424 results on '"Fundación Puigvert"'
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2. Appropriateness of the dialysis modality selection process: A cross-sectional study
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Salas-Gama, Karla, Díaz Gómez, Juan Manuel, Bolibar i Ribas, Ignasi, Universitat Autònoma de Barcelona, Institut Català de la Salut, [Salas-Gama K] Direcció de Qualitat, Processos i Innovació, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Unitat Docent de Medicina Preventiva i Salut Pública, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. PhD candidate at the Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Barcelona, Spain. [Díaz-Gómez JM] Nephrology Department, Fundación Puigvert, IIB Sant Pau, Barcelona, Spain. Medicine Department, Universitat de Vic (UVic-UCC), Vic, Spain. [Bolíbar Ribas I] Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Barcelona, Spain. Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Adult ,Male ,Peritoneal dialysis ,Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Renal Insufficiency, Chronic::Kidney Failure, Chronic [DISEASES] ,Underuse ,Renal Dialysis ,Chronic kidney disease ,Humans ,Appropriateness ,Therapeutics::Renal Replacement Therapy::Renal Dialysis [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Otros calificadores::/terapia [Otros calificadores] ,Aged ,Aged, 80 and over ,terapéutica::tratamiento de reemplazo renal::diálisis renal [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Diàlisi ,General Medicine ,Other subheadings::/therapy [Other subheadings] ,Middle Aged ,Cross-Sectional Studies ,Renal replacement treatment ,Nephrology ,enfermedades urogenitales masculinas::enfermedades urológicas::enfermedades renales::insuficiencia renal::insuficiencia renal crónica::fallo renal crónico [ENFERMEDADES] ,Kidney Failure, Chronic ,Female ,Peritoneal Dialysis ,Insuficiència renal crònica - Tractament - Abstract
Dialysis; Peritoneal dialysis Diálisis; Diálisis peritoneal Diàlisi; Diàlisi peritoneal Studies that specifically quantify the appropriateness of the process of dialysis modality selection are lacking. Peritoneal dialysis (PD) offers clinical and social advantages over hemodialysis (HD), but may be underused. We aimed to determine the appropriateness of the process of dialysis modality selection and quantify the percentage of patients who could potentially have been PD candidates. We performed a cross-sectional study that included adult patients from a hospital Nephrology Department in Barcelona who started dialysis between 2014 and 2015. We assessed the appropriateness of dialysis modalities selection by defining 3 sequential domains based on 3 critical steps in choosing a dialysis modality: eligibility for either treatment, information about modalities, and shared decision-making. We obtained data using medical records and a patient questionnaire. The dialysis modality selection process was considered appropriate when patients had no contraindications for the selected option, received complete information about both modalities, and voluntarily chose the selected option. A total of 141 patients were included in this study. The median age was 72 years (interquartile range 63–82 years), and 65% of the patients were men. The dialysis modality selection process was potentially inappropriate in 22% of the participants because of problems related to information about dialysis modalities (15%) or shared decision-making (7%). Appropriate PD use can potentially increase from 17% to 38%. Patient age and lack of information regarding dialysis options were independently associated with the potential degree of inappropriate dialysis modality selection. Our findings indicate areas for improvement in the selection of dialysis modalities. With better education and shared decision-making, the number of patients with PD could potentially double. The analysis of appropriateness is a helpful approach for studying renal replacement treatment patterns and identifying strategies to optimize their use.
