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Castellani D, Enikeev D, Gokce MI, Petov V, Gadzhiev N, Mahajan A, Maheshwari PN, Fong KY, Tursunkulov AN, Malkhasyan V, Zawadzki M, Sofer M, Cormio L, Busetto GM, Somani BK, Herrmann TR, Gauhar V. Influence of Prostate Volume on the Incidence of Complications and Urinary Incontinence Following Thulium Fiber Laser Enucleation of the Prostate: Results from Multicenter, Real-world Experience of 2732 patients. EUR UROL SUPPL 2024; 63:38-43. [PMID: 38558764 PMCID: PMC10981004 DOI: 10.1016/j.euros.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background The use of the new thulium fiber laser in enucleation of the prostate (ThuFLEP) has been introduced recently. Objective To evaluate complications and urinary incontinence (UI) after ThuFLEP in small and large prostate volume (PV). Design setting and participants We retrospectively reviewed patients who underwent ThuFLEP in six centers (from January 2020 to January 2023). The exclusion criteria were concomitant lower urinary tract surgery, previous prostate/urethral surgery, prostate cancer, and pelvic radiotherapy. Outcome measurements and statistical analysis Patients were divided into two groups: group 1: PV ≤80 ml; group 2: PV >80 ml. Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of overall UI. Results and limitations There were 1458 patients in group 1 and 1274 in group 2. There was no significant difference in age. The median PV was 60 (61-72) ml in group 1 and 100 (90-122) ml in group 2. En bloc enucleation was employed more in group 1, while the early apical release technique was used more in group 2. The rate of prolonged irrigation for hematuria, urinary tract infection, and acute urinary retention did not differ significantly. Blood transfusion rate was significantly higher in group 2 (0.5% vs 2.0%, p = 0.001). There was no significant difference in the overall UI rate (12.3% in group 1 vs 14.7% in group 2, p = 0.08). A multivariable regression analysis showed that preoperative postvoiding urine residual (odds ratio 1.004, 95% confidence interval 1.002-1.007, p < 0.01) was the only factor significantly associated with higher odds of UI. A limitation of this study was its retrospective nature. Conclusions Complications and UI rates following ThuFLEP were similar in patients with a PV up to or larger than 80 ml except for the blood transfusion rate that was higher in the latter. Patient summary In this study, we looked at outcomes after thulium fiber laser in enucleation of the prostate stratified by PV. We found that blood transfusion was higher in men with PV >80 ml, but urinary incontinence was similar.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Abhay Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad, India
| | | | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luigi Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
- Hannover Medical School, Hannover, Germany
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Fong KY, Yeo S, Luo H, Kofidis T, Teoh KLK, Kang GS. Stroke prevention strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. ANZ J Surg 2024; 94:522-535. [PMID: 38529814 DOI: 10.1111/ans.18947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/15/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Stroke is a much-feared complication of cardiac surgery, but existing literature on preventive strategies is fragmented. Hence, a systematic review and meta-analysis of stroke prevention strategies for cardiac surgery was conducted. METHODS An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) investigating perioperative interventions for cardiac surgery, with stroke as an outcome. Random-effects meta-analyses were conducted to generate risk ratios (RRs), 95% confidence intervals (95% CI), and forest plots. Descriptive analysis and synthesis of literature was conducted for interventions not amenable to meta-analysis, focusing on risks of stroke, myocardial infarction and study-defined major adverse cardiovascular events (MACE). RESULTS Fifty-six RCTs (61 894 patients) were retrieved. Many included trials were underpowered to detect differences in stroke risk. Among pharmacological therapies, only preoperative amiodarone was shown to reduce stroke risk in one trial. Concomitant left atrial appendage closure (LAAC) significantly reduced stroke risk (RR = 0.55, 95% CI = 0.36-0.84, P = 0.006) in patients with preoperative atrial fibrillation, and there was no difference in on-pump versus off-pump coronary artery bypass grafting (CABG) (RR = 0.94, 95% CI = 0.64-1.37, P = 0.735). Much controversy exists in literature on the timing of carotid endarterectomy relative to CABG in patients with severe carotid stenosis. The use of preoperative remote ischemic preconditioning was not found to reduce rates of stroke or MACE. CONCLUSION This review presents a comprehensive synthesis of existing interventions for stroke prevention in cardiac surgery, and identifies gaps in research which may benefit from future, large-scale RCTs. LAAC should be considered to reduce stroke incidence in patients with preoperative atrial fibrillation.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Selvie Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Haidong Luo
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Theodoros Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Kristine L K Teoh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Giap Swee Kang
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
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Chai CA, Somani B, Castellani D, Fong KY, Sarica K, Emiliani E, Ong WLK, Ragoori D, Gökce MI, Gadzhiev N, Tanidir Y, Lakmichi MA, Inoue T, Pirola GM, Teoh JYC, Hamri SB, Tursunkulov AN, Ganpule A, Chew BH, Traxer O, Gauhar V. Comparing Same-Sitting Bilateral vs Unilateral Retrograde Intrarenal Surgery in the Elderly. Urology 2024; 186:117-122. [PMID: 38417468 DOI: 10.1016/j.urology.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To compare same-sitting bilateral vs unilateral retrograde intrarenal surgery (RIRS) in elderly patients, focusing on postoperative complications and stone-free rates (SFR). METHODS Data from 2 multicenter databases, FLEXible ureteroscopy Outcomes Registry (FLEXOR) (unilateral RIRS) and same sitting bilateral-retrograde intrarenal surgery (SSB-RIRS) (bilateral RIRS), were analyzed, considering only patients aged 70+ with preoperative computed tomography. Patients were categorized into Group 1 (bilateral RIRS) and Group 2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed. RESULTS Group 1 included 146 patients, while group 2 had 495. Group 1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group 2 often underwent RIRS for incidental stones. Group 1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group 1. Group 2 had significantly higher overall stone-free rates, although there were no significant differences in ancillary procedures for residual fragments. Group 1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op hematuria not requiring transfusion. CONCLUSION In conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counseling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.
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Affiliation(s)
- Chu Ann Chai
- University Malaya, Department of Surgery Urology Unit, Kuala Lumpur, Malaysia.
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom
| | - Daniele Castellani
- Azienda ospedaliero universitaria Ospedali riuniti di Ancona Universita Politecnica delle Marche, Department of Urology, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine National University of Singapore, Faculty of Medicine, Singapore, Singapore
| | - Kemal Sarica
- Biruni University Medical School, Department of Urology, Istanbul, Turkey
| | - Estaban Emiliani
- Fundacion Puigvert Autónomos University of Barcelona, Department of Urology, Barcelona, Spain
| | | | - Deepak Ragoori
- Asian Institute Of Nephrology and Urology, Department of Urology, Hyderabad, India
| | - Mehmet Ilker Gökce
- Ankara University School of Medicine, Department of Urology, Ankara, Turkey
| | - Nariman Gadzhiev
- Saint Petersburg State University Hospital Russia, Department of Urology, St Petersburg, Russia
| | - Yiloren Tanidir
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Mohamed Amine Lakmichi
- University Hospital Mohammed the VIth of Marrakesh, Department of Urology, Marrakesh, Morocco
| | - Takaaki Inoue
- Hara Genitourinary Private Hospital and Kobe University, Department of Urology, Kobe, Japan
| | | | | | - Saeed Bin Hamri
- King Abdullah International Medical Research Center, Department of Surgery, Riyadh, Saudi Arabia
| | | | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Department of Urology, Nadiad, Gujarat, India
| | - Ben Hall Chew
- University of British Columbia, Department of Urology, Vancouver, Canada
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis Tenon Hospital, Department of Urology, Paris, France
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, Department of Urology, Singapore, Singapore
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Fong KY, Gan VHL, Lim BJH, Chan YH, Castellani D, Chen K, Tay KJ, Ho HSS, Yuen JSP, Aslim E, Teoh J, Lim EJ. Off-clamp vs on-clamp robot-assisted partial nephrectomy: a systematic review and meta-analysis. BJU Int 2024; 133:375-386. [PMID: 38069544 DOI: 10.1111/bju.16250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
OBJECTIVE To compare intra- and postoperative outcomes between off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN), using data from randomised controlled trials (RCTs) or covariate-matched studies (propensity score-matched or matched-pair analysis). METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature review was conducted on PubMed, EMBASE, Scopus and CENTRAL for relevant studies comparing off-clamp to on-clamp RAPN. Primary outcomes were estimated blood loss, postoperative percentage decrease in estimated glomerular filtration rate (eGFR), and margin positive rate. Secondary outcomes were operative time, postoperative eGFR, length of stay, all postoperative complications, major complications, and need for transfusion. Random-effects meta-analyses were performed to generate mean differences (MDs) or odds ratios (ORs). RESULTS A total of 10 studies (2307 patients) were shortlisted for analysis. There was no significant difference in estimated operative blood loss between off-clamp and on-clamp RAPN (MD 21.9 mL, 95% confidence interval [CI] -0.9 to 44.7 mL; P = 0.06, I2 = 58%). Off-clamp RAPN yielded a smaller postoperative eGFR deterioration (MD 3.10%, 95% CI 1.05-5.16%; P = 0.008, I2 = 13%) and lower odds of margin positivity (OR 0.62, 95% CI 0.40-0.94; P = 0.03, I2 = 0%). No significant differences were found for all secondary outcomes. CONCLUSIONS Off-clamp and on-clamp RAPN are similarly effective approaches for selected renal masses. Within the classic trifecta of PN outcomes, off-clamp RAPN yields similar rates of perioperative complications and may possibly offer better preservation of renal function and reduced margin-positive rates.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | - Edwin Aslim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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Gauhar V, Castellani D, Herrmann TRW, Gökce MI, Fong KY, Gadzhiev N, Malkhasyan V, Pirola GM, Naselli A, Mahajan A, Maheshwari PN, Biligere S, Tursunkulov AN, Nasirov F, Petov V, Dellabella M, Lim EJ, Socarrás MR, Zawadzki M, Cormio L, Busetto GM, Teoh JYC, Somani BK, Enikeev D, Sofer M, Gómez Sancha F. Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients. World J Urol 2024; 42:180. [PMID: 38507108 PMCID: PMC10954849 DOI: 10.1007/s00345-024-04886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To evaluate complications and urinary incontinence (UI) after endoscopic enucleation of the prostate (EEP) stratified by prostate volume (PV). METHODS We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with different energy sources in 14 centers (January 2019-January 2023). INCLUSION CRITERIA prostate volume ≥ 80 ml. EXCLUSION CRITERIA prostate cancer, previous prostate/urethral surgery, pelvic radiotherapy. PRIMARY OUTCOME complication rate. SECONDARY OUTCOMES incidence of and factors affecting postoperative UI. Patients were divided into 3 groups. Group 1: PV = 80-100 ml; Group 2 PV = 101-200 ml; Group 3 PV > 200 ml. Multivariable logistic regression analysis was performed to evaluate independent predictors of overall incontinence. RESULTS There were 486 patients in Group 1, 1830 in Group 2, and 196 in Group 3. The most commonly used energy was high-power Holmium laser followed by Thulium fiber laser in all groups. Enucleation, morcellation, and total surgical time were significantly longer in Group 2. There was no significant difference in overall 30-day complications and readmission rates. Incontinence incidence was similar (12.1% in Group 1 vs. 13.2% in Group 2 vs. 11.7% in Group 3, p = 0.72). The rate of stress and mixed incontinence was higher in Group 1. Multivariable regression analysis showed that age (OR 1.019 95% CI 1.003-1.035) was the only factor significantly associated with higher odds of incontinence. CONCLUSIONS PV has no influence on complication and UI rates following EEP. Age is risk factor of postoperative UI.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, IRCCS INRCA, Ancona, Italy.
