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1.
Alexander M. Helfand Rebekah Beach Miriam Hadj-Moussa Naveen Krishnan Chang He Jeffrey S. Montgomery Todd M. Morgan Alon Z. Weizer Khaled Hafez Cheryl T. Lee John T. Stoffel Ted A. Skolarus 《Urologic oncology》2017,35(1):33.e1-33.e9
Objective
To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.Methods
We conducted a retrospective cohort study of patients with benign UAS following cystectomy and urinary diversion using our institutional database. We compared time to stricture, renal function, rates of renal loss, and overall survival between patients undergoing ureteral reimplantation vs. those undergoing nonoperative management (nephrostomy tube or ureteral stent). A multivariable Cox proportional hazard model was used to determine whether reimplantation was independently associated with overall survival.Results
We identified 87 UAS in 69 patients. Reimplantation was performed in 26 patients (37.7%), and 43 patients (62.3%) were managed nonoperatively. The interval between cystectomy and stricture diagnosis was similar in the reimplanted and nonoperative groups (3.06 vs. 4.34 mo, P = 0.42). The differences between baseline and follow-up creatinine levels (+0.40 vs.+0.40 mg/dl, P = 0.72) and estimated glomerular filtration rate (?25.0 vs.?18.9 ml/min/1.73 m2, P = 0.66) were similar between groups, as were rates of renal loss (34.6% vs. 39.5%, P = 0.68); however, mortality was significantly higher in the nonoperative group. After multivariable adjustment, overall survival remained significantly higher among UAS patients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13–0.80).Conclusion
Reimplantation was associated with improved overall survival but not with improved long-term renal functional outcomes compared with nonoperative management. Nonrenal complications of nonoperative UAS management may play an important role in reducing longevity. 相似文献2.
Ian J. Stewart Jonathan A. Sosnov Brian D. Snow Augen Batou Jeffrey T. Howard Jud C. Janak Mary Bollinger Kevin K. Chung 《Burns : journal of the International Society for Burn Injuries》2017,43(2):290-296
Background
The long-term health effects of burn are poorly understood. We sought to evaluate the relationship between burn and the subsequent development of hypertension.Methods
Retrospective cohort study of patients admitted to our burn center from 2003 to 2010. Data collected included demographic variables, burn size, injury severity score, presence of inhalation injury, serum creatinine, need for renal replacement therapy, as well as days spent in the hospital, in the intensive care unit and on mechanical ventilation. Data for the subsequent diagnosis of hypertension was obtained from medical records. Cox proportional hazard regression models were performed to determine what factors were associated with hypertension.Results
Of the 711 patients identified, 670 were included for analysis after exclusions. After adjustment, only age (HR 1.06 per one year increase, 95% confidence interval 1.03–1.08; p < 0.001), percentage of total body surface area burned (HR 1.11 per 5% increase, 95% confidence interval 1.04–1.19; p = 0.002) and acute kidney injury (HR 1.68, 95% confidence interval 1.05–2.69; p = 0.03) were associated with hypertension.Conclusion
Burn size is independently associated with the subsequent risk of hypertension in combat casualties. Clinical support for primary prevention techniques to reduce the incidence of hypertension specific to burn patients may be warranted. 相似文献3.
Ahmed Adam Ruan de Jongh Charles Mathye Amit Satish Bhattu Haroun Patel 《The African Journal of Urology》2017,23(3):224-227
Introduction
The ‘encrusted and forgotten double J ureteric stent (JJ) phenomenon has always proven to be a challenging dilemma facing the attending urologist.Observation
Herein, we describe the first reported case of 3 encrusted stents within the same ureter, with an overall KUB score of 14 (K = 5, U = 4, B = 5). Complete (stent and stone) clearance was achieved using multiple combined, endo-urological procedures (sequentially) including; bladder stone laser lithotripsy, distal JJ stent coil resections, PCNL and prograde (flexible) ureteroscopy, followed by rigid and flexible retrograde ureteroscopy. The resulting reno-gram confirmed a 45% functioning ipsilateral system.Conclusion
The first report of 3 encrusted stents within the same ureter is presented. The prevention of JJ stent encrustation is crucial via adequate and appropriate patient counselling. In most patients with forgotten encrusted stents who qualify for endoscopic management, a multi-modality approach is required. 相似文献4.
