Frontiers in urology最新文献

{"title":"Reducing time from presentation to surgical intervention for testicular torsion: implementation of a quality improvement protocol","authors":"Shannon Richardson, Kathy Huen, Tabitha Benga, Bridgette Fajardo, Renea Sturm, Steven E. Lerman, Jennifer S. Singer","doi":"10.3389/fruro.2024.1383108","DOIUrl":"https://doi.org/10.3389/fruro.2024.1383108","url":null,"abstract":"Timely surgical intervention for patients with testicular torsion is a quality benchmark set by the U.S. News and World Report (USNWR) for pediatric urology. In this study, we describe and evaluate a quality improvement initiative to reduce the time to surgical intervention for testicular torsion at a single institution through the implementation of a clinical care pathway called “code torsion.”Data abstraction was performed through retrospective chart review to assess process measures. Patients <21 years old with testicular torsion requiring surgical intervention were included. The clinical protocol “code torsion” was created by a multidisciplinary quality improvement workgroup with the primary goal of reducing the time from emergency department presentation to surgical intervention for testicular torsion. “Code torsion” was implemented in October 2021, which was assessed in addition to subsequent interventions through plan–do–study–act (PDSA) cycles.A total of 30 patients were identified prior to “code torsion” implementation and 14 thereafter. The mean time from triage to operating room (OR) was 228 min prior to “code torsion” compared with 180 min after protocol implementation (p = 0.047). The proportion of cases that had surgical intervention within the 4-h USNWR metric increased from 63% pre-protocol to 93% post-protocol (p = 0.07). Of the patients, 40% required orchiectomy prior to “code torsion” compared with 29% after implementation (p = 0.5). Patients requiring orchiectomy had a significantly longer time from symptom onset to surgical intervention (87 vs. 9.8 h, p < 0.001).Implementation of the protocol “code torsion” was successful in reducing the time from presentation to surgical intervention for testicular torsion. The rates of testicular salvage did not differ after “code torsion” implementation and were instead found to be dependent on the total ischemia time.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642527","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}

{"title":"Clinical and environmental considerations for neonatal, office-based circumcisions compared with operative circumcisions","authors":"Benjamin Press, Michael Jalfon, Daniel Solomon, Adam B. Hittelman","doi":"10.3389/fruro.2024.1380154","DOIUrl":"https://doi.org/10.3389/fruro.2024.1380154","url":null,"abstract":"Neonatal male circumcision is a commonly performed procedure in the United States. Circumcisions are performed at various ages by a variety of clinical providers for multiple reasons, including religious, cultural, personal, and medical indications. In the United States, neonatal circumcision is routinely performed by non-urologic providers in the hospital within the first few days of life or as a religious ceremony on the 8th day of life. If neonatal circumcision is deferred in the hospital and subsequently not performed in the outpatient setting, it is then typically performed in the operating room under general anesthesia after 6 months of life. Neonatal circumcision is supported by both the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) due to the belief that the health benefits outweigh the minimal risk of the procedure. Despite this, neonatal circumcision rates have decreased in the United States in recent decades, in part due to access to the procedure, often related to changing insurance coverage. This has led to increased rates of operative circumcisions. Operative circumcisions are more costly to the healthcare system, subject the patient to cardiopulmonary and potentially neurotoxic effects of general anesthesia, and carry an increased environmental footprint, compared to neonatal circumcision. The intention of this paper is not to promote or justify circumcision for all patients, but rather to compare the clinical and environmental impact of neonatal versus operative circumcisions.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"29 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683915","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}

