Therapeutic Advances in Urology最新文献

{"title":"Under pressure: irrigation practice patterns during flexible ureteroscopy.","authors":"Bassel Salka,&nbsp;Jamsheed Bahaee,&nbsp;Jeff Plott,&nbsp;Khurshid R Ghani","doi":"10.1177/17562872231179009","DOIUrl":"https://doi.org/10.1177/17562872231179009","url":null,"abstract":"<p><strong>Introduction: </strong>Irrigation parameters during flexible ureteroscopy (fURS) may impact patient outcomes, yet there are limited data on current practice patterns of irrigation methods and parameter selection. We assessed the common irrigation methods, pressure settings, and situations that present the most problems with irrigation among worldwide endourologists.</p><p><strong>Methods: </strong>A questionnaire on fURS practice patterns was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Surgeons were from North America (the United States and Canada), Latin America, Europe, Asia, Africa, and Oceania.</p><p><strong>Results: </strong>Questionnaires were answered by 208 surgeons (response rate 14%). North American surgeons accounted for 36% of respondents; 29% Europe, 18% Asia, and 14% Latin America. In North America, the most common irrigation method was the pressurized saline bag using a manual inflatable cuff (55%). Saline bag (gravity) with a bulb or syringe injection system was the most common method in Europe (45%). Automated systems were the most common method in Asia (30%). For pressures used during fURS, the majority of respondents used 75-150 mmHg. The clinical scenario which had the greatest issue with adequate irrigation was during biopsy of urothelial tumor.</p><p><strong>Conclusion: </strong>There is variation in irrigation practices and parameter selection during fURS. North American surgeons primarily used a pressurized saline bag, in contrast to European surgeons who preferred a gravity bag with a bulb/syringe system. Overall, automated irrigation systems were not commonly used.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/f8/10.1177_17562872231179009.PMC10285609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary treatment (MDT) perspectives in renal cell carcinoma.","authors":"Jeanny B Aragon-Ching,&nbsp;Robert Uzzo","doi":"10.1177/17562872231182216","DOIUrl":"https://doi.org/10.1177/17562872231182216","url":null,"abstract":"able to achieve complete metastasectomy. 14 Metastasectomy can be achieved either with surgery or radiation. The use of stereotactic ablative radiation therapy (SABR) for oligometastatic renal cell carcinoma (ORCA) was evaluated in a meta-analysis of 28 studies, 15 which included 1602 mutually exclusive patients involving 3892 lesions with the potential benefit of effective delivery in lieu of systemic therapy, 16 potential delay of subsequent line of systemic treatment in true oligoprogressive disease or perhaps in combination with systemic therapy. The feasibility of a combination approach","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/81/10.1177_17562872231182216.PMC10286529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay.","authors":"Umberto Carbonara,&nbsp;Daniele Amparore,&nbsp;Leonardo D Borregales,&nbsp;Anna Caliò,&nbsp;Chiara Ciccarese,&nbsp;Pietro Diana,&nbsp;Selcuk Erdem,&nbsp;Laura Marandino,&nbsp;Michele Marchioni,&nbsp;Constantijn H J Muselaers,&nbsp;Carlotta Palumbo,&nbsp;Nicola Pavan,&nbsp;Angela Pecoraro,&nbsp;Eduard Roussel,&nbsp;Hannah Warren,&nbsp;Zhen-Jie Wu,&nbsp;Riccardo Campi,&nbsp;Riccardo Bertolo","doi":"10.1177/17562872231172834","DOIUrl":"https://doi.org/10.1177/17562872231172834","url":null,"abstract":"<p><p>Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both <i>via</i> a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic <i>versus</i> multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/f7/10.1177_17562872231172834.PMC10265377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10030402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus haemorrhagic cystitis in a pregnant patient with AIDS.","authors":"Bernard Marais,&nbsp;Veena John,&nbsp;Mariëtte Du Toit,&nbsp;Jeanne Mbambo,&nbsp;Jeff John","doi":"10.1177/17562872231159531","DOIUrl":"https://doi.org/10.1177/17562872231159531","url":null,"abstract":"<p><p>Cytomegalovirus (CMV), an AIDS defining disease, has a high seroprevalence in the general population, while symptomatic infections occur