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1.
Yonsei nomogram: A predictive model of new‐onset chronic kidney disease after on‐clamp partial nephrectomy in patients with T1 renal tumors 下载免费PDF全文
Ali Abdel Raheem Tae Young Shin Ki Don Chang Glen Denmer R Santok Mohamed Jayed Alenzi Young Eun Yoon Won Sik Ham Woong Kyu Han Young Deuk Choi Koon Ho Rha 《International journal of urology》2018,25(7):690-697
Objectives
To develop a predictive nomogram for chronic kidney disease‐free survival probability in the long term after partial nephrectomy.Methods
A retrospective analysis was carried out of 698 patients with T1 renal tumors undergoing partial nephrectomy at a tertiary academic institution. A multivariable Cox regression analysis was carried out based on parameters proven to have an impact on postoperative renal function. Patients with incomplete data, <12 months follow up and preoperative chronic kidney disease stage III or greater were excluded. The study end‐points were to identify independent risk factors for new‐onset chronic kidney disease development, as well as to construct a predictive model for chronic kidney disease‐free survival probability after partial nephrectomy.Results
The median age was 52 years, median tumor size was 2.5 cm and mean warm ischemia time was 28 min. A total of 91 patients (13.1%) developed new‐onset chronic kidney disease at a median follow up of 60 months. The chronic kidney disease‐free survival rates at 1, 3, 5 and 10 year were 97.1%, 94.4%, 85.3% and 70.6%, respectively. On multivariable Cox regression analysis, age (1.041, P = 0.001), male sex (hazard ratio 1.653, P < 0.001), diabetes mellitus (hazard ratio 1.921, P = 0.046), tumor size (hazard ratio 1.331, P < 0.001) and preoperative estimated glomerular filtration rate (hazard ratio 0.937, P < 0.001) were independent predictors for new‐onset chronic kidney disease. The C‐index for chronic kidney disease‐free survival was 0.853 (95% confidence interval 0.815–0.895).Conclusion
We developed a novel nomogram for predicting the 5‐year chronic kidney disease‐free survival probability after on‐clamp partial nephrectomy. This model might have an important role in partial nephrectomy decision‐making and follow‐up plan after surgery. External validation of our nomogram in a larger cohort of patients should be considered.2.
Kazushi Tanaka Jun Teishima Atsushi Takenaka Ryoichi Shiroki Yasuyuki Kobayashi Kazunori Hattori Hiro‐omi Kanayama Shigeo Horie Yasushi Yoshino Masato Fujisawa 《International journal of urology》2018,25(5):472-478
Objectives
To evaluate the outcomes of robotic partial nephrectomy compared with those of laparoscopic partial nephrectomy for T1 renal tumors in Japanese centers.Methods
Patients with a T1 renal tumor who underwent robotic partial nephrectomy were eligible for inclusion in the present study. The primary end‐point consisted of three components: a negative surgical margin, no conversion to open or laparoscopic surgery and a warm ischemia time ≤25 min. We compared data from these patients with the data from a retrospective study of laparoscopic partial nephrectomy carried out in Japan.Results
A total of 108 patients were registered in the present study; 105 underwent robotic partial nephrectomy. The proportion of patients who met the primary end‐point was 91.3% (95% confidence interval 84.1–95.9%), which was significantly higher than 23.3% in the historical data. Major complications were seen in 19 patients (18.1%). The mean change in the estimated glomerular filtration rate in the operated kidney, 180 days postoperatively, was ?10.8 mL/min/1.73 m2 (95% confidence interval ?12.3–9.4%).Conclusions
Robotic partial nephrectomy for patients with a T1 renal tumor is a safe, feasible and more effective operative method compared with laparoscopic partial nephrectomy. It can be anticipated that robotic partial nephrectomy will become more widely used in Japan in the future.3.
