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1.
Urol Pract ; 11(2): 385-393, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38215014

RESUMO

INTRODUCTION: Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce. METHODS: We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits. RESULTS: Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits. CONCLUSIONS: Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.


Assuntos
Cateterismo Urinário , Infecções Urinárias , Masculino , Adulto , Humanos , Idoso , Cateterismo Urinário/efeitos adversos , Hematúria/epidemiologia , Cateteres Urinários/efeitos adversos , Infecções Urinárias/epidemiologia , Doença Iatrogênica/epidemiologia
2.
Sex Med ; 11(5): qfad053, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37965376

RESUMO

Background: Low-intensity shockwave therapy for erectile dysfunction is emerging as a promising treatment option. Aim: This randomized sham-controlled crossover trial assessed the efficacy of low-intensity shockwave therapy in the treatment of erectile dysfunction. Methods: Thirty-three participants with organic erectile dysfunction were enrolled and randomized to shockwave therapy (n = 17) or sham (n = 16). The sham group was allowed to cross over to receive shockwave therapy after 1 month. Outcomes: Primary outcomes were the changes in Sexual Health Inventory for Men (SHIM) score and Erection Hardness Score at 1 month following shockwave therapy vs sham, and secondary outcomes were erectile function measurements at 1, 3, and 6 months following shockwave therapy. Results: At 1 month, mean SHIM scores were significantly increased in the shockwave therapy arm as compared with the sham arm (+3.0 vs -0.7, P = .024). Participants at 6 months posttreatment (n = 33) showed a mean increase of 5.5 points vs baseline (P < .001), with 20 (54.6%) having an increase ≥5. Of the 25 men with an initial Erection Hardness Score <3, 68% improved to a score ≥3 at 6 months. When compared with baseline, the entire cohort demonstrated significant increases in erectile function outcomes at 1, 3, and 6 months after treatment. Clinical Implications: In this randomized sham-controlled crossover trial, we showed that 54.6% of participants with organic erectile dysfunction met the minimal clinically important difference in SHIM scores after treatment with low-intensity shockwave therapy. Strengths and Limitations: Strengths of this study include a sham-controlled group that crossed over to treatment. Limitations include a modest sample size at a single institution. Conclusions: Low-intensity shockwave therapy improves erectile function in men with erectile dysfunction as compared with sham treatment, which persists even 6 months after treatment. Clinical Trial Registration: ClinicalTrials.gov NCT04434352.

3.
J Sex Med ; 20(12): 1440-1445, 2023 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-37872726

RESUMO

BACKGROUND: There are little published data regarding longer percutaneous drain durations following inflatable penile prosthesis placement; despite this, drain proponents suggest reduced scrotal hematoma formation, while detractors cite the risk of retrograde device seeding. AIM: Here, we quantify the outcomes of a multi-institutional cohort with drain durations of 48 hours or greater. METHODS: Data were collected retrospectively for patients undergoing primary 3-piece inflatable penile prosthesis (IPP) placement who had a postoperative drain placed. Cases were performed by 3 surgeons at 3 high-volume centers between January 1, 2020, and March 31, 2022. It was the routine practice of these surgeons to leave percutaneous drains for an interval of 48 hours or greater. R software was used to perform statistical analysis and data visualization. OUTCOMES: Primary outcomes included rates of infection and hematoma formation. Secondary outcomes included device explantation. RESULTS: During the study period, there were 224 patients meeting initial inclusion criteria. Of these, 15 patients had their drains removed before 48 hours, leaving 209 patients for the analysis. Mean drain duration was 67 ± 24.7 hours. The mean follow-up interval was 170 days. Diabetes mellitus was present in 84 (40%) patients with a mean hemoglobin A1c of 7.2%. Penoscrotal and infrapubic approaches were employed (n = 114 [54.5%] vs n = 95 [45.5%]). Reservoir location was split between space of Retzius and high submuscular, with space of Retzius being more common (n = 164 [78.5%] vs n = 45 [21.5%]). Discrete hematomas were observed in 7 patients, with subsequent operative intervention on 2. Notably, both of these were infection cases. There were 3 (1.4%) total device infections. Revision for noninfection causes was required in 9 (4.3%) patients. Fisher's exact testing demonstrated significant association between hematoma formation and anticoagulation and/or antiplatelet therapy (P = .017). On multivariable logistic regression, only anticoagulation and/or antiplatelet therapy remained significant (P = .035). CLINICAL IMPLICATIONS: Maintaining percutaneous closed-suction bulb drains for >48 hours following IPP placement is safe. STRENGTHS AND LIMITATIONS: This multi-institutional study fills a hole in IPP perioperative literature, as there have been no previously published data regarding drain durations >48 hours. The primary limitations are the retrospective nature and lack of a control population. CONCLUSION: Maintaining closed-suction bulb drains for >48 hours following IPP implantation is safe and associated with infection rates comparable to other modern cohorts and a very low rate of hematoma formation.


