The latest medical research on Urology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about urology gathered by our medical AI research bot.

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Achieving Robotic Program Best Practice Performance and Cost vs Laparoscopy: Two Case Studies Define a Framework for Optimization.

Int J Med

Da Vinci robotic surgery is seen by many hospital administrators and surgeons as slower and more expensive than laparoscopic surgery despite the implementation of commonly held robotic best practices. Multiple factors, including surgeon learning curves and program governance, are often overlooked, precluding optimal robotic program performance.

An assessment of several leading robotic surgery publications is presented followed by real-world case studies from two US hospitals: an existing robotic program in a mid-sized, regional hospital system and a small, rural hospital that launched a new program.

Improvements in robotic surgery costs/program efficiency were seen at the hospital system vs baseline at 18 months post-implementation; and high-performance robotic efficiency and cost benchmarks were matched or surpassed at the rural hospital at one year post-launch.

When best practices are utilized in robotic programs, surgical case times, costs, and efficiency performance metrics equaling or exceeding laparoscopy can be achieved. This article is protected by copyright. All rights reserved.

Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones.

BJU International

We performed a prospective and randomized study to compare the safety and efficacy of using a conventional nephrostomy sheath versus using a new access sheath with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones.

Sixty patients with staghorn stones were randomly assigned into two groups with 30 patients in each group. One group underwent MPCNL using conventional nephrostomy sheaths (CNS), whereas the other group underwent MPCNL with suction-evacuation nephrostomy sheaths (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analyzed.

The patient demographics and stone characteristics were similar among the two groups. We found that the SENS group showed a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient in removing stones and had a much shorter stone treatment time, a lower-frequency use of the stone extractor, and an ultimately higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade.

Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased efficacy in stone retrieval, decreased surgery-related complications, and an improved SFR.

Infectious complications of prostate biopsy: winning battles but not war.

World Journal of Diabetes

Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications.

In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined.

Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy.

Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members-included MDRs-although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.

Immunohistochemistry-based assessment of androgen receptor status and the AR-null phenotype in metastatic castrate resistant prostate cancer.

Prostate Cancer and Prostatic Diseases

Molecular and immunohistochemistry-based profiling of prostatic adenocarcinoma has revealed frequent Androgen Receptor (AR) gene and protein alterations in metastatic disease. This includes an AR-null non-neuroendocrine phenotype of metastatic castrate resistant prostate cancer which may be less sensitive to androgen receptor signaling inhibitors. This AR-null non-neuroendocrine phenotype is thought to be associated with TP53 and RB1 alterations. Herein, we have correlated molecular profiling of metastatic castrate resistant prostate cancer with AR/P53/RB immunohistochemistry and relevant clinical correlates.

Twenty-seven cases of metastatic castrate resistant prostate cancer were evaluated using histopathologic examination to rule out neuroendocrine differentiation. A combination of a hybridization exon-capture next-generation sequencing-based assay (n = 26), fluorescence in situ hybridization for AR copy number status (n = 16), and immunohistochemistry for AR (n = 27), P53 (n = 24) and RB (n = 25) was used to profile these cases.

Of 27 metastatic castrate resistant prostate cancer cases, 17 had AR amplification and showed positive nuclear expression of AR by immunohistochemistry. Nine cases lacked AR copy number alterations using next-generation sequencing/fluorescence in situ hybridization. A subset of these metastatic castrate resistant prostate cancer cases demonstrated the AR-null phenotype by immunohistochemistry (five cases and one additional case where next-generation sequencing failed). Common co-alterations in these cases involved the TP53, RB1, and PTEN genes and all these patients received prior therapy with androgen receptor signaling inhibitors (abiraterone and/or enzalutamide).

Our study suggests that AR immunohistochemistry may distinguish AR-null from AR-expressing cases in the metastatic setting. AR-null status informs clinical decision-making regarding continuation of therapy with androgen receptor signaling inhibitors and consideration of other treatment options. This might be a relevant and cost-effective diagnostic strategy when there is limited access and/or limited tumor material for molecular testing.

Androgen receptor variant-driven prostate cancer II: advances in clinical investigation.

Prostate Cancer and Prostatic Diseases

Approximately 10-30% of men with mCRPC will test positive for AR-V7 using one of two analytically and clinically validated circulating tumor cell (CTC)-based assays. These men have poor outcomes with approved AR-targeting therapies but may retain sensitivity to chemotherapy. Here, we discuss the clinical implications of testing and strategies that may benefit AR splice variant (AR-V)-positive men and discuss whether such variants are passengers or drivers of aggressive clinical behavior.

