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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, 't Hoen LA, O'Kelly F, Bindi E, Kibar Y, Silay MS. A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux. J Pediatr Urol 2024; 20:283-291. [PMID: 38000950 DOI: 10.1016/j.jpurol.2023.11.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. OBJECTIVE In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV + V) VUR in children. STUDY DESIGN A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. RESULTS Overall, 135 children who underwent either OUR (n = 68), or RALUR (n = 67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p < 0.01); the open cohort had a weight of 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (p < 0.01). No significant differences were found for intraoperative (1.5 % vs 7.5 %, p = 0.09) or for postoperative complication rates (7.4 % vs 9 %, p = 0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p < 0.01). The success rate was 94.0 % and 98.5 % in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. DISCUSSION This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. CONCLUSION RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.
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Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, Aimée 't Hoen L, O'Kelly F, Bindi E, Kibar Y, Silay MS. Response to Editorial Commentary Regarding 'A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux?'. J Pediatr Urol 2024; 20:293-294. [PMID: 38065759 DOI: 10.1016/j.jpurol.2023.11.024] [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: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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Lammers RJM, Tsachouridis G, Andersson MK, Dormeus S, Ekerhult TO, Frankiewicz M, Gunn CJ, Matuszewski M, de Mooij KL, Schroeder RPJ, Wyndaele MIA, Xing Z, De Kort LMO, de Graaf P. "What should be next in lifelong posterior hypospadias: Conclusions from the 2023 ERN eUROGEN and EJP-RD networking meeting". Neurourol Urodyn 2024. [PMID: 38289328 DOI: 10.1002/nau.25305] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND A congenital disease is for life. Posterior hypospadias, the severe form of hypospadias with a penoscrotal, scrotal, or perineal meatus, is a challenging condition with a major impact on lifelong quality of life. AIM Our network meeting is aimed to identify what is currently missing in the lifelong treatment of posterior hypospadias, to improve care, quality of life, and awareness for these patients. METHODS The network meeting "Lifelong Posterior Hypospadias" in Utrecht, The Netherlands was granted by the European Joint Programme on Rare Diseases-Networking Support Scheme. There was a combination of interactive sessions (hackathons) and lectures. This paper can be regarded as the last phase of the hackathon. RESULTS Surgery for hypospadias remains challenging and complications may occur until adulthood. Posterior hypospadias affects sexual function, fertility, and hormonal status. Transitional care from childhood into adulthood is currently insufficiently established. Patients should be more involved in defining desired treatment approach and outcome measures. For optimal outcome evaluation standardization of data collection and registration at European level is necessary. Tissue engineering may provide a solution to the shortage of healthy tissue in posterior hypospadias. For optimal results, cooperation between basic researchers from different centers, as well as involving clinicians and patients is necessary. CONCLUSIONS To improve outcomes for patients with posterior hypospadias, patient voices should be included and lifelong care by dedicated healthcare professionals guaranteed. Other requirements are joining forces at European level in uniform registration of outcome data and cooperation in basic research.