Assuntos
Disfunção Erétil , Implante Peniano , Prótese de Pênis , Masculino , Humanos , Prótese de Pênis/efeitos adversos , Estudos Retrospectivos , Sucção/efeitos adversos , Inibidores da Agregação Plaquetária , Implante Peniano/efeitos adversos , Hematoma/etiologia , Hematoma/cirurgia , Anticoagulantes , Disfunção Erétil/etiologia
4.
Transl Androl Urol ; 12(9): 1426-1438, 2023 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-37814692

RESUMO

Background and Objective: With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. Methods: We performed a search on PubMed between the years 1975-2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Key Content and Findings: Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. Conclusions: While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.

5.
J Invertebr Pathol ; 201: 107993, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37751834

RESUMO

Histopathology associated with the apicomplexan Aggregata valdessensis in the wild population of Octopus tehuelchus was studied. Moreover, to analyze the impact of the prevalence and infection intensity on the dorsal mantle length, sex, maturity stages, condition index and total hemocyte counts on wild O. tehuelchus, Generalized Linear Models (GLMs) were applied. Kruskal-Wallis (KW) test was used to compare growth parameter (RNA/DNA ratios) in infected and uninfected octopuses. Lesions including hypertrophy of host cells and destruction of the tissue organ architecture as well as the replacement of host tissue by parasites were associated with infection. The infection caused an inflammatory defensive response in form of hemocytic infiltration.. The prevalence of apicomplexan increased with octopus dorsal mantle length (GLM, t = 2.68; p = 0.007). Infection intensity was significantly higher in male octopus (GLM, t = 2.69; p = 0.009) and decreased at higher temperatures in both sexes (GLM, t = -2.42; p = 0.018). The digestive gland condition index did not significantly vary with infection intensity, and no significant relationship between total hemocyte counts and coccidian infection was found (Lineal Model, t = 0.46; p = 0.64). The acid nucleic ratio was significantly lower in octopuses infected by A. valdessensis (Kruskal Wallis test, H = 4.8; p = 0.02), suggesting a detrimental effect on O. tehuelchus growth caused by the coccidian.


Assuntos
Octopodiformes , Feminino , Masculino , Animais , Interações Hospedeiro-Parasita , Oceano Atlântico
7.
Pathogens ; 11(10)2022 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-36297148