Quentin Ballouhey Aurélien Binet Pauline Clermidi Karim Braik Thierry Villemagne Jérôme Cros Hubert Lardy Laurent Fourcade 《International journal of urology》2017,24(12):855-860
Objectives
To compare the outcomes of robot‐assisted heminephrectomy for duplex kidney in children with those of open heminephrectomy.Methods
The present retrospective multicentric analysis reviewed the records of robot‐assisted versus open heminephrectomy carried out for duplex kidney in children from 2007 to 2014. Demographic data, weight, surgical time, hospital stay, complications and outcome were recorded. Follow up was based on a clinical review, renal sonography and dimercaptosuccinic acid renal scintigraphy.Results
A total of 15 patients underwent robot‐assisted heminephrectomy, and 13 patients underwent retroperitoneal heminephrectomy by open approach. All patients weighed <15 kg. The mean age at the time of surgery was 20.2 months (range 7–39 months) in the robotic group, and 18.4 months (range 6–41 months) in the open group. The mean hospital stay was statistically longer for the open surgery group (6.3 days, range 5–8 days vs 3.4 days, range 1–7 days; P < 0.001). Regarding postoperative pain control, total morphine equivalent intake was statistically greater for the open group (0.52 mg/kg/day vs 1.08 mg/kg/day; P < 0.001). No patient lost the remaining healthy moiety. There was no significant difference in terms of operating time, complication rate or renal outcomes.Conclusions
Robot‐assisted heminephrectomy in small children seems to offer comparable renal outcomes with those of its standard open surgery counterpart. Specific technical adjustments are necessary, which typically increase the set‐up time.4.
Transurethral seminal vesiculoscopy acts as a therapeutic investigation for intractable hemospermia: Step‐by‐step illustrations and single‐surgeon experience 下载免费PDF全文
Objective
To describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the seminal tract, and to report a single‐surgeon experience with this procedure.Methods
A total of 38 consecutive patients with intractable macroscopic hemospermia were enrolled from January 2010 to July 2016. A 6/7.5‐Fr semirigid ureteroscope was used to enter the seminal tract by one of these two approaches: through either a trans‐ejaculatory duct opening or a trans‐utricle fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively.Results
The success rate of transurethral seminal vesiculoscopy was 92.1%, whereas the approaching method in most patients was the trans‐utricle fenestration (88.89%). A total of 34 (94.4%) transurethral seminal vesiculoscopy inspections ended with complete remission, even though nearly half of them (47.2%) only disclosed negative perioperative findings. The median period to complete remission was 4 weeks (interquartile range 4–6 weeks) after the procedure. Four patients had recurrent hemospermia, and the median time to recurrence was 21.5 (range 13–48.5) months.Conclusions
Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia, and also plays a therapeutic role by blocking the vicious cycle of stasis, calculi and seminal vesiculitis. More familiarity of the anatomy and enough practice would make the learning curve less steep.5.
Chemotherapy for metastatic testicular cancer: The first nationwide multi‐institutional study by the Cancer Registration Committee of the Japanese Urological Association 下载免费PDF全文
Takumi Shiraishi Terukazu Nakamura Osamu Ukimura the Cancer Registration Committee of the Japanese Urological Association 《International journal of urology》2018,25(8):730-736
Objectives
To assess clinicopathological data and oncological outcomes focused on metastatic testicular cancer patients, who received chemotherapy as the initial treatment, in the nationwide multi‐institutional study by the Cancer Registration Committee of the Japanese Urological Association.Methods
A testicular cancer survey was carried out by the Japanese Urological Association in 2011 to register newly diagnosed testicular cancers in 2005 and 2008. Among 1121 registered patients, 278 patients with metastases who received chemotherapy as the initial treatment and could be categorized by the Japanese Urological Association classification were eligible for the analysis.Results
As first‐line chemotherapy, bleomycin, etoposide and cisplatin, and etoposide and cisplatin therapies were chosen for 260 patients (93.5%). As second‐line therapy, vinblastine, ifosfamide and cisplatin/etoposide, ifosfamide and cisplatin; and paclitaxel, ifosfamide and cisplatin/paclitaxel, ifosfamide and nedaplatin therapies were carried out in 23 out of 63 (36.5%) and 29 out of 63 (46.0%) patients, respectively. The response rate and serum tumor marker normalization rate were 93.4% and 81.3% at first line, 75.4% and 60.7% at second line, and 41.7% and 16.7% at third line, respectively. The Japanese Urological Association classification (≥IIIB2 vs ≤IIIB1) and choriocarcinoma component in primary histology were independent prognostic factors of overall survival before starting chemotherapy. Furthermore, in patients with non‐seminomatous germ cell tumors, serum tumor marker normalization was an independent factor that was associated with better outcome of overall survival after completion of the initial series of chemotherapies.Conclusions
The initial accurate diagnosis and risk stratification is an important prognostic factor to achieve better oncological outcomes. In patients with non‐seminomatous germ cell tumors, aiming for serum tumor marker normalization with continuous sequential chemotherapy could improve overall survival.6.
Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome 下载免费PDF全文
Masahiro Sugiura Yusuke Imamura Koji Kawamura Satoshi Yamamoto Tomokazu Sazuka Kazuyoshi Nakamura Shinichi Sakamoto Hidekazu Nagano Hisashi Koide Tomoaki Tanaka Takashi Imamoto Akira Komiya Tomohiko Ichikawa 《International journal of urology》2018,25(6):583-588
Objectives
To identify pre‐treatment factors affecting the duration of post‐surgical steroid replacement in patients undergoing adrenalectomy for subclinical Cushing syndrome.Methods
The present retrospective analysis included 64 patients who underwent unilateral laparoscopic adrenalectomy for subclinical Cushing syndrome. Adrenal tumor and contralateral adrenal sizes together with various clinical factors were studied in association with the duration of post‐surgical steroid replacement. Adrenal tumor and contralateral adrenal size were measured at the level of the maximum transverse plane of the adrenal glands using computed tomography scan or magnetic resonance imaging. Cox's proportional hazards model was used for the statistical analysis.Results
All 64 patients were treated with post‐surgical steroid replacement after adrenalectomy. The median duration of the steroid treatment was 6 months. When assessing the duration of post‐surgical steroid replacement, contralateral adrenal volume <0.745 cm3, contralateral adrenal width <6.15 mm and serum cortisol after a 1‐mg dexamethasone suppression test >2.65 μg/dL were significant predictors of prolonged post‐surgical steroid treatment on univariate analysis. On multivariate analysis, contralateral adrenal width <6.15 mm was the only independent predictive factor for the prolonged post‐surgical steroid replacement.Conclusions
Contralateral adrenal width seems to represent a significant predictive factor for the duration of post‐surgical steroid replacement in subclinical Cushing syndrome patients. Pre‐surgical assessment of image findings might help clinicians determine the total duration of steroid therapy after adrenalectomy.7.
Intensity ratio curve analysis of small renal masses on T2‐weighted magnetic resonance imaging: Differentiation of fat‐poor angiomyolipoma from renal cell carcinoma 下载免费PDF全文
Shingo Moriyama Soichiro Yoshida Hajime Tanaka Hiroshi Tanaka Minato Yokoyama Junichiro Ishioka Yoh Matsuoka Kazutaka Saito Kazunori Kihara Yasuhisa Fujii 《International journal of urology》2018,25(6):554-560
Objectives
To assess the diagnostic ability of a pixel intensity‐based analysis in evaluating the magnetic resonance imaging characteristics of small renal masses, especially in differentiating fat‐poor angiomyolipoma from renal cell carcinoma.Methods
T2‐weighted images from 121 solid small renal masses (<4 cm) without visible fat (14 fat‐poor angiomyolipomas, 92 clear cell renal cell carcinomas, six chromophobe renal cell carcinomas and nine papillary renal cell carcinomas) were retrospectively evaluated. An intensity ratio curve was plotted using intensity ratios, which were ratios of signal intensities of tumor pixels (each pixel along a linear region of interest drawn across the renal tumor on T2‐weighted image) to the signal intensity of a normal renal cortex. The diagnostic ability of the intensity ratio curve analysis was evaluated.Results
The tumors were classified into three types: intensity ratio fat‐poor angiomyolipoma (n = 19) with no pseudocapsule, iso‐low intensity and no heterogeneity; intensity ratio clear cell renal cell carcinoma (n = 76) with a pseudocapsule, iso‐high intensity and heterogeneity; and other type of intensity ratio (n = 26), including tumors that did not fall into the above two categories. The sensitivity/specificity/accuracy of the intensity ratio curve analysis in diagnosing fat‐poor angiomyolipoma was 93%/94%/94%, respectively. When the intensity ratio curve analysis was applied only to the tumor with undetermined radiological diagnosis, the sensitivity for diagnosing fat‐poor angiomyolipoma compared with subjective reading alone significantly improved (93% vs 50%; P = 0.014).Conclusions
Our novel semiquantitative model for combined assessment of key features of fat‐poor angiomyolipoma, including low intensity, homogeneity and absence of a pseudocapsule on T2‐weighted image, might make diagnosis of fat‐poor angiomyolipoma more accurate.8.