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Affiliation(s)
- Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - George Tsachouridis
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Marie K Andersson
- Department of Pediatric Surgery, Sahlgrenska Academy, Women's and Children's Health, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Sarah Dormeus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teresa O Ekerhult
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Callum J Gunn
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Keetje L de Mooij
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Rogier P J Schroeder
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zhentao Xing
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O De Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Petra de Graaf
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
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O'Kelly F, t'Hoen LA, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Silay S. Pathways to paediatric urology subspecialisation: a study of casemix, incumbent attitudes and opinions. World J Urol 2024; 42:34. [PMID: 38217728 PMCID: PMC10787691 DOI: 10.1007/s00345-023-04743-y] [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: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. METHODS An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). CONCLUSION This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B Banuelos Marco
- Department of Urology, University Hospital El Clinico, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Linz, Austria
| | - E Bindi
- Department of Pediatric Surgery, AOU Delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, Istanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Linz, Austria
| | - S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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't Hoen LA, O'Kelly F, Lammers RJM, Dönmez Mİ, Baydilli N, Sforza S, Bindi E, Atwa A, Haid B, Quiroz Y, Marco BB. Mobility and Sporting Activity After Renal Trauma: A Survey Regarding Best Clinical Practice During the Recovery Stage. Urology 2024; 183:199-203. [PMID: 37806456 DOI: 10.1016/j.urology.2023.09.030] [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: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To evaluate strategies that are followed after pediatric renal trauma during the recovery stage, with an emphasis on mobility and involvement in subsequent sporting activities. Renal trauma is the most common urogenital trauma in children. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify the severity of injury. There is no consensus in the existing literature with respect to the recovery stage following renal trauma. METHODS A survey was constructed by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Pediatric Urology Working Group and then made digitally available on SurveyMonkey. The survey consists of 15 questions exploring relevant factors and timing to start again with mobility and activity. RESULTS In total 153 people responded, of whom 107 completed the entire survey. The presence of pain and severity of trauma were acknowledged as most important factors to commence mobilization, whereas presence of hematuria was identified as an additional factor for sporting activity. Regardless of severity of trauma a minimum of 90% of respondents recommend return to noncontact sports within 12weeks. For contact sports, a minimum of 33% of respondents advised >12weeks minimum before starting again. A small number of respondents would never allow sporting activities again. CONCLUSION The time to allow sporting activity shows high variation among the respondents, some even restricting sporting activities completely. This survey highlights the need for a standardized protocol based on multicenter follow-up data.
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Affiliation(s)
- Lisette A 't Hoen
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | - Ahmed Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bernard Haid
- Ordensklinikum Linz, Barmherzige Schwestern Hospital, Linz, Austria
| | - Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital El Clinico, Madrid, Spain
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O'Kelly F, t'Hoen LA, Silay S, Lammers RJM, Sforza S, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Marco BB. Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study. J Urol 2023; 210:899-907. [PMID: 37747130 DOI: 10.1097/ju.0000000000003701] [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: 01/30/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - E Bindi
- Department of Pediatric Surgery, AOU delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Banuelos Marco
- Department of Urology, University Hospital El Clinico, Madrid, Spain
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O'Kelly F, t'Hoen LA, Burgu B, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Radmayr C, Silay MS. A cross-sectional analysis of paediatric urologists' current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care. J Pediatr Urol 2023:S1477-5131(23)00152-3. [PMID: 37173199 DOI: 10.1016/j.jpurol.2023.04.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. METHODS An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. CONCLUSION This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - B Banuelos Marco
- Department of Urology, University Hospital Clinico San Carlos, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - E Bindi
- AOU Delle Marche, Ospedale Pediatrico G Salesi, Department of Pediatric Surgery, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - C Radmayr
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - M S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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van Valenberg FJP, van der Heijden AG, Lammers RJM, Falke J, Arends TJH, Oosterwijk E, Witjes JA. Intravesical radiofrequency induced hyperthermia enhances mitomycin C accumulation in tumour tissue. Int J Hyperthermia 2017; 34:988-993. [PMID: 29191126 DOI: 10.1080/02656736.2017.1406618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/14/2022] Open
Abstract
INTRODUCTION Non-muscle invasive bladder cancer (NMIBC) is a highly recurrent disease with potential progression to muscle invasive disease despite the standard bladder instillations with mitomycin C (MMC) or Bacille Calmette-Guérin immunotherapy. Therefore, alternatives such as radiofrequency-induced chemohyperthermia (RF-CHT) with MMC are being investigated. The mechanism explaining the efficacy of RF-CHT is only partly understood. We examined whether RF-CHT results in higher MMC tissue concentrations as compared to cold MMC instillation. PATIENTS AND METHODS Prior to a planned transurethral resection of bladder tumour (TURBT), patients with stage Ta NMIBC were allocated to either (1) cold MMC instillation or (2) RF-CHT. After MMC instillation, three biopsies were taken of both normal and tumour tissue. Biopsies were snap-frozen and MMC tissue concentrations were analysed using ultra-performance liquid chromatography. RESULTS Eleven patients were included of which six received RF-CHT. Ten patients had TaG2-LG/HG papillary tumours at pathology. One patient in the RF-CHT group appeared to be free of malignancy and was excluded from the analysis as no tumour biopsies were available. The median MMC concentration in tumour tissue was higher in the RF-CHT group (median 665.00 ng/g vs. 63.75 ng/g, U = 51.0, p = 0.018). Moreover, in both techniques the MMC concentration was lower in normal tissue compared to tumour tissue. Tissue MMC concentration measurements varied substantially within, and between, different patients from the same group. CONCLUSION Intravesical RF-CHT results in higher tumour MMC concentrations vs. cold MMC instillation which contributes to its superior efficacy.
