Therapeutic Advances in Urology最新文献

{"title":"Variation of diagnosis and treatment of catheter-associated urinary tract infections: an online survey among caretakers involved.","authors":"Tess van Doorn,&nbsp;Sophie A Berendsen,&nbsp;Rosa L Coolen,&nbsp;Jeroen R Scheepe,&nbsp;Bertil F M Blok","doi":"10.1177/17562872231191305","DOIUrl":"https://doi.org/10.1177/17562872231191305","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of a clinically significant catheter-associated urinary tract infection (CAUTI) in patients performing clean intermittent catheterization (CIC) or with an indwelling catheter (IC) can be challenging.</p><p><strong>Objective: </strong>To get an insight into the variation of the used definition, diagnosis and management of CAUTIs by relevant healthcare workers in the Netherlands.</p><p><strong>Design: </strong>An online clinical scenario-based survey.</p><p><strong>Methods: </strong>The survey was built in Limesurvey and distributed to healthcare workers from randomly selected urology departments, rehabilitation departments/centres and general practice offices between January and May 2022. Questions regarding their field of experience, management strategies, used guidelines and two hypothetical cases with clinical scenarios of a possible CAUTI were included.</p><p><strong>Results: </strong>A total of 172 individuals participated, of which 112 completed the survey. In all, 32 individuals who completed the survey partially were also included. Participants consisted of 68 [44 urologists, 22 rehabilitation doctors (RDs) and 2 general practitioners (GPs)] doctors, 60 nurses (46 from the urology department and 14 from rehabilitation centres/departments) and 16 medical assistants (13 from urology department and 3 from GP offices). The majority consulted patients with an IC or on CIC on a daily/weekly or monthly basis. In all, 35 urologists (79.5%), 9 RDs (40.9%), 21 (45.7%) nurses in the urology department and 6 (42.9%) nurses from a rehabilitation department/centre indicated bladder irrigation as a treatment option for prevention/treatment of CAUTIs, treatment of symptoms or treatment of blockage of the catheter. In the clinical scenarios presented, treatment discrepancies were seen between subspecialties and healthcare workers. Various guidelines were named for the definition of CAUTIs.</p><p><strong>Conclusion: </strong>A considerable variation in diagnoses and management of CAUTIs between the healthcare workers involved was seen. Uniformity in diagnosing and managing CAUTIs, to prevent overtreatment and possible resistance to antibiotics, is advised. Suitable multidisciplinary guidelines are preferred.</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://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10220048","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":"Simulation-based education in urology - an update.","authors":"Angus Ritchie,&nbsp;Maurizio Pacilli,&nbsp;Ramesh M Nataraja","doi":"10.1177/17562872231189924","DOIUrl":"https://doi.org/10.1177/17562872231189924","url":null,"abstract":"<p><p>Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.</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://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10371956","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":"A scoping review of tissue interposition flaps used in vesicovaginal fistulae repair.","authors":"Halime Serinçay,&nbsp;Hayrullah Uğur Güler,&nbsp;Kezban Ulubayram,&nbsp;Naşide Mangır","doi":"10.1177/17562872231182217","DOIUrl":"https://doi.org/10.1177/17562872231182217","url":null,"abstract":"<p><strong>Background: </strong>Research on the use of tissue interposition flaps (TIFs) in vesicovaginal fistulae (VVF) repair is a broad area where a very wide range of natural and synthetic materials have been used. The occurrence of VVF is also diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. The use of synthetic and autologous TIFs in VVF repair is not yet standardized with a lack of the most efficacious type and technique of the TIF.</p><p><strong>Objectives: </strong>The aim of this study was to systematically review all synthetic and autologous TIFs used in the surgical repair of VVFs.</p><p><strong>Data sources and methods: </strong>In this scoping review, the surgical outcomes of autologous and synthetic interposition flaps used in VVF treatment meeting the inclusion criteria were determined. We searched the literature using Ovid MEDLINE and PubMed databases between 1974 and 2022. Study characteristics were recorded, and data on the change in fistulae size and location, surgical approach, success rate, preoperative patient evaluation and outcome evaluation were extracted from each study independently by two authors.</p><p><strong>Results: </strong>A total of 25 articles that met the inclusion criteria were included in the final analysis. A total of 943 and 127 patients who had received autologous and synthetic flaps, respectively, were included in this scoping review. The fistulae characteristics were highly variable with regard to their size, complexity, aetiology, location and radiation. Outcome assessments of fistulae repair in included studies were mostly based on symptom evaluation. Physical examination, cystogram and methylene blue test were the methods in order of preference. Postoperative complications, such as infection, bleeding, donor site, pain, voiding dysfunction and other complications, were reported in patients after fistulae repair in all included studies.