Advances in Urology

Purpose . The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. Study Design and Data Source . Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. Data Collection . Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. Primary Outcome . Sum of radiologic studies within the first year of life or prior to pyeloplasty. Statistical Analysis . Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade. Results . Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42–1.73) and severe (RR: 2.09; 95% CI: 1.88–2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders. Conclusions . In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.

Anthony J. Schaeffer

Patrick C. Cartwright

Glen A. Lau

Mark D. Ebert

Nora F. Fino

Flory L. Nkoy

Rachel Hess

Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life

婴儿生命头12个月肾积水的放射影像学应用

Agenesis of the bladder and urethra is a rare congenital anomaly, with a very few living cases reported in the literature so far. Case Presentation. We are reporting two female patients (3 and 6 years old) with bladder and urethral agenesis who presented with urinary incontinence. In both patients, magnetic resonant imaging (MRI) revealed a case of bladder and urethral agenesis with normal ureters draining into the vagina. Patients underwent a neobladder and conduit creation surgery. The neobladder was constructed from the whole cecum and a part of the ascending colon, followed by an anastomose of the ureters into the neobladder in a nonrefluxing fashion; the appendix was used simultaneously as a continent catheterizable conduit. The two patients attained urinary continence postoperatively.We reported two cases of bladder agenesis, and for the first time, we have performed neobladder creation surgery using the cecum and ascending colon. One-year follow-up did not reveal any complications.

Salahaddin Delshad

Hadith Rastad

Parham Mardi

Congenital Bladder and Urethral Agenesis: Two Case Reports and Management

先天性膀胱和尿道发育不全：两例报告及处理

Background. Under the name of uncommon bladder cancers are gathered rare histological entities which represent less than 5% of bladder tumors. There is not a clear and consensual therapeutic management for these entities. Purpose. To review a single-institution 10-year experience with rare form of bladder cancers detailing the diagnosis, treatment, and patient outcome. Materials and Methods. We performed a retrospective review of 27 medical records of rare bladder cancer form treated at our center between February 2006 and February 2015. The clinicopathologic features are reported with emphasis on treatment and survival. Results. Mean patient age was 65.5 ± 20 yr and 70% of patients were males. Smoking background was found in 16 cases, chronic bladder irritation factors were found in 12 cases, and past urinary tract infection was found in 11 cases. The main symptom was total hematuria (93%) causing an anemia in 16 cases. The two mean histological forms were epidermoid carcinoma (37%) and adenocarcinoma (22%). 26% of patients were found to have extended invasive tumors (T4) at diagnosis. Metastatic disease was confirmed in 8 cases. Our patients were managed by a wide range of therapeutic modalities as total cystectomy with bilateral lymph node dissection (63%), palliative chemotherapy (30%), or concomitant radiochemotherapy (7%). 55.6% of patients were alive one year after diagnosis. Epidermoid carcinoma has the best prognosis followed by leiomyosarcoma and sarcomatoid carcinoma. Neuroendocrine carcinoma has the worst outcome. The overall 5-year survival rate is 33.3%. Conclusion. The rarity and small size of these tumors justify the absence of clear and consensual therapeutic management. No role of total cystectomy concerning the conclusions could be drawn but elements suggest this may be the treatment of choice. The highly aggressive nature of those lesions justifies an aggressive and fast therapy when feasible which gives the best outcomes.

Youssef Kadouri

Salim Lachkar

Hamza Dergamoun

Hachem El Sayegh

Lounis Benslimane

Yassine Nouini

Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years

罕见膀胱癌的管理：10年单中心经验

Cytokeratins belong to the family of intermediate filaments. They are expressed in a highly specific manner in epithelial cells where they play a crucial role in the integrity and mechanical stability of the cells. Several types of cytokeratins have been described in normal as well as neoplastic urothelium. In the case of urothelial neoplasms expression of CK20 and CK5/6 has been shown in several studies to have diagnostic and prognostic implications. Thus, low-grade urothelial carcinoma manifests CK expression limited to the umbrella cells, while high-grade tumors usually have an expression in the entire thickness of the urothelium except for the basal layer. CK5/6 expression on the other hand is expressed in the basal cells in all low-grade and some high-grade urothelial carcinomas. Diffuse CK20 staining accompanied by loss of CK5/6-positive basal layer is usually associated with aggressive clinical behavior. Double staining of the slides for these cytokeratins may facilitate proper interpretation and correlation.