RESUMO

Acute febrile illness (AFI) is a morbid condition with a sudden onset of fever with at least seven days of evolution, where no signs or symptoms related to an apparent infection have been identified. In Latin America, a high proportion of disease is typically due to malaria and arboviruses. However, among the infectious etiologies, tick-borne diseases (TBDs) should also be considered, especially in areas where people come into direct contact with these arthropods. This study aims to describe the etiology and epidemiology related to tick-borne agents in patients with AFI and the tick's natural infection by agents of TBD in the rural tropical Magdalena Medio region in Colombia, and explore the factors associated with the presence of Coxiella burnetii infection. We conduct a cohort study enrolling 271 patients with AFI to detect the bacteria of the genera Anaplasma, Ehrlichia, Coxiella, Rickettsia, Borrelia, and Francisella through molecular techniques, and additionally evaluate the presence of IgG antibodies with commercially available kits. We also conduct tick collection in the patient's households or workplaces for the molecular screening of the same bacterial genera. Seropositivity to IgG antibodies was obtained for all the bacteria analyzed, with Francisella being the most common at 39.5% (107/271), followed by R. rickettsii at 31.4% (85/271), Ehrlichia at 26.9% (73/271), R. typhi at 15.5% (42/271), Anaplasma at 14.4% (39/271), and Borrelia at 6.6% (18/271). However, these bacteria were not detected by the molecular techniques used. Coxiella burnetii infection was detected in 39.5% of the patients: 49.5% only by phase I and II IgG antibodies, 33.6% only by real-time PCR, and 16.8% had a concordant positive result for both techniques. A total of 191 adult ticks, 111 females and 80 males, were collected and identified as Rhipicephalus sanguineus s.l. and Rhipicephalus microplus. In the 169 adult ticks in which natural infection was evaluated, Ehrlichia spp. was detected in 21.3% (36/169), Coxiella spp. in 11.8% (20/169), and Anaplasma spp. in 4.7% (8/169). In conclusion, we identified the prior exposition to Francisella, Anaplasma, Ehrlichia, Rickettsia, Borrelia, and Coxiella in patients through serological tests. We also detected the infection of C. burnetii using molecular techniques. In the ticks, we identified bacteria of the genera Coxiella, Anaplasma, and Ehrlichia. These results suggest the importance of these zoonotic agents as possible causes of AFI in this region.

8.
Irrig Sci ; 40(4-5): 593-608, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36172254

RESUMO

Improved accuracy of evapotranspiration (ET) estimation, including its partitioning between transpiration (T) and surface evaporation (E), is key to monitor agricultural water use in vineyards, especially to enhance water use efficiency in semi-arid regions such as California, USA. Remote-sensing methods have shown great utility in retrieving ET from surface energy balance models based on thermal infrared data. Notably, the two-source energy balance (TSEB) has been widely and robustly applied in numerous landscapes, including vineyards. However, vineyards add an additional complexity where the landscape is essentially made up of two distinct zones: the grapevine and the interrow, which is often seasonally covered by an herbaceous cover crop. Therefore, it becomes more complex to disentangle the various contributions of the different vegetation elements to total ET, especially through TSEB, which assumes a single vegetation source over a soil layer. As such, a remote-sensing-based three-source energy balance (3SEB) model, which essentially adds a vegetation source to TSEB, was applied in an experimental vineyard located in California's Central Valley to investigate whether it improves the depiction of the grapevine-interrow system. The model was applied in four different blocks in 2019 and 2020, where each block had an eddy-covariance (EC) tower collecting continuous flux, radiometric, and meteorological measurements. 3SEB's latent and sensible heat flux retrievals were accurate with an overall RMSD ~ 50 W/m2 compared to EC measurements. 3SEB improved upon TSEB simulations, with the largest differences being concentrated in the spring season, when there is greater mixing between grapevine foliage and the cover crop. Additionally, 3SEB's modeled ET partitioning (T/ET) compared well against an EC T/ET retrieval method, being only slightly underestimated. Overall, these promising results indicate 3SEB can be of great utility to vineyard irrigation management, especially to improve T/ET estimations and to quantify the contribution of the cover crop to ET. Improved knowledge of T/ET can enhance grapevine water stress detection to support irrigation and water resource management. Supplementary Information: The online version contains supplementary material available at 10.1007/s00271-022-00787-x.

