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Park JH, Park I, Yoon J, Sim Y, Kim J, Lee SK, Joo B. Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery. Int Urol Nephrol 2024; 56:1543-1550. [PMID: 38091174 DOI: 10.1007/s11255-023-03898-2] [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: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
PURPOSE To investigate whether steep Trendelenburg in a major urologic surgery is associated with postoperative delirium, and to examine other potential clinical and radiologic factors predictive of postoperative delirium. METHODS 182 patients who received a major urologic surgery and underwent a 3.0-T brain MRI scan within 1 year prior to the date of surgery were retrospectively enrolled. Preoperative brain MRIs were used to analyze features related to small vessel disease burden and mesial temporal atrophy. Presence of a significant mesial temporal atrophy was defined as Scheltens' scale ≥ 2. Patients' clinico-demographic data and MRI features were used to identify significant predictors of postoperative delirium using the logistic regression analysis. Independent predictors found significant in the univariate analysis were further evaluated in the multivariate analysis. RESULTS Incidence of postoperative delirium was 6.0%. Patients with postoperative delirium had lower body mass index (21.3 vs. 25.0 kg/m2, P = 0.003), prolonged duration of anesthesia (362.7 vs. 224.7 min, P < 0.001) and surgery (302.2 vs. 174.5 min, P < 0.001), and had more significant mesial temporal atrophy (64% vs. 30%, P = 0.046). In the univariate analysis, female sex, type of surgery (radical prostatectomy over cystectomy), prolonged duration of anesthesia (≥ 6 h), and presence of a significant mesial temporal atrophy were significant predictors (all P-values < 0.050), but only the presence of significant mesial temporal atrophy was significant in the multivariate analysis [odds ratio (OR), 3.69; 95% CI 0.99-13.75; P = 0.046]. CONCLUSION Steep Trendelenburg was not associated with postoperative delirium. Significant mesial temporal atrophy (Scheltens' scale ≥ 2) in preoperative brain MRI was predictive of postoperative delirium. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Jae Hyon Park
- Department of Radiology, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongjin Yoon
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongsik Sim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Costa Silva A, Pina-Vaz T, Morgado A, Martins-Silva C, Antunes-Lopes T, Alturas Silva J. Prevalence of non-neurogenic male lower urinary tract symptoms after kidney transplantation. BJU Int 2024. [PMID: 38520403 DOI: 10.1111/bju.16347] [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] [Indexed: 03/25/2024]
Abstract
OBJECTIVE This review investigates the prevalence of male non-neurogenic lower urinary tract symptoms (LUTS) after renal transplant, as kidney transplantation is a transformative intervention for patients with end-stage renal disease significantly enhancing quality of life that might be diminished by LUTS. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the PubMed and Scopus databases was performed using specific terms. Inclusion criteria considered male kidney transplant recipients, analysing outcomes in English-language studies. Discrepancies were resolved by consultation. RESULTS Among 18 studies involving 29 086 recipients, the prevalence of non-neurogenic LUTS ranged from 5.8% to 33.0%. Studies predominantly used the International Prostate Symptom Score for evaluation. Surgical interventions, mostly for benign prostatic obstruction, ranged from 2.5% to 20.0%. Voiding and post-micturition symptoms were under-represented. CONCLUSION This review found varied non-neurogenic LUTS prevalence and characteristics in male kidney transplant recipients, emphasising the need for standardised assessments, prospective studies, and improved understanding of LUTS mechanisms. Enhanced knowledge can guide interventions, additionally benefiting recipient quality of life.
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Affiliation(s)
- Alberto Costa Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Teresa Pina-Vaz
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Afonso Morgado
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Martins-Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Antunes-Lopes
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Alturas Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Arabzadeh Bahri R, Peisepar M, Maleki S, Esmaeilpur Abianeh F, A Basti F, Kolahdooz A. Current evidence regarding alternative techniques for enterocystoplasty using regenerative medicine methods: a systematic review. Eur J Med Res 2024; 29:163. [PMID: 38475865 DOI: 10.1186/s40001-024-01757-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Enterocystoplasty is the most commonly used treatment for bladder reconstruction. However, it has some major complications. In this study, we systematically reviewed the alternative techniques for enterocystoplasty using different scaffolds. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library, and a total of 10 studies were included in this study. Five different scaffolds were evaluated, including small intestinal submucosa (SIS), biodegradable scaffolds seeded with autologous bladder muscle and urothelial cells, dura mater, human cadaveric bladder acellular matrix graft, and bovine pericardium. The overall results revealed that bladder reconstruction using regenerative medicine is an excellent alternative method to enterocystoplasty regarding the improvement of bladder capacity, bladder compliance, and maximum detrusor pressure; however, more large-scale studies are required.
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Affiliation(s)
- Razman Arabzadeh Bahri
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Maral Peisepar
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Maleki
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Esmaeilpur Abianeh
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh A Basti
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Ali Kolahdooz
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Bidault-Jourdainne V, Botto N, Peycelon M, Carricaburu E, Lopez P, Bonnard A, Blanc T, El-Ghoneimi A, Paye-Jaouen A. Response to commentary on: Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division Vs traction? a multicentric comparative study. J Pediatr Urol 2024:S1477-5131(24)00146-3. [PMID: 38493043 DOI: 10.1016/j.jpurol.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valeska Bidault-Jourdainne
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France.
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Sorbonne Université, INSERM, Maladies génétiques d'expression pédiatrique, APHP, Hôpital d'Enfants Armand Trousseau, Paris, France; UMR INSERM 1141 NEURODEV, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Thomas Blanc
- Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
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Kim HW, Hwang J, Pai KS, Suh YA. Urinary tract dilation classification system for predicting surgical management and urinary tract infection in neonates and young infants: a systematic review and meta-analysis. Pediatr Radiol 2024:10.1007/s00247-024-05854-3. [PMID: 38282063 DOI: 10.1007/s00247-024-05854-3] [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: 07/30/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The urinary tract dilation classification system has recently been developed to ensure a unified approach to describe urinary tract dilation in neonates and young infants. However, the predictive value of this system for surgical intervention or urinary tract infection (UTI) has not yet been evaluated in a meta-analysis. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the utility of a postnatal urinary tract dilation classification system for predicting surgical management or a UTI occurrence. MATERIALS AND METHODS As the urinary tract dilation classification system was introduced in 2014, we searched Embase and PubMed databases for studies published between January 2014 and December 2022. Original articles that reported surgical interventions or UTI episodes according to postnatal urinary tract dilation grades were included. The pooled odds ratio (OR) was calculated, using either the fixed-effects or random-effects model, given the lower urinary tract dilation grades as the base category. The quality of the included studies was evaluated using the Newcastle-Ottawa scale. RESULTS Of the 285 articles reviewed, eight (comprising 2,165 children) were included in the analysis. The studies were of medium-to-high quality. Pooled analysis demonstrated that urinary tract dilation P3 (combined OR, 21.41; 95% confidence interval [CI], 15.72-29.17) and urinary tract dilation P2-P3 (combined OR, 65.17; 95% CI, 33.08-128.38) were associated with surgical intervention. The urinary tract dilation P3 (combined OR, 2.11; 95% CI, 1.56-2.85) and urinary tract dilation P2-P3 (combined OR, 3.36; 95% CI, 2.43-4.63) were associated with UTI episodes. CONCLUSION The postnatal urinary tract dilation classification system is useful for predicting the need for surgical management and UTI episodes in infants with hydronephrosis.
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Affiliation(s)
- Hae Won Kim
- Department of Healthcare, Kakao Brain Co., Seongnam, Republic of Korea
| | - Jisun Hwang
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
| | - Ki Soo Pai
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yoong-A Suh
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
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Kumar BN, Shukla AK, Datt B, Prakash S. Inferior polar nephrectomy and vesicocalicostomy for complete ureteric stricture following antibody-mediated rejection in ABO-incompatible living donor kidney transplant: a report of a rare case. Korean J Transplant 2024:kjt.23.0054. [PMID: 38273644 DOI: 10.4285/kjt.23.0054] [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: 09/19/2023] [Revised: 11/19/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.
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Affiliation(s)
| | | | - Bhaskar Datt
- Department of Nephrology, Command Hospital (Southern Command), Pune, India
| | - Sudeep Prakash
- Department of Nephrology, Command Hospital (Southern Command), Pune, India
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Bidault-Jourdainne V, Botto N, Peycelon M, Carricaburu E, Lopez P, Bonnard A, Blanc T, El-Ghoneimi A, Paye-Jaouen A. Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study. J Pediatr Urol 2024:S1477-5131(24)00046-9. [PMID: 38310033 DOI: 10.1016/j.jpurol.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques. OBJECTIVE To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS). STUDY DESIGN Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared. RESULTS A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques. DISCUSSION Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view. CONCLUSIONS This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.
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Affiliation(s)
- Valeska Bidault-Jourdainne
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France.
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Sorbonne Université, INSERM, Maladies génétiques d'expression pédiatrique, APHP, Hôpital d'Enfants Armand Trousseau, Paris, France; UMR INSERM 1141 NEURODEV, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
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Badreddine J, Sun H, Tay K, Rhodes S, Chen D, Zell M, Jaeger I, Nevo A. The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic. World J Urol 2023:10.1007/s00345-023-04410-2. [PMID: 37160451 PMCID: PMC10169120 DOI: 10.1007/s00345-023-04410-2] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To describe the outcomes of Same-Day Discharge (SDD) following Holmium Laser Enucleation of the Prostate (HoLEP) in patients during the COVID-19 pandemic. METHODS A retrospective review of HoLEP surgeries at a single institution between January 2021 and March 2022 was performed. Patient demographic and operative data were collected, and postoperative outcomes were evaluated in terms of safety and efficacy and compared in both groups using a t-test and chi-square test. Logistic regression was also performed to identify factors that correlate with the failure of SDD. RESULTS A total of 155 patients were identified; 135 patients were successfully discharged on the same day and 20 were admitted (87% SDD rate). Admitted HoLEP patients had a significantly higher median prostate-specific antigen (5.7 vs 3.9 ng/dL, P < 0.001), prostate volume (152.3 vs 100.6 mL, P < 0.001), and enucleated tissue weight (90.3 vs 56.9 g, P = 0.04) compared to the SDD group. The SDD group had a 2.9% (n = 4) readmission rate and a 5.2% (n = 7) Emergency Department (ED) visit rate. There was no significant difference in the rate of postoperative ED visits (P = 0.64), readmissions (P = 0.98), complications, and catheterization time (P = 0.98) between both groups. Preoperative predictors of SDD failure included prostate gland volume > 150 mL (OR = 7.17; CI 2.01-25.67; P < 0.01) and history of antiplatelet/anticoagulation use (OR = 6.59; CI 2.00-21.67; P < 0.01). CONCLUSION Same-day discharge following HoLEP is a safe and effective approach that can be performed in most patients using a liberal discharge criteria and relying on postoperative findings only.