{"title":"Case report: Para-testicular spindle cell lipoma suspected of well-differentiated liposarcoma","authors":"Kengo Fujiwara, Kengo Fujimoto, Emi Ibuki, Ryo Ishikawa, Yushi Hayashida","doi":"10.3389/fruro.2024.1400674","DOIUrl":"https://doi.org/10.3389/fruro.2024.1400674","url":null,"abstract":"Spindle cell lipoma is a relatively rare benign tumor that can occur in the posterior neck, shoulder, and upper back. Herein, we present a case of intrascrotal spindle cell lipoma in a 71-year-old male who presented with a mass in the left scrotum that had developed over 2 years. Contrast-enhanced computed tomography (CT) revealed a 5.7cm mass accompanying enhanced solid components. Magnetic resonance imaging (MRI) showed a heterogeneous signal intensity. Therefore, a well-differentiated liposarcoma derived from the spermatic cord was suspected; therefore, the patient underwent radical inguinal orchidectomy with high ligation of the spermatic cord. Histopathological examination revealed mature adipocytes and bland-spindle cells. Immunohistochemically, the tumor cells were positive for CD-34 and negative for CDK4, MDM2, and p16. These findings indicated a spindle cell lipoma. Surgical margins were negative. Three months after surgery, no relapse was observed. This case underscores the rarity of para-testicular spindle cell lipoma. While CT and MRI play crucial roles in disease diagnosis, they may not detect all lesions. To prevent overtreatment, it’s essential to also consider pre-surgical examinations and intraoperative findings.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141270977","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}

{"title":"Lights and shadows on local recurrence after renal surgery: when, why and how to manage","authors":"Luca Di Gianfrancesco, Alessandro Crestani, A. Amodeo, Paolo Corsi, Davide De Marchi, E. Miglioranza, G. Lista, Ferdinando Daniele Vitelli, Francesca Simonetti, G. Busetto, U. Falagario, Martina Maggi, Filippo Marino, Giannicola Genovese, R. Falabella, Angelo Porreca","doi":"10.3389/fruro.2024.1419418","DOIUrl":"https://doi.org/10.3389/fruro.2024.1419418","url":null,"abstract":"This review aims to analyze the existing literature on local recurrence (LR) in patients undergoing partial nephrectomy (PN) for renal cell carcinoma, identifying relative risk factors, and exploring optimal clinical management strategies.A comprehensive literature search was conducted across bibliographic databases, primarily focusing on LR rates. Secondary outcomes included evaluation of positive surgical margins (PSM), nephrometry scores, pathological stage (T and grading), perioperative outcomes, time-to-LR, overall survival, and cancer-specific survival.Due to the heterogeneity, a narrative synthesis was performed. LR rates after PN varied in the literature; with PSM emerging as a significant risk factor. Other LR risk factors included pathological stage, nephrometry scores, and histological variants. However, evidence regarding optimal LR management in the absence of precise indications was lacking.LR represents a significant clinical challenge; requiring multidisciplinary assessment and shared decision-making with patients. Given well-established risk factors, clinicians must tailor management strategies to optimize patient outcomes.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"12 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141112772","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}

{"title":"Vascularization of kidney organoids: different strategies and perspectives","authors":"Irina B Raykhel, Masaki Nishikawa, Yasuyuki Sakai, Seppo J. Vainio, Ilya Skovorodkin","doi":"10.3389/fruro.2024.1355042","DOIUrl":"https://doi.org/10.3389/fruro.2024.1355042","url":null,"abstract":"Kidney diseases such as glomerulopathy and nephron dysfunction are estimated to grow to more than 900 million cases by 2030, in 45% of which kidney transplantation will be required, representing a major challenge for biomedicine. A wealth of progress has been made to model human diseases using induced pluripotent stem cells (iPSCs) in vitro differentiated to a variety of organoids, including kidney organoids, and in developing various microfluidics-based organ-on-a-chip (OoC) systems based on them. With the combination of targeted gene editing capacities, relevant polymorphic genetic variants can be established in such organoid models to advance evidence-based medicine. However, the major drawback of the current organoid disease models is the lack of functional endothelial vasculature, which especially concerns the kidney, the function of which is strongly associated with blood flow. The design of novel medical devices using tissue engineering approaches such as kidney organoids is also strongly dependent on the understanding of the fundamental principles of nephrogenesis and the vascularization of organs and tissues. Developmental vascularization of the kidney has been an area of intense research for decades. However, there is still no consensus among researchers on how exactly the vascularization of the kidney occurs in normal and pathological conditions. This lack of consensus is partly due to the lack of an appropriate model system to study renal vascularization during nephrogenesis. In this review, we will describe recent progress in the areas of kidney vasculature development, kidney organoids in general and assembled on microfluidic devices in particular. We will focus on the in vitro vasculature of kidney organoids in microfluidic OoC model systems to study kidney diseases and on the perspectives of tissue engineering for the modeling of kidney diseases and the design of bioartificial medical devices. We also aim to summarize the information related to the key mechanisms of intercellular communication during nephrogenesis and the formation of the renal vasculature in an OoC setup.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"91 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141116523","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}