9.
Transl Androl Urol ; 11(8): 1200-1209, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36092846

RESUMO

Background and Objective: Urinary incontinence following prostate treatment (IPT) is a common complication with corresponding negative impacts on quality of life. Pelvic floor muscle training (PFMT) is a non-invasive treatment strategy to treat combat this clinical issue, and has been recognized by medical associations globally and increasingly supported by large bodies of literature. Accordingly, many studies demonstrate a significant benefit of pelvic floor muscle training to continence status and quality of life in men with incontinence following prostate treatment. However, related research is limited by variety in treatment regimens, outcome measures, and study designs, with unclear impact on treatment success. We aim to provide a brief overview of pathology and incidence of incontinence following prostate surgery and an understanding how PFMT is currently used to treat and prevent this clinical consequence. Methods: A comprehensive literature search was conducted utilizing PubMed, Medline, and Google Scholar. Search criteria included systematic reviews and randomized control trials published in the year 2000 to present. References of resulting studies were further analyzed to identify further articles of relevance. Keywords searched included: "post-prostatectomy incontinence", "pelvic muscle strengthening", "Benign Prostatic Hyperplasia", and "pelvic floor muscle training". Peer-reviewed publications that demonstrated a novel addition to the existing body of literature on this subject were included. Key Content and Findings: Upon review of the current research landscape, PFMT is largely supported in treatment of IPT. Analysis of current literature on this subject demonstrates heterogeneity in protocols, measures of treatment success, and patient numbers. Nevertheless, benefits to continence and quality of life are noted across an expansive body of literature and as such, PFMT is therefore recommended as an important part of the treatment algorithm following radical prostatectomy. Conclusions: PFMT is an important and effective part of the treatment algorithm in the prevention and treatment of IPT. Additional research is needed to more extensively assess PFMT's role in treating this clinical consequence, especially following other prostate surgeries.

11.
Neurourol Urodyn ; 41(1): 229-236, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34559913

RESUMO

AIMS: To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS: We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. RESULTS: A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS: Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.


Assuntos
Estreitamento Uretral , Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Idoso , Remoção de Dispositivo/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Uretra/cirurgia , Estreitamento Uretral/complicações , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial/efeitos adversos
12.
Infect Dis Rep ; 13(2): 571-581, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34205497

RESUMO

Chromobacterium violaceum is a facultative anaerobic, Gram-negative rod found in different ecosystems, especially tropical and subtropical areas. Human infections are rare, and just a few cases have been reported in literature. In this paper, we present the first non-lethal infection due to Chromobacterium violaceum, in an adult male with polycystic kidney disease in Colombia. Periareolar soft tissue infection was documented with isolation of Chromobacterium violaceum. Clinical manifestations, treatment, and outcome are shown.

13.
Sci Rep ; 11(1): 14679, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34282205

RESUMO

Escherichia coli dynamics in urban watersheds are affected by a complex balance among external inputs, niche modulation and genetic variability. To explore the ecological processes influencing E. coli spatial patterns, we analyzed its abundance and phylogenetic structure in water samples from a stream network with heterogeneous urban infrastructure and environmental conditions. Our results showed that environmental and infrastructure variables, such as macrophyte coverage, DIN and sewerage density, mostly explained E. coli abundance. Moreover, main generalist phylogroups A and B1 were found in high proportion, which, together with an observed negative relationship between E. coli abundance and phylogroup diversity, suggests that their dominance might be due to competitive exclusion. Lower frequency phylogroups were associated with sites of higher ecological disturbance, mainly involving simplified habitats, higher drainage infrastructure and septic tank density. In addition to the strong negative relationship between phylogroup diversity and dominance, the occurrence of these phylogroups would be associated with increased facilitated dispersal. Nutrients also contributed to explaining phylogroup distribution. Our study proposes the differential contribution of distinct ecological processes to the patterns of E. coli in an urban watershed, which is useful for the monitoring and management of fecal pollution.


