Current Urology最新文献

{"title":"Leptomeningeal metastases in prostate cancer: A review of the current literature","authors":"U. Durrani, Kasem Rifai, Maha Z Arshad, Awais Paracha, E. Deol, Mariam Paracha, Fatima Waheed, Zohair Siddiqui, Ali Abid, Esed Mustafic, Wilson Rodriguez, Zachary Hamilton","doi":"10.1097/cu9.0000000000000245","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000245","url":null,"abstract":"\u0000 Leptomeningeal metastasis/leptomeningeal carcinomatosis (LMC; terms used interchangeably) is an inflammatory complication of primary tumors that involves the spread of the disease to the meninges (specifically the arachnoid and pia maters) and spinal cord. In the United States, approximately 110,000 new cases are diagnosed each year, and the prognosis is usually poor. Complications of LMC include cognitive impairment, cranial nerve dysfunction, ischemic stroke, and mortality. The survival times of untreated and treated LMC are approximately 4–6 weeks and 2–4 months, respectively. Leptomeningeal carcinomatoses are usually metastatic cancers that spread to the central nervous system. Although lung and breast cancers have a clearly defined relationship with LMC, it remains unclear whether prostate cancer (PC) is also directly associated with LMC. To determine whether such association exists, we conducted a PubMed review of the literature on patients with PC with coexisting LMCs. Our search yielded 23 case reports of patients with preexisting PC who developed LMC. In addition, 2 retrospective cohort studies were examined.\u0000 Various findings were identified in the revised cases and studies. The first 3 findings were related to the progression of the disease: patients presenting with neurological disease symptoms were in remission from PC for 7 years on average, LMCs tended to occur after other cancer diagnoses, and the disease had already rapidly progressed by the time the symptoms were present. Regarding diagnosis, the major finding was that most LMCs were detected by magnetic resonance imaging (which does not detect early dissemination), and it was suggested that single-photon emission computed tomography or positron emission tomography imaging could be used for earlier detection. Finally, in terms of treatment, the main finding was that treatment was palliative rather than curative and that prognosis remained poor despite treatment. On the basis of these results, we recommend for individuals with risk factors, such as high-grade PC and hormonal PC, to be evaluated on a case-by-case basis for increased surveillance of LMC development.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140220859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Agent Orange impacts prostate cancer risk, pathology, and treatment outcomes","authors":"Awais Paracha, Zohair Siddiqui, Ali Abid, E. Deol, Fatima Waheed, Zachary Hamilton","doi":"10.1097/cu9.0000000000000244","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000244","url":null,"abstract":"\u0000 Between 2.6 and 3.8 million veterans served in Vietnam while the US military dispersed Agent Orange (AO), although the exact number of exposed individuals is unknown. Agent Orange, an herbicide, is a known risk factor for various cancers, including sarcoma and leukemia, but less is known about its link with prostate cancer (PC). Prostate cancer is the most commonly diagnosed malignancy in men and the fifth most common cause of cancer-related death in men worldwide. In 2023, approximately 288,300 patients will be given a diagnosis of PC, and an estimated 34,700 fatalities will occur in the United States. However, whether the pathologic characteristics of PC among those exposed to AO differ from those in the general population remains unclear. Our review synthesizes the literature regarding the impact of AO exposure on PC incidence and disease course. A comprehensive PubMed literature search of articles published beginning in 1950 was performed using the primary search terms “Agent Orange,” “TCDD,” and “tetrachlorodibenzodioxin” and the secondary search terms “prostate cancer” or “prostate neoplasm.” The search was limited to studies that focused on human participants and were published in English. Four authors thoroughly reviewed the retrieved articles for relevancy to the study aims: discussion of PC diagnosis, prognosis, or management among patients exposed to AO. Of 108 studies identified in our search, 13 were included in this systematic review. Findings within studies concerning AO exposure with relation to PC incidence, age at diagnosis or treatment initiation, and PC severity seemed to be mixed and generally conflicting. However, the literature seems to indicate that there are no significant differences in survivorship between exposed and unexposed veterans who are given a diagnosis of PC. Given these heterogeneous outcomes, the evidence does not encourage a significantly different approach to the diagnosis and management of PC for veterans exposed to AO. Clinicians should make case-by-case decisions regarding PC screening and potential treatment options for this patient group, weighing clinical suspicion against the harms of diagnostic workup and treatment.