Simon P. Kim Cary P. Gross Neal Meropol Alexander Kutikov Marc C. Smaldone Nilay D. Shah James B. Yu Sarah Psutka Jonathon Kiechle Robert Abouassaly 《Urologic oncology》2017,35(3):113.e15-113.e21
Objective
To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy.Materials and methods
Using the National Cancer Database, we identified older patients (≥70 y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment—partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2–3.9, or 4–7 cm) and age groups (70–79 and ≥80 y) was used to identify covariates associated with different treatments.Results
Among 41,518 older patients with T1 renal cell carcinoma renal tumors, most were treated with radical nephrectomy (59.0%) followed by PN (20.0%) and ablation (8.4%). Only 12.6% were managed by EM. Among older patients aged 70 to 79 years with renal tumors 2 to 3.9 cm, PN was used more frequently in 2008 to 2009 (odds ratio [OR] = 1.32; P = 0.001) and 2010 to 2011 (OR = 1.87; P<0.001) compared to 2002 to 2003 and at academic hospitals (OR = 1.91; P<0.001) compared to community hospitals. Similar trends were observed for patients aged 70 to 79 years with 4 to 7 cm tumors and for patients aged≥80 years across renal tumor sizes.Conclusions
Among older patients with localized renal tumors and limited life expectancy, most are treated surgically with a growing use of PN. A smaller proportion of older patients are managed by EM in the United States. 相似文献5.
Introduction
Tamsulosin is an α-1A-specific blocker inducing selective relaxation of ureteral smooth muscle and inhibition of ureteral spasms leading to ureteral dilatation that can facilitates retrograde ureterorenoscopy (URS).Objective
To assess the efficacy of tamsulosin in improving the outcome of URS management of lower ureteral stones.Patients and methods
This prospective, randomised, controlled, clinical trial was carried out between June 2011 and December 2014. It included 98 patients with lower ureteral stones scheduled for treatment with URS. Before URS, patients were randomly divided into 2 groups; study group including 51 patients, in which pre-URS daily oral dose of tamsulosin 0.4 mg tab, for 1 week, was given and control group including 47 patients who received no additional therapy rather than standard analgesic on demand. The URS outcomes were evaluated and compared between both groups.Results
The demographic and stone characteristics were comparable between both groups. The mean URS time was significantly shorter in study group than in control group (52.0 ± 14.9 min vs. 71.0 ± 17.3 min; p = 0.039). Of the 98 patients, 89 (90.81%) had a successful URS procedures. The success rate was 94.1% (98/51) in study group compared 89.2% (58/65) in the control group, with statistically significant difference (p = 0.045). The major complications occurred in 4.25% of patients in control group but in only 1.96% of those received tamsulosin (p = 0.034).Conclusion
Post-tamsulosin ureteroscopy was easier and safer; leading to significantly increased stone-free rates and fewer complications. 相似文献6.