mostly in immunocompromised individuals. Symptomatic CMV infections commonly include pneumonia, encephalitis, retinitis and colitis, while urinary tract involvement is a rare entity. We present a rare case of massive macroscopic haematuria due to CMV haemorrhagic cystitis in a 29-year-old woman in her second trimester of pregnancy. She was treated with intravenous Ganciclovir after initial resuscitation, and her symptoms promptly resolved. Timely diagnosis and treatment of symptomatic CMV infection is necessary to prevent associated morbidity, and this is especially significant during pregnancy in order to prevent foetal transmission. Both our patient and her baby remained symptom free at the 6-month follow-up post-delivery. Clinicians should have a high index of suspicion to biopsy the bladder urothelium of at-risk patients who present with haemorrhagic cystitis and have non-specific cystoscopy findings as histopathological analysis is the mainstay of diagnosing CMV-cystitis.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/5c/10.1177_17562872231159531.PMC10034270.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9245935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: a historically controlled study.","authors":"Marco Carilli,&nbsp;Patrizio Pacini,&nbsp;Maurizio Serati,&nbsp;Valerio Iacovelli,&nbsp;Daniele Bianchi,&nbsp;Filomena Petta,&nbsp;Serena Pastore,&nbsp;Ivana Amato,&nbsp;Claudia Fede Spicchiale,&nbsp;Giulia D'Ippolito,&nbsp;Simone Pletto,&nbsp;Yuri Cavaleri,&nbsp;Andrea D'Amico,&nbsp;Isabella Parisi,&nbsp;Enrico Finazzi Agrò","doi":"10.1177/17562872231177779","DOIUrl":"https://doi.org/10.1177/17562872231177779","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking.<b>Objective::</b> To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies.</p><p><strong>Methods: </strong>MS patients with NDO were enrolled. Inclusion criteria were NDO not responding to pharmacological and behavioural therapies. Exclusion criteria were the presence of relevant comorbidities and urinary tract infections. Patients were evaluated using 3-day bladder diaries and validated questionnaires at baseline, after 4 weeks of educational therapy and after 12 PTNS sessions. The primary outcome measure was the percentage of patients considered responders after the behavioural therapy and after the PTNS in a historical controlled fashion (definition of 'responder' was reduction ⩾50% of urgency episodes).</p><p><strong>Results: </strong>A total of 33 patients (26 women, 7 men) were enrolled. Two patients dropped out for reasons not related to the protocol. Two out of 31 patients (6.5%) and 21/29 (72.4%) were considered responders at visits 1 and 2, respectively. In PTNS responders, a statistically significant improvement in both bladder diary results and standardized questionnaire scores was recorded, compared with that obtained with behavioural therapy alone. No serious adverse events were reported.</p><p><strong>Conclusion: </strong>This historically controlled study suggests that PTNS may be effective in improving NDO in MS patients.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/dd/10.1177_17562872231177779.PMC10233582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9637357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group.","authors":"Vineet Gauhar,&nbsp;Daniele Castellani,&nbsp;Ben Hall Chew,&nbsp;Daron Smith,&nbsp;Chu Ann Chai,&nbsp;Khi Yung Fong,&nbsp;Jeremy Yuen-Chun Teoh,&nbsp;Olivier Traxer,&nbsp;Bhaskar Kumar Somani,&nbsp;Thomas Tailly","doi":"10.1177/17562872231198629","DOIUrl":"https://doi.org/10.1177/17562872231198629","url":null,"abstract":"<p><strong>Background: </strong>Assessment of residual fragments (RFs) is a key step after treatment of kidney stones.</p><p><strong>Objective: </strong>To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) <i>versus</i> X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones.</p><p><strong>Design: </strong>A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021).</p><p><strong>Methods: </strong>Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs.</p><p><strong>Results: </strong>A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% <i>versus</i> 13.9%, <i>p</i> < 0.001) and after matching (43.1% <i>versus</i> 23.9%, <i>p</i> < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% <i>versus</i> 47.6%, <i>p</i> < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, <i>p</i> < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, <i>p</i> < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, <i>p</i> = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, <i>p</i> < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, <i>p</i> < 0.001) had significantly higher odds of having CSRFs.</p><p><strong>Conclusions: </strong>CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/ce/10.1177_17562872231198629.PMC10493056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of ureteropelvic junction obstruction and pyeloplasty on somatic growth during infancy.","authors":"Eyal Kord,&nbsp;Binyamin B Neeman,&nbsp;Dolev Perez,&nbsp;Boris Chertin,&nbsp;Amnon Zisman,&nbsp;Amos Neheman","doi":"10.1177/17562872231172835","DOIUrl":"https://doi.org/10.1177/17562872231172835","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the impact of perinatal ureteropelvic junction obstruction (UPJO) and surgical correction during infancy, on somatic growth are scarce. Understanding these impacts could help advise parents and aid in treatment decision making.</p><p><strong>Objectives: </strong>To assess the impact of unilateral UPJO and surgical correction on somatic growth in infants diagnosed antenatally and treated during infancy.</p><p><strong>Design: </strong>A retrospective bi-institutional analysis of somatic growth in patients under 2 years who underwent dismembered pyeloplasty for the treatment of UPJO was conducted.</p><p><strong>Methods: </strong>We evaluated patients who were diagnosed with unilateral hydronephrosis during pre-natal ultrasound screening for detection of fetal anomalies between May 2015 and October 2020. The height and weight of patients who were diagnosed with UPJO were recorded at the age of 1 month, time of surgery, and 6 months after surgery. Standard deviation scores (SDSs) for height and weight were calculated and compared.</p><p><strong>Results: </strong>Forty-eight patients under the age of 2 years were included in the analysis. Median age and weight at pyeloplasty were 6.9 months and 7.5 kg. At 1 month, the median SDS for weight in the entire cohort was -0.30 [interquartile range (IQR): -1.0 to 0.63] and the median SDS for height was -0.26 (IQR: -1.08 to 0.52). In 22.9% of patients (11/48), weight and height were below -1 age-appropriate standard deviations, and 6.3% (3/48) were below -2 standard deviations, suggesting growth restriction. When comparing SDS for the entire cohort, there was no significant difference corelated to measurement time or effect of surgery. In the growth restricted cohort, we found a significant improvement in linear growth for height, which was demonstrated between birth and surgery as well as after surgery.</p><p><strong>Conclusion: </strong>Infants with unilateral UPJO diagnosed antenatally as a single anomaly may be at an increased risk of somatic growth restriction in comparison with the general population. In children with growth restriction at time of birth, height seems to improve regardless of surgical treatment. Pyeloplasty during infancy does not seem to negatively affect somatic growth. These findings can be used to counsel parents regarding the potential effects of UPJO and pyeloplasty.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/93/10.1177_17562872231172835.PMC10201135.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9871472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of robotic surgery in urology: from augmented reality to the advent of metaverse.","authors":"Enrico Checcucci,&nbsp;Paolo Verri,&nbsp;Daniele Amparore,&nbsp;Giovanni Enrico Cacciamani,&nbsp;Juan Gomez Rivas,&nbsp;Riccardo Autorino,&nbsp;Alex Mottrie,&nbsp;Alberto Breda,&nbsp;Francesco Porpiglia","doi":"10.1177/17562872231151853","DOIUrl":"https://doi.org/10.1177/17562872231151853","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). TherapeuTic advances in urology","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/0a/10.1177_17562872231151853.PMC9893340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted radical prostatectomy is pushing the boundaries: a national survey of frailty using the national surgical quality improvement program.","authors":"Nassib F Abou Heidar,&nbsp;Christian Habib Ayoub,&nbsp;Anthony Abou Mrad,&nbsp;Jad Abdul Khalek,&nbsp;Hani Tamim,&nbsp;Albert El-Hajj","doi":"10.1177/17562872231177780","DOIUrl":"https://doi.org/10.1177/17562872231177780","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted radical prostatectomy (RARP) has been found to be comparable and, in some cases, favorable to open surgical approaches, while being used in a frailer population.