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140223251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head-to-head comparison of PSMA PET/CT and mpMRI for detecting biochemical recurrence of prostate cancer: A systematic review and meta-analysis","authors":"Xinru Zhang, Zhe Ma","doi":"10.1097/cu9.0000000000000242","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000242","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to evaluate the performance of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) in comparison to multiparametric magnetic resonance imaging (mpMRI) for detecting biochemical recurrence of prostate cancer (PCa).\u0000 \u0000 \u0000 \u0000 We conducted a comprehensive search for articles published in PubMed, Web of Science, Embase, and the Cochrane Library, spanning the inception of the database until October 26, 2022, which included head-to-head comparisons of PSMA PET/CT and mpMRI for assessing the biochemical recurrence of PCa.\u0000 \u0000 \u0000 \u0000 A total of 5 studies including 228 patients were analyzed. The overall positivity rates of PSMA PET/CT and mpMRI for detecting biochemical recurrence of PCa after final treatment were 0.68 (95% confidence interval [CI], 0.52–0.89) and 0.56 (95% CI, 0.36–0.88), respectively. The positivity rates of PSMA PET/CT and mpMRI for detecting local recurrence, lymph node metastasis, and bone metastases were 0.37 (95% CI, 0.30–0.47) and 0.38 (95% CI, 0.22–0.67), 0.44 (95% CI, 0.35–0.56) and 0.25 (95% CI, 0.17–0.35), and 0.19 (95% CI, 0.11–0.31) and 0.12 (95% CI, 0.05–0.25), respectively. Compared with mpMRI, PSMA PET/CT exhibited a higher positivity rate for detecting biochemical recurrence and lymph node metastases, and no significant difference in the positivity rate of local recurrence was observed between these 2 imaging modalities.\u0000 \u0000 \u0000 \u0000 Compared with mpMRI, PSMA PET/CT appears to have a higher positivity rate for detecting biochemical recurrence of PCa. Although both imaging methods showed similar positivity rates of detecting local recurrence, PSMA PET/CT outperformed PSMA PET/CT in detecting lymph node involvement and overall recurrence.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140232618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of the Moses effect and its applications in endourology","authors":"Adrià Piñero, A. Narváez, J. Placer, E. Miret, E. Trilla, Juan Morote","doi":"10.1097/cu9.0000000000000239","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000239","url":null,"abstract":"\u0000 The holmium:yttrium aluminum garnet laser, the gold standard for lithotripsy, is widely used in various endourological fields. Their physical characteristics contribute to the Moses effect. This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology. The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation. Lumenis® developed pulse modulation technology, the MOSES™ technology, that harnesses the Moses effect to optimize holmium energy. Preclinical studies concluded that the new technology improves stone retropulsion, allowing for reduced lithotripsy duration. However, the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions. The MOSES™ technology has also been applied in holmium laser enucleation of the prostate, reducing enucleation and hemostasis times, leading to improved enucleation efficiency. However, minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes. Further research is needed to fully evaluate the benefits and limitations of MOSES™ technology in clinical practice.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140247371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified percutaneous nephropexy for nephroptosis: Technical description and short-term results","authors":"Honglei Liu, Wenzhi Gao, Zheng Zhang, Kun-lin Yang, C. Meng, Bing Wang, Yangjun Han, Mingxin Diao, C. Zuo, Minghua Zhang, Y. Diao, Zhihua Li, Xinfei Li, Gang Wang, Chunjiao Wang, Zihui Gao, Yaming Gu, Xuesong Li","doi":"10.1097/cu9.0000000000000238","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000238","url":null,"abstract":"\u0000 \u0000 \u0000 Percutaneous nephropexy (PCN) has been demonstrated as a feasible method for treating nephroptosis. This study describes an improved technique for PCN that better addresses the issue of nephroptosis.\u0000 \u0000 \u0000 \u0000 We reviewed 4 patients who underwent the improved PCN procedure between January 2021 and January 2023. These patients were diagnosed with nephroptosis, with 1 case having both a narrow ureteropelvic junction and nephroptosis due to a kidney stone, and 3 cases having simple nephroptosis. Patient characteristics, perioperative data, and follow-up results were collected. Surgical success was determined by symptom relief (subjective success) and the absence of kidney descent by intravenous pyelography (objective success).\u0000 \u0000 \u0000 \u0000 Preoperative computed tomography urography showed that all patients had hydronephrosis, with severe hydronephrosis in 75% (3/4) and moderate hydronephrosis in 25% (1/4) of cases. The mean operative time was 63.8 minutes (range, 45–95 minutes), and the mean blood loss was 5 mL (range, 5–50 mL). The mean length of hospital stay was 4.5 days (range, 3–6 days). The mean time to removal of the nephrostomy tube was 2 months (range, 1–4 months). No serious complications (Clavien-Dindo grade ≥3) occurred during or after the procedure. The mean postoperative serum creatinine level was 54.75 μmoI/L (range, 43–65 μmoI/L). The mean follow-up time was 6.25 months (range, 4–8 months). The objective and subjective success rates were both 100%.\u0000 \u0000 \u0000 \u0000 The improved PCN procedure that was used in this study is feasible and provides a good option for treating nephroptosis.