Department of Urology, Memorial University, St. John's, NL, Canada
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162
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Karavani G, Kattan MS, Lau S, Lo KC, Grober ED, Mehra VM, Akroof B, Lajkosz K, Jarvi K. Idiopathic secondary azoospermia occurrence in men with oligospermia over time. J Assist Reprod Genet 2024; 41:2163-2171. [PMID: 38941005 PMCID: PMC11339189 DOI: 10.1007/s10815-024-03179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE To investigate the occurrence of idiopathic secondary azoospermia (ISA) in men with oligospermia over time and identify risk factors for ISA in this population. METHODS This was a retrospective cohort study conducted in a university-affiliated male infertility clinic. A total of 1056 oligospermic men (concentration < 15 million/ml (M/ml) and no azoospermia) with at least two SA done between 2000 and 2019 were included. The primary outcome was the occurrence of ISA by oligospermia severity. RESULTS In the entire cohort, 31 patients (2.9%) eventually became azoospermic with time. The ≤ 1 M/ml extremely severe oligospermia (ESO) group (283 patients) had significantly higher rates of ISA in each time period compared to the 1-5 M/ml severe oligospermia (SO) (310 patients) and 5-15 M/ml mild oligospermia (MO) (463 patients) groups (p < 0.05 for all comparisons), with rates of 21.1% in the ESO, 4.8% in the SO, and 0% in the MO group (p = 0.02) after 3-5 years, reaching 32% after 5 years in the ESO group compared to no cases in the other two groups (p = 0.006). Parameters shown to predict ISA were initial concentration < 1 M/ml (OR 22.12, p < 0.001) and time interval of > 3 and 5 years (OR 4.83 and 6.84, p = 0.009 and < 0.001, respectively), whereas testosterone levels were negatively associated with ISA (OR 0.88, p = 0.03). CONCLUSIONS Men with ≤ 1 M/ml, especially those with low testosterone levels, have a dramatically increased chance of becoming azoospermic with time. Therefore, sperm banking should be recommended in these cases. Men with a sperm concentration above 1 M/ml have low chances of becoming azoospermic, even after 3 or more years.
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Affiliation(s)
- Gilad Karavani
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Mohamed S Kattan
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Vrati M Mehra
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bader Akroof
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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163
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Rao K, Aswani Y, Bindner H, Patel A, Averill S, Davis T, Amarneh M. Intra-abdominal Venous Thromboses and Their Management. Acad Radiol 2024; 31:3212-3222. [PMID: 38184416 DOI: 10.1016/j.acra.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
While a plethora of articles discuss management of deep venous thromboses in extremities, there is a relative scarcity of literature comprehensively describing intra-abdominal venous thromboses, and their management. Intra-abdominal venous thromboses include iliocaval venous obstruction (ICVO), hepatic venous thrombosis (HVT), portal venous thrombosis (PVT), renal vein thrombosis (RVT), splenic vein thrombosis (SVT), and gonadal vein thrombosis (GVT); each of which provides unique microenvironmental challenges to management. Doppler ultrasound is the first line imaging modality for diagnosis, and computed tomography and magnetic resonance imaging can help define the extent of thrombus burden and aid with interventional planning. Systemic anticoagulation remains the common medical treatment for intra-abdominal venous thrombosis, however, catheter directed thrombolysis and thrombectomy show positive outcomes in ICVO, HVT, PVT, and RVT, with transjugular intrahepatic portosystemic shunt (TIPS) creation especially beneficial in HVT and PVT. In this review article, we describe pathophysiology, clinical features, imaging findings, and current management options for intra-abdominal venous thromboses.
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Affiliation(s)
- Karan Rao
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Yashant Aswani
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Hans Bindner
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Aditi Patel
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Sarah Averill
- Roswell Park Comprehensive Cancer Institute, Buffalo, New York, USA (S.A.)
| | - Trent Davis
- Dignity Health St. Joseph's Radiology, Phoenix, Arizona, USA (T.D.)
| | - Mohammad Amarneh
- Department of Pediatric Interventional Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, Massachusetts 02115, USA (M.A.).
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Gebeyehu TF, Harrop CM, Barbieri L, Thalheimer S, Harrop J. Do Postsurgical Follow-Up Calls Reduce Unplanned 30-Day Readmissions in Neurosurgery Patients? A Quality Improvement Project in a University Hospital. World Neurosurg 2024; 188:266-275.e4. [PMID: 38763460 DOI: 10.1016/j.wneu.2024.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Unplanned 30-day readmissions after surgery are a source of patient dissatisfaction, monitored by the Centers for Medicare and Medicaid Services, have financial penalties for hospitals, and are publicly reported. Neurosurgical operations have a higher 30-day unplanned readmission rate after the index discharge than other specialties. After a simple initiative for a 48-72-hour postdischarge telephone call, there was an observed significant decrease in readmission rates from 17% to 8% in 7 months at Thomas Jefferson University. To better understand the role of postoperative telephone calls in this reduction, a retrospective evaluation over a longer period was performed. METHODS A quality improvement initiative was assessed using patient records between August 2018 and May 2023. The primary observed subject is the 30-day unplanned readmission rate and secondarily a change in Physician Communication Score. Thirty-day unplanned readmission rate and Physician Communication Scores before and after the telephone call initiative were compared, checking for difference, variance, and correlation. RESULTS 874 readmissions (average, 28/month; 95% confidence interval [CI], 25.3-29.3), 12.9% (95% CI, 11.9-13.9) were reported before the telephone call; of 673 readmissions (average, 26/month; 95% CI, 23-28.8), 12.9% (95% CI, 11.6-14.1) were reported after the telephone call. No significant difference, variance of scores or rates, or correlation of rate with communication score were noted before and after the initiative. CONCLUSIONS Telephone calls and peridischarge efficient communication are needed after neurologic surgery. This approach decreased unplanned readmissions in certain instances without having a significant impact on neurosurgical patients.
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Affiliation(s)
- Teleale F Gebeyehu
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
| | - Catriona M Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Lauren Barbieri
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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165
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Akuffo-Addo E, Dalson J, Agyei K, Mohsen S, Yusuf S, Juando-Prats C, Simpson JS. Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis. J Am Coll Surg 2024; 239:151-160. [PMID: 38470049 DOI: 10.1097/xcs.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation. STUDY DESIGN Using critical qualitative inquiry and purposive sampling to ensure sex, geographical, and student or trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semistructured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by 4 analysts. RESULTS Twenty-seven participants including 18 medical students and 9 residents, were interviewed. The results showed 3 major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation, and insufficient safe spaces as the key deterrents to program completion. The intersection with sex exponentially increased these identified barriers. CONCLUSIONS Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.
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Affiliation(s)
- Edgar Akuffo-Addo
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Jaycie Dalson
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Kwame Agyei
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Samiha Mohsen
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Safia Yusuf
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Clara Juando-Prats
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Juando-Prats)
- Division of General Surgery, St Michael's Hospital, Toronto, ON, Canada (Juando-Prats, Simpson)
| | - Jory S Simpson
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
- Division of General Surgery, St Michael's Hospital, Toronto, ON, Canada (Juando-Prats, Simpson)
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166
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Kurze I, Jaekel AK. [Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis]. Aktuelle Urol 2024; 55:315-325. [PMID: 38653466 DOI: 10.1055/a-2281-7924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.
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Affiliation(s)
- Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Anke K Jaekel
- Klinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
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167
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Netsch C, Filmar S, Hook S, Rosenbaum C, Gross AJ, Becker B. [Follow-up after urinary diversion]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02401-8. [PMID: 39088083 DOI: 10.1007/s00120-024-02401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/02/2024]
Abstract
Radical cystectomy is currently the standard of care for muscle-invasive bladder cancer. Different parts of the small and large intestines can be utilized for continent and incontinent urinary diversion. The postoperative follow-up after urinary diversion should consider functional, metabolic and oncological aspects. The functional follow-up of (continent) urinary diversion includes stenosis, emptying disorders or incontinence. The oncological follow-up should focus on the detection of local, urethral and upper tract recurrences as well as distant metastases. As 90% of the tumor recurrences occur during the first 3 years, a close follow-up should be carried out during this period. Metabolic disturbances, such as vitamin B12 and bile acid deficits, acidosis and disorders of calcium metabolism can also occur during long-term follow-up. The metabolic follow-up should consider the metabolic consequences of the parts of the intestines utilized for the urinary diversion.