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- 2022
3. Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal
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López, Verónica, Vázquez, Teresa, Alonso-Titos, Juana, Cabello, Mercedes, Alonso, Angel, Beneyto, Isabel, Crespo, Marta, Díaz-Corte, Carmen, Franco, Antonio, González-Roncero, Francisco, Gutiérrez, Elena, Guirado, Luis, Jiménez, Carlos, Jironda, Cristina, Lauzurica, Ricardo, Llorente, Santiago, Mazuecos, Auxiliadora, Paul, Javier, Rodríguez-Benot, Alberto, Ruiz, Juan Carlos, Sánchez-Fructuoso, Ana, Sola, Eugenia, Torregrosa, Vicente, Zárraga, Sofía, Hernández, Domingo, Grupo de Estudio GREAT, Grupo de Estudio GREAT (Grupo Español de Actualizaciones en Trasplante), [López,V, Vázquez,T, Alonso-Titos,J, Cabello,M, Gutiérrez,E, Jironda,C, Sola,E, Hernández,D] Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), REDinREN (RD16/0009/0006), Málaga, Spain. [Alonso,A] Servicio de Nefrologia, Complejo Hospitalario A Coruña, Spain. [Beneyto,I] Servicio de Nefrología, Hospital Universitario Politécnico La Fe, Valencia, Spain. [Crespo,M, Díaz-Corte,C] Servicio de Nefrología, Hospital del Mar, Barcelona, España, Servicio de Nefrología, Hospital Central de Asturias, REDinREN RD16/0009/0021, Asturias, Spain. [Franco,A] Servicio de Nefrología, Hospital de Alicante, Alicante, Spain. [González-Roncero,F] Servicio de Nefrología, Hospital Virgen del Rocío, Sevilla, Spain. [Guirado,L] Servicio de Nefrología, Fundación Puigvert, REDinREN RD16/0009/0019, Barcelona, Spain. [Jiménez,C] Servicio de Nefrología, Hospital La Paz, Madrid, Spain. [Lauzurica,R] Servicio de Nefrología, Hospital Trias i Pujol, REDinREN RD16/0009/0032, Barcelona, Spain. [Llorente,S] Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain. [Mazuecos,A] Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain. [Paul,J] Servicio de Nefrología, Hospital Miguel Servet, Zaragoza, Spain. [Rodríguez-Benot,A] Servicio de Nefrología, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain. [Ruiz,JC] Servicio de Nefrología, Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, Spain. [Sánchez-Fructuoso,A] Servicio de Nefrología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain. [Torregrosa,V] Servicio de Nefrología, Hospital Clinic, Barcelona, Spain. [Zárraga,S] Servicio de Nefrología, Hospital de Cruces, Bilbao, Spain., Este artículo fue financiado en parte por el Ministerio de Economía, Industria y Competitividad de España, del ISCIII (PI17/02043), cofinanciado por el Fondo Europeo de Desarrollo Regional-FEDER, RETIC (REDinREN RED16/0009/0006, RD16/0009/0021, RD16/0009/0019, RD16/0009/0027, and RD16/0009/0032.
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Phenomena and Processes::Immune System Phenomena::Immunocompromised Host [Medical Subject Headings] ,Anatomy::Urogenital System::Urinary Tract::Kidney [Medical Subject Headings] ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population ,030230 surgery ,lcsh:RC870-923 ,medicine.disease_cause ,Kidney transplant ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Kidney transplantation ,03 medical and health sciences ,0302 clinical medicine ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [Medical Subject Headings] ,Pandemic ,COVID-19 ,inmunodeprimido ,trasplante renal ,kidney transplantation ,immunosuppressed ,SARS-CoV-2 ,Medicine ,Vulnerable population ,030212 general & internal medicine ,education ,Coronavirus ,Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings] ,education.field_of_study ,Inmunodeprimido ,business.industry ,Health Care::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics [Medical Subject Headings] ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,Virology ,Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings] ,Trasplante renal ,Immunosuppressed ,Nephrology ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents [Medical Subject Headings] ,Covid-19 ,business - Abstract
The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients. Resumen: La pandemia por coronavirus SARS-CoV-2 (Covid-19) está evolucionando de manera muy rápida y representa un riesgo especial en pacientes inmunodeprimidos y con comorbilidades añadidas. El conocimiento sobre esta infección emergente va también en aumento, si bien, aún sigue habiendo muchas incógnitas, sobre todo en la población con trasplante renal. Este manuscrito presenta una propuesta de actuación con recomendaciones generales y específicas para proteger y prevenir de la infección a esta población tan vulnerable como son los receptores de un trasplante renal.