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Affiliation(s)
- Jad Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Helen Sun
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kimberly Tay
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Zell
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Irina Jaeger
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amihay Nevo
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Gálvez Estévez CM, Valdivieso Castro MP, Galbarriatu Gutiérrez A, Tuduri Limousin I, Cardenal Alonso-Allende TM, Álvarez Martínez L, Blanco Bruned JL. Use of internal-external diversion stent in open pyeloplasty in patients under one year of age. Cir Pediatr 2023; 36:28-32. [PMID: 36629346 DOI: 10.54847/cp.2023.01.17] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There are various alternatives available for renal pelvis drainage following pyeloplasty. One of them is the use of an internal-external diversion stent, which according to our protocol, is knotted 48 hours following surgery, prior to discharge, and removed 7 days later on an outpatient consultation basis, with no sedation or analgesia required. OBJECTIVE To analyze the results of patients under one year of age who underwent open pyeloplasty associated with an outpatient internal-external diversion stent. MATERIALS AND METHODS A retrospective, descriptive analysis of 28 patients (31 renal units) undergoing surgery from 2011 to 2021 was carried out. Diagnostic methods, indications, surgical approach, and postoperative progression were assessed. RESULTS 28 patients (23 male) prenatally diagnosed with hydronephrosis confirmed by ultrasonography and/or renogram underwent pyeloplasty at a median age of 3 months (15 days-11 months). Pyeloplasty was conducted according to the Anderson-Hynes technique or dismembered pyeloplasty in 28 renal units, and according to the Culp-DeWeerd technique or spiral flap in 3. In all cases, an internal-external diversion stent was used according to our protocol. Mean hospital stay was 3.5 days (2-7 days), with a good postoperative progression. 2 patients had complications (urinary infection requiring intravenous antibiotics, and pyonephrosis requiring re-pyeloplasty). CONCLUSIONS Using an internal-external diversion stent following pyeloplasty in patients under 1 year of age with ureteropelvic junction obstruction is a simple and safe option that allows for early discharge with outpatient management. It also avoids a second general anesthesia for drainage catheter removal purposes.
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Affiliation(s)
- C M Gálvez Estévez
- Pediatric Surgery Department. Hospital Universitario de Cruces. Barakaldo (Spain)
| | | | | | - I Tuduri Limousin
- Pediatric Surgery Department. Hospital Universitario de Cruces. Barakaldo (Spain)
| | | | - L Álvarez Martínez
- Pediatric Surgery Department. Hospital Universitario de Cruces. Barakaldo (Spain)
| | - J L Blanco Bruned
- Pediatric Surgery Department. Hospital Universitario de Cruces. Barakaldo (Spain)
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Zhu W, Zhou H, Cao H, Li P, Tao Y, Ma L, Tao T, Zhou X, Zhao Y, Guo T, Han C, Zhuo R, Lv X, Cheng W, Feng Z. Modified technique for robot-assisted laparoscopic infantile ureteral reimplantation for obstructive megaureter. J Pediatr Surg 2022; 57:1011-1017. [PMID: 35717252 DOI: 10.1016/j.jpedsurg.2022.05.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/30/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe a novel modification of technique to improve efficacy of robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) in infants. MATERIALS AND METHODS Between April 2017 and July 2019, sixteen infants with primary obstructive megaureter (POM) (Age range: 4-12 months) underwent robot-assisted ureteral reimplantation were reviewed in this series. In addition to the conventional Lich-Gregoir technique, the detrusor tunnel has been extended to the mobilized anterior bladder wall to guarantee sufficient tunnel length/ureter diameter ratio and avoid ureteral angulation. All patients underwent repeated ultrasound, diuretic renal dynamic imaging and voiding cystourethrography (VCUG) perioperatively and the outcomes were documented. RESULTS All operations were completed with robotic assisted approach without conversion. Bilateral and unilateral reimplantation were respectively performed in two and fourteen patients. The mean operative time was 115.0 ± 19.5 min and the mean blood loss was 10.0 ± 1.8 ml. There were no high-grade complications (III-IV on Clavien-Dindo classification) except for one patient. The distal ureteric diameter was reduced from pre operative 1.7 ± 0.5 to 0.6 ± 0.5 cm 6 months post operatively (p < 0.05). One child (6.3%) required the second reimplantation for stenosis. The overall operative success rate was 94.4% (17 of 18 ureters) with a mean follow-up of 15.9 ± 7.4 months with no flux detected. CONCLUSION Our preliminary experience suggests that our modified robot-assisted laparoscopic extravesical ureteral reimplantation is feasible in infants with good results.
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Affiliation(s)
- Weiwei Zhu
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Huixia Zhou
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China.
| | - Hualin Cao
- Department of Urology, Nan Xi Shan Hospital of Guangxi Zhuangzu Autonomous Region, Guilin 541002, China
| | - Pin Li
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Yuandong Tao
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Lifei Ma
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Tian Tao
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Xiaoguang Zhou
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Yang Zhao
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Tao Guo
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Ce Han
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Ran Zhuo
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Xuexue Lv
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
| | - Wei Cheng
- New Century Healthcare Medical Center (Hong Kong), Hong Kong 999077, China
| | - Zhichun Feng
- Department of Urology, the Seventh Medical Centre, Chinese PLA General Hospital, No.5 Nan Mencang, Dongcheng District, Beijing 100700, China
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11
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Young GJ, Metcalfe C, Lane JA, Lewis AL, Abrams P, Blair PS, Ito H, Chapple C, Drake MJ. Prostate Surgery for Men with Lower Urinary Tract Symptoms: Do We Need Urodynamics to Find the Right Candidates? Exploratory Findings from the UPSTREAM Trial. Eur Urol Focus 2022; 8:1331-1339. [PMID: 34922898 PMCID: PMC9705260 DOI: 10.1016/j.euf.2021.11.010] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/21/2021] [Accepted: 11/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Identifying men whose lower urinary tract symptoms (LUTS) may benefit from surgery is challenging. OBJECTIVE To identify routine diagnostic and urodynamic measures associated with treatment decision-making, and outcome, in exploratory analyses of the UPSTREAM trial. DESIGN, SETTING, AND PARTICIPANTS A randomised controlled trial was conducted including 820 men, considering surgery for LUTS, across 26 hospitals in England (ISCTRN56164274). INTERVENTION Men were randomised to a routine care (RC) diagnostic pathway (n = 393) or a pathway that included urodynamics (UDS) in addition to RC (n = 427). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Men underwent uroflowmetry and completed symptom questionnaires, at baseline and 18 mo after randomisation. Regression models identified baseline clinical and symptom measures that predicted recommendation for surgery and/or surgical outcome (measured by the International Prostate Symptom Score [IPSS]). We explored the association between UDS and surgical outcome in subgroups defined by routine measures. RESULTS AND LIMITATIONS The recommendation for surgery could be predicted successfully in the RC and UDS groups (area under the receiver operating characteristic curve 0.78), with maximum flow rate (Qmax) and age predictors in both groups. Surgery was more beneficial in those with higher symptom scores (eg, IPSS >16), age <74 yr, Qmax <9.8 ml/s, bladder outlet obstruction index >47.6, and bladder contractility index >123.0. In the UDS group, urodynamic measures were more strongly predictive of surgical outcome for those with Qmax >15, although patient-reported outcomes were also more predictive in this subgroup. CONCLUSIONS Treatment decisions were informed with UDS, when available, but without evidence of change in the decisions reached. Despite the small group sizes, exploratory analyses suggest that selective use of UDS could detect obstructive pathology, missed by routine measures, in certain subgroups. PATIENT SUMMARY Baseline clinical and symptom measurements were able to predict treatment decisions. The addition of urodynamic test results, while useful, did not generally lead to better surgical decisions and outcomes over routine tests alone.
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Affiliation(s)
- Grace J. Young
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - J. Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Amanda L. Lewis
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Peter S. Blair
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Hiroki Ito
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Marcus J. Drake
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK,Corresponding author. University of Bristol and Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK. Tel. +44 7764662017.
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12
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Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Kaouk J. Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol 2022. [PMID: 35718816 DOI: 10.1007/s00345-022-04056-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To compare our initial perioperative and postoperative outcomes of the single-port (SP) transvesical radical prostatectomy (TVRP) approach with the single-port extraperitoneal radical prostatectomy (ERP) approach. MATERIALS AND METHODS Initial consecutive seventy-eight patients underwent SP TVRP between December 2020 and October 2021. Patients with extensive previous abdominal surgeries, or low- to intermediate-risk prostate cancer were selected. Data of consecutive 169 patients treated with SP ERP between February 2019 and November 2020, were used for comparison. Optimal matched-paired analysis of PSA value, biopsy Gleason score, and prostate volume was performed. Preoperative, perioperative, and early functional outcomes were included in the analysis. The median follow-up was 7 months and 9 months for TVRP and ERP groups respectively. RESULTS The median total operative time was longer in the TVRP compared to the ERP group (p = .002). There were no differences in intraoperative complications or surgical margin status. TVRP group had less rate of grade 3a Clavien-Dindo complications (p = .026). The Foley catheter duration was 3 (3, 4) days in the TVRP group compared to 7 (7, 8) days in the ERP group (p < .001). There was a consistently improved continence rate in the TVRP group at 6 weeks (72% TVRP, 48% ERP, p = .004), 3 months (97% TVRP, 81% ERP, p = .008), and 6 months postoperatively (100% TVRP, 93% ERP, p = .047). There was no difference in biochemical recurrence at 6 months of follow-up. CONCLUSION In our initial series, TVRP allows for a faster continence recovery, without other functional or oncological compromises.