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Giacomo Maria Pirola
- Urology Unit, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Urology Unit, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Abhay Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Furkat Nasirov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | | | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Luigi Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Gauhar V, Lim EJ, Fong KY, Sancha FG, Socarrás MR, Enikeev D, Sofer M, Tursunkulov AN, Elterman D, Bendigeri MT, Teoh JYC, Mahajan A, Bhatia TP, Ivanovich SN, Gadzhiev N, Ying LK, Sarvajit B, Somani BK, Herrmann TRW, Castellani D. Influence of early apical release on outcomes in endoscopic enucleation of the prostate: results from a multicenter series of 4392 patients. Urology 2024:S0090-4295(24)00146-8. [PMID: 38467289 DOI: 10.1016/j.urology.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/11/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To evaluate outcomes after laser Endoscopic enucleation of the prostate (EEP) stratified by whether early apical release (EAR) was performed or not. METHODS We retrospectively reviewed patients with clinical benign prostatic hyperplasia who underwent EEP with holmium or thulium fiber laser in 8 centers (January 2020-January 2022). EXCLUSION CRITERIA previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, concomitant lower urinary tract surgery. One-to-one propensity score-matching was performed between patients with EAR versus no EAR, with covariates including age, prostate volume, diabetes mellitus, hypertension, preoperative indwelling catheter, IPSS, Qmax, enucleation and laser types. Multivariable logistic regression analyses were performed to evaluate independent predictors of 30-day postoperative complications and urinary incontinence. RESULTS EAR was performed in 2094 of 4392 included patients. The matched cohort consisted of 787 patients per arm. Total operation time was significantly longer in the EAR group (median 75 vs 67 minutes, p=0.004). Early complications were higher in the EAR group (18.6% vs 12.5%, p=0.001), while postoperative incontinence rates were similar (14.1% vs 13.1%, p=0.61). Multivariable regression analysis showed that 3-lobe enucleation and operation time were significant predictors of postoperative complications; preoperative indwelling catheterization, higher prostate volume, and en-bloc enucleation were associated with higher odds of postoperative incontinence. LIMITATION retrospective nature. CONCLUSIONS Performing EAR during EEP is associated with a greater incidence of early complications, which was mainly driven by higher rates of postoperative hematuria and perioperative transfusion. The risk of postoperative incontinence and its duration are not affected by EAR.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - Mario Sofer
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Abhay Mahajan
- Department of Urology, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | - Tanuj Pal Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Biligere Sarvajit
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
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Tanidir Y, Sekerci CA, Bujons A, Castellani D, Ferretti S, Gatti C, Campobasso D, Quiroz Y, Teoh JYC, Pietropaolo A, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Fong KY, Sinha MM, Griffin S, Sarica K, Somani BK, Traxer O, Gauhar V. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology 2024:S0090-4295(24)00136-5. [PMID: 38432431 DOI: 10.1016/j.urology.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Anna Bujons
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Yesica Quiroz
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India.
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India.
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India.
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal.
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Stephen Griffin
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey.
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
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Lim EJ, Yen J, Fong KY, Tiong HY, Aslim EJ, Ng LG, Castellani D, Borgheresi A, Agostini A, Somani BK, Gauhar V, Gan VHL. Radiomics in Kidney Transplantation: A Scoping Review of Current Applications, Limitations, and Future Directions. Transplantation 2024; 108:643-653. [PMID: 37389652 DOI: 10.1097/tp.0000000000004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in kidney transplantation, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of transplantation was conducted on PubMed, EMBASE, and Scopus from inception to September 23, 2022. A total of 16 studies were included. The most widely studied clinical utility of radiomics in kidney transplantation is its use as an adjunct to diagnose rejection, potentially reducing the need for unnecessary biopsies or guiding decisions for earlier biopsies to optimize graft survival. Technology such as optical coherence tomography is a noninvasive procedure to build high-resolution optical cross-section images of the kidney cortex in situ and in real time, which can provide histopathological information of donor kidney candidates for transplantation, and to predict posttransplant function. This review shows that, although radiomics in kidney transplants is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic evaluation for living donors and potential in predicting and detecting rejection postoperatively.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Jie Yen
- Department of Urology, Singapore General Hospital, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche," Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche," Ancona, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
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9
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Lim EJ, Castellani D, Somani BK, Gökce MI, Fong KY, Sancha FG, Herrmann TR, Biligere S, Tursunkulov AN, Dellabella M, Sofer M, Enikeev D, Petov V, Gadzhiev N, Elterman D, Mahajan A, Socarras MR, Yunusov DS, Nasirov F, Teoh JY, Gauhar V. High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group. Prostate Int 2024; 12:40-45. [PMID: 38523902 PMCID: PMC10960086 DOI: 10.1016/j.prnil.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024] Open
Abstract
Background Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mehmet I. Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fernando G. Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | - Thomas R.W. Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | | | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Moises R. Socarras
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | | | - Furkat Nasirov
- Urology Department, Tashkent Medical Academy, Uzbekistan
| | - Jeremy Y.C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
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Too CW, Fong KY, Hang G, Sato T, Nyam CQ, Leong SH, Ng KW, Ng WL, Kawai T. Artificial Intelligence-Guided Segmentation and Path Planning Software for Transthoracic Lung Biopsy. J Vasc Interv Radiol 2024:S1051-0443(24)00168-4. [PMID: 38355040 DOI: 10.1016/j.jvir.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/21/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE To validate the sensitivity and specificity of a 3-Dimensional Convolution Neural Network (3D-CNN) AI software for lung lesion detection, and to establish concordance between AI-generated needle paths and those used in actual biopsy procedures. MATERIALS AND METHODS This was a retrospective study utilizing CT scans from three hospitals. Inclusion criteria were scans with 1-5 nodules of diameter ≥5mm; exclusion criteria were poor-quality scans or those with nodules measuring <5mm. In the lesion detection phase, 2147 nodules from 219 scans were used to develop and train the deep learning 3D-CNN to detect lesions. The 3D-CNN was validated with 235 scans (354 lesions) for sensitivity, specificity, and area-under-the-curve (AUC) analysis. In the path planning phase, Bayesian optimization was utilized to propose possible needle trajectories for lesion biopsy while avoiding vital structures. Software-proposed needle trajectories were compared against actual biopsy path trajectories from intraoperative CT scans in 150 patients, with a match defined as angular deviation of <5 degrees between the two. RESULTS The model achieved an overall AUC of 97.4% (95%CI=96.3-98.2%) for lesion detection, with mean sensitivity of 93.5% and mean specificity of 93.2%. 85.3% of software-proposed needle trajectories were feasible, with 82% matching actual paths, and similar performance between supine and prone/oblique patient orientations (p=0.311). Average angular deviation between matching trajectories was 2.30±1.22o; average path deviation was 2.94±1.60mm. CONCLUSIONS Segmentation, lesion detection and path-planning for CT-guided lung biopsy using an AI-guided software showed promising results. Future integration with automated robotic systems may pave the way towards fully automated biopsy procedures.
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Affiliation(s)
- Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Guanqi Hang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
| | - Takafumi Sato
- Department of Radiology, Nagoya City University East Medical Center, Japan.
| | | | | | | | - Wei Lin Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Malaysia.
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan.
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Castellani D, Gauhar V, Fong KY, Sofer M, Socarrás MR, Tursunkulov AN, Ying LK, Biligere S, Tiong HY, Elterman D, Mahajan A, Taratkin M, Ivanovich SN, Bhatia TP, Enikeev D, Gadzhiev N, Bendigeri MT, Teoh JYC, Dellabella M, Sancha FG, Somani BK, Herrmann TRW. Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non-en-bloc techniques: a multicenter, real-world experience of 5068 patients. Asian J Androl 2024:00129336-990000000-00155. [PMID: 38265232 DOI: 10.4103/aja202375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/16/2023] [Indexed: 01/25/2024] Open
Abstract
ABSTRACT We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, IRCCS INRCA, Ancona 60127, Italy
- Urology Unit, Marche University Hospital, Le Marche Polytechnic University, Ancona 60126, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Mario Sofer
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | | | | | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, Singapore 609606, Singapore
- Advanced Urology, Gleneagles Hospital, Singapore 258499, Singapore
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore 119228, Singapore
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Toronto M5G 2C4, Canada
| | - Abhay Mahajan
- Department of Urology, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad 431003, India
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow119435, Russian Federation
| | - Sorokin Nikolai Ivanovich
- Department of Urology and Andrology, Lomonosov Moscow State University, Moscow 119992, Russian Federation
| | - Tanuj Pal Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana 121006, India
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna 1090, Austria
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg 199034, Russian Federation
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 96H2+Q9, China
| | | | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton SO16 6YD, United Kingdom
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12
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Fong KY, Foo JCH, Chan YH, Aslim EJ, Ng LG, Gan VHL, Lim EJ. Graft retrieval incisions in minimally invasive donor nephrectomy: Systematic review and network meta-analysis. Transplant Rev (Orlando) 2024; 38:100813. [PMID: 37979238 DOI: 10.1016/j.trre.2023.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Various incisions are employed for graft extraction during minimally invasive donor nephrectomy, but an overarching synthesis of associated short-term donor outcomes is lacking. METHODS An electronic literature search was conducted on PubMed, EMBASE and Scopus for studies comparing ≥2 graft extraction incisions in laparoscopic or robotic donor nephrectomy with ≥10 patients per arm. Eligible study designs included randomized trials, case-control, and cohort studies. Primary outcomes were donor length of stay (LOS); in-hospital analgesic requirement; and postoperative complications. Secondary outcomes were warm ischemia time (WIT), total operation time (TOT), and estimated blood loss (EBL). Random-effects Frequentist network meta-analyses were conducted for all outcomes. RESULTS Twenty-nine studies (4702 patients) were shortlisted. Six incisions were analyzed: iliac, Pfannenstiel, midline hand-assisted laparoscopic (HAL), midline umbilical, flank and transvaginal natural orifice transluminal endoscopic surgery (NOTES). The flank incision had significantly longer LOS than all other incisions. LOS was significantly longer in Pfannenstiel than iliac incision (mean difference [MD] = 0.29, 95%CI = 0.002-0.58 days). Midline HAL had significantly shorter TOT than most other incisions. Midline umbilical incisions had significantly higher WIT than midline HAL and Pfannenstiel incisions. Midline HAL had shorter WIT than transvaginal NOTES (MD = 0.80, 95%CI = 0.05-1.56 min). No major differences were seen in analgesia requirement, postoperative complications and EBL. CONCLUSION Six different incisions for graft retrieval are broadly comparable across most short-term outcomes although long-term outcomes remain to be elucidated. Iliac and Pfannenstiel incisions yielded similar outcomes besides marginally lower LOS for the former. Midline incision for HAL may be associated with shorter TOT, and transvaginal NOTES is an effective technique for selected female donors. TRIAL REGISTRATION PROSPERO CRD42023445407.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Transplant Centre, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore.