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Affiliation(s)
- Christopher Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - Simon Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - Sophia Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - Clemens Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
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168
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Pinto DS, Clode H, Madrazo BL, Paes FM, Alessandrino F. Imaging review of spontaneous renal hemorrhage. Emerg Radiol 2024; 31:515-528. [PMID: 38703272 DOI: 10.1007/s10140-024-02233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Spontaneous renal hemorrhage (SRH) is a diagnostic challenge and a significant cause of morbidity, and sometimes mortality. Early identification is essential to institute lifesaving and reno-protective interventions. In this review, we classify spontaneous renal hemorrhage by location, presentation and etiology. We also discuss the diagnostic approach to renal hemorrhage and optimum imaging modalities to arrive at the diagnosis. Finally, we review strategies to avoid missing a diagnosis of SRH and discuss the pitfalls of imaging in the presence of renal hemorrhage.
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Affiliation(s)
- Denver S Pinto
- Jackson Memorial Hospital, University of Miami, Miami, USA.
| | - Hannah Clode
- Jackson Memorial Hospital, University of Miami, Miami, USA
- Department of Radiology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Fabio M Paes
- Miller School of Medicine, Jackson Memorial Hospital - Ryder Trauma Center, University of Miami, Miami, FL, USA
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Ong WLK, Somani BK, Fong KY, Teoh JYC, Sarica K, Chai CA, Ragoori D, Tailly T, Hamri SB, Heng CT, Biligere S, Emiliani E, Gadzhiev N, Tanidir Y, Chew BH, Castellani D, Traxer O, Gauhar V. Retrograde intrarenal surgery for asymptomatic incidental renal stones: a retrospective, real-world data analysis. BJU Int 2024; 134:201-206. [PMID: 38343138 DOI: 10.1111/bju.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To determine surgical outcomes and stone-free rates (SFRs) when offering upfront retrograde intrarenal surgery (RIRS) to patients with asymptomatic incidental renal stones (AIRS), as active surveillance, shockwave lithotripsy or upfront intervention in patients with AIRS is still a debate among urologists. PATIENTS AND METHODS This retrospective FLEXible Ureteroscopy Outcomes Registry (FLEXOR), supported by the Team of Worldwide Endourological Researchers (TOWER), examines adult patients who underwent RIRS. We analysed a subset of asymptomatic patients with renal stones on imaging who were treated with RIRS. Data includes patient characteristics, stone specifications, anaesthesia type, perioperative details, complications, and SFR. A multivariable logistic regression analysis was performed to assess factors associated with the SFR. RESULTS Among 679 patients with AIRS, 640 met the inclusion criteria. The median age was 55 years, with 33.4% being female. In all, 22.1% had positive urine cultures. The median stone diameter was 12 mm, commonly in lower and interpolar locations. RIRS was preferentially performed under general anaesthesia using a reusable scope in 443 cases. Prophylactic antibiotics were administered to 314 patients. The median operation time was 58 min and the median laser time was 24 min. The SFR was 68.8%. The use of holmium laser (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.06-0.63; P < 0.01) and multiple stones (OR 0.38, 95% CI 0.19-0.76; P < 0.01) were factors associated with lower odds of being stone free. Overall complications were minimal, with sepsis in 1.6% of patients. Re-interventions were performed in 76 cases (11.8%), with RIRS being the most common in 67 cases (10.6%). CONCLUSION Our multicentre real-world study is the first of its kind that highlights the pros and cons of offering RIRS to patients with AIRS and demonstrates a favourable SFR with acceptable complications. Pre-emptively discussing potential re-intervention helps patients make informed decisions, particularly in cases involving large and multiple stones.
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Affiliation(s)
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S. H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Thomas Tailly
- Department of Urology, ERN eUROGEN Accredited Centre, University Hospital of Ghent, Ghent, Belgium
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Esteban Emiliani
- Urology Department, Universidad Autónoma de Barcelona, Fundación Puigvert Barcelona, Barcelona, Spain
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Oliver Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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170
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Schults A, Tham RL, Nelson CP, Finkelstein JB. Factors contributing to telemedicine efficacy in pediatric urology. J Pediatr Urol 2024; 20:694.e1-694.e7. [PMID: 38679525 DOI: 10.1016/j.jpurol.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Despite swift implementation of telemedicine with the coronavirus disease 2019 pandemic, there is a paucity of research on its use for management of pediatric urology patients. Specifically, there is limited knowledge and inconsistent data on the effectiveness of telemedicine for various pediatric urologic conditions. Our aim was to evaluate the efficacy of pediatric urological care provided via video visits (VVs) at a large tertiary care children's hospital. MATERIAL AND METHODS We performed a prospective assessment of pediatric urology patients younger than 21 years who had a VV between 5/18/2022 and 5/17/2023. New patients with a testicular diagnosis were not eligible for VVs. After entering the diagnosis and submitting billing using a modifier for telemedicine, clinicians were mandated to select whether the VV allowed for: complete case management (CCM), suboptimal case management (SCM), or incomplete case management (ICM) requiring an in-person visit. Case management categorizations were analyzed according to patient pathology, visit type (i.e., new or established), and patient-centered variables including age, sex, race, insurance type, need for an interpreter, and distress score [a proxy for socioeconomic status]. RESULTS During the one-year period, there were 3267 telemedicine patients with a median age of 9 years (IQR 3-13) and 57.0% were male. Most VVs (89.3%) were established encounters. Almost 12% of telemedicine patients had external organ pathology (EOP, e.g., phimosis), 43.0% had internal organ pathology (IOP, e.g., hydronephrosis), and 45.1% had functional urological pathology (FUP, e.g., dysfunctional voiding). Clinicians deemed 96.9%, 2.7%, and 0.5% of VVs as having CCM, SCM or ICM, respectively. Telemedicine patients with IOP or FUP were more likely to have CCM, than those with EOP (98.5% and 97.8% vs 87.1%, p < 0.0001). On multivariable analysis, patient age, pathology, and visit type were predictive of VV efficacy. DISCUSSION Now that telemedicine use has slowed, it is necessary to evaluate and establish its optimal role in pediatric urology. Factors associated with VV efficacy included older patient age, internal organ or functional urological pathology, and established encounters. The long-term success of telemedicine requires suitable patient selection. CONCLUSIONS Telemedicine is quite effective for the management of a wide variety of pediatric urology patients. Continued evaluation of telemedicine, including multi-institutional investigation and corroboration, is necessary for the development of evidence-based best practice guidelines regarding appropriate, safe, and effective integration of telemedicine that drives pediatric urological care forward to meet the demands of the future.
