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Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

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Asian Journal of urology 2024年第1期11卷 72-79页

作者： Vanessa A.Lukas Rahul Dutta Ashok K.Hemal Matvey Tsivian Timothy E.Craven Nicholas A.Deebel David D.Thiel Ram Anil Pathak Brigham and Women's Hospital Division of UrologyDepartment of Surgery75 Francis StreetBostonMAUSA Atrium Health Wake Forest Baptist Medical Center Department of Urology1 Medical Center BlvdWinston-SalemNCUSA Mayo Clinic Florida Department of Urology4500 San Pablo RoadJacksonvilleFLUSA

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

关键词： Minimally-invasive partial nephrectomy The American College of Surgeons National Surgical Quality Improvement Program Lengthof stay Hospital readmission

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Predictive factors for successful sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia and a history of cryptorchidism

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Asian Journal of Andrology 2022年第5期24卷 503-508页

作者： Xing-Lin Chen Yu-Ang Wei Xiao-Han Ren Xu Zhang Guang-Yao Li Zhong-Wen Lu Dong Zhang Chao Qin Shi-Feng Su department of urology The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210009China

This study aims to explore the factors influencing the success rate of the microdissection testicular sperm extraction(Micro-TESE)in patients with nonobstructive azoospermia(NOA)and cryptorchidism.Clinical data of 162 patients with cryptorchidism who underwent Micro-TESE due to infertility from December 2015 to May 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively.In the univariate analysis,significant differences in the age of patient at the time of orchidopexy(median[interquartile range,IQR]:7.0[4.0–11.0]years vs 11.5[9.0–14.5]years,P<0.001),interval between orchidopexy and Micro-TESE(mean±standard deviation:17.5±5.0 years vs 14.4±4.4 years,P<0.001),severity of cryptorchidism(unilateral[62.8%]vs bilateral[31.6%],P<0.001;location of cryptorchidism,intra-abdominal[27.3%]vs inguinal[44.8%]vs suprascrotal[66.7%],P<0.001),volume of the dominant testis(median[IQR]:17.00[15.00–19.00]ml vs 14.50[11.75–16.25]ml,P<0.001),and levels of follicle-stimulating hormone(FSH;P=0.004)and testosterone(P=0.006)were observed between the successful and failed sperm extraction groups.After conducting the multivariate analysis,four of these factors,including unilateral/bilateral cryptorchidism(P<0.001),location of cryptorchidism(P=0.032),age of orchidopexy(P<0.001),and dominant testicular volume,were adopted in the clinical prediction model to evaluate preoperatively the success rate of Micro-TESE for patients with NOA and cryptorchidism.The likelihood of successful sperm retrieval by Micro-TESE in men with NOA and cryptorchidism increased in patients with mild forms of cryptorchidism.

关键词： azoospermia cryptorchidism microdissection testicular sperm extraction predictive

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Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

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Asian Journal of urology 2019年第4期6卷 330-338页

作者： Shi Qiu Siwei Bi Tianhai Lin Zhuheng Wu Qi’an Jiang Jiwen Geng Liangren Liu Yige Bao Xiang Tu Mingjing He Lu Yang Qiang Wei department of urology Institute of UrologyWest China Hospital of Sichuan UniversityChengduChina

Objective:To compare these managements focusing on the efficacy and safety to treat overactive bladder(OAB)in children through network meta-analysis(NMA).Methods:We searched PubMed,Embase,the Cochrane Library Central Register of Controlled Trials(CENTRAL)and the reference lists up to May 1st,2017.Data from eligible randomized controlled trails(RCT)studies including three different treatment options were extracted.The primary outcome was maximal voiding volume(MVV).We performed pairwise metaanalyses by random effects model and NMA by Bayesian model.We used the Grading of Recommendations,Assessment,Development and Evaluations(GRADE)framework to assess the quality of evidence contributing to each network estimate.Results:Six RCTs(462 patients)comparing three different interventions fulfilled the inclusion criteria.A low risk of bias was shown for the majority of the study items.The results of NMA showed that compared with antimuscarinic drugs,Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV(mean difference[MD]=58.50,95% confidential interval[CI]:45.95-69.52),followed by urotherapy group(MD=21.03,95%CI:11.85-29.97).When it comes to the constipation,antimuscarinic drugs exerted significant benefit than PTENS(odds ratio[OR]:0.22,95%CI:0.01-0.46).No significant difference was found between other treatments.Conclusion:Compared with antimuscarinic drugs,PTENS was associated with significant better efficacy considering MVV,but more constipation events in de novo OAB children.Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy.Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.

