Canadian Urological Association Journal最新文献_第6页

Making strides in POCUS training in urology 在泌尿外科 POCUS 培训方面取得进展

Canadian Urological Association Journal Pub Date : 2024-03-26 DOI: 10.5489/cuaj.8758

Nicholas R. Paterson

引用次数: 0

Leaving the room: A method of patient-centered care? 离开病房：以病人为中心的护理方法？

Canadian Urological Association Journal Pub Date : 2024-03-26 DOI: 10.5489/cuaj.8767

Michael Leveridge

引用次数: 0

Adult patients treated for bladder exstrophy at a young age 年轻时接受膀胱外翻治疗的成年患者

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8601

A. Bazinet, Alya Filfilan, Nawel Mokhtari, Louis Lenfant, Alaa Elghoneimi, E. Chartier-Kastler

{"title":"Adult patients treated for bladder exstrophy at a young age","authors":"A. Bazinet, Alya Filfilan, Nawel Mokhtari, Louis Lenfant, Alaa Elghoneimi, E. Chartier-Kastler","doi":"10.5489/cuaj.8601","DOIUrl":"https://doi.org/10.5489/cuaj.8601","url":null,"abstract":"Introduction: Bladder exstrophy-epispadias complex is a rare condition that necessitates numerous surgical procedures during a patient's youth to achieve adequate urine storage and continence. This study aimed to identify the specific needs and functional challenges faced by adults who underwent pediatric bladder exstrophy reconstructions and assessing the management of these issues in an adult population.\u0000Methods: A retrospective chart review was conducted for all bladder exstrophy complex patients who underwent surgery at a young age and were subsequently referred to our center between 2005 and 2020. Inclusion criteria included patients with cloacal or classical bladder exstrophy older than 18 years. We recorded the reasons for referral, management of contemporary complaints, types of past and present urinary reconstructions, and their current functional status.\u0000Results: The study included 38 patients. The primary reasons for referral were incontinence (39%) and catheterization difficulties (24%). Management typically involved partial or complete surgical revision of their urinary reservoir, occasionally combined with a bladder neck procedure. Ultimately, only three patients continued to experience incontinence, while none reported catheterization issues after they underwent treatment at our center. Long-term exstrophy-related reconstruction complications included urinary tract infections (39%), stones (29%), stenosis (24%), fistulas (13%), chronic renal disease (16%), metabolic abnormalities (3%), and cancer (3%).\u0000Conclusions: Adults who previously underwent bladder exstrophy reconstruction exhibit a wide range of urologic reconstructions. Their needs often revolve around continence and catheterization concerns. Most patients with satisfactory functional outcomes perform self-catheterization through a continent cutaneous channel and have either a continent pouch or an augmented bladder.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model 提高热度：在解剖模型中模拟摩西 2.0 激光手术

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8673

Christopher Wanderling, Aaron Saxton, Dennis Phan, K. Doersch, Lauren M. Shepard, Nathan Schuler, T. Osinski, Scott O. Quarrier, A. Ghazi

{"title":"Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model","authors":"Christopher Wanderling, Aaron Saxton, Dennis Phan, K. Doersch, Lauren M. Shepard, Nathan Schuler, T. Osinski, Scott O. Quarrier, A. Ghazi","doi":"10.5489/cuaj.8673","DOIUrl":"https://doi.org/10.5489/cuaj.8673","url":null,"abstract":"Introduction: With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model.\u0000Methods: Using high-fidelity, 3D printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction.\u0000Results: Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber.\u0000Conclusions: Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cancer centers of excellence for the multidisciplinary management of urologic cancers 多学科治疗泌尿系统癌症的卓越癌症中心

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8655

Daniel Andrés Nieva-Posso, Philippe E. Spiess, H. García-Perdomo

{"title":"Cancer centers of excellence for the multidisciplinary management of urologic cancers","authors":"Daniel Andrés Nieva-Posso, Philippe E. Spiess, H. García-Perdomo","doi":"10.5489/cuaj.8655","DOIUrl":"https://doi.org/10.5489/cuaj.8655","url":null,"abstract":"Urologic cancers are among the leading causes of morbidity and mortality in the world, representing more than 10% of the total number of new cancer cases worldwide. These complex diseases are linked to several issues related to their diagnosis, management, monitoring, and treatment — issues that require multidisciplinary solutions that encompass and manage patients as complex entities. In response to this, the so-called cancer centers of excellence (CCEs) emerged, defined as multidisciplinary institutions specialized in the diagnosis, management, monitoring, and treatment of specific diseases, including cancer. Different institutions, such as the European Association of Urology (EAU), have proposed and encouraged its consolidation, especially for the management of prostate cancer. These institutions must be composed of three areas: healthcare, education, and research, which have complementary interactions and relationships, stimulating research and problem-solving from a multidisciplinary approach and also covering elements of basic sciences and mental health. The implementation of these CCEs has brought positive results; therefore, it is necessary to stimulate their implementation with a uro-oncologic approach.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140090820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and tolerability of bacillus Calmette-Guérin strain Russia for the treatment of non-muscle-invasive bladder cancer 俄罗斯卡介苗菌株治疗非肌层浸润性膀胱癌的疗效和耐受性

