1
|
Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [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: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
Collapse
Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Golder WA. [The urological case reports of the Hippocratic Corpus : Medical practice in classical Greece]. Urologie 2024; 63:482-487. [PMID: 38498152 DOI: 10.1007/s00120-024-02314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Which theoretical and practical competences do the urologic case histories of the Hippocratic Corpus convey? MATERIALS AND METHODS The 431 Hippocratic case histories have been studied for reports and communication on diagnostic methods, treatment, and prognosis related to urologic diseases. RESULTS Within the seven books of the Hippocratic Epidemics, a total of 69 patients with urologic symptoms are described; in 21 cases the urologic disease is dominant. The leading clinical signs were urine discoloration and urinary sediment, polyuria, testicular swelling and pain, hematuria, stranguria, anuria, and renal pain, the most frequent diseases were nephritis and urolithiasis. Most patients were men in juvenile and adult age; 33 sick persons are named. The statements of patients regarding the course of their illness were often sparse. Diagnostic tests were restricted to inspection and palpation. Otherwise, treatment was confined to conservative measures. The dietary decisions for treatment of nephritis were differentiated but nonuniform. CONCLUSION The Hippocratic physician diagnosed and treated diseases of the urinary tract. Inflammatory conditions and traumatic lesions are described in detail. Highest priority was awarded to uroscopy. Nephritis was a widespread disorder und usually associated with other symptoms, above all fever. The urinary tract was often regarded as an indicator of physical and mental health. Conservative treatment measures dominate in the case reports.
Collapse
|
3
|
Krabbe L, Michel S, Krege S. [Practical relevance from urological guidelines]. Urologie 2024; 63:429-430. [PMID: 38739188 DOI: 10.1007/s00120-024-02332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Laura Krabbe
- Klinik für Urologie, Vivantes Netzwerk für Gesundheit GmbH, Am Nordgraben 2, 13509, Berlin, Deutschland.
| | - Stephan Michel
- Universitätsklinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Susanne Krege
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Kliniken Essen Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| |
Collapse
|
4
|
Dräger DL, Protzel C. [Pain therapy in urology-overview of current S3 guideline recommendations]. Urologie 2024; 63:462-468. [PMID: 38698261 DOI: 10.1007/s00120-024-02334-2] [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] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/05/2024]
Abstract
Dealing efficiently with patients suffering from pain is a central medical task. Pain, as an important function in developmental physiology, warns against damage to the body caused by external noxious agents as well as internal malfunctions and requires special attention in modern medicine. Peri- and postoperative pain is known to have a negative influence on postoperative convalescence. Treatment of tumor-related pain represents another relevant challenge in uro-oncology and palliative medicine. The updated guideline on perioperative pain therapy and palliative medicine for patients with incurable diseases or cancer is dedicated to these two topics.
Collapse
Affiliation(s)
- Desiree Louise Dräger
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Deutschland
- Arbeitskreis Schmerztherapie/Supportivtherapie/Palliativmedizin/Lebensqualität der DGU, Berlin, Deutschland
| | - Chris Protzel
- Klinik für Urologie, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19055, Schwerin, Deutschland.
- Arbeitskreis Schmerztherapie/Supportivtherapie/Palliativmedizin/Lebensqualität der DGU, Berlin, Deutschland.
| |
Collapse
|
5
|
Otto W. [Urology in Upper Palatinate-what archeology, historical research, and historiography reveal : Part 1: from Roman Antiquity to the late Middle Ages]. Urologie 2024; 63:269-277. [PMID: 38416168 PMCID: PMC10917864 DOI: 10.1007/s00120-024-02296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Since 1924, it has been possible to qualify as a specialist in urology in Germany. The first hospital departments for the treatment of urological conditions were established as early as the end of the German Empire and the Weimar Republic. However, the beginning of specialist medical care in the Bavarian administrative district of Upper Palatinate, often known as the "poorhouse" of Germany until the second half of the last century, was much later. Nevertheless, the lineage of "urological" activity here can be traced back to much earlier eras. Of course, it must be accepted that the evidence from times long past is weak. This is especially applicable when it comes to a topic such as the treatment of the sick and the preservation of health, which is not only considered a science but also often a central focus of life for us today, because in history it was often only mentioned in the fight against epidemics and in anecdotal descriptions. This is a circumstance which, when looking at the history of urology, gives rise to the hope of finding one or two interesting sources. This article not only aims to trace the history of the development of urology in a rural area from contemporary history to the present day, but also to explore the treatment of urological diseases in this region since late antiquity. Furthermore, we invite readers to look at other places of urological remembrance in a similar way.
Collapse
Affiliation(s)
- W Otto
- Lehrstuhl für Urologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- UROLOGIE im GesundheitsFORUM, Paracelsusstraße 2, 93053, Regensburg, Deutschland.
- Arbeitskreis Geschichte der Urologie der Deutschen Gesellschaft für Urologie, Uerdinger Str. 64, 40474, Düsseldorf, Deutschland.
| |
Collapse
|
6
|
Ahmed S. Stem Cells In Urology: A Promising Development For The Treatment Of Urological Disorders. J PAK MED ASSOC 2023; 73:2314. [PMID: 38013569 DOI: 10.47391/jpma.9321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Madam,
It was fascinating to read the latest research published in the Journal of Pakistan Medical Association (JPMA) on the utilisation of stem cells in urology. The study had some amazing findings, and I believe it has the power to revolutionise the treatment of urological disorders.1
Recent advances in stem cell research have opened new possibilities for treating various urological conditions. For example, findings have shown that stem cells can be used to promote tissue regeneration and repair in patients with urinary incontinence or erectile dysfunction.2 Additionally, stem cells can regenerate damaged renal tissue, offering the latest treatment options for patients with kidney disease.4
Apromising area of research includes use of mesenchymal stem cells (MSCs) to treat urological conditions. MSCs are multipotent cells that can specify into various cell types, including muscles, bones, and cartilage. They have been shown to up level the symptoms and improve quality of life in patients with urinary incontinence,They may also be very effective in treating a variety of urological conditions.2
One more area of research entails the use of induced pluripotent stem cells (iPSCs) in urology. iPSCs are reprogrammed from adult cells, like skin cells, into an embryonic-like state. They are differentiated into various cell types, making them a potentially important tool for regenerative medicine. Research has shown that iPSCs can be used to produce functional urothelial cells, which line the urinary tract and play a major role in bladder function.5
Overall, stem cell research in urology is a developing area that shows promise. It offers new treatment varieties for patients with urological conditions and has the potential to improve their quality of life. I strongly believe that this research will be of great interest to clinicians and researchers in this urology field, and I look forward to seeing further more developments in this exciting area of medicine.
It is also important to note that further research is strongly needed to fully explore the potential of stem cells in urology. This includes examining the long-term safety standards and efficacy of stem cell therapy, as well as identifying the optimal stem cell sources and delivery methods for variety of urological conditions. I strongly believe that ongoing research will continue to shed light on these important questions.
