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1.
World J Urol ; 42(1): 306, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38722445

RESUMO

PURPOSE: The question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort. METHODS: Patients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume ("PV"), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo ("CD") classification. RESULTS: We included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients' larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation's results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01). CONCLUSIONS: While aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.


Assuntos
Técnicas de Ablação , Lasers de Estado Sólido , Hiperplasia Prostática , Humanos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , Masculino , Idoso , Estudos Prospectivos , Lasers de Estado Sólido/uso terapêutico , Pessoa de Meia-Idade , Técnicas de Ablação/métodos , Terapia a Laser/métodos , Prostatectomia/métodos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Água , Resultado do Tratamento
2.
BMC Med Inform Decis Mak ; 24(1): 136, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38802886

RESUMO

BACKGROUND: The selection of data elements is a decisive task within the development of a health registry. Having the right metadata is crucial for answering the particular research questions. Furthermore, the set of data elements determines the registries' readiness of interoperability and data reusability to a major extent. Six health registries shared and published their metadata within a German funding initiative. As one step in the direction of a common set of data elements, a selection of those metadata was evaluated with regard to their appropriateness for a broader usage. METHODS: Each registry was asked to contribute a 10%-selection of their data elements to an evaluation sample. The survey was set up with the online survey tool "LimeSurvey Cloud". The registries and an accompanying project participated in the survey with one vote for each project. The data elements were offered in content groups along with the question of whether the data element is appropriate for health registries on a broader scale. The question could be answered using a Likert scale with five options. Furthermore, "no answer" was allowed. The level of agreement was assessed using weighted Cohen's kappa and Kendall's coefficient of concordance. RESULTS: The evaluation sample consisted of 269 data elements. With a grade of "perhaps recommendable" or higher in the mean, 169 data elements were selected. These data elements belong preferably to groups' demography, education/occupation, medication, and nutrition. Half of the registries lost significance compared with their percentage of data elements in the evaluation sample, one remained stable. The level of concordance was adequate. CONCLUSIONS: The survey revealed a set of 169 data elements recommended for health registries. When developing a registry, this set could be valuable help in selecting the metadata appropriate to answer the registry's research questions. However, due to the high specificity of research questions, data elements beyond this set will be needed to cover the whole range of interests of a register. A broader discussion and subsequent surveys are needed to establish a common set of data elements on an international scale.


Assuntos
Sistema de Registros , Sistema de Registros/normas , Alemanha , Humanos , Inquéritos e Questionários , Metadados
3.
World J Urol ; 37(7): 1353-1360, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30283994

RESUMO

INTRODUCTION: Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies. MATERIALS AND METHODS: We investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012-06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery. RESULTS: Of 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2-7) UroLift implants were implanted in patients of 38-85 years with a prostate size of 17-111 ml over 57 (42-90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien-Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up. CONCLUSION: PUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Hiperplasia Prostática/cirurgia , Implantação de Prótese , Obstrução Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alemanha , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Qualidade de Vida , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata , Obstrução Uretral/etiologia
4.
Urol Int ; 102(2): 187-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30481771

RESUMO

BACKGROUND: The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS). OBJECTIVE: To determine risk factors for the various PULS-grades caused by URS. METHOD: We prospectively investigated the independent influence of various risk factors in correlation with PULS-Grade 1+ and 2+ on 307 patients with ureterorenoscopic stone treatment from 14 German urologic departments. RESULTS: The following are the outcomes of the study: 117 (38.4%) and 188 (61.6%) of the calculi (median stone size 6 mm) were found in the kidney or ureter; 70% and 82.4% underwent preoperative or postoperative ureteral stenting; 44.3 and 7.2% received laser or ballistic lithotripsy; 60% of the patients presented with PULS grade 1+ and 8% with PULS grade of 2+. Only intracorporal lithotripsy revealed a significant independent risk factor for PULS grade 1+ or 2+. Both laser and ballistic therapies raised the probability of PULS grade 1+ by the factors 3.6 (p < 0.001) and 3.9 (p = 0.021), respectively. The ORs in conjunction with PULS grade 2+ were 3.1 (p = 0.038) and 5.8 (p = 0.014) respectively. Neither endpoint exhibited a significant difference regarding the lithotripsic procedure (laser vs. ballistic). CONCLUSION: Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.


Assuntos
Doença Iatrogênica , Cálculos Renais/cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Ureter/lesões , Cálculos Ureterais/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Adulto , Idoso , Benchmarking , Feminino , Alemanha , Humanos , Cálculos Renais/diagnóstico , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Intervalo Livre de Progressão , Estudos Prospectivos , Fatores de Risco , Stents , Fatores de Tempo , Cálculos Ureterais/diagnóstico , Ureteroscopia/instrumentação , Ureteroscopia/normas
5.
Urologie ; 62(11): 1144-1152, 2023 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-37702750

RESUMO

The substantial reduction of radiation exposure using (ultra-)low dose programs in native computed tomographic imaging has led to considerable changes in imaging diagnostics and treatment planning in urolithiasis in recent years. In addition, especially in Germany, ultrasound diagnostics is highly available in terms of equipment and with increasing expertise. This can largely replace the previous radiation-associated procedures in emergency and follow-up diagnostics, but also in intraoperative imaging, e.g., in percutaneous stone therapy (intraoperative fluoroscopy). This is reflected in the international guidelines, which recommend these two modalities as first-line diagnostics in all areas mentioned. Continuous technical development enables ever higher resolution imaging and thus improved diagnostics with high sensitivity and specificity. This also enables reliable imaging of particularly vulnerable patient groups, such as children or pregnant women. In addition, methods from the field of artificial intelligence (AI; machine learning, deep learning) are increasingly being used for automated stone detection and stone characterization including its composition. Furthermore, AI models can provide prognosis models as well as individually tailored treatment, follow-up, and prophyaxis. This will enable further personalization of diagnostics and therapy in the field of urolithiasis.