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8552

Sarah Flury-Sutter, Frederick Heuzeroth, Emilio Arbelaez, L. Bubendorf, H. Püschel, Stefanie Hayoz, Cyrill A. Rentsch

{"title":"Efficacy and tolerability of bacillus Calmette-Guérin strain Russia for the treatment of non-muscle-invasive bladder cancer","authors":"Sarah Flury-Sutter, Frederick Heuzeroth, Emilio Arbelaez, L. Bubendorf, H. Püschel, Stefanie Hayoz, Cyrill A. Rentsch","doi":"10.5489/cuaj.8552","DOIUrl":"https://doi.org/10.5489/cuaj.8552","url":null,"abstract":"Introduction: Little is known about the efficacy and tolerability of intravesical bacillus Calmette-Guérin (BCG) strain Russia for treatment of non-muscle-invasive bladder cancer (NMIBC) in a middle-European population.\u0000Methods: A prospective collection of outcomes of 101 BCG-naive patients with urothelial bladder carcinoma was carried out between January 2013 and October 2023 at the University Hospital Basel, Basel, Switzerland. Patients underwent BCG (ONCO-BCG-SIIL, Serum Institute of India, Pune, India) induction and a maximum of three maintenance cycles within one year. Adverse events were classified according to the World Health Organization rating scale.\u0000Results: One-, three-, and five-year recurrence-free survival (RFS) was 75.9%, 65.6%, and 61.6%, respectively. Tumor recurrence was seen in 31.7% of patients. One-, three-, and five-year progression-free survival (PFS) was 100%, 93.4%, and 93.4%, respectively. Cystectomy rate was 8.9%, with progression to muscle-invasive disease seen in two patients. Adverse events occurred in 72.3% of patients, with adverse events >class II seen in 8.9%. No BCG-related deaths occurred. Early cessation due to side effects resulting in non-adequate BCG therapy was seen in 3% of patients during induction and in 1% during maintenance therapy.\u0000Conclusions: BCG Russia was well-tolerated and resulted in comparable RFS and PFS to historical results of prospective clinical trials with other BCG strains. The use of BCG Russia for adjuvant treatment of papillary NMIBC and therapy of carcinoma in situ of the urinary bladder could help alleviate the BCG shortage.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140092553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic 即将毕业的住院医师和研究员为在 COVID-19 大流行期间从事普通泌尿科实践做好准备

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8639

Kyle M Waisanen, F. Hennig, Ellen Lutnick, Gaganjot Parmar, Daniel Baetzhold, Nathaniel Iskhakov, Kiana Saade, Matthew Peterson, Nader D. Nader, Kent Chevli

{"title":"Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic","authors":"Kyle M Waisanen, F. Hennig, Ellen Lutnick, Gaganjot Parmar, Daniel Baetzhold, Nathaniel Iskhakov, Kiana Saade, Matthew Peterson, Nader D. Nader, Kent Chevli","doi":"10.5489/cuaj.8639","DOIUrl":"https://doi.org/10.5489/cuaj.8639","url":null,"abstract":"Introduction: Our goal was to compare the perceived readiness of graduating urologic residents and fellows to program directors (PDs) in U.S.-based postgraduate training programs. Additionally, we set out to assess the impact of COVID-19 on postgraduation plans to pursue fellowship training.\u0000Methods: Graduating residents, fellows, and PDs of accredited residency/fellowship programs in the U.S. were surveyed. The ranked preparedness of trainees to perform common urologic procedures was measured using a Likert scale from 1 (not comfortable) to 5 (fully proficient). The impact of COVID-19 was measured using a three-point Likert scale. Chi-squared and Kruskal-Wallis analyses were used to compare the groups.\u0000Results: From 93 responders, 21 were residents, 19 were fellows, 24 were residency PDs, and 29 were fellowship PDs. The median levels of comfort for transurethral resection of the prostate, hydrocelectomy, vasectomy, and urethral sling were at or above (≥3) moderate for both PDs and trainees. PDs were more likely to report underperformance for hypospadias repair (60% vs. 39%), penile prosthesis implantation (39% vs. 26%), and orthotopic neobladder formation (57% vs. 18%) than the trainees. Fifty-three (57.0%) of the surveyors felt that COVID-19 did not impact the trainees’ comfort in performing general urologic procedures. COVID-19 influenced trainees' decision to pursue a fellowship or opt to practice as general urologists (p=0.002).\u0000Conclusions: Our study suggests there may be a self-reported discrepancy between graduating trainees and their PDs regarding trainees’ comfort levels performing general urologic procedures.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Microbiology of infection-related complications after transrectal ultrasound-guided prostate biopsy 经直肠超声引导前列腺活检术后感染相关并发症的微生物学研究