Mohammed Akhtar

Sameera Rashid

Mohamed Ben Gashir

Noheir Mostafa Taha

Issam Al Bozom

CK20 and CK5/6 Immunohistochemical Staining of Urothelial Neoplasms: A Perspective

CK20和CK5/6在尿路上皮肿瘤中的免疫组化染色：一种视角

Forgotten ureteral stents (FUS) and stent-related symptoms (SRS) lead to increased postprocedural emergency department visits and add to the psychological and financial burden of the patients.To review the usage and benefits of ureteral stent tracking and symptom monitoring through a single smartphone-based application (App) platform with 2-way clinician-patient communication. This study also compared the features with other smartphone apps used for stent tracking.100 patients were included in this single-center prospective study conducted between September 2019 and December 2019. Patients who had metallic or long-term indwelling stents, noncomprehensible patients, and those not willing to share their data were excluded from the study.Of 100 patients, 92 downloaded the Urostentz application, and 72 (78.2%) patients answered the pictorial symptom questionnaire. Symptom score analysis suggested that 62 patients (86.1%) had stent-related symptoms of which 3 required readmission and underwent early stent removal. The mean stent duration was 17.2 + 3.5 days (range: 11-23 days), with 69% of patients having their stent removed on the scheduled date and 25% of patients requesting a change of their appointment via the App.In this study, there was no case of FUS encountered. The "Urostentz" App is a freely available patient safety stent tracking application that provides a secure and simplified interface, which can significantly reduce the incidence of FUS and provide digital remote assistance in the management of stent-related symptoms.

B. M. Zeeshan Hameed

Milap J. Shah

Nithesh Naik

Mohan Amaresh

Padmaraj Hegde

Rahil Hussein Beary

Suraj Jayadeva

Bhaskar K. Somani

Are Technology-Driven Mobile Phone Applications (Apps) the New Currency for Digital Stent Registries and Patient Communication: Prospective Outcomes Using Urostentz App

技术驱动的移动电话应用程序（App）是否成为数字支架注册和患者沟通的新货币：使用Urostentz App的前瞻性结果

Although routine surveillance imaging to examine upper urinary tract urothelial cancer recurrence during follow-up of nonmuscle invasive bladder cancer is recommended, its necessity remains invalidated. A single-institute long-term follow-up cohort study to evaluate the clinical impact of routine surveillance imaging and identify risk factors for upper urinary tract urothelial cancer recurrence after nonmuscle invasive bladder cancer treatment was conducted.

Nobutaka Nishimura

Makito Miyake

Tatsuki Miyamoto

Takuto Shimizu

Tomomi Fujii

Yosuke Morizawa

Shunta Hori

Daisuke Gotoh

Yasushi Nakai

Kazumasa Torimoto

Nobumichi Tanaka

Kiyohide Fujimoto

Routine Surveillance of Upper Urinary Tract Imaging for Diagnosing Upper Urinary Tract Urothelial Cancer Recurrence in Patients with Nonmuscle Invasive Bladder Cancer