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13
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Ye L, Chen Y, Xu H, Xie H, Yao J, Liu J, Song B. Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis. Eur Radiol 2022; 32:6480-6492. [PMID: 35362750 DOI: 10.1007/s00330-022-08696-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate if removing DCE from the Vesical Imaging Reporting and Data System (VI-RADS) influences the diagnostic accuracy of muscle-invasive bladder cancer (MIBC). We also explored using different reference standards on the MRI diagnostic performance. METHODS We searched the Cochrane Library, Embase, and PubMed databases to June 26, 2021. Pooled biparametric MRI (bpMRI, T2WI+DWI) and multiparametric MRI (mpMRI, T2WI+DWI+DCE) sensitivities and specificities and the diagnostic performances of these methods for MIBC were compared using different reference standards. RESULTS Seventeen studies with 2344 patients were finally included, of which 7 studies, including 1041 patients, reported the diagnostic performance of bpMRI. VI-RADS showed sensitivities and specificities of 0.91 (95% CI 0.87-0.94) and 0.86 (95% CI 0.77-0.91) at cutoff scores of 3, and 0.85 (95% CI 0.77-0.90) and 0.93 (95% CI 0.89-0.96) at cutoff scores of 4. BpMRI showed sensitivities and specificities of 0.90 (95% CI 0.69-0.97) and 0.90 (95% CI 0.81-0.95), and 0.84 (95% CI 0.78-0.88) and 0.97 (95% CI 0.87-0.99), respectively, for cutoff scores of 3 and 4. The sensitivities of bpMRI vs mpMRI for MIBC were not significantly different, but bpMRI was more specific than mpMRI at cutoff scores of 3 (p = 0.02) and 4 (p = 0.02). The VI-RADS studies using primary transurethral resection of bladder tumors (TURBT) as the reference standard had significantly higher sensitivities (p < 0.001) than those using secondary TURBT or radical cystectomy as the reference. DATA CONCLUSION BpMRI and conventional VI-RADS had similar diagnostic efficacies for MIBC. Since MRI overestimated MIBC diagnoses using primary TURBT as the reference standard, we recommend using secondary TURBT as the reference standard. KEY POINTS • Biparametric MRI without DCE had similar diagnostic efficacies for MIBC compared with conventional VI-RADS. • The sensitivity of VI-RADS was overestimated when referring to the primary TURBT results. • Biparametric MRI comprised of T2WI and DWI could be used for detecting MIBC in clinical practice.
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Affiliation(s)
- Lei Ye
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Hui Xu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Huimin Xie
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
| | - Jin Yao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China.
| | - Jiaming Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China
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14
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Liao Y, Chen T. A commentary on "Evaluation and analysis of incidence and risk factors of lower extremity venous thrombosis after urologic surgeries: A prospective two-center cohort study using LASSO-logistic regression" (Int. J. Surg. 2021 (89) 105948). Int J Surg 2021; 95:106139. [PMID: 34634510 DOI: 10.1016/j.ijsu.2021.106139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Yang Liao
- Department of Urology, Chongqing Jiangjin District Central Hospital, Chongqing, 402260, China
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15
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Colenbrander J, Heesakkers J, Martens F. Vesico-Vaginal Fistula Repair by a Vaginal Approach. Urol Int 2021; 105:1113-1118. [PMID: 34583358 DOI: 10.1159/000519369] [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: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae (VVaFs) using a transvaginal approach with a Latzko technique. METHODS A retrospective chart study was conducted at the Department of Urology, Radboud University Medical Centre. Surgical approaches to repair VVaF, from 2014 to September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, for example, patient characteristics, leakage on cystography 2 weeks postoperative, and surgery time. RESULTS Thirty-one patients had surgery for VVaF. Twenty-five procedures (81%) were performed transvaginally. Thirteen of these (52%) had successful transvaginal closure after the first attempt. Seven out of 12 had their second attempt at the time of analysis, of which 4 (57%) were successfully closed thereafter. After either 1 or 2 attempts with the transvaginal approach, 17 (68%) of the VVaFs were successfully closed, but 79% if patients who did not yet had a second attempt were taken into account with the current success extrapolated. Only few minor complications were observed. CONCLUSION Transvaginal closure of VVaFs with a Latzko technique is successful in about 79% in either 1 or 2 attempts, with few minor complications. A second attempt in closing the fistula with a transvaginal approach is useful, and a previous transvaginal attempt is not a contraindication for a second transvaginal attempt in closing the VVaF surgically.
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Affiliation(s)
| | | | - Frank Martens
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
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16
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Reichelt AC, Dressler FF, Gratzke C, Miernik A, Schoeb DS. Evaluation of functional parameters, patient-reported outcomes and workload related to continuous urinary bladder irrigation after transurethral surgery. Transl Androl Urol 2021; 10:2921-2928. [PMID: 34430394 PMCID: PMC8350243 DOI: 10.21037/tau-21-165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background Continuous saline bladder irrigation (CBI) is a common procedure after transurethral surgery and to treat gross hematuria. We conducted this study to gather data on parameters of CBI, medical staff’s work load associated with CBI monitoring, patients’ feeling of safety and of patients’ impairments during CBI. Methods We observed CBI taking place after transurethral surgery for a 2–9-hour period. Patients were asked to rank how safe they felt, general impairments and impaired mobility. Irrigation parameters and complications were documented at least every 30 minutes. The staff’s workload was evaluated through the frequency of visits and presence time. Results The patients’ mobility was notably reduced with an average of 10.5%±16.7% of time spent outside of bed, pain was low (mean 0.60±1.15). Patients felt very safe with CBI (8.8±1.9), hardly impaired overall (3.8±3.0), but restricted in mobility (5.9±2.8). Pain was associated with general impairment and impaired mobility. Clot retention occurred in 5 patients. Average irrigation speed was 9.46±8.69 mL/min (0 to 86.7 mL/min). Urine bags were emptied on average every 2.2±1.2 hours. Patients were visited by medical personnel 1 to 11 times. Conclusions CBI remains an improvable procedure in terms of the irrigation process itself to prevent complications, the patients’ feeling of safety and comfort during CBI and the amount of work associated with its monitoring. We have provided parameters for the implementation of more individualized CBI monitoring. Trial registration German Clinical Trial Registry; DRKS00023707; Registered retrospectively November 25 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023707
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Affiliation(s)
- Anja Christina Reichelt
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Franz Friedrich Dressler
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Institute of Pathology, University Medical Center Schleswig Holstein Lübeck Campus, Ratzeburger Allee, D-23538 Lübeck, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dominik Stefan Schoeb
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
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17
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Zhang X, Shaffer RK, Dobberfuhl AD. The evolution of incontinence into resolved, refractory and de novo urgency urinary incontinence following sling placement at time of prolapse repair in a large urodynamic cohort. Investig Clin Urol 2021; 62:584-591. [PMID: 34387039 PMCID: PMC8421992 DOI: 10.4111/icu.20200480] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To improve counseling in women at risk of refractory and/or de novo urgency urinary incontinence (UUI) following sling placement at time of prolapse repair, we created an outcome model to characterize changes in storage dysfunction. MATERIALS AND METHODS We identified 139 women who underwent urodynamics followed by sling or no sling placement at the time of prolapse repair over a 6-year period. Our primary outcome was the presence of UUI following sling placement. Data were analyzed in SAS using chi-square, Fisher's exact, Student's t-test, and Kaplan-Meier methods. RESULTS At baseline, the sling group had significantly higher subjective (62/81 [76.5%] vs. 18/58 [31.0%]; p<0.001), objective (62/81 [76.5%] vs. 6/58 [10.3%]; p<0.001), and occult (41/81 [50.6%] vs. 6/58 [10.3%]; p<0.001) stress urinary incontinence (SUI); and rates of subjective and objective UUI were similar to the no sling group prior to surgery. After surgery (mean follow-up 859 days) there was no difference with or without sling, in the rate of SUI (subjective, objective) and further SUI treatments (bulking agent, repeat sling). Higher rates of de novo (13/81 [16.0%] vs. 6/58 [10.3%]; p=0.454) and refractory (31/81 [38.3%] vs. 14/58 [24.1%]; p=0.048) UUI were noted in the sling group following surgery. On Kaplan-Meier analysis, a greater proportion of women in the no sling group did not report UUI at longest follow-up (hazard ratio 0.63; 95% confidence interval 0.37-1.06; p=0.081). CONCLUSIONS Women should be counseled on the risk of de novo and refractory UUI following sling placement at time of prolapse repair.
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Affiliation(s)
- Xinyuan Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robyn K Shaffer
- Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
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18
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Briggs LG, Reitblat C, Bain PA, Parke S, Lam NY, Wright J, Catto JWF, Copeland RJ, Psutka SP. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol 2021; 81:157-167. [PMID: 34074558 DOI: 10.1016/j.eururo.2021.05.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT The Consensus on Therapeutic Exercise Training (CONTENT) scale assesses the therapeutic validity of exercise programs. To date, prehabilitation exercise programs for heath optimization before urologic cancer surgeries have not been assessed for therapeutic validity or efficacy. OBJECTIVE To systematically assess prehabilitation exercise programs before urologic cancer surgery for therapeutic validity and efficacy, informing discussion of best practices for future intervention. EVIDENCE ACQUISITION A systematic review was performed using Ovid, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases through June 2020. The review included prospective (randomized controlled and uncontrolled) trials where patients were enrolled in prehabilitation exercise programs before urologic cancer surgery. The primary outcomes of interest included therapeutic validity and efficacy (measures of cardiorespiratory fitness and postsurgical outcomes). Studies were evaluated for the risk of bias. A narrative synthesis was carried out given heterogeneity in populations, interventions, and outcomes across studies. EVIDENCE SYNTHESIS Ten unique studies and two associated post hoc analyses met the inclusion criteria. Seven studies demonstrated therapeutic validity. Eight demonstrated a high risk of bias. All demonstrated significant improvement in cardiorespiratory fitness. Four of five studies evaluating quality of life observed significant improvements. To date, zero trials have demonstrated reduction in postsurgical complications, mortality, length of stay, or readmission rates following prehabilitation exercise interventions. CONCLUSIONS While prehabilitation exercise may result in improved cardiorespiratory fitness and quality of life, current studies have yet to demonstrate impact on surgical outcomes. When designing prehabilitation exercise programs for use before urologic cancer surgery, the therapeutic validity of the intervention should be considered. Future prehabilitation studies should employ standardized content rubrics to ensure therapeutic validity. Consensus is needed regarding the appropriate outcomes to adjudicate prehabilitation efficacy. PATIENT SUMMARY In this report, we looked at the effectiveness and quality of prehabilitation exercise programs before urologic cancer surgery. We found that these programs effectively improve presurgical fitness, but may benefit from the use of structured methodology and outcome assessment to understand their potential to improve surgical outcomes.