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- 2020
4. Cystinuria: clinical practice recommendation
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Servais, Aude, Thomas, Kay, Dello Strologo, Luca, Sayer, John A, Bekri, Soumeya, Bertholet-Thomas, Aurelia, Bultitude, Matthew, Capolongo, Giovanna, Cerkauskiene, Rimante, Daudon, Michel, Doizi, Steeve, Gillion, Valentine, Gràcia-Garcia, Silvia, Halbritter, Jan, Heidet, Laurence, van den Heijkant, Marleen, Lemoine, Sandrine, Knebelmann, Bertrand, Emma, Francesco, Levtchenko, Elena, Metabolic Nephropathy Workgroup of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Guy's and St Thomas NHS Foundation Trust [London], Children's Hospital Bambino Gesù IRCCS [Rome], University of the Study of Campania Luigi Vanvitelli, Vilnius University [Vilnius], Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'urologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Cliniques Universitaires Saint-Luc [Bruxelles], Fundación Puigvert [Barcelona, Spain], University of Leipzig [Leipzig, Allemagne], University Medical Center [Utrecht], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Lyon, Department of Development and Regeneration, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University Hospitals Leuven [Leuven], UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, CarMeN, laboratoire, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte [CHU-Necker] (MARHEA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Urologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Leipzig University, Servais, Aude, Thomas, Kay, Dello Strologo, Luca, A Sayer, John, Bekri, Soumeya, Bertholet-Thomas, Aurelia, Bultitude, Matthew, Capolongo, Giovanna, Cerkauskiene, Rimante, Daudon, Michel, Doizi, Steeve, Gillion, Valentine, Gràcia-Garcia, Silvia, Halbritter, Jan, Heidet, Laurence, van den Heijkant, Marleen, Lemoine, Sandrine, Knebelmann, Bertrand, Emma, Francesco, and Levtchenko, Elena
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Adult ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Consensus ,Urinary system ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,MEDLINE ,potassium citrate ,tiopronin ,Disease ,Kidney ,Nephropathy ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,cystinuria ,medicine ,Humans ,d-penicillamine ,urolithiasis ,Child ,cystine ,Cystinuria ,business.industry ,D-penicillamine ,Evidence-based medicine ,medicine.disease ,3. Good health ,[SDV] Life Sciences [q-bio] ,030104 developmental biology ,Systematic review ,Nephrology ,Quality of Life ,Cystine ,tiopronin and urolithiasis ,business - Abstract
Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary cystine excretion leads to the formation of cystine stones because of the low solubility of cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities), conservative treatment (hydration, dietetic, alkalinization, and cystine-binding drugs), follow-up, self-monitoring, complications (renal failure and hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with cystinuria, including diagnosis, surgery, and medical treatment. ispartof: KIDNEY INTERNATIONAL vol:99 issue:1 pages:48-58 ispartof: location:United States status: published
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- 2021
5. Infección por SARS-CoV-2: implicaciones para la salud sexual y reproductiva. Una declaración de posición de la Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA)
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García José, Ferran, Alvarez Gonzalez, Juan G., Corral Molina, Juan Manuel, Bassas Arnau, Lluis, Moncada Iribarren, Ignacio, Martínez Jabalovas, José María, Meijide Rico, Fernando, García-Baquero, Rodrigo, Rosselló Gayá, Mariano, Lledó García, Enrique, Luque López, Carmen, Prieto Castro, Rafael, Martínez Salamanca, Juan Ignacio, UAM. Departamento de Cirugía, and [García José,F] Unidad de Andrología. Instituto Marqués. Barcelona, España. [Álvarez González,JG] Centro Androgen, La Coruña, España. Harvard Medical School, Boston, EE.UU. [Corral Molina,JM] Servicio de Urología, Hospital Clínico de Barcelona. Barcelona, España. [Bassas Arnau,L] Fundación Puigvert, Servicio de Andrologia, Universidad Autónoma de Barcelona, Barcelona, España. [Moncada Iribarren,I] Servicio de Urología, Hospital Universitario La Zarzuela, Madrid, España. [Martínez Jabaloyas,JM] Servicio de Urología, Hospital Clínico Universitario de Valencia. Valencia, España. [Meijide Rico,F] Servicio de Urología, Hospital Povisa, Vigo, Pontevedra, España. [García-Baquero,R] Servicio de Urología, Hospital Universitario Puerta del Mar. Cádiz, España. [Rosselló Gayá,M] Instituto Médico Rosselló - Centro Asoc. Quirón Palma-Planas Palma de Mallorca. [Lledó García,E] Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid. [Luque López,C] Centro Salud Albarizas. Marbella, Málaga, España. [Prieto Castro,R] Unidad de Andrología, Medicina Sexual y Reproductiva, Unidad Clínica de Urología, Hospital Regional Universitario Reina Sofía, Córdoba, España. [Martinez Salamanca,JI] Servicio de Urología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Majadahonda, Madrid, España.
