Search

Introduction: To describe the medium-term outcome of robotic augmentation ileocystoplasty by posterior and anterior approaches in the management of contracted low-capacity bladder from cystitis. Materials and Methods: Data on consecutive cases of robotic augmentation ileocystoplasty between 2011 and 2021 were prospectively collected and reviewed in our center. Retzius-sparing posterior approach was performed by anastomosis of an M-configuration small bowel plate to the posteriorly located U-shaped cystostomy. Conventional anterior augmentation ileocystoplasty was performed by anastomosis of an S-configuration small bowel plate to the anterior cystostomy. The procedure was as per conventional robotic pelvic surgery setting with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Perioperative data and postoperative complications were assessed. Preoperative and postoperative functional outcomes were compared. Results: Six patients underwent posterior augmentation cystoplasty and 20 patients underwent anterior augmentation cystoplasty with a mean follow-up of 51 ± 26 months. Mean operative time was 274 ± 113 minutes and 267 ± 102 minutes, respectively ( p = 0.889), and mean hospital stay was 9.0 ± 9.6 days and 8.3 ± 6.1 days, respectively ( p = 0.831). Additional procedures include eight ureteral reimplantations and one ileal interposition. Mean functional bladder capacity (FBC) at 2 years of the two approaches were similar, which were 350.2 ± 126.3 mL (posterior approach) and 310.2 ± 151.4 mL (anterior approach) ( p = 0.5936). Overall, FBC before the operation and at 24 months was 68.9 ± 48.2 mL and 318.5 ± 144.8 mL ( p = <0.0001), respectively. Analgesic requirement was decreased after the operation (preoperative 19 patients, postoperative 4 patients; p < 0.0001). Conclusions: Posterior approach of robotic augmentation ileocystoplasty provided an alternate option to expand the bladder capacity for patients with a small contracted bladder. It could provide a similar symptom relief and functional improvement as the anterior approach. The clinical trial number is CRE-2011.454.

Introduction: Kidney cancer, primarily renal cell carcinoma (RCC), ranks among the top 10 most common malignancies in the male population of Hong Kong. In 2019, members of two medical societies in Hong Kong formed an expert panel to establish a set of consensus statements for the management of metastatic RCC. On 22 June 2021, the same panel met to review recent evidence and reassess their positions regarding the management of advanced and metastatic RCC, with the aim of providing recommendations for physicians in Hong Kong., Participants: The panel included 12 experts (6 clinical oncologists and 6 urologists) who had extensive experience managing patients with RCC in Hong Kong., Evidence: The panel reviewed randomised controlled trials, observational studies, systematic reviews/meta-analyses, and international clinical guidelines to address key clinical questions that were identified before the meeting., Consensus Process: In total, 15 key clinical questions were identified before the meeting, covering the surgical and systemic treatment of advanced or metastatic clear cell, sarcomatoid, and non-clear cell RCCs. At the meeting, the panellists voted on these questions, then discussed relevant evidence and practical considerations., Conclusions: The treatment landscape for advanced and metastatic RCC continues to evolve. More immune checkpoint inhibitor (ICI)-based combination regimens will be indicated for the treatment of metastatic clear cell RCC. There is increasing evidence concerning the benefit of adjuvant ICI treatment for resected advanced RCC. This article summarises recent evidence and expert insights regarding a series of key clinical questions about the management of advanced and metastatic RCC., Competing Interests: All authors have disclosed no conflicts of interest.

Background: Public or patient versions of guidelines (PVGs) are derivative documents that "translate" recommendations and their rationale from clinical guidelines for health professionals into a more easily understandable and usable format for patients and the public. PVGs from different groups and organizations vary considerably in terms of quality of their reporting. In order to address this issue, we aimed to develop a reporting checklist for developers of PVGs and other potential users., Methods: First, we collected a list of potential items through reviewing a sample of PVGs, existing guidance for developing and reporting PVGs or other similar evidence-based patient tools, as well as qualitative studies on original studies of patients' needs about the content and/or reporting of information in PVGs or similar evidence-based patient tools. Second, we conducted a two-round Delphi consultation to determine the level of consensus on the items to be included in the final reporting checklist. Third, we invited two external reviewers to provide comments on the checklist., Results: We generated the initial list of 45 reporting items based on a review of a sample of 30 PVGs, four PVG guidance documents, and 46 relevant studies. After the two-round Delphi consultation, we formed a checklist of 17 items grouped under 12 topics for reporting PVGs., Conclusion: The RIGHT-PVG reporting checklist provides an international consensus on the important criteria for reporting PVGs.

