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1.
H. Takaki K. Yamakado N. Kuriyama A. Nakatsuka H. Sakuma S. Isaji 《Diagnostic and interventional imaging》2017,98(1):43-50
Purpose
To evaluate the clinical utility of percutaneous drainage of pancreatic fistula following pancreatectomy with real-time CT-fluoroscopic guidance.Material and methods
During January 2007 through March 2013, of 295 patients who underwent pancreatectomy, 20 patients received percutaneous drainage of pancreatic fistula with real-time CT-fluoroscopic guidance. The mean diameter of pancreatic fluid collections was 8.1 ± 2.7 (SD) cm (range: 3.5–15.0 cm). Feasibility, safety, and clinical success were evaluated. Primary and secondary clinical successes were defined respectively as the resolution of pancreatic fistula by initial drainage alone, and after additional intervention. Factors affecting primary clinical success and the drainage period were also evaluated.Results
Drainage catheters were placed in planned sites in all patients. No major complication occurred except in 1/20 patient (5%) who experienced endotoxin shock. Primary and secondary clinical success rates were, respectively, 50% (10/20) and 90% (18/20). An amylase level greater than 30,000 IU/L in the fluid collection was a significant factor lowering the primary clinical success rate (P < 0.02) and prolonging the drainage period (> 30 days) (P < 0.02).Conclusion
Real-time CT-fluoroscopic guided drainage is a feasible, safe, and useful therapeutic option for the management of pancreatic fistula after pancreatectomy. The fluid amylase level is a useful indicator to predict refractory pancreatic fistula. 相似文献2.
Bimal Bhindi Ross J. Mason Mustafa M. Haddad Stephen A. Boorjian Bradley C. Leibovich Thomas D. Atwell Adam J. Weisbrod Grant D. Schmit R. Houston Thompson 《European urology》2018,73(2):254-259
Background
While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.Objective
To compare outcomes between PCA and PN for tumors in a solitary kidney.Design, setting, and participants
Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures.Intervention
PCA and PN.Outcome measurements and statistical analysis
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models.Results and limitations
The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15, 0.96; p = 0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR = 0.95; 95% CI 0.53, 1.69; p = 0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β = –5%; 95% CI –13, 3; p = 0.2) or at 3 mo (12% vs 9%; β = 3%; 95% CI –3, 10; p = 0.3). Likewise, no significant differences were noted in local recurrence (HR = 0.87; 95% CI 0.38, 1.98; p = 0.7), distant metastases (HR = 0.60; 95% CI 0.30, 1.20; p = 0.2), or cancer-specific mortality (HR = 1.13; 95% CI 0.32, 3.98; p = 0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys.Conclusions
Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted.Patient summary
Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches. 相似文献3.
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4.
Keiko Uemura Satoki Inoue Masahiko Kawaguchi 《Brazilian Journal of Anesthesiology》2018,68(4):336-343
Background and objectives
Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement.Methods
Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement.Results
In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021–4.359), low surgical risk (OR = 1.729, 95% CI 1.038–2.881), short duration of anesthesia (OR = 0.961/10 min increase, 95% CI 0.945–0.979), and postoperative care outside of the intensive care unit (OR = 2.197, 95% CI 1.402–3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p = 0.032, OR = 2.282, 95% CI 1.076–4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p = 0.0536, OR = 2.115, 95% CI 0.988–4.526).Conclusions
More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on holidays, during low risk surgery, with a short duration of anesthesia, or in cases that do not require postoperative intensive care. 相似文献5.
6.