D.E. Orakwe K.H. Tijani E.A. Jeje M.A. Ogunjimi R.W. Ojewola 《The African Journal of Urology》2017,23(2):105-108
Objectives
To compare serum testosterone and prostate specific antigen (PSA) levels of patients diagnosed of prostate cancer to those with benign prostatic hyperplasia (BPH).Subjects and methods
One hundred and thirteen male patients with or without LUTS who had indication(s) for prostate biopsies were recruited. Blood samples were analysed for serum testosterone and serum PSA. Prostate sizes were measured and PSA densities calculated before trans-rectal prostate biopsies were performed.Results
On histology of prostate biopsy specimens, 54 patients (47.8%) had prostate adenocarcinoma while 59 patients (52.2%) had BPH. Serum testosterone levels were lower in the prostate cancer group (23.09 ± 2.31 nmol/L versus 24.37 ± 1.94 nmol/L in the BPH group) but this difference was not statistically significant (p = 0.671). Serum testosterone also did not differ significantly with Gleason grade and Gleason score in patients with prostate cancer.Serum PSA and PSA density (PSAD) values were significantly higher in men with prostate cancer, and also in prostate cancer patients with high grade disease.Conclusion
Serum testosterone levels of patients with prostate cancer did not significantly differ from those of patients with BPH and were not related to grade in prostate cancer patients. 相似文献7.
Peter A. Caputo Homayoun Zargar Daniel Ramirez Hiury S. Andrade Oktay Akca Tianming Gao Jihad H. Kaouk 《European urology》2017,71(1):111-117
Background
The traditional treatment for a cT1b renal tumor has been radical nephrectomy. However, recent guidelines have shifted towards partial nephrectomy (PN) in selected patients with cT1b renal tumors. Furthermore, practitioners have extended the role of cryoablation (CA) to treat cT1b tumors in selected patients.Objective
To evaluate the efficacy of CA compared to PN for cT1b renal tumors.Design, setting, and participants
We performed a retrospective review of patients who underwent either renal CA (laparoscopic or percutaneous) or PN (robot-assisted) for a cT1b renal mass (>4 cm and ≤7 cm) between November 1999 and August 2014. To reduce the inherent biases of a retrospective study, CA and PN groups were matched on the basis of key variables: tumor size, Charlson comorbidity index (CCI), age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative serum creatinine, preoperative estimated glomerular filtration rate (eGFR), gender, and solitary kidney. The matching algorithm was 1:1 genetic matching with no replacement.Outcome measurements and statistical analysis
Survival analysis was performed only for patients diagnosed with renal cell carcinoma according to histopathologic evaluation of a tumor biopsy or resected tumor specimen. Recurrence-free, overall, and cancer-specific survival were analyzed using Kaplan-Meier survival curves. Survival outcomes were compared between groups using the log-rank test.Results and limitations
A total of 31 patients were treated using CA and 161 using PN during the study period. After matching, there was no significant difference between the PN and CA groups for tumor size (4.6 vs 4.3 cm; p = 0.076), CCI (6 vs 6; p = 0.3), RENAL score (9 vs 8; p = 0.1), age (68 vs 68 yr; p = 0.9), BMI (30 vs 31 kg/m2; p = 0.2), ASA score (3 vs 3; p = 0.3), preoperative creatinine (1.2 vs 1.4 mg/dl; p = 0.2), preoperative eGFR (63 vs 53 ml/min/1.73 m2; p = 0.2), and proportion of patients with a solitary kidney (19% vs 32%; p = 0.4). The total postoperative complication rate was higher for PN than for CA (42% vs 23%; p = 0.10). There was no significant difference in percentage eGFR preservation between PN and CA (89% vs 93%; p = 0.5). The rate of local recurrence was significantly higher for CA than for PN (p = 0.019). There was no significant difference in cancer-specific mortality (p = 0.5) or overall mortality (p = 0.15) between the CA and PN groups.Conclusions
Patients treated with CA for cT1b renal tumors had a significantly higher rate of local cancer recurrence at 1 yr compared to those treated with PN. Until further studies are performed to clearly define the role of CA in cT1b renal tumors, CA should be reserved for patients with imperative indications for nephron-sparing surgery who cannot be subjected to the risks of more invasive PN.Patient summary
We evaluated the efficacy of renal cryoablation compared to partial nephrectomy for clinical T1b renal tumors. The cryoablation and partial nephrectomy groups were matched to provide a better comparison. We concluded that renal cryoablation had a higher rate of local cancer recurrence. 相似文献8.
