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Comparison of survival outcomes between laparoscopic versus open radical nephroureterectomy in upper tract urothelial cancer patients:Experiences of a tertiary care single center

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Current Urology 2023年第4期17卷 292-298页

作者： Benedikt Hoeh Marina Kosiba Mike Wenzel Nicola Meister Felix Preisser Shahrokh F.Shariat Jan Lukas Hohenhorst Andreas Becker Philipp Mandel Severine Banek Frederik Roos Pierre I.Karakiewicz Felix K.H.Chun luis a.kluth Department of Urology University Hospital FrankfurtGoethe University Frankfurt am MainFrankfurt am Main60590Germany Cancer Prognostics and Health Outcomes Unit Division of UrologyUniversity of Montreal Health CenterMontrealQuebecCanada Department of Urology Comprehensive Cancer CenterMedical University of ViennaViennaAustria Department of Urology Weill Cornell Medical CollegeNew YorkNYUSA Department of Urology University of Texas SouthwesternDallasTXUSA Department of Urology Second Faculty of MedicineCharles UniversityPragueCzech Republic Institute for Urology and Reproductive Health I.M.Sechenov First Moscow State Medical UniversityMoscowRussia Division of Urology Department of Special SurgeryJordan University HospitalThe University of JordanAmmanJordan Martini-Klinik Prostate Cancer Center University Hospital Hamburg-EppendorfHamburgGermany

Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional *** undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study *** with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were *** was performed according to the laparoscopic versus open surgical ***-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical ***,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study ***:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open *** and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),*** median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ***:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open ***,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.

关键词： Upper tract urothelial carcinoma Laparoscopic radical nephroureterectomy Open radical nephroureterectomy Overall survival

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Proposal and clinical validation of a perioperative algorithm enhancing antimicrobial stewardship in substitution urethroplasty

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Asian Journal of Urology 2024年第4期11卷 604-610页

作者： Phillip Marks Benedikt Kranzbühler luis a.kluth Christian P.Meyer Clemens M.Rosenbaum Tim A.Ludwig Liucheng Ding Lennart Kühnke Frederik König Roland Dahlem Margit Fisch Malte W.Vetterlein the European Association of Urology Young Academic Urologists Department of Urology University Medical Center Hamburg-EppendorfHamburgGermany Department of Urology University Hospital ZürichZürichSwitzerland Department of Urology University Hospital Frankfurt am MainFrankfurt am MainGermany Department of Urology Ruhr-University BochumCampus OWLHerfordGermany Department of Urology Asklepios Hospital BarmbekHamburgGermany Department of Urology The Second Affiliated Hospital of Nanjing Medical UniversityNanjingChina 不详

ObjectiveTo evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing *** undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile vs. non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum. The ability of the algorithm to improve antibiotic stewardship was tested by three endpoints: (a) immediate (UCx 2 days postoperatively), (b) short-term (21-day infectious complications), and (c) long-term (retreatment-free survival [RFS]). Statistical analyses included bivariate comparisons. The Kaplan–Meier estimators were used to compare RFS between the groups. The multivariable Cox regression was used to evaluate the independent effect of UCx status at the time of surgery on *** 374 men, 235 (63%) had a sterile and 139 (37%) a non-sterile culture at the time of surgery. The proportion of sterile cultures at the time of surgery (63%) was significantly improved to 82% 2 days postoperatively (p<0.001). There were 16 (4.3%) patients with infectious complications with no difference between patients with sterile versus non-sterile culture (p=0.6). At median follow-up of 29 months, there was no difference in RFS (84%) between patients with sterile versus non-sterile culture (p=0.3). Positive UCx was not a predictor of recurrence after multivariable adjustment (p=0.5).ConclusionA standardized protocol such as the one introduced improves antibiotic stewardship through frequent testing and culture-specific treatment. This is crucial in avoiding unnecessary antimicrobial treatment, and reducing infectious events and adverse effects of a positive UCx on long-term stricture recurrence.

关键词： Antibiotic prophylaxis Oral mucosa Urethroplasty Urethral stricture

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Prostate cancer screening： and yet it moves!

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Asian Journal of Andrology 2015年第3期17卷 437-438页

作者： Maciej Kwiatkowski Marco Randazzo luis kluth Lukas Manka Andreas Huber Franz Recker Department of Urology Cantonal Hospital Aarau Switzerland Department of Urology Academic Hospital Braunschweig Germany Department of Laboratory Medicine Cantonal Hospital Aarau Switzerland

The debate of prostate cancer （PCa） screening has been shaped over decades. There is a plethora of articles in the literature supporting as well as declining prostate-specific antigen （PSA） screening. Does screening decrease PCa mortality？ With the long-term results of the European Randomized Study of Screening for Prostate （ERSPC） the answer is clearly YES. It moves! However, in medicine there are no benefits without any harm and thus, screening has to be performed in targeted and smart way-or in other words^in a risk-adapted fashion when compared with the way it was done in the past. Here, we discuss the main findings of the ERSPC trials and provide insights on how the future screening strategies should be implemented.

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