B.M. de Kok A.W.K.S. Marinelli J.B.C.M. Puylaert L.P.J. Cobben 《Diagnostic and interventional imaging》2019,100(2):77-83
Objective
The purpose of this study was to retrospectively evaluate the safety and efficacy of posterior transperineal drainage in patients with presacral abscess.Materials and method
The records of 21 patients (14 men, 7 women; mean age: 62.1 ± 10 years) who underwent posterior transperineal drainage for the treatment of presacral abscess, either using fluoroscopy or computed tomography guidance, were retrospectively reviewed. Data were analysed with respect to technical success, tolerance, duration of drainage, complications and short-term outcome.Results
A total of 28 posterior transperineal drainage procedures of presacral abscesses were performed in 21 patients, either using fluoroscopy (24/28; 86%) or computed tomography (4/28; 14%) guidance. Technical success rate was 89% (25/28 procedures) and clinical success rate 88% (22/25 technically successful procedures). Transperineal catheter drainage was maintained for 3–105 days (mean 31 days ± 26 [SD]). After three procedures (3/28; 11%) patients reported discomfort. No major complications were reported.Conclusion
This study suggests that posterior transperineal drainage is an effective, safe and well-tolerated procedure for the treatment of presacral abscess. 相似文献7.
D. Kim S.I. Iqbal H.K. Ahari C.P. Molgaard S. Flacke B.D. Davison 《Diagnostic and interventional imaging》2018,99(1):15-21
Purpose
To investigate the rates of interval cholecystectomy and recurrent cholecystitis after initial percutaneous cholecystostomy (PC) and identify predictors of patient outcome after PC.Materials and methods
A total of 144 patients with acute cholecystitis who were treated with PC were included. There were 96 men and 48 women, with a mean age of 71 ± 13 (SD) years (range: 25–100 years). Patient characteristics, diagnostic imaging studies and results of laboratory tests at initial presentation, clinical outcomes after the initial PC treatment were reviewed.Results
Among the 144 patients, 56 patients were referred for acute acalculous and 88 patients for calculus cholecystitis. Five procedure-related major complications (3.6%) were observed including bile peritonitis (n = 3), hematoma (n = 1) and abscess formation (n = 1). Recurrent acute cholecystitis after initial clinical resolution and PC tube removal was observed in 8 patients (6.0%). The rate of interval cholecystectomy was 33.6% (47/140) with an average interval period of 100 ± 482 (SD) days (range: 3–1017 days). PC was a definitive treatment in 85 patients (60.7%) whereas 39 patients (27.9%) had elective interval cholecystectomy without having recurrent cholecystitis. The clinical outcomes after PC did not significantly differ between patients with calculous cholecystitis and those with acalculous cholecystitis. Multiple prior abdominal operations were associated with higher rates of recurrent cholecystitis.Conclusion
For both acute acalculous and calculous cholecystitis, PC is an effective and definitive treatment modality for more than two thirds of our study patients over 3.5-year study period with low rates of recurrent disease and interval cholecystectomy. 相似文献8.
J.Y. Hwang J.H. Shin Y.J. Lee H.M. Yoon Y.A. Cho K.S. Kim 《Diagnostic and interventional imaging》2018,99(3):157-162
Purpose
The purpose of this study was to evaluate the feasibility, safety, and clinical effectiveness of ultrasound and fluoroscopy-guided percutaneous nephrostomy (PCN) placement in infants and young children.Materials and methods
Between January 2000 and December 2015, 57 patients had a total of 66 fluoroscopically guided PCN placement procedures. There were 37 boys and 20 girls with a mean age 8.6 ± 15.3 (SD) months (range: 1 day–75.5 months). The most common underlying disease was upper-urinary-tract obstruction, including ureteropelvic-junction stenosis (27/66, 40.9%) and ureterovesical-junction stenosis (16/66, 24.2%). Technical success, complications, clinical effectiveness, and radiation exposure were retrospectively analyzed. Technical success was defined as completion of PCN catheter in the renal calyx or proximal ureter. Complications were graded in severity using the Common Terminology Criteria for Adverse Event (version 4.03). Clinical effectiveness was evaluated with presence of decompression of the hydronephrosis on follow-up ultrasonography.Results
All PCN placement procedures were technically successful. A total of 37 complications were identified in 33/37 procedures (89.2%), with transient gross hematuria (n = 28) being most common (mean hematuria duration 2.2 ± 1.4 [range: 1–6] days), which were grade 1 Postprocedural fever occurred after eight procedures; four and three patients were graded 1 and 2, respectively. Complete hydronephrosis decompression was achieved in 35/53 kidneys (66%), incomplete hydronephrosis decompression in 17/55 kidneys (32.1%), and progression of hydronephrosis was noted in 1/55 kidney (1.9%). Dose-area-product (DAP) was 44.86 ± 89 (SD) (range: 3.7–464) μGy cm2 and cumulative dose was 10.3 ± 20.4 (SD) (range: 0.3–97.9) mGy.Conclusion
PCN is a feasible and effective treatment option to relieve urinary obstruction, and can serve as a bridging procedure until definitive corrective surgery in pediatric patients. 相似文献9.
