European urology focus最新文献

{"title":"Innovations in Phage Therapy for Urinary Tract Infection.","authors":"Lorenz Leitner, Thomas M Kessler, Shawna E McCallin","doi":"10.1016/j.euf.2024.07.006","DOIUrl":"https://doi.org/10.1016/j.euf.2024.07.006","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) are among the most common infections. Increasing rates of multidrug-resistant bacteria are complicating treatment, necessitating alternative strategies. Bacteriophages (phages) are viruses that only target and kill bacteria, and this specific lytic activity can be harnessed therapeutically. Bioengineering holds innovative potential for the use of phages as diagnostic and therapeutic tools for rapid targeted treatments. However, phage therapy and phage products are not currently approved by regulatory agencies in the Western world and can only be applied under specific regulatory frameworks in individual countries. Further basic and clinical research is essential to address the challenges of phage therapy and to explore its value in combating UTIs. PATIENT SUMMARY: Urinary tract infections (UTIs) are becoming more difficult to treat because of antibiotic resistance. Bacteriophages are viruses that kill bacteria and have promise for UTI treatment, but more research and regulatory approval are needed before they become more widely available.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readability Assessment of Patient Education Materials on Uro-oncological Diseases Using Automated Measures.","authors":"Severin Rodler, Serena Maruccia, Andre Abreu, Declan Murphy, David Canes, Stacy Loeb, Rena D Malik, Aditya Bagrodia, Giovanni E Cacciamani","doi":"10.1016/j.euf.2024.06.012","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.012","url":null,"abstract":"<p><strong>Background and objective: </strong>Readability of patient education materials is of utmost importance to ensure understandability and dissemination of health care information in uro-oncology. We aimed to investigate the readability of the official patient education materials of the European Association of Urology (EAU) and American Urology Association (AUA).</p><p><strong>Methods: </strong>Patient education materials for prostate, bladder, kidney, testicular, penile, and urethral cancers were retrieved from the respective organizations. Readability was assessed via the WebFX online tool for Flesch Kincaid Reading Ease Score (FRES) and for reading grade levels by Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Smog Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of ≥70 and with the other readability indexes <7 according to European Union recommendations. This study assessed only objective readability and no other metrics such as understandability.</p><p><strong>Key findings and limitations: </strong>Most patient education materials failed to meet the recommended threshold for laypersons. The mean readability for EAU patient education material was as follows: FRES 50.9 (standard error [SE]: 3.0), and FKGL, GFS, SI, CLI, and ARI all with scores ≥7. The mean readability for AUA patient material was as follows: FRES 64.0 (SE: 1.4), with all of FKGL, GFS, SI, and ARI scoring ≥7 readability. Only 13 out of 70 (18.6%) patient education materials' paragraphs met the readability requirements. The mean readability for bladder cancer patient education materials was the lowest, with a FRES of 36.7 (SE: 4.1).</p><p><strong>Conclusions and clinical implications: </strong>Patient education materials from leading urological associations reveal readability levels beyond the recommended thresholds for laypersons and may not be understood easily by patients. There is a future need for more patient-friendly reading materials.</p><p><strong>Patient summary: </strong>This study checked whether health information about different cancers was easy to read. Most of it was too hard for patients to understand.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Eileen V. Johnson, Kelsie Kaiser. Clinical Consultation Guide: Pelvic Floor Prehabilitation. Eur Urol Focus 2024;10:13-5.","authors":"Manuela Tutolo, Donatella Giraudo, Francesco Montorsi","doi":"10.1016/j.euf.2024.05.026","DOIUrl":"https://doi.org/10.1016/j.euf.2024.05.026","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis.","authors":"Christian Moro, Charlotte Phelps, Vineesha Veer, Mark Jones, Paul Glasziou, Justin Clark, Kari A O Tikkinen, Anna Mae Scott","doi":"10.1016/j.euf.