关键词： Overactive bladder Meta-analysis Anticholinergics Parasacral transcutaneous electrical nerve stimulation

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Retroperitoneal laparoscopic nondismembered pyeloplasty for uretero-pelvic junction obstruction due to crossing vessels: A matched-paired analysis and review of literature

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Asian Journal of urology 2018年第3期5卷 172-181页

作者： Jens Rassweiler Jan Klein Ali Serdar Goezen department of urology and Pediatric urology SLK Kliniken HeilbronnUniversity of HeidelbergHeibronnGermany department of urology Medical School UlmUniversity of UlmUlmGermany

Objective:To compare laparoscopic Anderson-Hynes pyeloplasty(LAHP)and retroperitoneal laparoscopic YV-pyeloplasty(LRYVP)in ureteropelvic junction obstruction(UPJ)in presence of a crossing vessels(CV).Methods:Our database showed 380 UPJO-cases,who underwent laparoscopic retroperitoneal surgery during the last 2 decades including 206 non-dismembered LRYVP,157 dismembered pyeloplasties LAHP,and 17 cases of laparoscopic ureterolysis.Among them 198 cases were suitable for a matched-pair(2:1)analysis comparing laparoscopic retroperitoneal non-dismembered LRYVP(Group 1,n Z 131)and dismembered LAHP(Group 2,n Z 67)in presence of a crossing vessel.Patients were matched according to age,gender,kidney functions,and obstruction grade.Complications were graded according to modified Clavien-classification.Results:Comparative data were similar between both groups(LRYVP vs.LAHP)including mean operating time(112 min vs.114 min),complication rates(4.2%vs.7.3%)mainly Grade 1e2 according to Clavien classification,and success rates(90%vs.89%).These results reflected in the reviewed literature indicate that LRYVP provides the advantage of minimal dissection in case of CV with similar outcome.However,redundant pelvis and anteriorly crossing vessels still require a dismembered pyeloplasty LAHP.Conclusion:LRYVP has achieved similar results compared with the previous golden standard of open surgery,especially in case of crossing vessels apart from presence of a redundant pelvis or anteriorly crossing vessel.This can be further improved when using the small access retroperitoneoscopic technique respectively mini-laparoscopy.

关键词： Kidney pelvis Laparoscopy Ureteropelvic junction obstruction Mini-laparoscopy Crossing vessel

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Modified onlay island flap versus tubularized incised plate urethroplasty for hypospadias reoperation

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Asian Journal of Andrology 2023年第5期25卷 583-586页

作者： Xiao-Jiang Zhu Yong-Ji Deng Jun Wang Yun-Fei Guo Zheng Ge department of urology Children's Hospital of Nanjing Medical UniversityNanjing 210008China

This study aimed to assess the outcomes of modified onlay island flap(MOIF)urethroplasty for hypospadias reoperation.A retrospective analysis was conducted using clinical data on children reoperated with MOIF or tubularized incised plate(TIP)urethroplasty for hypospadias in the Children's Hospital of Nanjing Medical University(Nanjing,China)from December 2016 to September 2020.A total of 90 children with hypospadias who failed primary repair and were reoperated on with MOIF(MOIF group,n=46)or TIP urethroplasty(TIP group,n=44)were recruited.All children were postoperatively followed up for at least 6 months.Six patients with postoperative urinary fistula,2 patients with glans dehiscence,and 1 patient with urethral diverticulum were reported in the MOIF group,while 7 patients with postoperative urinary fistula,2 patients with urethral stricture,and 1 patient with glans dehiscence were reported in the TIP group.Postoperative infection,flap necrosis and other complications were not recorded.A total of 37(80.4%)patients in the MOIF group and 34(77.3%)patients in the TIP group were successfully reoperated.Although the success rates of MOIF and TIP urethroplasty are comparable,pediatricians should master different types of repair techniques for individualized hypospadias reoperation.MOIF urethroplasty can be recommended after failure of the primary repair.

关键词： children hypospadias reoperation urethroplasty

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Ureter-an unusual site of breast cancer metastasis: A case report

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World Journal of Clinical Cases 2019年第20期7卷 3347-3352页

作者： Zhong-Han Zhou Li-Jiang Sun Gui-Ming Zhang department of urology The Affiliated Hospital of Qingdao University

BACKGROUND Breast cancer(BCa)is one of the most common malignancies in women;however,ureteral metastasis of BCa has rarely been reported in the literature.CASE SUMMARY A 55-year-old Chinese woman with an 8-year history of BCa presented with lower back pain that had persisted for 3 mo.The patient underwent bilateral modified radical mastectomy and subclavian and submandibular clearance,and received systemic treatment,including chemotherapy,radiotherapy,and targeted therapy during treatment.Ureteroscopy did not acquire a satisfactory biopsy.Thus,laparoscopic nephroureterectomy was performed,and ureteral metastases of BCa were pathologically confirmed.As suggested by her oncologist,she continued to receive apatinib.Postoperative 3-mo follow-up indicated further progression of axillary lymph node metastases.CONCLUSION Ureteral metastasis of BCa shows nonspecific symptoms.Diagnosing ureter metastasis from BCa can be established by histopathology and immunohistochemistry.

