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Brandt SB, Ibsen L, Lam GW, Bøttcher M, Kingo PS, Jensen JB. Ureteroenteric strictures after cystectomy: Side-specific risk factors and radiological assessment. BJUI COMPASS 2024; 5:699-708. [PMID: 39022665 PMCID: PMC11250374 DOI: 10.1002/bco2.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/31/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To evaluate risk factors contributing to side-specific benign ureteroenteric strictures following radical cystectomy with an ileal conduit. Materials and Methods Data obtained from patients with bladder cancer who underwent radical cystectomy with ileal conduit surgery between 2015 and 2018 were retrospectively analysed. Imaging prior to surgery was analysed, regarding calcifications in the aorta, sarcopenia and postoperatively for length of remaining left ureter. Descriptive analyses were performed on preoperative and perioperative data, comparing patients who developed unilateral left- or right-sided strictures, bilateral strictures, to those who remained free of strictures. COX regression analysis was employed to calculate crude and adjusted hazard ratio for side-specific strictures. Results The study included 395 patients. Strictures developed in 19% (75/395) of the patients, within a median period of 9 months: 57% (43/75) unilateral left sided, 20% (15/75) unilateral right sided and 23% (17/75) bilateral. Unilateral left-sided stricture was associated with higher body mass index (p = 0.077) and hypercholesterolemia (p = 0.007). Right-sided stricture was associated with a history of prior abdominal surgery (p = 0.029) and postoperative leakage (p = 0.004). Bilateral stricture was associated with smoking (p = 0.006) and high BMI (p = 0.015). The adjusted HR comparing patients with and without previous abdominal surgery was only significantly higher for right-sided ureteroenteric strictures (HR 3.18 [95% CI: 1.11; 9.05]) compared with patients without strictures. No association was identified between strictures and preoperative aortic calcification of the abdominal aorta or sarcopenia as estimated from imaging. Conclusion The aetiology of ureteroenteric strictures appears multifactorial. Our findings suggest that development of left-sided stricture is influenced by factors associated with metabolic syndrome, indicating a potential role of distal ureteric ischemia. On the other hand, right-sided stricture was more frequent in patients with previous abdominal surgery and postoperative leakage.
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Affiliation(s)
- Simone Buchardt Brandt
- Department of UrologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lotte Ibsen
- Department of RadiologyAarhus University HospitalAarhusDenmark
| | - Gitte Wrist Lam
- Department of UrologyHerlev and Gentofte University HospitalCopenhagenDenmark
| | - Morten Bøttcher
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyRegional Hospital GødstrupHerningDenmark
| | - Pernille Skjold Kingo
- Department of UrologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Jørgen Bjerggaard Jensen
- Department of UrologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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2
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Cortese BD, Chelluri R, Skokan AJ, Xia L, Ostrowski DA, Roberson DS, Schwartz L, Lee DJ, Lukowiak TM, Guzzo TJ, Malkowicz SB, Miller CJ, Kovell RC. Oncologic control and predictors of urologic reconstruction after Mohs micrographic surgery for low-risk penile malignancy. Int Urol Nephrol 2024:10.1007/s11255-024-04121-6. [PMID: 38922534 DOI: 10.1007/s11255-024-04121-6] [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: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a low-risk penile cancer management option. However, contemporary patients' short-term oncologic control and preoperative characteristics predicting reconstruction needs are undefined. This study assesses MMS's oncologic efficacy for low-risk penile cancer and identifies baseline predictors of post-resection reconstruction referral. METHODS We retrospectively reviewed 73 adult males with 78 penile cutaneous malignancies treated with MMS from 2005 to 2019. Patients underwent MMS with or without surgical reconstruction. Demographic information, MMS operative details, lesion pathology, and short-term outcomes were recorded. Descriptive statistics for all variables were calculated, and logistic regression identified predictive factors for urologic referral for complex reconstruction. RESULTS Seventy-three men with 78 lesions, all staged ≤ cT1a prior to MMS, were identified. Twenty-one men were found to have invasive SCC. Median follow-up was 2.0 years (IQR 0.8-5.2 years). MMS was able to clear the disease in 90.4% of cases. One patient had disease related death following progression. Dermatology closed primarily in 68% of patients. Twenty percent of patients had a complication, most commonly poor wound healing. On univariate and multivariate linear regression analysis, lesion size > 3 cm and involvement of the glans independently predicted the need for referral to a reconstructive surgeon. CONCLUSIONS MMS for penile cancer appears to provide sound oncologic control in the properly selected patient. Involvement of a reconstructive surgeon may be needed for glandular and large lesions, necessitating early referral to a comprehensive multidisciplinary care team.
