Hasil untuk "Diseases of the genitourinary system. Urology"

Alicia K. Morgans, Stacy Loeb

Yuki Oba, Ayaka Hane, Katsuyuki Miki et al.

Abayomi Bolaji Ajayi, Victor Ajayi, Kazeem Adewale Osuolale et al.

Abstract Background Sperm DNA fragmentation detection methods include SCSA, SCD, COMET assay, and TUNEL. In 2021, the DFI test became the first evidence-based sperm DNA integrity test included in international guidelines. However, limited data exists from Nigeria. This study explores the relationship between demographic, lifestyle, and medical factors and DFI among infertility patients at Nordica Fertility Centre, aiming to guide interventions to improve fertility outcomes. Methods A total of 643 male infertility patients undergoing DFI analysis were evaluated. Participants were categorized based on age, occupation, BMI, alcohol use, smoking habits, and ejaculation frequency. The DFI was assessed both continuously and categorically using a 25% threshold (≤ 25% good, > 25% poor integrity). Chi-square tests examined associations between categorical variables while t-test was also used to examine significant association in terms of mean comparisons between DFI and other variables. Logistic regression analysis, with forward stepwise selection, identified independent predictors of high DFI, adjusting for potential confounders. Results Participants had a mean age of 44.1 years; 55.7% were under 45. Most were professionals (57.1%) with a mean BMI of 27.5 kg/m². Alcohol use was reported by 45.2% and smoking by 9.6%. Mean DFI was 37.8% (range: 6–93%). Higher DFI was significantly associated with older age (χ²=12.21, p = 0.001), non-professional occupation (χ²=162.75, p < 0.001), and poor sperm motility (χ²=5.724, p = 0.017). Logistic regression showed that age above 45 years (OR = 2.45, 95% CI: 1.39–4.32, p = 0.002), occupation category (Professional/Technical/Managerial/ Clerical) (OR = 0.001, 95% CI: 0.0001–0.011, p < 0.001), and alcohol use (OR = 18.01, 95% CI: 7.03–46.12, p < 0.001) were independently associated with the outcome. Conclusion Older age, alcohol consumption, Professional/Technical/Managerial/ Clerical occupations, and alcohol use are associated with increased sperm DNA fragmentation. These findings highlight the need for personalized fertility assessments and targeted interventions to enhance male reproductive health.

Ronald S. Boris

Byeongdo Song, Sang Hun Song, Seong Jin Jeong

This study was performed to investigate the learning curve of transurethral enucleation with bipolar energy (TUEB) for benign prostatic hyperplasia. The study involved 494 consecutive patients who underwent TUEB for benign prostatic hyperplasia from August 2018 to March 2022 by one surgeon (SJJ, Seoul National University Bundang Hospital, Seongnam, Korea). The patients were followed up at 1 week, 1 month, 3 months, and 6 months postoperatively. To evaluate the learning curve of TUEB, perioperative parameters including the enucleation ratio (enucleated tissue weight/transitional zone volume), TUEB efficiency (enucleated tissue weight/operation time), and enucleation efficiency (enucleated tissue weight/enucleation time) were analyzed. Functional outcomes and postoperative complications were also assessed, including the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, and uroflowmetry outcomes. The patients’ median age was 72 (interquartile range [IQR]: 66–78) years, and the estimated prostate volume and transitional zone volume were 63.0 (IQR: 46.0–90.6) ml and 37.1 (IQR: 24.0–60.0) ml, respectively. The enucleation ratio, TUEB efficiency, and enucleation efficiency were 0.60 (IQR: 0.46–0.54) g ml−1, 0.33 (IQR: 0.22–0.46) g min−1, and 0.50 (IQR: 0.35–0.72) g min−1, respectively, plateauing after 70 cases. The functional outcomes, including total IPSS, IPSS QoL score, and uroflowmetry outcomes, significantly improved at 6 months after TUEB (all P < 0.05), but without significant differences over the learning curve. Sixty-five (13.2%) patients developed complications after TUEB, 21.5% of whom experienced major complications (Clavien–Dindo grade ≥3). The rate of major complications declined as the number of TUEB cases increased (P = 0.013). Our results suggest that the efficiency of TUEB stabilized within 70 procedures.