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Affiliation(s)
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | - Ny-Ying Lam
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA, USA
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, WA, USA
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
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Tang G, Qi L, Sun Z, Liu J, Lv Z, Chen L, Huang B, Zhu S, Liu Y, Li Y. Evaluation and analysis of incidence and risk factors of lower extremity venous thrombosis after urologic surgeries: A prospective two-center cohort study using LASSO-logistic regression. Int J Surg 2021; 89:105948. [PMID: 33892158 DOI: 10.1016/j.ijsu.2021.105948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/19/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is among the most frequent complications of surgery. This study aimed to analyse the incidence and risk factors of lower extremity venous thrombosis after urologic surgery. MATERIALS AND METHODS This prospective two-centre study was conducted from August 2019 to January 2020. Patients who underwent urological procedures were enrolled. The primary endpoint was the detection of asymptomatic or symptomatic DVT of the lower extremity within 7 days after surgery. Univariate and least absolute shrinkage and selection operator (LASSO) logistic regression analyses were performed. RESULTS Fifty-six of 1011 patients developed DVT. In the univariate analysis, Barthel Index ≤40, d-dimer level ≥0.5 mg/L and age ≥60 years (p < 0.001) were identified as the most significant risk factors. The LASSO logistic regression model identified nine factors: age, history of DVT, lymph node dissection, perioperative steroid use, Caprini score, Barthel Index, D-dimer level, cystectomy, and prostatectomy. CONCLUSION Our study used the LASSO logistic regression model to provide reliable data on the risk factors for DVT after comprehensive urologic surgery. The incidence of DVT in this group was 5.54%. This might facilitate individualised anticoagulant management in patients undergoing urological procedures.
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Affiliation(s)
- Guyu Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zepeng Sun
- Department of Statistics, School of Mathematics and Statistics, Beijing Technology and Business University, Haidian, Beijing, 100048, China
| | - Jing Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zhengtong Lv
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Lingxiao Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Bin Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Shuai Zhu
- Department of Urology, Hunan Cancer Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Yao Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
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Ginsburg KB, Pressprich MF, Wurst HA, Cher ML. Association of lymph node yield with overall survival in patients with pathologically node negative prostate cancer. Curr Probl Cancer 2021; 45:100740. [PMID: 33931243 DOI: 10.1016/j.currproblcancer.2021.100740] [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: 01/13/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
We investigated the association between lymph node yield (LNY) with overall survival (OS) and post-radical prostatectomy (RP) secondary treatments among men with pathologically node negative (pN0) prostate cancer. We reviewed the National Cancer Database for men with Gleason Grade Group 2 or higher prostate cancer treated with RP and had pathologically node-negative disease. LNY was modeled as a continuous and categorical variable grouped by quartiles of LNY. Secondary treatment was defined as the use of radiation or systemic therapy post-RP. Multivariable Cox proportional hazards and logistic regression models were used to test for an association of LNY with OS and secondary treatments, respectively. We identified 89,416 men with pN0 prostate cancer treated with RP from 2010-2015. LNY was associated with improved OS when modeled as a categorical and continuous variable. The third (6-9 nodes) and fourth (≥10 nodes) quartiles of LNY were associated with improved OS (HR 0.87, 95% CI 0.79-0.96, P = 0.006 and HR 0.88, 95% CI 0.79-0.98, P= 0.017, respectively) when compared with the lowest quartile of LNY (≤3 nodes) and the hazard of death decreased by 1% for each benign lymph node removed (HR 0.99, 95% CI 0.98-0.99, P= 0.022). Additionally, categorical and continuous LNY was associated with significantly less use of post-RP secondary treatments. Removal of additional negative lymph nodes was associated with improved OS and less secondary treatments in patients with pN0 prostate cancer. These data suggest that removing a higher quantity of lymph nodes provides more accurate staging and prognosis.
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Affiliation(s)
- Kevin B Ginsburg
- Department of Urology, Wayne State University, Detroit, Michigan.
| | | | - Hallie A Wurst
- Wayne State University, School of Medicine, Detroit, Michigan
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, Michigan
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Marcq G, Foerster B, Abufaraj M, Matin SF, Azizi M, Gupta M, Li WM, Seisen T, Clinton T, Xylinas E, Mir MC, Schweitzer D, Mari A, Kimura S, Bandini M, Mathieu R, Ku JH, Guruli G, Grabbert M, Czech AK, Muilwijk T, Pycha A, D'Andrea D, Petros FG, Spiess PE, Bivalacqua T, Wu WJ, Rouprêt M, Krabbe LM, Hendricksen K, Egawa S, Briganti A, Moschini M, Graffeille V, Autorino R, John P, Heidenreich A, Chlosta P, Joniau S, Soria F, Pierorazio PM, Shariat SF, Kassouf W. Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study. Eur Urol Focus 2021; 8:491-497. [PMID: 33773965 DOI: 10.1016/j.euf.2021.03.018] [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: 01/07/2021] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories. OBJECTIVE To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective study including 1214 patients from 21 centers who underwent ureterorenoscopy (URS) with biopsy followed by radical nephroureterectomy (RNU) for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multivariate logistic regression analysis identified predictors of muscle invasion (≥pT2) at RNU. The Youden index was used to identify cutoff points. RESULTS AND LIMITATIONS A total of 811 patients (67%) were male and the median age was 71 yr (interquartile range 63-77). The presence of non-organ-confined disease on preoperative imaging (p < 0.0001), sessile tumor (p < 0.0001), hydronephrosis (p = 0.0003), high-grade cytology (p = 0.0043), or biopsy (p = 0.0174) and higher age at diagnosis (p = 0.029) were independently associated with ≥pT2 at RNU. Tumor size was significantly associated with ≥pT2 disease only in univariate analysis with a cutoff of 2 cm. Tumor size and all significant categorical variables defined the high-risk category. Tumor multifocality and a history of radical cystectomy help to dichotomize between low-risk and intermediate-risk categories. The odds ratio for muscle invasion were 5.5 (95% confidence interval [CI] 1.3-24.0; p = 0.023) for intermediate risk versus low risk, and 12.7 (95% CI 3.0-54.5; p = 0.0006) for high risk versus low risk. Limitations include the retrospective design and selection bias (all patients underwent RNU). CONCLUSIONS Patients with low-risk UTUC represent ideal candidates for KSS, while some patients with intermediate-risk UTUC may also be considered. This classification needs further prospective validation and may help stratification in clinical trial design. PATIENT SUMMARY We investigated factors predicting stage 2 or greater cancer of the upper urinary tract at the time of surgery for ureter and kidney removal and designed a new risk stratification. Patients with low or intermediate risk may be eligible for kidney-sparing surgery with close follow-up. Our classification scheme needs further validation based on cancer outcomes.
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Affiliation(s)
- Gautier Marcq
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, Division of Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
| | - Mohit Gupta
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Thomas Seisen
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris Descartes University, Paris, France
| | - M Carmen Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Donald Schweitzer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Marco Bandini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Ja H Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Georgi Guruli
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Markus Grabbert
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Armin Pycha
- Department of Urology, Provincial Hospital of Bozen, Bozen, Italy; Medical School, Sigmund Freud University, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Firas G Petros
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity Bivalacqua
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Morgan Rouprêt
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia John
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Phillip M Pierorazio
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada.
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Schoeb DS, Schwarz J, Hein S, Schlager D, Pohlmann PF, Frankenschmidt A, Gratzke C, Miernik A. Mixed reality for teaching catheter placement to medical students: a randomized single-blinded, prospective trial. BMC Med Educ 2020; 20:510. [PMID: 33327963 PMCID: PMC7745503 DOI: 10.1186/s12909-020-02450-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/11/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Cost-effective methods to facilitate practical medical education are in high demand and the "mixed-reality" (MR) technology seems suitable to provide students with instructions when learning a new practical task. To evaluate a step-by-step mixed reality (MR) guidance system for instructing a practical medical procedure, we conducted a randomized, single-blinded prospective trial on medical students learning bladder catheter placement. METHODS We enrolled 164 medical students. Students were randomized into 2 groups and received instructions on how to perform bladder catheter placement on a male catheterization training model. One group (107 students) were given their instructions by an instructor, while the other group (57 students) were instructed via an MR guidance system using a Microsoft HoloLens. Both groups did hands on training. A standardized questionnaire covering previous knowledge, interest in modern technologies and a self-evaluation was filled out. In addition, students were asked to evaluate the system's usability. We assessed both groups's learning outcome via a standardized OSCE (objective structured clinical examination). RESULTS Our evaluation of the learning outcome revealed an average point value of 19.96 ± 2,42 for the control group and 21.49 ± 2.27 for the MR group - the MR group's result was significantly better (p = 0.00). The self-evaluations revealed no difference between groups, however, the control group gave higher ratings when evaluating the quality of instructions. The MR system's assessment showed less usability, with a cumulative SUS (system usability scale) score of 56.6 (lower half) as well as a cumulative score of 24.2 ± 7.3 (n = 52) out of 100 in the NASA task load index. CONCLUSIONS MR is a promising tool for instructing practical skills, and has the potential to enable superior learning outcomes. Advances in MR technology are necessary to improve the usability of current systems. TRIAL REGISTRATION German Clinical Trial Register ID: DRKS00013186.