Prognostic impact of the pretreatment aspartate transaminase/alanine transaminase ratio in patients treated with first‐line systemic tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma 下载免费PDF全文
Minyong Kang Jiwoong Yu Hyun Hwan Sung Hwang Gyun Jeon Byong Chang Jeong Se Hoon Park Seong Soo Jeon Hyun Moo Lee Han Yong Choi Seong Il Seo 《International journal of urology》2018,25(6):596-603
Objectives
To examine the prognostic role of the pretreatment aspartate transaminase/alanine transaminase or De Ritis ratio in patients with metastatic renal cell carcinoma receiving first‐line systemic tyrosine kinase inhibitor therapy.Methods
We retrospectively searched the medical records of 579 patients with metastatic renal cell carcinoma who visited Samsung Medical Center, Seoul, Korea, from January 2001 through August 2016. After excluding 210 patients, we analyzed 360 patients who received first‐line tyrosine kinase inhibitor therapy. Cancer‐specific survival and overall survival were defined as the primary and secondary end‐points, respectively. A multivariate Cox proportional hazards regression model was used to identify independent prognosticators of survival outcomes.Results
The overall population was divided into two groups according to the pretreatment De Ritis ratio as an optimal cut‐off value of 1.2, which was determined by a time‐dependent receiver operating characteristic curve analysis. Patients with a higher pretreatment De Ritis ratio (≥1.2) had worse cancer‐specific survival and overall survival outcomes, compared with those with a lower De Ritis ratio (<1.2). Notably, a higher De Ritis ratio (≥1.2) was found to be an independent predictor of both cancer‐specific survival (hazard ratio 1.61, 95% confidence interval 1.13–2.30) and overall survival outcomes (hazard ratio 1.69, 95% confidence interval 1.19–2.39), along with male sex, multiple metastasis (≥2), non‐clear cell histology, advanced pT stage (≥3), previous metastasectomy and the Memorial Sloan Kettering Cancer Center risk classification.Conclusion
Our findings show that the pretreatment De Ritis ratio can provide valuable information about the survival outcomes of metastatic renal cell carcinoma patients receiving first‐line tyrosine kinase inhibitor therapy.9.
Prostate‐specific antigen screening impacts on biochemical recurrence in patients with clinically localized prostate cancer 下载免费PDF全文
Takeshi Hashimoto Makoto Ohori Kenji Shimodaira Naoto Kaburaki Yosuke Hirasawa Naoya Satake Tatsuo Gondo Yoshihiro Nakagami Kazunori Namiki Yoshio Ohno 《International journal of urology》2018,25(6):561-567
Objective
To clarify the impact of prostate‐specific antigen screening on surgical outcomes of prostate cancer.Methods
Patients who underwent radical prostatectomy were divided into two groups according to prostate‐specific antigen testing opportunity (group 1, prostate‐specific antigen screening; group 2, non‐prostate‐specific antigen screening). Perioperative clinical characteristics were compared using the Wilcoxon rank‐sum and χ2‐tests. Cox proportional hazards models were used to identify independent predictors of postoperative biochemical recurrence‐free survival.Results
In total, 798 patients (63.2%) and 464 patients (36.8%) were categorized into groups 1 and 2, respectively. Group 2 patients were more likely to have a higher prostate‐specific antigen level and age at diagnosis and larger prostate volume. Clinical T stage, percentage of positive cores and pathological Gleason score did not differ between the groups. The 5‐year biochemical recurrence‐free survival rate was 83.9% for group 1 and 71.0% for group 2 (P < 0.001). On multivariate analysis, prostate‐specific antigen testing opportunity (hazard ratio 2.530; P < 0.001) was an independent predictive factor for biochemical recurrence after surgery, as well as pathological T stage, pathological Gleason score, positive surgical margin and lymphovascular invasion. Additional analyses showed that prostate‐specific antigen screening had a greater impact on biochemical recurrence in a younger patients, patients with a high prostate‐specific antigen level, large prostate volume and D'Amico high risk, and patients meeting the exclusion criteria of the Prostate Cancer Research International Active Surveillance study.Conclusions
Detection by screening results in favorable outcomes after surgery. Prostate‐specific antigen screening might contribute to reducing biochemical recurrence in patients with localized prostate cancer.10.
Clinical complications in renal biopsy using two different needle gauges: The impact of large hematomas,a random clinical trial study 下载免费PDF全文
Paulo Ramos Botelho Antunes Fabiano Franco Monteiro Prado Fabrício Tinôco Alvim de Souza Elisa Carvalho de Siqueira Marcos Álvares de Campos Maria Carolina Barbosa Álvares Rene Berindoague Neto 《International journal of urology》2018,25(6):544-548
Objective
To compare complications of ultrasound‐guided percutaneous renal biopsy using two needle gauges (16‐G and 18‐G).Methods
A total of 238 individuals with renal biopsy indication were included and randomly separated into two groups: ultrasound‐guided percutaneous renal biopsy procedure carried out with a 16‐G or 18‐G needle. The adequacy of biopsy samples and post‐procedure complications were compared between the two groups.Results
The procedures carried out with a 16‐G needle collected fragments with a mean of 22.1 ± 10.8 glomeruli, and those carried out with an 18‐G needle had a mean of 17.5 ± 9.4 glomeruli. Patients submitted to renal biopsies with a 16‐G needle had a higher likelihood of having a complication (OR5.1, 95% CI 1.7–15.4, P = 0.001). The overall mean volume of post‐biopsy hematoma in patients with complications was significantly larger than those without complications (44 ± 56.1 mL vs 5.9 ± 6.6 mL; P < 0.001).Conclusions
Renal biopsies carried out by ultrasonography using an 18‐G needle provide adequate histological analysis, showing a lower amount of glomeruli but with similar clinical quality as a 16‐G needle. Furthermore, it is associated with a lower risk of procedure‐related complications.11.