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Affiliation(s)
| | | | - Rianne J M Lammers
- a Department of Urology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Johannes Falke
- a Department of Urology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tom J H Arends
- a Department of Urology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Egbert Oosterwijk
- a Department of Urology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - J Alfred Witjes
- a Department of Urology , Radboud University Medical Center , Nijmegen , The Netherlands
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Arends TJH, Lammers RJM, Falke J, van der Heijden AG, Rustighini I, Pozzi R, Ravic M, Eisenhardt A, Vergunst H, Witjes JA. Pharmacokinetic, Pharmacodynamic, and Activity Evaluation of TMX-101 in a Multicenter Phase 1 Study in Patients With Papillary Non-Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2014; 13:204-9.e2. [PMID: 25660383 DOI: 10.1016/j.clgc.2014.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 09/22/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/BACKGROUND Non-muscle-invasive bladder cancer (NMIBC) has a strong tendency to recur despite adjuvant instillations. TMX-101 is a new liquid form of imiquimod for intravesical instillation and has activity in vitro against urothelial carcinoma. The purpose was to analyze the activity of TMX-101 in low-grade NMIBC. Furthermore, pharmacokinetic and pharmacodynamic characteristics and adverse events were evaluated. PATIENTS AND METHODS A multicenter, prospective phase 1 trial in 7 patients with low-grade NMIBC was conducted. All patients underwent a marker lesion transurethral resection of the bladder tumor and 6 weekly instillations with TMX-101 0.2% or 0.4%. Cystoscopy 2 to 4 weeks after the last instillation evaluated the effect of TMX-101. RESULTS The effective biologic dose (EBD = complete response [CR] in > 2 patients) could not be defined because none of the patients experienced CR. Maximum plasma concentration was 75.1 ng/mL in the 0.4% dose group. No drug accumulation was observed. In the pharmacodynamic analysis, urinary interleukin 1 receptor agonist (IL-1ra) represents the most sensitive and uniform response after TMX-101 instillation. A total of 87.0% reported at least 1 adverse event. All events were of grade 2 severity or less (Common Terminology Criteria of Adverse Events version 4.02). No clinically significant changes in laboratory parameters or vital signs were observed during or after treatment. CONCLUSION Toll-like receptor 7 (TLR-7) agonists are effective in urothelial carcinoma in preclinical research. The EBD in this phase 1 study could not be determined because no patient experienced CR. IL-1ra could be valuable as a urinary biomarker in future developments. The safety of TMX-101 has been reconfirmed. New doses, other schedules, and NMIBC subgroups should be tested to define the EBD. A pilot study in carcinoma-in-situ patients is currently ongoing and results are expected shortly.