{"title":"Long-term follow-up results of prostate capsule-sparing and nerve-sparing radical cystectomy with neobladder: a single-center retrospective analysis","authors":"Zai-Sheng Zhu, Yiyi Zhu, Hongqi Shi, Penfei Zhou, Yadong Xue, Shengye Hu","doi":"10.3389/fruro.2024.1355605","DOIUrl":"https://doi.org/10.3389/fruro.2024.1355605","url":null,"abstract":"This study aims to investigate and analyze the feasibility, oncological outcomes, functional efficacy, and complications with the prostatic capsule sparing (PCS) as well as the nerve sparing (NS) in radical cystectomy for bladder cancer.Between January 2007 and December 2021, 67 total cystectomies with PCS and 54 with NS were performed at our institution. The inclusion criteria for PCS were as follows: proactive, fully informed patient consent; negative transurethral resection of the bladder neck; normal prostate-specific antigen (PSA) level < 4 ng/dL; and normal transrectal ultrasonography with biopsy of any suspicious nodes. Patients received complete oncological and functional follow-ups. The Kaplan-Meier method was utilized to characterize survival outcomes after surgery.The median follow-up times for PCS and NS were 144 and 122 months, respectively. Cumulative survival estimated the 5- and 10-years cancer-specific survival were 93.0% and 88.7% for the PCS group and 79.7% and 79.6% for the NS group, respectively (p = 0.123). In terms of function, the daytime urinary control at 3, 6, and 12 months postoperatively was 80.60%, 97.01%, and 100% in the PCS group, and 53.70%, 85.19%, and 94.44% in the NS group, respectively (p = 0.002, 0.023, and 0.100); and nocturnal urinary control was 62.69%, 94.03%, and 98.51% in the PCS group, and 40.74%, 72.22%, and 87.04% in the NS group, respectively (p = 0.016, 0.001, and 0.022). The erectile function recovery revealed that 62.69% and 40.74% of patients returned to preoperative levels (International Index of Erectile Function (IIEF)-5 score ≥ 15) in the PCS and NS groups, respectively (p = 0.016). Considering complications within 30 days after surgery, 4.48% and 7.69% patients had Clavien ≥ III complications in the PCS and NS groups, respectively (p = 0.700).The PCS provides better restored urinary control and sexual function than the NS technique and does not affect oncological outcomes. However, PCS is prone to bladder-neck obstruction complications and requires closer long-term follow-up.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"61 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114191","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}

{"title":"Editorial: Urological cancer awareness month – 2022","authors":"G. Verras, F. Mulita","doi":"10.3389/fruro.2024.1278688","DOIUrl":"https://doi.org/10.3389/fruro.2024.1278688","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"21 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141120788","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}

{"title":"Updates in pelvic neuromodulation: the role of pelvic neuromodulation in pelvic disorders","authors":"Baydaa Alsannan, M. Banakhar, Magdy Hassouna","doi":"10.3389/fruro.2024.1329305","DOIUrl":"https://doi.org/10.3389/fruro.2024.1329305","url":null,"abstract":"Pelvic disorders affecting both male and female patients are major areas of concern for clinicians in cases where pharmacotherapy and behavioral therapy are not effective. In such cases, pelvic neuromodulation has become an alternative therapy that could relieve chronic pelvic pain and enhance the quality of life. The goal of this paper was to present a summary of the current therapeutic applications of various pelvic neuromodulation techniques and their efficacy in treating patients with a range of pelvic illnesses. Based on the available literature, this review assessed the validity and significance of the last 10 years’ advancements in the fields of sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and pudendal neuromodulation (PNM), including meta-analyses, randomized controlled trials, and observational, prospective, and retrospective studies.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"22 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140240534","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}

