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1.
Can Urol Assoc J ; 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32223879

RESUMO

INTRODUCTION: Digital rectal examination (DRE) is part of the clinical evaluation of men on active surveillance (AS). The purpose of the present study is to analyze the value of DRE as a predictor of upgrading in a population of men with prostate cancer (PC) treated with AS. METHODS: We used the prostate biopsy (PBx) database from an academic center, including PBx from 2006-2018, and identified 2029 confirmatory biopsies (CxPBx) of men treated with AS, of which 726 men had both diagnostic (initial) and CxPBx information available. We did a descriptive analysis and evaluated sensitivity, specificity, and predictive values of DRE for the detection of clinically significant PC (csPC). Multivariable regression analysis was done to identify predictors of csPC. The primary outcome was to evaluate DRE as a predictor of the presence of csPC at CxPBx. RESULTS: Among the 2029 patients with a CxPBx, 75% had PC, and of these, 30.3% had upgrading to ISUP Grade ≥2. Thirteen percent of men had a suspicious DRE (done by their treating physician). Sensitivity, specificity, negative and positive predictive values of DRE to detect csPC were best with a PSA <4 ng/ml (27%, 88%, 31%, and 87%, respectively). A suspicious DRE at CxPBx, particularly if the DRE at diagnosis was negative, was a predictor of csPC (odds ratio [OR] 2.34; p=0.038). The main limitation of our study is the retrospective design and the lack of magnetic resonance imaging. CONCLUSIONS: We believe DRE should still be used as part of AS and can predict the presence of csPC even with low PSA values. A suspicious nodule on DRE represents a higher risk of upgrading and should prompt further assessment.

2.
J Urol ; : 101097JU0000000000000808, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32068483

RESUMO

PURPOSE: The role of percent-free PSA (%fPSA) in patients who have undergone radical prostatectomy (RP) and subsequently relapsed is unclear. We previously conducted two retrospective studies and found %fPSA ≥15 in the setting of biochemical recurrence (BCR) confers more aggressive disease. To validate that, we propose to use biobank specimens collected prospectively when patients were first diagnosed with BCR. MATERIALS AND METHOD: Biobank specimens of patients with undetectable PSA after RP and then develop BCR(PSA ≥0.1) were analyzed for %fPSA. Patients were stratified according to the %fPSA cut-off of 15%. Univariable and multivariable logistic regression analysis was performed to predict covariates associated with a higher %fPSA. Cox proportional hazard models were performed to evaluate the prognostic effect of %fPSA on androgen deprivation therapy (ADT) free survival, metastasis-free survival, castrate resistant (CRPC) free survival, cancer-specific (CSS) survival. RESULTS: 154 men were included in the study, of which 126 (82%) had %fPSA<15 and 28 (18%) had %fPSA≥15. Median follow up for %fPSA<15 and %fPSA≥15 was 75 and 69 months, respectively. Patients with %fPSA≥15 had increased hazard of receiving ADT (25% vs. 43%, adjusted HR 2.40 [95% CI 1.12-5.11]), developing metastatic disease (7.9% vs. 21%, adjusted HR 4.10 [95% CI 1.11-15.2]), and developing CRPC(4.0% vs. 14%, unadjusted HR 4.14 [95% CI 1.11-15.5]). CONCLUSIONS: Patients with %fPSA≥15 were started on ADT earlier, and they progressed to CRPC and metastatic stage earlier. %fPSA of ≥15 in the setting of BCR after RP is an indicator of a more aggressive disease. Unlike in the diagnostic setting, a higher %fPSA portends a worse clinical outcome.

5.
BJU Int ; 125(4): 525-530, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31863617

RESUMO

OBJECTIVES: To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). PATIENTS AND METHODS: A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. RESULTS: In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243-19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5-9.5) and 23.5 (15.75-25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5-11) and 6 (5-12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. CONCLUSIONS: sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

6.
Can Urol Assoc J ; 13(8): 250-255, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31496491

RESUMO

INTRODUCTION: Active surveillance (AS) is standard of care in low-risk prostate cancer (PCa). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP). METHODS: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years followup. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo/prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival (PFS) curves between TCLo density groups. Test characteristics of TCLo density were explored with receiver operating characteristic (ROC) curves. RESULTS: We included 181 patients who had CBx from 2012-2015 and met inclusion criteria. The mean age of patients was 62.58 years (standard deviation [SD] 7.13) and median followup was 60.9 months (interquartile range [IQR] 23.4). A high TCLo density score (>0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62-8.42; p<0.001) and GP (HR 3.85; 95% CI 1.91-7.73; p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression. CONCLUSIONS: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PCa.