Siobhan S Ennis Huifang Guo Lata Raman Paul A Tambyah Swaine L Chen Ho Yee Tiong 《International journal of urology》2018,25(7):684-689
Objectives
To examine the impact on quality of life of recurrent acute uncomplicated urinary tract infection among premenopausal Singaporean women, and to determine the risk factors for lower quality of life among these patients.Methods
A total of 85 patients with recurrent acute uncomplicated urinary tract infection who were referred to the Urology Department at the National University Hospital, Singapore, were prospectively recruited over a 3‐year period to complete the validated Short Form 36 Health Survey version 1. In addition, demographic and clinical details including symptomology and medical history were analyzed for factors impacting quality of life. Short Form 36 Health Survey version 1 results were compared with published population norms.Results
After adjusting for age, gender and race, recurrent acute uncomplicated urinary tract infection patients had significantly lower quality of life on seven out of eight Short Form 36 Health Survey version 1 domains when compared with age‐, gender‐ and race‐adjusted population norms for Singapore. Among those with recurrent acute uncomplicated urinary tract infection, those who also reported caffeine consumption had significantly lower Short Form 36 Health Survey version 1 scores than those who did not. Those who reported chronic constipation also had consistently lower Short Form 36 Health Survey version 1 scores across all domains.Conclusions
Recurrent acute uncomplicated urinary tract infection has a negative impact on the quality of life of premenopausal, otherwise healthy women. Recurrent acute uncomplicated urinary tract infection patients who also have chronic constipation or consume caffeine have lower quality of life than those who do not. More studies are required to understand the relationships between these common problems and risk factors.12.
Primary whole‐gland ablation for localized prostate cancer with high‐intensity focused ultrasound: The important predictors of biochemical recurrence 下载免费PDF全文
Po Yen Chen Po Hui Chiang Yi Yang Liu Yao Chi Chuang Yuan Tso Cheng 《International journal of urology》2018,25(6):615-620
Objectives
To identify predictive factors of biochemical recurrence for patients undergoing high‐intensity focused ultrasound treatment for localized prostate cancer.Methods
We retrospectively identified patients receiving whole‐gland prostate ablation with high‐intensity focused ultrasound for localized prostate cancer from 2009 to 2015. All the patients received pre‐high‐intensity focused ultrasound radical transurethral resection of the prostate. We included perioperative parameters as follows: age, preoperative prostate volume, stage of operation, initial prostate‐specific antigen, T stage, postoperative prostate‐specific antigen nadir, Gleason score, time to prostate‐specific antigen nadir and the presence of prostate‐specific antigen biochemical recurrence. Multivariable Cox regression and Kaplan–Meier analysis were used for investigating predictors of recurrence, and receiver operating characteristic analysis was used for the cut‐off values of prostate‐specific antigen nadir.Results
Among 182 patients, 26.9% had prostate‐specific antigen biochemical recurrence after high‐intensity focused ultrasound during the median follow‐up period of 32.21 months. Gleason score ≥7 (Gleason score 7, hazard ratio 2.877, P = 0.027), stage ≥T2b (T2b, hazard ratio 3.16, P = 0.027) and prostate‐specific antigen nadir (hazard ratio 1.11, P < 0.001) were statistically significant, whereas there was no significance in prostate volume and initial prostate‐specific antigen. We posit that a cut‐off level of prostate‐specific antigen nadir 0.43 ng/mL might be considered as an independent predictive factor for prostate‐specific antigen biochemical recurrence in high‐intensity focused ultrasound patients in multivariate analysis (P < 0.001, hazard ratio 7.39, 95% confidence interval 3.56–15.37), and created a new nadir‐related prediction model for biochemical recurrence prediction.Conclusions
Postoperative prostate‐specific antigen nadir of 0.43 ng/mL can be considered an important predictive factor for biochemical recurrence in primary whole‐prostate gland high‐intensity focused ultrasound treatment, and the nadir‐related prediction model might provide a reference for early salvage treatment. Furthermore, Gleason score ≥7, stage ≥T2b might be associated with unfavorable outcomes, although prostate volume and higher initial prostate‐specific antigen appear not to be associated with biochemical recurrence for the high‐intensity focused ultrasound treatment.13.