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Affiliation(s)
- D. S. Schoeb
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - J. Schwarz
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - S. Hein
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - D. Schlager
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - P. F. Pohlmann
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Frankenschmidt
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Gratzke
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Miernik
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Tai JW, Sorkhi SR, Trivedi I, Sakamoto K, Albo M, Bhargava V, Rajasekaran MR. Evaluation of Age- and Radical-Prostatectomy Related Changes in Male Pelvic Floor Anatomy Based on Magnetic Resonance Imaging and 3-Dimensional Reconstruction. World J Mens Health 2020; 39:566-575. [PMID: 32648374 PMCID: PMC8255398 DOI: 10.5534/wjmh.200021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Puborectalis muscles (PRM) and ischiocavernosus muscles (ICM) play important roles in urinary continence and male erectile functions. Understanding of anatomy and surgical-injury related changes to these muscles is critical to monitor changes in continence or erectile function. Anatomical description of these muscles has undergone revisions because these conclusions were derived from cadavers. Our objectives were to: (i) elucidate male pelvic muscles by in-vivo magnetic resonance imaging (MRI) and 3-dimensional (3-D) reconstruction of these images and (ii) compare PRM and ICM thickness in healthy volunteers and symptomatic patients. Materials and Methods Healthy young male (mean age, 25 years; n=5), older male (age, 65–70 years; n=5), and post-prostatectomy patients with erectile dysfunction and urinary incontinence (age, 65–70 years; n=5) were scanned on a 3T-magnetic resonance scanner. Images were acquired from slices above urinary bladder base to urethra entry into penis. Pelvic bone, bladder/urethra, corpus cavernosum, ICM, PRM, and prostate were segmented. 3-D models of each structure were generated and assembled into composite images, and ICM and PRM thicknesses were calculated. Results We successfully reconstructed 3-D male pelvic floor anatomy including ICM, PRM, bladder, urethra, bulbospongiosus, corpus cavernosa, prostate and bones from the two groups. We documented significant reduction in PRM and ICM thickness in older men. Conclusions This is perhaps the first 3-D reconstruction of male pelvic floor structures based on in-vivo MRI in healthy and symptomatic patients. Observed reduction in PRM and ICM thickness is possibly due to age-related atrophy.
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Affiliation(s)
- Jesse W Tai
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Samuel R Sorkhi
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Ishika Trivedi
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Kyoko Sakamoto
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Michael Albo
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Valmik Bhargava
- Division of Cardiology, San Diego VA Healthcare System & University of California, San Diego, CA, USA
| | - Mahadevan Raj Rajasekaran
- Department of Urology, San Diego VA Healthcare System & University of California, San Diego, CA, USA.
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Campos-Juanatey F, Portillo Martín JA, Martínez-Piñeiro Lorenzo L. Management of male anterior urethral strictures in adults. Results from a national survey among urologists in Spain. Actas Urol Esp 2020; 44:71-77. [PMID: 32005523 DOI: 10.1016/j.acuro.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/31/2019] [Revised: 03/23/2019] [Accepted: 06/09/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE Assessment of urethral stricture (US) management seems important to evaluate the quality of attention and plan educational interventions. We aim to investigate the practice patterns on diagnostic and therapeutic approaches to adult male anterior US among urologists in Spain. MATERIALS AND METHODS 23-question on-line survey conducted among all members of AEU (Spanish Urological Association). Demography data and practices on evaluation and treatment of US were included. 1737 invitation letters sent by email, with 21.7% response rate. Data were prospectively collected during 2016. Descriptive analysis and univariate comparisons conducted using X2 test. Statistical significance considered when P≤.05. RESULTS Responders were mainly from Tertiary and Teaching University Hospitals. 63.2% treated≥10 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool followed by uroflowmetry (UF), and internal urethrotomy under direct vision (DVIU) the most frequent treatment. 84.4% limited DVIU for US≤1.5cm. 62.3% performed≤5 urethroplasties/year. Anastomotic urethroplasties were performed by 75.7% and graft repairs by 68.9%. Dorsal grafting was preferred rather than ventral. Non-transecting techniques were used by 23.9%. UF was the most common follow-up tool. 88.4% felt that referral units were required. Tertiary hospitals used Patient Reported Outcome Measure (PROM) questionnaires more frequently than secondary centres. High-volume urologists were more likely to use non-transecting techniques and to choose urethroplasty as first choice procedure. CONCLUSIONS Male anterior US in Spain are treated by many urologists, mainly using endoscopic procedures. RUG is preferred for diagnosis, and UF for follow-up. A high percentage of urologists perform urethroplasties, mainly anastomotic repairs, but in low volume.
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Affiliation(s)
- F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España.
| | - J A Portillo Martín
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
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Choi DK, Kim S, Oh JJ. Effects of pelvic bone fracture on recurrence-free rate after bulbomembranous anastomotic urethroplasty in men with posterior urethral injuries. Investig Clin Urol 2020; 61:99-106. [PMID: 31942469 PMCID: PMC6946827 DOI: 10.4111/icu.2020.61.1.99] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the impact of pelvic bone fracture on the recurrence of urethral stenosis after bulbomembranous anastomotic urethroplasty. Materials and Methods A total of 197 patients with complete posterior urethral injuries underwent bulbomembranous anastomotic urethroplasty. These patients were divided into two groups according to the presence of pelvic bone fracture. Recurrence of urethral stenosis was defined as the need for any postoperative surgical intervention. The surgical outcomes and postoperative recurrence rate of urethral stenosis were compared between the two groups, and significant predictors for posterior urethral restenosis, including pelvic bone fracture, were analyzed via multivariate analysis. Results Of the patients, 92 had pelvic bone fractures and the other 105 patients did not. The patients with pelvic bone fracture had increased involvement of the prostatic urethra compared to the group without pelvic bone fracture (3.8% vs. 17.4%, p=0.002). Recurrence of urethral stenosis was more common in the pelvic bone fracture group (42/92, 45.7%) than the group without pelvic fracture (27/105, 25.7%). In a Kaplan—Meier analysis, the recurrence rate at 5 years was significantly lower in the pelvic bone fracture group (59.1% vs. 72.6%, p=0.003). A Cox proportional hazard analysis showed that the presence of pelvic bone injury was a significant predictor of posterior urethral re-stenosis. Conclusions Patients with posterior urethral injuries associated with pelvic bone fracture had a higher recurrence rate of urethral stenosis after bulbomembranous anastomotic urethroplasty than those without pelvic bone fracture.
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Affiliation(s)
- Don Kyoung Choi
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Sungjin Kim
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Ramos-Castaneda JA, Ruano-Ravina A, Munoz-Price LS, Toro-Bermúdez R, Ruiz-Londoño D, Segura-Cardona AM, Lemos-Luengas EV. Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study. Am J Infect Control 2019; 47:1474-8. [PMID: 31375294 DOI: 10.1016/j.ajic.2019.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB. METHODS We conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure. RESULTS A total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96). CONCLUSIONS There was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.
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Owyong M, Koru-Sengul T, Miao F, Razdan S, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Impact of Surgical Technique on Surgical Margin Status Following Partial Cystectomy. Urol Oncol 2019; 37:870-876. [PMID: 31445895 PMCID: PMC7696003 DOI: 10.1016/j.urolonc.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/19/2019] [Revised: 06/15/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort. MATERIALS AND METHODS Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs). RESULTS Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70-1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85-1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09-3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00-5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21-2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47-0.94, P = 0.022). CONCLUSIONS Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.
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Affiliation(s)
- Michael Owyong
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Shirin Razdan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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Blau EK, Adelstein SA, Amin KA, Durfy SJ, Lucioni A, Kobashi KC, Lee UJ. Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery. Investig Clin Urol 2019; 61:S57-S63. [PMID: 32055755 PMCID: PMC7004833 DOI: 10.4111/icu.2020.61.s1.s57] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/26/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal. Materials and Methods We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale. Results One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery. Conclusions This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.
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Affiliation(s)
- Elliot K Blau
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sarah A Adelstein
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Katherine A Amin
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sharon J Durfy
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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Dobberfuhl AD, Zhang X, Comiter CV. The mechanical stop test and isovolumetric detrusor contractile reserve are associated with immediate spontaneous voiding after transurethral resection of prostate. Int Urol Nephrol 2019; 52:239-246. [PMID: 31673936 DOI: 10.1007/s11255-019-02322-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify urodynamic factors associated with the mechanical stop test and immediate spontaneous voiding following transurethral resection of prostate (TURP). METHODS We identified 90 men who underwent TURP over a 12-month period. Forty-three (mean age 68 years) underwent urodynamic evaluation prior to TURP. Isovolumetric detrusor contractile pressure (Piso) was obtained using the mechanical stop test during the voiding phase, and used to calculate detrusor contractile reserve (Pres = Piso - Pdet@Qmax). Primary outcome was spontaneous voiding after TURP. RESULTS Preoperative catheter-free spontaneous voiding was present in 63% of men (27/43) with a urodynamic (mean ± SD): Qmax 6.2 ± 2.7 mL/s, Pdet@Qmax 102 ± 47 cmH2O, Piso 124 ± 49 cmH2O, Pres 22 ± 16 cmH2O, bladder outlet obstruction index (BOOI) 90 ± 49, and bladder contractility index (BCI) 132 ± 44. The remaining 16 catheter-dependent men demonstrated a urodynamic (mean ± SD): Qmax 3.6 ± 3.3 mL/s, Pdet@Qmax 87 ± 38 cmH2O, Piso 99 ± 51 cmH2O, Pres 10 ± 18 cmH2O, BOOI 82 ± 36, and BCI 106 ± 48. Following TURP, 67% of men voided spontaneously with their first void trial, and in receiver operator analysis of urodynamic measures (Pdet@Qmax, Piso, Pres, BOOI and BCI), only Pres was significantly associated with immediate spontaneous voiding after TURP (threshold Pres ≥ 9 cmH2O, AUC = 0.681, p = 0.035). CONCLUSIONS In men who underwent TURP, a Pres ≥ 9 cmH2O was associated with immediate spontaneous voiding and may be easily incorporated into the postoperative pathway.