Introduction: Blood loss in Total Joint Arthroplasty can be significant and often under-estimated. This study aims to investigate the safety and efficacy of different routes of tranexamic acid (TXA) administration in reducing blood transfusion after Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). The secondary aim is to find the safest and most efficacious route and dose of TXA., Material and Methods: PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, and OpenGrey were systemically searched for randomised controlled trials investigating the efficacy and/or safety of TXA for THA and/or TKA. Network meta-analysis, comparing the number of transfusion and deep vein thrombosis (DVT) among different interventions, was performed using a multivariate meta-regression model with random-effects, adopting a frequentist approach., Results: 211 publications (20,639 individuals) were included. For outcome of transfusion, all interventions showed significantly lower transfusion rates compared to placebo. When compared to placebo, TXA via intra-venous and topical showed statistically significant lowest risk ratio (RR = 0.11, 95CI: 0.03, 0.41). For safety, TXA via topical showed relatively lowest risk ratio (RR = 0.75, 95CI 0.44, 1.30). TXA via topical and intra-articular had the highest but statistically insignificant RR (RR = 1.10, 95%CI: 0.51, 2.38). Therefore, current studies did not reveal any significant safety issue in using TXA., Conclusion: All forms of TXA administration showed significantly lower transfusion rate compared to control. There is a trend towards better efficacy with intra-venous and topical. In patients with higher risk of thrombosis, physicians may consider topical alone for its best safety profile., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: It has been hypothesized that endothelial dysfunction and pelvic atherosclerosis may contribute to lower urinary tract symptoms (LUTS). We assessed the relationship between cardiovascular risk factors and LUTS severity in male patients presented to urology clinic., Methods: It is a cross-sectional study on patients who presented between 2013 and 2015 with LUTS. A total of 1176 male patients were encountered, and 966 were included for analysis after excluding patients with urinary tract malignancy, urethral stricture, bladder stone and history of urinary tract surgery. Cardiovascular risk factors including components of Framingham risk score, body mass index, uroflowmetry, International Prostate Symptoms Score, fasting blood glucose and serum prostate-specific antigen (PSA) were assessed. Correlation between Framingham risk score, cardiovascular risk factors and severity of LUTS was investigated., Results: Multinomial logistic regression analysis showed that severe LUTS significantly associated with Framingham score (P = 0.008) and its components of total cholesterol (OR = 1.318; P = 0.010) and age (OR = 1.032; P = 0.006) compare with mild symptoms. Framingham risk score was found to correlate with storage symptoms (CC = 0.083; P < 0.0001) but not voiding symptoms (CC = - 0.029; P = 0.185)., Conclusions: Severity of LUTS and storage symptom significantly increases Framingham risk score, particularly with the components of total cholesterol level and age.

Objective: To evaluate the use of a new single-port robotic system, da Vinci SP (Intuitive Surgical, Sunnyvale, CA) in performing retzius-sparing radical prostatectomy in a cadaveric model., Methods: A cadaver was placed in supine position on operating table. A 4-cm skin incision was made above the umbilicus for insertion of the robotic port via a GelPoint Mini Advanced Access Platform (Applied Medical, Rancho Santa Margarita, CA). An additional 10-mm assistant port was inserted in the right lower quadrant. The operating table was then placed at a 30° Trendelenburg position and the robotic system was docked. The robotic endoscopic camera was set to pass in at the 6 o'clock to facilitate upward viewing during surgery. The parietal peritoneum was incised at the anterior surface of the rectovesical pouch. Vas deferens and seminal vesicles were dissected. Posterior dissection was performed till the prostatic apex. Lateral dissection was then performed with division of the prostatic pedicles. The dissection was continued distally and anteriorly until reaching the apical region. The lateral contour of the prostate was defined. The vesicoprostatic junction was identified by careful dissection of the perivesical fat and following the contour of the lateral prostatic surface. Bladder neck was identified and incised. Prostate was then retracted downward and the anterior prostatic surface was dissected. Finally, urethra was divided just distal to prostatic apex after urethra catheter withdrew. The vesicourethral anastomosis was completed with 2 barbed sutures., Result: The procedure was completed without conversion and the total robotic surgical time was 146 minutes., Conclusion: The use of da Vinci SP system (Intuitive Surgical, Sunnyvale, CA) for retzius sparing radical prostatectomy was feasible. The flexible robotic camera provides additional benefit in viewing the operating field, in particular during the posterior dissection, bladder dissection, and anastomosis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Lower urinary tract symptoms (LUTS) have a strong effect on socio-economic and individual quality of life. The aim of the present study was to investigate the prevalence of LUTS in an Asian population., Methods: A telephone survey of individuals aged ≥40 years and of Chinese ethnicity was conducted. The survey included basic demographics, medical and health history, drinking habits, International Prostate Symptom Score, overactive bladder symptom score, Patient Health Questionnaire (PHQ-9) score, and Short Form (SF)-12v2 score., Results: From March to May 2017, 18 881 calls were made, of which 1543 fulfilled the inclusion criteria. In the end, 1000 successful respondents were recruited (302 men and 698 women). Age-adjusted prevalence of overactive bladder syndrome was 15.1%. The older the respondent, the more prevalent the storage symptoms and voiding symptoms (storage symptoms: r =0.434, P<0.001; voiding symptom: r =0.190, P<0.001). Presence of hypertension and diabetes were found to be significantly and positively correlated with storage and voiding symptoms. Storage and voiding symptoms were found to affect PHQ-9 scores (storage symptoms: r =0.257, P<0.001; voiding symptoms: r =0.275, P<0.001) and SF-12v2 scores (storage symptoms: r =0.467, P<0.001; voiding symptoms: r =0.335; P<0.001). Nocturia was the most prominent symptom among patients who sought medical help for their LUTS., Conclusions: Lower urinary tract symptoms are common in Asian populations. Both storage and voiding symptoms have a negative impact on mental health and general well-being of individuals., Competing Interests: The authors have no conflicts of interest to disclose.

