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1.
J Korean Med Sci ; 37(12): e98, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35347906

RESUMO

BACKGROUND: It is quite difficult to distinguish retractile testis from gliding testis, which requires different treatment planning in the clinic setting. We evaluated practice patterns of urologists in Korea regarding the diagnosis and management of retractile and gliding testes. METHODS: We mailed or e-mailed self-completion questionnaires consisting of 20 items to 106 urologists practicing in Korean hospitals concerning the diagnosis and treatment of cryptorchidism. We collected and analyzed the responses statistically. RESULTS: Responses were received from 62 urologists. The response rate was 58.5%. Thirty-seven urologists (59.7%) actually felt they had difficulty in distinguishing retractile testis from gliding testis in the clinic setting. This rate was higher for non-pediatric urologists (78.1%) than for pediatric urologists (40.0%) (P = 0.006). In cases of infant retractile testis, only five urologists (8.1%) said that they would perform orchiopexy immediately, with 54 (87.1%) urologists saying they would do follow-up. In cases of preschool-age children with retractile testis, 17 urologists (27.4%) said that they would perform orchiopexy immediately with 41 (66.1%) urologists saying they would do follow-up. In cases of infant gliding testis, 37 urologists (59.7%) said that they would perform orchiopexy immediately with 24 (38.7%) urologists saying they would do a follow-up. CONCLUSION: More than half (59.7%) of Korean urologists revealed it challenging to distinguish retractile testis and gliding testis in the clinical setting. The more it was difficult to diagnose retractile testis with certainty, the more frequent surgical correction was chosen for treatment. Therefore, it is essential to prevent unnecessary surgical treatment by establishing a practical guideline.


Assuntos
Criptorquidismo , Urologistas , Criança , Pré-Escolar , Compreensão , Criptorquidismo/diagnóstico , Criptorquidismo/cirurgia , Humanos , Lactente , Masculino
2.
Urologiia ; (4): 86-90, 2022 Sep.
Artigo em Russo | MEDLINE | ID: mdl-36098599

RESUMO

The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patients treatment should be carried out in a specialized hospital using modern surgical technologies.


Assuntos
Endometriose , Ureter , Doenças Ureterais , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Seguimentos , Humanos , Ureter/patologia , Doenças Ureterais/diagnóstico , Doenças Ureterais/cirurgia , Urologistas
4.
J Urol ; 208(4): 830-837, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36082555

RESUMO

PURPOSE: Our aim was to evaluate whether transperineal (TP) MRI-targeted prostate biopsy (TBx) may improve the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology ≥2, in comparison to transrectal (TR) TBx. MATERIALS AND METHODS: A multicenter retrospective cohort study comprising patients who underwent MRI-guided prostate biopsy was conducted. To address possible benefits of TP-TBx in the detection of prostate cancer (PCa) and csPCa, a cohort of patients undergoing TP-TBx were compared to patients undergoing TR-TBx. Multivariable logistic regression analyses were performed to assess predictors of PCa and csPCa detection. RESULTS: Overall, 1,936 and 3,305 patients who underwent TR-TBx vs TP-TBx at 10 referral centers were enrolled. The rate of PCa and csPCa diagnosed was higher for TP-TBx vs TR-TBx (64.0% vs 50%, p <0.01 and 49% vs 35%, p <0.01). At multivariable analysis adjusted for age, biopsy naïve/repeated biopsy, cT stage, Prostate Imaging-Reporting and Data System®, prostate volume, PSA, and number of biopsy cores targeted, TP-TBx was an independent predictor of PCa (odds ratio [OR] 1.37, 95% CI 1.08-1.72) and csPCa (1.19, 95% CI 1.12-1.50). When considering the approach according to the site of the index lesion, TP-TBx had a significantly higher likelihood than TR-TBx to detect csPCa in the apex (OR 4.81, 95% CI 1.03-6.27), transition/central zone (OR 2.67, 95% CI 1.42-5.00), and anterior zone (OR 5.62, 95% CI 1.74-8.13). CONCLUSIONS: The use of TP-TBx allows a better cancer grade definition and PCa risk assessment. This has important implication in the decision-making process and in patient counseling for further therapies.