非肌层浸润性膀胱癌患者上尿路影像学常规监测诊断上尿路尿路上皮癌复发的研究

Introduction and Objectives. ESWL is a popular treatment modality for small to medium sized renal calculi; however, the reported clearance rates especially in the lower pole have been poor. Mechanical percussion and inversion (MPI) therapy can be used as an adjunct to ESWL and has been shown to significantly improve stone clearance rates in several studies. In these studies, MPI therapy was administered in hospital by medical staff, requiring further hospital appointments with increased clinician and financial resources. Our objective was to evaluate whether patient-directed mechanical percussion and inversion (MPI) therapy performed at home after ESWL can improve stone-free rates compared with ESWL alone. Methods. We conducted a prospective randomised control trial. Included patients were males and females greater than 18 years of age with single or multiple ipsilateral renal calculi of total ≤10 mm on plain X-ray and noncontrast CT KUB. ESWL was performed at a single centre, at supine position under general anaesthesia with maximum 3000 shocks at a rate of 100 shocks per minute. Patients were discharged and randomised to either the control arm or MPI therapy. MPI therapy was self-directed in a home setting for 10 minutes a day, three times per week. Both arms had standard follow-up at 12 weeks with a plain X-ray KUB. Patients in the control group were offered cross over to the MPI arm after 12 weeks if residual stone fragments were detected. Statistical analysis was performed using SPSS software via Chi squared and Fisher’s exact tests. Ethical approval was obtained via the Prince Charles Hospital HREC Committee, HREC/2022/QPCH/84961. Results. 70 patients met inclusion criteria and underwent ESWL, and 5 were withdrawn. 33 patients were randomised to the MPI group and 32 to the control group. MPI significantly increased the stone clearance rate anywhere in the kidney (87.9% in the MPI group versus 59.4% in the control group, <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"><mi>p</mi><mo>=</mo><mn>0.089</mn></math> ), as well as the clearance rate in the lower pole (91.7% in the MPI group versus 63.2% in the control group, <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"><mi>p</mi><mo>=</mo><mn>0.022</mn></math> ). Delayed percussion did not improve the clearance rate over primary percussion <math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"><mfenced open="(" close=")" separators="|"><mrow><mi>p</mi><mo>=</mo><mn>0.835</mn></mrow></mfenced></math> . Conclusion. This study has shown that MPI can be effectively performed in a home setting without the need for medical supervision and results in improved stone clearance rates post ESWL. The main limitations to the study were the use of X-ray over CT during the follow-up and variability in MPI compliance and administration. Further research is warranted into standardising home MPI protocols. This trial is registered with ANZCTR387061.

Nishal Patel

Adrian Roe

Donna Stanton

Jay Roberts

Akshay Kothari

SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi

SLAP试验：肾结石体外冲击波碎石术后冲击波碎石与机械叩击疗法

Introduction. Women with lower urinary tract symptoms (LUTS) and high-tone pelvic floor often experience pain and have positive trigger points upon pelvic floor examination. However, the correlation of these findings has not yet been systematically examined and sufficiently understood. The aim of this cross-sectional study is to examine the correlation of pelvic myofascial pain with LUTS and pelvic floor tone. Materials and Methods. All participants filled a standardized pelvic floor questionnaire to assess LUTS, which consists of a total of 43 questions regarding bladder, bowel, and sexual function as well as prolapse symptoms. Myofascial trigger points in different muscle groups including pubococcygeus, iliococcygeus, and obturator as well as pelvic floor muscle tone were assessed using a standardized digital examination technique. Results. 110 women were included in the study. There was a significant correlation between pain in various muscle groups and LUTS as well as high-tone pelvic floor muscle. A significant correlation could also be found between high pelvic floor muscle tone and the overall questionnaire score ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>p</a:mi><a:mo>&lt;</a:mo><a:mn>0.001</a:mn></a:math> ) as well as the bladder function score ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>p</c:mi><c:mo>&lt;</c:mo><c:mn>0.001</c:mn></c:math> ) and various pain scores of the different groups. Individuals with high-tone pelvic floor were more likely to have more LUTS and higher pain scores. Conclusions. The existence of myofascial pelvic floor trigger points and high pelvic floor muscle tone seem to be reflective of pelvic floor symptoms, as assessed with a standardized pelvic floor questionnaire.

Sabrina Einig

Esther Ruess

Andreas Schoetzau

Kerstin Ayllon Bartet

Viola Heinzelmann-Schwarz

Francesco Vigo

Tilemachos Kavvadias

Pelvic Pain of Myofascial Origin in Women: Correlation with Lower Urinary Tract Symptoms

女性肌筋膜源性盆腔疼痛与下尿路症状的相关性研究

Objectives. In Japan, caudal block with 1% lidocaine is commonly used for transrectal prostate biopsy. Although 10 mL of 1% lidocaine is commonly used, the appropriate dosage of 1% lidocaine has not been studied. Our hospital routinely uses two different doses (5 or 10 mL) of 1% lidocaine for caudal block for transrectal prostate biopsy. Herein, we retrospectively evaluated the efficacy and safety of both doses of 1% lidocaine. Methods. This retrospective study included 869 patients who underwent transrectal prostate biopsy with caudal block at our hospital. The amount of 1% lidocaine was determined by the day of the week on which the biopsy was performed, and the patient voluntarily chose the day of the biopsy, unaware of the dose of 1% lidocaine used on that day. Pain, anal sphincter tonus, cancer diagnosis rate, and early complications were compared. Results. In total, 466 and 403 patients received 5 and 10 mL of 1% lidocaine for a caudal block, respectively. After propensity-score matching for patient characteristics, each group contained 395 patients. The pain score, anal sphincter tonus score, or prostate cancer diagnosis rate were not significantly different between the two groups. However, rectal bleeding was significantly more frequent and severe in the 10-mL than the 5-mL group ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"><mi>p</mi><mo>=</mo><mn>0.018</mn></math> and <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"><mi>p</mi><mo>=</mo><mn>0.0036</mn></math> , respectively). The incidence of other complications was not significantly different between the groups. Conclusions. Our results suggest that 5 mL of 1% lidocaine may be more suitable than 10 mL for caudal block during transrectal prostate biopsy.

