Hasil untuk "Diseases of the genitourinary system. Urology"

David J. Benjamin, Arash Rezazadeh Kalebasty

Aditya Sathe, Charles Peyton

Wubshet Jote Tolossa, Eyob Beyene Deyasu, Addisu Melke Ejigu et al.

Laura Bukavina, Philip Abbosh

Harun Wijanarko Kusuma Putra, Gerhard Reinaldi Situmorang, Arry Rodjani et al.

A 14-months old female child was diagnosed with bilateral single system ectopic ureters opening into the urethra, with small bladder capacity, horseshoes kidneys, and bilateral hydronephrosis, presenting recurrent febrile UTI accompanied by continuous incontinence and elevated renal function. Early bilateral re-implantation of the ureters (modified Lich-Gregoir) was done in one setting, resulting jn no recurring febrile UTIs and continuous wetting, improving renal function parameter, competent bladder neck, and 10 folds increased in bladder capacity after 1-year follow up. We showed that earlier treatment enables patient to preserve both renal and bladder function without involving complex reconstructive surgery.

Wei Chen, Jihua Feng, Pan Ji et al.

Abstract Background Increasing evidence shows that an elevated homocysteine(Hcy) level is associated with an increased risk of chronic kidney disease (CKD). This study systematically evaluated the correlation between homocysteine level and the incidence of CKD reported in cohort and cross-sectional studies. Methods We searched electronic databases and reference lists for relevant articles. 4 cohort studies and 7 cross-sectional studies including 79,416 patients were analyzed in a meta-analysis. Hyperhomocysteinemia was defined as a Hcy level > 15 µmol/L, which was the criterium used in previous studies. Meta-analyses were conducted of literature searches from online databases such as PubMed, Embase, Cochrane and Scopus. Computed pooled adjusted odds ratios with corresponding 95% confidence intervals (95% CI) were used to estimate the risk of new-onset CKD according to Hcy levels in the general population. Results People with high Hcy levels were more likely to suffer from CKD than people with normal Hcy levels (pooled OR, 2.09; 95% CI, 1.72–2.55). This positive relationship persisted across different study types such as cohort studies (summary OR, 2.2; 95% CI, 1.55–3.13) and cross-sectional studies (summary OR, 2.07; 95% CI, 1.63–2.63). Conclusions People with hyperhomocysteinemia have a higher incidence of CKD, Hyperhomocysteinemia may also be an independent risk factor for CKD in the general population.

Lorenz Leitner, Shawna McCallin

Gabriel Chahade Sibanto Simões, Roberto Paladino, Alexandre Gomes Sibanto Simões

T. Konuma, J. Kanda, N. Uchida et al.

The impact of conditioning intensity on different donor groups has been unclear in allogeneic transplantation. The objective of this study was to clarify the effect of conditioning intensity on disease‐free survival (DFS), relapse, non‐relapse mortality (NRM), neutrophil engraftment, and graft‐versus‐host disease for each donor type. We retrospectively evaluated the effect of conditioning intensity on transplant outcomes for patients with acute leukemia or myelodysplastic syndrome aged between 16 and 60 years in Japan using the transplant conditioning intensity (TCI) scoring system. A total of 8526 patients who received first allogeneic transplantation from 6/6 antigen‐matched sibling donor (MSD, n = 2768), 8/8 allele‐matched unrelated donor (MUD, n = 2357), and unrelated single‐cord blood (UCB, n = 3401) were eligible for the analyses. Compared to conditioning with TCI score 4.0, which was corresponds to conventional myeloablative conditioning, including cyclophosphamide with total body irradiation 12 Gy or busulfan 12.8 mg, and was considered as the reference group in the multivariate analyses, intensified conditioning with TCI score ≥4.5 improved DFS (hazard ratio [HR],0.81, P < 0.001) and relapse rate (HR, 0.70, P < 0.001) but only after UCB transplants and not MSD and MUD transplants. In contrast, NRM was higher after intensified conditioning with TCI score ≥4.5 for MSD (HR, 1.39, P = 0.008) and MUD (HR, 1.47, P = 0.002) transplants but not UCB transplants (HR, 1.12, P = 0.240). Neutrophil engraftment was also significantly higher after intensified conditioning with TCI score ≥4.5 but only for UCB transplants (HR, 1.24, P < 0.001), whereas it was significantly lower after reduced‐intensity conditioning with TCI score ≤3.5 for MSD transplants only (HR, 0.82, P < 0.001). These data demonstrated that an intensified conditioning regimen improved survival and engraftment rate only after a UCB transplants. Therefore, TCI scoring system could enable the optimization of conditioning intensity according to donor type, particularly in terms of survival and engraftment.