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Affiliation(s)
- Brian D Cortese
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raju Chelluri
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Leilei Xia
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David A Ostrowski
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Daniel S Roberson
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania Health System, Philadelphia, PA, 19107, USA
| | - Daniel J Lee
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Tess M Lukowiak
- Department of Dermatology, Rutgers Robert Wood Johnson, Somerset, NJ, USA
| | - Thomas J Guzzo
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - S Bruce Malkowicz
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - R Caleb Kovell
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA.
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Golder H, Casanova D, Papalois V. Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications. Cir Esp 2023; 101:637-642. [PMID: 36781046 DOI: 10.1016/j.cireng.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/13/2023]
Abstract
The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, both of which contribute its to high inter-rater reliability. It has been validated for use in many specialties due to strong correlation with key outcome measures including length of stay, postsurgical quality of life and case-related renumeration. Limitations of the classification include concerns over differentiating grade III and IV complications and not classifying intraoperative complications. The Comprehensive Complication Index is an adaptation of the CD classification which generates a morbidity score from 0 to 100. It has been proposed as a more effective method of assessing the morbidity burden of surgical procedures. However, it remains less popular as calculations of morbidity are complicated and time-consuming. In recent years there have been suggestions of adaptations to the CD classification such as the Clavien-Dindo-Sink classification, while in some specialties, completely new classifications have been proposed due to evidence the CD classification is not reliable. Similarly, the Surgical Expertise and Validity Evaluation project aims to determine benchmarks against which surgeons may compare their own practice.
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4
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Protocol for CAMUS Delphi Study: A Consensus on Comprehensive Reporting and Grading of Complications After Urological Surgery. Eur Urol Focus 2022; 8:1493-1511. [PMID: 35221259 DOI: 10.1016/j.euf.2022.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reproducible assessment of postoperative complications is essential for reliable evaluation of quality of care to enable comparison between healthcare centres and ensure transparent patient counselling. Currently, significant discrepancies exist in complication reporting and grading due to heterogeneous definitions and methodologies. OBJECTIVE To develop a standardised and reproducible assessment of perioperative complications and overall associated morbidity, to allow for the construction of a uniform language for complication reporting and grading. DESIGN, SETTING, AND PARTICIPANTS The 12-part REDCap-based Delphi survey was developed in conjunction with methodologist review and experienced urologist opinion. International urologists, anaesthetists, and intensive care unit specialists will be included. A minimum sample size of 750 participants (500 urologists and 250 critical care specialities) is targeted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The survey assesses participant demographics, opinion on complication reporting and the proposed Complications After Major & Minor Urological Surgery (CAMUS) reporting recommendations, grading of intervention events using the existing Clavien-Dindo classification and the proposed CAMUS classification, and rating of various clinical scenarios. Consensus will be defined as ≥75% majority agreement. If consensus is not reached, then subsequent Delphi rounds will be performed under steering committee guidance. RESULTS AND LIMITATIONS Twenty-one participants completed the draft survey. The median survey completion time was 128 min (interquartile range 88-135). The survey revealed that 90% of participants believe that the current complication classification systems are useful but inaccurate, while 100% of participants believe that there is a universal demand for reporting consensus. Several amendments were made following feedback. Limitations include complexity of the proposed supplemental grades and time to completion of the survey. CONCLUSIONS To ensure comprehensive and comparable complication reporting and grading across centres worldwide, a conclusive uniform language for complication reporting must be created. We intend to address shortcomings of the current complication reporting and classification systems with a new CAMUS classification system developed through multidisciplinary expert consensus obtained through a Delphi survey. Ultimately, standardisation of urological complication reporting and grading may improve patient counselling and quality of care. PATIENT SUMMARY The reporting and grading of operative complications that occur during or after an operation and associated costs provide a means to stratify quality of patient care. Current complication reporting and classification systems are not standardised and somewhat inaccurate, and thus significantly underestimate patient morbidity and surgical risk. This Delphi survey will provide the basis for the creation of a uniform complication reporting and grading system. Our new system may allow improved reporting and grading between centres, and ultimately improve patient counselling and care.