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Affiliation(s)
- Tom J H Arends
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne J M Lammers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes Falke
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | - Henk Vergunst
- Department of Urology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Arends TJH, Falke J, Lammers RJM, Somford DM, Hendriks JCM, de Weijert MCA, Arentsen HC, van der Heijden AG, Oosterwijk E, Alfred Witjes J. Urinary cytokines in patients treated with intravesical mitomycin-C with and without hyperthermia. World J Urol 2014; 33:1411-7. [DOI: 10.1007/s00345-014-1458-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022] Open
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Lammers RJM, Palou J, Witjes WPJ, Janzing-Pastors MHD, Caris CTM, Witjes JA. Comparison of expected treatment outcomes, obtained using risk models and international guidelines, with observed treatment outcomes in a Dutch cohort of patients with non-muscle-invasive bladder cancer treated with intravesical chemotherapy. BJU Int 2014; 114:193-201. [PMID: 24304638 DOI: 10.1111/bju.12495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 11/28/2022]
Abstract
OBJECTIVE To compare the risks according to the American Urological Association (AUA), EAU, European Organization for Research and Treatment of Cancer (EORTC) and Club Urológico Español de Tratamiento Oncologico (CUETO) classifications with real outcomes in a cohort of patients in the Netherlands, and to confirm that patients who were undertreated according to these risk models have worse outcomes than adequately treated patients. PATIENTS AND METHODS Patients treated with complete transurethral resection of bladder tumour and intravesical chemotherapy were included. Not all patients would have received intravesical chemotherapy had they been treated to current standards, and thus comparison of the observed outcomes in our Dutch cohort vs expected outcomes based on the EORTC risk tables and CUETO scoring model was possible. The cohort was reclassified according to the definitions of five index patients (IPs), as defined by the AUA guidelines, and three risk groups, defined according to the EAU guidelines, to compare the outcomes of undertreated patients with those of adequately treated patients. RESULTS A total of 1001 patients were available for comparison with the AUA definitions and 728 patients were available for comparison with the EORTC and CUETO models. There was a large overlap between the observed outcomes and expected recurrence and progression probabilities when comparison was made using the EORTC risk tables. The observed recurrence outcomes were in general higher than the expected probabilities according to the CUETO risk classification, especially in the long term. No differences in progression were found when comparing these two models to the Dutch cohort. Patients who were undertreated according to the guidelines showed, in general, a higher risk of developing recurrence and progression. Limitations are i.a. its retrospective nature and the differences in grading system. CONCLUSION Comparisons between the observed outcomes in our Dutch cohort and the expected outcomes based on EAU and CUETO risk models and the EORTC and AUA guidelines showed that lack of adherence to existing guidelines translates into worse outcomes.
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Falke J, Lammers RJM, Arentsen HC, Ravic M, Pozzi R, Cornel EB, Vergunst H, de Reijke TM, Witjes JA. Results of a phase 1 dose escalation study of intravesical TMX-101 in patients with nonmuscle invasive bladder cancer. J Urol 2012. [PMID: 23206424 DOI: 10.1016/j.juro.2012.11.150] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Imiquimod, a toll like receptor 7 (TLR-7) agonist, is effective as a topical treatment for skin malignancies. TMX-101 is a liquid formulation of imiquimod. In this study we establish a safety profile of TMX-101 in patients with nonmuscle invasive bladder cancer. MATERIALS AND METHODS We conducted a multicenter phase 1 dose escalation study in patients with nonmuscle invasive bladder cancer. Patients were included in 1 of 4 dose groups (0.05%, 0.1%, 0.2% or 0.4%) and treated with 6 weekly instillations of TMX-101, starting 2 weeks after transurethral resection of bladder tumor. Patients were evaluated weekly, and pharmacokinetic and pharmacodynamic parameters were measured. RESULTS A total of 16 patients were included in the study with 4 per dose group. Two patients dropped out after instillation 2 in dose groups 1 and 2. Overall, 88 instillations were administered without serious adverse events. There were 118 adverse events, of which 84 were related to the study drug. All adverse events were mild or moderate and number or severity was not correlated with dose group. Of the related adverse events 70% were confined to the genitourinary tract and resolved without intervention. There was a dose dependent systemic uptake with low plasma levels up to dose group 3 (0.2%, 100 mg). Maximum plasma concentration in dose group 4 (0.4%, 200 mg) was 71.7 ng/ml. This is below plasma concentrations of 123 and 128 ng/ml without significant side effects measured in healthy volunteers after subcutaneous (30 mg) or oral intake (100 mg) of imiquimod, respectively. CONCLUSIONS Intravesical treatment with TMX-101 is safe. The side effects are common but mild and mostly limited to the genitourinary tract. There is a low systemic uptake.