</p><p><strong>Objectives: </strong>We aimed to illustrate the trend in population frailty and compare morbidity and mortality postoperatively in patients who underwent RARP.</p><p><strong>Design and methods: </strong>The National Surgical Quality Improvement Program data set was used to select patients who underwent RARP between the years 2011-2019. Age, frailty indicators, surgical characteristics, and perioperative morbidity and mortality were compared between the years 2011-2019 using the chi-square test (χ²) for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables.</p><p><strong>Results: </strong>Our patient population consisted of 66,683 patients who underwent RARP. There was an increase in mean age and frailty indicated by an increase in 5-item frailty score ⩾2, metabolic syndrome index = 3, and American Society of Anesthesiologists' (ASA) class ⩾3 between the years 2011-2019 (<i>p</i> < 0.001). Whereas the rate of mortality and morbidity, indicated by postoperative Clavien-Dindo grade ⩾4 and major morbidity, remained the same over the same period (<i>p</i> > 0.264). Furthermore, operative time and length of stay decreased over the same period (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>RARP is being performed on more frail patients, with no added morbidity or mortality.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/4a/10.1177_17562872231177780.PMC10265338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10030401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative predictors of prolonged length of stay in radical cystectomy: a retrospective study using the American College of Surgeons-National Surgical Quality Improvement Program Dataset.","authors":"Elia Abou Chawareb,&nbsp;Christian Habib Ayoub,&nbsp;Jad Najdi,&nbsp;Joseph Ghoubaira,&nbsp;Albert El-Hajj","doi":"10.1177/17562872231191654","DOIUrl":"https://doi.org/10.1177/17562872231191654","url":null,"abstract":"<p><strong>Background: </strong>Radical cystectomy (RC) is considered a complex procedure that entails significant morbidity and mortality.</p><p><strong>Objectives: </strong>We aimed to determine pre-operative patient characteristics that help predict a prolonged length of hospital stay (PLOS) following RC.</p><p><strong>Design and methods: </strong>The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was used to select patients who underwent RC between the years 2011 and 2020. Prolonged length of stay was defined as a hospital stay ⩾9 days. We compared patient demographics, pre-operative labs, surgical characteristics, and medical history between patients with or without PLOS. Multivariable logistic regression models controlling for pre-operative characteristics and propensity score matching for post-operative complications were conducted to control for possible confounders.</p><p><strong>Results: </strong>The analysis yielded details of 19,158 RC patients of which 6007 (31%) patients had a PLOS. Patients with PLOS were more likely to have post-operative complications that could serve as predictors for the PLOS rather than their pre-operative characteristics. Hence, we matched our cohort for these complications. After matching, patient pre-operative characteristics that predict PLOS included female gender (Odds Ratio (OR) = 5.91), 10-year increase in age (OR = 1.15), non-White race (OR = 1.98), partially or totally dependent functional health status (OR = 2.86), bleeding disorders (OR = 4.67), congestive heart failure (OR = 1.59), pre-operative transfusion (OR = 3.03), and a 20-min increase in operative time (OR = 1.01) (<i>p</i> < 0.046).</p><p><strong>Conclusion: </strong>Patient demographics and pre-operative factors can help predict PLOS in RC patients. These predictors could serve as tools for patient counseling and risk stratification.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/0b/10.1177_17562872231191654.PMC10413889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9999242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}