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13
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Gauhar V, Nedbal C, Castellani D, Fong KY, Sofer M, Socarrás MR, Tursunkulov AN, Ying LK, Elterman D, Mahajan A, Petov V, Ivanovich SN, Bhatia TP, Enikeev D, Gadzhiev N, Chiruvella M, Teoh JYC, Galosi AB, Sancha FG, Somani BK, Herrmann TRW. Comparison Between Thulium Fiber Laser and High-power Holmium Laser for Anatomic Endoscopic Enucleation of the Prostate: A Propensity Score-matched Analysis from the REAP Registry. Eur Urol Focus 2024; 10:182-188. [PMID: 37414615 DOI: 10.1016/j.euf.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Different lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date. OBJECTIVE To compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes. DESIGN, SETTING, AND PARTICIPANTS The study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR). RESULTS AND LIMITATIONS After PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate was higher in the HP-HoLEP arm (22% vs 8%; p = 0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%; p = 0.120). Rates of other early and delayed complications were low and comparable between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature. CONCLUSIONS This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS. PATIENT SUMMARY As lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Vienna Medical University, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
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Fong KY, Chan YH, Chia CML, Agasthian T, Lee P. Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer ≤ 2 cm: a systematic review and patient-level meta-analysis. Updates Surg 2023; 75:2343-2354. [PMID: 37563486 DOI: 10.1007/s13304-023-01627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
Despite lobectomy being the standard of care for early-stage non-small-cell lung cancer (NSCLC), sublobar resection (segmentectomy or wedge resection) has recently been suggested to achieve similar outcomes. An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) or propensity score-matched studies (PSMs) comparing lobectomy to sublobar resection in stage IA NSCLC ≤ 2 cm in size, with provision of Kaplan-Meier curves for overall survival (OS) and disease-free survival (DFS). A graphical reconstructive algorithm was used to obtain OS and DFS of individual patients, which was then pooled under random-effects individual patient data meta-analysis using Cox models to determine hazard ratios (HRs). Sensitivity analyses for OS and DFS were also performed, restricting to results from RCTs only. Seven studies (2528 patients) were retrieved. There were no significant differences in OS (shared-frailty HR = 0.92, 95% CI = 0.77-1.11, p = 0.378) or DFS (shared-frailty HR = 1.06, 95% CI = 0.90-1.24, p = 0.476) between lobectomy and sublobar resection. This comparison remained non-significant even when restricted to RCTs only. Pooled Kaplan-Meier curves of OS appeared to diverge over time, in favor of sublobar resection. This was confirmed on analysis of restricted mean survival time curves. This patient-level meta-analysis of high-quality studies demonstrates that sublobar resection is equivalent to lobectomy in patients with small stage IA NSCLC. Sublobar resection offers greater down-the-road benefits in patients who experience recurrence or a second primary tumor since the lung-sparing index surgery allows patients to receive further treatment safely. This heralds sublobar resection as the new standard of care in carefully selected early-stage patients.Trial registration: PROSPERO CRD42023385358.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cynthia Ming Li Chia
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | | | - Pyng Lee
- Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore, Singapore
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Gauhar V, Gómez Sancha F, Enikeev D, Sofer M, Fong KY, Rodríguez Socarrás M, Elterman D, Chiruvella M, Bendigeri MT, Tursunkulov AN, Mahajan A, Bhatia TP, Ivanovich SN, Gadzhiev N, Ying LK, Sarvajit B, Dellabella M, Petov V, Somani BK, Castellani D, Herrmann TRW. Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate (REAP) by evaluating trends and outcomes and nuances of prostate enucleation in a real-world setting. World J Urol 2023; 41:3033-3040. [PMID: 37782323 DOI: 10.1007/s00345-023-04626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To collect a multicentric, global database to assess current preferences and outcomes for endoscopic enucleation of the prostate (EEP). METHODS Endourologists experienced in EEP from across the globe were invited to participate in the creation of this retrospective registry. Surgical procedures were performed between January 2020 and August 2022. INCLUSION CRITERIA lower urinary tract symptoms not responding to or worsening despite medical therapy and absolute indication for surgery. EXCLUSION CRITERIA prostate cancer, concomitant lower urinary tract surgery, previous prostate/urethral surgery, pelvic radiotherapy. RESULTS Ten centers from 7 countries, involving 13 surgeons enrolled 6193 patients. Median age was 68 [62-74] years. 2326 (37.8%) patients had large prostates (> 80 cc). The most popular energy modality was the Holmium laser. The most common technique used for enucleation was the 2-lobe (48.8%). 86.2% of the procedures were performed under spinal anesthesia. Median operation time was 67 [50-95] minutes. Median postoperative catheter time was 2 [1, 3] days. Urinary tract infections were the most reported complications (4.7%) followed by acute urinary retention (4.1%). Post-operative bleeding needing additional intervention was reported in 0.9% of cases. 3 and 12-month follow-up visits showed improvement in symptoms and micturition parameters. Only 8 patients (1.4%) required redo surgery for residual adenoma. Stress urinary incontinence was reported in 53.9% of patients and after 3 months was found to persist in 16.2% of the cohort. CONCLUSION Our database contributes real-world data to support EEP as a truly well-established global, safe minimally invasive intervention and provides insights for further research.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Vienna Medical University, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | | | | | | | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Biligere Sarvajit
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Vladislav Petov
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK
| | - Daniele Castellani
- Urology Unit, IRCCS INRCA, Ancona, Italy.
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Le Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
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Lim EJ, Fong KY, Li J, Chan YH, Aslim EJ, Ng LG, Gan VHL. Single versus multiple renal arteries in living donor kidney transplantation: A systematic review and patient-level meta-analysis. Clin Transplant 2023; 37:e15069. [PMID: 37410577 DOI: 10.1111/ctr.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/26/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Grafts with multiple renal arteries (MRAs) were historically considered a relative contraindication to transplantation due to the higher risk of vascular and urologic complications. This study aimed to evaluate graft and patient survival between single renal artery (SRA) and MRA living-donor kidney transplants. METHODS An electronic literature search was conducted on PubMed, EMBASE, and Scopus for prospective or retrospective studies comparing SRA versus MRA in living donor renal transplantation, with the provision of Kaplan-Meier curves for recipient overall survival (OS) or graft survival (GS). A graphical reconstructive algorithm was used to obtain OS and GS of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Meta-regression of baseline covariates versus HRs of OS and GS was performed for variables reported in 10 or more studies. RESULTS Fourteen studies were retrieved, of which 13 (8400 patients) reported OS and 9 (6912 patients) reported GS. There were no significant differences in OS (shared-frailty HR = .94, 95%CI = .85-1.03, p = .172) or GS (shared-frailty HR = .95, 95%CI = .83-1.08, p = .419) between SRA and MRA. This comparison remained non-significant even when restricted to open- or laparoscopic-only studies. Meta-regression yielded no significant associations of GS with donor age, recipient age, and percentage of double renal arteries within the MRA arm. CONCLUSIONS The similar rates of GS and OS between MRA and SRA grafts suggest that there is no need for discrimination between the two when evaluating donors for nephrectomy.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingqiu Li
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
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Gauhar V, Traxer O, Woo SJQ, Fong KY, Ragoori D, Wani A, Soebhali B, Mahajan A, Pankaj M, Gadzhiev N, Tanidir Y, Mehmet İG, Aydin C, Bostanci Y, Bin Hamri S, Barayan FR, Sinha MM, Inoue T, Teoh JYC, Castellani D, Somani BK, Lim EJ. PCNL vs RIRS in management of stones in calyceal diverticulum: outcomes from a global multicentre match paired study that reflects real world practice. World J Urol 2023; 41:2897-2904. [PMID: 37864647 DOI: 10.1007/s00345-023-04650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Calyceal diverticulum (CD) is the outpouching of a calyx into the renal parenchyma, connected by an infundibulum. Often associated with recurrent stones, common surgical options include percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS). We aim to present the real-world practises and outcomes comparing both approaches and the technical choices made. MATERIALS AND METHODS Retrospective data including 313 patients from 11 countries were evaluated. One hundred and twenty-seven underwent mini-PCNL and one hundred and eighty-six underwent RIRS. Patient demographics, perioperative parameters, and outcomes were analysed using either T test or Mann-Whitney U test. Categorical data between groups were analysed using the Chi-squared test. Propensity score matching (PSM) was performed matching for baseline characteristics. Subgroup analyses for anomalous/malrotated kidneys and difficult diverticulum access were performed. RESULTS After PSM, 123 patients in each arm were included, with similar outcomes for stone-free rate (SFR) and complications (p < 0.001). Hospitalisation was significantly longer in PCNL. Re-intervention rate for residual fragments (any fragment > 4 mm) was similar. RIRS was the preferred re-intervention for both groups. Intraoperative bleeding was significantly higher in PCNL (p < 0.032) but none required transfusion. Two patients with malrotated anatomy in RIRS group required transfusion. Lower pole presented most difficult access for both groups, and SFR was significantly higher in difficult CD accessed by RIRS (p < 0.031). Laser infundibulotomy was preferred for improving diverticular access in both. Fulguration post-intervention was not practised. CONCLUSION The crux lies in identification of the opening and safe access. Urologists may consider a step-up personalised approach with a view of endoscopic combined approach where required.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, NUHS, Singapore, Singapore
| | - Olivier Traxer
- Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
| | - Shauna Jia Qian Woo
- Department of Urology, Singapore General Hospital, Singapore Health Services, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrourology, Hyderabad, India
| | - Amish Wani
- Department of Urology, Asian Institute of Nephrourology, Hyderabad, India
| | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra, India
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - İlker Gokce Mehmet
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Cemil Aydin
- Department of Urology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
| | - Yakup Bostanci
- Department of Urology, Ondokuz Mayis University, Samsun, Turkey
| | - Saeed Bin Hamri
- Department of Urology, Advanced Laser Endourology at King Abdulaziz National Guard Medical City Saudi Arabia, Jeddah, Saudi Arabia
| | - Fahad R Barayan
- Division of Urology, Department of Surgery, Ministry of National Guard-Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospital NHS Trust, Southampton, UK
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore Health Services, Singapore, Singapore.