Collapse
Affiliation(s)
- Shah Ahmed
- 4th Year MBBS Student, Muhammad Medical College, MirpurKhas, Pakistan
| |
Collapse
|
7
|
Brady SS. A Social Ecological Perspective of Lower Urinary Tract Symptoms and Other Urological Conditions. J Urol 2023; 210:396-397. [PMID: 37340910 DOI: 10.1097/ju.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| |
Collapse
|
8
|
Laukhtina E. Gender aspects in urological disease. World J Urol 2023; 41:1719-1720. [PMID: 37439930 DOI: 10.1007/s00345-023-04504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
9
|
The return of the "in person" Urology Congress. BJU Int 2022; 130:140-1. [PMID: 35839134 DOI: 10.1111/bju.15844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Dobrowolska-Glazar B, Chrzan R, Bagłaj M. Various aspects of transition of care for adolescents with urological conditions. ADV CLIN EXP MED 2022; 31:157-163. [PMID: 35148571 DOI: 10.17219/acem/142758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transition into adulthood is a common issue in many disciplines. However, urology faces additional difficulties due to different models of care and training as well as a wide diversity of pathologies. The goal of this paper is to discuss various aspects of the transition of urological care. This review provides some examples of pathologies that might require special attention of specialists. Most patients with rare diseases must be closely followed up in the long term. However, high-volume conditions may also have a huge impact on the well-being and quality of life in adulthood. Children who are cured due to oncological conditions will probably need additional attention in adulthood. The urological care during childhood is provided by a pediatric urologist, a pediatric surgeon or a urologist, depending on the local regulations and the organization of care. All patients are subsequently referred to a general urologist. Nowadays, a multidisciplinary approach is recommended in many cases, with a pediatric urologist as one of the team members. The patient, caregivers and healthcare professionals must be fully involved and focused on close cooperation to make the transition process smooth and successful.
Collapse
Affiliation(s)
- Barbara Dobrowolska-Glazar
- Department of Pediatric Urology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Rafał Chrzan
- Department of Pediatric Urology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Bagłaj
- Division of Pediatric Propedeutics and Rare Disorders, Department of Pediatrics, Wroclaw Medical University, Poland
| |
Collapse
|
11
|
Lee DJ, Shelton JB, Brendel P, Doraiswami R, Makarov D, Meeks W, Fang R, Roe MT, Cooperberg MR. Impact of the COVID-19 Pandemic on Urological Care Delivery in the United States. J Urol 2021; 206:1469-1479. [PMID: 34470508 PMCID: PMC8584199 DOI: 10.1097/ju.0000000000002145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/05/2022]
Abstract
PURPOSE We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. MATERIALS AND METHODS We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. RESULTS We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). CONCLUSIONS This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.
Collapse
Affiliation(s)
- Daniel J. Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy B. Shelton
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | | | | | - Danil Makarov
- VA New York Harbor Healthcare System and Departments of Urology and Population Health, New York University Langone Medical Center, New York, New York
| | - William Meeks
- American Urological Association Education & Research, Department of Data Management & Statistical Analysis, Linthicum, Maryland
| | - Raymond Fang
- American Urological Association Education & Research, Department of Data Management & Statistical Analysis, Linthicum, Maryland
| | | | - Matthew R. Cooperberg
- Departments of Urology, and Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| |
Collapse
|
12
|
Haas H, Rassweiler J, Wirth M, Michel MS. [Outpatient urology in Europe]. Urologe A 2021; 61:52-58. [PMID: 34673997 DOI: 10.1007/s00120-021-01658-7] [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] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
In the care for patients with urological diseases, outpatient urology secures a near-to-home treatment by specialists in urology and is located between general practitioner and urological clinic. Comparably little is known about the structure and fields of work in this area of urology. A survey of the EAU Section ESUO of outpatient and office urology ( https://uroweb.org/section/esuo/ ) shows the diversity in terms of content and organisation of this sector in Europe, in which more than 16,500 outpatient urologists and thus about half of all professional urologists work full-time. This diversity is related to the diagnostic and therapeutic methods in outpatient urology and to the working conditions of outpatient urologists. For comparison, this information about European countries is contrasted with data from the German office urology as one type of outpatient urology.
Collapse
Affiliation(s)
- Helmut Haas
- Chairman of the EAU Section ESUO, Kiefernweg 3, 64646, Heppenheim, Deutschland.
| | - Jens Rassweiler
- Klinik für Urologie und Kinderurologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - Manfred Wirth
- Technische Universität Dresden, Dresden, Deutschland
| | - Maurice Stephan Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Deutschland
| |
Collapse
|
13
|
Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2021. [PMID: 32462305 DOI: 10.1007/s00345-%20020-%2003246-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
PURPOSE AND OBJECTIVE We performed a systematic review on COVID-19 and its potential urological manifestations. METHODS A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. RESULTS There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30-13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46-100%) amongst them. 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71-83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. CONCLUSIONS Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures.
Collapse
Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
| |
Collapse
|
14
|
Gallioli A, Albo G, Lievore E, Boeri L, Longo F, Spinelli MG, Costantino G, Montanari E, De Lorenzis E. How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone. Urology 2021; 147:43-49. [PMID: 33010292 PMCID: PMC7527349 DOI: 10.1016/j.urology.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. METHODS We retrospectively analysed all consecutive admissions to ED from 1 January to 9 April in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. RESULTS The number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (95% confidence interval -0.41/-0.19; Beta = -0.8; P < .0001). The average access per day was significantly lower after 10 March 2020 (1.5 ± 1.1 vs 6.5 ± 2.6; P < .0001), compared to reference period. From 11 March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; P = .001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; P = .02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta = 0.88; P < .0001) during 2020. CONCLUSION Urological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.
Collapse
Affiliation(s)
- Andrea Gallioli
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Giancarlo Albo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Lievore
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Fabrizio Longo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Emergency Department & Emergency Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| |
Collapse
|
15
|
Winkelman AJ, Beller HL, Morgan KE, Corbett ST, Leroy SV, Noona SW, Berry KL, Kern NG. Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic. J Pediatr Urol 2020; 16:840.e1-840.e6. [PMID: 33077389 PMCID: PMC7543732 DOI: 10.1016/j.jpurol.2020.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic. OBJECTIVE The primary aim of this study was to assess visit success rate and identify barriers to completing video visits. The secondary aim identified types of pathologies feasible for video visits and travel time saved. We hypothesize socioeconomic status is a predictor of a successful visit. MATERIALS AND METHODS Data was prospectively collected and analyzed on video visits focusing on visit success, defined by satisfactory completion of the visit as assessed by the provider. Other variables collected included duration, video platform and technical problems. Retrospective data was collected via chart review and analyzed including demographics, insurance, and distance to care. Socioeconomic status was estimated using the Distressed Communities Index generated for patient zip code. RESULTS/DISCUSSION Out of 116 attempted visits, 81% were successful. The top two reasons for failure were "no-show" (64%) and inability to connect (14%). Success versus failure of visit was similar for patient age (p = 0.23), sex (p = 0.42), type of visit (initial vs. established) (p = 0.51), and socioeconomic status (p = 0.39). After adjusting for race, socioeconomic status, and type of provider, having public insurance remained a significant predictor of failure (p = 0.017). Successful visits were conducted on multiple common pediatric urologic problems (excluding visits requiring palpation on exam), and video was sufficient for physical exams in most cases (Summary Table). A median of 2.25 h of travel time was saved. CONCLUSIONS While socioeconomic status, estimated using the Distressed Communities Index, did not predict success of video visits, patients with public insurance were more likely to have a failed video visit. There is compelling evidence that effective video visits for certain pathologies can be rapidly achieved in a pediatric urology practice with minimal preparation time.