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140249109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal function in pediatric urologic surgical patients: Insight from the National Surgical Quality Improvement Program—Pediatric cohort","authors":"V. Chalfant, Carlos Riveros, Andrew A. Stec","doi":"10.1097/cu9.0000000000000234","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000234","url":null,"abstract":"\u0000 \u0000 \u0000 Renal protection is a frequent indication for urological surgery in pediatric patients; however, preoperative assessment is not routinely performed. We assessed the rates of preoperative renal function testing and stratified outcomes after major pediatric urological surgery. Pediatric urology patients, specifically high-risk patients undergoing genitourinary surgeries, are likely to have an underdiagnosis of renal dysfunction after surgery.\u0000 \u0000 \u0000 \u0000 Cases were identified from the 2012 to 2019 National Surgical Quality Improvement Program—Pediatric database. Patients who underwent major urological surgery on an inpatient basis were included in this study. Abnormal renal function was defined as a creatinine (Cr) level of ≥0.5 mg/dL (younger than 2 years) and a glomerular filtration rate of <90 mL/min (2 years or older). Glomerular filtration rate was calculated using the bedside Schwartz equation (2 years or older): estimated glomerular filtration rate = 0.413 × (height/Cr).\u0000 \u0000 \u0000 \u0000 A total of 17,315 patients were included, of whom 3792 (21.9%) had documented Cr values. Based on the defined criteria, abnormal renal function was found in 7.3% of infants (younger than 2 years), 33.6% of children (2–9 years), and 52.5% of adolescents (10–18 years). Patients with abnormal preoperative renal function values were significantly (p < 0.001) more likely to experience readmission (10.2% vs. 5.8%), reoperation (3.7% vs. 1.6%), surgical organ/space infection (0.9% vs. 0.4%), transfusion (1.5% vs. 0.6%), renal insufficiency (1.6% vs. 0.4%), or urinary tract infection (5.1% vs. 3.6%).\u0000 \u0000 \u0000 \u0000 In this pediatric population, 21.9% of the patients had documented preoperative Cr values before major urological surgery. Patients with documented abnormal preoperative renal function tests experienced higher complication rates. These patients have higher rates of progressive renal insufficiency and acute renal failure than those with normal renal function. The introduction of a standardized and unbiased risk assessment tool has the potential to offer patients benefits by pinpointing individuals with a heightened risk of complications. Further investigation is necessary to enhance the precise categorization of at-risk patients.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140250397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and influencing factors of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer","authors":"Xiao Fang, Kong Ren, Yan Li, Qiao Meng, Mingyue Li, Miao Miao, Jing Zhan, Xia Wang, Fei Wu, Meixia Zhang","doi":"10.1097/cu9.0000000000000243","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000243","url":null,"abstract":"\u0000 \u0000 \u0000 This study aims to not only investigate the prevalence of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer but also identify the contributing factors.\u0000 \u0000 \u0000 \u0000 A total of 245 elderly patients diagnosed with prostate cancer and undergoing radical prostatectomy at a tertiary care general hospital in Jinan were included in this study. To assess the patients, several questionnaires were used. These included the General Situation Questionnaire, General Alienation Scale, Social Impact Scale, Modified Memorial Anxiety Scale for Prostate Cancer, and Perceived Social Support Scale. Pearson correlation analysis was conducted to examine the relationships between variables, whereas multiple linear regression was used to identify the factors influencing social alienation among patients who underwent radical prostatectomy.\u0000 \u0000 \u0000 \u0000 Patients who underwent radical prostatectomy had a mean total score of 44.13 ± 7.24 on the Social Alienation Scale. The results of the Pearson correlation analysis indicated that social alienation showed an inverse association with social support (r = −0.627, p < 0.05) and positive associations with age, disease stigma, and anxiety (r = 0.325, 0.575, 0.421, all p’s < 0.01) among patients who underwent radical prostatectomy. The findings from multiple linear regression analysis demonstrated that educational level, age, urinary incontinence, disease stigma, anxiety, and social support significantly influenced social alienation among elderly patients who underwent radical prostatectomy (p < 0.05).\u0000 \u0000 \u0000 \u0000 Elderly patients who undergo radical prostatectomy often experience social alienation. This study found that social alienation was associated with factors such as educational level, age, urinary incontinence, social support, anxiety, and disease stigma. Consequently, healthcare providers should actively monitor the degree of social alienation in elderly patients after radical prostatectomy and provide suitable psychological care to facilitate positive social reintegration and alleviate their feelings of social alienation.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140248630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?","authors":"Ali Kaan Yildiz, Ahmet Varan, Hakan Kurt, Omer Gokhan Doluoglu, Berat Cem Ozgur","doi":"10.1097/CU9.0000000000000143","DOIUrl":"10.1097/CU9.0000000000000143","url":null,"abstract":"<p><strong>Background: </strong>The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones.</p><p><strong>Materials and methods: </strong>Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic.</p><p><strong>Results: </strong>Preference for conservative treatment increased during the COVID-19 pandemic (<i>p</i> = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (<i>p</i> = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (<i>p</i> = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (<i>p</i> = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (<i>p</i> = 0.018; OR, 1.97; 95% CI, 1.15-3.38).</p><p><strong>Conclusions: </strong>A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44908470","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":"Role of virtual reality in improving the spatial perception of the kidney during flexible ureteroscopy: A feasibility study using virtual reality simulators and 3D models.","authors":"Ali Talyshinskii, Bm Zeeshan Hameed, Ulanbek Zhanbyrbekuly, Mesrur Selcuk Silay, Nithesh Naik, Milap Shah, Anshuman Singh, Bakhman Guliev, Patrick Juliebø-Jones, Bhaskar Kumar Somani","doi":"10.1097/CU9.0000000000000207","DOIUrl":"10.1097/CU9.0000000000000207","url":null,"abstract":"<p><strong>Background: </strong>The aims were to describe a software-based reconstruction of the patient-specific kidney cavity intraluminal appearance via a head-mounted device and to estimate its feasibility for training novices.</p><p><strong>Materials and methods: </strong>In total, 15 novices were recruited. Each novice was shown a three-dimensional reconstruction of a patient's computed tomography scan, whose kidney was printed. They then joined the surgeon in the operating room and assisted them in detecting the stone during flexible ureteroscopy on the printed model. Then, each participant did a 7-day virtual reality (VR) study followed by virtual navigation of the printed kidney model and came to the operating room to help the surgeon with ureteroscope navigation. The length of the procedure and the number of attempts to find the targeted calyx were compared.</p><p><strong>Results: </strong>With VR training, the length of the procedure (<i>p</i> = 0.0001) and the number of small calyces that were incorrectly identified as containing stones were significantly reduced (<i>p</i> = 0.0001). All the novices become highly motivated to improve their endourological skills further. Participants noticed minimal values for nausea and for disorientation. However, oculomotor-related side effects were defined as significant. Five specialists noticed a good similarity between the VR kidney cavity representation and the real picture, strengthening the potential for the novice's education via VR training.</p><p><strong>Conclusions: </strong>Virtual reality simulation allowed for improved spatial orientation within the kidney cavity by the novices and could be a valuable option for future endourological training and curricula.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44078756","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":"Lack of consensus in atypical congenital obstructive urethral lesions in children: Snapshot of the web-based ObsCUre (obstruction to the child urethra) study.","authors":"Rachel Ng, Ahmed Adam, Nathan Poppleton, Christopher Oldmeadow, Aniruddh V Deshpande","doi":"10.1097/CU9.0000000000000092","DOIUrl":"10.1097/CU9.0000000000000092","url":null,"abstract":"<p><strong>Background: </strong>Atypical Congenital Obstructive Urethral Lesions (ACOUL) are uncommon causes of urethral obstruction in children. They include Cobb's collar or Moorman's ring, Type III posterior urethral valve (PUV), congenital urethral narrowing and anterior urethral valves. This study is aimed to evaluate the knowledge and current practice amongst clinicians attending to ACOUL. An international online case based questionnaire was performed.</p><p><strong>Materials and methods: </strong>A survey was administered to members of international urological societies. It included 22 clinical questions on cases with ACOUL (14 questions suitable for statistical analysis) using cases of Type I PUV as controls. Two sets of paired questions evaluated change in opinion(s) after additional information was provided.</p><p><strong>Results: </strong>One hundred twenty-one participants responded with 71% reporting exposure of less than 5 cases per annum. In questions regarding diagnosis between 11.6% (14/121) and 21.5% (26/121) of participants identified the ACOUL as PUV. Among them, 66% of respondents agreed on ACOUL's causative role in urethral obstruction. Gini coefficient was consistently lower for ACOUL compared to PUV: diagnosis (mean 0.33 vs. 0.44) and prognosis (0.23 vs. 0.43). High intra-rater concordance (kappa 0.420.57) was observed for paired questions-a mean of 5.79% (7.44% and 4.13% for questions 10 and 12, 16 and 17, respectively) of participants changed their answers from an alternate diagnosis to the correct diagnosis of ACOUL after viewing endoscopic images. High variation in management of ACOUL was noted (Gini 0.51).</p><p><strong>Conclusions: </strong>This global snapshot survey identified substantial inconsistency among clinicians dealing with ACOUL. Although rarely encountered in clinical practice, better overall education of ACOUL is warranted.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44137422","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}