Rebecca A. Heidenberg, B.S., Elizabeth S. Ginsburg, M.D., Catherine E. Gordon, M.D. et al.

Objective: To study the difference in the live birth rates between anovulatory women with hypothalamic hypogonadism (HH) and those with polycystic ovary syndrome (PCOS) and normo-ovulatory women undergoing fresh embryo transfer or frozen embryo transfer (FET). Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): Patients with oligoanovulation (HH, n = 47; PCOS, n = 533) and normo-ovulation (tubal factor infertility, n = 399) undergoing in vitro fertilization and intracytoplasmic sperm injection cycles from January 1, 2012, to June 30, 2019. Intervention(s): None. Main Outcome Measure(s): Live birth rate. Result(s): Patients with HH had longer stimulation durations than both patients with PCOS and tubal factor infertility. Patients with HH had fewer oocytes retrieved than patients with PCOS, but their numbers of blastocysts were similar. Patients with HH and tubal factor infertility had similar numbers of oocytes retrieved and blastocysts. In fresh embryo transfer cycles, the live birth rates were similar among patients with HH, PCOS, and tubal factor infertility (37.5% vs. 37.1% vs. 29.3%, respectively). When evaluating FET cycles, patients with HH had lower live birth rates than patients with PCOS (26.5% vs. 46.7%) and tubal factor infertility (42.6%). Conclusion(s): Live birth rates are similar among patients with HH, PCOS, and normo-ovulation undergoing fresh embryo transfer but are significantly lower in women with HH undergoing FET.

W. Krajewski, Ł. Nowak, B. Małkiewicz et al.

Background: Upper tract urothelial carcinoma (UTUC) accounts for up to 10% of all urothelial neoplasms. Currently, various tumor-related factors are proposed to be of importance in UTUC prognostic models; however, the association of the primary UTUC location with oncological outcomes remains controversial. Thus, we sought to perform a systematic review and meta-analysis of the latest available evidence and assess the impact of primary tumor location on long-term oncological outcomes in patients with UTUC undergoing radical nephroureterectomy. Materials and Methods: A computerized systematic literature search was conducted in October 2021 through the PubMed, Web of Science, Scopus, and Cochrane Library databases. The primary endpoint was cancer-specific survival (CSS), and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Effect measures for the analyzed outcomes were reported hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among the total number of 16,836 UTUC in 17 included studies, 10,537 (62.6%) were renal pelvic tumors (RPTs), and 6299 (37.4%) were ureteral tumors (UTs). Pooled results indicated that patients with UT had significantly worse CSS (HR: 1.37, p < 0.001), OS (HR: 1.26, p = 0.003, and DFS (HR: 1.51, p < 0.001) compared to patients with RPT. Based on performed subgroup analyses, we identified different definitions of primary tumor location and geographical region as potential sources of heterogeneity. Conclusions: Ureteral location of UTUC is associated with significantly worse long-term oncological outcomes. Our results support the need for close follow-up and the consideration of perioperative chemotherapy in patients with UTUC located in the ureter. However, further prospective studies are needed to draw final conclusions.

M. HADJ BRAHIM, A. Azzabi, W. Sahtout et al.

T. Higashihara, H. Nishi, K. Takemura et al.

Jihwan Park, Mi Jung Rho, Hyong Woo Moon et al.

Purpose: Prostate cancer has a low mortality rate and requires persistent treatment; however, treatment decisions are challenging. Because prostate cancer is complex, the outcomes warrant thorough follow-up evaluation for appropriate treatment. Electronic health records (EHRs) do not present intuitive information. This study aimed to develop a Clinical Decision Support System (CDSS) for prognosis management of radical prostatectomy. Methods: We used data from 5,199 prostate cancer patients from three hospitals’ EHRs in South Korea, comprising laboratory results, surgery, medication, and radiation therapy. We used open source R for data preprocessing and development of web-based visualization system. We also used R for automatic calculation functionalities of two factors to visualize the data, e.g., Prostate-Specific Antigen Doubling Time (PSADT), and four Biochemical Recurrence (BCR) definitions: American Society of Therapeutic Radiology and Oncology (ASTRO), Phoenix, consecutive PSA > 0.2 ng/mL, and PSA > 0.2 ng/mL. Results: We developed the Prostate Cancer Trajectory Map (PCT-Map) as a CDSS for intuitive visualization of serial data of PSA, testosterone, surgery, medication, radiation therapy, BCR, and PSADT. Conclusions: The PCT-Map comprises functionalities for BCR and PSADT and calculates and visualizes the newly added patient data automatically in a PCT-Map data format, thus optimizing the visualization of patient data and allowing clinicians to promptly access patient data to decide the appropriate treatment.