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8553

Cynthia T. Nguyen, A. Lew, N. Pettit, Jennifer Pisano, Luke F. Reynolds

{"title":"Microbiology of infection-related complications after transrectal ultrasound-guided prostate biopsy","authors":"Cynthia T. Nguyen, A. Lew, N. Pettit, Jennifer Pisano, Luke F. Reynolds","doi":"10.5489/cuaj.8553","DOIUrl":"https://doi.org/10.5489/cuaj.8553","url":null,"abstract":"Introduction: The objective of this study was to describe the incidence, microbiology, and risk factors related to infectious complications after transrectal prostate biopsies.\u0000Methods: This was a single-center, retrospective cohort study of patients undergoing prostate biopsies. Throughout the study period, the institutional standard for antibiotic prophylaxis was cephalexin and ciprofloxacin. Due to the desire to limit fluoroquinolone use, the ciprofloxacin duration of therapy was reduced from 48 to 24 hours in the middle of the study period. The primary outcome was the incidence of infection-related complications, defined as a urinary tract infection or bacteremia within 30 days post-procedure.\u0000Results: A total of 1471 transrectal prostate biopsies were included. All patients received antibiotic prophylaxis, with 86.1% (1268/1472) of patients receiving both ciprofloxacin and cephalexin. The incidence of infection-related complications was 1.6% (24/1471). Four patients experienced bacteremia, all of which were due to E. coli and all of these patients had received antibiotic prophylaxis with an active antibiotic. The use of ciprofloxacin was associated with a lower risk of infection-related complications (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.07, 0.55). Bacteriuria within one year prior to the procedure was associated with increased risk of infection-related complications (OR 4.77, 95% CI 1.34, 16.93). Four (0.3%) patients experienced an antibiotic-related adverse event.\u0000Conclusions: We observed a low rate of infection-related complications and antibiotic-related adverse events in the setting of antibiotic prophylaxis with ciprofloxacin and cephalexin for 24 hours, without pre-procedure rectal culture screening. Investigation into procedural or host factors may uncover opportunities to further reduce infection-related complications.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying patients at risk for depression after radical cystectomy 识别根治性膀胱切除术后有抑郁风险的患者

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8611

Z. Savin, Liron Ben Dayan, O. Yossepowitch, S. Dekalo

{"title":"Identifying patients at risk for depression after radical cystectomy","authors":"Z. Savin, Liron Ben Dayan, O. Yossepowitch, S. Dekalo","doi":"10.5489/cuaj.8611","DOIUrl":"https://doi.org/10.5489/cuaj.8611","url":null,"abstract":"Introduction: We aimed to assess rates of depression in patients with bladder cancer undergoing radical cystectomy and identify its predictors.\u0000Methods: Depressive symptoms in 42 consecutive patients were evaluated using the Beck's Depression Inventory (BDI) on the day prior to surgery, postoperative day (POD) 6, six weeks after surgery, and 12–18 months postoperatively.\u0000Results: Fifteen patients (36%) presented with BDI scores ≥10 before the operation; this rate increased to 64% on POD 6 and 69% at six weeks post-surgery. Depression score rose from a preoperative median of 7 to 11 on POD 6 (p=0.003) and to 15 at six weeks after surgery (p=0.001). Patients who arrived with BDI score of <10 had a higher increase in the BDI at six weeks compared to patients with depressive symptoms prior to surgery (average increase 9.8 vs. 0.8, p<0.01). Age, gender, type of diversion, and complications were not associated with depression at presentation or progression of depression. Patients who did not receive neoadjuvant chemotherapy tended to be at increased risk for depression progression (57.1% vs. 14.3%, p=0.093). Twenty-four patients completed a fourth questionnaire 12–18 months postoperatively. Median BDI score was 8; three patients with disease recurrence had a higher increase in the BDI score (average 12.7 vs. -5.2, p<0.01).\u0000Conclusions: Depression among patients facing cystectomy is high and postoperative progression is substantial. Patients without depressive symptoms preoperatively are at increased risk of developing postoperative depression. After 12–18 months, the most influential risk factor for depression is recurrence. These findings highlight the need to consider interventions in selected patients.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE) 对进展期前列腺癌的加拿大治疗序列进行真实世界评估（REACTIVATE）

Canadian Urological Association Journal Pub Date : 2024-03-01 DOI: 10.5489/cuaj.8620

Jenny J. Ko, Lawrence Mbuagbaw, S. Tyldesley, Jennifer Lowther, K. Sunderland, Catherine Royer, Mareva Faure, Corin Macphail, Shoaib Faizi, Winson Y. Cheung, R. Lee-Ying

{"title":"Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE)","authors":"Jenny J. Ko, Lawrence Mbuagbaw, S. Tyldesley, Jennifer Lowther, K. Sunderland, Catherine Royer, Mareva Faure, Corin Macphail, Shoaib Faizi, Winson Y. Cheung, R. Lee-Ying","doi":"10.5489/cuaj.8620","DOIUrl":"https://doi.org/10.5489/cuaj.8620","url":null,"abstract":"Introduction: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces.\u0000Methods: This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately.\u0000Results: OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66–0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894–1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93–2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec.\u0000Conclusions: Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0