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Affiliation(s)
- Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA.
| | - Xinyuan Zhang
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA
| | - Craig V Comiter
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA
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Barroso FMDS, Paiva CS, Sousa FAD, Andrade Júnior GFD, Alves RADC, Costa KGD, Silva RTSD, Rodriguez JER, Peder Júnior EAD. Large verrucous penis cancer in a young patient in the Brazilian Amazon: Case report and discussion on the region's reality. Urol Case Rep 2019; 24:100857. [PMID: 31211068 PMCID: PMC6562281 DOI: 10.1016/j.eucr.2019.100857] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Penile cancer is a rare malignant tumour top in urology, especially in developed countries or in a favourable cultural habit. However, in developing countries or with a low socio-economic population, the incidence increases considerably, as does the stage at which the patient arrives for the first care. CASE PRESENTATION Male patient, 20 years old, from the interior of Amazonas - Brazil, has been referred to a Urological Service in the Emergency Room due to a vegetative lesion of approximately 10 centimetres, with an ulcerated centre and irregular borders in penile glans. An incisional biopsy was performed, which revealed invasive squamous cell carcinoma and was referred to the elective surgery service. CONCLUSIONS The socioeconomic condition of the population influences in a relevant way in cases in the Amazon region, with little and difficult access to preventive information and to the public health system, mainly in the interior of the state. Young patients tend to maintain the confidentiality of the picture that leads to the progression of the disease, with negative outcomes, requiring intense psychological monitoring.
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Affiliation(s)
- Francisco Marcos da Silva Barroso
- Urology service at Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Cristiano Silveira Paiva
- Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Flavio Antunes de Sousa
- Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Gualter Ferreira de Andrade Júnior
- Urology service at Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Roger Arthur da Cunha Alves
- Urology service at Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Ketlen Gomes da Costa
- General Surgery service at Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Rafaelle Taynah Soares da Silva
- General Surgery service at Getúlio Vargas University Hospital (HUGV): Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Juan Eduardo Rios Rodriguez
- Medical School of Federal University of Amazon (UFAM): Rua Afonso Pena, 1053, Praça 14 de Janeiro, Manaus, Amazonas, 69020-160, Brazil
| | - Evandro Aulice de Peder Júnior
- Medical School of Federal University of Amazon (UFAM): Rua Afonso Pena, 1053, Praça 14 de Janeiro, Manaus, Amazonas, 69020-160, Brazil
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Schulz GB, Grimm T, Buchner A, Jokisch F, Casuscelli J, Kretschmer A, Mumm JN, Ziegelmüller B, Stief CG, Karl A. Validation of a High-End Virtual Reality Simulator for Training Transurethral Resection of Bladder Tumors. J Surg Educ 2019; 76:568-577. [PMID: 30181038 DOI: 10.1016/j.jsurg.2018.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The oncological outcome in patients with bladder cancer (BC) significantly correlates with the quality of transurethral resection of bladder tumors (TUR-BT). Virtual reality (VR) training simulators have been developed to improve surgical skills. We evaluated the advantages and limitations of the novel Uro Trainer (UT) (Karl Storz GmbH, Germany) with respect to training for TUR-BT. DESIGN Participants underwent VR training based on 4 different TUR-BT cases accompanied by self-assessment and evaluation questionnaires. Results were compared between experienced endourologists and novices, and furthermore, correlated with self-rated capabilities for content and construct validity. Student's t tests, Pearson's correlation, and chi-squared tests were performed for statistical evaluation. SETTING The study was performed at the tertiary care urological department of the Ludwig-Maximilians-University, Munich, Germany. PARTICIPANTS A total of 22 urological physicians, including residents and consultants, were included in the study. RESULTS There is a need to improve TUR-BT training as 27.3% of the participants had already experienced overtaxing situations during TUR-BT and only a few reported of high satisfaction with the classical "see one-do one" teaching mode. Construct validity was demonstrated, as consultants achieved significantly higher overall scores (p < 0.001) and safety (p = 0.004) and visualization (p = 0.001) subscores. Interestingly, the self-assessed capability to perform a TUR-BT correlated significantly (p = 0.01) with overall UT scores. Significant progress of self-rated abilities was shown for several parameters, including inspection (p = 0.046) and resection (p = 0.026). Although participants indicated improvements in several procedural skills and overall benefit of the VR training with the UT was rated 4.6 on a 5-point scale by consultants, limitations of the UT were demonstrated predominantly for tissue feedback and authenticity of different tissue layers. CONCLUSIONS The novel VR simulator showed a high face and construct validity, and therefore has a great potential to complement endourological training.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Jan-Niclas Mumm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Kim JY, Kim JY, Park M, Oh CK, Chung JS, Park SH, Kim SC. Surgical managements of pseudoepitheliomatous keratotic and micaceous balanitis: A case report. Int J Surg Case Rep 2019; 55:37-40. [PMID: 30684817 PMCID: PMC6351345 DOI: 10.1016/j.ijscr.2018.12.008] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/29/2018] [Indexed: 11/24/2022] Open
Abstract
Pseudoepitheliomatous keratotic and micaceous balanitis is rare and had the distinctive clinical findings. Deep biopsy is needed to diagnose the accurate tumor staging. Glansectomy with split-thickness skin graft can be performed to treat and diagnose.
Introduction Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an extremely rare disease. Herein, we report a case of PKMB in a patient who underwent two surgical procedures, since the 5-FU cream was not available. Presentation of case A 50 year-old Korean man undergoing circumcision in a local clinic presented with a tumor-like lesion on the glans penis. Peeling the mass was performed to remove the entire mass after an excisional biopsy. A pathologic finding of mass showed hyperkeratotic and papillomatous squamous epithelium without obvious cytologic atypia. Considering that the lesion recurred after 4 weeks, the patient underwent glansectomy with split-thickness skin graft (STSG). There had been no evidence of recurrence at the surgical site during the follow-up at 6 years postoperatively. Discussion If the 5-FU cream is not available, two surgical procedures can be performed for treatment and biopsy. Peeling the mass has the advantage of confirming the characteristics of the whole lesion, but it cannot confirm tumor invasion because it is unable to obtain the subepithelial layer. Glansectomy is able to accurately identify the tumor stage because it removes the tumor and total glans penis and has excellent outcome. Conclusion PKMB is very rare and has a characteristic appearance, which is mica-like crusts and keratotic horny mass on the glans penis. Glansectomy with STSG is a good procedure when the 5-FU cream was not available.
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Affiliation(s)
- Joo Yeon Kim
- Department of Pathology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Ji Yeon Kim
- Department of Pathology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Myungchan Park
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jae-Seung Chung
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang Hyun Park
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea.
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Abdrabuh AM, Salih EM, Aboelnasr M, Galal H, El-Emam A, El-Zayat T. Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience. J Pediatr Surg 2018; 53:2250-2255. [PMID: 29954589 DOI: 10.1016/j.jpedsurg.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/08/2017] [Revised: 05/06/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other. METHODS Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up. RESULTS Mean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP. CONCLUSION In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP. A LEVEL-OF-EVIDENCE RATING FOR CLASSIFYING STUDY QUALITY LEVEL III Retrospective comparative study.
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Affiliation(s)
| | - Elsayed M Salih
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt
| | | | - Hussein Galal
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt
| | | | - Tarek El-Zayat
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt; Department of Radiodiagnosis, Al-Azhar university Hospitals, Cairo, Egypt
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Saluk JL, Blackwell RH, Gange WS, Zapf MAC, Kothari AN, Kuo PC, Quek ML, Flanigan RC, Gupta GN. The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality. Curr Urol 2018; 12:20-26. [PMID: 30374276 DOI: 10.1159/000447226] [Citation(s) in RCA: 3] [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] [Received: 08/30/2017] [Accepted: 11/21/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials & Methods Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated "high-risk" LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, "high risk" patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.
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Affiliation(s)
- Jennifer L Saluk
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Robert H Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA.,Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - William S Gange
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Matthew A C Zapf
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.,Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Anai N Kothari
- Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA.,Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Paul C Kuo
- Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA.,Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA.,Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA.,Department of One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL, USA
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Oh JH, Chung HS, Yu HS, Kang TW, Kwon D, Kim SO. Hydrocelectomy via scrotal incision is a valuable alternative to the traditional inguinal approach for hydrocele treatment in boys. Investig Clin Urol 2018; 59:416-421. [PMID: 30402575 PMCID: PMC6215779 DOI: 10.4111/icu.2018.59.6.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Few studies have explored the treatment of isolated communicating hydroceles via scrotal incision. We prospectively evaluated the surgical outcomes of such treatment in boys with hydroceles compared with that using traditional, inguinal incision hydrocelectomy. Materials and Methods Of 347 boys aged 0–12 years who were diagnosed as hydrocele on ultrasonography, 173 boys were assigned to the scrotal incision hydrocelectomy group (group I, n=173) and 172 boys were assigned to the traditional inguinal incision hydrocelectomy group (group II, n=172), and finally 156 boys in group I and 156 boys in group II were included in this study. Surgical outcomes, including postoperative complications and hydrocele relapse rates, were compared between groups. Results The overall success rates were similar in both groups (group I, 96.8%; group II, 89.1%; p=0.740). The operation time and hospital stay were significantly shorter in group I (30.94±3.95 minutes and 3.94±0.30 days) than in group II (38.02±7.12 minutes and 4.24±0.99 days; p<0.001 and p=0.009, respectively). The postoperative complication rate was lower in group I than in group II (3.2% vs. 10.9%, p=0.740). Conclusions Scrotal incision hydrocelectomy in boys was associated with shorter operative time and hospital stay, and a lower postoperative complication rate, than was the inguinal incision approach. The scrotal incision technique might be an easy and effective alternative treatment when used to treat hydroceles in boys as well as inguinal incision approach.