Jun Nyung Lee, Mi Young Kim, Jae Hoon Kang et al.

Purpose: Oligoprogressive lesions are observed in a subset of patients who progress to castration-resistant prostate cancer (CRPC), while other lesions remain controlled by systemic therapy. This study evaluates the impact of progression-directed therapy (PDT) on these oligoprogressive lesions. Materials and Methods: This retrospective study included 40 patients diagnosed with oligoprogressive CRPC. PDT was performed for treating all progressive sites using radiotherapy. Fifteen patients received PDT using radiotherapy for all progressive sites (PDT group) while 25 had additional first-line systemic treatments (non-PDT group). In PDT group, 7 patients underwent PDT and unchanged systemic therapy (PDT-A group) and 8 patients underwent PDT with additional new line of systemic therapy on CRPC (PDT-B group). The Kaplan–Meier method was used to assess treatment outcomes. Results: The prostate specific antigen (PSA) nadir was significantly lower in PDT group compare to non-PDT group (p=0.007). A 50% PSA decline and complete PSA decline were observed in 13 patients (86.7%) and 10 patients (66.7%) of PDT group and in 18 patients (72.0%) and 11 patients (44.0%) of non-PDT group, respectively. The PSA-progression free survival of PDT-B group was significantly longer than non-PDT group. The median time to failure of first-line systemic therapy on CRPC was 30.2 months in patients in PDT group and 14.9 months in non-PDT group (p=0.014). PDT-B group showed a significantly longer time to progression than non-PDT group (p=0.025). Minimal PDT-related adverse events were observed. Conclusions PDT can delay progression of disease and enhance treatment efficacy with acceptable tolerability in oligoprogressive CRPC.

Joeci A. Jacobowski, Jocelaine B. Rodrigues, Leonora Ramlow Leodoro da Silva et al.

Luciana Angélica da Silva de Jesus, Bruno Valle Pinheiro, Ana Beatriz Laguardia Almeida et al.

Abstract Background The measurement properties of the falls efficacy scale have not been evaluated in patients on hemodialysis. This study determined the inter- and intrarater reliability, standard error of measurement, minimal detectable change, and limits of agreements of the falls efficacy scale in patients on hemodialysis. Methods A cross-sectional study was conducted with 65 patients (57.5 ± 13.9 years, 63.1% male) on hemodialysis. The fear of falling was assessed by two previously trained raters using the falls efficacy scale. The intraclass correlation coefficient, standard error of measurement, minimal detectable change, and Bland–Altman plot were calculated to assess the inter- and intrarater reliability of the falls efficacy scale. Results The interrater intraclass correlation coefficient was 0.91, and the intrarater intraclass correlation coefficient was 0.78, representing excellent interrater and good intrarater reliability. The standard error of measurement for inter- and intrarater assessments were 2.99 and 4.46, and the minimal detectable change for inter- and intrarater assessments were 9.26 and 12.33, respectively. The interrater mean difference score was 0.26 (95% limits of agreement: − 8.01 to 8.53), and the intrarater mean difference score was − 1.06 (95% limits of agreement: − 13.39 to 11.27). Conclusion In patients on hemodialysis, the falls efficacy scale showed excellent and good inter- and intrarater reliability, respectively. Additionally, standard error of measurement, minimal detectable change, and limits of agreements of the falls efficacy scale score were satisfactory.