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Affiliation(s)
- Austin Schults
- Department of Urology Massachusetts General Hospital, Boston, MA, USA.
| | - Regina L Tham
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
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171
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Basile G, Necchi A, Prakash G, Oualla K, Spiess PE, Johnstone PAS. The case for centralization of care in penile cancer - respecting geographical needs. Nat Rev Urol 2024; 21:453-454. [PMID: 38622327 DOI: 10.1038/s41585-024-00879-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Giuseppe Basile
- Department of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Andrea Necchi
- Department of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Gagan Prakash
- Department of Surgical Oncology, Division of Urologic Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Karima Oualla
- Medical Oncology Department, Hassan II University Hospital, Fes, Morocco
| | - Philippe E Spiess
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
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172
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Blumenau Pedersen M, Saxton JM, Rasmussen Villumsen B, Bjerggaard Jensen J, Birch S. Detailed description of multidisciplinary prehabilitation in patients admitted to nerve sparring radical prostatectomy - A randomized feasibility study protocol. Contemp Clin Trials Commun 2024; 40:101319. [PMID: 38947984 PMCID: PMC11211855 DOI: 10.1016/j.conctc.2024.101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 07/02/2024] Open
Abstract
Background Localized prostate cancer treated with radical prostatectomy is highly effective, though severe side-effects are common after the surgery. Prehabilitation is an approach to optimize patient's physical and mental resources before surgery, to improve postoperative outcomes. The feasibility of a multi-modal home-based prehabilitation program, delivered using telehealth in patients awaiting radical prostatectomy is unknown. This paper describes the development of a prehabilitation program for patients awaiting radical prostatectomy. Method A model by The Medical Research Council for developing and evaluating complex interventions (MRC Framework) was used in the development process. The Template for Intervention Description and Replication (TIDieR) checklist was applied for ensuring sufficient description of the interventions. A total of 40 patients will be randomized to either intervention or control group. Patients in the control group will follow standard care. The 4-week prehabilitation programme consists of exercise, pelvic floor exercise, sexual counseling, stress management and nutritional support. The interventions are home-based and delivered using telehealth. Feasibility outcomes will include recruitment, attrition rates, adherence, safety and suitability. Conclusion We have developed a multimodal prehabilitation programme, which has the potential to bring tangible health benefits to men with prostate cancer awaiting radical prostatectomy. The results of the feasibility study will inform the design of a fully powered randomized controlled trial.
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Affiliation(s)
- Malene Blumenau Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Gødstrup Hospital, Gødstrup, Denmark
- Department of Occupational- and Physiotherapy, Gødstrup Hospital, Gødstrup, Denmark
| | - John M. Saxton
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
| | | | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Birch
- Department of Occupational- and Physiotherapy, Gødstrup Hospital, Gødstrup, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrup, Denmark
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173
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Queißert F, Schrader AJ. ["Pressure kills kidneys": protection of the upper urinary tract through neuro-urological management]. Aktuelle Urol 2024; 55:302-307. [PMID: 38653468 DOI: 10.1055/a-2287-4933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Low compliance is not an independent disease but a severe manifestation resulting from various disorders of the storage and excretory function of the bladder. Reduced distensibility of the detrusor muscle can lead to a pressure load on the upper urinary tract but also to urge-dominant LUTS and urinary tract infections. Neurogenic causes, especially spinal cord injury/spina bifida but also iatrogenic damage or subvesical obstruction, can contribute to the development. This article is intended to provide information about the epidemiology and complex pathogenetic mechanisms as well as the necessary diagnostic steps. Various medical, interventional and surgical treatment strategies are evaluated on the basis of current scientific findings, thus supporting the reader in the care of this complex patient group.
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Affiliation(s)
- Fabian Queißert
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Germany
| | - Andres Jan Schrader
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Germany
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174
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Geilswijk M, Genuardi M, Woodward ER, Nightingale K, Huber J, Madsen MG, Liekelema-van der Heij D, Lisseman I, Marlé-Ballangé J, McCarthy C, Menko FH, Moorselaar RJAV, Radzikowska E, Richard S, Rajan N, Sommerlund M, Wetscherek MTA, Di Donato N, Maher ER, Brunet J. ERN GENTURIS clinical practice guidelines for the diagnosis, surveillance and management of people with Birt-Hogg-Dubé syndrome. Eur J Hum Genet 2024:10.1038/s41431-024-01671-2. [PMID: 39085584 DOI: 10.1038/s41431-024-01671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Birt-Hogg-Dubé syndrome (BHD syndrome) is an autosomal dominant multisystem disorder with variable expression due to pathogenic constitutional variants in the FLCN gene. Patients with BHD syndrome are predisposed to benign cutaneous fibrofolliculomas/trichodischomas, pulmonary cysts with an associated risk of spontaneous pneumothorax, and renal cell carcinoma. A requirement for updated International consensus recommendations for the diagnosis and management of BHD syndrome was identified. Based on a comprehensive literature review and expert consensus within the fields of respiratory medicine, urology, radiology, dermatology, clinical oncology and clinical genetics, updated recommendations for diagnosis, surveillance and management in BHD syndrome were developed. With the widespread availability of FLCN genetic testing, clinical scenarios in which a diagnosis should be considered and criteria for genetic testing were defined. Following a clinical and/or molecular diagnosis of BHD syndrome, a multidisciplinary approach to disease management is required. Regular renal cancer surveillance is recommended in adulthood and life-long, but the evidence base for additional tumour surveillance is limited and further research warranted. Recommendations for the treatment of cutaneous, pulmonary and renal manifestations are provided. Awareness of BHD syndrome needs to be raised and better knowledge of the clinical settings in which the diagnosis should be considered should enable earlier diagnosis. Further details, including areas for future research topics are available at: https://www.genturis.eu/l=eng/Guidelines-and-pathways/Clinical-practice-guidelines.html .
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Affiliation(s)
| | - Maurizio Genuardi
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Genetica Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester, UK
| | | | | | | | | | - Ian Lisseman
- Myrovlytis Trust, BHD Foundation, Manchester, UK
| | - Jenny Marlé-Ballangé
- BHD FRANCE (a charity working closely with the BHD foundation), La Rochelle, France
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Fred H Menko
- Antoni van Leeuwenhoek Hospital, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | | | - Stéphane Richard
- French NCI (INCa) network for rare cancers in adults PREDIR, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Maria T A Wetscherek
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nataliya Di Donato
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Eamonn R Maher
- University of Cambridge, Cambridge, UK
- Aston University, Birmingham, UK
| | - Joan Brunet
- Catalan Institute of Oncology, Barcelona, Spain
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175
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Lee H, Thakker S, Pineault K, Wysock J, Tan WP. Salvage Cryoablation for Recurrent Prostate Cancer Following Radiation-A Comprehensive Review. Cancers (Basel) 2024; 16:2717. [PMID: 39123445 PMCID: PMC11312114 DOI: 10.3390/cancers16152717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
The treatment options for prostate cancer typically entail active surveillance, surgery, radiation, or a combination of the above. Disease recurrence remains a concern, with a wide range of recurrence rates having been reported in the literature. In the setting of recurrence, the salvage treatment options include salvage prostatectomy, salvage high-intensity focused ultrasound (HIFU), stereotactic body radiotherapy (SBRT), salvage brachytherapy, and salvage cryoablation. In this review, we analyze the currently available data related to salvage cryoablation for recurrent prostate cancer following radiation.
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Affiliation(s)
| | | | | | | | - Wei Phin Tan
- Department of Urology, NYU Langone Health, New York, NY 10016, USA
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176
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Cheung T, Raskolnikov D, Small A, Watts KL. Strategies for optimizing pain management after ureteroscopy. Transl Androl Urol 2024; 13:1309-1311. [PMID: 39100822 PMCID: PMC11291410 DOI: 10.21037/tau-24-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/16/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Tracy Cheung
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dima Raskolnikov
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Alex Small
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Kara L. Watts
- Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
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177
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Zekan D, Praetzel R, Luchey A, Hajiran A. Local Therapy and Reconstruction in Penile Cancer: A Review. Cancers (Basel) 2024; 16:2704. [PMID: 39123432 PMCID: PMC11311999 DOI: 10.3390/cancers16152704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Local therapy for penile cancer provides robust survival and can preserve the penis functionally and cosmetically. Interventions must target the appropriate clinical stage. We reviewed studies regarding the primary therapy in penile cancer, from topical therapy to radical penectomy, and reconstructive techniques. Topical therapy (5-FU or Imiquimod) provides a robust oncologic response in patients with Ta or Tis disease. Multiple laser therapies are available for localized patients and those with low-grade T1 disease. There is a non-trivial risk of progression and nodal metastases in poorly selected patients. Wide local excision provides an oncologically sound option in patient with up to T1 disease; less evidence exists for Mohs microsurgery in the setting of penile cancer. Increasingly aggressive approaches include glansectomy and partial/radical penectomy, which provide 5- and 10-year cancer-specific survival rates of over 80%. Meticulous reconstruction is necessary for the durable function of the remaining penis. Preservation of voiding and sexual function occurs via penile skin grafting, glans resurfacing, creation of a functional penile stump, and phalloplasty with a penile implant. Perineal urethrostomy provides an alternative in pathology demanding extensive partial or radical penectomy, and a durable option for seated voiding. Clinical suspicion and timely diagnosis are paramount in terms of management as less-invasive options for earlier-stage disease develop.