Zhangqun Ye Guohua Zeng Huan Yang Kun Tang Xiaochun Zhang Hong Li Weibing Li Zhong Wu Lingwu Chen Xingfa Chen Xiankui Liu Yaoliang Deng Tiejun Pan Jinchun Xing Shusheng Wang Yue Cheng Xiaojian Gu Wenxi Gao Hua Xu 《European urology》2018,73(3):385-391
Background
Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones.Objective
To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo.Design, setting, and participants
We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin.Intervention
Participants were randomly assigned (1:1) into tamsulosin (0.4 mg) or placebo groups for 4 wk.Outcome measurements and statistical analysis
The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events.Results and limitations
Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p < 0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5 mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p < 0.001), required lower use of analgesics compared with placebo (p < 0.001), and significantly relieved renal colic (p < 0.001). No differences in the incidence of adverse events were identified between the two groups.Conclusions
Our data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5 mm, but no effect for stones ≤5 mm.Patient summary
In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. 相似文献10.
Matthew D. Galsky Huan Wang Noah M. Hahn Przemyslaw Twardowski Sumanta K. Pal Costantine Albany Mark T. Fleming Alexander Starodub Ralph J. Hauke Menggang Yu Qianqian Zhao Guru Sonpavde Michael J. Donovan Vaibhav G. Patel John P. Sfakianos Josep Domingo-Domenech William K. Oh Nicholas Akers Andrew V. Uzilov 《European urology》2018,73(5):751-759
Background
Chemotherapy may exert immunomodulatory effects, thereby combining favorably with the immune checkpoint blockade. The pharmacodynamic effects of such combinations, and potential predictive biomarkers, remain unexplored.Objective
To determine the safety, efficacy, and immunomodulatory effects of gemcitabine and cisplatin (GC) plus ipilimumab and explore the impact of somatic DNA damage response gene alterations on antitumor activity.Design, setting, and participants
Multicenter single arm phase 2 study enrolling 36 chemotherapy-naïve patients with metastatic urothelial cancer. Peripheral blood flow cytometry was performed serially on all patients and whole exome sequencing of archival tumor tissue was performed on 28/36 patients.Intervention
Two cycles of GC followed by four cycles of GC plus ipilimumab.Outcome measurements and statistical analysis
The primary endpoint was 1-yr overall survival (OS). Secondary endpoints included safety, objective response rate, and progression-free survival.Results and limitations
Grade ≥3 adverse events occurred in 81% of patients, the majority of which were hematologic. The objective response rate was 69% and 1-yr OS was 61% (lower bound 90% confidence interval: 51%). On exploratory analysis, there were no significant changes in the composition and frequency of circulating immune cells after GC alone. However, there was a significant expansion of circulating CD4 cells with the addition of ipilimumab which correlated with improved survival. The response rate was significantly higher in patients with deleterious somatic DNA damage response mutations (sensitivity = 47.6%, specificity = 100%, positive predictive value = 100%, and negative predictive value = 38.9%). Limitations are related to the sample size and single-arm design.Conclusions
GC + ipilimumab did not achieve the primary endpoint of a lower bound of the 90% confidence interval for 1-yr OS of >60%. However, within the context of a small single-arm trial, the results may inform current approaches combining chemotherapy plus immunotherapy from the standpoint of feasibility, appropriate cytotoxic backbones, and potential predictive biomarkers. Trial registration: ClinicalTrials.gov NCT01524991.Patient summary
Combining chemotherapy and immune checkpoint blockade in patients with metastatic urothelial cancer is feasible. Further studies are needed to refine optimal combinations and evaluate tests that might identify patients most likely to benefit. 相似文献11.