We conducted a systemic review of the literature, covering updates since our 2016 review on androgen receptor variants in mCRPC, outcomes, and existing and novel approaches to therapy. We provide an expert opinion about management strategies for AR-V7-positive men and key unanswered research questions.

AR-V7-positive men, defined by Epic nuclear protein detection or the modified AdnaTest mRNA detection in CTCs, identify a subset of men with mCRPC that have a low probability of response to AR-targeting therapy with short progression-free and overall survival in multivariable analyses. AR-variants do not exist in isolation, but rather in the context of a complex, heterogeneous, and evolving mCRPC genome and phenotype as well as patient-specific clinical heterogeneity, and multiple mechanisms of resistance likely exist in patients regardless of AR-V7 detection. Efforts to develop broader resistance assays are needed, and effective treatment strategies beyond taxanes are needed to address the causal driver role of AR-variants and to benefit patients with AR-V-expressing prostate cancer.

CTC AR-V7 detection using the AdnaTest mRNA or Epic nuclear protein assays represents the first analytically and prospective clinically validated liquid biopsy assays that may inform treatment decisions in men with mCRPC, particularly after failure of first-line AR-therapy. The importance of AR-variants is likely to increase with the earlier use of AR-targeting strategies in other settings, and novel interventions for these men are needed.

Synthetic Apparent Diffusion Coefficient for High b-Value Diffusion-Weighted MRI in Prostate.

Prostate Cancer

It has been reported that diffusion-weighted imaging (DWI) with ultrahigh b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher Materials and Methods. Fifteen patients (7 malignant and 8 benign) were included in this study retrospectively with the institutional ethical committee approval. All images were acquired at a 3T MR scanner. The ADC values were calculated using a monoexponential model. Synthetic ADC (sADC) for higher b-value increases the diagnostic power of prostate cancer. DWI with higher.

No significant difference was observed between actual ADC and sADC for b-value increases the diagnostic power of prostate cancer. DWI with higher p=0.002, paired t-test) in sDWI as compared to DWI. Malignant lesions showed significantly lower sADC as compared to benign lesions (p=0.002, paired t-test) in sDWI as compared to DWI. Malignant lesions showed significantly lower sADC as compared to benign lesions (Discussion/.

Our initial investigation suggests that the ADC values corresponding to higher b-value can be computed using log-linear relationship derived from lower b-values (b ≤ 1000). Our method might help clinicians to decide the optimal b-value for prostate lesion identification.b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher b-value increases the diagnostic power of prostate cancer. DWI with higher.

Considering the role of radical prostatectomy in 21st century prostate cancer care.

Nature Reviews Urology

The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially des...

Association of Angiotensin I Converting Enzyme Insertion/287 bp Deletion Polymorphisms and Proliferative Prostatic Diseases among Lebanese Men.

Prostate Cancer

Angiotensin I converting enzyme (ACE) insertion (I) and 287 bp Alu repeat DNA fragment deletion (D) polymorphisms have been indicated in various cancers. Here, we investigated I/D polymorphisms in prostate cancer (PCa) and benign prostate hyperplasia (BPH) among Lebanese men.

Blood DNA extracted from 69 control subjects, 69 subjects with clinically confirmed PCa, and 69 subjects with clinical BPH, all the subjects were aged 50 years or older, was subjected to the polymerase chain reaction. The PCR products were resolved in polyacrylamide gels to determine II, ID, and DD genotypes. The odds ratios (OR), 95% confidence intervals (CI), and p values of the allele frequencies and genotype ratios were calculated for establishing possible association of the alleles and/or genotypes and PCa and/or BPH.

The proportions of II, ID, and DD genotypes were significantly different from Hardy-Weinberg equilibrium for BPH and PCa groups (but not the control group), mostly due to overabundance of the ID genotypes. There was no significant difference in the I and D allele frequencies between the control groups and the affected groups. The ratio of (DD + ID)/II is significantly lower among the control group compared to the BPH group (RR = 8.92, p values of the allele frequencies and genotype ratios were calculated for establishing possible association of the alleles and/or genotypes and PCa and/or BPH. p values of the allele frequencies and genotype ratios were calculated for establishing possible association of the alleles and/or genotypes and PCa and/or BPH.

Our data indicate that the D allele of the I/D polymorphisms of the ACE gene is associated with increased risk of BPH, and the ID genotype is a risk factor for both BPH and PCa among Lebanese males.