Impact of a novel biopsy instrument with a 25‐mm side‐notch needle on the detection of prostate cancer in transrectal biopsy 下载免费PDF全文
Kent Kanao Keishi Kajikawa Ikuo Kobayashi Shingo Morinaga Hiroyuki Muramatsu Genya Nishikawa Masahito Watanabe Kenji Zennami Kogenta Nakamura Makoto Sumitomo 《International journal of urology》2018,25(8):746-751
Objectives
To evaluate the impact of a novel biopsy instrument that extends the length of the side‐notch on the detection of prostate cancer in transrectal needle biopsy.Methods
We collaborated with a biopsy needle manufacturer and developed a novel biopsy instrument (PRIMECUT II long‐notch type) with a 25‐mm side‐notch length and 28‐mm stroke length to take longer tissue cores. The sampled core length, cancer detection rate, pain and complications of 489 patients who underwent transrectal biopsy using the long‐notch needle were compared with those of 469 patients who underwent biopsy using a normal instrument with a 19‐mm side‐notch length and 22‐mm stroke length.Results
The mean length of tissue taken by the long‐notch needle was significantly longer than that of tissue taken by the normal‐notch needle (16.3 vs 22.4 mm, P < 0.001). The overall cancer detection rate was 42.0% for the normal‐notch needle and 51.1% for the long‐notch needle (P = 0.005). In patients with a prostate volume of 20–40 mL, the cancer detection rate for the long‐notch needle was especially higher than that for the normal‐notch needle (74.2% vs 47.5%, P < 0.001). Multivariate analysis showed that the long‐notch needle improved cancer detection significantly (odds ratio 1.702, P < 0.001). There were no differences of pain during biopsy and complication between the two groups.Conclusions
The novel biopsy instrument with a 25‐mm side‐notch can take longer tissue samples safely and has a significantly higher rate of prostate cancer detection in transrectal biopsy.14.
Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node‐positive prostate cancer patients: External validation on a multi‐institutional database 下载免费PDF全文
Lorenzo Bianchi Riccardo Schiavina Marco Borghesi Federico Mineo Bianchi Alberto Briganti Marco Carini Carlo Terrone Alex Mottrie Mauro Gacci Paolo Gontero Ciro Imbimbo Giansilvio Marchioro Giulio Milanese Vincenzo Mirone Francesco Montorsi Giuseppe Morgia Giacomo Novara Angelo Porreca Alessandro Volpe Eugenio Brunocilla 《International journal of urology》2018,25(6):574-581
Objectives
To assess the predictive accuracy and the clinical value of a recent nomogram predicting cancer‐specific mortality‐free survival after surgery in pN1 prostate cancer patients through an external validation.Methods
We evaluated 518 prostate cancer patients treated with radical prostatectomy and pelvic lymph node dissection with evidence of nodal metastases at final pathology, at 10 tertiary centers. External validation was carried out using regression coefficients of the previously published nomogram. The performance characteristics of the model were assessed by quantifying predictive accuracy, according to the area under the curve in the receiver operating characteristic curve and model calibration. Furthermore, we systematically analyzed the specificity, sensitivity, positive predictive value and negative predictive value for each nomogram‐derived probability cut‐off. Finally, we implemented decision curve analysis, in order to quantify the nomogram's clinical value in routine practice.Results
External validation showed inferior predictive accuracy as referred to in the internal validation (65.8% vs 83.3%, respectively). The discrimination (area under the curve) of the multivariable model was 66.7% (95% CI 60.1–73.0%) by testing with receiver operating characteristic curve analysis. The calibration plot showed an overestimation throughout the range of predicted cancer‐specific mortality‐free survival rates probabilities. However, in decision curve analysis, the nomogram's use showed a net benefit when compared with the scenarios of treating all patients or none.Conclusions
In an external setting, the nomogram showed inferior predictive accuracy and suboptimal calibration characteristics as compared to that reported in the original population. However, decision curve analysis showed a clinical net benefit, suggesting a clinical implication to correctly manage pN1 prostate cancer patients after surgery.15.