D. Assimos

available at https://pubmed.ncbi.nlm.nih.gov/32208971 Editorial Comment: Using the center of the T11 vertebral body as the superior extent of computerized tomography of the abdomen and pelvis uniformly resulted in total visualization of both kidneys and limited the field of radiation. The targeted goal was less than 15% of the scan length above the top of the kidneys. The authors achieved a mean of 10.6%. They did not provide measurements of the amount of ionized radiation (ie millisieverts). However, I suspect that the amount would be lower using this technique. Dean G. Assimos, MD Suggested Reading Fulgham PF, Assimos DG, Pearle MS et al: Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2013; 189: 1203. Yecies T, Bandari J, Fam M et al: Risk of radiation from computerized tomography urography in the evaluation of asymptomatic microscopic hematuria. J Urol 2018; 200: 967. Saltzman AF, Carrasco A Jr, Weinman J et al: Initial imaging for pediatric renal tumors: an opportunity for improvement. J Urol 2018; 199: 1330. Sternberg KM and Littenberg B: Trends in imaging use for the evaluation and followup of kidney stone disease: a single center experience. J Urol 2017; 198: 383. Chen TT, Wang C, Ferrandino MN et al: Radiation exposure during the evaluation and management of nephrolithiasis. J Urol 2015; 194: 878. Neisius A, Wang AJ, Wang C et al: Radiation exposure in urology: a genitourinary catalogue for diagnostic imaging. J Urol 2013; 190: 2117. Heldt JP, Smith JC, Anderson KM et al: Ureteral calculi detection using low dose computerized tomography protocols is compromised in overweight and underweight patients. J Urol 2012; 188: 124. Re: Risk of Kidney Stone among Workers Exposed to High Occupational Heat StressdA Case Study from Southern Indian Steel Industry V. Venugopal, P. K. Latha, R. Shanmugam, M. Krishnamoorthy, K. Srinivasan, K. Perumal and J. S. Chinnadurai Department of Environmental Health Engineering and Department of Physiology, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, India Sci Total Environ 2020; 722: 137619. doi: 10.1016/j.scitotenv.2020.137619 Abstract available at https://pubmed.ncbi.nlm.nih.gov/32197155available at https://pubmed.ncbi.nlm.nih.gov/32197155 Editorial Comment: This study demonstrates the environmental contribution to kidney stone risk. These investigators found that steel workers exposed to elevated temperatures had higher levels of strain, including increases in core body temperature, urinary specific gravity and sweat rate. A higher proportion of the heat exposed cohort manifested renal related symptoms, including flank/low back discomfort and lower urinary tract symptoms. Those with urinary tract symptoms were evaluated with renal ultrasonography, and the heat exposed cohort had a UROLITHIASIS/ENDOUROLOGY 873 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. significantly higher prevalence of nephrolithiasis. These results indicate that proactive programs should be established to ensure that individuals exposed to high temperatures at work receive adequate hydration. This practice would have both health related and economic benefits. Dean G. Assimos, MD Suggested Reading Borghi L, Meschi T, Amato F et al: Hot occupation and nephrolithiasis. J Urol 1993; 150: 1757. Borghi L, Meschi T, Amato F et al: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 1996; 155: 839. Ferraro PM, Ticinesi A, Meschi T et al: Short-term changes in urinary relative supersaturation predict recurrence of kidney stones: a tool to guide preventive measures in urolithiasis. J Urol 2018; 200: 1082. Pearle MS, Goldfarb DS, Assimos DG et al: Medical management of kidney stones: AUA Guideline. J Urol 2014; 192: 316. Re: Prospective Randomized Trial Comparing the Safety and Clarity of Water versus Saline Irrigant in Ureteroscopy F. Pirani, S. S. Makhani, F. Y. Kim, A. H. Lay, C. B. Cimmino, L. Hartsell, A. Spence, V. A. Master and K. Ogan Medical College of Georgia, Augusta University, Augusta, School of Medicine, Mercer University, Macon and Department of Urology, Emory University School of Medicine, Atlanta, Georgia Eur Urol Focus 2020; Epub ahead of print. doi: 10.1016/j.euf.2020.02.009 Abstract available at https://pubmed.ncbi.nlm.nih.gov/32146123available at https://pubmed.ncbi.nlm.nih.gov/32146123 Editorial Comment: The authors report that using water in uncomplicated ureteroscopy is safe and provides better visualization as indexed by a measurement of turbidity. However, I would not use this as a platform for integrating this approach into practice. The duration of cases in this series was short. Complex ureteroscopic procedures (longer duration, larger stone burdens) are now being commonly undertaken, and the risk of hyponatremia may be higher in such cases. The visualization provided with saline irrigation has typically been more than adequate over the years, especially with the integration of digital endoscopy. Visualization may become an issue when there is bleeding, especially when working in the renal collecting system. This event may be due to violation of the papillary epithelium or urothelium, and thus fluid absorption could occur. Bleeding typically subsides and visualization improves in such cases, although if it does not, the safest approach is to place a stent and come back another day! Dean G. Assimos, MD Suggested Reading Assimos D, Krambeck A, Miller NL et al: Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol 2016; 196: 1161. Hermanns T, Grossmann NC, Wettstein MS et al: Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol 2015; 193: 211. Collins JW, Macdermott S, Bradbrook RA et al: The effect of the choice of irrigation fluid on cardiac stress during transurethral resection of the prostate: a comparison between 1.5% glycine and 5% glucose. J Urol 2007; 177: 1369. 874 UROLITHIASIS/ENDOUROLOGY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.