Assuntos
Neoplasias da Próstata , Urologia , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Masculino , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Urologistas
5.
Curr Opin Urol ; 32(5): 451-455, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35916009

RESUMO

PURPOSE OF REVIEW: To highlight the latest changes in prostate cancer (PCa), urothelial carcinoma, upper tract urothelial carcinoma (UTUC) and renal cell carcinoma (RCC) diagnosis and the impact of genetics in this field. RECENT FINDINGS: Breast cancer1/2 mutations start to play a major role in PCa treatment with regard to personalized medicine. In urothelial carcinoma an overlap between histological pathological and molecular findings exists, fibroblast growth factor receptor alteration are starting to play a major role, programmed death-ligand 1 although problematic is still important in the treatment setting. UTUC is rare, but genetically different from urothelial carcinoma. In the development of RCC, different genetic pathways such as Von Hippel-Lindau, but also tuberous sclerosis 1/2 and others play a major role in tumor development. SUMMARY: Over the last years, genetics has become increasingly important role in the diagnosis and the treatment of patients with urological malignancies. The upcoming 5th edition (1) of the WHO still considers conventional surgical pathology as the diagnostic gold standard, but molecular pathology is gaining importance not only for diagnosis, but also in personalized treatment, of prostate, kidney cancer and urothelial carcinomas. Therefore, a close collaboration between surgical urology, pathology and oncology departments is mandatory. In this review, we will discuss the latest evolutions in PCa, urothelial carcinoma, upper urinary tract carcinomas and RCC s in the field of genetics in urology.


Assuntos
Carcinoma de Células Renais , Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias da Bexiga Urinária , Neoplasias Urológicas , Carcinoma de Células Renais/patologia , Carcinoma de Células de Transição/patologia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/genética , Neoplasias Renais/terapia , Masculino , Neoplasias da Bexiga Urinária/patologia , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/genética , Neoplasias Urológicas/terapia , Urologistas , Urotélio/patologia
6.
Urologie ; 61(9): 939-947, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35925108

RESUMO

BACKGROUND: Ensuring future urological care at the interface between out- and inpatient care is challenging due to demographic developments with an increasing proportion of urological diseases, the simultaneous threat of a shortage of physicians, and the increasing outpatient treatment of complex urological diseases. OBJECTIVES: The cross-sectoral cooperation model between a university maximum care provider and the urologic joint practice with a hospital affiliation (BAG) presented below can serve as an ideal model for outpatient-inpatient care. MATERIALS AND METHODS: Since 2016, there has been close cooperation between the BAG in Winsen/Buchholz and the University Medical Center Hamburg-Eppendorf (UKE). In addition to direct patient transfer and the continuous pre- and posttreatment of patients, two residents from the UKE rotate to the BAG every year. RESULTS: The BAG benefits from this cooperation through planning security and support in everyday patient care, while the UKE benefits from patient transfer as well as surgical and "basic urological" training of residents. By avoiding duplicate examinations and earlier discharge of patients into outpatient follow-up care, resources are spared. Meaningful patient preselection enables minor interventions to be performed close to home via the BAG, whereas complex cases are carried out at a center of excellence. CONCLUSIONS: The cooperation is seen positively by all parties without exception and, above all, as a benefit for the patient's wellbeing. The optimal training and further education of young urologists in this expanding field can thus be supported and should be integrated into urological resident training.


Assuntos
Doenças Urológicas , Urologia , Assistência Ambulatorial , Humanos , Pacientes Ambulatoriais , Doenças Urológicas/diagnóstico , Urologistas , Urologia/educação
7.
Urologie ; 61(9): 933-938, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35925112

RESUMO

In view of the growing demand for urological care and the simultaneous demographic change, the need for urologists in Germany is increasing. Therefore, young professionals are urgently needed to ensure urological care in the future. This objective can be achieved by fascinating medical students for urology and by implementing satisfactory residency programs in clinical departments and outpatient offices. Perspectives and possible career paths should be shown to junior colleagues at an early stage. Structured research funding is needed to reconcile academic with clinical work. The German Society for Residents in Urology (GeSRU) offers young urologists a platform for networking, for representation of interests as well as for education and training.