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Affiliation(s)
- David Zekan
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
| | - Rebecca Praetzel
- College of Osteopathic Medicine, Liberty University, Lynchburg, VA 24502, USA;
| | - Adam Luchey
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
| | - Ali Hajiran
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (A.L.); (A.H.)
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178
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Malshy K, Marthi S, Ortiz R, Nicaise E, Golijanin B, Miller K, Hartsell L, Cancian M. Timing Considerations for Artificial Urinary Sphincter Implantation Postpelvic Radiotherapy. Urology 2024:S0090-4295(24)00601-0. [PMID: 39089495 DOI: 10.1016/j.urology.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To explore the optimal timing for placing an artificial urinary sphincter (AUS) postradiation therapy (RT). METHODS A bi-institutional retrospective review of all patients who underwent their first (virgin) AUS placement after pelvic RT between January 1, 2011 and July 1, 2023. To determine the optimal timeline for device implantation 2-5years post-RT, we compared hazard ratios for device revision/explantation (Rev/Exp) using Kaplan-Meier curves for each year (earlier vs later than 2/3/4/5 years post-RT). The Pearson correlation coefficient identified trends in Rev/Exp reasons (erosion/infection vs other). RESULTS Seventy-two patients met our inclusion criteria with a median age of 65.5years (interquartile range 70-81.25). Fifteen (20.8%) had undergone one or more previous urethral or bladder neck interventions (urethroplasty in 1 [1.4%], internal urethrotomy in 7 [9.7%], and bladder neck incision in 9 [12.5%]). After a median follow-up of 57.5months (interquartile range 13-107), a total of 36 (50%) devices were Rev/Exp, with mechanical failure in 14 (19.4%) and device erosion in 12 (16.7%) being the main reasons. Device survival analysis revealed no significant difference in the risk of device Rev/Exp when implanted earlier vs later than 2, 3, 4, or 5years post-RT, with P-values of .3, .3, .4, and .4, respectively. A constant trend toward higher infection/erosion rates as indication for device Rev/Exp the later the insertion was noticed: R2 = 0.98. CONCLUSION Despite a small sample size, our study indicates that implanting an AUS within 5 years after RT shows comparable device lifespan. However, later insertions may have higher removal rates due to erosion/infection. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kamil Malshy
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; The Warren Alpert Medical School of Brown University, Providence, RI.
| | | | - Rebecca Ortiz
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI
| | - Edouard Nicaise
- Department of Urology, Emory University Hospital, Atlanta, GA
| | - Borivoj Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kennon Miller
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Madeline Cancian
- The Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; The Warren Alpert Medical School of Brown University, Providence, RI
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Zhang ZH, Luo F, Wang YS, Li J. "Five-Step" Vaporization of the Prostate Using 180-W XPS Greenlight Laser in Patients with Benign Prostatic Hyperplasia of Large Volume: Improved Efficacy and Safety. Photobiomodul Photomed Laser Surg 2024. [PMID: 39075040 DOI: 10.1089/pho.2024.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Objective: To evaluate the safety and efficacy of 180-W XPS Greenlight laser "Five-step" photoselective vaporization of the prostate (PVP) in patients with benign prostatic hyperplasia (BPH) with prostate volume (PV) > 80 mL. Background: In patients with BPH with large PV, PVP often results in bleeding, unclear visual field, additional damage, and insufficient tissue vaporization. Methods: This single-center, retrospective study enrolled patients with BPH with PV > 80 mL treated with the Five-step PVP or the Conventional PVP from January 2018 to June 2021. Comorbidities, high-risk habits, and operative parameters were analyzed and compared. The short-term functional outcomes and postoperative complications were recorded over the 24-month follow-up. Results: Two hundred eligible patients were divided into the Five-step PVP and Conventional PVP groups (n = 100 each). These groups showed no differences in comorbidities, living habits, baseline perioperative parameters, operative time, lasing time, or energy use. However, a higher energy density (3.95 [interquartile range (IQR) 3.37, 4.52] vs 3.68 [IQR 3.17, 4.20] kJ/mL) and energy-time ratio (7.23 [IQR 6.12, 8.52] vs 6.72 [IQR 5.51, 7.87] kj/min p = 0.034) were obtained in the Five-step PVP group. Subgroup analysis of patients with PV ≥120 mL showed similar results. The short-term functional outcomes were similar between the two study groups with significant improvement from baseline, but the total prostate-specific antigen levels at 1 and 6 months were lower in the Five-step PVP group. Further, incidences of intraoperative bleeding, bladder mucosa injury, postoperative hematuria, and urinary tract infection were lower in the Five-step PVP group. In the Conventional PVP group, four patients required conversion to transurethral resection of the prostate in surgery and two patients required retreatment during the 24-month follow-up. Conclusions: The 180-W XPS Greenlight laser Five-step PVP has advantages of less bleeding, high vaporization efficiency, and low rates of perioperative complications, and, therefore, it is a promising treatment to improve short-term functional outcomes for patients with BPH with large PV.
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Affiliation(s)
- Zhi-Hua Zhang
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Fei Luo
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Ya-Shen Wang
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Jian Li
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
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180
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Liang CC, Shaw SW, Chen TC, Lin YH, Huang YH, Lee TH. Local Injection of Stem Cells Can Be a Potential Strategy to Improve Bladder Dysfunction after Outlet Obstruction in Rats. Int J Mol Sci 2024; 25:8310. [PMID: 39125879 PMCID: PMC11313184 DOI: 10.3390/ijms25158310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
This study investigates whether hAFSCs can improve bladder function in partial bladder outlet obstruction (pBOO) rats by targeting specific cellular pathways. Thirty-six female rats were divided into sham and pBOO groups with and without hAFSCs single injection into the bladder wall. Cystometry, inflammation/hypoxia, collagen/fibrosis/gap junction proteins, and smooth muscle myosin/muscarinic receptors were examined at 2 and 6 weeks after pBOO or sham operation. In pBOO bladders, significant increases in peak voiding pressure and residual volume stimulated a significant upregulation of inflammatory and hypoxic factors, TGF-β1 and Smad2/3. Collagen deposition proteins, collagen 1 and 3, were significantly increased, but bladder fibrosis markers, caveolin 1 and 3, were significantly decreased. Gap junction intercellular communication protein, connexin 43, was significantly increased, but the number of caveolae was significantly decreased. Markers for the smooth muscle phenotype, myosin heavy chain 11 and guanylate-dependent protein kinase, as well as M2 muscarinic receptors, were significantly increased in cultured detrusor cells. However, hAFSCs treatment could significantly ameliorate bladder dysfunction by inactivating the TGFβ-Smad signaling pathway, reducing collagen deposition, disrupting gap junctional intercellular communication, and modifying the expressions of smooth muscle myosin and caveolae/caveolin proteins. The results support the potential value of hAFSCs-based treatment of bladder dysfunction in BOO patients.
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Affiliation(s)
- Ching-Chung Liang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (C.-C.L.); (Y.-H.L.); (Y.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.W.S.); (T.-C.C.)
| | - Steven W. Shaw
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.W.S.); (T.-C.C.)
- Division of Obstetrics, Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Prenatal Cell and Gene Therapy Group, Institute for Women’s Health, University College London, London WC1E 6BT, UK
| | - Tse-Ching Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.W.S.); (T.-C.C.)