7.
Tissue Eng Regen Med ; 16(4): 365-384, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31413941

RESUMO

BACKGROUND: Urinary tract is subjected to a variety of disorders such as urethral stricture, which often develops as a result of scarring process. Urethral stricture can be treated by urethral dilation and urethrotomy; but in cases of long urethral strictures, substitution urethroplasty with genital skin and buccal mucosa grafts is the only option. However a number of complications such as infection as a result of hair growth in neo-urethra, and stone formation restrict the application of those grafts. Therefore, tissue engineering techniques recently emerged as an alternative approach, aiming to overcome those restrictions. The aim of this review is to provide a comprehensive coverage on the strategies employed and the translational status of urethral tissue engineering over the past years and to propose a combinatory strategy for the future of urethral tissue engineering. METHODs: Data collection was based on the key articles published in English language in years between 2006 and 2018 using the searching terms of urethral stricture and tissue engineering on PubMed database. RESULTS: Differentiation of mesenchymal stem cells into urothelial and smooth muscle cells to be used for urologic application does not offer any advantage over autologous urothelial and smooth muscle cells. Among studied scaffolds, synthetic scaffolds with proper porosity and mechanical strength is the best option to be used for urethral tissue engineering. CONCLUSION: Hypoxia-preconditioned mesenchymal stem cells in combination with autologous cells seeded on a pre-vascularized synthetic and biodegradable scaffold can be said to be the best combinatory strategy in engineering of human urethra.

8.
World J Urol ; 37(6): 991-999, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30859272

RESUMO

PURPOSE: Prostate cancer is the second commonest cancer among men. In the large European Randomized Study of Screening for Prostate Cancer (ERSPC) trial, prostate-specific antigen (PSA) screening has been shown to substantially reduce prostate cancer mortality. However, PSA screening is known to lead to more unnecessary prostate biopsies and over-diagnosis of clinically insignificant cancer. Therefore, it is imperative that smarter screening methods be developed to overcome the weaknesses of PSA screening. This review explores the novel screening tools that are available. METHODS: A comprehensive literature search was performed using PubMed regarding newer biomarkers, imaging techniques and risk-predicting models that are used to screen for prostate cancer in mainly biopsy-naïve men. RESULTS: Novel serum-based models like 4Kscore® and prostate health index (PHI) are generally better than PSA alone in detecting clinically significant cancer. Similarly, urine-based biomarkers like prostate cancer antigen 3 (PCA3) and HOXC6/DLX1 have been shown to be more accurate than PSA screening. More recently, multiparametric magnetic resonance imaging (mpMRI) is gaining popularity for its ability to detect clinically significant cancer. There is also evidence that combining individual tests to develop prediction models can reliably predict high-risk prostate cancers while reducing the number of unnecessary biopsies. Combinations such as the Stockholm-3 model (STHLM3) and other novel combinations are presented in this review. CONCLUSION: While we continue to find the smarter screening methods that are reliable, precise, and cost-effective, we continue to advocate shared decision-making in prostate cancer screening in order to work in our patients' best interests.


Assuntos
Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Neoplasias da Próstata/diagnóstico , Humanos , Masculino
9.
J Coll Physicians Surg Pak ; 28(3): S69-S70, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29482714

RESUMO

A 46-year gentleman presented with a left-sided lumbar region pain without fever or dysuria. He denied episodes of acute urinary retention. There was a hard mass at the distal urethra with normal laboratory blood tests. Computed tomography urogram revealed a concurrent left renal staghorn calculus and large distal urethral stone. The urethral stone was fragmented via endourologic technique successfully. We report a case of a non-obstructing large urethral calculus in a gentleman with concurrent left renal staghorn calculus and discuss the literature review.