关键词： Breast cancer Ureter metastasis Immunohistochemistry Chemotherapy Case report

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Complete response to an anti-programmed cell death 1 antibody following a combination therapy of an anti-programmed cell death ligand 1 antibody and a tyrosine kinase inhibitor for metastatic renal cell carcinoma

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Asian Journal of urology 2023年第1期10卷 103-105页

作者： Masayuki Kurokawa Sei Naito Tomoyuki Kato Masaki Ushijima Atsushi Yamagishi Toshihiko Sakurai Hayato Nishida Norihiko Tsuchiya department of urology Yamagata University Faculty of MedicineYamagataJapan

Dear Editor,Several Phase 3 trials have demonstrated the efficacy of immune checkpoint inhibitor(ICI)-based combination therapies in the treatment of advanced clear cell renal cell carcinoma(RCC)[1-5].However,there is still no well-defined adequate treatment for patients who experience disease progression after initial ICI-based combination therapy.

关键词： death carcinoma treatment

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Modulatory effect of aquaporin 5 on estrogen-induced epithelial-mesenchymal transition in prostate epithelial cells

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Chinese Medical Journal 2021年第4期134卷 448-455页

作者： Yu Fan Tu-Run Song Qiang Wei Lu Yang Tao Lin Xiao-Bing Feng Xian-Ding Wang Zhong-Li Huang Shi-Jian Feng department of urology Institute of UrologyOrgan Transplantation CenterWest China Hospital of Sichuan UniversityChengduSichuan 610041China

Background:Estrogen is involved in the pathophysiological process of benign prostatic hyperplasia(BPH),in which epithelial-mesenchymal transition(EMT)plays an important role.Upregulation of aquaporin(AQP)5,which is directly activated by estrogen,has been reported to promote EMT in multiple cells.This study aimed to examine the effects of AQP5 on estrogen-induced EMT in the prostate.Methods:Normal prostate(NP)tissue samples without any histopathological changes and BPH tissue samples with pathologically confirmed hyperplasia were obtained.An EMT cell model was subsequently established by adding estradiol(E2)to RWPE-1 cells,after which AQP5 knockdown was performed.Tissue morphological and immunohistochemical features were examined using hematoxylin-eosin and immunohistochemical staining.Western blot analysis was performed to determine the expression of AQPs,estrogen receptors,and EMT-related proteins.Cell proliferation was assessed and supernatants were collected for enzyme-linked immunosorbent assay to determine transforming growth factor-β1(TGF-β1)concentrations.Immunofluorescence staining was performed to assess protein expressions in RWPE-1 cells.Results:BPH tissues exhibited greater EMT(TGF-β1:1.362±0.196 vs.0.107±0.067,P=0.003;vimentin:1.581±0.508 vs.0.221±0.047,P<0.001;E-cadherin:0.197±0.188 vs.1.344±0.088,P<0.001),higher AQP5(1.268±0.136 vs.0.227±0.055,P<0.001)and estrogen receptor(ER)α(1.250±0.117 vs.0.329±0.134,P<0.001)expression but lower ERβ(0.271±0.184 vs.1.564±0.130,P<0.001)expression than NP tissues.E2-stimulated cells had higher AQP5 expression(1.298±0.058 vs.1.085±0.104,P=0.049),increased cell proliferation(1.510±0.089 vs.1.000±0.038,P<0.001),and EMT(TGF-β1 concentration:0.352±0.021 ng/mL vs.0.125±0.014 ng/mL,P<0.001;vimentin:1.641±0.120 vs.0.188±0.020,P=0.002;E-cadherin:0.075±0.030 vs.0.843±0.046,P<0.001)than controls.E2-stimulated cells with AQP5 knockdown exhibited decreased EMT(TGF-β1 concentration:0.223±0.041 ng/mL vs.0.352±0.021 ng/mL,P=0.016;vimentin:0.675±0.056 vs.1.641±0.120,P=0.001;E-cadh

关键词： Aquaporin Benign prostatic hyperplasia Epithelial-mesenchymal transition Estrogen Prostate epithelial cells

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A prospective randomized study to define the role of low dose continuous prophylactic antibiotics and anti-adherence agents in altering the microbial colonization related to indwelling double‐J stents

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Asian Journal of urology 2021年第3期8卷 269-274页

作者： Kumar Madhavan Sanchit Rustagi Rahul Jena Uday Pratap Singh M.S.Ansari Aneesh Srivastava Rakesh Kapoor Sanjoy Kumar Sureka department of urology and Renal Transplantation SGPGIMSLucknowIndia

Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.

关键词： Antibiotic Prophylaxis Stent Cranberry Infection

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Underactive bladder:Pathophysiology and clinical significance

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Asian Journal of urology 2018年第1期5卷 17-21页

作者： Reem Aldamanhori Nadir I.Osman Christopher R.Chapple department of urology University of DammamSaudi Arabia department of urology Royal Hallamshire HospitalSheffieldUK

Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

关键词： Detrusor underactivity Lower urinary tract symptoms Underactive bladder Bladder outlet obstruction

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