- Department of Anatomical Pathology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Yi-Hao Lin
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (C.-C.L.); (Y.-H.L.); (Y.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.W.S.); (T.-C.C.)
| | - Yung-Hsin Huang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (C.-C.L.); (Y.-H.L.); (Y.-H.H.)
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.W.S.); (T.-C.C.)
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
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Guo Y, Dong Y, Zheng R, Yan J, Li W, Xu Y, Yan X, Ke Y, Li Y, Xiang L. Correlation between viral infections in male semen and infertility: a literature review. Virol J 2024; 21:167. [PMID: 39080728 PMCID: PMC11290048 DOI: 10.1186/s12985-024-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/06/2024] [Indexed: 08/02/2024] Open
Abstract
Infertility affects approximately one-sixth of couples globally, with the incidence of male infertility steadily increasing. However, our understanding of the impact of viral infections on fertility remains limited. This review consolidates findings from previous studies, outlining 40 viruses identified in human semen and summarizing their key characteristics, modes of transmission, and their effects on both the reproductive and endocrine systems. Furthermore, it elucidates potential pathogenic mechanisms and treatment prospects of viruses strongly associated with male infertility. This synthesis will enhance our comprehension of how viral infections influence male reproductive health, offering valuable insights for future research as well as the diagnosis and treatment of infectious infertility.
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Affiliation(s)
- Yan Guo
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunhua Dong
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Runzi Zheng
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jiacong Yan
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Weiyuan Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ya Xu
- Department of Clinical Laboratory, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Xuelan Yan
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunmei Ke
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yantao Li
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Lifeng Xiang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China.
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
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Omidele OO, Siegal AS, Roshandel R, Te AE, Kaplan SA. Aquablation at 4-years: Real World Data From the Largest Single-center Study With Associated Outcomes Follow-up. Urology 2024:S0090-4295(24)00625-3. [PMID: 39084348 DOI: 10.1016/j.urology.2024.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To report real-world experience of 4-year safety and efficacy outcomes of Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH). METHODS This is a prospective single-center, observational study evaluating the outcomes of robotic-assisted Aquablation therapy for moderate-to-severe BPH between December 2019 and December 2023. Patient-level data included age, prostate volume, IPSS score, peak urinary flow rate (Qmax), post-void residual (PVR) were evaluated at 3 M, 6 M, and Years 1-4. Primary outcomes included change in IPSS score, change in Qmax, change in PVR, preservation of antegrade ejaculation, and complications. RESULTS In this cohort of 330 men, mean prostatic volume was 110.3 mL (range 38-330 mL) at baseline. International Prostate Symptom Score (IPSS) improved from a baseline of 23.8 (SD 8.4) to 6.9 (SD 2.9) at 4 years. Mean peak urinary flow rate (Qmax) also demonstrated improvement and increased from 6.4 mL/sec (SD 4.2) to 17.4 mL/sec (SD 5.5) at 4 years. At 1 year, mean prostate volume reduction was 45.5 mL (-41.3%). Postoperative antegrade ejaculation was preserved in 249/250 men (99.6)% of men. Complications included urinary tract infection within first month after procedure in 37 (11.2%) and bleeding requiring blood transfusion in 11 (3.3%). Thirteen patients (3.9%) required a second procedure including 2 for post-operative bleeding, 1 for a bladder neck disruption and 10 (3.0%) for transurethral resection of residual anterior tissue. CONCLUSION We demonstrate Aquablation to not only be safe but also providing durable outcomes at 4 years for men with BPH.
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Affiliation(s)
- Olamide O Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra S Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reza Roshandel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexis E Te
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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183
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Liu Z, Wang X, Shui W, Yan Y, Zhou M, Chen B, Zhang R, Ying T. Ultrasonographic features of female urethral caruncle: a retrospective study of 20 patients. Sci Rep 2024; 14:17431. [PMID: 39075141 PMCID: PMC11286946 DOI: 10.1038/s41598-024-68355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
Female urethral caruncle is the most common urethral mass in postmenopausal women, yet there is a lack of studies on its imaging. The aim of this study was to provide a summary of the clinical and ultrasound features as well as the precise location of female urethral caruncle. This study reviewed the clinical and ultrasonographic records of 20 consecutive women with pathologically confirmed urethral caruncle. Data on patient demographics, symptoms, and transperineal and transrectal ultrasound imaging features, including location, shape, margin, size, blood flow, and inner echo of the caruncle, were extracted. Each patient presented with only one mass at the urethral meatus. Most caruncles were located on the posterior lip (75%) of the urethra, presenting as oval (80%), mixed-echoic (50%), or hypo-echoic (40%) nodules with abundant linear (40%) or dendritic (60%) blood flow. The average distance between the bladder neck and the cranial end of the masses was 28 mm. Hyper-echogenic spots, cystic echo areas, and macrocalcifications were detected in thirteen caruncles (70%). This study shows that transperineal combined with transrectal ultrasound can be used to assess female urethral caruncle, and its relative location to the urethra can be accurately described, which is helpful for surgeons making preoperative localization and conversations.
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Affiliation(s)
- Zhiran Liu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xia Wang
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Shui
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yulin Yan
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Minzhi Zhou
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Bin Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rui Zhang
- Department of Gynaecology and Obstetrics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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184
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Wu FCW, Lo K. Initiating male contraception methods. Andrology 2024. [PMID: 39073522 DOI: 10.1111/andr.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/12/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024]
Abstract
Non-surgical (reversible) male contraception methods, when approved for general clinical application, should be made available to all interested men aged 18 50 years in good general health regardless of their semen parameters. In the preliminary workup, a complete personal and family history aimed at identifying specific conditions that may potentially increase the risks for adverse effects (associated with testosterone replacement) is advisable but a general or andrological examination is not required, unless indicated by the history. Baseline body weight, blood pressure and haemoglobin should be recorded for the purpose of future monitoring. While risks and benefits of vasectomy have been well established, appropriately nuanced patient counselling and assessment are essential for ensuring a satisfactory outcome of vasectomy.
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Affiliation(s)
- Frederick C W Wu
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
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185
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Cyr MP, Nahon I, Worman R, Cowley D, Hodges PW. Classification systems for chronic pelvic pain in males: a systematic review. BJU Int 2024. [PMID: 39075791 DOI: 10.1111/bju.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
OBJECTIVE To systematically review the classification systems for male chronic pelvic pain (CPP). METHODS The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Web of Science were searched. Any publication, with no restriction to publication date, was eligible. Publications had to propose a classification system for CPP in males or provide additional information of a system that had been identified. Systems were assessed with an adapted Critical Appraisal of Classification Systems tool. RESULTS A total of 33 relevant publications were identified, with 22 proposing an original classification system. Systems aimed to: (i) diagnose CPP and/or differentially diagnose CPP from other conditions, (ii) differentially diagnose subtypes within CPP, or (iii) identify features that could inform underlying mechanisms and/or treatment selection. Conditions referred to as chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis/bladder pain syndrome were most represented. Clinical signs/symptoms, pathoanatomical investigations, and presumed pain mechanisms were used for classification. Quality of systems was low to moderate, implying limitations to consider for their interpretation. CONCLUSIONS Many classification systems for CPP in males exist. Careful consideration of their intended purpose is required. Future work should examine whether outcomes for patients are improved when decisions are guided by their use.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Irmina Nahon
- Department of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rachel Worman
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - David Cowley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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186
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Gunashekar DD, Bielak L, Oerther B, Benndorf M, Nedelcu A, Hickey S, Zamboglou C, Grosu AL, Bock M. Comparison of data fusion strategies for automated prostate lesion detection using mpMRI correlated with whole mount histology. Radiat Oncol 2024; 19:96. [PMID: 39080735 PMCID: PMC11287985 DOI: 10.1186/s13014-024-02471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/14/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND In this work, we compare input level, feature level and decision level data fusion techniques for automatic detection of clinically significant prostate lesions (csPCa). METHODS Multiple deep learning CNN architectures were developed using the Unet as the baseline. The CNNs use both multiparametric MRI images (T2W, ADC, and High b-value) and quantitative clinical data (prostate specific antigen (PSA), PSA density (PSAD), prostate gland volume & gross tumor volume (GTV)), and only mp-MRI images (n = 118), as input. In addition, co-registered ground truth data from whole mount histopathology images (n = 22) were used as a test set for evaluation. RESULTS The CNNs achieved for early/intermediate / late level fusion a precision of 0.41/0.51/0.61, recall value of 0.18/0.22/0.25, an average precision of 0.13 / 0.19 / 0.27, and F scores of 0.55/0.67/ 0.76. Dice Sorensen Coefficient (DSC) was used to evaluate the influence of combining mpMRI with parametric clinical data for the detection of csPCa. We compared the DSC between the predictions of CNN's trained with mpMRI and parametric clinical and the CNN's trained with only mpMRI images as input with the ground truth. We obtained a DSC of data 0.30/0.34/0.36 and 0.26/0.33/0.34 respectively. Additionally, we evaluated the influence of each mpMRI input channel for the task of csPCa detection and obtained a DSC of 0.14 / 0.25 / 0.28. CONCLUSION The results show that the decision level fusion network performs better for the task of prostate lesion detection. Combining mpMRI data with quantitative clinical data does not show significant differences between these networks (p = 0.26/0.62/0.85). The results show that CNNs trained with all mpMRI data outperform CNNs with less input channels which is consistent with current clinical protocols where the same input is used for PI-RADS lesion scoring. TRIAL REGISTRATION The trial was registered retrospectively at the German Register for Clinical Studies (DRKS) under proposal number Nr. 476/14 & 476/19.