Introduction
Percutaneous nephrolithotomy (PCNL) could be mentioned as the most important treatment of choice for kidney staghorn stones. Previous publications reported that the novel biomarker urinary neutrophil gelatinase-associated lipocalin (NGAL) activity significantly increases in acute kidney injury (AKI) but there is not many published articles related to increase of NGAL after PCNL procedure.Objective
This study aimed to investigate AKI by urinary measurement of NGAL after PCNL procedure.Subjects and methods
Based on a cross-sectional design, 41 patients with staghorn renal stones were nominated. All patients have been informed and signed the consent form. NGAL levels were measured by urinary sampling at 2 h before and 12 h after the procedure. Serum creatinines (Cr) were measured 12 h before and 48 h after the surgery. Demographic and clinical data including surgical procedure were recorded in Excel and analyzed by SPSS (SPSS Inc., Chicago, IL) for windows.Results
With a minimum of 20 and a maximum of 70, the mean age of patients was 47 years old. 71% of patients studied were males. There was a significant change in mean serum Cr (1.06 versus 1.12 mg/dL; p < 0.01) before and after the procedure respectively. Glomerular filtration rate (GFR) with a mean of 81.93 umol/L before the procedure was decreased (p < 0.02) to 77.46 umol/L after the procedure. The changes in urine level of NGAL were significant (p < 0.02), associated to an increase in mean value of 20.63 ng/mL (two hours before) versus 56.28 ng/mL (twelve hours after)the PCNL procedure.Conclusions
Within different extents after PCNL procedure there was a significant increase in the biomarker of NGAL levels.In order to reduce AKI and other post-operative complications, further studies in a large population of patients seem to be advantageous. 相似文献9.
A. Ibrahim I. Elsotohi S. Mahjoub A. Elatreisy Kh. Soliman M. Mabrouk I. Khalaf 《The African Journal of Urology》2017,23(3):208-213
Objective
To determine factors affecting perioperative complications of percutaneous nephrolithotomy (PCNL) at a tertiary care academic center.Patients and methods
Data from medical records of all patients who had undergone PCNL and matched the selection criteria in a tertiary care center between March 2010 and March 2015 were retrospectively reviewed. The demographic data, stone parameters, and stone free rate were addressed. Factors affecting perioperative complications of PCNL were evaluated and classified according to the modified Clavien classification (MCC) using different statistical methods.Results
A total of 518 patients undergoing 575 PCNL procedures were enrolled in this study. Complications were detected in 148 patients (28.6%); the most serious complication was peri-operative bleeding in 53 patients (10.2%), which required conversion to open surgery in 12 cases (2.3%). Mortality occurred in 2 patients (0.4%). Grade I, II, IIIa, IIIb, IVa, IVb, V complications represented (14.1%), (15.4%), (7.5%), (2.3%), (0.6%), (0%), (0.4%), respectively. Complications of PCNL were significantly associated with tract numbers, tract location, method of stone extraction, and surgeon experience (P < 0.05), while gender, stone shape and location, stone burden, degree of hydronephrosis, pervious surgery, position of PCNL (supine vs. prone) and comorbidity did not impact perioperative complications (P > 0.05).Conclusion
Perioperative complications of PCNL were significantly affected by surgeon experience, number of PCNL tracts, accessed calyx as well as method of stone extraction. However, patient gender, stone characteristics (configuration, location and burden), degree of hydronephrosis, pervious renal surgery, surgical position (supine vs. prone) did not impact the outcome of PCNL. 相似文献10.
