EAU Update Series最新文献

{"title":"Preoperative Nomograms and Artificial Neural Networks (ANNs) for Identification of Surgical Candidates","authors":"M. Remzi,&nbsp;M. Waldert,&nbsp;B. Djavan","doi":"10.1016/j.euus.2005.03.001","DOIUrl":"10.1016/j.euus.2005.03.001","url":null,"abstract":"<div><p>Selection of prostate cancer risk patients for surgical treatment has traditionally been accomplished by the creation of risk groups, like clinical stage, prostate specific antigen and others. Using these data knowledge-based expert systems were created. Among these the most popular model is the logistic regression model. Ideally, this prediction should be as accurate as possible. Many studies have shown that even expert on its field often are incorrect compared to the validated nomograms and artifical neural networks (ANNs) presented herein. Nomograms are instruments that predict outcomes for the individual patient using algorithms that incorporate multiple variables. Nomograms consist of a set of axes. Each variable is represented by a scale, with each value of that variable corresponding to a specific number of points according to its prognostic impact. In a final pair of axes, the total point value from all he variables is converted to the probability of reaching the end point By using scales, nomograms calculate the continuous probability of a certain outcome, resulting in more accurate predictions than models based on risk grouping. ANNs has gained increasing popularity and are the most popular artificial learning tool in biotechnology. This technique can roughly be described as a universal algebraic function that will distinguish dependency between dependent and independent variables, which is either unknown or very complex. The application of ANNs to complex relationships makes them highly attractive for the study of complexed medical decisions like predicting pathological stage or local recurrence after radical prostatectomy (RPE). Accuracy of nomograms and ANNs for pathological staging and PSA recurrence varies between 72–88.3% versus 77–91%, and 75–81% and 67–83%, respectively.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 63-71"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88684848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Imaging Studies","authors":"S. Dominique,&nbsp;V. Ravery","doi":"10.1016/j.euus.2005.03.002","DOIUrl":"10.1016/j.euus.2005.03.002","url":null,"abstract":"<div><p>More accurate pre-treatment staging of prostate cancer allows an appropriate selection of therapy and increases the likelihood of favourable treatment outcome. Indeed, tables and nomograms do not incorporate imaging staging although these explorations could be useful. Traditional transrectal ultrasonography does not offer additional information compared to DRE and CTscan is not useful in local staging. MRI eventually completed by metabolic informations could help but only for patients with high risk features in whom microscopic local extension has not been detected. Routine studies (CTscan and MRI) are disappointing for lymph node assessment. Performed in high risk patients they can detect nodal metastasis, but their normality does not allow the practitioner to avoid pelvic lymphadenectomy. Ultra small paramagnetic oxide (USPIO) is very promising but still experimental. In high risk patients, radionuclide bone scan has to be performed. In case of abnormalities, confirmatory studies (X-rays, CTscan or MRI) are requested.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 72-76"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88299742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Outcomes of Percutaneous Nephrolithotomy: Access","authors":"Brian R. Matlaga,&nbsp;Sam C. Kim,&nbsp;James E. Lingeman","doi":"10.1016/j.euus.2004.11.002","DOIUrl":"10.1016/j.euus.2004.11.002","url":null,"abstract":"<div><p>Percutaneous nephrolithotomy is a particularly effective procedure, commonly used to treat patients with complex renal calculi. Critical to the success of the procedure is proper patient selection. A thorough preoperative evaluation will serve to optimize treatment outcome. Careful attention to intraoperative details facilitates a safe and efficient access to the collecting system and subsequent stone removal. Postoperative decisions regarding drainage tubes must be well thought out. Performing the procedure as a single stage event optimizes many of these essential points.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 37-43"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.11.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73957677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economics of Stone Management","authors":"Yair Lotan,&nbsp;Margaret S. Pearle","doi":"10.1016/j.euus.2004.08.005","DOIUrl":"10.1016/j.euus.2004.08.005","url":null,"abstract":"<div><h3>Objective:</h3><p>Cost has become an important factor, in addition to efficacy and morbidity, in determining the best therapeutic modality for a variety of disease states. We sought to evaluate the role of cost in the management of urolithiasis.</p></div><div><h3>Methods:</h3><p>A comprehensive literature search was performed to identify articles addressing the issue of cost in the medical and surgical management of renal and ureteral calculi. Published cost analyses and cost comparisons were critically reviewed to arrive at conclusions regarding the most cost-effective approach to acute stone events, surgical treatment and prophylaxis.