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Affiliation(s)
- Deepa Darshini Gunashekar
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany.
| | - Lars Bielak
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Benedict Oerther
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Benndorf
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Nedelcu
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samantha Hickey
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Oncology Center, European University Cyprus, Limassol, Cyprus
| | - Anca-Ligia Grosu
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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187
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Rajamohan N, Kapoor H, Khurana A, Nelson L, Ganesh HS, Khatri G, Nair RT. MR imaging of penile pathology and prostheses. Abdom Radiol (NY) 2024:10.1007/s00261-024-04417-2. [PMID: 39066812 DOI: 10.1007/s00261-024-04417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024]
Abstract
Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Affiliation(s)
- Naveen Rajamohan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA.
| | - Harit Kapoor
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Aman Khurana
- Department of Radiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Leslie Nelson
- Department of Radiology, University of Wisconsin, Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Halemane S Ganesh
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
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188
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James C, Whitehead A, Plummer JT, Thompson R, Badal S. Failure to progress: breast and prostate cancer cell lines in developing targeted therapies. Cancer Metastasis Rev 2024:10.1007/s10555-024-10202-w. [PMID: 39060878 DOI: 10.1007/s10555-024-10202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Developing anticancer drugs from preclinical to clinical takes approximately a decade in a cutting-edge biomedical lab and still 97% of most fail at clinical trials. Cell line usage is critical in expediting the advancement of anticancer therapies. Yet developing appropriate cell lines has been challenging and overcoming these obstacles whilst implementing a systematic approach of utilizing 3D models that recapitulate the tumour microenvironment is prudent. Using a robust and continuous supply of cell lines representing all ethnic groups from all locales is necessary to capture the evolving tumour landscape in culture. Next, the conversion of these models to systems on a chip that can by way of high throughput cytotoxic assays identify drug leads for clinical trials should fast-track drug development while markedly improving success rates. In this review, we describe the challenges that have hindered the progression of cell line models over seven decades and methods to overcome this. We outline the gaps in breast and prostate cancer cell line pathology and racial representation alongside their involvement in relevant drug development.
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Affiliation(s)
- Chelsi James
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica
| | - Akeem Whitehead
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica
| | | | - Rory Thompson
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Simone Badal
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica.
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189
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Tabei SS, Lippold B, Baas W, Murphy G. Penetrating Posterior Urethral Injuries: Case Report and Management Strategies. Case Rep Urol 2024; 2024:7839379. [PMID: 39104899 PMCID: PMC11300079 DOI: 10.1155/2024/7839379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/18/2024] [Accepted: 06/17/2024] [Indexed: 08/07/2024] Open
Abstract
Penetrating posterior urethral trauma from gunshot wounds (GSW) is rare and requires prompt treatment to minimize complications. Data regarding the management of such cases is scarce in the literature and poorly addressed in the guidelines. Different management approaches exist, including urinary diversion with immediate versus delayed urethroplasty/fistula repair. We present our case series to add to our experience to the literature. Three patients aged 18-44 presented with ballistic posterior urethra injuries from GSW. Initial management involved urethral catheter placement, with one patient requiring operative placement of urethral and suprapubic catheters (SPTs). Complications included recurrent membranous stricture, urinary retention, rectourethral fistula, and erectile dysfunction (ED). Posterior urethral injuries from GSW are complex as they can be either isolated or affect adjacent organs. Bladder, ureteral, and urethral injuries must be ruled out. Unlike bladder neck injuries, immediate urethroplasty/fistula repair would be very challenging and not advised for standard prostatic or membranous injuries. Urethral catheter or suprapubic tube is recommended and can result in fistula closure and urethral patency. It is critical to maintain close follow-up with the patient due to the possibility of stricture recurrence. Urethroplasty in a delayed fashion can be very successful.
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Affiliation(s)
- Seyed Sajjad Tabei
- Division of UrologyDepartment of SurgeryUniversity of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267, USA
| | - Brandon Lippold
- Division of Urologic SurgeryWashington University School of Medicine in St. Louis, 4960 Children's Place, Campus Box 842, St. Louis, Missouri 63110, USA
| | - Wesley Baas
- Division of UrologyDepartment of SurgeryUniversity of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267, USA
| | - Gregory Murphy
- Division of Urologic SurgeryWashington University School of Medicine in St. Louis, 4960 Children's Place, Campus Box 842, St. Louis, Missouri 63110, USA
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190
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Cho EY, Chaudry AE, Puri D, Kim S, Viers BR, Witthaus M, Buckley JC. Outcomes of Robot-assisted Appendiceal Ureteroplasty From a Multi-institutional Experience. Urology 2024:S0090-4295(24)00628-9. [PMID: 39069159 DOI: 10.1016/j.urology.2024.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To evaluate the viability of robot-assisted appendiceal ureteroplasty as an innovative surgical approach for the reconstruction of ureteral strictures in cases where traditional methods are unsuitable. METHODS We conducted a retrospective review of 14 patients who underwent robot-assisted appendiceal ureteroplasty for right-sided ureteral stricture disease at three academic centers between March 2018 and November 2022. Patients were selected based on stricture characteristics, tissue quality, and the need for tissue transfer techniques. Surgical outcomes, including stricture-free rates, renal function, and complication rates, were analyzed. RESULTS The median patient age was 63years, with a balanced gender distribution. The median stricture length was 4.75 cm. The majority of strictures were located in the proximal ureter (50%). Surgical approaches included appendiceal onlay flaps (71.4%) and interposition flaps (28.6%). The median operative time was 268 minutes, with an average estimated blood loss of 75 mL. Postoperatively, ureteral patency was achieved in 92.9% of patients. Two patients (14.3%) experienced urinary tract infections requiring readmission. There was no significant change in serum creatinine levels postoperatively. Hydronephrosis grade significantly improved following surgery (P = .025). CONCLUSION Robot-assisted appendiceal ureteroplasty is a safe and effective technique for managing ureteral strictures. It offers a high success rate with minimal complications, making it a valuable addition to the urologic surgeon's armamentarium for complex ureteral reconstructions.