</p><p><strong>Conclusion: </strong>The use of TIFs in VVF repair was common especially in complex and large fistulae. Autologous TIFs appear to be the standard of care at the moment, and synthetic TIFs were investigated in prospective clinical trials in a limited number of selected cases. Evidence levels of clinical studies evaluating the effectiveness of interposition flaps were overall low.</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/3d/ef/10.1177_17562872231182217.PMC10331086.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9817891","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":"Report of testicular tumour in a toddler: management beyond the testis.","authors":"Amit Sharma,&nbsp;Deepak Biswal,&nbsp;Satyadeo Sharma,&nbsp;Kishore Roy","doi":"10.1177/17562872221148382","DOIUrl":"https://doi.org/10.1177/17562872221148382","url":null,"abstract":"<p><p>Testicular tumours in prepubertal children tend to be pure yolk sac tumours detected in stage I and have good prognosis. We describe a case of a 2-year old male child with a mixed testicular tumour presenting with stage IIC disease and managed with retroperitoneal lymph node dissection for residual retroperitoneal disease post adjuvant chemotherapy.</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/25/90/10.1177_17562872221148382.PMC9896083.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215691","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":"Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis.","authors":"Marwan Zein,&nbsp;Ali A Nasrallah,&nbsp;Nassib F Abou Heidar,&nbsp;Jad Najdi,&nbsp;Layal Hneiny,&nbsp;Albert El Hajj","doi":"10.1177/17562872231171757","DOIUrl":"https://doi.org/10.1177/17562872231171757","url":null,"abstract":"<p><strong>Introduction: </strong>Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone.</p><p><strong>Methods: </strong>For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts.</p><p><strong>Results: </strong>For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock.</p><p><strong>Conclusion: </strong>A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.</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/0a/c6/10.1177_17562872231171757.PMC10176578.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9530405","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":"Current state of mobile health apps in endourology: a review of mobile platforms in marketplaces and literature.","authors":"Ali Talyshinskii,&nbsp;Guliev Bakhman,&nbsp;Bm Zeeshan Hameed,&nbsp;Amelia Pietropaolo,&nbsp;Nithesh Naik,&nbsp;Bhaskar K Somani","doi":"10.1177/17562872231176368","DOIUrl":"https://doi.org/10.1177/17562872231176368","url":null,"abstract":"<p><p>Several mobile healthcare (mHealth) apps are available in various marketplaces, but there is still concern about their accuracy, data safety, and regulation. The goal of this review was to critically analyze the mobile apps created for education, diagnosis, and medical and surgical treatment of patients with kidney stone disease (KSD), as well as to assess the level of data security, the contribution of physicians in their development and adherence to the Food and Drug Administration (FDA) and Medical Device Regulation (MDR) guidance. A comprehensive literature search was performed using PubMed (September 2022), in the Apple App Store and Google Play store using relevant keywords and inclusion criteria. Information was extracted for the name of the app, primary and additional functionalities, release and last update, number of downloads, number of marks and average rating, Android/iOS compatibility, initial and in-app payments, data safety statement, physician involvement statement, and FDA/MDR guidance. A total of 986 apps and 222 articles were reviewed, of which based on the inclusion, 83 apps were finally analyzed. The apps were allocated to six categories about their primary purpose: education (<i>n</i> = 8), fluid trackers (<i>n</i> = 54), food content description and calculators (<i>n</i> = 11), diagnosis (<i>n</i> = 3), pre- and intra-operative application (<i>n</i> = 4), and stent trackers (<i>n</i> = 2). Of these apps, the number of apps supported for Android, iOS, and both of them were 36, 23, and 23, respectively. Despite a wide range of apps available for KSD, the participation of doctors in their development, data security, and functionality remains insufficient. Further development of mHealth should be carried out properly under the supervision of urological associations involving patient support groups, and these apps must be regularly updated for their content and data security.</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/b1/e4/10.1177_17562872231176368.PMC10240556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9645608","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":"New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology.","authors":"Morgan Salkowski,&nbsp;Enrico Checcucci,&nbsp;Alexander K Chow,&nbsp;Craig C Rogers,&nbsp;Firas Adbollah,&nbsp;Evangelos Liatsikos,&nbsp;Prokar Dasgupta,&nbsp;Gustavo C Guimaraes,&nbsp;Jens Rassweiler,&nbsp;Alexander Mottrie,&nbsp;Alberto Breda,&nbsp;Simone Crivellaro,&nbsp;Jihad Kaouk,&nbsp;Francesco Porpiglia,&nbsp;Riccardo Autorino","doi":"10.1177/17562872231177781","DOIUrl":"https://doi.org/10.1177/17562872231177781","url":null,"abstract":"<p><p>Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.