A.S. Abdelaziz Y.A. Badran A.Y. Aboelsaad H. Elhilaly 《The African Journal of Urology》2017,23(1):38-42
Objectives
To evaluate and compare the efficacy of tamsulosin (0.4 mg, once/day) and combinations of it with trospium (20 mg, twice/day) in the treatment of single small lower ureteral stones.Patients and methods
A total of 126 patients presenting to urology outpatient clinics from July 2012 to May 2015, with a single 5–10 mm sized lower ureteral stone were randomly classified into two treatment groups. Patients in group A (n = 62) received an oral dose of 0.4 mg tamsulosin once daily and 20 mg trospium chloride twice daily. Patients in group B (n = 64) received 0.4 mg tamsulosin once daily and placebo twice daily. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated.Results
There were no significant differences in baseline characteristic of the patients in both groups. Stone expulsion was observed in 47 patients (75.8%), and 58 (90.62%) in groups A and B respectively. The average time to expulsion was 11.65 ± 5.32 days in group A and 17.35 ± 6.21 days in group B. The spontaneous stone passage rate through the ureter was significantly higher and the stone expulsion time was faster in groups A than in group B (p < 0.05). The adverse effects observed in both groups were comparable and were mild.Conclusions
The combination of 0.4 mg tamsulosin and 40 mg trospium as MET for single lower ureteral stones <10 mm is safe and more effective than 0.4 mg tamsulosin as a mono-therapy. 相似文献11.
MR Danzig RA Ghandour P Chang AA Wagner PM Pierorazio ME Allaf JM McKiernan 《Urologic oncology》2017,35(3):116
Purpose
We compared renal function outcomes among patients in the surveillance and intervention arms of the DISSRM registry.Materials and methods
Patients were grouped into chronic kidney disease stages by estimated glomerular filtration rate range. Cases were considered up staged if a more advanced chronic kidney disease stage was entered during followup. Chronic kidney disease up staging-free survival was compared among groups using Kaplan-Meier analysis and paired comparisons log rank tests. Multivariate Cox regression identified independent predictors of chronic kidney disease up staging-free survival.Results
A total of 162 patients met the study inclusion criteria, with 68 in the surveillance arm, 65 undergoing partial nephrectomy, 15 undergoing radical nephrectomy, and 14 undergoing cryoablation. Median tumor size was 2.2 cm. Mean estimated glomerular filtration rate change was significantly larger for radical nephrectomy vs. surveillance (?9.2 vs. ?0.5 ml/min/1.73 m2) and for radical vs. partial nephrectomy (?9.2 vs. ?1.9 ml/min/1.73 m2) (P = 0.001). No other groups differed significantly. On Kaplan-Meier analysis, patients undergoing radical nephrectomy had significantly worse chronic kidney disease up staging-free survival vs. those treated with partial nephrectomy (P = 0.029), surveillance (P = 0.007), and cryoablation (P = 0.019). No other groups differed significantly. On multivariate analysis, radical nephrectomy independently predicted poor chronic kidney disease up staging-free survival (odds ratio vs. surveillance 30.6, P = 0.001). Neither partial nephrectomy (P = 0.985) nor cryoablation (P = 0.976) predicted poor chronic kidney disease up staging-free survival relative to surveillance.Conclusions
Patients in the surveillance arm had superior estimated glomerular filtration rate preservation compared to those in the radical nephrectomy but not the partial nephrectomy arm. In certain patients with small renal masses, surveillance and partial nephrectomy may offer comparable renal functional outcomes. This could be partly attributable to a modest estimated glomerular filtration rate decrease associated with surveillance itself. A thorough understanding of the renal functional impacts of treatment modalities is critical in the management of small renal masses. 相似文献12.