Collapse
Affiliation(s)
| | - Haerin L Beller
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Kathryn E Morgan
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean T Corbett
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Susan V Leroy
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean W Noona
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Kaitlin L Berry
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
16
|
Douven P, Assmann R, Breukink SO, Melenhorst J, Kleijnen J, Joosten EA, van Koeveringe GA. Sacral Neuromodulation for Lower Urinary Tract and Bowel Dysfunction in Animal Models: A Systematic Review With Focus on Stimulation Parameter Selection. Neuromodulation 2020; 23:1094-1107. [PMID: 32809262 PMCID: PMC7818262 DOI: 10.1111/ner.13245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Conventional sacral neuromodulation (SNM) has shown to be an effective treatment for lower urinary tract and bowel dysfunction, but improvements of clinical outcome are still feasible. Currently, in preclinical research, new stimulation parameters are being investigated to achieve better and longer effects. This systematic review summarizes the status of SNM stimulation parameters and its effect on urinary tract and bowel dysfunction in preclinical research. MATERIALS AND METHODS The literature search was conducted using three databases: Ovid (Medline, Embase) and PubMed. Articles were included if they reported on stimulation parameters in animal studies for lower urinary tract or bowel dysfunction as a primary outcome. Methodological quality assessment was performed using the SYRCLE Risk of Bias (RoB) tool for animal studies. RESULTS Twenty-two articles were eligible for this systematic review and various aspects of stimulation parameters were included: frequency, intensity, pulse width, stimulation signal, timing of stimulation, and unilateral vs. bilateral stimulation. In general, all experimental studies reported an acute effect of SNM on urinary tract or bowel dysfunction, whereas at the same time, various stimulation settings were used. CONCLUSIONS The results of this systematic review indicate that SNM has a positive therapeutic effect on lower urinary tract and bowel dysfunction. Using low-frequency-SNM, high-frequency-SNM, bilateral SNM, and higher pulse widths showed beneficial effects on storage and evacuation dysfunction in animal studies. An increased variability of stimulation parameters may serve as a basis for future improvement of the effect of SNM in patients suffering from urinary tract or bowel dysfunction.
Collapse
Affiliation(s)
- Perla Douven
- Department of UrologyMaastricht University Medical CenterThe Netherlands
- Department of Anesthesiology and Pain ManagementMaastricht University Medical CenterThe Netherlands
- Department of SurgeryMaastricht University Medical CenterThe Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityThe Netherlands
| | - Roman Assmann
- Department of SurgeryMaastricht University Medical CenterThe Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityThe Netherlands
| | - Stephanie O. Breukink
- Department of SurgeryMaastricht University Medical CenterThe Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityThe Netherlands
| | - Jarno Melenhorst
- Department of SurgeryMaastricht University Medical CenterThe Netherlands
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business ParkYorkUK
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain ManagementMaastricht University Medical CenterThe Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityThe Netherlands
| | - Gommert A. van Koeveringe
- Department of UrologyMaastricht University Medical CenterThe Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityThe Netherlands
| |
Collapse
|
17
|
Abstract
The COVID-19 pandemic has caused a global health threat. This disease has brought about huge changes in the priorities of medical and surgical procedures. This short review article summarizes several test methods for COVID-19 that are currently being used or under development. This paper also introduces the corresponding changes in the diagnosis and treatment of urological diseases during the COVID-19 pandemic. We further discuss the potential impacts of the pandemic on urology, including the outpatient setting, clinical work, teaching, and research.
Collapse
Affiliation(s)
- Peng Jin
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hyusim Park
- Department of Electrical Engineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Sungyong Jung
- Department of Electrical Engineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Jayoung Kim
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA,
- Department of Medicine, University of California, Los Angeles, California, USA,
| |
Collapse
|
18
|
Santin Y, Lluel P, Rischmann P, Gamé X, Mialet-Perez J, Parini A. Cellular Senescence in Renal and Urinary Tract Disorders. Cells 2020; 9:cells9112420. [PMID: 33167349 PMCID: PMC7694377 DOI: 10.3390/cells9112420] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
Cellular senescence is a state of cell cycle arrest induced by repetitive cell mitoses or different stresses, which is implicated in various physiological or pathological processes. The beneficial or adverse effects of senescent cells depend on their transitory or persistent state. Transient senescence has major beneficial roles promoting successful post-injury repair and inhibiting malignant transformation. On the other hand, persistent accumulation of senescent cells has been associated with chronic diseases and age-related illnesses like renal/urinary tract disorders. The deleterious effects of persistent senescent cells have been related, in part, to their senescence-associated secretory phenotype (SASP) characterized by the release of a variety of factors responsible for chronic inflammation, extracellular matrix adverse remodeling, and fibrosis. Recently, an increase in senescent cell burden has been reported in renal, prostate, and bladder disorders. In this review, we will summarize the molecular mechanisms of senescence and their implication in renal and urinary tract diseases. We will also discuss the differential impacts of transient versus persistent status of cellular senescence, as well as the therapeutic potential of senescent cell targeting in these diseases.
Collapse
Affiliation(s)
- Yohan Santin
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
| | - Philippe Lluel
- Urosphere SAS, Rue des Satellites, 31400 Toulouse, France;
| | - Pascal Rischmann
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31432 Toulouse, France; (P.R.); (X.G.)
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31432 Toulouse, France; (P.R.); (X.G.)
| | - Jeanne Mialet-Perez
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
| | - Angelo Parini
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
- Correspondence: ; Tel.: +33-561325601
| |
Collapse
|
19
|
Gomes CM, Favorito LA, Henriques JVT, Canalini AF, Anzolch KMJ, de Carvalho Fernandes R, Bellucci CHS, Silva CS, Wroclawski ML, Pompeo ACL, de Bessa J. Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists. Int Braz J Urol 2020; 46:1042-1071. [PMID: 32539253 PMCID: PMC7527096 DOI: 10.1590/s1677-5538.ibju.2020.99.15] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
Collapse
Affiliation(s)
- Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - João Victor T Henriques
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alfredo F Canalini
- Divisão de Urologia, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Karin M J Anzolch
- Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Carlos H S Bellucci
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Caroline S Silva
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | - Marcelo L Wroclawski
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Departamento de Urologia, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | | | - José de Bessa
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| |
Collapse
|
20
|
Abstract
Although often considered a single-entity, chronic kidney disease (CKD) comprises many pathophysiologically distinct disorders that result in persistently abnormal kidney structure and/or function, and encompass both monogenic and polygenic aetiologies. Rare inherited forms of CKD frequently span diverse phenotypes, reflecting genetic phenomena including pleiotropy, incomplete penetrance and variable expressivity. Use of chromosomal microarray and massively parallel sequencing technologies has revealed that genomic disorders and monogenic aetiologies contribute meaningfully to seemingly complex forms of CKD across different clinically defined subgroups and are characterized by high genetic and phenotypic heterogeneity. Investigations of prevalent genomic disorders in CKD have integrated genetic, bioinformatic and functional studies to pinpoint the genetic drivers underlying their renal and extra-renal manifestations, revealing both monogenic and polygenic mechanisms. Similarly, massively parallel sequencing-based analyses have identified gene- and allele-level variation that contribute to the clinically diverse phenotypes observed for many monogenic forms of nephropathy. Genome-wide sequencing studies suggest that dual genetic diagnoses are found in at least 5% of patients in whom a genetic cause of disease is identified, highlighting the fact that complex phenotypes can also arise from multilocus variation. A multifaceted approach that incorporates genetic and phenotypic data from large, diverse cohorts will help to elucidate the complex relationships between genotype and phenotype for different forms of CKD, supporting personalized medicine for individuals with kidney disease.