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Fong KY, Low CHX, Chan YH, Ho KW, Keh YS, Chin CT, Chin CY, Fam JM, Wong N, Idu M, Wong ASL, Lim ST, Koh TH, Tan JWC, Yeo KK, Yap J. Role of Invasive Strategy for Non-ST-Elevation Myocardial Infarction in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 205:369-378. [PMID: 37639763 DOI: 10.1016/j.amjcard.2023.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Patients with chronic kidney disease (CKD) have traditionally been excluded from randomized trials. We aimed to compare percutaneous coronary intervention versus conservative management, and early intervention (EI; within 24 hours of admission) versus delayed intervention (DI; after 24 to 72 hours of admission) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and concomitant CKD. An electronic literature search was performed to search for studies comparing invasive management to conservative management or EI versus DI in patients with NSTEMI with CKD. The primary outcome was all-cause mortality; secondary outcomes were acute kidney injury (AKI) or dialysis, major bleeding, and recurrent MI. Hazard ratios (HRs) for the primary outcome and odds ratios for secondary outcomes were pooled in random-effects meta-analyses. Eleven studies (140,544 patients) were analyzed. Invasive management was associated with lower mortality than conservative management (HR 0.62, 95% confidence interval 0.57 to 0.67, p <0.001, I2 = 47%), with consistent benefit across all CKD stages, except CKD 5. There was no significant mortality difference between EI and DI, but subgroup analyses showed significant benefit for EI in stage 1 to 2 CKD (HR 0.75, 95% confidence interval 0.58 to 0.97, p = 0.03, I2 = 0%), with no significant difference in stage 3 and 4 to 5 CKD. Invasive strategy was associated with higher odds of AKI or dialysis and major bleeding, but lower odds of recurrent MI compared with conservative management. In conclusion, in patients with NSTEMI and CKD, an invasive strategy is associated with significant mortality benefit over conservative management in most patients with CKD, but at the expense of higher risk of AKI and bleeding. EI appears to benefit those with early stages of CKD. Trial Registration: PROSPERO CRD42023405491.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chloe Hui Xuan Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Yann Shan Keh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Chee Yang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jiang Ming Fam
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Muhammad Idu
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Aaron Sung Lung Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Soo Teik Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Tian Hai Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
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Fong KY, Chan YH, Yeo C, Lip GYH, Tan VH. Systematic Review and Meta-Analysis of Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation With Low Stroke Risk. Am J Cardiol 2023; 204:366-376. [PMID: 37573616 DOI: 10.1016/j.amjcard.2023.07.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Pivotal trials comparing direct oral anticoagulants (DOACs) against warfarin in patients with atrial fibrillation (AF) predominantly involved patients with high stroke risk. This study aimed to evaluate the efficacy and safety of DOAC versus warfarin in patients with low stroke risk. An online literature search was conducted to retrieve studies comparing clinical outcomes between patients treated with DOAC versus warfarin for AF, reporting outcomes for patients at low or minimal risk of stroke (CHA2DS2-VASc scores ranging from 0 to 2 or CHADS2 scores ranging from 0 to 1). The primary outcome was the occurrence of stroke or systemic embolism. Secondary outcomes included major bleeding, intracranial hemorrhage, and all-cause mortality. Hazard ratios for all outcomes were pooled in random-effects meta-analyses. A network meta-analysis of individual DOACs versus warfarin was also conducted. In total, 11 studies (132,980 patients) were included. DOAC was associated with a significantly lower risk of stroke or systemic embolism (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96, p = 0.008, I2 = 0%), major bleeding, intracranial hemorrhage, and mortality compared with warfarin. This benefit persisted even when study arms which had CHA2DS2-VASc scores of 2 were excluded. When restricted to 3 studies investigating only patients with a single nongender-related stroke risk factor, significant benefit was seen only for the outcome of major bleeding. In the network meta-analysis, only dabigatran was superior to warfarin for all 4 outcomes. In conclusion, DOACs should be the standard of care in low-risk patients with AF who require anticoagulation. In particular, dabigatran appears to have the best balance of stroke prevention and reduction in major bleeding.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Gregory Y H Lip
- Department of Cardiovascular Medicine, Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore.
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Fong KY, Ong JHW, Chan YH, Yap J, Ho KW, Aslim EJ, Ng LG, Gan VHL, Lim EJ. A Systematic Review and Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Kidney Transplant Patients. Am J Cardiol 2023; 204:22-25. [PMID: 37536199 DOI: 10.1016/j.amjcard.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Transplant Centre, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore.
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Zhao JJ, Fong KY, Chan YH, Tey J, Dawood S, Lee SC, Finn RS, Sundar R, Lim JSJ. Indirect Treatment Comparison of First-Line CDK4/6-Inhibitors in Post-Menopausal Patients with HR+/HER2- Metastatic Breast Cancer. Cancers (Basel) 2023; 15:4558. [PMID: 37760527 PMCID: PMC10527344 DOI: 10.3390/cancers15184558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background: CDK4/6-inhibitors have demonstrated similar efficacy and are considered an effective first-line endocrine treatment of patients with hormone-receptor positive (HR+)/human-epidermal-growth-factor-receptor-2 negative (HER2-) metastatic breast cancer (MBC) in the endpoint of progression-free survival (PFS). Amongst these, palbociclib was first to achieve regulatory approval, followed subsequently by ribociclib and abemaciclib. However, recent updates of overall survival (OS) showed inconsistencies in the OS benefit for palbociclib compared with the other two CDK4/6-inhibitors. With the lack of head-to-head comparison studies, our study sought to compare indirect survival outcomes between CDK4/6-inhibitors in this setting using a novel reconstructive algorithm. Methods: Phase III randomized trials comparing first-line aromatase inhibitor with/without a CDK4/6-inhibitor in post-menopausal patients with HR+/HER2- MBC were identified through systemic review and literature search of online archives of published manuscripts and conference proceedings. A graphical reconstructive algorithm was utilized to retrieve time-to-event data from reported Kaplan-Meier OS and PFS plots to allow for comparison of survival outcomes. Survival analyses were conducted with Cox proportional-hazards model with a shared-frailty term. Results: Three randomized phase III trials-PALOMA-2, MONALEESA-2 and MONARCH-3-comprising 1827 patients were included. Indirect pairwise comparisons of all CDK4/6-inhibitors showed no significant PFS differences (all p > 0.05). Likewise, indirect treatment comparison between ribociclib vs. palbociclib (one-stage: HR = 0.903, 95%-CI: 0.746-1.094, p = 0.297), abemaciclib vs. palbociclib (one-stage: HR = 0.843, 95%-CI: 0.690-1.030, p = 0.094) and abemaciclib vs. ribociclib (one-stage: HR = 0.933, 95%-CI: 0.753-1.157, p = 0.528) failed to demonstrate a significant OS difference. Conclusions: Findings from this indirect treatment comparison suggest no significant PFS or OS differences between CDK4/6-inhibitors in post-menopausal patients with HR+/HER2- MBC.
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Affiliation(s)
- Joseph J. Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; (J.J.Z.); (K.Y.F.); (S.C.L.)
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119074, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; (J.J.Z.); (K.Y.F.); (S.C.L.)
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore 119074, Singapore;
| | - Shaheenah Dawood
- Department of Medical Oncology, Mediclinic City Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates;
| | - Soo Chin Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; (J.J.Z.); (K.Y.F.); (S.C.L.)
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119074, Singapore
- Cancer Science Institute, National University of Singapore, Singapore 119074, Singapore
| | - Richard S. Finn
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA;
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; (J.J.Z.); (K.Y.F.); (S.C.L.)
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119074, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore 169547, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore 117456, Singapore
- Singapore Gastric Cancer Consortium, Singapore 119074, Singapore
| | - Joline S. J. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; (J.J.Z.); (K.Y.F.); (S.C.L.)
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119074, Singapore
- Cancer Science Institute, National University of Singapore, Singapore 119074, Singapore
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So WZ, Fong KY, Wang Z, Tiong HY. Outcomes of Localized Renal Cell Carcinoma Across Different Races. Clin Med Res 2023; 21:122-128. [PMID: 37985170 PMCID: PMC10659133 DOI: 10.3121/cmr.2023.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 11/22/2023]
Abstract
Introduction: Epidemiological outcomes of renal cell carcinoma (RCC) remain sparse. This study aims to compare preoperative characteristics, surgical outcomes, and oncological outcomes of RCC patients at a urology unit in Singapore.Methods: A retrospective cohort analysis of 137 RCC patients in the National University Hospital of Singapore who had undergone partial nephrectomy between 2009 and 2020 was conducted. χ2 tests (Chi-Square Test, Fisher's Exact Test) and one-way analysis of variance (ANOVA) were used for comparing categorical and continuous variables respectively. Kaplan-Meier estimates were used for survival analysis.Results: In total, 137 patients were identified (Chinese [n=82], Malay [n=19], Indian [n=15], Others [n=21]). Indian patients were diagnosed at an earlier age (52.13±10.52 years, P=0.018). A larger percentage of Malay patients (78.9%, P<0.001) were operated on before 2016, prior to the center's adoption of the robotic surgical technique. More Malay and Indian patients underwent laparoscopic surgery (36.8% and 46.7%, P=0.008), experiencing higher rates of intra-operative conversions compared to the Chinese and other ethnicities (5.3% and 13.3% vs. 0%, P=0.011). They also had longer post-operative stays compared to Chinese (7.42±6.46 days; 7.40±7.69 days vs. 4.88±2.87 days, P=0.036). Malays were much less likely to undergo robotic partial nephrectomy compared to Chinese patients (OR=0.295, 95% CI=0.102-0.856) and had the highest rate of metastatic recurrence (10.5%, P=0.023).
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Wu AGR, Mohan R, Fong KY, Chen Z, Bonney GK, Kow AWC, Ganpathi IS, Pang NQ. Early vs late drain removal after pancreatic resection-a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:317. [PMID: 37587225 DOI: 10.1007/s00423-023-03053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Reducing clinically relevant post-operative pancreatic fistula (CR-POPF) incidence after pancreatic resections has been a topic of great academic interest. Optimizing post-operative drain management is a potential strategy in reducing this major complication. METHODS Studies involving pancreatic resections, including both pancreaticoduodenectomy (PD) and distal pancreatic resections (DP), with intra-operative drain placement were screened. Early drain removal was defined as removal before or on the 3rd post-operative day (POD) while late drain removal was defined as after the 3rd POD. The primary outcome was CR-POPF, International Study Group of Pancreatic Surgery (ISGPS) Grade B and above. Secondary outcomes were all complications, severe complications, post-operative haemorrhage, intra-abdominal infections, delayed gastric emptying, reoperation, length of stay, readmission, and mortality. RESULTS Nine studies met the inclusion criteria and were included for analysis. The studies had a total of 8574 patients, comprising 1946 in the early removal group and 6628 in the late removal group. Early drain removal was associated with a significantly lower risk of CR-POPF (OR: 0.24, p < 0.01). Significant reduction in risk of post-operative haemorrhage (OR: 0.55, p < 0.01), intra-abdominal infection (OR: 0.35, p < 0.01), re-admission (OR: 0.63, p < 0.01), re-operation (OR: 0.70, p = 0.03), presence of any complications (OR: 0.46, p < 0.01), and reduced length of stay (SMD: -0.75, p < 0.01) in the early removal group was also observed. CONCLUSION Early drain removal is associated with significant reductions in incidence of CR-POPF and other post-operative complications. Further prospective randomised trials in this area are recommended to validate these findings.
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Affiliation(s)
- Andrew Guan Ru Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ramkumar Mohan
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhaojin Chen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Glenn Kunnath Bonney
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Alfred Wei Chieh Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Iyer Shridhar Ganpathi
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.
- Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
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Castellani D, Fong KY, Lim EJ, Chew BH, Tailly T, Emiliani E, Teoh JYC, Chai CA, Heng CT, Ong Lay Keat W, Tanidir Y, Ragoori D, Galosi AB, Singh A, Bin Hamri S, Traxer O, Somani BK, Gauhar V. Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. J Urol 2023; 210:323-330. [PMID: 37126223 DOI: 10.1097/ju.0000000000003504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. MATERIALS AND METHODS Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free. RESULTS Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. CONCLUSIONS This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - 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
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
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Fong KY, Lim MJR, Fu S, Low CE, Chan YH, Deepak DS, Xu X, Thong M, Jain S, Teo K, Gardner PA, Snyderman CH, Nga VDW, Yeo TT. Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis. Pituitary 2023:10.1007/s11102-023-01335-2. [PMID: 37389776 DOI: 10.1007/s11102-023-01335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Surgical resection is the main treatment for symptomatic nonfunctioning pituitary adenomas (NFPA). We aimed to analyze the impact of surgical approach, completeness of resection, and postoperative radiotherapy on long-term progression-free survival (PFS) of NFPA, using individual patient data (IPD) meta-analysis. METHODS An electronic literature searched was conducted on PubMed, EMBASE, and Web of Science from database inception to 6 November 2022. Studies describing the natural history of surgically resected NFPA, with provision of Kaplan-Meier curves, were included. These were digitized to obtain IPD, which was pooled in one-stage and two-stage meta-analysis to determine hazard ratios (HRs) and 95%CIs of gross total resection (GTR) versus subtotal resection (STR), and postoperative radiotherapy versus none. An indirect analysis of single-arm data between endoscopic endonasal (EES) and microscopic transsphenoidal (MTS) surgical technique was also performed. RESULTS Altogether, eleven studies (3941 patients) were retrieved. PFS was significantly lower in STR than GTR (shared-frailty HR 0.32, 95%CI 0.27-0.39, p < 0.001). Postoperative radiotherapy significantly improved PFS compared to no radiotherapy (shared-frailty HR 0.20, 95%CI 0.15-0.26, p < 0.001), including in the subgroup of patients with STR (shared-frailty HR 0.12, 95%CI 0.08-0.18, p < 0.001). Similar PFS was observed between EES and MTS (indirect HR 1.09, 95%CI 0.92-1.30, p = 0.301). CONCLUSIONS This systematic review and patient-level meta-analysis provides a robust prognostication of surgically treated NFPA. We reinforce current guidelines stating that GTR should be the standard of surgical resection. Postoperative radiotherapy is of considerable benefit, especially for patients with STR. Surgical approach does not significantly affect long-term prognosis. REGISTRATION PROSPERO CRD42022374034.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Level 8, National University Health Systems Tower Block, 1E Kent Ridge Rd, Singapore, 119228, Singapore.
| | - Shuning Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Xinni Xu
- Division of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Mark Thong
- Division of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Swati Jain
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Paul A Gardner
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
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Fong KY, Zhao JJ, Syn NL, Nair P, Chan YH, Lee P. Comparing bronchial thermoplasty with biologicals for severe asthma: Systematic review and network meta-analysis. Respir Med 2023:107302. [PMID: 37257786 DOI: 10.1016/j.rmed.2023.107302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/12/2023] [Accepted: 05/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Bronchial thermoplasty (BT) has shown favorable safety and efficacy in several randomized controlled trials (RCTs), but has not been directly compared to biological therapies. METHODS Electronic literature searches were performed on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, to retrieve RCTs of BT or FDA-approved biologicals against controls in patients with severe asthma. Six outcomes were analyzed: Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), the number of patients experiencing ≥1 asthma exacerbation, annualized exacerbation rate ratio (AERR), oral corticosteroid dose reduction (OCDR), and morning peak expiratory flow rate (amPEF). Random-effects, Frequentist network meta-analysis (NMA) were performed, and therapies were ranked using P-scores. RESULTS Twenty-nine RCTs (15,547 patients) were included. Fewer patients treated with BT experienced ≥1 asthma exacerbation (risk ratio [RR] = 0.66, 95%CI = 0.45-0.98) compared to control. AERR of BT versus control was non-significant, but significant improvements in ACQ score (mean difference [MD] -0.41, 95%CI -0.63 to -0.20), AQLQ score (MD = 0.54, 95%CI = 0.30-0.77), amPEF and OCDR were found. No significant differences between BT and biologics were seen across indirect comparisons of all studies. CONCLUSIONS Despite the lack of head-to-head comparative trials, this NMA suggests that BT is non-inferior to biologicals in terms of quality-of-life scores, and represents a promising alternative for patients with severe asthma.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pyng Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore.
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Wong YJ, Nguyen VH, Yang HI, Li J, Le MH, Wu WJ, Han NX, Fong KY, Chen E, Kumar R, Wong C, Rui F, Xu X, Xue Q, Hu XY, Leow WQ, Goh GBB, Cheung R, Wong G, Wong VWS, Yu MW, Nguyen MH. Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis. Clin Mol Hepatol 2023:cmh.2023.0004. [PMID: 37157776 PMCID: PMC10366810 DOI: 10.3350/cmh.2023.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
Objective Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients. Design We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random-effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment. Results We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88%-95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27-0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all P≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, P<0.0001). On Cox regression, CHB-FL was associated with lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (hazard ratio=0.68, 0.61, 0.38, 1.35, respectively, all P≤0.004). Conclusion IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.
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Affiliation(s)
- Yu Jun Wong
- Department of Gastroenterology & Hepatology, Changi General Hospital, SingHealth, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Program, Singapore
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Centre, Palo Alto, California, USA
- Harvard Medical School, Boston, MA
| | - Hwai-I Yang
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Biomedical Translation Research Centre, Academia Sinica, Taipei, Taiwan
| | - Jie Li
- Department of Infectious Disease, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Michael Huan Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Centre, Palo Alto, California, USA
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Wan-Jung Wu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Nicole Xinrong Han
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elizebeth Chen
- Department of Gastroenterology & Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Rajneesh Kumar
- SingHealth Duke-NUS Medicine Academic Clinical Program, Singapore
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Connie Wong
- Lane library, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Fajuan Rui
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
| | - Xiaoming Xu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
| | - Qi Xue
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Xin Yu Hu
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University
| | - Wei Qiang Leow
- Department of Pathology, Singapore General Hospital, Singapore
| | - George Boon-Bee Goh
- SingHealth Duke-NUS Medicine Academic Clinical Program, Singapore
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Centre, Palo Alto, CA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Grace Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong
| | - Ming-Whei Yu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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Fong KY, Xin L, Ng J, Loh SEK, Ng JJ, Choong AMTL. A systematic review and meta-analysis of sirolimus-eluting stents for treatment of below-the-knee arterial disease. J Vasc Surg 2023; 77:1264-1273.e3. [PMID: 36183989 DOI: 10.1016/j.jvs.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to analyze the efficacy and safety of sirolimus-eluting stents (SESs) in the treatment of below-the-knee (BTK) arterial disease. METHODS An electronic literature search was conducted from inception to July 24, 2021. Retrospective, prospective, and randomized studies that had used SESs to treat BTK arterial disease and had reported the primary patency, technical success, target lesion revascularization, and/or mortality were included. Meta-analyses of the proportions were conducted to derive pooled summary statistics of the outcomes. Where Kaplan-Meier curves were provided for primary patency, a meta-analysis of the individual patient data was conducted via a graphic reconstruction tool to estimate primary patency at various follow-up points. For studies comparing SESs and bare metal stents (BMSs), a two-stage meta-analysis was performed to compare the 6-month primary patency of SESs vs BMSs. RESULTS Ten studies across 13 publications, including 995 patients, were retrieved for analysis. In the meta-analysis of proportions, across six studies (n = 339 patients), the pooled 6-month primary patency was 87.3% (95% confidence interval [CI], 81.6%-92.1%). Across seven studies (n = 283 patients), the pooled 6-month mortality was 5.4% (95% CI, 1.4%-11.2%). An individual patient data analysis of three studies (n = 282 patients) yielded a primary patency rate of 95.2% (95% CI, 92.7%-97.8%), 82.8% (95% CI, 78.3%-87.6%), 79.8% (95% CI, 75.0%-85.0%), and 79.8% (95% CI, 75.0%-85.0%) at 6, 12, 18, and 24 months, respectively. The 12-month target lesion revascularization rate across four studies (n = 324 patients) was 9.6% (95% CI, 6.4%-13.4%). In the two-stage meta-analysis of 6-month primary patency across three studies (n = 168 patients), the use of SESs was significantly favored over BMSs (risk ratio, 1.28; 95% CI, 1.12-1.46; P < .001). CONCLUSIONS The overall evidence suggests that the use of SESs appears to be safe and offers favorable outcomes for BTK arterial disease compared with BMSs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Liu Xin
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Magdalen College, University of Oxford, Oxford, UK
| | - Josiah Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Stanley E K Loh
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Diagnostic Imaging, National University Health System, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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Fong KY, Yap JJL, Chan YH, Ewe SH, Chao VTT, Amanullah MR, Govindasamy SP, Aziz ZA, Tan VH, Ho KW. Network Meta-Analysis Comparing Transcatheter, Minimally Invasive, and Conventional Surgical Aortic Valve Replacement. Am J Cardiol 2023; 195:45-56. [PMID: 37011554 DOI: 10.1016/j.amjcard.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but time-varying outcomes have yet to be comprehensively explored. This study aimed to compare the all-cause mortality among 3 AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional AVR (CAVR). An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI with CAVR and RCTs or propensity score-matched (PSM) studies comparing MIAVR with CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality were derived from graphical reconstruction of Kaplan-Meier curves. Pairwise comparisons and network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk, as well as patients who underwent transfemoral (TF) TAVI. A total of 27 studies with 16,554 patients were included. In the pairwise comparisons, TAVI showed superior mortality to CAVR until 37.5 months, beyond which there was no significant difference. When restricted to TF TAVI versus CAVR, a consistent mortality benefit favoring TF TAVI was seen (shared frailty hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.76 to 0.98, p = 0.024). In the network meta-analysis involving majority PSM data, MIAVR demonstrated significantly lower mortality than TAVI (HR = 0.70, 95% CI = 0.59 to 0.82) and CAVR (HR = 0.69, 95% CI = 0.59 to 0.80); this association remained compared with TF TAVI but with a lower extent of benefit (HR = 0.80, 95% CI = 0.65 to 0.99). In conclusion, the initial short- to medium-term mortality benefit for TAVI over CAVR was attenuated over the longer term. In the subset of patients who underwent TF TAVI, a consistent benefit was found. Among majority PSM data, MIAVR showed improved mortality compared with TAVI and CAVR but less than the TF TAVI subset, which requires validation by robust RCTs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | | | | | - Zameer Abdul Aziz
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore
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Fong KY, Yap J, Ewe SH, Chao V, Amanullah M, Sivaraj G, Aziz ZA, Tan VHH, Ho KW. COMPARISON OF TRANSCATHETER, MINIMALLY INVASIVE AND CONVENTIONAL SURGICAL AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01323-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Fong KY, Lai TP, Chan KS, See IJL, Goh CC, Muthuveerappa S, Tan AH, Liang S, Lo ZJ. Clinical validation of a smartphone application for automated wound measurement in patients with venous leg ulcers. Int Wound J 2023; 20:751-760. [PMID: 36787270 PMCID: PMC9927911 DOI: 10.1111/iwj.13918] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 12/07/2022] Open
Abstract
Chronic wounds are associated with significant clinical, economic and quality-of-life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5-week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter-rater and intra-rater reliability between clinical and TA-based measurements were analysed using intra-class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5-week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter-rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799-0.919, P < 0.001). Separate measurements of intra-rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967-0.985 and range 0.977-0.984 respectively, P < 0.001). Inter-rater reliability between TA used on the iOS and Android systems was also excellent (0.987-0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Tina Peiting Lai
- Wound and Stoma Care, Nursing ServiceTan Tock Seng HospitalSingaporeSingapore
| | - Kai Siang Chan
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Isabel Jia Le See
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing ServiceTan Tock Seng HospitalSingaporeSingapore
| | | | - Audrey Huimin Tan
- Wound and Stoma Care, Nursing ServiceTan Tock Seng HospitalSingaporeSingapore
| | | | - Zhiwen Joseph Lo
- Department of SurgeryWoodlands HealthSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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García-Rojo E, Traxer O, Vallejo Arzayús DM, Castellani D, Ferretti S, Gatti C, Bujons Tur A, Quiroz Madarriaga Y, Teoh JYC, Ragoori DR, Bhatia TP, Chandra Mohan V, Shrestha A, Lim EJ, Sinha M, Griffin S, Pietropaolo A, Fong KY, Tanidir Y, Somani BK, Gauhar V. Comparison of Low-Power vs High-Power Holmium lasers in pediatric RIRS outcomes. J Endourol 2023; 37:509-515. [PMID: 36860192 DOI: 10.1089/end.2022.0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES to compare the outcomes of using low-power (up to 30W) vs high-power (up to 120W) holmium lasers in retrograde intrarenal surgery (RIRS) in children and to analyse if lasering techniques and the use of access sheath have any influence on the outcomes. METHODS We retrospectively reviewed data from 9 centres of children who underwent RIRS with holmium laser for the treatment of kidney stones between January 2015 and December 2020. Patients were divided into two groups: high-power and low-power holmium laser. Clinical, perioperative variables and complications were analysed. Outcomes were compared between groups using Student's T-test for continuous variables, and Chi-square and Fisher's exact test for categorical variables. A multivariable logistic regression analysis model was also performed. RESULTS 314 patients were included. A high-power and low-power holmium laser was used in 97 and 217 patients, respectively. Clinical and demographic variables were comparable between both groups, except for stone size where the low-power group treated larger stones (mean 11.11 mm vs 9.70 mm; p 0.018). In the high-power laser group, a reduction in surgical time was found (mean 64.29 min vs 75.27 min; p 0.018) with a significantly higher stone-free rate (SFR) (mean 81.4% vs 59%; p <0.001). We found no statistical differences in complication rates. The multivariate logistic regression model showed lower SFR in the low-power holmium group, especially with larger (p = 0.011) and multiple stones (p < 0.001). CONCLUSION Our real-world pediatric multicenter study favours high-power holmium laser and establishes its safety and efficacy in children. .