Zhao-Kai Low Wai-Yee Ng Stephanie Fook-Chong Bien-Keem Tan Si-Jack Chong Jolie Hwee Sook-Muay Tay 《Burns : journal of the International Society for Burn Injuries》2017,43(2):436-444
Objective
Diabetic burns patients may be at risk of worse clinical outcomes. This study aims to further investigate the impact of diabetes mellitus on clinical outcomes in burns patients in Singapore.Methods
A 3-year retrospective review was performed at the Singapore General Hospital Burns Centre (2011–2013). Pure inhalational burns were excluded. Diabetic (N = 53) and non-diabetic (N = 533) patients were compared, and the impact of diabetes on clinical outcomes, adjusting for confounders, was investigated using multivariate logistic regression.Results
The diabetic group had a significantly higher incidence of wound infection and severe renal impairment, as well as a longer length of stay, higher number of operations and higher rate of unplanned readmission. ICU admission was significantly associated with hyperglycaemia (OR 5.44 [2.61–11.35], p < 0.001) and a higher total body surface area of burn (OR per 1% TBSA 1.07 [1.05–1.09], p < 0.001). Unplanned readmission was significantly associated with wound infection (OR 4.29 [1.70–10.83], p = 0.002), and mortality associated with a higher TBSA (OR per 1% TBSA 1.1 [1.07–1.14], p < 0.001). After adjusting for confounders, diabetes mellitus was not significantly associated with unplanned readmission or mortality.Conclusions
Diabetic burns patients have an increased risk of worse clinical outcomes, including wound infections, renal impairment and longer length of stay. 相似文献13.
Fiona Mei Wen Wu Fiona Burkhard Filippo Turri Marc Furrer Lukas Loeffel George Thalmann Patrick Wuethrich 《Urologic oncology》2017,35(10):602.e11-602.e17
Objective
To determine whether a restrictive perioperative fluid management in the context of an enhanced recovery after surgery program for radical cystectomy and urinary diversion affects renal function, as fluid restriction and the use of vasopressors have been linked to impaired tissue perfusion, potentially resulting in renal dysfunction.Methods
We followed 166 patients initially included in a randomized clinical trial and equally allocated to receive a continuous norepinephrine administration combined with 1 ml/kg/h initially, and after cystectomy 3 ml/kg/h crystalloid infusion (intervention group, n = 83), or a standard crystalloid infusion of 6 ml/kg/h throughout surgery (control group, n = 83). All patients followed our institutional enhanced recovery after surgery program. We prospectively assessed renal function (plasma creatinine values and estimated glomerular filtration rate Chronic Kidney Disease Epidemiology Collaboration equation) postoperatively. Decreased renal function was defined as a decrease in glomerular filtration rate is greater than 20% compared to preoperative values.Results
There was no significant difference in renal function between the groups postoperatively at any time point after discharge: diabetes mellitus (HR = 2.81 [95% CI: 1.48–5.36]; P = 0.002), preoperative estimated glomerular filtration rate (HR = 1.02 [95% CI: 1.00–1.03]; P = 0.007), and age (OR = 1.03 [95% CI: 11.00–1.06]; P = 0.038) were negative predictors for renal deterioration.Conclusion
Postoperative renal function evolution was similar in patients receiving restrictive hydration with norepinephrine administration when compared to liberal hydration intraoperatively, suggesting that there is no influence of fluid management and administration of vasopressors on mid-term renal function. 相似文献14.
Michael Daugherty Dillon Sedaghatpour Oleg Shapiro Srinivas Vourganti Alexander Kutikov Gennady Bratslavsky 《Urologic oncology》2017,35(4):153.e15-153.e20
Objective
The influence of histology in metastatic potential is often overlooked when discussing the management options of small renal masses (SRM), with size or growth rate often serving as the triggers for the intervention. We aim to re-examine the definition of a SRM by evaluating the metastatic potential of renal masses incorporating tumor size and histology to create metastatic risk tables.Materials and methods
Surveillance Epidemiology and End Results (SEER)-18 registries database was queried for all cases of clear cell, papillary, and chromophobe renal cell carcinoma (RCC) diagnosed between 2004 and 2012. There were 55,478 cases identified that included 43,783, 8,587, and 3,208 cases of clear cell, papillary, and chromophobe, respectively. Tumors were stratified using 1-cm increments to determine the metastatic potential by calculating the metastatic rate at presentation for different size intervals in histologic categories.Results
For all 3 histologies, tumors measuring 5 cm or less had a rate of metastatic RCC at presentation of less than 4%. The metastatic potential was highest for clear cell, followed by papillary and then chromophobe tumors. Setting a cutoff of no more than 3% for metastatic potential to be called a SRM, makes clear cell carcinoma and papillary carcinoma a SRM up to 4 cm, whereas the chromophobe RCC would be considered a SRM up to 7 cm.Conclusion
Although clinical staging and tumor size have been the key determinants in decision-making of patients with solid renal tumors, the histology-specific risks of metastatic potential are different for each mass. The definition of a SRM should be based on the metastatic potential and not on tumor size alone. This information could be helpful for counseling and managing patients with SRMs as well as for modifying active surveillance protocols. 相似文献15.