Assuntos
Internato e Residência , Urologia , Currículo , Alemanha , Humanos , Urologistas , Urologia/educação
8.
Urologie ; 61(9): 951-958, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35925114

RESUMO

BACKGROUND: The proportion of female urologists is steadily increasing, yet they continue to be underrepresented in academic leadership positions. A postdoctoral lecture qualification (habilitation), which is mandatory for a successful scientific career, is achieved significantly less often by female urologists in Germany than by their male colleagues. OBJECTIVE: To identify factors to effectively promote female urologists into academic leadership positions, the current situation, as well as factors influencing successful habilitation of women who are members of the German Society of Urology (Deutsche Gesellschaft für Urologie [DGU]) were investigated. METHODS: An online questionnaire was distributed to 1343 female members of the DGU in Germany, Austria, and Switzerland. The responses of 521 women were statistically analyzed with respect to baseline characteristics and in relation to research funding. The primary endpoint of our study was the habilitation rate. RESULTS: The average age of the 521 participating female urologists who completed the questionnaire was 37 years (range 21-67 years). Of these, most female physicians were in postgraduate training (n = 168, 32%), worked full-time (n = 324, 62%), and had children (n = 277, 53%). Overall, 359 (69%) of the participants had a PhD and 63 (12%) were still working on their PhD. Thirty (5.8%) female urologists had a habilitation. In univariable logistic regression models, age (odds ratio [OR] 1.06), working time model (part-time OR 0.19), a research fellowship (OR 21.4), release from clinical work for research purposes (OR 13.7), and participation in a funding program (OR 6.9) or mentoring program (OR 7.0) were independent predictors of achieving habilitation. Whether a urologist had children was not an independent predictor of achieving habilitation. In multivariable logistic regression models, age (OR 1.08), and a research fellowship (OR 9.04) were independent predictors of achieving habilitation. CONCLUSIONS: Promoting habilitation among female urologists is required in order to increase the proportion of women in leading academic positions. The results of the data analysis show that the promotion of research fellowships explicitly for women could be a promising approach.


Assuntos
Urologia , Adulto , Idoso , Bolsas de Estudo , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Urologistas , Urologia/educação , Adulto Jovem
9.
Urologie ; 61(9): 996-1010, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35943546

RESUMO

Alongside Paris, Vienna was one of the early centers of specialization and professionalization in medicine and urology in the 19th century. Especially the 2nd Vienna Medical School (Erna Lesky) with its main representatives Carl Freiherr von Rokitansky (in Czech: Karel Rokytanský; 1804-1878) and Joseph Ritter von Skoda (1895-1881) was able to create the perfect scientific environment for young students to become acquainted with new fields of research often in an interdisciplinary setting, e.g., chemistry, microscopy or pathology in combination with clinical departments like surgery. We analyze the process of habilitation using the example of a urologist to outline this process within the history of science.


Assuntos
Medicina , Urologia , História do Século XIX , Humanos , Faculdades de Medicina/história , Especialização , Urologistas , Urologia/história
10.
Artigo em Inglês | MEDLINE | ID: mdl-35955004

RESUMO

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.


Assuntos
Neoplasias da Bexiga Urinária , Biomarcadores Tumorais/análise , Cistoscopia , Humanos , Valor Preditivo dos Testes , Neoplasias da Bexiga Urinária/diagnóstico , Urologistas
11.
Urologie ; 61(8): 839-843, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925290

RESUMO

Structured residency programmes within dedicated associations of hospitals, practices and medical care centres offer the opportunity to improve the quality of training and to increase the attractiveness of urology through fixed rotations of doctors in continued training. The implementation of such programmes is guided by the framework conditions of the respective location. Possible rotations range from andrology to paediatric urology and uro-gynaecology to interdisciplinary uro-oncology. An outpatient training period also offers the chance for a change of perspective and supports career orientation. Rotations in the interdisciplinary intermediate care unit offer the opportunity to become familiar with the care of complex disease processes, including the differential diagnostic assessment of abdominal diseases, which is important in urology. In summary, the diversity of urological training available can enable junior urologists to receive more individualised and targeted training by promoting multilayered, intersectoral as well as interprofessional training.