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Affiliation(s)
- Johannes Falke
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Lammers RJM, Witjes WPJ, Janzing-Pastors MHD, Caris CTM, Witjes JA. Intracutaneous and intravesical immunotherapy with keyhole limpet hemocyanin compared with intravesical mitomycin in patients with non-muscle-invasive bladder cancer: results from a prospective randomized phase III trial. J Clin Oncol 2012; 30:2273-9. [PMID: 22585689 DOI: 10.1200/jco.2011.39.2936] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite current treatment after transurethral resection of a bladder tumor, recurrences and progression remain a problem. Keyhole limpet hemocyanin (KLH) was beneficial in earlier studies. In this study, safety and efficacy of KLH were compared with that of mitomycin (MM). PATIENTS AND METHODS Patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) without carcinoma in situ were enrolled in a randomized phase III trial. In all, 283 patients were randomly assigned for 16 adjuvant intravesical instillations with KLH after preimmunization, and 270 patients were randomly assigned for 11 adjuvant intravesical instillations with MM. Primary outcome measurement was recurrence-free survival (RFS). Secondary outcome measurements were progression-free survival, adverse events (AEs), and the effect of delayed-type hypersensitivity (DTH) response on clinical outcome. RESULTS There were significantly more pT1 tumors in the MM group (P = .01). In a log-rank test, univariate and multivariate Cox regression analysis, KLH was less effective than MM regarding RFS (all P < .001). Progression was uncommon (n = 20). In univariate Cox regression analyses, KLH tended to prevent progression more effectively than MM, but in multivariate Cox regression analyses, this could not be shown. AEs were common but mild. Fever, flu-like symptoms, and fatigue occurred significantly more after KLH treatment. Allergic reactions and other skin disorders occurred significantly more after MM treatment. Significantly more DTH-positive patients developed a recurrence than DTH-negative patients. CONCLUSION KLH had a different safety profile and was inferior to MM in preventing NMIBC recurrences. KLH tended to be more effective than MM in preventing progression. More research is needed to clarify the immunologic effects of KLH and the effects of KLH on progression.
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Affiliation(s)
- Rianne J M Lammers
- CuraTrial Site Management Organisation & Research, Arnhem, The Netherlands
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Lammers RJM, Witjes JA. Discussion on the influence of HER2 status on the clinical outcome of bladder cancer continues. Expert Rev Anticancer Ther 2011; 11:853-8. [PMID: 21707282 DOI: 10.1586/era.11.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of: Bolenz C, Shariat SF, Karakiewicz PI et al. Human epidermal growth factor receptor 2 expression status provides independent prognostic information in patients with urothelial carcinoma of the urinary bladder. BJUI 106, 1216-1222 (2010). The article under evaluation by Bolenz et al. reports on an association between human EGF receptor 2 (HER2) overexpression and aggressive urothelial carcinoma of the urinary bladder: more lymphovascular invasion, higher risk of recurrence and higher disease-specific mortality. These results add to the controversy regarding HER2 status and clinical outcome that is currently known. First, a consensus for the best technique and cut-off is needed. Only then can the relationship between HER2 overexpression and clinical outcome be investigated without current limitations. Although there are already trials ongoing on targeted therapy in bladder cancer, this should be viewed with caution, as patient selection is based on inconsistent definitions of HER2 overexpression. Selection of patients who might benefit from targeted therapy can only be carried out after consensus has been reached.
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Affiliation(s)
- Rianne J M Lammers
- Department of Urology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10 (659), PO Box 9101, 6500 HB Nijmegen, The Netherlands
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