Hiroki Ishihara Tsunenori Kondo Kazuhiko Yoshida Kenji Omae Toshio Takagi Junpei Iizuka Kazunari Tanabe 《Urologic oncology》2017,35(9):542.e1-542.e9
Objectives
The effect of response to first-line tyrosine kinase inhibitor (TKI) therapy on second-line survival in patients with metastatic renal cell carcinoma who receive second-line molecular-targeted therapy (mTT) after first-line failure remains unclear.Materials and methods
Sixty patients who developed disease progression after first-line TKI, without prior cytokine therapy, were enrolled. According to the median first-line time to progression (1L-TTP), patients were divided into 2 groups (i.e., short vs. long). Second-line progression-free survival (2L-PFS) and second-line overall survival (2L-OS) were defined as the time from second-line mTT initiation. Survival was calculated with the Kaplan-Meier method and compared using the log-rank test between patients with short and long 1L-PFS. Predictors for survivals were identified using Cox proportional hazards regression models.Results
The median 1L-TTP was 8.84 months. Thirty patients (50.0%) with short 1L-TTP (<8.84 mo) had significantly shorter 2L-PFS and 2L-OS compared to patients with long 1L-TTP (2L-PFS: 4.96 vs. 10.2 mo, P = 0.0002; 2L-OS: 9.6 vs. 28.0 mo, P = 0.0036). Multivariable analyses for 2L-PFS and 2L-OS showed that 1L-TTP was an independent predictor both as a categorical classification (cutoff: 8.84 mo) and as a continuous variable (both P<0.05). The median follow-up duration was 13.1 months (interquartile range: 6.56–24.7).Conclusions
Patients who achieve a long-term response after first-line TKI therapy could have a favorable prognosis with second-line mTT. 相似文献16.
Emil Christensen Karin Birkenkamp-Demtröder Iver Nordentoft Søren Høyer Kirstin van der Keur Kim van Kessel Ellen Zwarthoff Mads Agerbæk Torben Falck Ørntoft Jørgen Bjerggaard Jensen Lars Dyrskjøt 《European urology》2017,71(6):961-969
Background
Disease surveillance in patients with bladder cancer is important for early diagnosis of progression and metastasis and for optimised treatment.Objective
To develop urine and plasma assays for disease surveillance for patients with FGFR3 and PIK3CA tumour mutations.Design, setting, and participants
Droplet digital polymerase chain reaction (ddPCR) assays were developed and tumour DNA from two patient cohorts was screened for FGFR3 and PIK3CA hotspot mutations. One cohort included 363 patients with non–muscle-invasive bladder cancer (NMIBC). The other cohort included 468 patients with bladder cancer undergoing radical cystectomy (Cx). Urine supernatants (NMIBC n = 216, Cx n = 27) and plasma samples (NMIBC n = 39, Cx n = 27) from patients harbouring mutations were subsequently screened using ddPCR assays.Outcome measurements and statistical analysis
Progression-free survival, recurrence-free survival, and overall survival were measured. Fisher's exact test, the Wilcoxon rank-sum test and Cox regression analysis were applied.Results and limitations
In total, 36% of the NMIBC patients (129/363) and 11% of the Cx patients (44/403) harboured at least one FGFR3 or PIK3CA mutation. Screening of DNA from serial urine supernatants from the NMIBC cohort revealed that high levels of tumour DNA (tDNA) were associated with later disease progression in NMIBC (p = 0.003). Furthermore, high levels of tDNA in plasma samples were associated with recurrence in the Cx cohort (p = 0.016). A positive correlation between tDNA levels in urine and plasma was observed (correlation coefficient 0.6). The retrospective study design and low volumes of plasma available for analysis were limitations of the study.Conclusions
Increased levels of FGFR3 and PIK3CA mutated DNA in urine and plasma are indicative of later progression and metastasis in bladder cancer.Patient summary
Urine and plasma from patients with bladder cancer may be monitored for diagnosis of progression and metastasis using mutation assays. 相似文献17.