Assuntos
Andrologia , Internato e Residência , Urologia , Andrologia/educação , Criança , Educação Continuada , Humanos , Urologistas , Urologia/educação
12.
Rev Bras Ginecol Obstet ; 44(7): 654-659, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35940172

RESUMO

OBJECTIVE: Urodynamic studies (UDSs) are a set of tests that assess the storage and emptying of urine, and they are widely used by gynecologists and urologists in the management of urinary incontinence (UI), despite the discussion about its indications. The objectives of the present study were to verify whether UDSs are routinely used in the conservative and surgical approaches to female UI, their other clinical indications, and to compare the responses of Brazilian gynecologists and urologists. METHODS: The present is an opinion survey applied from August 2020 to January 2021 through a semistructured questionnaire about the clinical practice sent by e-mail to all participants. The responses were compared through statistical analyses. RESULTS: Of the 329 participants, 238 were gynecologists (72.3%) and 91, urologists (27.7%). Most gynecologists (73.5%) and urologists (86.6%) do not request UDSs before the conservative treatment of UI; but UDSs are indicated in the preoperative period of anti-incontinence surgeries. Most participants request UDSs in the initial approach to overactive bladder (gynecologists: 88.2%; urologists: 96.7%), and the urologist has greater chance to request this study (odds ratio [OR] = 3.9). For most participants, it is necessary to request uroculture before the UDSs. CONCLUSION: Most Brazilian gynecologists and urologists who participated in the present study do not request UDSs before the conservative treatment of UI, according to national and internacional guidelines, and often request it before the surgical treatment for female UI. The indication of this exam in the initial approach of idiopathic overactive bladder should be reviewed by the participants.


OBJETIVO: O estudo urodinâmico (EU) é um conjunto de exames que avalia o armazenamento e esvaziamento da urina, e é amplamente utilizado por ginecologistas e urologistas no manejo da incontinência urinária (IU), apesar das discussões sobre suas indicações. O objetivo deste estudo foi verificar se a urodinâmica é rotineiramente utilizada nas abordagens conservadora e cirúrgica da IU feminina, além de outras de suas indicações clínicas, e comparar as respostas de ginecologistas e urologistas brasileiros. MéTODOS: Trata-se de uma pesquisa de opinião, realizada entre agosto de 2020 e janeiro de 2021, por meio de questionário semiestruturado composto por perguntas sobre a prática clínica enviado por e-mail a todos os participantes. As respostas foram comparadas mediante análises estatísticas. RESULTADOS: Dos 329 participantes, 238 eram ginecologistas (72,3%) e 91, urologistas (27,7%). A maioria dos ginecologistas (73,5%) e urologistas (86,6%) não solicita EU antes do tratamento conservador da IU; mas o EU é indicado no pré-operatório de cirurgias para IU. A maioria dos participantes solicita EU na abordagem inicial da bexiga hiperativa (ginecologistas: 88,2%; urologistas: 96,7%), e os urologistas têm maior chance de solicitar esse exame (razão de chances [RC] = 3,9). Para a maioria dos entrevistados, é necessário solicitar urocultura junto com o EU. CONCLUSãO: A maioria dos ginecologistas e urologistas brasileiros que participaram deste estudo não solicita EU antes do tratamento conservador da IU, de acordo com as principais diretrizes nacionais e internacionais, e muitas vezes o solicita antes do tratamento cirúrgico da IU feminina. A indicação desse exame na abordagem inicial da bexiga hiperativa idiopática deve ser revista pelos participantes.