P. M. Kayumova, Sh. I. Giyasov, M. B.  Krasnenkova et al.

Introduction. Currently, the Erector Spinae Plane (ESP) block is widely used both as an independent method of anesthesia and as a component of multimodal anesthesia. It creates an extensive sensor block, spreads over 5 – 7 spinal segments.Objective. To evaluate the efficacy of ESP block as a component of multimodal anesthesia during open kidney surgery.Material &amp; methods. The studies were conducted on 116 patients of ASA class I – III at the age of 18 – 85 years All patients were performed inhalation anesthesia with Isoflurane. NSAID (Diclofenac 75 mg IM) was administered as pre-emptive analgesia. In the Study group (n = 60), after tracheal intubation and positioning, an ESP block was performed under ultrasound control at the Th-9 level with a 0.5% Sol. Bupivacaine (25 – 30 ml). In the Control group (n = 56), only inhalation anesthesia was performed. Pain severity, opioid consumption frequency (Sol. Promedoli), postoperative nausea and vomiting were assessed in the postoperative period. A numeric rating scale (NRS) was used to assess pain, which was recorded every 6 hours during the day.Results. Patients in the study group showed a low assessment of postoperative pain on the numeric rating scale compared to the Control group (p &lt; 0.001). The consumption of opiates (Sol. Promedoli) was also lower, especially in the first 6 hours after surgery (p &lt; 0.001).Conclusions. The results of our studies confirmed the efficiency of ESP block by reducing the consumption of opiates and NSAIDs. The main advantage of this method is its ease of implementation and safety.

Kevin J. Hebert, Rano Matta, Kiarad Fendereski et al.

Dario Garcia-Rojo, Jesus Muñoz-Rodriguez, Clara Centeno et al.

Nikita Shrivastava, Gopal Sharma, Puneet Ahluwalia et al.

Context: The superiority of off-clamp robot-assisted partial nephrectomy (RAPN) over the on-clamp technique has recently been questioned by randomized controlled trials comparing the two techniques. Objective: To systematically review the recent literature and perform a quantitative synthesis of data on the comparison of off-clamp versus off-clamp hilar control during RAPN. Evidence acquisition: A systematic search was performed in the PubMed, Embase, Web of Science, and Scopus databases for studies comparing off-clamp versus on-clamp RAPN in terms of perioperative and functional outcomes. The study protocol was registered in the PROSPERO database (CRD42023413160). Only prospective randomized controlled trials and retrospective matched observational studies were included. The primary outcome of the study was the percentage decrease in the estimated glomerular filtration rate (eGFR). Evidence synthesis: A total of 11 studies were included involving a total of 2483 patients (944 patients in the off-clamp and 1539 patients in the on-clamp group). There was no difference between the two groups in the percentage decline in eGFR (mean difference [MD] 0.04%, 95% confidence interval [CI] −3.7% to 3.86%; p = 0.98). There were so significant differences between the groups for length of hospital stay (p = 0.56), complications (p = 0.08), conversion to open or radical surgery (p = 0.18), estimated blood loss (p = 0.06), or need for blood transfusion (p = 0.07). The operative time was shorter in the off-clamp group (MD−21.89 min, 95% CI −42.5 to −1.27; p = 0.04) but after sensitivity analysis the difference was no longer statistically significant (p = 0.15). The positive surgical margin rate was significantly lower in the off-clamp group (odds ratio 0.6, 95% CI 0.39–0.91; p = 0.02). Conclusions: Our review revealed no clinically relevant differences in perioperative and functional outcomes between off-clamp and on-clamp RAPN. Patient summary: In this review, we compared the two methods of controlling the kidney blood vessels during robot-assisted surgery to remove part of the kidney. We noted that there was no difference between the two groups for outcomes such as complications and the decrease in kidney function after surgery.

Hidetomo Nakamoto, Ryutaro Aoyagi, Takeru Kusano et al.