</p></div><div><h3>Results:</h3><p>The cost of medical care, surgical treatment and medication varies widely across health care systems, resulting in differing conclusions with regard to cost-effective treatment strategies. In general, for renal calculi, percutaneous nephrostolithotomy (PCNL) is more cost effective than shock wave lithotripsy (SWL) for stones, while SWL may be cost-effective for smaller stones. For ureteral stones, observation is the least costly treatment strategy, but among surgical options, URS is less costly than SWL. For single and recurrent stone formers, prophylactic strategies involving drug therapy are more costly than conservative therapy involving dietary measures alone, but yield fewer stone recurrences.</p></div><div><h3>Conclusions:</h3><p>To determine the most cost-effective treatment strategy for the management of renal or ureteral calculi, the efficacy, cost and complication rates of each procedure, as well as the cost of retreatment for failures must be taken into consideration. International cost comparisons are limited by differing degrees of subsidization of components of health care, such as medication or surgery. Decision tree modeling allows determination of the most cost-effective treatment approach in any given health care system or institution.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 51-60"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75193718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in Management of Ureteric Stones","authors":"Thomas Knoll,&nbsp;Peter Alken,&nbsp;Maurice Stephan Michel","doi":"10.1016/j.euus.2004.08.004","DOIUrl":"10.1016/j.euus.2004.08.004","url":null,"abstract":"<div><p>Most symptomatic urinary stones are found within the ureter. Depending on stone localisation and size, a substantial portion is able to pass the upper urinary tract spontaneously. This process may take days to weeks and the patient has to receive sufficient analgetic and spasmolytic medication. There is some evidence, that alpha-adrenoreceptor blockade supports expulsion of praevesical stones.</p><p>Standard and least invasive treatment for ureteric stones is extracorporeal shockwave lithotripsy (SWL). However, stone free rate after SWL of ureteric stones after single SWL is lower than for kidney stones and many patients require more than one shockwave application. Recent developments in ureteroscopy (URS) like small-calibre scopes and Ho:YAG laser lithotripsy have changed treatment algorithms as URS is highly efficient, has lower costs than SWL and is still minimally invasive. Especially for larger stones (&gt;10<!--> <!-->mm), URS seems to have advantages compared to SWL. Today, open or laparoscopic ureterolithotomy are reserved for special indications and are not used routinely.</p><p>In summary, SWL offers minimal-invasiveness but a higher risk of treatment failure compared to URS which reaches immediate high stone free rates. Treatment decisions have to be drawn individually taking into account patients preference, personal experience and local equipment.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 44-50"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78648982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in Lithotriptor Technology","authors":"Jens J. Rassweiler ,&nbsp;Geert G. Tailly ,&nbsp;Christian Chaussy","doi":"10.1016/j.euus.2004.11.003","DOIUrl":"10.1016/j.euus.2004.11.003","url":null,"abstract":"<div><h3>Introduction:</h3><p>Based on own experiences and the review of the recent literature, this paper focusses on actual theories about the physics of shock waves (i.e. mechanism of stone disintegration and tissue trauma), actual lithotriptor concepts, new technological developments, and the comparison of lithotriptors.</p></div><div><h3>Material and Methods:</h3><p>We performed a MEDLINE research, evaluating more than 50 articles on extracorporeal shock wave lithotripsy. In addition, the results of recent experimental and clinical studies performed in collaboration with manufacturers and acoustic phycisists were included in this survey.</p></div><div><h3>Results:</h3><p>Today mainly two types of lithotriptors are provided by the companies: an economic ESWL-table or a more sophisticated urolithotriptor. Stone localization is predominantly based on fluoroscopy (isocentric C-arm). There are four discussed mechanisms of stone disintegration: the tear-and-shear forces by reflection of shock waves at acoustical interphases play a major role in the initiation of stone comminution, whereas the role of cavitation is limited to the final process of stone disintegration (together with dynamic fatigue). Recent studies did not support the theory of quasistatic squeezing. Nevertheless, larger focal zones seem to be advantageous, since shock wave energy (not peak pressure) represents the most important parameter for stone fragmentation. Energy density is responsible for shock wave induced tissue trauma, which is mainly caused by cavitation.