Fei Ma David E Hunt Lin Leng Richard Bucala Katherine L Meyer‐Siegler Pedro L Vera 《International journal of urology》2018,25(10):887-893
Objectives
To develop a rodent model of persistent non‐inflammatory bladder pain and to test macrophage migration inhibitory factor and high mobility box group 1 as mediators of bladder pain.Methods
Female C57BL/6 mice received intravesical instillations of protease activated receptor 4 (100 μmol/L, for 1 h) three times every other day and abdominal mechanical hypersensitivity (50% mechanical threshold) was tested on day 0 (baseline), and at days 1, 2, 3, 4, 7 and 9 after the first protease‐activated receptor 4 injection. At the end of the experiment, micturition changes were measured and bladders were examined for histological changes. Macrophage migration inhibitory factor antagonist (MIF098; 40 mg/kg i.p. b.i.d.) or high mobility group box 1 inhibitor (glycyrrhizin; 50 mg/kg i.p. daily) was administered from day 2 until day 8.Results
There was a significant and persistent decrease in abdominal mechanical threshold starting from day 3 in the protease‐activated receptor 4‐treated group that persisted until day 9 (5 days post‐last instillation), but not in the control group. Glycyrrhizin fully reversed while MIF098 partially reversed abdominal mechanical hypersensitivity in protease‐activated receptor 4‐treated mice. The changes started on day 3 after the first protease‐activated receptor 4 instillation, and analgesic effects lasted throughout the rest of the testing period. None of the groups had significant micturition changes or overt bladder histological changes.Conclusions
Repeated intravesical protease activated receptor 4 instillations produce persistent bladder pain without inflammation. Macrophage migration inhibitory factor and high mobility group box 1 are possible effective target molecules for bladder pain alleviation.16.
Recurrent stone‐forming patients have high visceral fat ratio based on computed tomography images compared to first‐time stone‐forming patients 下载免费PDF全文
Shimpei Yamashita Takashi Iguchi Satoshi Nishizawa Akinori Iba Yasuo Kohjimoto Isao Hara 《International journal of urology》2018,25(6):569-573
Objectives
To compare various fat parameters based on computed tomography images between recurrent stone‐forming patients and patients forming stones for the first time.Methods
Included in the present study were 300 patients with upper urinary tract calculi who had undergone active stone removal in our hospital. Using pretreatment computed tomography images, we measured visceral fat area and volume, subcutaneous fat area and volume, visceral fat area ratio and visceral fat volume ratio. We compared patient backgrounds and these fat parameters between those who recurrently formed stones and those who formed stones for the first time. We also performed logistic regression analysis to identify factors that contribute to severe stones.Results
A total of 148 (49.3%) patients were recurrent stone‐forming patients. Recurrent stone‐forming patients were statistically significantly younger (P < 0.01) and there were more male patients (P < 0.01). In addition, visceral fat area ratio and visceral fat volume ratio in recurrent stone‐forming patients were significantly higher than those in first‐time stone‐forming patients (P = 0.03 and P = 0.01, respectively). On the other hand, there was no significant difference in visceral fat area (P = 0.32), subcutaneous fat area (P = 0.36), visceral fat volume (P = 0.38) or subcutaneous fat volume (P = 0.23). Receiver operating characteristics analysis showed that area under the curve of visceral fat volume ratio (0.583) for recurrent stones was larger than that of visceral fat area ratio (0.571). In multivariate analysis, increasing visceral fat volume ratio was an independent significant predictor of recurrent stones (P = 0.04).Conclusions
Recurrent stone‐forming patients have high visceral fat ratios compared to first‐time stone‐forming patients, shown here for the first time.17.
Glutamatergic cells in the periaqueductal gray matter mediate sensory inputs after bladder stimulation in freely moving rats 下载免费PDF全文
Aryo Zare Ali Jahanshahi Celine Meriaux Harry WM Steinbusch Gommert A van Koeveringe 《International journal of urology》2018,25(6):621-626
Objectives
To determine the phenotype of the ventrolateral part of the periaqueductal gray matter neurons after bladder stimulation.Methods
In the experimental group, electrical stimulation of the bladder was carried out under freely moving condition by a bipolar stimulation electrode implanted in the bladder wall. Thereafter, the brain sections were processed for immunohistochemical analysis using antibodies against c‐Fos (neuronal activation marker) together with one of the following: tyrosine hydroxylase (dopaminergic cell marker), vesicular glutamate transporter (glutamatergic cell marker), serotonin, glutamate decarboxylase (glutamate decarboxylase 67, gamma‐aminobutyric acid cell marker) and neuronal nitric oxide synthase. We used design‐based confocal stereological analysis to quantify the immunohistochemically stained sections.Results
A significant increase in the number of c‐Fos‐positive cells in the ventrolateral part of the periaqueductal gray matter after stimulation was found. Furthermore, the ratio of c‐Fos cells double labeled with vesicular glutamate transporter was significantly higher in the ventrolateral part of the periaqueductal gray matter region in the stimulated compared with the sham group. Quantitative analysis of the other four cell types did not show any significant difference.Conclusion
These findings suggest that glutamatergic neurotransmission in the ventrolateral part of the periaqueductal gray matter is seemingly the main pathway to be activated after receiving sensory signals from the bladder.18.