</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/f5/39/10.1177_17562872231177781.PMC10265325.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10030404","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":"RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study.","authors":"Vineet Gauhar,&nbsp;Chu Ann Chai,&nbsp;Ben H Chew,&nbsp;Abhishek Singh,&nbsp;Daniele Castellani,&nbsp;Thomas Tailly,&nbsp;Esteban Emiliani,&nbsp;William Ong Lay Keat,&nbsp;Deepak Ragoori,&nbsp;Mohamed Amine Lakmichi,&nbsp;Jeremy Yuen-Chun Teoh,&nbsp;Olivier Traxer,&nbsp;Bhaskar Kumar Somani","doi":"10.1177/17562872231158072","DOIUrl":"https://doi.org/10.1177/17562872231158072","url":null,"abstract":"<p><strong>Introduction: </strong>With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage.</p><p><strong>Methods: </strong>Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) <i>versus</i> Group 2 (Disposable scopes, 1855 patients).</p><p><strong>Results: </strong>The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively (<i>p</i> < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 (<i>p</i> < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 (<i>p</i> < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher (<i>p</i> < 0.001) for lower pole, larger, harder, multiple stones and in elderly.</p><p><strong>Conclusion: </strong>Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.</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/81/2e/10.1177_17562872231158072.PMC10009018.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9120344","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":"Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept.","authors":"Jia-Lun Kwok,&nbsp;Vincent De Coninck,&nbsp;Amelia Pietropaolo,&nbsp;Patrick Juliebø-Jones,&nbsp;Eugenio Ventimiglia,&nbsp;Thomas Tailly,&nbsp;Florian Alexander Schmid,&nbsp;Manuela Hunziker,&nbsp;Cédric Poyet,&nbsp;Olivier Traxer,&nbsp;Daniel Eberli,&nbsp;Etienne Xavier Keller","doi":"10.1177/17562872231179332","DOIUrl":"https://doi.org/10.1177/17562872231179332","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes.</p><p><strong>Design and methods: </strong>IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed.</p><p><strong>Results: </strong>IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector (<i>p</i> < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS (<i>R</i>² = 0.82, <i>p</i> < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.</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://www.ncbi.nlm.nih.gov/pmc/articles/PMC10291398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9729787","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":"Insights from the AQUA Registry: a retrospective study of anticholinergic polypharmacy in the United States.","authors":"Matthew R Cooperberg,&nbsp;Rachel Mbassa,&nbsp;David Walker,&nbsp;William Meeks,&nbsp;Amy Lockefeer,&nbsp;Baoguo Jiang,&nbsp;Tina Li,&nbsp;Karissa Johnston,&nbsp;Raymond Fang","doi":"10.1177/17562872221150572","DOIUrl":"https://doi.org/10.1177/17562872221150572","url":null,"abstract":"<p><strong>Background: </strong>Anticholinergic (ACH) burden is a risk factor for negative health outcomes among older adults. Several medications contribute to ACH burden, including antimuscarinics used to manage overactive bladder (OAB).</p><p><strong>Objectives: </strong>This study aimed to understand the extent of ACH burden in an OAB population in the United States.</p><p><strong>Design: </strong>Non-interventional retrospective analysis.</p><p><strong>Methods: </strong>Adults with OAB whose care providers participated in the American Urological Association Quality (AQUA) Registry between 2014 and 2020 were included in this study. An adapted version of the Pharmacy Quality Alliance (PQA) measure of anticholinergic polypharmacy (poly-ACH) was used to assess ACH burden. The primary outcome was the annual prevalence of poly-ACH, and a secondary outcome was the percentage of patients taking 0, 1, 2, 3, 4, or ⩾ 5 ACH medications by calendar year. Analyses were stratified by age category at diagnosis and sex.</p><p><strong>Results: </strong>The sample comprised 552,840 patients with OAB. The mean age at initial OAB diagnosis was 65.7 years (58.2% male; 57.4% white). Prevalence of poly-ACH was highest in 2015 (3.7%) and lowest in 2020 (1.9%). Patients prescribed no ACH medications made up the largest proportion of each cohort, while those prescribed five or more comprised the smallest. The trend of decreasing proportions of patients taking increasing numbers of ACH medications was consistent. The proportion of patients prescribed no ACH medications increased from 63.3% in 2014 to 74.6% in 2020. The percentage of those prescribed three or more ACHs remained largely unchanged. Poly-ACH was highest among younger individuals (< 65 years of age) and females; temporal trends were similar overall and within each age and sex stratum.</p><p><strong>Conclusion: </strong>In this study, poly-ACH in patients with OAB was relatively infrequent and decreased over the study period. Further evaluation of poly-ACH is needed to assess whether the study findings reflect increased awareness of the negative effects of poly-ACH.</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/8f/59/10.1177_17562872221150572.PMC9871979.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10628116","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}