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.euf.2024.07.002","url":null,"abstract":"<p><strong>Background and objective: </strong>With over 50% of women suffering from at least one episode of urinary tract infection (UTI) each year and an increasing prevalence of antimicrobial resistance, efforts need to be made to clearly identify the evidence supporting potential non-drug interventions. This study aims to compare the effects of cranberry juice, cranberry tablets, and increased liquids for the management of UTIs.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane CENTRAL were searched for randomised controlled trials. The primary outcome was the number of UTIs, and the secondary outcomes were UTI symptoms and antimicrobial consumption. A risk of bias assessment was performed using the Cochrane risk of bias tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Key findings and limitations: </strong>A total of 20 trials (3091 participants) were included, with 18 studies highlighting a 54% lower rate of UTIs with cranberry juice consumption than no treatment and a 27% lower rate than placebo liquid. Cranberry juice also resulted in a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on a network meta-analysis of six studies. The use of cranberry compounds also reduced the prevalence of symptoms associated with UTIs.</p><p><strong>Conclusions and clinical implications: </strong>With moderate to low certainty, the evidence supports the use of cranberry juice for the prevention of UTIs. While increased liquids reduce the rate of UTIs compared with no treatment, cranberry in liquid form provides even better clinical outcomes in terms of reduction in UTIs and antibiotic use and should be considered for the management of UTIs.</p><p><strong>Patient summary: </strong>With the increasing prevalence of antimicrobial-resistant UTIs, alternate non-drug treatment options for its management are required. Available evidence supports the use of cranberry compounds and increases in fluid intake for managing UTIs.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Alessandro Uleri, Jean Nicolas Cornu, Andrea Gobbo, et al. Association of 5α-Reductase Inhibitors with Depression and Suicide: A Mini Systematic Review and Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2024.04.009.","authors":"David-Dan Nguyen, Naeem Bhojani, Quoc-Dien Trinh","doi":"10.1016/j.euf.2024.06.013","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.013","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Deep Learning-based Artificial Intelligence System for Interpreting Urolithiasis in Computed Tomography.","authors":"Jin Kim, Chan Woo Kwak, Saangyong Uhmn, Junghoon Lee, Sangjun Yoo, Min Chul Cho, Hwancheol Son, Hyeon Jeong, Min Soo Choo","doi":"10.1016/j.euf.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.euf.2024.07.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Our aim was to develop an artificial intelligence (AI) system for detection of urolithiasis in computed tomography (CT) images using advanced deep learning capable of real-time calculation of stone parameters such as volume and density, which are essential for treatment decisions. The performance of the system was compared to that of urologists in emergency room (ER) scenarios.</p><p><strong>Methods: </strong>Axial CT images for patients who underwent stone surgery between August 2022 and July 2023 comprised the data set, which was divided into 70% for training, 10% for internal validation, and 20% for testing. Two urologists and an AI specialist annotated stones using Labelimg for ground-truth data. The YOLOv4 architecture was used for training, with acceleration via an RTX 4900 graphics processing unit (GPU). External validation was performed using CT images for 100 patients with suspected urolithiasis.</p><p><strong>Key findings and limitations: </strong>The AI system was trained on 39 433 CT images, of which 9.1% were positive. The system achieved accuracy of 95%, peaking with a 1:2 positive-to-negative sample ratio. In a validation set of 5736 images (482 positive), accuracy remained at 95%. Misses (2.6%) were mainly irregular stones. False positives (3.4%) were often due to artifacts or calcifications. External validation using 100 CT images from the ER revealed accuracy of 94%; cases that were missed were mostly ureterovesical junction stones, which were not included in the training set. The AI system surpassed human specialists in speed, analyzing 150 CT images in 13 s, versus 38.6 s for evaluation by urologists and 23 h for formal reading. The AI system calculated stone volume in 0.2 s, versus 77 s for calculation by urologists.</p><p><strong>Conclusions and clinical implications: </strong>Our AI system, which uses advanced deep learning, assists in diagnosing urolithiasis with 94% accuracy in real clinical settings and has potential for rapid diagnosis using standard consumer-grade GPUs.