Abstract In 2022, the government approved the telemedicine system for peritoneal dialysis (PD) in Japan in the form of medical fees. In 2000, we completed a telemedicine system for PD using an automatic peritoneal dialysis (APD) machine. We have published several papers and obtained international patents, but it was impossible to spread them. In recent years, the use of the internet and the spread of COVID-19 have led to the recognition of the importance of telemedicine, leading to the approval of medical fees for telemedicine in PD treatment in Japan. This change is believed to indicate the future direction of PD medicine. However, the current systems are still inadequate. They are difficult to use, and it is difficult for older patients to master their use. Therefore, we hope to develop a system that is easy to use, even for older patients. The new system is a wristwatch or mobile phone monitoring system for blood pressure, heart rate, partial pressure of oxygen, and electrocardiogram. However, development competition for such a mechanism occurs worldwide. Soon, the use of telemedicine in home medical care is expected to become a common practice. It is expected that the telemedicine system, which has been approved for patients using APD in Japan, will also be available for patients undergoing PD other than APD and patients undergoing home hemodialysis in the future. One important feature would be cooperation among doctors, nurses, clinical engineers, medical care teams, and primary care physicians. Advances in artificial intelligence (AI) and information technology (IT) are expected to significantly expand PD medical care in the future. This review is focused on the use of AI and IT for PD medical care in Japan and expectations for the future.

Reza Baghbanian, Mohsen Savaie, Farhad Soltani et al.

Introduction: Effective antiviral medications with minimal side effects has received scholarly attention since the start of the COVID-19 pandemic. Ivermectin, a long-time anti-parasitic drug, has been proven through laboratory tests to have anti-COVID-19 effects. Objectives: This study investigated the effects of inclusion of ivermectin to the standard treatment of mechanically ventilated patients. Patients and Methods: This study is a double-blinded, randomized, placebo-controlled clinical trial that was conducted on COVID-19 patients, in Ahvaz, Iran, from March 2020 to September 2021. Intubated COVID-19 patients who met the inclusion criteria were randomly allocated into two groups, placebo (n = 29) and the ivermectin-treated (n = 31). The primary outcome was the mortality, and the secondary outcomes were pulmonary compliance and vital signs. Results: Two groups were similar regarding demographic characteristics such as age, gender, the length of time since the onset of symptoms before intubation, the level of lactate dehydrogenase (LDH) in the blood. Moreover, the difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, and interleukin 6 (IL-6) was not significant between the two groups. Regarding mortality rate, no significant difference between the two groups was detected. Furthermore, O2 saturation on day 5 was significantly higher in the ivermectin group as opposed to the control group (P=0.008). No statistically significant difference was found between the two groups regarding respiratory rate, heart rate, systolic and diastolic blood pressure, and lung compliance (dynamic and static). Conclusion: Regarding the importance of blood oxygen saturation in COVID-19 patients, our results showed no significant effect of ivermectin in the treatment of ventilated COVID-19 patients, suggesting that its addition to the standard COVID-19 treatment either is ineffective or has no synergistic effect. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (Identifier: IRCT20190417043295N2; https://www.irct.ir/trial/57603, ethical code#IR.AJUMS. REC.1400.234).

Delia Leisy Miranda-González, Lesnay Martínez-Rodríguez, Evelyn Fernández-Castillo

Introducción: La alfabetización en salud se reconoce como resultado del proceso de educación para la salud. El conocimiento sobre estilos de vida saludables o las medidas necesarias para evitar el desarrollo o progreso de enfermedades es importante en etapas vulnerables como la juventud. Objetivo: Evaluar el conocimiento que poseen los jóvenes universitarios cubanos sobre la enfermedad renal crónica. Material y Método: Estudio observacional descriptivo de corte transversal. El estudio se llevó a cabo en la Universidad Central “Marta Abreu” de las Villas, (Cuba). Se obtuvo una muestra de 420 estudiantes mediante muestreo probabilístico aleatorio estratificado. Se empleó como instrumento el Cuestionario de conocimiento sobre la enfermedad renal crónica. Además se estudiaron otras variables como sexo, edad, carrera, facultad, año académico y provincia de residencia. Resultados: El 55,7% de los jóvenes no tenía conocimientos previos sobre la enfermedad renal. No se encontraron diferencias estadísticamente significativas entre los hombres y las mujeres en cuanto nivel de conocimiento por categorías temáticas. Se encontraron diferencias estadísticamente significativas en la puntuación total del Cuestionario entre las diferentes facultades y años académicos. Conclusiones: Se reconoce un mayor nivel de conocimiento en las categorías temáticas síntomas, características y detección de la enfermedad renal crónica y factores predisponentes, mientras que la categoría de comorbilidades asociadas mostró los peores resultados. Las facultades de Construcciones, Matemática, Física y Computación e Ingeniería Mecánica e Industrial mostraron mejores resultados en las respuestas ofrecidas