Assuntos
Exposição à Radiação , Urolitíase , Gravidez , Criança , Humanos , Feminino , Inteligência Artificial , Urolitíase/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia
6.
Stud Health Technol Inform ; 289: 25-28, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35062083

RESUMO

The FAIR Guiding Principles do not address the quality of data and metadata. Therefore, data collections could be FAIR but useless. In a funding initiative of registries for health services research, trueness of data received special attention. Completeness in the definition of recall was selected to represent this dimension in a cross-registry benchmarking. The first analyses of completeness revealed a diversity of its implementation. No registry was able to present results exactly as requested in a guideline on data quality. Two registries switched to a source data verification as alternative, the three others downsized to the dimension integrity. The experiences underline that the achievement of appropriate data quality is a matter of costs and resources, whereas the current Guiding Principles quote for a transparent culture regarding data and metadata. We propose the extension to FAIR-Q, data collections should not only be findable, accessible, interoperable, and reusable, but also quality assured.


Assuntos
Confiabilidade dos Dados , Metadados , Pesquisa sobre Serviços de Saúde , Sistema de Registros
7.
J Endourol ; 34(10): 1015-1020, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32475165

RESUMO

Objectives: Due to the increasing fragility of the instruments and rising concerns about the sterility of reprocessable scopes, several single-use devices for flexible ureteroscopy have been introduced. In this study, we compare currently available disposable digital and fiberoptic flexible ureteroscopes with a contemporary reusable fiberoptic device. Materials and Methods: LithoVue™, Pusen Uscope® (UE3011, UE3022), Flexor®Vue™, and a reusable fiber optic flexible ureteroscope (BOA vision®) were tested in kidney models. The setup included (1) visualization of all calices (correct assignment of colored pearls) and (2) the extraction of human calculi with a standard disposable extraction device (NGage®). We documented the effective visualization, stone extraction, and times to completion. In addition, the surgeons' workload and performance were determined using the National Aeronautics and Space Administration-Task Load Index. Results: In visualizing and identifying calices, the LithoVue and both generations of the Uscope performed similarly, but time to completion was significantly longer for all single-use devices in comparison with the Boa Vision. LithoVue retracted stones almost as well as the reusable scope (97% vs 95%/82%/96% stone clearance), while accessibility was impeded using Uscope UE3011, as reflected by the retrieval time per stone (73 vs 102 seconds/stone). This disadvantage has, however, been overcome with the new Uscope Generation UE3022, showing a retrieval time of only 65 seconds per stone, excelling over the reusable scope in this category. The Uscope UE3022 image quality was also rated best, but showed no significant difference. Conclusions: In comparison with disposable ureteroscopes available, LithoVue offers performance and characteristics similar to a reusable device, while the FlexorVu's performance does not yet yield satisfactory results for clinical use. The first generation of Uscope exhibits potential, but requires further technical improvements to match the performance of a reusable device. With the new-generation UE3022, Pusen has made significant improvement and offers a quality comparable with the LithoVue's.


Assuntos
Cálculos Renais , Ureteroscópios , Desenho de Equipamento , Humanos , Rim , Ureteroscopia
8.
Aktuelle Urol ; 50(1): 56-62, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30541155

RESUMO

Flexible ureteroscopy (fURS) has become a success story in urology. Since its implementation into the treatment of urolithiasis, fURS has demonstrated excellent clinical performance and safety. In recent years, the spread of disposable ureteroscopes has shaped the field of endoscopic stone treatment. However, the primary advantage of these devices is that they improve the workflow in urology theatres (no sterilisation, no repair costs) and possibly minimise bacteria transfer in working channels rather than being a real technological "game changer". Novel disruptive improvements such as automatic laser lithotripsy or intrarenal pressure and temperature control in real time are still waiting to enter the clinical routine. These innovations might take fURS to the next level and disruptively change endoscopic stone treatment.


Assuntos
Cálculos Renais/terapia , Ureteroscopia/métodos , Humanos , Lasers de Estado Sólido/uso terapêutico , Ureteroscópios , Ureteroscopia/instrumentação , Urolitíase
9.
Arab J Urol ; 12(1): 58-61, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26019925

RESUMO

OBJECTIVE: To define the learning curve of robot-assisted laparoscopic surgery for prostatectomy (RALP) and upper tract procedures, and show the differences between the classical approach to training and the new concept of parallel learning. METHODS: This mini-review is based on the results of a Medline search using the keywords 'da Vinci', 'robot-assisted laparoscopic surgery', 'training', 'teaching' and 'learning curve'. RESULTS: For RALP and robot-assisted upper tract surgery, a learning curve of 8-150 procedures is quoted, with most articles proposing that 30-40 cases are needed to carry out the procedure safely. There is no consensus about which endpoints should be measured. In the traditional proctored training model, the surgeon learns the procedure linearly, following the sequential order of the surgical steps. A more recent approach is to specify the relative difficulty of each step and to train the surgeon simultaneously in several steps of equal difficulty. The entire procedure is only performed after all the steps are mastered in a timely manner. Recently, a 'warm-up' before robotic surgery has been shown to be beneficial for successful surgery in the operating room. CONCLUSION: There is no clear definition of the duration of the effective learning curve for RALP and robotic upper tract surgery. The concept of stepwise, parallel learning has the potential to accelerate the learning process and to make sure that initial cases are not too long. It can also be assumed that a preoperative 'warm up' could help significantly to improve the progress of the trainee.

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