Collapse
Affiliation(s)
- Emily E Groopman
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gundula Povysil
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - David B Goldstein
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - Ali G Gharavi
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York, NY, USA.
- Center for Precision Medicine and Genomics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
| |
Collapse
|
21
|
Lu Y, Liu X. Urologists and the Novel Coronavirus Disease 2019 (COVID-19): a Urologist's Perspective from China. Urol J 2020; 17:557. [PMID: 32920814 DOI: 10.22037/uj.v16i7.6086] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023]
Abstract
No need for letter to the editor.
Collapse
Affiliation(s)
- Yi Lu
- epartment of Urology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Xiaoqiang Liu
- epartment of Urology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| |
Collapse
|
22
|
Jain A, Croghan SM, Kelly C, Scanlon L, Daniels AE, Fitzgibbon L, O'Connor K, Shields WP, Nama G, Cullen IM, Daly PJ. The Early Impact of COVID-19 on Urological Service Provision. Ir Med J 2020; 113:157. [PMID: 33730472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aim COVID-19 has posed an unprecedented challenge to healthcare systems. We aimed to observe the impact on urological care delivery in an Irish university hospital. Methods Data on urological activity was prospectively collected for 3 months from March 2020. A retrospective review of the same period in 2019 was performed for control data. Results Over the 2020 study period, 356 urological admissions were recorded; a 23.1% decrease from the 2019 corresponding period(n=463). A 21.7% decrease in flexible cystoscopies was seen (162 versus 207). 125 theatre cases (36 off-site) were performed in the 2020 period, versus 151 in 2019. Emergency case load remained stable, with 69 cases in the 2020 period. The percentage of trainee-performed cases was preserved. COVID-era outpatient activity increased, to involve 559 clinic consultations compared to 439 the preceding year; a reflection of annual growth in service demand and facilitated by virtual clinic application (n=403). There were 490 instances of patients cancelling/failing to attend outpatient appointments, compared to 335 in 2019. Conclusion The Irish COVID-19 outbreak has created obstacles for urological care. Nonetheless, urgent/emergent urological cases persist. Our unit has managed this to-date with flexible adaptation of service delivery. The global challenge posed by COVID-19 will demand ongoing resourcefulness to minimise impact on patients with time-sensitive urological conditions.
Collapse
Affiliation(s)
- A Jain
- University Hospital Waterford, Waterford, Ireland
| | - S M Croghan
- University Hospital Waterford, Waterford, Ireland
| | - C Kelly
- University Hospital Waterford, Waterford, Ireland
| | - L Scanlon
- University Hospital Waterford, Waterford, Ireland
| | - A E Daniels
- University Hospital Waterford, Waterford, Ireland
| | - L Fitzgibbon
- University Hospital Waterford, Waterford, Ireland
| | - K O'Connor
- University Hospital Waterford, Waterford, Ireland
| | - W P Shields
- University Hospital Waterford, Waterford, Ireland
| | - G Nama
- University Hospital Waterford, Waterford, Ireland
| | - I M Cullen
- University Hospital Waterford, Waterford, Ireland
| | - P J Daly
- University Hospital Waterford, Waterford, Ireland
| |
Collapse
|
23
|
Papaefstathiou E, Apostolopoulou A, Papaefstathiou E, Moysidis K, Hatzimouratidis K, Sarafis P. Urology during a Crisis: A Management Algorithm. Urol J 2020; 17:536-539. [PMID: 32869251 DOI: 10.22037/uj.v16i7.6278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/09/2020] [Indexed: 06/11/2023]
Abstract
COVID-19 pandemic has affected more than a million people worldwide causing a public health crisis. Under these unique circumstances, urologists continue to provide essential healthcare services and support healthcare systems, by participating in the treatment of COVID-19(+) patients and sparing vital equipment and hospital beds. However, delivering medical care during the pandemic requires strategic planning for all surgical and outpatient activities. Proposed measures include rescheduling elective non-oncological surgeries and using a prioritization protocol for oncological surgeries according to hospital capacity. Following that, outpatient clinics could be partly replaced by telemedicine. Additionally, urologists should be trained in screening and treating patients with COVID-19 during their daily routine. In order to efficiently provide their services, a management protocol for suspected or known COVID-19 urological patients should be implemented. Furthermore, preventive measures for the nosocomial dispersion of the virus and training on self-protective equipment is mandatory for all physicians. Finally, organizational planning for the best utilization of the staff is of utmost importance. Implementation and adaptation of the protocols according to local requirements and guidelines will ameliorate the quality of services and population's health status. Finally, enhancement of current practices will prepare health systems for future crisis.
Collapse
Affiliation(s)
- Efstathios Papaefstathiou
- 2nd Urology Department of Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Aikaterini Apostolopoulou
- GP- Emergency Department, General Hospital AHEPA, reference center for COVID-19, Thessaloniki, Greece.
| | | | - Kyriakos Moysidis
- 2nd Urology Department of Medical School, Aristotle University of Thessaloniki.
| | | | | |
Collapse
|
24
|
Affiliation(s)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
| | - Cristina Mussini
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
25
|
Spinoit AF, Haid B, Hiess M, Banuelos B, Hoen L', Radford A, Silay MS. Impact of the COVID-19 Pandemic on Paediatric Urology Practice in Europe: A Reflection from the European Association of Urology Young Academic Urologists. Eur Urol 2020; 78:122-124. [PMID: 32331707 PMCID: PMC7158800 DOI: 10.1016/j.eururo.2020.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023]
Affiliation(s)
| | - Bernhard Haid
- Department of Paediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria; Department of Urology, Ludwig Maximilians University, Munich, Germany
| | - Manuela Hiess
- Department of Paediatric Urology, Medical University of Vienna, Vienna, Austria
| | - Beatriz Banuelos
- Department of Urology, Charité University Clinic, Berlin, Germany
| | - Lisette 't Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anna Radford
- Department of Paediatric Surgery, Leeds Children's Hospital NHS Trust, Leeds, UK
| | - Mesrur Selçuk Silay
- Division of Paediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
26
|
Sighinolfi MC, Rocco B, Mussini C. COVID-19: Importance of the Awareness of the Clinical Syndrome by Urologists. Eur Urol 2020; 78:e40-e41. [PMID: 32345522 DOI: 10.1016/j.eururo.2020.0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 05/20/2023]
Affiliation(s)
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
| | - Cristina Mussini
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
27
|
Chen W, Wang XM, Fu GQ, Zeng X, Wu CP, Liang Y, Liu JH, Teoh JYC. Special strategies and management of urological diseases during the COVID-19 pandemic: initial experiences from a Medical Center of China. Int Braz J Urol 2020; 46:19-25. [PMID: 32549072 PMCID: PMC7719996 DOI: 10.1590/s1677-5538.ibju.2020.s102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 01/18/2023] Open
Abstract
Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.