Karl H. Pang Ruth Groves Suresh Venugopal Aidan P. Noon James W.F. Catto 《European urology》2018,73(3):363-371
Background
Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery.Objective
We report the application of ERAS to patients undergoing radical cystectomy (RC).Design, setting, and participants
Prospective collection of outcomes from consecutive patients undergoing RC at a single institution.Intervention
Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intraoperative fluid resuscitation, regional local anaesthesia, cessation of nasogastric tubes, omitting oral bowel preparation, avoiding drain use, early mobilisation, chewing gum use, and audit.Outcome measurements and statistical analysis
Primary outcomes were length of stay and readmission rate. Secondary outcomes included intraoperative blood loss, transfusion rates, survival, and histopathological findings.Results and limitations
Four hundred and fifty-three consecutive patients underwent RC, including 393 (87%) with ERAS. Length of stay was shorter with ERAS (median [interquartile range]: 8 [6–13] d) than without (18 [13–25], p < 0.001). Patients with ERAS had lower blood loss (ERAS: 600 [383–969] ml vs 1050 [900–1575] ml for non-ERAS, p < 0.001), lower transfusion rates (ERAS: 8.1% vs 25%, chi-square test, p < 0.001), and fewer readmissions (ERAS: 15% vs 25%, chi-square test, p = 0.04) than those without. Histopathological parameters (eg, tumour stage, node count, and margin state) and survival outcomes did not differ with ERAS use (all p > 0.1). Multivariable analysis revealed ERAS use was (p = 0.002) independently associated with length of stay.Conclusions
The use of ERAS pathways was associated with lower intraoperative blood loss and faster discharge for patients undergoing RC. These changes did not increase readmission rates or alter oncological outcomes.Patient summary
Recovery after major bladder surgery can be improved by using enhanced recovery pathways. Patients managed by these pathways have shorter length of stays, lower blood loss, and lower transfusion rates. Their adoption should be encouraged. 相似文献12.
Brent K. Hollenbeck Samuel R. Kaufman Phyllis Yan Lindsey A. Herrel Tudor Borza Florian R. Schroeck Bruce L. Jacobs Ted A. Skolarus Vahakn B. Shahinian 《European urology》2018,73(4):491-498
Background
Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.Objective
To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.Design, setting, and participants
A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.Intervention
Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.Outcome measurements and analysis
Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.Results
Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.Conclusions
Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.Patient summary
We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient. 相似文献13.
A. Nayman I. Yildiz N. Koca S. Deniz M. Koplay L. Oguzkurt 《Diagnostic and interventional imaging》2017,98(1):29-36
Purpose
The purpose of this study was to determine the occlusion rate of incompetent great saphenous veins (GSVs) and small saphenous veins (SSVs) treated with radiofrequency ablation (RFA) and individualize variables associated with recanalization.Materials and methods
A retrospective review of 311 veins (256 GSVs and 55 SSVs) in 211 patients [177 women, 34 men; mean age, 45 years ± 12 (SD) (range: 18–75 years)] with incompetent GSVs and/or SSVs who were treated using new-generation RFA catheters was performed. The clinical results, occlusion rates, and variables associated with recanalization for the incompetent GSVs and SSVs were analyzed.Results
No major complications were observed in the study population. Ten months after RFA, the occlusion rate was 89% (227/256) for GSVs and 91% (50/55) for SSVs. An increased pre-procedure diameter of the incompetent GSVs was associated with a higher rate of recanalization (OR: 0.825; 95% CI: 0.715–0.952) (P < 0.05). No significant differences in age, gender, and side of treated veins were found between patients with recanalization of treated veins and those without recanalization.Conclusion
Our results show that pre-procedure diameter of the GSV is the single risk factor for recanalization after RFA. 相似文献14.