</p><p>Electromagnetic sources are used most frequently in new lithotriptors (Siemens, Storz, Dornier, Direx), because of the variabilty of focal zone (i.e. different focussing principles, dual focus), constancy of the impulses, and long-term reliability (more than 1 Mio. shock waves). The clinical comparison of different lithotriptors should be based on modified Efficacy Quotients (i.e. distinguishing between curative and adjuvant auxiliary measures). Recent studies indicate, that actual lithotriptors are able to meet the “gold standard” of the Dornier HM3, however with all advantages of a multifunctional table, high patient comfort (i.e. treatment without general anesthesia) and significantly lower costs.</p></div><div><h3>Conclusions:</h3><p>After a decade of minimal changes and progress, exciting technological developments based on a better understanding of shock wave physics are taking place, which will definitively stimulate further research and thus improve the results of extracorporeal shock wave lithotripsy.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 17-36"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81147850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Imaging for the Management of Urinary Stones","authors":"S.V. Bariol,&nbsp;S.A. Moussa,&nbsp;D.A. Tolley","doi":"10.1016/j.euus.2004.11.001","DOIUrl":"10.1016/j.euus.2004.11.001","url":null,"abstract":"<div><h3>Objective:</h3><p>The factors associated with a successful outcome for the treatment of urinary lithiasis are well described. We reviewed current methods of imaging utilised in stone treatment planning, with specific reference to their ability to identify predictors of outcome.</p></div><div><h3>Methods:</h3><p>A literature search for articles concerning the investigation and management of patients with urolithiasis was conducted through PubMed (<span><u>www.ncbi.nlm.nih.gov/PubMed/</u></span><svg><path></path></svg>). In addition a hand search of the abstract books from the most recent major urological conferences was performed to identify data of interest that have so far been presented in abstract form only.</p></div><div><h3>Results:</h3><p>Non-contrast computed tomography is superior in terms of diagnostic efficacy, with sensitivity and specificity approaching 100%. The intravenous urogram and contrast CT with 3-dimensional reconstruction provide the best anatomical detail.</p></div><div><h3>Conclusion:</h3><p>Although non-contrast helical computed tomography is the most sensitive investigation for suspected ureteric colic, the anatomical and functional information afforded by intravenous urography remains important for treatment planning in some patients.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 3-9"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91318701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urolithiasis: Update on Stone Management","authors":"David A. Tolley","doi":"10.1016/j.euus.2004.11.004","DOIUrl":"10.1016/j.euus.2004.11.004","url":null,"abstract":"","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 1-2"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.11.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76109376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Treatment: Worthwhile and When?","authors":"Roger L. Sur,&nbsp;Glenn M. Preminger","doi":"10.1016/j.euus.2004.04.001","DOIUrl":"10.1016/j.euus.2004.04.001","url":null,"abstract":"<div><p>The incidence of nephrolithiasis in industrialized countries is 0.5% to 1% annually. Stone formers subsequently face recurrence rates of 50% over 5 years. Annual costs in the United States for evaluation and treatment have been estimated at $1.83 billion USD [Clark JY, Thompson IM, Optenburg SA. Economic impact of urolithiasis in the United States. J Urol 1995;154:2020–2024]. Clearly the impact of urinary stone management poses an ever increasing medical, economic and social burden to modern society. The ability to detect 97% of underlying medical abnormalities in stone forming patients has stimulated discoveries of both selective and non-selective medical therapies to prevent stone recurrence. And yet there is no clear evidence in the literature that medical prophylaxis is cost effective. Various studies support the cost effectiveness of both proponents and adversaries of medical stone management. Nevertheless, there is clear evidence that medical therapy effectively prevents stone formation, especially when analyzing surrogate endpoints such as 24 urinary abnormalities, as well as primary endpoints such as stone formation. Therefore it makes intuitive sense to offer a search for underlying metabolic abnormalities in stone-forming patients and subsequently provide medical therapy, if the patient desires. Herein, we provide an overview in the medical evaluation and medical management of urinary stone disease.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 1","pages":"Pages 10-16"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2004.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74273835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Index Volume 2, 2004","authors":"","doi":"10.1016/S1570-9124(04)00062-5","DOIUrl":"https://doi.org/10.1016/S1570-9124(04)00062-5","url":null,"abstract":"","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"2 4","pages":"Page 195"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(04)00062-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138377778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}