Collapse
Affiliation(s)
- Wei Chen
- Zigong Fourth People's HospitalDepartment of UrologySichuanChinaDepartment of Urology, Zigong Fourth People's Hospital, Sichuan, China
- Zigong Fourth People's HospitalDepartment of Science and EducationSichuanChinaDepartment of Science and Education, Zigong Fourth People's Hospital, Sichuan, China
| | - Xiao-Meng Wang
- Zigong Fourth People's HospitalDepartment of Hospital InfectionSichuanChinaDepartment of Hospital Infection, Zigong Fourth People's Hospital, Sichuan, China
| | - Guang-Qing Fu
- Zigong Fourth People's HospitalDepartment of UrologySichuanChinaDepartment of Urology, Zigong Fourth People's Hospital, Sichuan, China
| | - Xiang Zeng
- Zigong Fourth People's HospitalDepartment of UrologySichuanChinaDepartment of Urology, Zigong Fourth People's Hospital, Sichuan, China
| | - Cui-Ping Wu
- Zigong Fourth People's HospitalDepartment of Science and EducationSichuanChinaDepartment of Science and Education, Zigong Fourth People's Hospital, Sichuan, China
| | - Yong Liang
- Zigong Fourth People's HospitalDepartment of UrologySichuanChinaDepartment of Urology, Zigong Fourth People's Hospital, Sichuan, China
| | - Jian-Hui Liu
- Zigong Fourth People's HospitalDepartment of UrologySichuanChinaDepartment of Urology, Zigong Fourth People's Hospital, Sichuan, China
| | - Jeremy Yuen-Chun Teoh
- The Chinese University of Hong KongSH Ho Urology CentreDepartment of SurgeryHong KongChinaDepartment of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
28
|
Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2020; 39:3127-3138. [PMID: 32462305 PMCID: PMC7251800 DOI: 10.1007/s00345-020-03246-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose and objective We performed a systematic review on COVID-19 and its potential urological manifestations. Methods A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. Results There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30–13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46–100%) amongst them. 5.74% (95% CI 2.88–9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71–83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. Conclusions Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures. Electronic supplementary material The online version of this article (10.1007/s00345-020-03246-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
| |
Collapse
|
29
|
Porreca A, Colicchia M, D'Agostino D, Amenta M, Corsaro A, Zaramella S, Zegna L, Gallo F, Schenone M, Bozzini G, Calori A, Pastore AL, Al Salhi Y, Sciorio C, Spirito L, Varca V, Marenghi C, Greco F, Altieri VM, Verze P, Barba C, Antonelli A, Cerruto MA, Falabella R, Di Bello S, Leonardo C, Tufano A, Volpe A, Umari P, Parma P, Nidini M, Pini G, Borghesi M, Terrone C, Cacciamani GE, Sighinolfi MC, Busetto GM, Wennberg AM, Finocchiaro M, Falsaperla M, Oderda M, Ceruti C, Rocco B, Schiavina R, Bianchi L, Mari A, Di Maida F, Dalpiaz O, Celia A, Pirozzi M, Bove P, Iacovelli V, Cafarelli A, Cindolo L, Ferrari G, Gatti L, Pirola G, Annino F, Pucci L, Romagnoli D, Artibani W, Minervini A. Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy. Urol Int 2020; 104:631-636. [PMID: 32434207 PMCID: PMC7360500 DOI: 10.1159/000508512] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. MATERIALS AND METHODS A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. RESULTS Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). CONCLUSION In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.
Collapse
Affiliation(s)
- Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | | | | | - Michele Amenta
- Department of Urology, Ospedale Civile di Portogruaro, Portogruaro, Italy
| | - Alfio Corsaro
- Department of Urology, Ospedale Civile di Portogruaro, Portogruaro, Italy
| | | | - Luisa Zegna
- Department of Urology, Biella Hospital, Ponderano, Italy
| | - Fabrizio Gallo
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
| | - Maurizio Schenone
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | - Antonio L Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Urology Unit, ICOT Hospital Latina, Rome, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Urology Unit, ICOT Hospital Latina, Rome, Italy
| | | | | | - Virginia Varca
- Hospital G. Salvini, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | - Carlo Marenghi
- Hospital G. Salvini, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | | | - Paolo Verze
- Department of Urology, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Ciro Barba
- Department of Urology, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Roberto Falabella
- Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | - Silvana Di Bello
- UO Pronto Soccorso, Accettazione, Medicina Urgenza, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | | | - Antonio Tufano
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Umari
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Parma
- Urology Department, ASST Mantova, Mantova, Italy
| | | | | | - Marco Borghesi
- Department of Urology, S. Martino Hospital, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Carlo Terrone
- Department of Urology, S. Martino Hospital, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Maria C Sighinolfi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University Policlinico Umberto I, Rome, Italy
| | - Alexandra M Wennberg
- Department of Neurosciences (Padova Neuroscience Centre), Università degli Studi di Padova, Padova, Italy
| | | | | | - Marco Oderda
- Università di Torino, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carlo Ceruti
- Università di Torino, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bernardo Rocco
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy
| | | | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Marco Pirozzi
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Pierluigi Bove
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Rome, Italy
| | - Valerio Iacovelli
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Rome, Italy
| | | | - Luca Cindolo
- Department of Urology, Villa Stuart Casa di Cura, Rome, Italy
| | | | - Lorenzo Gatti
- Department of Urology, Hesperia Hospital, Modena, Italy
| | - Giacomo Pirola
- Department of Urology, San Donato Hospital, USL Toscana Sudest, Arezzo, Italy
| | - Filippo Annino
- Department of Urology, San Donato Hospital, USL Toscana Sudest, Arezzo, Italy
| | - Luigi Pucci
- Department of Urology, AORN A. Cardarelli, Naples, Italy
| | | | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | | |
Collapse
|
30
|
Souders CP, Zhao H, Ackerman AL. Considerations for Bedside Urologic Procedures in Patients With Severe Acute Respiratory Syndrome Coronavirus-2. Urology 2020; 142:26-28. [PMID: 32339561 PMCID: PMC7195357 DOI: 10.1016/j.urology.2020.04.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 01/08/2023]
Abstract
Objective To provide guidance when performing bedside urologic procedures on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive patients and offer considerations to maximize the safety of the patients and providers, conserve supplies, and provide optimal management of urologic issues. Methods Urologic trainees and attending physicians at our institution, who are familiar with existing safety recommendations and guidelines regarding the care of infected patients, were queried regarding their experiences to determine an expert consensus on best practices for bedside procedures for SARS-CoV-2 positive patients. Results Our team developed the following general recommendations for urologic interventions on SARS-CoV-2 positive patients: maximize use of telehealth (even for inpatient consults), minimize in-room time, use personal protective equipment appropriately, enlist a colleague to assist, and acquire all supplies that may be needed and maintain them outside the room. Detailed recommendations were also developed for difficult urethral catheterization, bedside cystoscopy, incision and drainage of abscesses, and gross hematuria/clot irrigations. Conclusion As patients hospitalized with SARS-CoV-2 infection are predominantly men over 50 years old, there are significant urologic challenges common in this population that have emerged with this pandemic. While there is tremendous variation in how different regions have been affected, the demographics of SARS-CoV-2 mean that urologists will continue to have a unique role in helping to manage these patients. Here, we summarize recommendations for bedside urologic interventions specific to SARS-CoV-2 positive patients based on experiences from a large metropolitan hospital system. Regulations and requirements may differ on an institutional basis, so these guidelines are intended to augment specific local protocols.