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Sexual health ,Anatomy::Urogenital System::Genitalia::Genitalia, Male::Prostate [Medical Subject Headings] ,Medicina ,Check Tags::Male [Medical Subject Headings] ,Orchitis ,Diseases::Male Urogenital Diseases::Genital Diseases, Male::Testicular Diseases::Orchitis [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Peptide Hormones::Gonadotropins::Gonadotropins, Pituitary::Follicle Stimulating Hormone [Medical Subject Headings] ,Diseases::Endocrine System Diseases::Gonadal Disorders::Hypogonadism [Medical Subject Headings] ,Anatomy::Cells::Blood Cells::Leukocytes [Medical Subject Headings] ,Semen ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Preservation, Biological::Tissue Preservation::Semen Preservation [Medical Subject Headings] ,Chemicals and Drugs::Nucleic Acids, Nucleotides, and Nucleosides::Nucleic Acids::RNA::RNA, Viral [Medical Subject Headings] ,Persons::Persons::Age Groups::Adult [Medical Subject Headings] ,Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings] ,Salud sexual ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Serum Globulins::Immunoglobulins::Antibodies::Immunoglobulin Isotypes::Immunoglobulin G [Medical Subject Headings] ,SARS-CoV-2 ,Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Gonadal Hormones::Gonadal Steroid Hormones::Testosterone Congeners::Testosterone [Medical Subject Headings] ,Health Care::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics [Medical Subject Headings] ,COVID-19 ,Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Genetic Techniques::Nucleic Acid Amplification Techniques::Polymerase Chain Reaction::Reverse Transcriptase Polymerase Chain Reaction [Medical Subject Headings] ,Anatomy::Fluids and Secretions::Bodily Secretions::Semen [Medical Subject Headings] ,Diseases::Cardiovascular Diseases::Vascular Diseases::Vasculitis [Medical Subject Headings] ,Orquitis ,Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Peptide Hormones::Gonadotropins::Gonadotropins, Pituitary::Luteinizing Hormone [Medical Subject Headings] ,Fertilidad masculina ,Male fertility ,Reproductive health ,Salud reproductiva ,Persons::Persons::Age Groups::Adult::Young Adult [Medical Subject Headings] ,Anatomy::Urogenital System::Genitalia::Genitalia, Male::Testis [Medical Subject Headings] - Abstract
Objective The main objective of this revision is to summarize the current existing evidence of the potential adverse effects of SARS-CoV-2 on the male reproductive system and provide the recommendations of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA) concerning the implications of COVID-19 infection in the management of male infertilty patients and testicular endocrine dysfunction. Methods A comprehensive systematic literature search of the databases of PubMed, Web of Science, Embase, Medline, Cochrane and MedRxiv, was carried out. Results The presence of orchitis as a potential complication of the infection by SARS-CoV-2 has not yet been confirmed. One study reported that 19% of males with COVID-19 infection had scrotal symptoms suggestive of viral orchitis which could not be confirmed. It is possible that the virus, rather than infecting the testes directly, may induce a secondary autoimmune response leading to autoimmune orchitis. COVID-19 has been associated with coagulation disorders and thus the orchitis could be the result of segmental vasculitis. Existing data concerning the presence of the virus in semen are contradictory. Only one study reported the presence of RNA in 15.8% of patients with COVID-19. However, the presence of nucleic acid or antigen in semen is not synonyms of viral replication capacity and infectivity. It has been reported an increase in serum levels of LH in males with COVID-19 and a significant reduction in the T/LH and FSH/LH ratios, consistent with subclinical hypogonadism. Conclusions The findings of recent reports related to the potential effects of COVID-19 infection on the male reproductive system are based on poorly designed, small sample size studies that provide inconclusive, contradictory results. Since there still exists a theoretical possibility of testicular damage and male infertilty as a result of the infection by COVID-19, males of reproductive age should be evaluated for gonadal function and semen analysis. With regard to the sexual transmission