Assuntos
Ginecologia , Bexiga Urinária Hiperativa , Incontinência Urinária , Brasil , Feminino , Humanos , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Urodinâmica , Urologistas
13.
World J Urol ; 40(8): 2091-2098, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35776174

RESUMO

PURPOSE: To evaluate the current practice of percutaneous nephrolithotomy (PCNL), conducting a worldwide survey among urologists with a special interest in endo-urology. METHODS: A 22-question survey was specifically developed by the European Association of Urology (EAU) young academic urologists (YAU) and uro-technology (ESUT) groups and globally distributed via SurveyMonkey to almost 2000 members of Endourology Society. The questionnaire included questions dedicated to the demographics and general practice of the participating urologists. RESULTS: In total, 441 responses (male/female ratio - 418/23) were received. A comparatively higher percentage of specialists (56.2%) practiced in academic institutions and had specific endo-urological fellowship training (56.7%). The classical prone PCNL remained the most practiced approach among the surveyed specialists, 47.7% stated to always do prone PCNLs, while 51.8% of respondents used multiple positioning options as required. The PCNL tract was mostly performed by urologists (84.3%) and fluoroscopic guidance was still predominantly used by 74.5% of respondents. The most practiced tract dilation method was balloon dilator used by 42% of respondents. Most of the surveyed urologists had ultrasonic, pneumatic or laser lithotripsy devices in their armamentarium. The use of some form of post-procedural drainage was reported in 85.1% of respondents, whereas tubeless PCNL remained a fairly uncommon practice. CONCLUSION: The majority of urologists still use prone positioning, get their own access under fluoroscopy guidance and use a balloon for tract dilation. However, we also identified that when necessary, urologists will deviate from routine practice and change strategy, adopting other approaches for PCNL.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Urologia , Feminino , Humanos , Masculino , Nefrostomia Percutânea/métodos , Padrões de Prática Médica , Urologistas , Urologia/educação
14.
World J Urol ; 40(9): 2331-2338, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35831471

RESUMO

PURPOSE: To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. METHODS: Data from 235 patients who underwent vamPCNL were analysed. Patient's demographics, stones' characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy's score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). RESULTS: iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy's score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. CONCLUSION: One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Cirurgiões , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Urologistas
15.
Med Care ; 60(9): 665-672, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35880758

RESUMO

BACKGROUND: Vertical and horizontal integration among health care providers has transformed the practice arrangements under which many physicians work. OBJECTIVE: To examine the influence of type of practice structure, and by implication the financial incentives associated with each structure, on treatment received among men newly diagnosed with low-risk prostate cancer. RESEARCH DESIGN: We compiled a unique database from cancer registry records from 4 large states, Medicare enrollment and claims for the years 2005-2014 and SK & A physician surveys corroborated by extensive internet searches. We estimated a multinomial logit model to examine the influence of urologist practice structure on type of initial treatment received. RESULTS: The probability of being monitored with active surveillance was 7.4% and 4.2% points higher for men treated by health system and nonhealth system employed urologists ( P <0.01), respectively, in comparison to men treated by single specialty urology practices. Among multispecialty practices, the rate of active surveillance use was 3% points higher compared with single specialty urology practices( P <0.01). Use of intensity modulated radiation therapy among urologists with ownership in intensity modulated radiation therapy was 17.4% points higher compared with urologists working in small single specialty practices. CONCLUSIONS: Physician practice structure attributes are significantly associated with type of treatment received but few studies control for such factors. Our findings-coupled with the observation that urologist practice structure shifted substantially over this time period due to mergers of small urology groups-provide one explanation for the limited uptake of active surveillance among men with low-risk disease in the US.


Assuntos
Neoplasias da Próstata , Urologia , Idoso , Humanos , Masculino , Medicare , Padrões de Prática Médica , Neoplasias da Próstata/diagnóstico , Estados Unidos , Urologistas
17.
PLoS One ; 17(6): e0269827, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35700180

RESUMO

INTRODUCTION: Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. MATERIALS AND METHODS: To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. RESULTS: A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. CONCLUSION: While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.