Norichika Ueda

Mototaka Sato

Shunsuke Mori

Atsuki Matsukawa

Yuta Oki

Yuma Kujime

Ryoya Mizuno

Hiromu Horitani

Tetsuya Yamamoto

Shota Fukae

Mitsuhiro Yoshinaga

Makoto Matsushita

Mai Akiyama

Satoshi Kamido

Ayako Honda

Jiro Nakayama

Norihide Tei

Osamu Miyake

Lower Dose of 5 mL of 1% Lidocaine is More Suitable than the Conventional 10 mL for Caudal Block in Transrectal Prostate Biopsy: A Retrospective Cohort Study

5 mL 1% 利多卡因低剂量比传统 10 mL 更适合经直肠前列腺活检的骶管阻滞：一项回顾性队列研究

Objective . To examine one academic institution’s experiences with SpaceOAR placement, its associated complications, and periprocedural characteristics that affect outcomes for the purpose of quality improvement. Materials and Methods . We conducted a retrospective review of 233 patients who received SpaceOAR from four surgeons and one radiation oncologist between 2018 and 2021. Variables such as demographics, oncologic parameters, radiation plan, and radiographic assessment of hydrogel placement were recorded. The Charlson Comorbidity Index (CCI) was used to assess comorbidity risk. Mann–Whitney and Fisher’s exact tests were performed to compare patients with and without complications. Results . Of the 233 patients who received SpaceOAR, 24 (10.3%) experienced toxicity. All complications were Clavien I or II, such as pelvic pain postplacement, pelvic fullness, bleeding, and lower urinary tract symptoms. 16 patients (6.9%) had some portion of the hydrogel injected into the rectal wall, but it was never clinically significant. The average CCI was 3.2 ± 0.95 for patients who experienced complications; the average CCI was 3.6 ± 1.6 ( p = 0.48) in the group without complications. Of the physicians with higher procedure volumes, Physician #1 had the highest rate of patient‐reported complications at 11 out of 68 (16.2%) and Physician #2 had the lowest rate of complications at 4 out of 96 placements (4.2%). Multivariate analysis found that patients who had received hormone therapy previously had less odds of reporting complications after SpaceOAR placement. Conclusions . The listed attending on the procedure had a significant correlation to complications with SpaceOAR placement on univariate analysis, and hormone therapy had some benefits to the tolerance for the procedure on multivariate analysis. Overall, the hydrogel placement was well tolerated with low incidence of mild and transient procedure‐related toxicity.

Kerith R Wang

Rishabh K Simhal

Cassra B Clark

Mark J Mann

James R Mark

Costas D Lallas

Robert Den

Edouard J Trabulsi

Complications and Influential Perioperative Factors Associated with SpaceOAR Hydrogel Placement

与SpaceOAR水凝胶放置相关的并发症及围手术期影响因素

短名	Adv. Urol.
Journal Impact	1.82
国际分区	UROLOGY & NEPHROLOGY(Q3)

ISSN	1687-6369, 1687-6377
h-index	38

涉及主题	医学内科学生物外科遗传学病理泌尿科解剖内分泌学癌症放射科化学心理学数学生物化学泌尿系统精神科物理
出版信息	出版商: Hindawi Publishing Corporation，出版周期: ，期刊类型: journal，开源期刊: 是
基本数据	创刊年份: 2009，原创研究文献占比: 80.00%，自引率:0.00%， Gold OA占比: 97.06%
期刊费用	$950详情
平均审稿周期	网友分享经验：15 Weeks

Advances in Urology

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