of the virus, there is not sufficient evidence to recommend asymptomatic couples to abstein from having sex in order to protect themselves from being infected by the virus. Additional studies are needed to understand the long-term effects of SARS-CoV-2 on male reproductive function, including male fertility potential and endocrine testicular function. Objetivo El objetivo de esta revisión es resumir la evidencia disponible sobre los posibles efectos adversos del SARS-CoV-2 en el sistema reproductor masculino y proporcionar una declaración de posición oficial de la Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA). Métodos Se realizó una búsqueda exhaustiva en las bibliotecas Pubmed, Web of Science, Embase, Medline, Cochrane y MedRxiv. Resultados No se ha confirmado la orquitis como una posible complicación de la infección por SARS-CoV-2. Un estudio informó que el 19% de los hombres con COVID-19 presentaban molestias escrotales sugestivas de orquitis viral, que no se pudo confirmar. Es posible que el virus no infecte los testículos directamente, si no que desencadene una respuesta autoinmune secundaria y que cause una orquitis autoinmune. COVID-19 se ha asociado con anormalidades en la coagulación por lo que la orquitis podría ser el resultado de una vasculitis segmentaria. Los datos disponibles sobre la presencia del virus en semen son contradictorios. Sólo un estudio informó de la presencia de ARN en el 15,8% de enfermos de COVID-19. La presencia de ácido nucleico o antígeno en el semen no implica la existencia de virus con capacidad de replicación o infección. En hombres con COVID-19 se ha observado un incremento significativo de LH en suero y una drástica disminución de la ratio T/LH y FSH/LH, congruente con un hipogonadismo subclínico. Conclusiones Los datos disponibles y los hallazgos de los estudios recientes se basan en tamaños de muestra pequeños y proporcionan informaciones contradictorias. Existe la posibilidad teórica de que pueda producirse daño testicular y posterior infertilidad después de la infección por COVID-19, por lo que especialmente para aquellos hombres en edad reproductiva, se debe sugerir consulta y evaluación de la función gonadal y análisis de semen. En cuanto a la posibilidad de transmisión sexual, no hay evidencia suficiente para respaldar la necesidad de que las parejas asintomáticas eviten las relaciones sexuales para protegerse contra la transmisión del virus. Se necesita más investigación para comprender los impactos a largo plazo del SARS-CoV-2 en la función reproductiva masculina, incluidos sus posibles efectos sobre la fertilidad y la función endocrina testicular. Yes
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- 2020
6. Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group
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Sunil Patel, Toshio Takagi, Andrew Tracey, Cosimo De Nunzio, Ali Abdel Raheem, Estefania Linares, Riccardo Autorino, Gaelle Fiard, Stephen Ryan, Nicola Pavan, Jean−Alexandre A. Long, Alessandro Antonelli, Bo Yang, Koon Ho Rha, Thomas Amiel, Carlotta Palumbo, Maria Carmen Mir, Simone Crivellaro, Alessandro Larcher, Luigi Schips, Riccardo Bertolo, Ahmet Bindayi, Carlo Trombetta, Chao Zhang, Francesco Montorsi, Tobias Maurer, Francesco Porpiglia, Umberto Capitanio, Estevão Lima, Ithaar Derweesh, Zachary Hamilton, Ryan W. Dobbs, Kazunari Tanabe, Antonio Celia, Joan Palou, Roberto Castellucci, Alberto Breda, Bindayi, A., Autorino, R., Capitanio, U., Pavan, N., Mir, M. C., Antonelli, A., Takagi, T., Bertolo, R., Maurer, T., Ho Rha, K., Long, J. -A., Yang, B., Schips, L., Lima, E., Breda, A., Linares, E., Celia, A., De Nunzio, C., Dobbs, R., Patel, S., Hamilton, Z., Tracey, A., Larcher, A., Trombetta, C., Palumbo, C., Tanabe, K., Amiel, T., Raheem, A., Fiard, G., Zhang, C., Castellucci, R., Palou, J., Ryan, S., Crivellaro, S., Montorsi, F., Porpiglia, F., Derweesh, I. H., Department of urology, Università Vita-Salute San Raffaele, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Urology, Medical University Graz, Sant'Andrea Hospital - Sapienza University of Rome, Cancer Prognostics and Health Outcomes Unit, Université de Montréal [Montréal], Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), China Agricultural University (CAU), servicio de urologia, Fundación Puigvert, Centre d'Études Biologiques de Chizé - UMR 7372 (CEBC), Institut National de la Recherche Agronomique (INRA)-Université de La Rochelle (ULR)-Centre National de la Recherche Scientifique (CNRS), Université de Montréal (UdeM), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Université de La Rochelle (ULR)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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Male ,Urologic Diseases ,medicine.medical_specialty ,Outcome Assessment ,Urology ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Renal function ,Kidney ,Nephrectomy ,03 medical and health sciences ,Postoperative Complications ,Text mining ,0302 clinical medicine ,Elderly ,Chronic Kidney Disease ,medicine ,Carcinoma ,Humans ,In patient ,Stage (cooking) ,Trifecta ,Survival analysis ,Retrospective Studies ,Aged ,MESH: Carcinoma ,Partial Nephrectomy ,Renal Cell ,Aged, 80 and over ,business.industry ,Renal surgery ,Age Factors ,Margins of Excision ,renal carcinoma ,medicine.disease ,Kidney Neoplasms ,3. Good health ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Background: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention: PN. Outcome measurements and statistical analysis: Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p < 0.001), lower intraoperative (5.3% vs 27%, p < 0.001) and postoperative (25.4% vs 37.8%, p = 0.001) complications, shorter hospital stay (p = 0.045), and lower ΔeGFR (p < 0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07–1.51, p = 0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32–0.62, p < 0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p < 0.001) and CKD upstaging (84.3% vs 8.2%, p < 0.001). Limitations include retrospective design. Conclusions: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation. Partial nephrectomy in elderly patients provides quality outcomes as measured by trifecta. Tumor complexity is a key determinant for trifecta achievement, and trifecta attainment is associated with improved function. Increasing utilization of robotics has benefits in recovery without compromising quality.
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- 2020
7. Transethnic, Genome-Wide Analysis Reveals Immune-Related Risk Alleles and Phenotypic Correlates in Pediatric Steroid-Sensitive Nephrotic Syndrome
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Elisabet Ars, Claire Dossier, José Ballarín, Stéphanie Debette, Pierre Ronco, Eric Letouzé, Hanna Debiec, Tabassome Simon, Siham Chafai Elalaoui, Matthias Kretzler, Georges Deschênes, Marina Vivarelli, Manuela Colucci, Valery Elie, Matthew G. Sampson, Philippe Amouyel, Evelyne Jacqz-Aigrain, Christopher E. Gillies, Valérie Dubois, Francesco Emma, Abdelaziz Sefiani, Rosemary K B Putler, Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Néphrologie pédiatrique [Hôpital Robert Debré, Paris], Hôpital Robert Debré-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Equipe labellisée Ligue contre le Cancer, Labex Immuno-oncology, Université Paris Descartes - Paris 5 (UPD5)-PRES Sorbonne Paris Cité, Unité de Formation et de Recherche Santé, Médecine, Biologie Humaine [Bobigny], Université Paris 13 (UP13)-Sorbonne Paris Cité, Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7), Pediatric Nephrology [Ann Arbor, MI, USA] (School of Medicine), University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Nephrology and Dialysis Department [Rome, Italy], Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù [Rome, Italy], Molecular Biology Laboratory [Barcelona, Spain] (Fundació Puigvert - UAB), Universitat Autònoma de Barcelona (UAB)-Instituto de Investigaciones Biomédicas Sant Pau [Barcelona, Spain]-Fundació Puigvert [Barcelona, Spain], Centre d'Investigation Clinique 1426 (CIC 1426), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie des maladies chroniques : impact des interactions gène environnement sur la santé des populations, Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Department of Medical Genetics [Rabat, Morocco], Institut National d’Hygiène [Rabat, Morocco], Human Genomic Center [Rabat, Morocco], Université Mohamed V - Souissi, Etablissement français du sang - Auvergne-Rhône-Alpes (EFS), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche Clinique de l’Est Parisien [CHU Saint-Antoine] (URC-EST), Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (CHNO)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Internal