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Affiliation(s)
- Esther García-Rojo
- Hospital Universitario HM Sanchinarro, 221921, Department of Urology, Calle Oña, 10, Madrid, 28050, Madrid, Spain, 28050;
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France;
| | | | - Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | | | - Claudia Gatti
- University Hospital of Parma, 18630, Pediatric Surgery, Parma, Emilia-Romagna, Italy;
| | - Anna Bujons Tur
- Fundacio Puigvert, 16444, Pediatric Urology, Barcelona, Catalunya, Spain;
| | | | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Deepak Reddy Ragoori
- Asian Institute of Nephrology and Urology, 519389, Urology, 6-3-562/A, behind MORE megamart, Errum Manzil, Hyderabad, Telangana, India, 500082;
| | - Tanuj Paul Bhatia
- Sarvodaya Hospital, 76257, Urology, Sector 8, Faridabad, Faridabad, Haryana, India, 121006.,Sarvodaya Hospital and research centre, Sector 8, Faridabad, Faridabad, India;
| | - Vaddi Chandra Mohan
- preeti urology and kidney hospital, Urology, MIG-1,307, Raod No.4 , KPHB Colony, Kukatpally, Hyderabad, hyderabad, Telangana, India, 500072;
| | | | - Ee Jean Lim
- Singapore General Hospital, Department of Urology, Academia Level 5, 20 College Rd, Singapore 169856, Singapore, Singapore, 169856;
| | - Mrigyanka Sinha
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Stephen Griffin
- University Hospitals Southampton NHS Trust, Paediatric Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Amelia Pietropaolo
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Khi Yung Fong
- National University of Singapore, 37580, Singapore, Singapore;
| | - Yiloren Tanidir
- Marmara University School of Medicine, Urology, Marmara Universitesi Pendik EAH, Fevzi Cakmak Mah. Mimar Sinan Cad., No:41 Uroloji AD. Kat:4, Ust kaynarca / Pendik, Istanbul, Turkey, 34899;
| | - Bhaskar K Somani
- University Hospitals Southampton NHS Trust, Urology, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland, SO16 6YD.,United Kingdom of Great Britain and Northern Ireland;
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore;
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Castellani D, Somani BK, Ferretti S, Gatti C, Sekerci CA, Madarriaga YQ, Fong KY, Campobasso D, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Sinha MM, Lim EJ, Teoh JYC, Griffin S, Tur AB, Tanidir Y, Traxer O, Gauhar V. Role of Preoperative Ureteral Stent on Outcomes of Retrograde Intra-Renal Surgery (RIRS) in Children. Results From a Comparative, Large, Multicenter Series. Urology 2023; 173:153-158. [PMID: 36460062 DOI: 10.1016/j.urology.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones. METHODS Children/adolescent with kidney stones undergoing RIRS in 9 centers between 2015 and 2020 were retrospectively reviewed. EXCLUSION CRITERIA ureteral lithotripsy, bilateral procedures. Stone-free status was evaluated at 3-month and defined as a single residual fragment (RF) ≤2 mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no-prestenting; Group 2 prestenting). Student's, Chi-square and Fisher's exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical significance: P-value <0.05. RESULTS Three hundred eighty-nine children/adolescents were included (192 patients in Group 1). Prestented patients were younger compared with non-prestented (mean age 8.30 ± 4.93 vs 10.43 ± 4.30 years, P < 0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, P = 0.016). Sepsis occurred in 2.1% of patients in Group 2 and no patient in Group 1 (P = 0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (P = 0.322). In univariate logistic regression analysis, stone size was associated with RF (OR 1.12 95%CI 1.06-1.18, P < 0.001), whereas Thulium fiber laser with a lower incidence (OR 0.24 95%CI 0.06-0.69, p=0.020). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95%CI 1.08-1.36, P = 0.001). CONCLUSIONS RIRS showed similar stone-free rate in pre and non-prestented children/adolescents, although prestented patients were younger. A higher risk of post-operative infections was reported in prestented patients.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Urology Unit, Nuovo Ospedale Civile Sant'Agostino Estense - NOCSE, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Cagri Akin Sekerci
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Deepak Ragoori
- Department Urology, Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India
| | - Mriganka Mani Sinha
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Stephen Griffin
- Department of Paediatric Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Anna Bujon Tur
- Pediatric Urology, Fundacio Puigvert, Barcelona, Catalunya, Spain
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Olivier Traxer
- GRC n°20 Lithiase Renale, Sorbonne University, AP-HP, Hôpital Tenon, F-75020 Paris, France
| | - Vineet Gauhar
- Department of Minimally Invasive Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Fong KY, Zhao JJ, Sultana R, Lee JJX, Lee SY, Chan SL, Yau T, Tai DWM, Sundar R, Too CW. First-Line Systemic Therapies for Advanced Hepatocellular Carcinoma: A Systematic Review and Patient-Level Network Meta-Analysis. Liver Cancer 2023; 12:7-18. [PMID: 36872922 PMCID: PMC9982345 DOI: 10.1159/000526639] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/09/2022] [Indexed: 02/19/2023] Open
Abstract
Introduction Sorafenib was historically the standard of care for advanced hepatocellular carcinoma (aHCC) until it was superseded by the combination of atezolizumab and bevacizumab. Thereafter, several novel first-line combination therapies have demonstrated favorable outcomes. The efficacies of these treatments in relation to current and previous standards of care are unknown, necessitating an overarching evaluation. Methods A systematic literature search was conducted on PubMed, EMBASE, Scopus, and the Cochrane Controlled Register of Trials for phase III randomized controlled trials investigating first-line systemic therapies for aHCC. Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) were graphically reconstructed to retrieve individual patient-level data. Derived hazard ratios (HRs) for each study were pooled in a random-effects network meta-analysis (NMA). NMAs were also conducted using study-level HRs for various subgroups, according to viral etiology, Barcelona Clinic Liver Cancer (BCLC) staging, alpha-fetoprotein (AFP) levels, macrovascular invasion, and extrahepatic spread. Treatment strategies were ranked using p scores. Results Among 4,321 articles identified, 12 trials and 9,589 patients were included for analysis. Only two therapies showed OS benefit over sorafenib: combined anti-programmed-death and anti-VEGF pathway inhibitor monoclonal antibodies (Anti-PD-(L)1/VEGF Ab), including atezolizumab-bevacizumab and sintilimab-bevacizumab biosimilar (HR = 0.63, 95% CI = 0.53-0.76) and tremelimumab-durvalumab (HR = 0.78, 95% CI = 0.66-0.92). Anti-PD-(L)1/VEGF Ab showed OS benefit over all other therapies except tremelimumab-durvalumab. Low heterogeneity (I2 = 0%) and inconsistency (Cochran's Q = 0.52, p = 0.773) was observed. p scores for OS ranked Anti-PD-(L)1/VEGF Ab as the best treatment in all subgroups, except hepatitis B where atezolizumab-cabozantinib ranked highest for both OS and PFS, as well as nonviral HCC and AFP ≥400 μg/L where tremelimumab-durvalumab ranked highest for OS. Conclusion This NMA supports Anti-PD-(L)1/VEGF Ab as the first-line therapy for aHCC and demonstrates a comparable benefit for tremelimumab-durvalumab which also extends to certain subgroups. Results of the subgroup analysis may guide treatment according to baseline characteristics, while pending further studies.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Jonathan Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joycelyn Jie Xin Lee
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Suat Ying Lee
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Stephen Lam Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Thomas Yau
- Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - David Wai Meng Tai
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore, Singapore.,The N. 1 Institute for Health, National University of Singapore, Singapore, Singapore.,Singapore Gastric Cancer Consortium, Singapore, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore.,Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore.,Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore, Singapore
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Lim MJR, Yeo J, Fong KY, Eng SWO, Fu S, Tan BYQ, Yeo LLL, Nga VDW, Yeo TT. Characteristics of subarachnoid hemorrhage associated with COVID-19 infection: A systematic review and descriptive analysis. J Stroke Cerebrovasc Dis 2023; 32:106904. [PMID: 36442281 PMCID: PMC9678815 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) has been reported as a neurological manifestation in 0.1% of COVID-19 patients. This systematic review investigated the outcomes and predictive factors of SAH in patients with COVID-19. MATERIALS AND METHODS An electronic literature search was conducted on PubMed, Embase, and Scopus from inception to 10th September 2021. Studies reporting SAH in COVID-19 patients were included. Demographic characteristics, risk factors for disease, severity of COVID-19, and mortality of SAH in COVID-19 patients were analyzed. Subgroup analyses stratified by COVID-19 severity and mortality were conducted. RESULTS 17 case reports, 11 case series, and 2 retrospective cohort studies, with a total of 345 cases of SAH in COVID-19 patients, were included for analysis. Most published cases were reported in the US. Mean age was 55±18.4 years, and 162 patients (48.5%) were female. 242 patients (73.8%) had severe-to-critical COVID-19, 56.7% had aneurysmal SAH, 71.4% were on anticoagulation, and 10.8% underwent surgical treatment. 136 out of 333 patients (40.8%) died. Among patients with severe-to-critical COVID-19, 11 out of 18 (61.1%) died, and 8 out of 8 (100.0%) were non-aneurysmal SAH. CONCLUSIONS SAH is a rare but morbid occurrence in COVID-19. The mortality rate of COVID-SAH patients was 40.8%, with a higher prevalence of severe-to-critical COVID-19 (100% versus 53.8%) and non-aneurysmal SAH (85.7% versus 44.6%) among COVID-SAH deaths. Given the changing landscape of COVID-19 variants, further studies investigating the association between COVID-19 and SAH may be warranted to identify the long-term effects of COVID-19.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Corresponding author at: Division of Neurosurgery, University Surgical Centre, National University Hospital, National University Health Systems Tower Block, 1E Kent Ridge Rd, 119228, Singapore
| | - Jonathan Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Corresponding author at: Division of Neurosurgery, University Surgical Centre, National University Hospital, National University Health Systems Tower Block, 1E Kent Ridge Rd, 119228, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sean Wai-Onn Eng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuning Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Leonard Leong Litt Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fong KY, Zhao JJ, Chan YH, Wang Y, Yeo C, Tan VH. Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis. Ann Acad Med Singap 2023. [DOI: 10.47102/annals-acadmedsg.2022326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AAD.