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Affiliation(s)
- Jeong Hoon Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dongdeuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Abstract
PURPOSE Perineal hypospadias correction has swung from two-stage repair in the 1960s to one-stage repair in the 1980s and back to two-stage repair in the 2000s. The author's experience with a technique in which Chordee Excision and Distal Urethroplasty (CEDU) was performed at the first operation leaving a 1-cm segment as perineal urethrotomy to be reconstructed at the second operation is presented. PATIENTS AND METHODS Between January 2013 and December 2016, the CEDU technique was performed in 63 patients with perineal hypospadias. The records of 59 patients who maintained regular follow-up were reviewed. The principle is to excise the hypoplastic urethral plate, atretic corpus spongiosum, and longitudinal layer of tunica albuginea; split the glans in the midline; and reconstruct a healthy urethral plate using preputial and lateral skin flaps to the tip of the glans. Distal urethroplasty was performed leaving 1 cm at the proximal end to be reconstructed 3-6 months later. This principle was used by Duplay in the 1880s. Patient age ranged between 6 months and 2 years (mean 8 months). All the patients had perineal hypospadias and bifid scrotum with severe deep chordee. Follow-up period ranged from 17 to 53 months (mean 36). A transurethral Silastic catheter was inserted for 4 days. Three months later, the remaining 1 cm of the new urethra was reconstructed, and final adjustment of the glans and foreskin was performed. RESULTS Satisfactory results were obtained in 54 patients (90%). Three children experienced glans dehiscence that was corrected in the second stage, one child developed fistula after the second operation, and one developed diverticulum. The fistula and diverticulum were corrected at the third operation successfully. DISCUSSION It was necessary in this series to divide the urethral plate and excise the hypoplastic corpus spongiosum and the outer longitudinal layer of tunica albuginea to correct the associated deep chordee. The lateral skin flaps receive double blood supply from the base of the penis and the preputial vessels. This natural urinary diversion allows early removal of the catheter, reduces the discomfort of the patient, and allows the new urethra to heal without urine irritation for 3 months. Long-term follow-up for 15 years is necessary to assess the technique objectively. CONCLUSIONS The CEDU technique diverts urine away from the site of urethroplasty for 3 months without a catheter. It reduces the hospital stay and patient discomfort. It produces satisfactory results and has become a the standard technique in perineal hypospadias.
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Affiliation(s)
- A T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany.
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Zapała P, Dybowski B, Poletajew S, Białek Ł, Niewczas A, Radziszewski P. Clinical rationale and safety of restaging transurethral resection in indication-stratified patients with high-risk non-muscle-invasive bladder cancer. World J Surg Oncol 2018; 16:6. [PMID: 29334958 PMCID: PMC5769235 DOI: 10.1186/s12957-018-1310-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/21/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Indications for restaging transurethral resection of the bladder tumor (reTURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remain controversial. This study was aimed at evaluation of clinical value and safety of reTURBT in different clinical indications. Methods This is a retrospective analysis of consecutive 141 patients who underwent TURBT followed by reTURBT in years 2011–2015 in a single department. Pathological results and surgical complications were analyzed in the whole study cohort and stratified by clinical stage (Ta, T1, Tx (no muscle in the specimen)) and grade (low-grade (LG), high-grade (HG)) of bladder cancer diagnosed at primary TURBT. Results Full data was available for 132 patients. Residual disease was found in 53 patients (40.2%) with highest rate for Ta-HG cases (57.1%) followed by T1-HG (51.4%), Tx-HG (45.2%), T1-LG (32.1%), and Tx-LG (25.8%). In the multivariate analysis, high grade (p = 0.02) was the only independent predictor of residual disease. Upstaging to muscle-invasive bladder cancer was noticed in 9 patients (6.8%). The rate of grade ≥ 2 Clavien-Dindo complications (1.5 vs. 5.3%) did not differ significantly between TURBT and reTURBT cases. Conclusions ReTURBT is a safe procedure that remains crucial for therapeutic and staging purposes in patients with T1, Tx, or high-grade bladder cancer found in the primary resection.
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Affiliation(s)
- Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland
| | - Bartosz Dybowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland
| | - Sławomir Poletajew
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland.
| | - Łukasz Białek
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland
| | - Andrzej Niewczas
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4 Str, 02-005, Warsaw, Poland
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Ikeda T, Akiyama S, Kim WJ, Ito S, Yamazaki Y. Prevention of ventriculoperitoneal shunt complications after intraperitoneal urological surgeries. J Pediatr Surg 2017; 52:1169-1172. [PMID: 28277297 DOI: 10.1016/j.jpedsurg.2016.09.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/13/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate perioperative management for the prevention of postoperative shunt infection and malfunction after intraperitoneal urological surgery in patients with myelodysplasia and a ventriculoperitoneal shunt. METHODS From 2005 to 2015, 20 consecutive patients with myelodysplasia and a ventriculoperitoneal shunt who underwent intraperitoneal urological surgeries were managed with the same perioperative regimen. Intraperitoneal surgeries involved opening gastrointestinal tracts, including bladder augmentation by enterocystoplasty, creating continent catheterizable channels and Malone antegrade continent enema. We compared results with those from seven previous reports regarding postoperative shunt complications, surgical histories of previous shunt revisions, management of bacteriuria before surgery preoperative bowel preparation, antibiotic regimens, and duration of indwelling drain. RESULTS Of 20 patients, 18 received prior shunt revisions, and 14 had positive urine culture before surgery that was managed with oral antibiotics. Thirteen patients underwent bladder augmentation with ileum, and one underwent augmentation with sigmoid colon. Nineteen patients underwent Malone antegrade continent enema using the appendix. All parenteral antibiotics were stopped on postoperative day 2.5. Mean duration of indwelling peritoneal drain was 2.7days. Mean follow-up period was 59.8months. Neither postoperative shunt infections nor intraperitoneal shunt malfunctions were recognized during follow-up period. CONCLUSIONS This is the first study to evaluate postoperative ventriculoperitoneal shunt complications in patients with myelodysplasia who underwent intraperitoneal urological surgeries with a specific perioperative regimen. Shunt complications are greatly reduced by rigorous perioperative management, including preoperative control of bacteriuria, appropriate administration of prophylactic antibiotics, and early removal of intraperitoneal drains. LEVELS OF EVIDENCE The type of study: Case series with no comparison group, IV.
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Affiliation(s)
- Takashi Ikeda
- Department of Urology, Kanagawa Children's Medical Center
| | - Sayaka Akiyama
- Department of Urology, Kanagawa Children's Medical Center
| | - Woo Jin Kim
- Department of Urology, Kanagawa Children's Medical Center
| | - Susumu Ito
- Department of Neurosurgery, Kanagawa Children's Medical Center
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Yamazaki Y, Kim WJ, Akiyama S, Ikeda T. Retroperitoneoscopic assisted single-site pyeloplasty using EZ access in children: Comparison with open dismembered pyeloplasty. J Pediatr Surg 2017; 52:574-7. [PMID: 27717566 DOI: 10.1016/j.jpedsurg.2016.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to compare the results of the retroperitoneoscopic assisted pyeloplasty (RASP) using EZ access (silicone rubber cap) with open dismembered pyeloplasty (ODP) in children. METHODS A retrospective review was performed of patients treated for ureteropelvic junction (UPJ) obstruction with either RASP or ODP from 2010 to 2015. For patients with RASP, two 5-mm trocars were placed in the EZ access. The UPJ was dissected retroperitoneoscopically and dismembered pyeloplasty was performed extracorporeally. Patient demographics and operative outcomes were compared between the groups. RESULTS A total of 50 children were included, with 25 RASP and 25 ODP. Mean patient age was 49months in the RASP group and 53months in the ODP group. Perioperative outcomes, including operative time (185 vs 188min) and postoperative hospital stay (2.0 vs 2.2days), were similar between the two groups. Mean skin scar length (17 vs 34mm) was significantly smaller in the RASP group. The postoperative success rate (96% vs 100%) was not significantly different between the groups. CONCLUSIONS The RASP represents a safe and effective single-site procedure in children. This procedure significantly reduces the skin scar length and has equivalent surgical outcomes to ODP. THE TYPE OF STUDY Retrospective comparative study. LEVELS OF EVIDENCE III.
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Jude E, Deshpande A, Barker A, Khosa J, Samnakay N. Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age. J Pediatr Urol 2017; 13:47.e1-47.e7. [PMID: 27836442 DOI: 10.1016/j.jpurol.2016.09.009] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to assess the outcome of intravesical ureteric reimplantation for primary obstructed megaureter (POM) performed in infants under 1 year of age. MATERIALS AND METHODS A retrospective cohort study was carried out of all infants undergoing intravesical ureteric reimplantation surgery for POM at two pediatric centers in the 12 years between 2003 and 2014. Outcomes were compared with those of children aged over 1 year undergoing intravesical reimplantation for POM during this period. Follow-up was until November 2015. RESULTS Thirty-seven megaureters in 34 infants were reimplanted, at median age 5.2 months (Table). Operative success was 97%, with one out of 34 patients (3%) requiring reoperation for recurrent ureteric obstruction. Renal preservation was high. One patient of 34 (3%), who had bilateral congenital renal dysplasia, showed evidence of decline in renal function. Five patients of 34 (15%) had postoperative urinary tract infections (UTIs). Four (13%) of those toilet trained had some symptoms of lower urinary tract dysfunction (LUTD). Three patients (9%) who had congenitally dysplastic kidneys developed hypertension. Comparatively, 14 children with POM underwent reimplantation over 1 year of age. Operative success was 86%, with two children requiring reoperation for recurrent stenosis. Both had evidence of bladder dysfunction before surgery, and thickened bladder walls noted during surgery. One of 14 (7%) had a decline in ipsilateral renal function after recurrent stenosis. Two (14%) had postoperative UTI. Three (25%) had evidence of LUTD. DISCUSSION There are few data about feasibility and long-term outcomes specifically of ureteric reimplantation for POM in infancy. This is the first study to document long-term outcomes of intravesical ureteric reimplantation in infancy for POM. The recently published British Association of Paediatric Urologists consensus statement supports delaying definitive reimplantation surgery for POM that requires intervention until after 1 year of age. There is little evidence presented for this recommendation. Our study confirms the safety and feasibility of intravesical ureteric reimplantation for POM in infants under age 1, with an operative success rate of 97%, and high renal function preservation rate. UTI risk improved after surgery in children >6 months old and remained stably low in those <6 months of age. Postoperative rates of LUTD were low. Hypertension occurred in only three cases with congenital renal dysplasia. CONCLUSIONS Ureteric reimplantation in infants under 1 year of age is a safe and effective option for managing POM that requires intervention, and compares favorably with those undergoing reimplantation over 1 year of age.
