Turkish journal of urology最新文献

{"title":"Trends in benign prostatic hyperplasia surgery over the years: A multicenter 14-year retrospective study.","authors":"Muhammed Arif İbis,&nbsp;Selahittin Cayan,&nbsp;Zafer Tokatli,&nbsp;İrfan Orhan,&nbsp;Ramazan Ascı,&nbsp;Fatih Kocamanoglu,&nbsp;Erdem Akbay,&nbsp;Onder Yaman","doi":"10.5152/tud.2021.21262","DOIUrl":"https://doi.org/10.5152/tud.2021.21262","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to show the surgical trend over the past 14 years using the data from five major centers in Turkey with accumulated experience in benign prostatic hyperplasia (BPH) surgery.</p><p><strong>Material and methods: </strong>This study included 94,954 patients with low urinary tract symptoms (LUTSs) secondary to BPH. By using electronic databases, we identified 7,163 patients who underwent BPH surgery, including monopolar transurethral prostate resection (M-TURP), bipolar transurethral prostate resection (BTURP), transurethral incision of the prostate (TUIP), open prostatectomy (OP), and holmium laser enucleation of the prostate (HoLEP) from 2006 to 2019. The years were grouped as 2006-2010, 2011-2015, and 2016-2019.</p><p><strong>Results: </strong>The total number of outpatient treatments for BPH increased by 72.9% from 5,379 in 2006 to 9,302 in 2019. Until 2019, the annual number of surgeries increased from 375 to 937 (increasing 150%). All surgical approaches for BPH, except TUIP, were most frequently performed between the ages of 60 and 69. The rate of surgery including M-TURP, B-TURP, and TUIP was statistically different between 2006 and 2010, 2011 and 2015, and 2016 and 2019 (P < .001), except OP (P ¼ .071). The highest increase was observed in HoLEP in the first half of the 2010s compared to the second half of the 2010s. The rate of M-TURP decreased from 77.9% to 17.9% from 2016 to 2019.</p><p><strong>Conclusion: </strong>With the aging population, the number of patients diagnosed and treated with BPH is increasing. B-TURP as a resection technique and HoLEP as an enucleation technique replace M-TURP. Healthcare services and government spending should be organized according to these data.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 6","pages":"501-508"},"PeriodicalIF":1.3,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/5f/tju-47-6-501.PMC9612752.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888409","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}

{"title":"Editorial comment on comparison of the micro-percutaneous nephrolithotomy results between adult and pediatric cases: Is it safe and effective for pediatric cases? Seçkiner et al.","authors":"Patrick Juliebø-Jones,&nbsp;Bhaskar K Somani","doi":"10.5152/tud.2021.21235","DOIUrl":"https://doi.org/10.5152/tud.2021.21235","url":null,"abstract":"","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"347-348"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612769/pdf/tju-47-5-347.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888411","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}

{"title":"Editorial Comment for the paper entitled \"Robotic simple prostatectomy is safe and effective technique for benign prostatic hyperplasia: Our single center initial results for 42 patients\".","authors":"Ali Atan","doi":"10.5152/tud.2021.21231","DOIUrl":"https://doi.org/10.5152/tud.2021.21231","url":null,"abstract":"I congratulate the authors for their valuable study titled “Robotic simple prostatectomy is safe and effective technique for benign prostatic hyperplasia: Our single center initial results for 42 patients.” After technologic improvements and the development of new endoscopic systems, surgical approaches have changed dramatically in recent years. It has become an obligation to adapt to developing technologies for the surgeons. One of the branches of surgery in which this change and adaptation is the fastest and most prominent is urology. As urologists, we have been experiencing this change clearly in the last 20 years. After the introduction of robotic surgery into daily urology practice, there is an increasing trend in many countries to perform a robotassisted surgery in all of the cases. There is even an exaggerated incentive to conduct robotic surgery. Open simple prostatectomy (OSP) is one of those overly encouraged surgeries. Although robot-assisted surgery is suitable and reasonable for some urological surgeries, we should provide an answer to the question whether or not robotic surgery is really necessary for all types of urological surgery.","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"349-350"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/2f/tju-47-5-349.PMC9612777.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888413","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}