Method: Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores.
Results: Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25–0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25–0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07–0.30) for combined CBA and RFA, 0.20 (95% CI=0.10–0.41) for hot-balloon ablation, 0.43 (95% CI=0.15–1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18–0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy.
Conclusion: The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis.
Keywords: Atrial fibrillation, catheter ablation, network meta-analysis
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yue Wang
- Changi General Hospital, Singapore
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Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of 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
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
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Fong KY, Zhao JJ, Chan YH, Wang Y, Yeo C, Tan VH. Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis. Ann Acad Med Singap 2023; 52:27-40. [PMID: 36730803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AADs. METHOD Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores. RESULTS Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25-0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25-0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07-0.30) for combined CBA and RFA, 0.20 (95% CI=0.10-0.41) for hot-balloon ablation, 0.43 (95% CI=0.15-1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18-0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy. CONCLUSION The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Quiroz Y, Somani BK, Tanidir Y, Tekgul S, Silay S, Castellani D, Lim EJ, Fong KY, Garcia Rojo E, Corrales M, Hameed BMZ, Llorens E, Teoh JYC, Dogan HS, Traxer O, Bujons Tur A, Gauhar V. Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends. J Endourol 2022; 36:1511-1521. [PMID: 35972727 DOI: 10.1089/end.2022.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
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Affiliation(s)
- Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul Medeniyet University, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Daniele Castellani
- Department of Urology, Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Department of Urology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Garcia Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College Mangalore, Karnataka, India
| | - Erika Llorens
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Anna Bujons Tur
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
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Fong KY, Tan ASM, Bin Sulaiman MS, Leong SH, Ng KW, Too CW. Phantom and Animal Study of a Robot-Assisted, CT-Guided Targeting System using Image-Only Navigation for Stereotactic Needle Insertion without Positional Sensors. J Vasc Interv Radiol 2022; 33:1416-1423.e4. [PMID: 35970505 DOI: 10.1016/j.jvir.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the feasibility and accuracy of a robotic system to integrate and map computed tomography (CT) and robotic coordinates, followed by automatic trajectory execution by a robotic arm. The system was hypothesized to achieve a targeting error of <5 mm without significant influence from variations in angulation or depth. MATERIALS AND METHODS An experimental study was conducted using a robotic system (Automated Needle Targeting device for CT [ANT-C]) for needle insertions into a phantom model on both moving patient table and moving gantry CT scanners. Eight spherical markers were registered as targets for 90 insertions at different trajectories. After a single ANT-C registration, the closed-loop software targeted multiple markers via the insertion of robotically aligned 18-gauge needles. Accuracy (distance from the needle tip to the target) was assessed by postinsertion CT scans. Similar procedures were repeated to guide 10 needle insertions into a porcine lung. A regression analysis was performed to test the effect of needle angulation and insertion depth on the accuracy of insertion. RESULTS In the phantom model, all needle insertions (median trajectory depth, 64.8 mm; range, 46.1-153 mm) were successfully performed in single attempts. The overall accuracy was 1.36 mm ± 0.53, which did not differ between the 2 types of CT scanners (1.39 mm ± 0.54 [moving patient table CT] vs 1.33 mm ± 0.52 [moving gantry CT]; P = .54) and was not significantly affected by the needle angulation and insertion depth. The accuracy for the porcine model was 9.09 mm ± 4.21. CONCLUSIONS Robot-assisted needle insertion using the ANT-C robotic device was feasible and accurate for targeting multiple markers in a phantom model.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexander Sheng Ming Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | | | | | - Ka Wei Ng
- NDR Medical Technology Pvt Ltd, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
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Lim EJ, Castellani D, So WZ, Fong KY, Li JQ, Tiong HY, Gadzhiev N, Heng CT, Teoh JYC, Naik N, Ghani K, Sarica K, De La Rosette J, Somani B, Gauhar V. Radiomics in Urolithiasis: Systematic Review of Current Applications, Limitations, and Future Directions. J Clin Med 2022; 11:jcm11175151. [PMID: 36079078 PMCID: PMC9457189 DOI: 10.3390/jcm11175151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in urolithiasis, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of urolithiasis was conducted on PubMed, EMBASE, and Scopus from inception to 21 March 2022. A total of 7 studies were included. Radiomics has been successfully applied in the field of urolithiasis to differentiate phleboliths from calculi and classify stone types and composition pre-operatively. More importantly, it has also been utilized to predict outcomes and complications after endourological procedures. Although radiomics in urolithiasis is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic and therapeutic factors.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore 169608, Singapore
- Correspondence: ; Tel.: +65-6321-4693
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, 60126 Ancona, Italy
| | - Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Jing Qiu Li
- Department of Urology, Singapore General Hospital, Singapore 169608, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore 119074, Singapore
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, 199034 St. Petersburg, Russia
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong Hospital, Singapore 609606, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kemal Sarica
- Department of Urology, Biruni University, 34010 Istanbul, Turkey
| | - Jean De La Rosette
- Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1, 34010 Istanbul, Turkey
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore 609606, Singapore
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Chanchareonsook N, Ling ML, Sim QX, Teoh KH, Tan K, Tan BH, Fong KY, Poon CY. Failure of sterilization in a dental outpatient facility: Investigation, risk assessment, and management. Medicine (Baltimore) 2022; 101:e29815. [PMID: 35945734 PMCID: PMC9351878 DOI: 10.1097/md.0000000000029815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In 2017, an incident of failed sterilization of dental instruments occurred at a large dental outpatient facility in Singapore. We aim to describe findings of the investigation of the sterilization breach incident, factors related to risk of viral transmission to the potentially affected patients, and the contact tracing process, patient management, and blood test results at a 6-month follow-up. A full assessment of the incident was immediately carried out. The factors related to risk of viral transmission due to affected instruments were analyzed using 3 keys points: breached step(s) and scale of the incident, prevalence of underlying bloodborne diseases and immunity in the Singapore population, health status of potential source patients, and type of dental procedure performed, and health status of affected patients and type of dental procedure received. Up to 72 affected instrument sets were used in 714 potentially affected patients who underwent noninvasive dental procedures. The investigation revealed that there was a lapse in the final step of steam sterilization, resulting in the use of incompletely sterilized items. The assessment determined that there was an extremely low risk of bloodborne virus transmission of diseases to the patients. At the 6-month follow-up, there were no infected/colonized cases found related to the incident. Lapses in the sterilization process for medical and dental instruments can happen, but a risk assessment approach is useful to manage similar incidents. Quick response and proper documentation of the sterilization process can prevent similar incidents.
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Affiliation(s)
- N Chanchareonsook
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - ML Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - QX Sim
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - KH Teoh
- Clinical and Regional Health, National Dental Centre Singapore, Singapore
| | - K Tan
- Clinical Governance and Quality Management, National Dental Centre Singapore, Singapore
| | - BH Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | | | - CY Poon
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
- National Dental Centre Singapore, Singapore
- *Correspondence: CY Poon, Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore. (e-mail: )
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Fong KY, Ng CJR, Wang Y, Yeo C, Tan VH. Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies. J Am Heart Assoc 2022; 11:e024756. [PMID: 35656975 PMCID: PMC9238723 DOI: 10.1161/jaha.121.024756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Subcutaneous implantable cardioverter‐defibrillators (S‐ICDs) have been of great interest as an alternative to transvenous implantable cardioverter‐defibrillators (TV‐ICDs). No meta‐analyses synthesizing data from high‐quality studies have yet been published. Methods and Results An electronic literature search was conducted to retrieve randomized controlled trials or propensity score–matched studies comparing S‐ICD against TV‐ICD in patients with an implantable cardioverter‐defibrillator indication. The primary outcomes were device‐related complications and lead‐related complications. Secondary outcomes were inappropriate shocks, appropriate shock, all‐cause mortality, and infection. All outcomes were pooled under random‐effects meta‐analyses and reported as risk ratios (RRs) and 95% CIs. Kaplan–Meier curves of device‐related complications were digitized to retrieve individual patient data and pooled under a 1‐stage meta‐analysis using Cox models to determine hazard ratios (HRs) of patients undergoing S‐ICD versus TV‐ICD. A total of 5 studies (2387 patients) were retrieved. S‐ICD had a similar rate of device‐related complications compared with TV‐ICD (RR, 0.59 [95% CI, 0.33–1.04]; P=0.070), but a significantly lower lead‐related complication rate (RR, 0.14 [95% CI, 0.07–0.29]; P<0.0001). The individual patient data–based 1‐stage stratified Cox model for device‐related complications across 4 studies yielded no significant difference (shared‐frailty HR, 0.82 [95% CI, 0.61–1.09]; P=0.167), but visual inspection of pooled Kaplan–Meier curves suggested a divergence favoring S‐ICD. Secondary outcomes did not differ significantly between both modalities. Conclusions S‐ICD is clinically superior to TV‐ICD in terms of lead‐related complications while demonstrating comparable efficacy and safety. For device‐related complications, S‐ICD may be beneficial over TV‐ICD in the long term. These indicate that S‐ICD is likely a suitable substitute for TV‐ICD in patients requiring implantable cardioverter‐defibrillator implantation without a pacing indication.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of Singapore Singapore
| | | | - Yue Wang
- Department of Cardiology Changi General Hospital Singapore
| | - Colin Yeo
- Department of Cardiology Changi General Hospital Singapore
| | - Vern Hsen Tan
- Department of Cardiology Changi General Hospital Singapore