Purpose: Traditionally, transurethral resection of bladder tumors (TURB) is performed using monopolar technique. Bipolar resection has been postulated to reduce complications. In this study we compare safety and efficacy between monopolar TURB (mTURB) and bipolar TURB (bTURB) for patients with primary non-muscle invasive bladder cancer (NMIBC)., Materials and Methods: Data were obtained from an international multicenter randomized clinical trial that compared the use of white light cystoscopy with narrow band imaging-assisted TURB using the Olympus system between 2010 and 2014. Main outcomes of interest were operative time, perioperative, and postoperative complications, and 12-month recurrence-free survival., Results: In total, 716 patients were treated for primary NMIBC with mTURB (310 patients) or bTURB (406 patients). The use of white light cystoscopy or narrow band imaging was equally distributed between the 2 resection techniques. Multilevel logistic and linear regression corrected for possible confounders showed no significant difference between mTURB and bTURB for postoperative complications (OR = 1.76, P = 0.180), postoperative bleeding (OR = 1.27, P = 0.722), and the combination of intra + postoperative bleeding (OR = 1.992, P = 0.108). Additionally, no significant difference was found between mTURB and bTURB concerning operative time (1.05min. longer for bTURB, P = 0.536), intraoperative bleeding requiring intervention (OR:1.38, P=0.809), incidence of obturator reflex (OR = 0.93, P = 0.854), and bladder perforation (OR = 3.05, P = 0.195). In total, 185 patients (25.8%) developed a recurrence (mTURB = 88, bTURB = 97). Recurrence-free survival at 12 months in the mTURB and bTURB group was 70% and 74% (P = 0.410), respectively., Conclusion: Based on these results, bTURB is as safe and effective as mTURB in treatment of primary NMIBC. bTURB seems to have no evident advantages over mTURB with respect to operation time, perioperative and postoperative complication rates, and recurrence rates at 12 months., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. A checklist and an explanation and elaboration statement were developed. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline., (Copyright © 2017. Published by Elsevier GmbH.)

Background: To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD)., Methods: PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels., Results: 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54)., Conclusion: "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Cytosolic DNA-mediated activation of the transcription factor IRF3 is a key event in host antiviral responses. Here we found that infection with DNA viruses induced interaction of the metabolic checkpoint kinase mTOR downstream effector and kinase S6K1 and the signaling adaptor STING in a manner dependent on the DNA sensor cGAS. We further demonstrated that the kinase domain, but not the kinase function, of S6K1 was required for the S6K1-STING interaction and that the TBK1 critically promoted this process. The formation of a tripartite S6K1-STING-TBK1 complex was necessary for the activation of IRF3, and disruption of this signaling axis impaired the early-phase expression of IRF3 target genes and the induction of T cell responses and mucosal antiviral immunity. Thus, our results have uncovered a fundamental regulatory mechanism for the activation of IRF3 in the cytosolic DNA pathway.

Background: Bupivacaine is an amide local anesthetic used in hyperbaric and plain forms administered as spinal anesthesia for cesarean delivery. In this systematic review, we summarized the effectiveness and safety of hyperbaric versus plain bupivacaine in providing anesthesia for cesarean delivery. We considered the adequacy of anesthesia for completion of cesarean delivery and the need for interventions to treat complications., Methods: We searched the CENTRAL, MEDLINE, and EMBASE databases. We imposed no language restriction. We included all randomized controlled trials involving patients undergoing spinal anesthesia for elective cesarean delivery that compared the use of hyperbaric bupivacaine with plain bupivacaine., Results: We included 6 studies with a total of 394 patients in this review. These studies have small sample size, few observed events, differences in methodology, and insufficient information pertaining to assessment of risk of bias. This prevented us from calculating pooled estimates. Results show that there is no compelling evidence in favor of the use of intrathecal plain or hyperbaric bupivacaine for spinal anesthesia for cesarean delivery., Conclusions: There is a lack of clear evidence regarding the superiority of hyperbaric compared with plain bupivacaine for spinal anesthesia for cesarean delivery. The need for conversion to general anesthesia because of failed spinal anesthesia is an important clinical outcome, but current data are insufficient to compare spinal anesthesia induced with hyperbaric compared with plain bupivacaine for this outcome. Further research is required.