{"title":"Outcomes of intravesical Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer: a retrospective study in Australia","authors":"Chamodi Pillippu Hewa, Stephen Della-Fiorentina, Kayvan Haghighi, Wei Chua, P. Kok","doi":"10.3389/fruro.2024.1309532","DOIUrl":"https://doi.org/10.3389/fruro.2024.1309532","url":null,"abstract":"Induction intravesical Bacillus Calmette-Guerin (BCG) followed by maintenance after transurethral resection of bladder tumor, is the standard adjuvant therapy for high-risk non-muscle invasive bladder cancer (NMIBC). There is sparse evidence on the practice of intravesical BCG in Australia. Our aim was to determine the outcomes of intravesical BCG therapy in NMIBC in Southwestern Sydney.This was a multi-center retrospective audit of NMIBC patients who received intravesical BCG between January 2008 and June 2020. Data was collected across six tertiary hospitals in South Western Sydney. Primary outcome was disease-free survival (DFS). Secondary outcomes were overall survival (OS), BCG induction and maintenance rates.Of the 200 eligible patients over 12.5 years, median age was 77 years and 83% were male. Of these, 55%, 4.5%, 35% and 5% were Tis, Ta, T1 and unknown stage, respectively. All patients received induction BCG and 56% received maintenance BCG (range 3-36 months). Completion rate of induction BCG was 91%. Only 9% ceased treatment due to intolerance. The median duration of cystoscopy follow-up was 17 months. After a median follow-up time of 37 months, 55% developed recurrence (29% non-muscle invasive, 32% muscle-invasive disease, 8% distant metastasis). The 1-year and 5-year DFS rates were 72% and 41% (median DFS: 39 months). The 1-year and 5-year OS rates were 98% and 87% (median OS: not reached).The DFS and OS rates were comparable to previous literature. This provides real-world data to assist future clinical trials in NMIBC.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"36 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838572","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}

{"title":"Outcomes of intravesical Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer: a retrospective study in Australia","authors":"Chamodi Pillippu Hewa, Stephen Della-Fiorentina, Kayvan Haghighi, Wei Chua, P. Kok","doi":"10.3389/fruro.2024.1309532","DOIUrl":"https://doi.org/10.3389/fruro.2024.1309532","url":null,"abstract":"Induction intravesical Bacillus Calmette-Guerin (BCG) followed by maintenance after transurethral resection of bladder tumor, is the standard adjuvant therapy for high-risk non-muscle invasive bladder cancer (NMIBC). There is sparse evidence on the practice of intravesical BCG in Australia. Our aim was to determine the outcomes of intravesical BCG therapy in NMIBC in Southwestern Sydney.This was a multi-center retrospective audit of NMIBC patients who received intravesical BCG between January 2008 and June 2020. Data was collected across six tertiary hospitals in South Western Sydney. Primary outcome was disease-free survival (DFS). Secondary outcomes were overall survival (OS), BCG induction and maintenance rates.Of the 200 eligible patients over 12.5 years, median age was 77 years and 83% were male. Of these, 55%, 4.5%, 35% and 5% were Tis, Ta, T1 and unknown stage, respectively. All patients received induction BCG and 56% received maintenance BCG (range 3-36 months). Completion rate of induction BCG was 91%. Only 9% ceased treatment due to intolerance. The median duration of cystoscopy follow-up was 17 months. After a median follow-up time of 37 months, 55% developed recurrence (29% non-muscle invasive, 32% muscle-invasive disease, 8% distant metastasis). The 1-year and 5-year DFS rates were 72% and 41% (median DFS: 39 months). The 1-year and 5-year OS rates were 98% and 87% (median OS: not reached).The DFS and OS rates were comparable to previous literature. This provides real-world data to assist future clinical trials in NMIBC.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"62 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778717","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}