Collapse
Affiliation(s)
- Colby P Souders
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hanson Zhao
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - A Lenore Ackerman
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| |
Collapse
|
31
|
Mozaffar M, Shahrbaf MA, Arabzadeh A, Shojaei R, Azimi B. Urinary Tract Bleeding as a Rare Manifestation of Uterine Artery Pseudoaneurysm. Ann Vasc Surg 2020; 68:570.e5-570.e8. [PMID: 32339681 DOI: 10.1016/j.avsg.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/19/2022]
Abstract
Pseudoaneurysm of the uterine artery is a rare condition, which usually occurs after a traumatic birth, cesarean section, dilatation and curettage, and hysterectomy. This case is a 28-year-old female patient that presented with the chief complaint of severe urinary tract bleeding and hypovolemic shock. This patient underwent cesarean section 2 months before the first presentation. After the primary examination, the patient was sent to the hybrid operation room with the primary diagnosis of uterine artery pseudoaneurysm and coil embolization was done for treating the pseudoaneurysm. Considering continued bleeding, open surgery was performed and the internal iliac artery was ligated.
Collapse
Affiliation(s)
- Mohammad Mozaffar
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirahmad Arabzadeh
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shojaei
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Azimi
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
32
|
Ribal MJ, Cornford P, Briganti A, Knoll T, Gravas S, Babjuk M, Harding C, Breda A, Bex A, Rassweiler JJ, Gözen AS, Pini G, Liatsikos E, Giannarini G, Mottrie A, Subramaniam R, Sofikitis N, Rocco BMC, Xie LP, Witjes JA, Mottet N, Ljungberg B, Rouprêt M, Laguna MP, Salonia A, Bonkat G, Blok BFM, Türk C, Radmayr C, Kitrey ND, Engeler DS, Lumen N, Hakenberg OW, Watkin N, Hamid R, Olsburgh J, Darraugh J, Shepherd R, Smith EJ, Chapple CR, Stenzl A, Van Poppel H, Wirth M, Sønksen J, N'Dow J. European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era. Eur Urol 2020; 78:21-28. [PMID: 32376137 PMCID: PMC7183974 DOI: 10.1016/j.eururo.2020.04.056] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.
Collapse
Affiliation(s)
- Maria J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
| | - Philip Cornford
- Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Alberto Briganti
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Thomas Knoll
- Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Alberto Breda
- Oncology Urology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Axel Bex
- The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jens J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - Ali S Gözen
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
| | | | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Alex Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ramnath Subramaniam
- Department of Paediatric Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, University Campus, Ioannina, Greece
| | - Bernardo M C Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Li-Ping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Morgan Rouprêt
- Urology, Sorbonne University, GRC 5 Predictive onco-uro, AP-HP, Pitie-Salpetriere Hospital, Paris, France
| | - Maria P Laguna
- Department of Urology Medipol Mega, Istanbul Medipol University, Istanbul, Turkey; Amsterdam UMC, Amsterdam, The Netherlands
| | - Andrea Salonia
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gernot Bonkat
- Alta Uro AG, Merian Iselin Klinik, Center of Biomechanics and Calorimetry, University Basel, Basel, Switzerland
| | - Bertil F M Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis mit Steinzentrum, Vienna, Austria
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Oliver W Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Germany
| | - Nick Watkin
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | - Rizwan Hamid
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathon Olsburgh
- Department of Urology and Transplant, Guy's & St Thomas' NHS Trust Hospitals, London, UK
| | - Julie Darraugh
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Robert Shepherd
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma-Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Manfred Wirth
- Department of Urology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Jens Sønksen
- Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
33
|
Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Imaging findings of infectious and inflammatory diseases of the urinary system mimicking neoplastic diseases. Abdom Radiol (NY) 2020; 45:1110-1121. [PMID: 31570959 DOI: 10.1007/s00261-019-02222-w] [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] [Indexed: 12/26/2022]
Abstract
Neoplastic diseases affecting the urinary organs are common, and diagnosis by imaging is usually straightforward. However, infectious/inflammatory processes also commonly affect these organs and can be mistaken for a neoplasm. Familiarity with these potential mimickers and awareness of their imaging presentations are key for correct diagnosis. We present the imaging findings of non-neoplastic infectious/inflammatory diseases that can mimic a neoplastic process.
Collapse
Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| |
Collapse
|
34
|
Hong JY, Suh SW, Shin J. Clinical significance of urinary obstruction in critically ill patients with urinary tract infections. Medicine (Baltimore) 2020; 99:e18519. [PMID: 31895786 PMCID: PMC6946250 DOI: 10.1097/md.0000000000018519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (P = .01 and P < .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate -3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate -2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate -6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
Collapse
Affiliation(s)
| | | | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| |
Collapse
|
35
|
Capogrosso P, Candela L, Rossi P, Guarasci C, Muttin F, Roscigno M, Chianese R, Santoleri L, Tassara M, Carcano G, Naspro R, Da Pozzo L, Montorsi F, Salonia A, Dehò F. Increased Use of Blood Transfusions to Manage Urological Conditions during the COVID-19 Pandemic. Urol Int 2020; 104:849-852. [PMID: 33017835 PMCID: PMC7573906 DOI: 10.1159/000511651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022]
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to an extensive reorganization of the healthcare system in Italy, with significant deferment of the treatment of urology patients. We aimed to assess the impact of deferred treatment during the SARS-CoV-2 pandemic on the need for blood transfusions in 3 Italian urology departments. Methods We reviewed hospital chart data on blood transfusions at the urology units of 3 academic centers in the north of Italy from March to April 2020. Data were compared with values from the same time frame in 2019 (March to April 2019). Results We observed significant reductions of the number of patients admitted to the urology units from March to April 2020 (373 vs. 119) and the number of performed surgeries (242 vs. 938) compared to 2019. Though, the number of transfused blood units was comparable between the 2 years (182 vs. 252), we found a greater mean number of blood units transfused per admission in 2020 (0.49 vs. 0.22; p < 0.0001). As a whole, the transfusion rate for hematuria was higher in 2020 than in 2019 (36 vs. 7.9%; p < 0.0001). Discussion/Conclusion The observed increased number of blood transfusions needed throughout the SARS-CoV-2 era could have had a negative impact on both patients and the healthcare system. It is possible to speculate that this is the consequence of a delayed diagnosis and deferred treatment of acute conditions.