Introduction
Incidence of lower ureteric injuries has increased due to proliferation of complex pelvic laparoscopic and ureteroscopic procedures.Objective
To describe our experience of laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas due to different aetiologies.Patients and methods
A total of 42 patients underwent laparoscopic ureteric reimplantation from January 2007 to December 2013 after preoperative evaluation by intravenous urography or CT urogram to delineate the site and length of stricture or ureterovaginal fistula. All the patients were followed up with ultrasonography and micturating cystourethrogram at 3 months. Out of the total 42 patients, 22 patients (group 1) underwent laparoscopic ureteric reimplant for lower ureteric stricture and 20 patients (group 2) underwent laparoscopic ureteric reimplant for ureterovaginal fistula.Results
There were 5 male and 37 female patients. The mean patient age was 43.5 ± 12 (range 24–62 yrs), mean operating time was 129 ± 11 (range 110–160) minutes, mean hospital stay was 2.8 (range 2–6) days and mean follow up period of 16 months (range 6–70). Two procedures had to be converted to open (one each in both groups). There were no major (Clavien grade III and above) intra-operative or post-operative complications. One of the failures in lower ureteric stricture group was managed by open reconstruction with boari flap.Conclusion
Laparoscopic ureteric reimplantation is an excellent modality for both lower ureteric strictures and ureterovaginal fistulas with long term good outcomes in addition to the advantage of lesser hospital stay and lesser comorbidities. 相似文献18.
19.
Introduction
Chromophobe renal cell carcinoma accounts for 3–5% of all RCCs. However, its association with urothelial carcinoma of urinary bladder has never been reported. We report a case of synchronous association of chromophobe RCC with low grade urothelial carcinoma of urinary bladder.Observations
A 64-year old gentleman, presented with a dull aching pain in right loin region of one month duration. General physical and abdominal examinations were unremarkable. Ultrasonography of abdomen showed a well-defined hypoechoic mass lesion involving the lower pole of right kidney. CECT abdomen revealed a partially exophytic mass lesion of size 4 cm × 4.3 cm × 5.1 cm arising from lower pole of right kidney. Surprisingly, urinary bladder also showed a polypoidal mass lesion measuring 15 mm × 12 mm × 13 mm in posterior wall inferior to right vesico-ureteric junction. We proceeded with right partial nephrectomy followed by transurethral resection of bladder tumor. Histopathology report revealed chromophobe RCC and low grade urothelial carcinoma of urinary bladder. The patient is under regular follow-up.Conclusion
Synchronous association of chromophobe RCC with urothelial carcinoma of urinary bladder has not been reported so far, hence there is no scientific consensus in the management of these lesions. 相似文献20.
R.A. Gadelkareem D.A. Hameed A.M. Moeen A.M. El-Araby M.A. Mahmoud A.M. El-Taher A.A. El-Haggagy M.F. Ramzy 《The African Journal of Urology》2017,23(1):56-61