Armin Soave Roland Dahlem Hans O. Pinnschmidt Michael Rink Jessica Langetepe Oliver Engel Luis A. Kluth Birte Loechelt Philip Reiss Sascha A. Ahyai Margit Fisch 《European urology》2018,73(6):910-922
Background
Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial.Objective
To analyze in detail intensity and quality of pain as well as oral morbidity following closure (C) versus nonclosure (NC) of the donor site.Design, setting, and participants
Randomized controlled trial on 135 patients treated with BMGU between October 15, 2014 and December 18, 2015.Intervention
Following computer-based randomization, 63 and 72 patients, respectively, received C and NC of the donor site at the inner cheek. Preoperatively, on days 1, 5, and 21 as well as at 3 and 6 mo postoperatively, patients completed standardized questionnaires, including validated questions on intensity and quality of pain as well as oral morbidity.Outcome measurements and statistical analysis
The coprimary end points were intensity and quality of oral pain. Secondary end points included oral morbidity and intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of various covariates on intensity and quality of oral pain, oral morbidity, as well as intensity of pain of the perineogenital region.Results and limitations
There was noninferiority for NC versus C in intensity and affective quality of oral pain at every time point following BMGU. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, whistling, diet, and speech. Time from BMGU had significant effects on intensity (p < 0.001) and quality of oral pain (sensory pain: p < 0.001, affective pain: p < 0.001, total pain: p < 0.001). Length of buccal mucosa graft had significant effects on intensity (p = 0.001) and quality of oral pain (sensory pain: p = 0.020, total pain: p = 0.042).Conclusions
NC is noninferior to C of the donor site in intensity and quality of oral pain, and offers a treatment alternative. Time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications.Patient summary
We investigated pain, morbidity, and complications following closure (C) versus nonclosure (NC) of the buccal mucosa harvest site in patients undergoing buccal mucosa graft urethroplasty (BMGU). We found that NC is not worse than C regarding oral pain. In addition, time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications. 相似文献15.
Robert J. Motzer Alain Ravaud Jean-Jacques Patard Hardev S. Pandha Daniel J. George Anup Patel Yen-Hwa Chang Bernard Escudier Frede Donskov Ahmed Magheli Giacomo Carteni Brigitte Laguerre Piotr Tomczak Jan Breza Paola Gerletti Mariajose Lechuga Xun Lin Michelle Casey Michael Staehler 《European urology》2018,73(1):62-68
Background
Adjuvant sunitinib significantly improved disease-free survival (DFS) versus placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence after nephrectomy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59–0.98; p = 0.03).Objective
To report the relationship between baseline factors and DFS, pattern of recurrence, and updated overall survival (OS).Design, setting, and participants
Data for 615 patients randomized to sunitinib (n = 309) or placebo (n = 306) in the S-TRAC trial.Outcome measurements and statistical analysis
Subgroup DFS analyses by baseline risk factors were conducted using a Cox proportional hazards model. Baseline risk factors included: modified University of California Los Angeles integrated staging system criteria, age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS), weight, neutrophil-to-lymphocyte ratio (NLR), and Fuhrman grade.Results and limitations
Of 615 patients, 97 and 122 in the sunitinib and placebo arms developed metastatic disease, with the most common sites of distant recurrence being lung (40 and 49), lymph node (21 and 26), and liver (11 and 14), respectively. A benefit of adjuvant sunitinib over placebo was observed across subgroups, including: higher risk (T3, no or undetermined nodal involvement, Fuhrman grade ≥2, ECOG PS ≥1, T4 and/or nodal involvement; hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55–0.99; p = 0.04), NLR ≤3 (HR 0.72, 95% CI 0.54–0.95; p = 0.02), and Fuhrman grade 3/4 (HR 0.73, 95% CI 0.55–0.98; p = 0.04). All subgroup analyses were exploratory, and no adjustments for multiplicity were made. Median OS was not reached in either arm (HR 0.92, 95% CI 0.66–1.28; p = 0.6); 67 and 74 patients died in the sunitinib and placebo arms, respectively.Conclusions
A benefit of adjuvant sunitinib over placebo was observed across subgroups. The results are consistent with the primary analysis, which showed a benefit for adjuvant sunitinib in patients at high risk of recurrent RCC after nephrectomy.Patient summary
Most subgroups of patients at high risk of recurrent renal cell carcinoma after nephrectomy experienced a clinical benefit with adjuvant sunitinib.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.