Sho Uehara

K. Daly, G. Durkan

Background: IgG4 related prostatitis is very rare manifestation of IgG4-related disease. The first case of IgG4 prostatitis was reported in 2006. The largest case series identifies 6 cases. Most cases have been seen in the context IgG4 related disease affecting other organs most commonly the pancreas and is often an incidental histological diagnosis. Isolated IgG4-related prostatitis is a rare occurrence and disease-causing functional impairment more so. Methods: We present a rare case of isolated IgG4 prostatitis presenting with rapidly progressive lower urinary tract symptoms leading to urethral stricture. The diagnosis was made following recurrence of symptoms following prostatic resection and re-examination of histology for IgG4. The disease process leads to extensive inflammation of the prostate resulting in obliteration of the prostatic urethra and the need for urinary diversion. Results: A 68-year-old fit and healthy farmer presents to the urology service with rapidly progression lower urinary tract symptoms, perineal pain and urethral discharge. This was investigated with a cystoscopy under general anaesthetic which revealed a normal urethra and bladder but an abnormal prostate gland with necrotic appearing prostatic tissue distorting the anatomy. Resection tissue revealed extensive inflammation and necrosis which was subsequently confirmed as IgG4 related disease. Treatment was commenced with oral steroids and Rituximab leading to remission in symptoms. Subsequent investigation with antegrade and retrograde urethrograms demonstrated significant structuring of the posterior urethra secondary to the disease process. Conclusions: IgG4 related disease is a recently described inflammatory disease which can affect multiple organs. Its manifestation in the genitourinary system is rare but has been reported in the kidneys, ureters, prostate and testes. It represents an important consideration for urologists when met with diagnostic uncertainty. As seen in this case IgG4 related prostatitis can present with extensive inflammation leading to disruption of function. Early diagnosis is key as the management favours systemic anti-inflammatory treatment over a surgical approach.