{"title":"A hybrid technique of lap perineal pelvic lymphadenectomy after open radical perineal prostatectomy in localized carcinoma prostate: Our initial experience.","authors":"Pirzada Faisal Masood,&nbsp;Hemant Kumar Goel,&nbsp;Umesh Sharma,&nbsp;Sumit Gahlawat,&nbsp;Karandeep Guleria,&nbsp;Rajeev Sood","doi":"10.5152/tud.2021.21172","DOIUrl":"https://doi.org/10.5152/tud.2021.21172","url":null,"abstract":"<p><strong>Objective: </strong>The major disadvantage of radical perineal prostatectomy (RPP) is the difficulty to perform pelvic lymphadenectomy via the same incision. Open retropubic, mini laparotomy, and transperitoneal laparoscopic pelvic lymphadenectomy as an adjunct to open RPP have been tried but need change in patient position and separate incision, thereby decreasing the acceptability of this procedure. Open RPP followed by a lap perineal pelvic lymphadenectomy via the same perineal incision is a hybrid technique that is aimed to decrease morbidity of lymphadenectomy.</p><p><strong>Material and methods: </strong>Patients of low and intermediate risk localized carcinoma prostate with a Partin score of >5% were taken for this procedure. After completing prostatectomy part of RPP, lap perineal pelvic lymphadenectomy was performed via same incision using single incision laparoscopic surgery port.</p><p><strong>Results: </strong>We performed this new hybrid technique in eight patients. Bilateral lymph node dissection required an additional mean time of 35 minutes. A total of 68 nodes were retrieved from eight patients with a median number of eight nodes (range: 6-12). None of our cases had any complications related to lymphadenectomy. Bilateral lymph node dissection was feasible in seven patients, and in one patient, it could be done on one side only.</p><p><strong>Conclusion: </strong>Sandwiching lap perineal pelvic lymphadenectomy between prostatectomy part of RPP and urethra-vesical anastomosis (by open approach) is a safe, reproducible, and feasible approach to pelvic lymphadenectomy compared to lymphadenectomy from other routes with simultaneous reduction in the operative time, patient morbidity, and discomfort. Ease of doing lymphadenectomy from same incision can increase the acceptability of this excellent procedure.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"386-391"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/dd/tju-47-5-386.PMC9612773.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889277","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}

{"title":"Evolution of AquablationVR-From innovation to establishment.","authors":"Johannes Stein,&nbsp;Alexander Cox,&nbsp;Stefan Hauser,&nbsp;Manuel Ritter,&nbsp;Thorsten Bach","doi":"10.5152/tud.2021.21126","DOIUrl":"https://doi.org/10.5152/tud.2021.21126","url":null,"abstract":"<p><p>Technological progress is continuously improving medical care. The urological profession is well-known for further development of technical innovations and quick transfer into daily practice. Robot-assisted surgery, for example, has been part of the clinical routine in modern urological clinics for many years. In the endourological field, the implementation and further evolution of laser-based procedures have dominated research in the last decade. Recently, in 2015, the presentation of a new robot-assisted technique of waterjet-based ablation of prostate tissue raised attention in the society-the AquablationVR therapy. Aquablation therapy has been investigated within several randomized and controlled clinical trials, and-with growing experience- the technique has been modified over recent years to improve the safety of the procedure. Due to the clinical outcome, the number of hospitals performing Aquablation therapy is increasing continuously. This article provides an overview of the technique, its modifications, and the current status of evidence.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"351-357"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612770/pdf/tju-47-5-351.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888414","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}

{"title":"Factors affecting outcome of adult hypospadias single stage repair: A prospective observational study.","authors":"Hemant Kumar Goel,&nbsp;Chaure Mayur Tirthraj,&nbsp;Sumit Kabra,&nbsp;Sumit Gahlawat,&nbsp;Umesh Sharma,&nbsp;Rajeev Sood","doi":"10.5152/tud.2021.21163","DOIUrl":"https://doi.org/10.5152/tud.2021.21163","url":null,"abstract":"<p><strong>Objective: </strong>In our part of the world, many patients present with hypospadias in adult age, where results are often poor and associated with increased complications. This study was conducted to assess the factors affecting outcome of single stage hypospadias surgery in adults.</p><p><strong>Material and methods: </strong>This study included patients (>12 years) undergoing hypospadias repair in single stage. Preoperative factors were assessed and outcome parameters including early complications (within 1 month) and late complications (after 1 month) were studied and statistically analyzed.</p><p><strong>Results: </strong>Of the 31 patients included (mean age 20.8 6 7.87 years), 38.7% had a history of previous surgery. Mean glans width was 17.54 6 1.78mm. Postoperatively, the median hospital stay was 5 days (range: 4- 10 days), and the median catheter duration was 21 days (range: 7-21 days). Overall complication rate was 54.83% at 6-month follow-up. Early complications comprised of infection, skin necrosis, and dehiscence of suture line. Late complications included urethrocutaneous fistula, glans dehiscence, and urethral stricture. On performing univariate logistic regression, glans width, urethral plate width and shape, and history of previous surgery were significant risk factors of postsurgery complications. On multivariate logistic regression, glans width was an independent significant risk factor (odds ratio: 0.197).</p><p><strong>Conclusion: </strong>Several factors are associated with significant complications in adult hypospadias single stage repair. Among the various risk factors, glans width is an independent significant risk factor affecting outcome.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"420-426"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/f2/tju-47-5-420.PMC9612767.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889279","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}