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Shahat AA, Kamel AA, Taha TM, Abonnoor AEI, Reda A, Faddan AA, Elderwy AA, Safwat AS, Kurkar A, Abdelkawi IF. A randomized trial comparing transurethral to percutaneous cystolithotripsy in boys. BJU Int 2022; 130:254-261. [DOI: 10.1111/bju.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed A. Shahat
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmed A. Kamel
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Taha M. Taha
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | | | - Ahmed Reda
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Amr A. Faddan
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmad A. Elderwy
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Ahmed S. Safwat
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Adel Kurkar
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
| | - Islam F. Abdelkawi
- Urology and Nephrology Hospital Faculty of Medicine Assiut University Asyut Egypt
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Teoh JYC, Chan EOT, Kang SH, Patel MI, Muto S, Yang CK, Hatakeyama S, Chow TSF, Mok A, Zhang R, Kijvikai K, Lee LS, Chen H, Ohyama C, Horie S, Chan ESY. Perioperative Outcomes of Robot-Assisted Radical Cystectomy with Intracorporeal Versus Extracorporeal Urinary Diversion. Ann Surg Oncol 2021; 28:9209-9215. [PMID: 34152523 DOI: 10.1245/s10434-021-10295-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to investigate and compare the perioperative outcomes of intracorporeal urinary diversion (ICUD) versus extracorporeal urinary diversion (ECUD) following robotic-assisted radical cystectomy (RARC) in patients with localized bladder cancer from the Asian Robot-Assisted Radical Cystectomy (RARC) Consortium. METHODS The Asian RARC registry was a multicenter registry involving nine centers in Asia. Consecutive patients who underwent RARC were included. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed and compared between the ICUD and ECUD groups. Postoperative complications were the primary outcomes, whereas secondary outcomes were the estimated blood loss and the duration of hospitalization. Multivariate regression analyses were performed to adjust potential confounders. RESULTS From 2007 to 2020, 556 patients underwent RARC; 55.2% and 44.8% had ICUD and ECUD, respectively. ICUD group had less estimated blood loss (423.1 ± 361.1 vs. 541.3 ± 474.3 mL, p = 0.002) and a shorter hospital stay (15.7 ± 12.3 vs 17.8 ± 11.6 days, p = 0.042) than the ECUD group. Overall complication rates were similar between the two groups. Upon multivariate analysis, ICUD was associated with less estimated blood loss (Regression coefficient: - 143.06, 95% confidence interval [CI]: - 229.60 to - 56.52, p = 0.001) and a shorter hospital stay (Regression coefficient: - 2.37, 95% CI: - 4.69 to - 0.05, p = 0.046). In addition, ICUD was not associated with any increased risks of minor, major, and overall complications. CONCLUSIONS RARC with ICUD was safe and technically feasible with similar postoperative complication rates as ECUD, with additional benefits of reduced blood loss and a shorter hospitalization.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,European Association of Urology Young Academic Urologists, Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands.