Collapse
Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy,
| | - Luigi Candela
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Piercarlo Rossi
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
| | - Cristian Guarasci
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
| | - Fabio Muttin
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Marco Roscigno
- Department of Urology, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Rosa Chianese
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
- University of Insubria, Varese, Italy
| | - Luca Santoleri
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michela Tassara
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Carcano
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
- University of Insubria, Varese, Italy
| | - Richard Naspro
- Department of Urology, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XIII Hospital, Bergamo, Italy
- University of Bicocca, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Dehò
- Department of Urology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
- University of Insubria, Varese, Italy
| |
Collapse
|
36
|
Abstract
Diseases of the urinary tract are reviewed, covering infectious (bacterial, viral, parasitic), degenerative, congenital, metabolic, nutritional, neoplastic, obstructive, and toxic causes. Some clinical presentations and diagnostic procedures are described for ferrets, rabbits, guinea pigs, hamsters, mice, rats, chinchillas, hedgehogs, and sugar gliders, as well as therapies.
Collapse
Affiliation(s)
- Drury R Reavill
- Zoo/Exotic Pathology Service, 6020 Rutland Drive #14, Carmichael, CA 95608-0515, USA.
| | - Angela M Lennox
- Avian and Exotic Animal Clinic of Indianapolis, 9330 Waldemar Road, Indianapolis, IN 46268, USA
| |
Collapse
|
37
|
Loughlin KR. Are You A Hedgehog Or A Fox? Can J Urol 2019; 26:10007. [PMID: 31860415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
38
|
Tatar İ, Huri E, Selçuk İ, Moon YL, Paoluzzi A, Skolarikos A. Review of the effect of 3D medical printing and virtual reality on urology training with ‘MedTRain3DModsim’ Erasmus + European Union Project. Turk J Med Sci 2019; 49:1257-1270. [PMID: 31648427 PMCID: PMC7018298 DOI: 10.3906/sag-1905-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background/aim It is necessary to incorporate novel training modalities in medical education, especially in surgical fields, because of the limitations of cadaveric training. Traditional medical education has many drawbacks, such as residency working hour restrictions, patient safety conflicts with the learning needs, and the lack of hands-on workshops. The MedTRain3DModsim Project aimed to produce 3-dimensional (3D) medical printed models, simulations, and innovative applications for every level of medical training using novel worldwide technologies. It was aimed herein to improve the interdisciplinary and transnational approaches, and accumulate existing experience for medical education, postgraduate studies, and specialty training. Materials and methods This project focused on models of solid organs and the urinary system, including the kidney, prostate, ureter, and liver. With 3D medical printing, it is possible to produce a body part from inert materials in just a few hours with the standardization of medical 3D modeling. Results The target groups of this project included medical students and residents, graduate students from engineering departments who needed medical education and surgical training, and medical researchers interested in health technology or clinical and surgical an atomy. Conclusion It was also intended to develop a novel imaging platform for education and training by reevaluating the existing data using new software and 3D modalities. Therefore, it was believed that our methodology could be implemented in all related medical fields.
Collapse
Affiliation(s)
- İlkan Tatar
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Huri
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlker Selçuk
- Department of Gynecologic-Oncology, Zekai Tahir Burak Research and Educational Hospital, Ankara, Turkey
| | - Young Lee Moon
- Department of Orthopedics, Chosun University, Chosun, South Korea
| | - Alberto Paoluzzi
- Department of Mathematics and Physics, Rome Tre University, Rome, Italy
| | | |
Collapse
|
39
|
Glybochko PV, Butnaru DV. [Multidisciplinary approach in urology. Research aspect]. Urologiia 2019:2-6. [PMID: 31535790] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Multidisciplinary studies in urology is becoming a new global trend which is associated with an emerging of omix technology, big data, the development of IT and other technologies. The concept of "multidisciplinary approach" as well as a brief historical analysis of the development of urologic science are discussed in the article, based on the international Scopus database. An example of a multidisciplinary approach implemented in the Science and Technology Park for Biomedicine of Sechenov University is given. The stages of the creation and implantation of the tissue-engineering urethral wall are described. For the successful development of urologic researches, the active involvement of specialists from various fields of knowledge is required. Such a combination of competencies has already allowed to solve problems of an extremely high level of complexity now, and not in the distant future.
Collapse
Affiliation(s)
- P V Glybochko
- Science and Technology Park for Biomedicine FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - D V Butnaru
- Science and Technology Park for Biomedicine FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| |
Collapse
|
40
|
Glybochko PV, Gadzhiev ZK, Alyaev YG, Gazimiev MA. [Multidisciplinary approach in urology. Clinical aspects]. Urologiia 2019:28-35. [PMID: 31535795] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A solving diagnostic and therapeutic problems in patients with various urologic diseases often requires a cooperation between different specialists which emphasizes the interdisciplinarity of our discipline. A number of clinical manifestations and diseases that urologists have to deal with and in which they definitely need a timely assistance from other specialists are described in the article. Determining the connecting links in the work of different specialists, we tried to recall the main " intersection points" and draw attention to the necessary cooperation.
Collapse
Affiliation(s)
- P V Glybochko
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - Z K Gadzhiev
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - Yu G Alyaev
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - M A Gazimiev
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| |
Collapse
|
41
|
Nassir AM, Baazeem A, Saada H, Elkoushy MA, Badr H, Bahuwyrith M, Melebari HA, Nasser J, Azhar RA. Urological knowledge among primary health care physicians in Saudi Arabia. Saudi Med J 2019; 40:483-489. [PMID: 31056626 PMCID: PMC6535177 DOI: 10.15537/smj.2019.5.24080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the general knowledge among primary health care (PHC) physicians regarding the management of common urological problems in Saudi Arabia. Methods: This is an observational prospective study, where a self-administered questionnaire was distributed to practicing PHC physicians in the western region of Saudi Arabia on January 2017. The questionnaire consisted of 21-item questions, inquiring about demographics and general urological knowledge and skills. The management of common urological problems was assessed by case scenarios for specific urological condition, including urethral catheterization, definition and evaluation of hematuria, recognition of age-specific increase in prostatic specific antigen (PSA), and management of lower urinary tract symptoms. Results: A total of 148 questionnaires were distributed, with a response rate of 75.7%, where 112 respondents completed the questionnaires, including 54.3% residents, 39% general practitioners, and 5.4% specialists. Fifty-seven percent of respondents were males and 68% were Saudi practitioners. A higher number of respondents expressed that they were able to catheterize a male than female patient (56.5% versus 34.3%). Only 6.4% of respondents defined microscopic hematuria accurately. Knowledge about hematuria, serum prostate specific antigen and overactive bladder was low in all groups. Apart from hematuria, seeking urological consultations was less than 35% for all other disease entities. Conclusion: Urological knowledge among PHC physicians seems to be insufficient. Significant percentages of the participants were unable to catheterize a female patient, did not know the definition of hematuria; and whether to ask for urological consultations in cases of hematuria, increased PSA, and overactive bladder.
