RESUMEN
PURPOSE: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. METHODS: Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. RESULTS: The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. CONCLUSIONS: This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.
Asunto(s)
Técnica Delphi , Obstrucción Ureteral , Ureteroscopía , Urolitiasis , Humanos , Urolitiasis/cirugía , Factores de Riesgo , Ureteroscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Constricción Patológica , Complicaciones Posoperatorias/etiología , Enfermedad Iatrogénica , Internacionalidad , ConsensoRESUMEN
PURPOSE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Litotricia , Complicaciones Posoperatorias , Ureteroscopía , Urolitiasis , Humanos , Ureteroscopía/efectos adversos , Factores de Riesgo , Urolitiasis/cirugía , Urolitiasis/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Litotricia/efectos adversos , Litotricia/métodos , Constricción Patológica , Nefrolitotomía Percutánea/efectos adversos , Nefrolitotomía Percutánea/métodos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugíaRESUMEN
The aim of this study is to evaluate if surgical experience could influence the outcomes of retrograde intrarenal surgery (RIRS) in terms of stone clearance and complication rate. Patients from five institutions were included in this study. Patients were divided into two groups. Group 1: patients treated by three surgeons in the early phase of learning curve (surgical experience <100 procedures); Group 2: cases operated by two surgeons with great endourological experience (>400 procedures). Patients and stone characteristics, outcome and complications were analyzed. Multivariable regression model was used. Differences between groups were estimated using propensity scores to adjust for the bias inherent to the different characteristics. 381 RIRS were analyzed (Group 1: 150 RIRS; Group 2: 231 RIRS). Clinical data and stone parameters were comparable. The SFR was 70 % in Group 1 and 77.9 % in Group 2 (p = 0.082). Operative time was significantly shorter in the Group 2 (76.3 vs. 53.1 min, p = 0.001). The overall complication rate was significantly lower in Group 2 (20.7 vs. 8.7, p = 0.001). At unadjusted analysis, a non-significant difference was found between centers on SFR (OR 1.51 95 % CI 0.95-2.41). Conversely, a significant difference was found on overall complications (OR 0.36 95 %CI 0.20-0.67) with lower overall complication in Group 2. This study shows that surgeon experience influences the outcomes of RIRS mainly in terms of safety. Further studies will be needed to assess the exact number of procedures necessary to obtain a plateau in the rate of complications and success.
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Competencia Clínica , Cálculos Renales/cirugía , Complicaciones Posoperatorias/epidemiología , Ureteroscopía/efectos adversos , Adulto , Anciano , Femenino , Humanos , Riñón/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/etiología , Puntaje de Propensión , Estudios Prospectivos , Cirujanos/educación , Resultado del Tratamiento , Ureteroscopía/métodos , Urología/educaciónRESUMEN
Surprisingly perhaps for a tumor where there is such clear proof of a primary hormonal basis to its development, there is emerging evidence that all elements playing a key role in prostate cancer somehow affect the host immune system. This review turns the spotlight on some previously unsuspectable aspects, able to interact with the immune system in prostate cancer patients PSA, sex hormones, inflammatory infiltrates, cytokines, growth factors, neoformed blood vessels, neurotransmitters and neurotrophins, cigarette smoking, diet, therapeutic approaches. The concept of exploiting the immune system to combat cancer is not new, but only nowadays immunotherapy is a reality. Prostate cancer is an excellent target, involved in an increasing number of clinical immunotherapeutic trials. The main current purpose is to overcome the host immune tolerance of tumor cells. The most recent progresses in gene, monoclonal antibody and vaccine therapies are reported.
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Neoplasias de la Próstata/inmunología , Citocinas/inmunología , Hormonas Esteroides Gonadales/inmunología , Humanos , Inmunoterapia , Masculino , Neoplasias de la Próstata/terapiaRESUMEN
The rat adrenal gland contains ganglion cells able to synthesize nitric oxide (NO). This messenger molecule controls and modulates adrenal secretory activity and blood flow. The present study analyzed the number, size, and distribution of NO-producing adrenal neurons in adulthood and during postnatal development by means of beta-nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry. This method reliably visualizes the enzyme responsible for NO generation. The reactive neurons per adrenal gland were 350-400 in both male and female adult rats. The positive nerve cell bodies were mostly located in the medulla, few being detected within the cortex and the subcapsular region. Dual labeling with anti-microtubule-associated protein 2 antibody, specific for neuronal elements, confirmed this distribution. Anti-microtubule-associated protein 1b antibody identified a subset of NADPH-d-positive neurons, displaying different degrees of maturation according to their position within the adrenal gland. At birth, there were about 220 NADPH-d-labeled neurons per adrenal gland in both sexes. As confirmed by dual immunocytochemical labeling, their great majority was evenly distributed between the cortex and the subcapsular region, the medulla being practically devoid of stained neurons. After birth, the number of adrenal NADPH-d-positive ganglion cells displayed a strong postnatal increase and reached the adult-like distribution after 1-2 months. During the period of increase, there was a transient difference in the numbers of these cells in the two sexes. Thus we present here evidence of plasticity in the number, size, and distribution of NADPH-d-positive adrenal neurons between birth and adulthood; in addition, we describe transient sex-related differences in their number and distribution during the 2nd postnatal week, which are possibly related to the epigenetic action of gonadal hormones during this period.
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Glándulas Suprarrenales/anatomía & histología , Tamaño de la Célula/fisiología , Ganglios/anatomía & histología , NADPH Deshidrogenasa/metabolismo , Factores de Edad , Animales , Femenino , Masculino , Ratas , Ratas Wistar , Factores SexualesRESUMEN
Dihydronicotinamide adenine-dinucleotide phosphate diaphorase (NADPH-d) positive neurons in the superficial layers of superior colliculus (SC) were studied in the adult rat after eye enucleation at postnatal day 5 (P5). Bilaterally, NADPH-d histochemistry revealed either weakly or intensely labeled neurons. In the SC contralateral to the enucleation, the volume of superficial layers decreased significantly, whereas the total number of NADPH-d positive neurons was only slightly reduced, thus resulting in an increased cell density. Bilaterally, the number of NADPH-d positive neurons was around 20% of Nissl-stained neurons. While the number of neurons which were weakly positive for NADPH-d was unchanged contralateral to the enucleation (thus resulting in a significant increase in their percentage on the overall NADPH-d population), the number of intensely labeled neurons decreased by 30%. Intensely labeled neurons were classified with respect to cell size and dendritic distribution. Some (126) were reconstructed and analyzed on the computer, in order to quantitate morphological differences in dendritic distribution in the denervated and control SC. The percent of neurons which could be assigned to some classes (marginal, stellate, narrow field vertical and wide field vertical) was reduced contralateral to the enucleation. In addition, vertically-oriented neurons (narrow field vertical, wide field vertical and pyriform) showed a significant decrease in soma size, dendritic length and number of branch points. And finally, the overall orientation of dendrites on narrow and wide field vertical neurons was more dispersed, when compared to the control colliculus. Thus, P5 eye enucleation affects the adult morphology of NADPH-d positive neurons in the superficial layers of the rat SC, resulting in increased cell density, changed relative number of cells in each morphological type, and altered soma size, dendritic length and orientation in specific neurons.