| | - Erica On-Ting Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Seok-Ho Kang
- Department of Urology, School of Medicine, Korea University, Seoul, Republic of Korea
| | - Manish I Patel
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Satoru Muto
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Timothy Shing-Fung Chow
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Mok
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lui-Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore.,Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeo Horie
- Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan
| | - Eddie Shu-Yin Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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7
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Landberg A, Lindblad P, Harmenberg U, Lundstam S, Ljungberg B, Thorstenson A, Sundqvist P. The renal cell cancer database Sweden (RCCBaSe) - a new register-based resource for renal cell carcinoma research. Scand J Urol 2020; 54:235-240. [PMID: 32436435 DOI: 10.1080/21681805.2020.1766561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: In 2005, the National Swedish Kidney Cancer Register (NSKCR) was set up to collect data on newly diagnosed patients with renal cell carcinoma (RCC). In 2015, the NSKCR was linked to a number of national healthcare and demographic registers to construct the Renal Cell Cancer Database Sweden (RCCBaSe). The aim was to facilitate research on trends in incidence, effects of treatment and survival, with detailed data on tumour characteristics, treatment, pharmaceutical prescriptions, socioeconomic factors and comorbidity.Material and methods: All patients registered in the NSKCR between 2005 and 2014 were included. For each case, ten controls and first-degree relatives for cases and controls were identified. The RCCBaSe was created linking all cases, controls and first-degree relatives to a number of national registers with information on co-morbidity, socioeconomic factors and pharmaceutical prescriptions.Results: Between 2005 and 2014, a total of 9,416 patients with RCC were reported to the NSKCR. 94,159 controls and a total cohort of 575,007 individuals including cases, controls and first-degree relatives were identified. Linkage to the Swedish cancer register resulted in 106,772 matches. When linked to the National patient register, 432,677 out-patient and 471,359 in-patient matches were generated. When linked to the Swedish renal registry 1,778 matches were generated. Linkage to the Prescribed drug register resulted in 448,084 matches and linkage to the The Longitudinal integration database for health insurance and labour market studies database resulted in 450,017 matches.Conclusion: By linking the NSKCR to several Swedish national databases, a unique database for RCC research has been created.
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Affiliation(s)
- Anna Landberg
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Lindblad
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrika Harmenberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Börje Ljungberg
- Department of Surgical and perioperative sciences, Umeå University, Umeå, Sweden
| | - Andreas Thorstenson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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8
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Shahat AA, Abonnoor AEI, Allaham SMT, Abdel-Moneim AM, El-Anany FG, Abdelkawi IF. Critical Application of Adult Nephrolithometric Scoring Systems to Children Undergoing Mini-Percutaneous Nephrolithotomy. J Endourol 2020; 34:924-931. [PMID: 32363937 DOI: 10.1089/end.2020.0281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate and compare the ability of the Guy's stone score (GSS), the S.T.O.N.E. nephrolithometry, and the Clinical Research Office of the Endourology Society (CROES) nomogram to predict the outcome of mini-percutaneous nephrolithotomy (MPNL) in children, and to identify which of the predictors involved in these scoring systems can separately affect this outcome. Patients and Methods: All children younger than 14 years who had MPNL in our center over a period of 3 years were included prospectively. Bivariate analyses were done to evaluate the associations of the three scoring systems and the predictors composing them with single-session stone clearance and complications. Receiver operating characteristic (ROC) curve analyses of the three scoring systems were conducted to evaluate and compare their abilities to predict the outcomes. Decision curve analyses for the three scoring systems were conducted to evaluate the clinical benefit of using each of them to predict stone clearance. Results: We consecutively enrolled 92 renal units in 89 children with a median age of 9.5 years. Single-session stone clearance was achieved in 76 (82.6%) renal units. Complications occurred with 19 (20.7%) procedures. Stone multiplicity (p = 0.043), staghorn stone (p = 0.007), prior stone treatment (p < 0.001), number of calices involved (p = 0.006), stone burden (p = 0.003), GSS (p < 0.001), S.T.O.N.E. nephrolithometry (p = 0.012), and CROES nomogram (p < 0.001) had significant associations with stone clearance. Only stone attenuation was significantly associated with complications (p = 0.031). For prediction of stone clearance, CROES nomogram demonstrated the greatest area under the ROC curve and the greatest net benefit on decision curve analyses. Conclusions: For children undergoing MPNL, CROES nomogram is the best to predict stone clearance. However, none of the studied scoring systems predicted complications efficiently.