{"title":"Intraurethral lidocaine use during urodynamics in female patients: A systematic review and meta-analysis.","authors":"Dian Paramita Oktaviani,&nbsp;Mohammad Ayodhia Soebadi,&nbsp;Yudhistira Pradnyan Kloping,&nbsp;Furqan Hidayatullah,&nbsp;Zakaria Aulia Rahman,&nbsp;Soetojo Soetojo","doi":"10.5152/tud.2021.21182","DOIUrl":"https://doi.org/10.5152/tud.2021.21182","url":null,"abstract":"<p><p>Pain and discomfort may occur in catheterization during a urodynamic examination. A lidocaine gel combined with a water-based lubricant is sometimes used to reduce pain during catheterization. Several studies claimed that intraurethral lidocaine administration could cause inaccurate urodynamic parameters results. However, its definite effects in urodynamics testing on humans are still not clear. We aimed to evaluate the effects of intraurethral lidocaine on pain and urodynamic study parameters in patients undergoing an invasive urodynamic examination. A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed in the MEDLINE, PubMed, and ScienceDirect databases for randomized controlled trials (RCTs). The bias of the studies is evaluated using the Cochrane risk of bias tool by two independent reviewers. The analyses of continuous outcomes were displayed as mean difference (MD), whereas odds ratio is used to analyze dichotomous data. Heterogeneity between studies is determined using the I2 value. A total of three RCTs out of 622 discovered that articles were eligible for analysis. Forest plot analysis of the mean visual analogue scale difference of the studies indicated an insignificant difference between the lidocaine and placebo group (MD -7.68; 95% CI -34.04 to -18.68, P ¼ .57). All urodynamic parameter results were also similar between the two groups (P > .05). Routine intraurethral lidocaine injection prior to a urodynamic study does not affect pain intensity and urodynamic parameters.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"366-374"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612774/pdf/tju-47-5-366.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889275","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}

{"title":"Misconduct in research integrity: Assessment the quality of systematic reviews in Cochrane urological cancer review group.","authors":"Hanieh Salehi-Pourmehr, Amirreza Naseri, Ali Mostafaei, Leila Vahedi, Sana Sajjadi, Sona Tayebi, Hadi Mostafaei, Sakineh Hajebrahimi","doi":"10.5152/tud.2021.21038","DOIUrl":"10.5152/tud.2021.21038","url":null,"abstract":"<p><strong>Objective: </strong>Cochrane Library provides a powerful and authoritative database to aid medical decision making. We aimed to evaluate the quality of clinical trials and systematic reviews recorded in the Cochrane urology cancers group.</p><p><strong>Material and methods: </strong>This analytic cross-sectional study was conducted on 44 published systematic reviews of the Cochrane urology group which were published until May 2020. In the current study, we selected the urological cancer reviews. All types of biases in the understudied randomized controlled trials (RCTs) or quasi-RCTs of these systematic reviews were evaluated using the Cochrane appraisal checklist. We also separated and stratified the types of biases in the included studies. In addition, the quality of systematic reviews was assessed using the Joanna Briggs Institute (JBI) appraisal checklist.</p><p><strong>Results: </strong>A total of 44 systematic reviews and their understudied 340 RCTs were evaluated. On the basis of the JBI appraisal checklist results, 93.2% of systematic reviews had high quality. In terms of the quality of understudied RCTs in these reviews, the common prevalent risk of bias of the understudied RCTs or quasi- RCTs was unclear selection bias (allocation concealment and random sequence generation). The highest risk of bias was seen in the blinding of participants and personnel (performance bias).</p><p><strong>Conclusion: </strong>Although most Cochrane urological cancer reviews had high quality, performance bias was the highest one in their understudied RCTs. Regarding it and considering the increasing unclear risk of detection, attrition, and reporting biases, it is obvious that they have structural deficiencies; therefore, it is recommended to observe integrity principles for preventing research misconduct.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"392-419"},"PeriodicalIF":1.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612768/pdf/tju-47-5-392.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889278","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}