Assuntos
COVID-19 , Neoplasias da Próstata , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/radioterapia , Inquéritos e Questionários , Urologistas
18.
BMC Urol ; 22(1): 86, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35706024

RESUMO

BACKGROUND: Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed to report knowledge, attitudes, and practices (KAP) of AS for PCa among urologists in Brazil. METHODS: This cross-sectional study used a questionnaire with 50 questions divided into participant characteristics, knowledge regarding inclusion criteria for AS, follow-up, intervention triggers, acceptance, and practice for an index patient. Data analysis comprises absolute and relative frequencies of the variables. After that, a logistic regression was performed in order to verify possible patterns of answers provided by the respondents in the index patient questionnaire. RESULTS: Questionnaires were sent through the SurveyMonkey® platform to 5,015 urologists using email addresses and through social media. A total of 600 (12%) questionnaires returned and 413 (8.2%) were completed and included in the analysis. Only 53% of urologists adopt AS for low- and very-low-risk PCa. Inclusion criteria were patients with age > 50 years (32.2%), prostate specific antigen (PSA) < 10 ng/mL (87.2%), T1 clinical stage (80.4%), Biopsy Gleason score ≤ 6, positive cores ≤ 2 (44.3%), positive core involvement < 50% (45.3%), and magnetic resonance imaging findings (38.7%). The PSA doubling time was still used by 60.3%. Confirmatory biopsy (55.9%), PSA level (36.6%), and digital rectal examination (34.4%) were considered by most urologists for follow-ups. Patient preference (85.7%), upgrade of Gleason score (73.4%), and increased number of positive cores (66.8%) were associated with conversion to definitive treatment. In an index patient, non-acceptance and active treatment request were the most cited reasons for not performing AS. CONCLUSION: There is significant variability in the KAP of AS in Brazil, which indicates the need to reinforce AS, its inclusion and follow-up criteria, and the benefits for physicians and the general population. TRIAL REGISTRATION: Not applicable.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Brasil , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Inquéritos e Questionários , Urologistas , Conduta Expectante/métodos
19.
J Endourol ; 36(9): 1168-1176, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35521646

RESUMO

Purpose: Retrograde intrarenal surgery (RIRS) requires urologists to adopt an awkward body posture for long durations. Few urologists receive training in ergonomics despite the availability of ergonomic best practices utilized by other surgical specialties. We characterize ergonomic practice patterns and rates of musculoskeletal (MSK) pain among urologists performing RIRS. Methods: A web-based survey was distributed through the Endourological Society, the European Association of Urology, and social media. Surgeon anthropometrics and ergonomic factors were compared with ergonomic best practices. Pain was assessed with the Nordic Musculoskeletal Questionnaire (NMQ). Results: Overall, 519 of 526 participants completed the survey (99% completion rate). Ninety-three percent of urologists consider ergonomic factors when performing RIRS to reduce fatigue (68%), increase performance (64%), improve efficiency (59%), and reduce pain (49%). Only 16% received training in ergonomics. Residents/fellows had significantly lower confidence in ergonomic techniques compared with attending surgeons with any career length. Adherence to proper ergonomic positioning for modifiable factors was highly variable. On the NMQ, 12-month rates of RIRS-associated pain in ≥1 body part, pain limiting activities of daily living (ADLs), and pain requiring medical evaluation were 81%, 51%, and 29%, respectively. Annual case volume >150 cases (odds ratio [OR] 0.55 [0.35-0.87]) and higher adherence to proper ergonomic techniques (OR 0.67 [0.46-0.97]) were independently associated with lower odds of pain. Limitations include a predominantly male cohort, which hindered the ability to assess gender disparities in pain and ergonomic preferences. Conclusions: Adherence to ergonomic best practices during RIRS is variable and may explain high rates of MSK pain among urologists. These results underscore the importance of utilizing proper ergonomic techniques and may serve as a framework for establishing ergonomic guidelines for RIRS.


Assuntos
Doenças Musculoesqueléticas , Dor Musculoesquelética , Doenças Profissionais , Atividades Cotidianas , Ergonomia/métodos , Feminino , Humanos , Masculino , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/prevenção & controle , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Inquéritos e Questionários , Urologistas
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