A review of recent advancements in soft and flexible robots for medical applications.

Int J Med

Background Soft and flexible robots for medical applications are needed to change their flexibility over a wide range to perform tasks adequately. ...

Augmented Reality for Narrow Area Navigation in Jaw Surgery: Modified Tracking by Detection Volume Subtraction Algorithm.

Int J Med

Jaw surgery based on Augmented Reality (AR) still has limitations in terms of navigating narrow areas. Surgeons need to avoid nerves, vessels and teeth in their entirety, not just root canals. Inaccurate positioning of the surgical instrument may lead to positional or navigational errors and can result in cut blood vessels, nerve channels or root canals. This research aims to decrease the positional error during surgery and improve navigational accuracy by reducing the positional error.

The proposed 2D/3D system tracks the surgical instrument, consisting of the shaft and the cutting element, each part being assigned a different feature description. In the case of the 3D position estimation, the input vector is composed of image descriptors of the instrument and the output value consists of 3D coordinates of the cutter.

Sample results from a jawbone - maxillary and mandibular jaw - demonstrate that the positional error is reduced. The system, thus, led to an improvement in alignment of the video accuracy by 0.25mm-0.35mm from 0.40mm-0.55mm and a decrease in processing time of 11-14 frames per second (fps) against 8-12 fps of existing solutions.

The proposed system is focused on overlaying only on the area to be operated on. Thus, this AR-based study contributes to accuracy in navigation of the deeper anatomical corridors through increased accuracy in positioning of surgical instruments. This article is protected by copyright. All rights reserved.

Are Elderly Patients at High Risk for Postoperative Complications after Robotic Ventral Hernia Repair? A Propensity Score Matching Analysis.

Int J Med

The purpose of this study was to compare the elderly(≥65 years) and non-elderly groups regarding perioperative outcomes after robotic ventral hernia repair(RVHR).

A one-to-one propensity score matching(PSM) analysis was conducted to obtain balanced groups. Postoperative complications including surgical site events(SSEs) [surgical site infections(SSIs), surgical site occurrences(SSOs), and surgical site occurrence procedural interventions(SSOPIs)] were compared.

The unmatched sample included 521 patients. Of these, 139 patients were elderly(range 65-94 years). After PSM, 98 patients were assigned to each group. Intraoperative variables were similar. The non-elderly and elderly groups experienced similar complication rates during the first 90 days. SSEs (SSIs, SSOs, SSOPIs) did not differ between the two groups.

RVHR is safe and efficacious for patients aged 65 and over. Age alone need not be a prohibitive factor in determining patient selection for RVHR, however, it would be more beneficial to take into consideration other patient-related factors as well. This article is protected by copyright. All rights reserved.

Super early detailed assessment of lower urinary tract symptoms after holmium laser enucleation of the prostate (HoLEP): a prospective study.

World Journal of Diabetes

To prospectively investigate early and consecutive changes of lower urinary tract symptoms (LUTS), specifically storage symptoms after holmium laser enucleation of the prostate (HoLEP).

Patients referred for HoLEP completed the International Prostatic Symptom Score (IPSS) the day before, at discharge, and 1, 2, 3, 4, 6, 8, 12, 16, 20, 24, and 52 weeks after HoLEP. Total IPSS was stratified into mild (score 0-7), moderate (8-19), and severe (20-35) LUTS. Storage symptoms were sub-stratified into storage "negative" and "positive". IPSS changes served as the main postoperative outcome. Mixed linear models identified risk factors affecting postoperative recovery of LUTS.

Between December 2010 and 2012, 144 consecutive HoLEP patients were prospectively included in the study. Preoperatively 57.6% of the cohort reported severe storage symptoms (mean total IPSS: 22.6 ± 5.0). Total IPSS decreased significantly immediately after surgery (p < 0.001). Patients with severe LUTS, storage-positive sub-score, and high maximum urinary flow rate were affected by a rebound of mainly storage symptoms 6-8 weeks after HoLEP and prolonged recovery from LUTS. Of these, about 7.4% presented persisting urge complaints. Finally, 12 weeks following HoLEP, the vast majority of patients were symptom-free. Limitations of this study include missing urodynamic workup and a comparative patient cohort.

Immediately after HoLEP, patients experience a significant decrease of LUTS. Continuous symptom recovery seems to be hampered in patients with severe and storage-positive baseline symptoms. (De-novo) storage symptoms slightly affect postoperative recovery. Quality of life is restored to a stable and significantly improved status 3 months after surgery.