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Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Chan VWS, Tur AB, Pietropaolo A, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Mani M, Juliebø-Jones P, Griffin S, García Rojo E, Corrales M, Sekerci CA, Tanidir Y, Teoh JYC, Gauhar V, Somani BK. Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World J Urol 2022; 40:1223-1229. [PMID: 35129624 DOI: 10.1007/s00345-022-03950-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/25/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyse and report the practice, outcomes and lessons learnt from a global series of retrograde intrarenal surgery (RIRS) in a paediatric multicentre series. METHODS A retrospective review of anonymized pooled data gathered globally from 8 centres in paediatric patients (≤ 18 years of age) who had renal stones and underwent RIRS from 2015 to 2020 was performed. Patient demographics, perioperative parameters, stone characteristics, complications and stone-free rate (SFR; defined as endoscopically stone free and/or residual fragments < 2 mm on follow up imaging) were analysed. The cohort was stratified into 3 groups by age: < 5 years (Group A), 5-10 years (Group B) and > 10 years (Group C). Overall, post-operative complication rate was 13.7%. Chi-square comparisons were used for categorical variables; analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables. RESULTS 314 patients were analysed. The mean age was 9.54 ± 4.76 years. Groups A, B and C had 67 (21.3%), 83 (26.4%) and 164 (52.2%) patients, respectively. Mean stone size was 10.7 ± 4.62 mm. Pre-stenting was performed in 155 (49.4%) of patients, ureteral access sheaths (UAS) was used in 54.5% of patients with majority (71%) utilizing holmium laser for stone fragmentation. All complications were minor (Clavien-Dindo grade 1 and 2). SFR was 75.5%. CONCLUSIONS RIRS is acceptable as a first-line intervention in the paediatric population with reasonable efficacy and low morbidity. Complications are slightly higher in patients < 5 years of age, which should be taken into account while counselling patients.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Anna Bujons Tur
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain
| | | | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital Sarvodaya, Guwahati, Assam, India
| | - Mriganka Mani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Stephen Griffin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Cagri Akin Sekerci
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore
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Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Shun Chan VW, Tur AB, Pietropaolo A, Ragoori D, Shrestha A, Mohan Vaddi C, Bhatia TP, Mani M, Juliebø-Jones P, Griffin S, Rojo EG, Corrales M, Sekerci CA, Tanidir Y, Yuen-Chun Teoh J, Gauhar V, Somani BK. MP17-09 OUTCOMES AND LESSONS LEARNT FROM PRACTICE OF RETROGRADE INTRARENAL SURGERY (RIRS) IN A PAEDIATRIC SETTING OF VARIOUS AGE GROUPS: A GLOBAL STUDY ACROSS 8 CENTRES. J Urol 2022. [DOI: 10.1097/ju.0000000000002550.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lim EJ, Fong KY, Li J, Huang HH, Chen K, Tay KJ, Cheng CWS, Ho HSS, Ngo NT, Yuen JSP. Clinicopathological features of non-conventional renal cell carcinoma histological subtypes: Learning points from a large contemporary series spanning over three decades. Investig Clin Urol 2022; 63:151-158. [PMID: 35244988 PMCID: PMC8902431 DOI: 10.4111/icu.20210373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To perform a retrospective review of the clinicopathological features of patients with conventional and non-conventional renal cell carcinoma (cRCC and ncRCC). Materials and Methods A large prospectively maintained uro-oncological registry was accessed to extract clinicopathological data of patients diagnosed with renal tumors who subsequently underwent nephrectomy from 1990–2019. Demographics and operative parameters were extracted. Analyses of overall survival (OS) and cancer-specific survival (CSS) were performed using the Kaplan–Meier method. Cox proportional-hazards analysis was used to identify risk factors which influenced survival. Results There were a total of 1,686 consecutive nephrectomies which was retrieved, with 1,286 cRCC and 400 ncRCC. The commonest ncRCC subtypes were papillary (n=198, 11.7%), clear cell papillary (n=50, 3.0%) and chromophobe (n=49, 2.9%) RCC. Kaplan–Meier estimates of OS were higher in cRCC (0.74; 95% confidence interval [CI], 0.71–0.78) than ncRCC (hazard ratio, 1.47; 95% CI, 1.16–1.87). Among individual subtypes, chromophobe RCC had the highest 5-year OS (0.90; 95% CI, 0.79–1.0). Among ncRCC subtypes, acquired cystic RCC demonstrated the highest association with end-stage renal failure and hypertension, with the highest CSS. MiT family translocation RCC had the youngest mean age at presentation (45.6±12.8 y) and excellent CSS. Factors associated with increased OS in the entire cohort included shorter operative time, partial nephrectomy and lower tumor stages. Conclusions This study provides a comprehensive contemporary overview of ncRCCs which are yet poorly characterized, in comparison to cRCCs. Data from this study would contribute towards tailored patient counseling and healthcare resource planning.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingqiu Li
- Department of Urology, Singapore General Hospital, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | | | | | - Nye Thane Ngo
- Department of Pathology, Singapore General Hospital, Singapore
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Lim MJR, Fong KY, Zheng Y, Chua CYK, Miny S, Lin JB, Nga VDW, Ong HT, Rathakrishnan R, Yeo TT. Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2361-2373. [PMID: 35217961 DOI: 10.1007/s10143-022-01757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
To analyze the efficacy and safety of high-frequency VNS versus control (low-frequency VNS or no VNS) in patients with DRE using data from randomized controlled trials (RCTs). An electronic literature search was conducted on PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL); 12 RCTs reporting seizure frequency or treatment response in studies containing a high-frequency VNS treatment arm (conventional VNS or transcutaneous VNS [tVNS]) compared to control (low-frequency VNS or no VNS) were included. Seizure frequency, treatment response (number of patients with ≥ 50% reduction in seizure frequency), quality of life (QOL), and adverse effects were analyzed. Seizure frequency was reported in 9 studies (718 patients). Meta-analysis with random-effects models favored high-frequency VNS over control (standardized mean difference = 0.82, 95%-CI = 0.39-1.24, p < .001). This remained significant for subgroup analyses of low-frequency VNS as the control, VNS modality, and after removing studies with moderate-to-high risk of bias. Treatment response was reported in 8 studies (758 patients). Random-effects models favored high-frequency VNS over control (risk ratio = 1.57, 95%-CI = 1.19-2.07, p < .001). QOL outcomes were reported descriptively in 4 studies (363 patients), and adverse events were reported in 11 studies (875 patients). Major side effects and death were not observed to be more common in high-frequency VNS compared to control. High-frequency VNS results in reduced seizure frequency and improved treatment response compared to control (low-frequency VNS or no VNS) in patients with drug-resistant epilepsy. Greater consideration for VNS in patients with DRE may be warranted to decrease seizure frequency in the management of these patients.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yilong Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christopher Yuan Kit Chua
- Division of Neurology, University Medical Centre, National University Hospital, Singapore, Singapore
| | - Samuel Miny
- Systematic Review Unit, National University Hospital, Singapore, Singapore
| | - Jeremy Bingyuan Lin
- Division of Pediatric Neurology, Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Hian Tat Ong
- Division of Pediatric Neurology, Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Rahul Rathakrishnan
- Division of Neurology, University Medical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
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Lim MJR, Fong KY. Letter: Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-analyses: Lessons From a Collaborative Effort. Neurosurgery 2022; 90:e130-e131. [PMID: 35196292 DOI: 10.1227/neu.0000000000001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Fong KY, Zhao JJ, Tan E, Syn NL, Sultana R, Zhuang KD, Chua JME, Patel A, Irani FG, Tay KH, Tan BS, Too CW. Drug Coated Balloons for Dysfunctional Haemodialysis Venous Access: A Patient Level Meta-Analysis of Randomised Controlled Trials. Eur J Vasc Endovasc Surg 2021; 62:610-621. [PMID: 34362627 DOI: 10.1016/j.ejvs.2021.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/26/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To perform an individual patient data level meta-analysis of randomised controlled trials comparing drug coated balloon angioplasty (DCB) against conventional percutaneous transluminal angioplasty (PTA) in the treatment of dysfunctional haemodialysis venous access. METHODS A search was conducted from inception to 13 November 2020. Kaplan-Meier curves comparing DCB with PTA by target lesion primary patency (TLPP) and access circuit primary patency (ACPP) were graphically reconstructed to retrieve patient level data. One stage meta-analyses with Cox models with random effects shared frailties were conducted to determine hazard ratios (HRs). Dynamic restricted mean survival times (RMST) were conducted in view of violation of the proportional hazards assumption. Conventional two stage meta-analyses and network meta-analyses under random effects Frequentist models were conducted to determine overall and comparative outcomes of paclitaxel concentrations used. Where outliers were consistently detected through outlier and influence analyses, sensitivity analyses excluding those studies were conducted. RESULTS Among 10 RCTs (1 207 patients), HRs across all models favoured DCB (one stage shared frailty HR 0.62, 95% CI 0.53 - 0.73, p < .001; two stage random effects HR 0.60, 95% CI 0.42 - 0.86, p = .018, I2 = 65%) for TLPP. Evidence of time varying effects (p = .005) was found. TLPP RMST was + 3.54 months (25.0%) longer in DCB treated patients compared with PTA (p = .001) at three years. TLPP at six months, one year, and two years was 75.3% vs. 58.1%, 51.1% vs. 37.1%, and 31.4% vs. 26.0% for DCB and PTA, respectively. The P-Scores within the Frequentist network meta-analysis suggest that higher concentrations of paclitaxel were associated with better TLPP and ACPP. Among six RCTs (854 patients), the one stage model favoured DCB (shared frailty HR 0.72, 95% CI 0.60 - 0.87, p < .001) for ACPP. Conversely, the two stage random effects model demonstrated no significant difference (HR 0.76, 95% CI 0.35 - 1.67, p = .41, I2 = 81%). Sensitivity analysis excluding outliers significantly favoured DCB (HR 0.61, 95% CI 0.41 - 0.91, p = .027, I2 = 62%). CONCLUSION Overall evidence suggests that DCB is favoured over PTA in TLPP and ACPP.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eelin Tan
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Kun Da Zhuang
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Jasmine Ming Er Chua
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Ankur Patel
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Farah G Irani
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Kiang Hiong Tay
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Bien Soo Tan
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Chow Wei Too
- Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
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Yang Y, Thumboo J, Earnest A, Yong SL, Fong KY. The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital. Lupus 2014; 23:714-20. [DOI: 10.1177/0961203314522340] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/08/2014] [Indexed: 01/04/2023]
Abstract
Objectives The objective of the study was to assess the disease burden of systemic lupus erythematosus (SLE) and the usefulness of the Charlson Comorbidity Index (CCI) as risk-adjusted hospital mortality predictors in patients with SLE using a hospital administrative database. Methods A historical cohort study of a hospital discharge database from 2004 to 2011 was used to identify cases with SLE and comorbidity using the International Statistical Classification of Diseases and Related Health Problems, ninth revision, Australian modification (ICD-9-AM) codes. Results Over the eight years, 841 patients met the criteria of SLE with a hospital mortality rate of 9.2%. The hospital mortality rates (2.4%, 15.7%, 25.0%, and 30.4%, respectively, p < 0.001) and hospital length of stay (geometric mean, 3.5, 5.6, 8.8, and 7.5 days, respectively, p < 0.001) were consistently increased for patients with CCI ranging from none, low, moderate to high grade, respectively. Cox proportional hazards model analysis showed that CCI (hazard ratio (HR) 7.8 high vs. none, p < 0.001) and infectious disease (HR 2.0, p = 0.016) were significant and independent predictors of hospital mortality. Similar results were also seen with hospital length of stay by zero-truncated negative binomial regression model analysis. Conclusion The SLE burden is high in this population. Comorbidities and infectious disease were some of the most important contributors to hospital mortality and resource utilization.
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Affiliation(s)
- Y Yang
- Department of Epidemiology, Medical Board, Singapore General Hospital, Singapore
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - J Thumboo
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - A Earnest
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - SL Yong
- Medical Board, Singapore General Hospital, Singapore
| | - KY Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
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