{"title":"A systematic review of non-HPV prognostic biomarkers used in penile squamous cell carcinoma.","authors":"Jessica Bowie,&nbsp;Sobha Singh,&nbsp;Ciaran O'Hanlon,&nbsp;Vishal Shiatis,&nbsp;Oliver Brunckhorst,&nbsp;Asif Muneer,&nbsp;Kamran Ahmed","doi":"10.5152/tud.2021.21199","DOIUrl":"https://doi.org/10.5152/tud.2021.21199","url":null,"abstract":"<p><p>The presence of lymph node metastasis is the most important prognostic indicator for patients with penile cancer. However, predicting which clinically node negative patients will harbor lymph node metastases remains unclear. The aim of this systematic review is to provide an overview of biomarkers p53, Ki-67, and SCCAg in predicting lymph node metastasis (LNM) and cancer-specific survival (CSS) in penile squamous cell carcinoma (SCC). MEDLINE, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception until 15 October 2020. Eligible studies were identified by three independent reviewers. Outcome measures included the presence of penile LNM and CSS. Extracted data were narratively synthesized with GRADE criteria utilized to evaluate the quality of evidence. In total, 999 articles were screened with 20 selected for inclusion. Studies reporting the use of p53 to predict LNM and CSS were rated as having the highest quality of evidence using the GRADE criteria, and the majority showed a positive association between p53 expression and LNM and CSS. All biomarkers and outcome combinations had at least one study showing a significant effect on predicting the outcome. However, studies were heterogeneous, and many reported nonsignificant effects. Identifying p53 overexpression may help one to identify patients at higher risks of LNM to be considered for early inguinal lymphadenectomy. There is contradictory and unreliable evidence for the prognostic value of Ki-67 and SCCAg in penile SCC for LNM and CSS. Larger studies are required with more rigorous methods and reports to improve the evidence base.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"358-365"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/a9/tju-47-5-358.PMC9612776.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889274","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}

{"title":"Current advances in neuromodulation techniques in urology practices: A review of literature.","authors":"Bulent Erol,&nbsp;Yavuz Onur Danacioglu,&nbsp;Kenneth M Peters","doi":"10.5152/tud.2021.21152","DOIUrl":"https://doi.org/10.5152/tud.2021.21152","url":null,"abstract":"<p><p>Neuromodulation has become a valid therapeutic option for patients with various lower urinary tract disorders. In clinical practice, the most used and recommended neuromodulation techniques are sacral neuromodulation (SNM), pudendal neuromodulation (PN), and percutaneous tibial nerve stimulation (PTNS). There are many theories concerning the mechanism of action of neuromodulation. Although SNM, PN, and PTNS show their activities through different nerve roots, all provide central and peripheral nervous system modulations. SNM has been approved for the treatment of overactive bladder (OAB), nonobstructive urinary retention, and fecal incontinence, while PTNS has been approved for OAB treatment. However, they are also used off-label in other urinary and nonurinary pelvic floor disorders, such as neurogenic lower urinary system disorder, interstitial cystitis, chronic pelvic pain, and sexual dysfunction. Minor and nonsurgical reversible complications are usually seen after neuromodulation techniques. In addition, in the last few years, there have been various developments in neuromodulation technology. Some of the examples of these developments are rechargeable batteries with wireless charging, improvements in programing, less invasive single-stage implantation in outpatient settings, and lower-cost new devices. We performed a literature search using Medline (PubMed), Cochrane Library, EMBASE, and Google scholar databases in the English language from January 2010 to February 2021. We included reviews, meta-analyses, randomized controlled trials, and prospective and retrospective studies to evaluate the activities and reliability of SNM, PN, and PTNS and the developments in this area in the last decade based on the current literature.</p>","PeriodicalId":23366,"journal":{"name":"Turkish journal of urology","volume":"47 5","pages":"375-385"},"PeriodicalIF":1.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/ee/tju-47-5-375.PMC9612778.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889276","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}