</p><p><strong>Patient summary: </strong>We developed a new AI (artificial intelligence) system that can quickly and accurately detect kidney stones in CT (computed tomography) scans. Testing showed that this system is highly effective, with accuracy of 94% for real cases in the emergency department. It is much faster than traditional methods and provides rapid and reliable results to help doctors in making better treatment decisions for their patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperineal Is the Way To Go.","authors":"Adrian Pilatz, Fabian Stangl, Jennifer Kranz, Gernot Bonkat, Rajan Veeratterapillay","doi":"10.1016/j.euf.2024.06.010","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.010","url":null,"abstract":"<p><p>The evidence available shows that transperineal prostate biopsy is significantly superior to transrectal biopsy in terms of infectious complications and is therefore recommended as the first choice in the European Association of Urology guidelines.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Therapy for Locally Advanced Prostate Cancer: How Do We Treat Patients with cN1 Disease?","authors":"Jean-Emmanuel Bibault, Méjean Arnaud, Fabien Hyafil, Constance Thibault, Stéphane Oudard","doi":"10.1016/j.euf.2024.06.009","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.009","url":null,"abstract":"<p><p>Radiotherapy (RT) for high-risk localized prostate cancer (HRLPC) can be controversial in the context of increasing detection of suspicious lymph nodes via advanced imaging techniques. The EORTC 22683 trial initially established RT with androgen deprivation therapy (ADT) as the standard of care for HRLPC, but many patients remain uncured. GETUG-AFU-12 showed that addition of docetaxel and estramustine to ADT improved relapse-free survival but not overall survival. STAMPEDE later demonstrated that abiraterone acetate with ADT and RT significantly improved failure-free survival and overall survival. Ongoing trials such as ENZARAD, ATLAS, DASL-HiCap, and GETUG-P17 ALADDIN are investigating the efficacy of new androgen receptor pathway inhibitors combined with RT and ADT. These studies aim to refine treatment strategies for HRLPC, particularly in the context of advanced imaging and patient upstaging. PATIENT SUMMARY: Addition of newer medications to standard radiation therapy has shown promise in improving survival for men with high-risk prostate cancer. Ongoing studies are testing these options to find the best combination. The aim is to increase the chances of curing prostate cancer, especially as advanced scan techniques are detecting more cases.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Place for De-escalating Therapy in Patients with Metastatic Hormone-sensitive Prostate Cancer?","authors":"Fabio Turco, Bertrand Tombal, Silke Gillessen, Aurelius Omlin","doi":"10.1016/j.euf.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.008","url":null,"abstract":"<p><p>Although intermittent androgen deprivation therapy was often recommended for metastatic hormone-sensitive cancer therapy in the past, we do not know whether its use can be extrapolated to combination therapy. Trials evaluating intermittent therapy are necessary as this strategy could improve patient quality of life and reduce adverse events and costs.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Second Opinion Expert Pathology Review in Patient Management at the Time of Transurethral Resection of the Bladder.","authors":"Daniele Robesti, Marco Moschini, Nazario Pio Tenace, Giusy Burgio, Chiara Re, Riccardo Leni, Mario De Angelis, Pietro Scilipoti, Francesco Pellegrino, Donato Cannoletta, Giorgio Gandaglia, Nicola Fossati, Andrea Gallina, Claudio Doglioni, Maurizio Colecchia, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Roberta Lucianò","doi":"10.1016/j.euf.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.euf.2024.06.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Pathological features in non-muscle-invasive bladder cancer specimens are pivotal in determining correct patients' therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer.</p><p><strong>Methods: </strong>The study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines.</p><p><strong>Key findings and limitations: </strong>Among 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found.</p><p><strong>Conclusions and clinical implications: </strong>The second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management.</p><p><strong>Patient summary: </strong>We investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}