Assuntos
Escherichia coli/classificação , Rios/microbiologia , Águas Residuárias/microbiologia , Cidades , Ecossistema , Monitoramento Ambiental , Poluição Ambiental , Escherichia coli/genética , Escherichia coli/crescimento & desenvolvimento , Estuários , Microbiota , Filogenia , São Francisco , Microbiologia da Água
14.
Neurourol Urodyn ; 40(4): 1035-1041, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33792973

RESUMO

AIMS: To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement. METHODS: A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement. Men were stratified into two groups based on serum testosterone: low serum testosterone (LT) (<280 ng/dl) and normal serum testosterone (NT) (>280 ng/dl). Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated. RESULTS: Among 161 AUS patients with serum testosterone levels, 84 (52.2%) had LT (mean: 136.8 ng/dl, SD: 150.4 ng/dl) and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range: 3.6-13.4 months), most of whom (30/42, 71.4%) were testosterone deficient. LT levels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519, p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. CONCLUSIONS: LT is an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.


Assuntos
Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Testosterona , Uretra
15.
Curr Urol Rep ; 22(5): 30, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33779844

RESUMO

PURPOSE OF REVIEW: To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. RECENT FINDINGS: Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.


Assuntos
Uretra/cirurgia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial/efeitos adversos , Idoso , Humanos , Masculino , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
16.
Int. braz. j. urol ; 47(2): 415-422, Mar.-Apr. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1154456

RESUMO

ABSTRACT Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.


Assuntos
Humanos , Masculino , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária por Estresse/diagnóstico , Slings Suburetrais , Prostatectomia , Estudos Retrospectivos , Resultado do Tratamento , Tosse
17.
Curr Urol Rep ; 22(4): 20, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554295

RESUMO

PURPOSE OF REVIEW: To discuss mechanical and surgical innovations in inflatable penile prosthesis (IPP) surgery and their implications on reservoir placement and patient outcomes. RECENT FINDINGS: The past decade has seen a new emphasis on optimizing outcomes and minimizing complications associated with IPP reservoirs. Innovations in device design have accordingly yielded safer, more durable IPP outcomes over the past four decades. Modifications in surgical approach for reservoir placement abound for both traditional space of Retzius and ectopic reservoir placement techniques. Surgical and medical history, patient anatomy, and patient preference should all be considered when choosing approach for IPP reservoir placement. Prosthetic urologists should be proficient in multiple approaches to provide the best care to their patients.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/métodos , Prótese de Pênis , Desenho de Prótese , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pelve/cirurgia , Implante Peniano/efeitos adversos , Implante Peniano/instrumentação , Implante Peniano/tendências , Prótese de Pênis/efeitos adversos , Prótese de Pênis/tendências , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Desenho de Prótese/tendências , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
18.
Urology ; 149: 245-250, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33301744

RESUMO

OBJECTIVE: At present, excision and primary anastomosis (EPA) urethroplasty is a highly reliable method of reconstruction for short bulbar urethral strictures. Longer strictures are often managed with grafting techniques to ensure a tension-free repair. Here we report our initial experience with a new, extended anastomotic technique for long bulbar strictures that incorporates plication of the ventral corporal bodies to reduce the distance between the urethral ends and obviates the need for grafting. METHODS: We reviewed records for all urethroplasties performed by a single surgeon at our institution between January 2018 and February 2020. We identified a cohort of older patients with complex strictures who underwent Extended Primary Anastomosis with Penile Plication (EPAPP). Patient demographics, stricture characteristics, perioperative 75 parameters, and postoperative outcomes were evaluated. RESULTS: Of 346 urethroplasty records reviewed, 10 patients (2.9%) underwent EPAPP. Mean stricture length was 3.75 ± 1.4 cm. EPAPP patients were older than those repaired by other techniques (mean age 66.6 vs 55.6, P = .024), and most were not sexually active preoperatively. Postoperative voiding cystourethrogram confirmed urethral patency without extravasation in all patients. At a median follow up of 9.7 months (IQR 8.5-11.5) 8 patients remained asymptomatic after EPAPP alone and 2 patients required a single balloon dilation for stricture recurrence. CONCLUSION: EPAPP is a promising alternative option for the management of long bulbar strictures among appropriately selected patients.