Therapy‐related acute myeloid leukemia and myelodysplastic syndrome among refractory germ cell tumor patients 下载免费PDF全文
Yuta Inoue Terukazu Nakamura Hiroyuki Nakanishi Masakatsu Oishi Fumiya Hongo Koji Okihara Shinsuke Mizutani Junya Kuroda Osamu Ukimura 《International journal of urology》2018,25(7):678-683
Objectives
To analyze cases of therapy‐related acute myeloid leukemia and myelodysplastic syndrome diagnosed after chemotherapy for refractory testicular and extragonadal germ cell tumor in our experience.Methods
A total of 171 consecutive patients who were diagnosed and treated as refractory germ cell tumor and had records of detailed chemotherapy doses between April 1998 and December 2015 were retrospectively reviewed.Results
Four testicular tumor patients (4/171, 2.3%) developed therapy‐related acute myeloid leukemia and myelodysplastic syndrome. Three of them were affected after complete remission of the primary testicular tumor. A median time interval from a start of chemotherapy to a secondary tumor development was 6.8 years (range 3.7–11.5 years). The median total dose of etoposide, ifosfamide, cisplatin and nedaplatin were 3640 mg/m2 (range 2906–4000 mg/m2), 42.7 g (range 19.5–54.0 g), 1100 mg/m2 (range 600–1500 mg/m2) and 500 mg/m2 (range 300–1600 mg/m2), respectively. Etoposide had the only significant relationship between a cumulative dose and leukemogenesis in univariate analysis (P < 0.05). One patient had complete remission, but the other three patients died.Conclusions
The present findings show that refractory germ cell tumor patients have an increased risk of therapy‐related acute myeloid leukemia and myelodysplastic syndrome. A cumulative dose of etoposide is a significant risk of leukemogenesis. As therapy‐related acute myeloid leukemia and myelodysplastic syndrome has a poor prognosis, close follow up is required for refractory germ cell tumor patients.19.
Psychotherapy combined with drug therapy in patients with category III chronic prostatitis/chronic pelvic pain syndrome: A randomized controlled trial 下载免费PDF全文
Jianxin Wang Kuixiang Liang Huijing Sun Lianpeng Li Hongcai Wang Jingyuan Cao 《International journal of urology》2018,25(8):710-715
Objectives
To explore the efficacy of psychotherapy combined with drug therapy in patients with category III chronic prostatitis/chronic pelvic pain syndrome.Methods
A total of 156 patients with category III chronic prostatitis/chronic pelvic pain syndrome were randomly divided into two groups: the control group of 78 patients receiving routine medication; and the intervention group of 78 patients receiving psychological intervention therapy combined with routine medications. Treatment courses were for 3 months. The end‐points were the response rate of the National Institutes of Health Chronic Prostatitis Symptom Index, International Index of Erectile Function‐5, Self‐Rating Anxiety Scale, Self‐Rating Depression Scale and expressed prostatic secretion‐white blood cells.Results
After 3 months, the average scores of the National Institutes of Health Chronic Prostatitis Symptom Index decreased to 10.1 ± 5.0 in the control group compared with 14.1 ± 4.9 in the intervention group; thus, significant differences were observed between the two groups in the study (P < 0.001). The average scores of the International Index of Erectile Function‐5 were improved in the two groups, but compared with the control group, a more marked improvement was detected in the psychological intervention group, and there was a significant difference between the two groups (P < 0.001). There was significant difference between the two groups in terms of the Self‐Rating Anxiety Scale and Self‐Rating Depression Scale scores (P < 0.001). Expressed prostatic secretion‐white blood cell counts significantly decreased to 4.4 ± 3.5 in the control group compared with 9.8 ± 3.4 in the intervention group (P < 0.001).Conclusions
Psychological intervention therapy can effectively improve the psychological status and sexual function in patients with category III chronic prostatitis/chronic pelvic pain syndrome than the routine medication.20.
Yuriko Yamanishi Tomonori Yamanishi Hakujyu Tajima Shunya Ikeda 《International journal of urology》2018,25(10):863-870