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Affiliation(s)
- Eric Y Cho
- Department of Urology, University of California San Diego, San Diego, CA
| | - Ameen E Chaudry
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, San Diego, CA.
| | - Sunchin Kim
- Department of Urology, University of Arizona College of Medicine - Tucson, Tucson, AZ
| | | | | | - Jill C Buckley
- Department of Urology, University of California San Diego, San Diego, CA
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191
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Woo HY, An JM, Park MY, Han A, Kim Y, Kang J, Ahn S, Min SK, Ha J, Kim D, Min S. Cysteine as an Innovative Biomarker for Kidney Injury. Transplantation 2024:00007890-990000000-00828. [PMID: 39049125 DOI: 10.1097/tp.0000000000005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Kidney transplantation is a widely used treatment for end-stage kidney disease. Nevertheless, the incidence of acute kidney injury (AKI) in deceased donors poses a potential hazard because it significantly increases the risk of delayed graft function and potentially exerts an influence on the kidney allograft outcome. It is crucial to develop a diagnostic model capable of assessing the existence and severity of AKI in renal grafts. However, no suitable kidney injury markers have been developed thus far. METHODS We evaluated the efficacy of the molecular probe NPO-B, which selectively responds to cysteine, as a new diagnostic tool for kidney injury. We used an in vitro model using ischemia/reperfusion injury human kidney-2 cells and an in vivo ischemia/reperfusion injury mouse model. Additionally, cysteine was investigated using urine samples from deceased donors and living donors to assess the applicability of detection techniques to humans. RESULTS This study confirmed that the NPO-B probe effectively identified and visualized the severity of kidney injury by detecting cysteine in both in vitro and in vivo models. We observed that the fluorescence intensity of urine samples measured using NPO-B from the deceased donors who are at a high risk of renal injury was significantly stronger than that of the living donors. CONCLUSIONS If implemented in clinical practice, this new diagnostic tool using NPO-B can potentially enhance the success rate of kidney transplantation by accurately determining the extent of AKI in renal grafts.
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Affiliation(s)
- Hye Young Woo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Min An
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Min Young Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngwoong Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jisoo Kang
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dokyoung Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, Core Research Institute (CRI), Kyung Hee University, Seoul, Republic of Korea
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- Center for Converging Humanities, Kyung Hee University, Seoul, Republic of Korea
- KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Republic of Korea
- UC San Diego Materials Research Science and Engineering Center, La Jolla, CA
- Center for Brain Technology, Brain Science Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Department of Precision Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hamel C, Avard B, Brahm G, Fung D, Martens B, Michaud A, Miller L, Sala E, Wallis CJD, Fung C. Canadian Association of Radiologists Genitourinary Imaging Referral Guideline. Can Assoc Radiol J 2024:8465371241261317. [PMID: 39054585 DOI: 10.1177/08465371241261317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Genitourinary Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, family medicine, nephrology, and urology, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 22 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 30 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 65 recommendation statements across the 22 scenarios (2 scenarios point to the CAR Obstetrics and Gynecology Diagnostic Imaging Referral Guideline). This guideline presents the methods of development and the referral recommendations for haematuria, hypertension, renal disease (or failure), renal colic, renal calculi in the absence of acute colic, renal lesion, urinary tract obstruction, urinary tract infection, scrotal mass, or pain, including testicular torsion, adrenal mass, incontinence, urgency, and frequency, chronic pelvic pain, elevated PSA, infertility, and pelvic floor.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Gary Brahm
- Department of Medical Imaging, Western University, London Health Sciences Centre, London, ON, Canada
| | - Daisy Fung
- Kaye Edmonton Clinic Family Medicine Clinic, Edmonton, AB, Canada
| | | | | | - Lisa Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Sala
- Memorial University of Newfoundland, St. John's, NL, Canada
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193
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Arafa MA, Omar I, Farhat KH, Elshinawy M, Khan F, Alkhathami FA, Mokhtar A, Althunayan A, Rabah DM, Badawy AHA. A Comparison of Systematic, Targeted, and Combined Biopsy Using Machine Learning for Prediction of Prostate Cancer Risk: A Multi-Center Study. Med Princ Pract 2024:1-10. [PMID: 39047698 DOI: 10.1159/000540425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES The aims of the study were to construct a new prognostic prediction model for detecting prostate cancer (PCa) patients using machine-learning (ML) techniques and to compare those models across systematic and target biopsy detection techniques. METHODS The records of the two main hospitals in Riyadh, Saudi Arabia, were analyzed for data on diagnosed PCa from 2019 to 2023. Four ML algorithms were utilized for the prediction and classification of PCa. RESULTS A total of 528 patients with prostate-specific antigen (PSA) greater than 3.5 ng/mL who had undergone transrectal ultrasound-guided prostate biopsy were evaluated. The total number of confirmed PCa cases was 234. Age, prostate volume, PSA, body mass index (BMI), multiparametric magnetic resonance imaging (mpMRI) score, number of regions of interest detected in MRI, and the diameter of the largest size lesion were significantly associated with PCa. Random Forest (RF) and XGBoost (XGB) (ML algorithms) accurately predicted PCa. Yet, their performance for classification and prediction of PCa was higher and more accurate for cases detected by targeted and combined biopsy (systematic and targeted together) compared to systematic biopsy alone. F1, the area under the curve (AUC), and the accuracy of XGB and RF models for targeted biopsy and combined biopsy ranged from 0.94 to 0.97 compared to the AUC of systematic biopsy for RF and XGB algorithms, respectively. CONCLUSIONS The RF model generated and presented an excellent prediction capability for the risk of PCa detected by targeted and combined biopsy compared to systematic biopsy alone. ML models can prevent missed PCa diagnoses by serving as a screening tool.
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Affiliation(s)
- Mostafa A Arafa
- The Cancer Research Chair, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Islam Omar
- Klipsch School of Electrical and Computer Engineering, New Mexico State University, Las Cruces, New Mexico, USA
| | - Karim H Farhat
- The Cancer Research Chair, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mona Elshinawy
- Engineering Technology and Surveying Engineering Department, New Mexico State University, Las Cruces, New Mexico, USA
| | - Farrukh Khan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal A Alkhathami
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alaa Mokhtar
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Althunayan
- The Cancer Research Chair, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Danny M Rabah
- The Cancer Research Chair, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdel-Hameed A Badawy
- Klipsch School of Electrical and Computer Engineering, New Mexico State University, Las Cruces, New Mexico, USA
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194
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Wenk MJ, Hartung FO, Egen L, Netsch C, Kosiba M, Grüne B, Herrmann J. The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases. World J Urol 2024; 42:436. [PMID: 39046537 PMCID: PMC11269500 DOI: 10.1007/s00345-024-05097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. METHODS Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. RESULTS Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). CONCLUSIONS HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
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Affiliation(s)
- M J Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F O Hartung
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - L Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - M Kosiba
- Department of Urology, University Hospital Frankfurt, Frankfurt Main, Germany
| | - B Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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195
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Kalayeh K, Fowlkes JB, Yeras S, Chen A, Daignault-Newton S, Schultz WW, Sack BS. A Comparative Study of Commercially Available Ultrasound Contrast Agents for Sub-harmonic-Aided Pressure Estimation (SHAPE) in a Bladder Phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00226-6. [PMID: 39054243 DOI: 10.1016/j.ultrasmedbio.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The goal of this study was to evaluate the performance of different commercial ultrasound contrast microbubbles (MBs) when measuring bladder phantom pressure with sub-harmonic-aided pressure estimation (SHAPE) methodology. We hypothesized that SHAPE performance is dependent on MB formulation. This study aimed to advance the SHAPE application for bladder pressure measurements in humans. METHODS Using a previously designed and built bladder phantom, we tested four different commercial agents: Definity, Lumason, Sonazoid and Optison. A standard clinical cystometrogram (CMG) system was used to infuse a MB-saline mixture into the bladder phantom to measure pressure. Ultrasound imaging was performed using the GE Healthcare LOGIQ E10 scanner. RESULTS All agents showed a predicted inverse linear relationship between change in pressure and SHAPE signal. However, they differ from each other in terms of stability, linear correlation, sensitivity to pressure and error. Generally, Definity and Lumason showed the highest performance during the SHAPE-based bladder phantom pressure assessments. CONCLUSION Our results show that the SHAPE signal decreases as bladder phantom pressures increases, regardless of the agent or CMG phase, suggesting the possibility of using SHAPE for measuring bladder pressure without a catheter. However, the efficacy of SHAPE in measuring pressure varies by MB formulation. These observations support using Lumason and Definity in a human subject feasibility study as we advance toward a catheter-free solution for measuring voiding bladder pressure via SHAPE.