Collapse
Affiliation(s)
- Anmar M Nassir
- Department of Surgery, Umm-Alqura University, Makkah, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Miah S, Dunford C, Edison M, Eldred-Evans D, Gan C, Shah TT, Lunn P, Winkler M, Ahmed HU, Gibbons N, Hrouda D. A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic. Ann R Coll Surg Engl 2019; 101:30-34. [PMID: 30286648 PMCID: PMC6303818 DOI: 10.1308/rcsann.2018.0151] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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] [Accepted: 06/02/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. MATERIAL AND METHODS We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. RESULTS In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. CONCLUSIONS Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.
Collapse
Affiliation(s)
- S Miah
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Both are first joint authors
| | - C Dunford
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Both are first joint authors
| | - M Edison
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - C Gan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - TT Shah
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P Lunn
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M Winkler
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - HU Ahmed
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - N Gibbons
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Hrouda
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| |
Collapse
|
43
|
Abstract
Minimally invasive interventional therapies are the new standard of care in veterinary medicine. In comparison with standard surgical procedures, they are associated with minimal tissue injury, leading to shorter, smoother recovery and decreasing the perioperative morbidity and mortality. A thorough understanding of the therapeutic options available is essential to properly educate and inform clients. Proper equipment, technical expertise, and experience are essential prerequisites to many of these procedures.
Collapse
Affiliation(s)
- Emmanuelle Butty
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd, North Grafton, MA 01536, USA
| | - Catherine Vachon
- Centre Hospitalier Universitaire Vétérinaire, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Marilyn Dunn
- Centre Hospitalier Universitaire Vétérinaire, Faculty of Veterinary Medicine, University of Montreal, 1525 Rue des Vétérinaires, Saint-Hyacinthe, QC J2S 8H5, Canada.
| |
Collapse
|
44
|
Bikbov B, Perico N, Remuzzi G. A comparison of metrics and performance characteristics of different search strategies for article retrieval for a systematic review of the global epidemiology of kidney and urinary diseases. BMC Med Res Methodol 2018; 18:110. [PMID: 30340535 PMCID: PMC6194627 DOI: 10.1186/s12874-018-0569-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Conducting a systematic review requires a comprehensive bibliographic search. Comparing different search strategies is essential for choosing those that cover all useful data sources. Our aim was to develop search strategies for article retrieval for a systematic review of the global epidemiology of kidney and urinary diseases, and evaluate their metrics and performance characteristics that could be useful for other systematic epidemiologic reviews. METHODS We described the methodological framework and analysed approaches applied in the previously conducted systematic review intended to obtain published data for global estimates of the kidney and urinary disease burden. We used several search strategies in PubMed and EMBASE, and compared several metrics: number needed to retrieve (NNR), number of extracted data rows, number of covered countries, and when appropriate, sensitivity, specificity, precision, and accuracy. RESULTS The initial search obtained 29,460 records from PubMed, and 4247 from EMBASE. After the revision, the full text of 381 and 14 articles respectively was obtained for data extraction (the percentage of useful records is 1.3% for PubMed, 0.3% for EMBASE). For PubMed we developed two search strategies and compared them with a 'gold standard' formed by merging their results: free word search strategy (FreeWoSS) was based on the search for keywords in all fields, and subject headings based search strategy (SuHeSS) used only MeSH-mapped conditions and countries names. SuHeSS excluded almost 15% of useful articles and data rows extracted from them, but had a lower NNR of 40 and higher specificity. FreeWoSS had better sensitivity and was able to cover the vast majority of articles and extracted data rows, but had a higher NNR of 65. CONCLUSIONS The sensitive FreeWoSS strategy provides more data for modelling, while the more specific SuHeSS strategy could be used when resources are limited. EMBASE has limited value for our systematic review.
Collapse
Affiliation(s)
- Boris Bikbov
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via G.-B. Camozzi 3 –, 24020 Bergamo, Ranica Italy
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via G.-B. Camozzi 3 –, 24020 Bergamo, Ranica Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via G.-B. Camozzi 3 –, 24020 Bergamo, Ranica Italy
- Unit of Nephrology, Dialysis and Transplantation, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
45
|
Kim HH, Tulin-Silver S, Yu RN, Chow JS. Common genitourinary catheters: a systematic approach for the radiologist. Pediatr Radiol 2018; 48:1155-1166. [PMID: 29748933 DOI: 10.1007/s00247-018-4148-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/24/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
Catheters are commonly used to treat and diagnose urinary tract abnormalities in the pediatric population. This pictorial essay reviews commonly placed genitourinary catheters imaged by radiography, fluoroscopy, computed tomography (CT) and ultrasonography (US). The purpose of the catheter, how the catheter is placed, and the imaging findings associated with appropriately positioned catheters as well as misplaced and displaced catheters are described. It is important for radiologists to recognize common genitourinary catheters, and be familiar with their normal and abnormal positions as displacement is often first recognized by diagnostic imaging.
Collapse
Affiliation(s)
- Helen Hr Kim
- Department of Radiology,, UMass Memorial Medical Center,, 55 N. Lake Ave, Worcester, MA, 01655, USA.
| | - Sheryl Tulin-Silver
- Department of Radiology,, Columbia University Medical Center,, New York, NY, USA
| | - Richard N Yu
- Department of Urology,, Boston Children's Hospital,, Boston, MA, USA
| | - Jeanne S Chow
- Department of Radiology,, Boston Children's Hospital,, Boston, MA, USA
| |
Collapse
|
46
|
Dvoretskii LI. [The ailments of the greats. Urological problems of I.S. Turgenev]. Urologiia 2018:153-157. [PMID: 30035438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- L I Dvoretskii
- I.M. Sechenov First MSMU of Minzdrav of Russia, Moscow, Russia
| |
Collapse
|
47
|
Morgoshiia TS. [Outstanding contribution of german professors J. Israel (18481926) and M. Nitze (18481906) to clinical urology (to the 170th anniversary of their birth)]. Urologiia 2018:149-152. [PMID: 30035437] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The article describes the achievements of James Israel and Max Nitze, who were successfully developing European medicine for more than 30 years of their scientific and practical activities, enriching it with both experimental and large clinical experience. Their scientific and practical accomplishments greatly contributed to the development of modern urology. The author analyzes the fact that the history of medicine gives rich material not only for understanding evolution but also for the possibility to foresee its further development. The current state of clinical urology has been achieved by the progress of basic research in biology, physics, biochemistry, bacteriology, immunology, pharmacology. At the same time, the personality of the scientist-physician, his observation, non-standard view, the ability to see the opening perspectives, to bring up worthy successors and create a scientific and clinical school of urologists, is of utmost importance. The great German urologists J. Israel and M. Nitze had all these fundamental characteristics of a great scientist-physician.
Collapse
Affiliation(s)
- T Sh Morgoshiia
- Prof. A.A. Rusanov Department of Surgery Saint-Petersburg State Pediatric Medical University of Minzdrav of Russia, St. Petersburg, Russia
| |
Collapse
|
48
|
Affiliation(s)
- Bimal H Ashar
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 601 North Caroline Street, #7143, Baltimore, MD 21287, USA.
| |
Collapse
|
49
|
Abstract
Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.
Collapse
Affiliation(s)
- Adarsh S Manjunath
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA
| | - Matthias D Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA.
| |
Collapse
|
50
|
[Resolution of the XIII Meeting and XVII Congress of the RSU]. Urologiia 2018;:8-9. [PMID: 29634126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|