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Affiliation(s)
- Emily Jude
- Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia.
| | - Aniruddh Deshpande
- Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia; Department of Paediatric Surgery and Urology, John Hunter's Children's Hospital, Newcastle, Australia
| | - Andrew Barker
- Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia
| | - Japinder Khosa
- Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia
| | - Naeem Samnakay
- Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
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Abstract
The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.
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Affiliation(s)
- Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chester J. Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Michaud JE, Ko JS, Lue K, Di Carlo HN, Redett RJ, Gearhart JP. Use of muscle pedicle flaps for failed bladder neck closure in the exstrophy spectrum. J Pediatr Urol 2016; 12:289.e1-289.e5. [PMID: 27086261 DOI: 10.1016/j.jpurol.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/02/2015] [Accepted: 03/22/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE The authors have reviewed the use of muscle pedicle flaps for the treatment of failed bladder neck closure in exstrophy spectrum patients. METHODS A retrospective review of all exstrophy spectrum patients who underwent continence procedures with the use of muscle pedicle flaps at our institution during the last 15 years was performed. Patient characteristics, surgical history, and outcomes, including complications, continence, morbidity, and infection, were assessed. The authors utilized muscle pedicle flaps in eight exstrophy patients, including four patients with classic bladder exstrophy and four patients with cloacal exstrophy. Seven of eight patients had failed at least one prior bladder neck closure, and they had undergone a median of three prior urologic procedures. To achieve continence, five rectus muscle flaps and three gracilis muscle flaps were utilized in combination with bladder neck closure. RESULTS There were no major intraoperative or postoperative complications. All patients were initially continent, and after a median follow-up of 18.7 months seven of eight patients were continent. One patient required continent urinary stoma revision and one patient developed perineal incontinence after perineal trauma. No patients required revision of, or additional, continence procedures at the bladder neck. DISCUSSION The use of pedicle muscle flaps appears to be a safe and feasible option for exstrophy spectrum patients with failed bladder neck closure. Although achieving continence can be difficult in this population, use of muscle flaps and bladder neck closure is a viable and effective option in this challenging subset of patients.
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Affiliation(s)
- Jason E Michaud
- Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Joan S Ko
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kathy Lue
- Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heather N Di Carlo
- Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Mazur DJ, Fuchs DJ, Abicht TO, Peabody TD. Update on Antibiotic Prophylaxis for Genitourinary Procedures in Patients with Artificial Joint Replacement and Artificial Heart Valves. Urol Clin North Am 2016; 42:441-7. [PMID: 26475941 DOI: 10.1016/j.ucl.2015.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/31/2023]
Abstract
Infection of artificial joint replacements and heart valves is an uncommon but serious complication encountered anytime after the implantation of these prostheses. It is known that bacteremia can lead to infection of a prosthetic device. However, there is no strong evidence to correlate urologic procedures with the development of periprosthetic joint infection or prosthetic valve endocarditis. Therefore, antibiotic prophylaxis for the prevention of endocarditis is not recommended in patients undergoing urologic procedures. However, guidelines regarding prophylaxis to prevent infection of an artificial joint in the setting of a genitourinary procedure are more varied.
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Affiliation(s)
- Daniel J Mazur
- Department of Urology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA.
| | - Daniel J Fuchs
- Department of Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA
| | - Travis O Abicht
- Department of Surgery-Cardiac Surgery, Feinberg School of Medicine, Northwestern University, 251 East Huron, Galter 3-150, Chicago, IL 60611, USA
| | - Terrance D Peabody
- Department of Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA
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Harel M, Herbst KW, Nelson E. Practice patterns in the surgical approach for adolescent varicocelectomy. Springerplus 2015; 4:772. [PMID: 26697282 PMCID: PMC4678127 DOI: 10.1186/s40064-015-1573-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022]
Abstract
Objective To describe practice patterns in the choice of surgical approach for adolescent varicocelectomy using the Pediatric Health Information System (PHIS) database. Methods Hospitals enrolled in the PHIS database that reported all outpatient surgeries by CPT code from 2003 to 2012 were included. Patients at least 10 years of age whose records contained both the ICD-9 code for varicocele (456.4) and a CPT code for varicocelectomy [55550 (laparoscopic), 55530 (open inguinal), 55535 (open abdominal)] were identified. Microsurgical approach was identified by the add-on CPT code 69990. Comparisons among surgical approaches were made using one-way ANOVA, and time trend was evaluated with linear regression. Results A total cohort of 2528 patients was identified from 38 hospitals. Laparoscopic approach was utilized in 53.6 % of patients. (n = 1354) Microsurgical approach was reported in only 2 % (n = 23) of open varicocelectomies. A subgroup analysis was performed including only those hospitals that reported varicocelectomies in every year of the study period. (n = 587) In this subgroup, 57 % of cases were performed laparoscopically (n = 333), and the trend in laparoscopic cases within this subgroup remained stable over the study period (r2 = 0.00, p = 0.97). Conclusions Laparoscopic varicocelectomy was the most commonly reported surgical approach in this cohort, and the distribution of surgical approaches appeared to remain stable between 2003 and 2012. While subinguinal microsurgical repair has become the gold standard for management of varicocele in adults with infertility, this technique does not appear to be widely adopted in adolescents, though use of an operating microscope is likely underreported in the PHIS database.
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Affiliation(s)
- Miriam Harel
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA ; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106 USA
| | - Katherine W Herbst
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106 USA
| | - Eric Nelson
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA ; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106 USA
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Kang M, Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Conditional Survival and Associated Prognostic Factors in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Retrospective Study at a Single Institution. Cancer Res Treat 2015; 48:621-31. [PMID: 26511817 PMCID: PMC4843715 DOI: 10.4143/crt.2015.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/19/2015] [Accepted: 08/21/2015] [Indexed: 01/05/2023] Open
Abstract
Purpose The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. Materials and Methods A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. Results UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. Conclusion Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Suk Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Abstract
Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.
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Affiliation(s)
- Darren J Bryk
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Yuka Yamaguchi
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
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Oh KJ, Choi YD, Chung HS, Hwang EC, Jung SI, Kwon DD, Park K, Kang TW. A novel transurethral resection technique for superficial flat bladder tumor: grasp and bite technique. Korean J Urol 2015; 56:227-32. [PMID: 25763127 PMCID: PMC4355434 DOI: 10.4111/kju.2015.56.3.227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/01/2014] [Accepted: 01/14/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. MATERIALS AND METHODS Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. RESULTS Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. CONCLUSIONS The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.
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Affiliation(s)
- Kyung Jin Oh
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Ho Suck Chung
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University School of Medicine, Gwangju, Korea
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Albala DM, Riebman JB, Kocharian R, Ilie B, Albanese J, Shen J, Ovington L, Batiller J. Hemostasis during urologic surgery: fibrin sealant compared with absorbable hemostat. Rev Urol 2015; 17:25-30. [PMID: 26028998 PMCID: PMC4444771] [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] [Indexed: 06/04/2023]
Abstract
In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components-fibrinogen and thrombin-that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding.
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Abstract
OBJECTIVE Few reports discuss post-pubertal renal complications after pyeloplasty. We analyzed long-term complications, such as decreased renal function (RF) measured by serum creatinine (SCr), hypertension (HTN), or proteinuria (protU) following pediatric pyeloplasty. SUBJECTS AND METHODS We retrospectively investigated 257 patients who underwent dismembered pyeloplasty due to ureteropelvic junction obstruction from January 1986 to December 2001. Medical history, preoperative and postoperative blood pressure, urinalysis, and SCr results were reviewed. RESULTS Fifty-five patients (47 male, 8 female) who were followed up for at least 10 years with post-pubertal follow-up data available were analyzed. Seven (12.7%) patients were diagnosed with HTN, and 10 (18.2%) with protU. The grade of hydronephrosis decreased, and the differential RF measured by MAG-3 renal scan significantly increased at final analysis (p<0.001). Presence of preoperative symptoms (p=0.034), and SCr elevation (p=0.018) showed correlation with HTN. HTN took 15.7 (±5.8) (7-25) years, and protU detection took 16.2 (±5.9) (6-23) years, with the highest incidence of both HTN and protU between 15 and 20 years postoperatively. CONCLUSION According to our investigation, a prudent evaluation of signs of RF decrease at 10 years after surgery, and then every 5 years, until 20 years should be recommended, although further studies are necessary.
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Affiliation(s)
- Hahn-Ey Lee
- Department of Urology, Gachon University Gil Medical Center, Seoul, South Korea
| | - Kwanjin Park
- Department of Urology, The Armed Forces Medical Command, South Korea.
| | - Hwang Choi
- Department of Urology, The Armed Forces Medical Command, South Korea
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Abstract
PURPOSE The purpose of this study was to present the "bilateral based skin flap (BILAB) technique" for patients with perineal hypospadias associated with severe deep chordee and report the follow up. OPERATIVE PRINCIPLE The short urethral plate is incised, the hypoplastic corpus spongiosum excised, the glans split in the midline, and a healthy urethral plate is reconstructed from the lateral penile skin and foreskin to the tip of the glans. PATIENTS AND METHODS Between January 2005 and December 2011, the BILAB technique was performed in 68 patients with perineal hypospadias associated with severe chordee as a one or two stage repair. The records of 63 patients who maintained regular follow up were reviewed. The new urethra was reconstructed from the new urethral plate during the same setting in 26 patients. The remaining 37 patients had the urethroplasty performed 3-6 months later as a two stage repair. Patient age ranged from 8 months and 2 years (mean 10 months). Follow-up period ranged from 18 months to 8 years (mean 43 months). RESULTS Satisfactory results were obtained in 54 patients (85%). Two children developed diverticula, two patients developed glans dehiscence, one child developed fistula, and one child had complete wound dehiscence, and urethroplasty was successfully reconstructed 6 months later. Three patients developed scar contraction 6-12 months after surgery. This was corrected by excision of the scarred intermediate layer. CONCLUSIONS The BILAB technique is a reliable technique for patients with perineal hypospadias. It produces slit like meatus at the tip of the glans. The surgeon may decide intra-operatively whether to complete the urethroplasty in one or two stages. Long term follow up until puberty is being carried out.
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Affiliation(s)
- Ahmed T Hadidi
- Hypospadias Clinic, Department of Pediatric Surgery, Emma and Sana Offenbach Hospitals, Germany.
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