Assuntos
Cistotomia/métodos , Cálculos Coraliformes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Cálculos Urinários/diagnóstico por imagem , Urografia , Dor Abdominal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Cálculos Urinários/cirurgia
11.
Investig Clin Urol ; 58(3): 186-191, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28480344

RESUMO

PURPOSE: This study aimed to determine the urethral stricture (US) rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PK-TURP). MATERIALS AND METHODS: This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. RESULTS: A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%), and most of them (10 of 13, 76.9%) presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6%) occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. CONCLUSIONS: The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.


Assuntos
Ressecção Transuretral da Próstata/efeitos adversos , Uretra/cirurgia , Estreitamento Uretral/etiologia , Idoso , Estudos de Casos e Controles , Humanos , Masculino , Próstata/cirurgia , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/cirurgia , Fatores de Risco , Ressecção Transuretral da Próstata/instrumentação , Ressecção Transuretral da Próstata/métodos
12.
Urol Ann ; 9(2): 197-199, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28479778

RESUMO

Aggressive angiomyxoma (AAM) particularly testicular origin is a rare benign mesenchymal myxoid tumor which is locally aggressive, blatant for local recurrence, and may metastasize. It occurs mostly in females of childbearing age and extremely rare in males. AMM particular testicular origin is not reported in literature yet. This is a 65-year-old man who had a right scrotal swelling. Ultrasound scrotum showed a soft tissue tumor of the right testis. The patient underwent radical right orchidectomy of which histopathologically confirmed to be a paratesticular AAM with clear resection margins. There were no signs of local recurrence or metastasis 2 years postsurgical resection.

13.
World J Urol ; 35(8): 1199-1203, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27987032

RESUMO

PURPOSE: To determine the rate of hospital admissions for infection after transperineal biopsy of prostate (TPB) with single-dose cephazolin prophylaxis using a prospective database. METHOD: Between April 2013 and February 2016, 577 patients undergoing TPB had 2 g of cephazolin given intravenously at induction of anaesthesia. Data collected from these patients included age, PSA, prostate volume, number of cores taken and post-operative complications. RESULTS: No patients were readmitted to hospital with infection post-TPB. Seven patients developed acute urinary retention, and one patient developed clinical prostatitis that was treated with oral antibiotics in the community. CONCLUSION: It is safe to use single-dose cephazolin only as antibiotic prophylaxis prior to TPB, negating the need for quinolones. This study supports Australia's current Therapeutic Guidelines recommendation for TPB prophylaxis and the existing evidence that sepsis post-TPB is a rare complication. Whether any antibiotic prophylaxis is needed at all for TPB is the subject of a future study.


Assuntos
Antibacterianos/uso terapêutico , Cefazolina/uso terapêutico , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Neoplasias da Próstata/patologia , Sepse/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Biópsia com Agulha de Grande Calibre/métodos , Bases de Dados Factuais , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Períneo , Neoplasias da Próstata/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia
14.
PLoS One ; 10(6): e0130820, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26098884

RESUMO

OBJECTIVES: To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting. MATERIALS AND METHODS: We conducted a cross-sectional study of 1021 men aged 40-79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses. RESULTS: There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity. CONCLUSION: Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.


Assuntos
Doenças Cardiovasculares/patologia , Sintomas do Trato Urinário Inferior/patologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , Grupos Étnicos , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Micção/fisiologia
15.
Korean J Urol ; 56(1): 63-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25598938

RESUMO

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.


Assuntos
Constrição Patológica/diagnóstico , Ureter/patologia , Cálculos Ureterais/terapia , Ureterolitíase/cirurgia , Ureteroscopia/efeitos adversos , Humanos , Hidronefrose/diagnóstico , Rim/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco , Ultrassonografia , Ureter/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
16.
Med J Malaysia ; 67(2): 169-72, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22822637

RESUMO

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis


Assuntos
Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Ureter/lesões , Ureter/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Malásia , Masculino , Pessoa de Meia-Idade , Reimplante , Estudos Retrospectivos , Stents , Retalhos Cirúrgicos , Fatores de Tempo
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