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Affiliation(s)
- Ahmed A Shahat
- Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | | | - Shadi M T Allaham
- Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Ahmad M Abdel-Moneim
- Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Fathy G El-Anany
- Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Islam F Abdelkawi
- Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
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9
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Hsu FS, Chou CW, Chang HC, Tu YP, Sha SJ, Chung HH, Huang KH. Comparison of Multipulse Laser Vaporesection versus Plasmakinetic Resection for Treatment of Benign Prostate Obstruction. Sci Rep 2019; 9:6427. [PMID: 31015537 PMCID: PMC6478674 DOI: 10.1038/s41598-019-42903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/10/2019] [Indexed: 11/24/2022] Open
Abstract
We aimed to compare the efficacy and safety of Multipulse laser vaporesection of the prostate (MPVP) versus plasmakinetic resection of the prostate (PKRP) for treatment of patients with benign prostate obstruction (BPO) in a prospective trial. From January 2016 to April 2017, a total of 144 patients were included in the cohort study, of whom 73 patients underwent MPVP and 71 underwent PKRP. All patients received pre-operative evaluation and followed up at 1, 3, 6 and 12 months postoperatively. Baseline characteristics, perioperative data and postoperative outcomes were compared. Early (within 30 days postoperatively) and late complications were also recorded. Preoperative data, including age, prostate volume, international prostate symptom score (IPSS), International Index of Erectile Function Questionnaires (IIEF-5), the rate of anticoagulants use, Charlson comorbidity index were similar in two groups. Peri-operative parameters, including the rate of transfusion, and decrease in hemoglobin level were comparable. The operative time, the duration of catheterization and length of hospital stay were significantly shorter in the MPVP group. The voiding parameters and the quality-of-life scores (QoL) improved significantly in both groups postoperatively. There was a significantly difference in QoL at 1-year in the MPVP group (p < 0.001), under mixed model analysis with random effect and Bonferroni correction. There were no significant differences in improvement of IPSS, Qmax, IIEF-5, residual prostate volume ratio and PSA level reduction at the 1-year follow-up. MPVP was significantly superior to PKRP in terms of a reduction in overall complication rate (21.9% vs 45.0%, p = 0.004). Both treatments led to comparable symptomatic improvements. MPVP demonstrates satisfactory efficiency, shorter catheterization time and shorter hospital stay. Our data revealed that MPVP may be a promising technique which is safe and favorable alternative for patients with BPO.