Boris Gershman Holly K. Van Houten Jeph Herrin Daniel M. Moreira Simon P. Kim Nilay D. Shah R. Jeffrey Karnes 《European urology》2017,71(1):55-65
Background
Prostate biopsy and postbiopsy complications represent important risks of prostate-specific antigen (PSA) screening. Although landmark randomized trials and updated guidelines have challenged routine PSA screening, it is unclear whether these publications have affected rates of biopsy or postbiopsy complications.Objective
To evaluate whether publication of the 2008 and 2012 US Preventive Services Task Force (USPSTF) recommendations, the 2009 European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or the 2013 American Urological Association (AUA) guidelines was associated with changes in rates of biopsy or postbiopsy complications, and to identify predictors of postbiopsy complications.Design, setting, and participants
This quasiexperimental study used administrative claims of 5 279 315 commercially insured US men aged ≥40 yr from 2005 to 2014, of whom 104 584 underwent biopsy.Interventions
Publications on PSA screening.Outcome measurements and statistical analysis
Interrupted time-series analysis was used to evaluate the association of publications with rates of biopsy and 30-d complications. Logistic regression was performed to identify predictors of complications.Results and limitations
From 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100 000 person-months, with immediate reductions following the 2008 USPSTF recommendations (?10.1; 95% confidence interval [CI], ?17.1 to ?3.0; p < 0.001), 2012 USPSTF recommendations (?13.8; 95% CI, ?21.0 to ?6.7; p < 0 .001), and 2013 AUA guidelines (?8.8; 95% CI, ?16.7 to ?0.92; p = 0.03). Concurrently, complication rates decreased 10% from 8.7 to 7.8 per 100 000 person-months, with a reduction following the 2012 USPSTF recommendations (?2.5; 95% CI, ?4.5 to ?0.45; p = 0.02). However, the proportion of men undergoing biopsy who experienced complications increased from 14% to 18%, driven by nonsepsis infectious complications (p < 0.001). Predictors of complications included prior fluoroquinolone use (odds ratio [OR]: 1.27; 95% CI, 1.22–1.32; p < 0.001), anticoagulant use (OR: 1.14; 95% CI, 1.04–1.25; p = 0.004), and age ≥70 yr (OR: 1.25; 95% CI, 1.15–1.36; p < 0.001). Limitations included the retrospective design.Conclusions
Although there has been an absolute reduction in rates of biopsy and 30-d complications, the relative morbidity of biopsy continues to increase. These observations suggest a need to reduce the morbidity of biopsy.Patient summary
Absolute rates of biopsy and postbiopsy complications have decreased following landmark publications about prostate-specific antigen screening; however, the relative morbidity of biopsy continues to increase. 相似文献18.
Ilana Sebbag Raymond Tang Vit Gunka JagPaul Sahota Himat Vaghadia Andrew Sawka 《Brazilian Journal of Anesthesiology》2018,68(3):280-284
Study objective
The purpose of this study was to assess whether application of dorsal table tilt and body rotation to a parturient seated for neuraxial anesthesia increased the size of the paramedian target area for neuraxial needle insertion.Setting
Labor and Delivery Room.Patients
Thirty term pregnant women, ASA I–II, scheduled for an elective C‐section delivery.Interventions
Lumbar ultrasonography was performed in four seated positions: (F) lumbar flexion; (FR) as in position F with right shoulder rotation; (FT) as in position F with dorsal table‐tilt; (FTR) as in position F with dorsal table‐tilt combined with right shoulder rotation.Measurements
For each position, the size of the ‘target area’, defined as the visible length of the posterior longitudinal ligament was measured at the L3‐L4 interspace.Main results
The mean posterior longitudinal ligament was 18.4 ± 4 mm in position F, 18.9 ± 5.5 mm in FR, 19 ± 5.3 mm in FT, and 18 ± 5.2 mm in FTR. Mean posterior longitudinal ligament length was not significantly different in the four positions.Conclusions
These data show that the positions studied did not increase the target area as defined by the length of the posterior longitudinal ligament for the purpose of neuraxial needle insertion in obstetric patients. The maneuvers studied will have limited use in improving spinal needle access in pregnant women. 相似文献19.
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20.
K.A. Gautam A.N. Singh A.N. Srivastav S.N. Sankhwar 《The African Journal of Urology》2018,24(2):98-103