T. Kawahara, H. Ishiguro, Y. Li et al.

A-F. Spinoit, L. Tack, E. Van Hoecke et al.

C.H. Lee, J. Chung, C. Kwak et al.

Jae-Seung Chung, Todd M. Morgan, Sung Kyu Hong

New classification systems based on molecular features have been introduced to improve precision medicine for prostate cancer (PCa). This review covers the increasing risk of PCa and the differences in response to targeted therapy that are related to specific gene variations. We believe that genomic evaluations will be useful for guiding PCa risk stratification, screening, and treatment. We searched the PubMed and MEDLINE databases for articles related to genomic testing for PCa that were published in 2020 or earlier. There is increasing evidence that germline mutations in DNA repair genes, such as BRCA1/2 or ATM, are closely related to the development and aggressiveness of PCa. Targeted prostate-specific antigen screening based on the presence of germline alterations in DNA repair genes is recommend to achieve an early diagnosis of PCa. In cases of localized PCa, even if it has a favorable risk classification, patients under active surveillance with these gene alterations are likely to develop aggressive PCa. Thus, active treatment may be preferable to active surveillance for these patients. In cases of metastatic castration–resistant PCa, BRCA1/2 and DNA mismatch repair genes may be useful biomarkers for predicting the response to androgen receptor–targeting agents, poly (ADP-ribose) polymerase inhibitors, platinum chemotherapy, prostate-specific membrane antigen–targeted therapy, immunotherapy, and radium-223. Genomic evaluations may allow for risk stratification of patients with PCa based on their molecular features, which may help guide precision medicine for treating PCa.

Natassia Alberici Anselmo, Leticia Colombo Paskakulis, Renata Correia Garcias et al.

ABSTRACT Introduction: Ischemia-reperfusion (IR) injury results from inflammation and oxidative stress, among other factors. Because of its anti-inflammatory and antioxidant properties, the Brazil nut (BN) might attenuate IR renal injury. Objective: The aim of the present study was to investigate whether the intake of BN prevents or reduces IR kidney injury and inflammation, improving renal function and decreasing oxidative stress. Methods: Male Wistar rats were distributed into six groups (N=6/group): SHAM (control), SHAM treated with 75 or 150 mg of BN, IR, and IR treated with 75 or 150 mg of BN. The IR procedure consisted of right nephrectomy and occlusion of the left renal artery with a non-traumatic vascular clamp for 30 min. BN was given daily and individually for 7 days before surgery (SHAM or IR) and maintained until animal sacrifice (48h after surgery). We evaluated the following parameters: plasma creatinine, urea, and phosphorus; proteinuria, urinary output, and creatinine clearance; plasmatic TBARS and TEAC; kidney expression of iNOS and nitrotyrosine, and macrophage influx. Results: Pre-treatment with 75 mg of BN attenuated IR-induced renal changes, with elevation of creatinine clearance and urinary output, reducing proteinuria, urea, and plasmatic phosphorus as well as reducing kidney expression of iNOS, nitrotyrosine, and macrophage influx. Conclusion: Low intake of BN prior to IR-induced kidney injury improves renal function by inhibition of macrophage infiltration and oxidative stress.