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Affiliation(s)
- Fu-Shun Hsu
- Department of Urology, New Taipei City Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Wei Chou
- Department of Urology, New Taipei City Hospital, New Taipei City, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Po Tu
- Shu-Tien Urology Ophthalmology Clinic, Taipei, Taiwan
| | - Shing-Jia Sha
- Department of Pathology, New Taipei City Hospital, New Taipei City, Taiwan
| | - Huang-Hsin Chung
- Department of Urology, New Taipei City Hospital, New Taipei City, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
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10
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Rajih E, Tholomier C, Hueber PA, Alenizi AM, Valdivieso R, Azizi M, Gonzalez RR, Eure G, Kriteman L, Hai M, Zorn KC. Evaluation of Surgical Outcomes with Photoselective GreenLight XPS Laser Vaporization of the Prostate in High Medical Risk Men with Benign Prostatic Enlargement: A Multicenter Study. J Endourol 2017; 31:686-693. [DOI: 10.1089/end.2016.0782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Emad Rajih
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
- Department of Urology, Taibah University, Madinah, Saudi Arabia
| | - Come Tholomier
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Abdullah M. Alenizi
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Mounsif Azizi
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | | | - Gregg Eure
- Department of Urology, Urology of Virginia, PLLC, Virginia Beach, Virginia
| | - Lewis Kriteman
- North Fulton Urology PC, Georgia Urology, Roswell, Georgia
| | - Mahmood Hai
- Comprehensive Urology, The Surgical Institute of Michigan, Westland, Michigan
| | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
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11
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Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M. Validation of the Clavien-Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus 2017; 4:608-613. [PMID: 28753862 DOI: 10.1016/j.euf.2017.02.014] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/21/2017] [Indexed: 01/13/2023]
Abstract
CONTEXT Since 2012 uniformed reporting of complications after urological procedures has been advocated by the European Association of Urology (EAU) guidelines. The Clavien-Dindo grading system was recommended to report the outcomes of urologic procedures. OBJECTIVE To validate the Clavien-Dindo grading system in urology. DESIGN, SETTING, AND PARTICIPANTS Members of the EAU working group compiled a list of case scenarios including those with minor and major complications. A survey was administered online via Survey Monkey to the members of EAU committees for the appropriate grading according to the Clavien-Dindo classification of surgical complications. Scenarios with intraoperative complications were intentionally included to assess respondents' awareness of the Clavien-Dindo applicability. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survey data collected were used to calculate agreement rates and to estimate the overall inter-rater agreement on all cases using Fleiss' kappa (κ). Differences in agreement rates for each scenario among groups with different criteria about the system were estimated using the chi-square test. RESULTS AND LIMITATIONS Evaluable responses were received from 81 out of 174 invited raters (46.5%). Of them 56.9% believed that the Clavien-Dindo system was adequate for grading postoperative complications. The agreement rate was over a score of ≥80% in nine cases, 60-79% in 10 cases, 40-59% in 14 cases, and <40% in two cases. Interestingly, the agreement rate on the nonapplicability of the Clavien-Dindo system was quite low, ranging from 27.5% to 67.2% (κ=0.147). Being a resident rather than a specialist affected only the distribution of agreement rates in case 1 (ie, score IIIb: 83.3% vs 94.1%). Being an academic or having affiliation did not have any impact on the distribution of agreement rates in all cases but one. CONCLUSIONS The Clavien-Dindo classification is a standardised approach to grade and report postoperative complications in urology and should be used systematically. However, it does not apply for intraoperative complications, and there is a need for an additional tool. PATIENT SUMMARY A rigorous methodology is mandatory when surgeons report about complications after surgery. In this study, the European Association of Urology Guidelines Panel has validated the use of the Clavien-Dindo grading system in urology.
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Affiliation(s)
- Dionysios Mitropoulos
- 1st Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Walter Artibani
- Department of Surgery, Urology Clinic, University of Verona, Verona, Italy
| | | | | | - Morgan Rouprêt
- Academic Department of Urology, Pitié-Salpétrière Hospital, AP-HP, Paris, France; UPMC University Paris 06, Institut Universitaire de Cancérologie, Paris, France
| | - Michael Truss
- Department of Urology, Klinikum Dortmund GmbH, Dortmund, Germany
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Surgical complications in 448 gynecological 3D laparoscopic surgeries adopting the Clavien—Dindo classification. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10397-016-0973-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Biyani CS, Myatt A, Palit V, Burgess N, Joyce AD. Re: Jean J.M.C.H. de la Rosette, Dedan Opondo, Francisco P.J. Daels, et al., on behalf of the CROES PCNL Study Group. Categorisation of complications and validation of the clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-55. Eur Urol 2012; 63:e23-4. [PMID: 23141051 DOI: 10.1016/j.eururo.2012.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 10/28/2012] [Indexed: 11/19/2022]
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