S. Kaplan

available at http://www.ncbi.nlm.nih.gov/pubmed/30039715 Editorial Comment: Regardless of our background, training or geographic location, we often get stuck in our own bubble or lane and tend to see all events from that perspective. This includes our views on politics, finance, social issues and, in our particular world, health care. We tend to do and believe in what we do and believe in. Drilling down to the benign prostate hyperplasia (BPH) world, there tend to be advocates for certain procedures who become almost loyalists. Folks become wed to the notion of picking winners and “best in class” procedures. So why do some BPH procedures become much more common in day-to-day use? These 2 studies provide some insight. Castellan et al compared the learning curves for 180 watt GreenLight XPS laser therapy system in novice (fewer than 30 transurethral prostatectomies) vs experienced urologists (more than 130 transurethral prostatectomies). The bottom line is that this procedure can be quickly taught with a shorter learning curve for experienced surgeons. That said, it took anywhere from 50 to 100 cases to achieve adequate status. Anderson et al began with the premise that holmium laser enucleation of the prostate (HoLEP) is the cr eme de la cr eme of BPH procedures with superior results and exceptional long-term durability compared to other techniques. They analyzed the American College of Surgeons NSQIP to ascertain what urologists in the real world actually do. The results are not surprising in that the most common procedure performed was electrosurgical transurethral prostatectomy, followed by photovaporization of the prostate (done half as often), with HoLEP being performed as infrequently (4% to 5%) as simple open prostatectomy (3% to 5%). While the authors tout the lower rates of readmission and transfusion with HoLEP and wonder why so few of these procedures are being done in the United States, they miss the obvious: the procedure takes too long to learn. In experienced hands HoLEP is a very good option. But the key word is EXPERIENCED. While we can analyze data any which way we want, the real world is the real world and, at least between 2011 and 2015, the people have spoken. Folks do what’s easy to learn, what offers good results and what they’re comfortable with. Until something easier to learn comes along, I suspect that these trends will continue. Time will tell! Steven A. Kaplan, MD Suggested Reading Foster HE, Barry MJ, Dahm P et al: Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol 2018; 200: 612. Re: Impact of Metabolic Syndrome-Related Factors on the Development of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in Asian Population J. S. Park, K. C. Koo, H. K. Kim, B. H. Chung and K. S. Lee Department of Urology, Yonsei University College of Medicine and Health Promotion Center, Gangnam Severance Hospital, Seoul, Korea Medicine (Baltimore) 2019; 98: e17635. doi: 10.1097/MD.0000000000017635 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/31626149available at http://www.ncbi.nlm.nih.gov/pubmed/31626149 Editorial Comment: It has become increasingly accepted that metabolic syndrome is related to benign prostatic hyperplasia (BPH) and the ensuing lower urinary tract symptoms (LUTS). However, while we believe that altering aspects of metabolic health through weight reduction, smoking cessation, and normalization of serum glucose and lipid parameters is a good start, there is little evidence about how these changes impact BPH parameters. The authors analyzed 4,880 Korean men who had undergone transrectal ultrasound and correlated it to baseline metabolic characteristics, and tried to identify factors that could alter prostate growth over time. Men who had undergone previous biopsy, been treated for LUTS/BPH either medically or surgically, or were receiving therapy for components of metabolic syndrome were excluded. In other words, this study reflects the natural history of men with untreated BPH. 1038 BENIGN PROSTATIC HYPERPLASIA Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. At baseline men with BPH/LUTS (International Prostate Symptom Score 8 or higher) were older and had larger prostate volumes, higher prostate specific antigen levels and lower quality of life compared to those without metabolic syndrome. Other predictive values for prostate volume included body mass index, basal metabolic rate and apolipoprotein A1, fasting blood glucose and HDL cholesterol levels. These findings have been noted in other studies. Mean annual prostate growth for men with BPH/LUTS was 0.48 gm. However, the natural progression of disease could be altered by lowering fat mass and LDL levels. Is this a new cure for BPH? Given the role of heighted inflammatory factors in men with metabolic syndrome and prostatic enlargement, these findings intuitively make sense. Finally, the results give credence to urologists becoming more educated and adept at evaluating metabolic syndrome factors that can alter the arc of disease progression. We will bring better value to our patients when we view them as a whole rather than a specific body part! Steven A. Kaplan, MD Suggested Reading Mitsui T, Kira S, Ihara T et al: Metabolomics approach to male lower urinary tract symptoms: identification of possible biomarkers and potential targets for new treatments. J Urol 2018; 199: 1312. Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Hospitalisation and Readmission Costs after Radical Cystectomy in a Nationally Representative Sample: Does Urinary Reconstruction Matter? G. A. Joice, M. R. Chappidi, H. D. Patel, M. Kates, N. A. Sopko, C. J. Stimson, P. M. Pierorazio and T. J. Bivalacqua Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland BJU Int 2018; 122: 1016e1024. doi: 10.1111/bju.14448 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29897156available at http://www.ncbi.nlm.nih.gov/pubmed/29897156 Editorial Comment: It is generally accepted that patients who undergo continent urinary diversion following radical cystectomy have a higher complication rate than those undergoing ileal conduit diversion. In this U.S. study the authors examined the Nationwide Readmissions Database and identified more than 20,000 patients who underwent radical cystectomy. The majority of patients (92%) underwent standard noncontinent ileal loop diversion, while the remainder underwent continent urinary diversion. Continent diversion was associated with a higher 90-day readmission rate, greater hospital costs, higher rate of infectious complications and increased genitourinary complication rate compared to standard diversion. It is noteworthy that those patients who underwent cystectomy with continent diversion were younger and healthier, and the operations were more frequently performed at major academic centers. Thus, patients who undergo cystectomy with continent urinary diversion should continue to be advised of the higher complication rate, and certainly these patients should be followed closely with more frequent office visits and/or phone calls. David S. Wang, MD DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE 1039 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.

Luciano Alves Favorito, Rodrigo R. Vieiralves, Rodrigo S. Pires et al.

A. Soti, Jakob Usemann, B. Schaub et al.