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Affiliation(s)
- Kourosh Kalayeh
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Yeras
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Amy Chen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - William W Schultz
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Bryan S Sack
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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196
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Zouari M, Belhajmansour M, Ben Kraiem N, Ben Ameur H, Ben Dhaou M, Mhiri R. Risk factors for 30-day complications following ureteral reimplantation for vesicoureteral reflux in children. Int J Urol 2024. [PMID: 39046362 DOI: 10.1111/iju.15549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Mohamed Zouari
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Manel Belhajmansour
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Najoua Ben Kraiem
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hana Ben Ameur
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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197
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Padzel S, Ariffin F, Yusuf SYM, Ali NDM. Giant Urinary Bladder in a Woman with Down Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944260. [PMID: 39044396 PMCID: PMC11299874 DOI: 10.12659/ajcr.944260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/19/2024] [Accepted: 05/23/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Non-neurogenic neurogenic bladder involves fluctuating flow rates due to involuntary muscle contractions during voiding in those with normal neurological function. The diagnostic challenge lies in distinguishing between massive urinary bladder distension and ovarian tumors. While various pathologies mimicking ovarian tumors are documented, cases of a massively distended urinary bladder, known as giant urinary bladder, posing as such are notably scarce. CASE REPORT This case report presents the unique clinical scenario of a 31-year-old woman with Down syndrome who was initially misdiagnosed with an ovarian tumor due to progressive abdominal distention, reduced appetite, and weight loss. On presentation, she appeared dehydrated, with an abnormal renal profile. Despite hydration, the renal profile worsened. Initial ultrasound showed a large, uniloculated cystic lesion measuring 11×15 cm in the pelvis. Due to the size of the cyst, which appeared to be ovarian in origin, ovarian tumor was suspected. However, tumor markers were normal. A computed tomography scan subsequently showed a massively distended urinary bladder measuring 11.6×13.6×17.6 cm causing bilateral obstructive uropathy, with moderate hydronephrosis and hydroureter. Needing intermittent catheterization at first, the patient subsequently passed urine on her own following behavioral modification. CONCLUSIONS This rare case of non-neurogenic neurogenic bladder causing a giant urinary bladder in a patient with Down syndrome highlights the importance of an awareness of this condition for effective assessment and patient treatment.
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Affiliation(s)
- Syameme Padzel
- Department of Primary Care Medicine, Jalan Hospital, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Farnaza Ariffin
- Department of Primary Care Medicine, Jalan Hospital, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Salma Yasmin Mohd Yusuf
- Department of Primary Care Medicine, Jalan Hospital, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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198
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Ranieri V, Warren H, Florez I, Neves JB, Walkden M, Bernstein DE, Santiapillai J, Williams N, Wildgoose WH, Patki P, Stewart GD, Kinsella N, Pizzo E, Barod R, Bex A, Mumtaz F, El-Sheikh S, Gurusamy K, Tran MGB. Identifying the facilitators and barriers to implementation of renal tumour biopsy in the diagnostic pathway for small renal masses. BJU Int 2024. [PMID: 39041496 DOI: 10.1111/bju.16470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES To understand the facilitators and barriers to the implementation of renal tumour biopsy (RTB) in the diagnostic pathway for renal tumours in England. PATIENTS AND METHODS Participants consisted of patients who had a renal tumour diagnosed and/or treated at one of five tertiary centres in England, healthcare professionals involved in the direct care of patients diagnosed with renal tumours, and clinical service managers and commissioners. The study employed a mixed-methods research methodology consisting of individual interviews and an on-line survey that explored the types of facilitators and barriers individuals perceived and experienced and the frequency in which these were reported. A public dissemination event took place following the completion of data collection; to facilitate discussion of potential solutions to implementing RTB. RESULTS There were 50 participant interviews (23 patients, 22 clinicians, and five health service commissioners/operations managers). The patient on-line survey received 52 responses, and the clinician survey received 22 responses. Patients most frequently reported influences in choosing whether to undergo RTB pertained to wanting to know the diagnosis of their kidney mass (40%), the advice or information provided by healthcare professionals (40%), and not wishing to delay treatment (23%). Clinicians most frequently reported barriers to recommending RTB related to their uncertainty of diagnostic accuracy (56%), availability of appointments or hospital beds (52%), concerns of risk of bleeding (44%), risk of seeding (41%), and delays in meeting national cancer pathway targets (41%). The dissemination event was attended by 18 participants (seven patients and 11 clinicians). Suggestions to improve implementation included reducing variation and promotion of standardisation of practice by a consensus statement, increasing the evidence base (clinicians) and improved communication by developing better patient aids such as videos and diagrams (patients and clinicians). CONCLUSION Implementation of RTB may be dependent on the quality of information provided, its format and perceived reliability of the information. Increased utilisation of RTB may be improved by development of a consensus statement on the role of biopsy, with patients expressing a preference for alternative information aids such as patient videos.
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Affiliation(s)
- Veronica Ranieri
- Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, London, UK
| | - Hannah Warren
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Isabella Florez
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Joana B Neves
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Miles Walkden
- Department of Interventional Radiology, University College Hospital, London, UK
| | - Darryl E Bernstein
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Joseph Santiapillai
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Norman Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | | | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Netty Kinsella
- Urology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Elena Pizzo
- Research Department of Primary Care and Public Health, London, UK
| | - Ravi Barod
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Faiz Mumtaz
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Soha El-Sheikh
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
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199
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Kavoussi PK, Gherabi N, Saleh R. Clinical predictors of successful outcomes for couples with nonobstructive azoospermic male partners undergoing micro-TESE. Asian J Androl 2024:00129336-990000000-00209. [PMID: 39040009 DOI: 10.4103/aja202436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 07/24/2024] Open
Abstract
ABSTRACT Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.
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Affiliation(s)
- Parviz K Kavoussi
- Department of Reproductive Urology, Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, TX 78746, USA
| | - Nazim Gherabi
- Department of Medicine, Algiers 1 University, Algiers 16000, Algeria
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag 83534, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag 83534, Egypt
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200
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Posa A, Barbieri P. Spermatic vein sclero-embolization through basilic vein access: A short communication. Phlebology 2024:2683555241265601. [PMID: 39041898 DOI: 10.1177/02683555241265601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Objectives: To depict the basics of percutaneous spermatic vein sclero-embolization through a right basilic vein access and to qualitatively assess the reduced discomfort and pain of this access compared to the femoral one through a VAS scale. Methods: From February 2019 to March 2020, 20 varicocele sclero-embolizations through a right basilic vein were performed and retrospectively evaluated. All patients were men with a median age of 24.5 years. Treatment technique is described, as well as mean radiation dose and procedural time, and complication rates. Results: Technical success was obtained in all patients. 1 access site complication requiring conversion to femoral access occurred. 100% of patients reported only a "mild" pain ranging from 1 to 3 on VAS scale, suggesting a comfortable access for this procedure. Conclusions: Basilic vein access determines easy left and right spermatic vein catheterization, rapid ambulation as well as easy monitoring of the access site for post-procedural evaluations.
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Affiliation(s)
- Alessandro Posa
- Department of Radiology, AFaR-IRCCS Fatebenefratelli Hospital Foundation for Health Research and Education, Roma, Italy
| | - Pierluigi Barbieri
- Interventional and Emergency Radiology, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Roma, Italy
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