Assuntos
Estomia/métodos , Pênis/cirurgia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Idoso , Anastomose Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , Estudos Retrospectivos , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
19.
Artigo em Inglês | MEDLINE | ID: mdl-35002012

RESUMO

Accurate quantification of the partitioning of evapotranspiration (ET) into transpiration and evaporation fluxes is necessary to understanding ecosystem interactions among carbon, water, and energy flux components. ET partitioning can also support the description of atmosphere and land interactions and provide unique insights into vegetation water status. Previous studies have identified leaf area index (LAI) estimation as a key descriptor of biomass conditions needed for the estimation of transpiration and evaporation. LAI estimation in clumped vegetation systems, such as vineyards and orchards, has proven challenging and is strongly related to crop phenological status and canopy management. In this study, a feature extraction model based on previous research was built to generate a total of 202 preliminary variables at a 3.6-by-3.6-meter-grid scale based on submeter-resolution information from a small Unmanned Aerial Vehicle (sUAV) in four commercial vineyards across California. Using these variables, a machine learning model called eXtreme Gradient Boosting (XGBoost) was successfully built for LAI estimation. The XGBoost built-in function requires only six variables relating to vegetation indices and temperature to produce high-accuracy LAI estimation for the vineyard. Using the six-variable XGBoost-based LAI map, two versions of the Two-Source Energy Balance (TSEB) model, TSEB-PT and TSEB-2T were used for energy balance and ET partitioning. Comparing these results with the Eddy-Covariance (EC) tower data, showed that TSEB-PT outperforms TSEB-2T on the estimation of sensible heat flux (within 13% relative error) and surface heat flux (within 34% relative error), while TSEB-2T outperforms TSEB-PT on the estimation of net radiation (within 14% relative error) and latent heat flux (within 2% relative error). For the mature vineyard (north block), TSEB-2T performs better than TSEB-PT in partitioning the canopy latent heat flux with 6.8% relative error and soil latent heat flux with 21.7% relative error; however, for the younger vineyard (south block), TSEB-PT performs better than TSEB-2T in partitioning the canopy latent heat flux with 11.7% relative error and soil latent heat flux with 39.3% relative error.

20.
Artigo em Inglês | MEDLINE | ID: mdl-35002013

RESUMO

sUAS (small-Unmanned Aircraft System) and advanced surface energy balance models allow detailed assessment and monitoring (at plant scale) of different (agricultural, urban, and natural) environments. Significant progress has been made in the understanding and modeling of atmosphere-plant-soil interactions and numerical quantification of the internal processes at plant scale. Similarly, progress has been made in ground truth information comparison and validation models. An example of this progress is the application of sUAS information using the Two-Source Surface Energy Balance (TSEB) model in commercial vineyards by the Grape Remote sensing Atmospheric Profile and Evapotranspiration eXperiment - GRAPEX Project in California. With advances in frequent sUAS data collection for larger areas, sUAS information processing becomes computationally expensive on local computers. Additionally, fragmentation of different models and tools necessary to process the data and validate the results is a limiting factor. For example, in the referred GRAPEX project, commercial software (ArcGIS and MS Excel) and Python and Matlab code are needed to complete the analysis. There is a need to assess and integrate research conducted with sUAS and surface energy balance models in a sharing platform to be easily migrated to high performance computing (HPC) resources. This research, sponsored by the National Science Foundation FAIR Cyber Training Fellowships, is integrating disparate software and code under a unified language (Python). The Python code for estimating the surface energy fluxes using TSEB2T model as well as the EC footprint analysis code for ground truth information comparison were hosted in myGeoHub site https://mygeohub.org/ to be reproducible and replicable.

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