Medicine and Computational Medicine and Bioinformatics [Ann Arbor, MI, USA], Department of Nephrology [Barcelona, Spain], Fundación Puigvert [Barcelona, Spain], Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Service de Néphrologie et Dialyses [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), This study was funded by European Research Council grant ERC-2012- ADG_20120314 (grant agreement 322947) and Agence Nationale pour la Recherche 'Genetransnephrose' grant ANR-16-CE17-004-01. M.G.S. is supported by the Charles Woodson Clinical Research Fund and National Institutes of Health grant R01-DK108805. The Nephrotic Syndrome Study Network Consortium (NEPTUNE, U54-DK-083912) is a part of the National Center for Advancing Translational Sciences (NCATS) Rare Disease Clinical Research Network (RDCRN) supportedthrough a collaboration between the Office of Rare Diseases Research(ORDR), the NCATS, and the National Institute of Diabetes, Digestive,and Kidney Diseases. The RDCRN is an initiative of the ORDR of theNCATS. Additional funding and/or programmatic support for thisproject has also been provided by the University of Michigan, NephCureKidney International, and the Halpin Foundation. The NEPHROVIRcohort has been supported by two grants from the Programme Hospitalier de Recherche Clinique: grants PHRC 2007-AOM07018 and PHRC 2011-AOM11002. The NEPHROVIR network is coordinated by the Pediatric Nephrology Unit of Robert Debré Hospital, the 'Unité de Recherche Clinique de l’Est Parisien,' and the 'Délégation de la Recherche Clinique de la Région Ile-de-France.' M.V. and M.C. are supported by the Associazone per la Cura del bambino Nefropatico Organizzazione Non Lucrativa di Utilità Sociale., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Universitat Autònoma de Barcelona (UAB)-Fundació Puigvert [Barcelona, Spain]-Instituto de Investigaciones Biomédicas Sant Pau [Barcelona, Spain], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Mohammed V de Rabat [Agdal] (UM5), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Direction de la Recherche Clinique et de l'Innovation [AP-HP] (DRCI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Département de Néphrologie = Service de Néphrologie et Dialyses [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and RONCO, Pierre
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Male ,0301 basic medicine ,030232 urology & nephrology ,Genome-wide association study ,Cohort Studies ,0302 clinical medicine ,Africa, Northern ,HLA-DQ beta-Chains ,Medicine ,Child ,Genetics ,nephrotic syndrome ,genetic renal disease ,General Medicine ,Phenotype ,Italy ,Nephrology ,Child, Preschool ,Cohort ,[SDV.BBM.GTP] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN] ,Female ,Steroids ,France ,pediatrics ,Quantitative Trait Loci ,Black People ,Single-nucleotide polymorphism ,Polymorphism, Single Nucleotide ,White People ,03 medical and health sciences ,HLA-DQ Antigens ,Up Front Matters ,[SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN] ,Humans ,SNP ,Allele ,Alleles ,Genetic association ,focal segmental glomerulosclerosis ,genome-wide association study ,Butyrophilins ,business.industry ,HLA-DR Antigens ,Genetic architecture ,HLA-DRB5 Chains ,030104 developmental biology ,Spain ,Case-Control Studies ,Expression quantitative trait loci ,gene expression ,business ,HLA-DRB1 Chains - Abstract
Background Steroid-sensitive nephrotic syndrome (SSNS) is a childhood disease with unclear pathophysiology and genetic architecture. We investigated the genomic basis of SSNS in children recruited in Europe and the biopsy-based North American NEPTUNE cohort. Methods We performed three ancestry-matched, genome-wide association studies (GWAS) in 273 children with NS (Children Cohort Nephrosis and Virus [NEPHROVIR] cohort: 132 European, 56 African, and 85 Maghrebian) followed by independent replication in 112 European children, transethnic meta-analysis, and conditional analysis. GWAS alleles were used to perform glomerular cis -expression quantitative trait loci studies in 39 children in the NEPTUNE cohort and epidemiologic studies in GWAS and NEPTUNE (97 children) cohorts. Results Transethnic meta-analysis identified one SSNS-associated single-nucleotide polymorphism (SNP) rs1063348 in the 3′ untranslated region of HLA-DQB1 ( P =9.3×10 −23 ). Conditional analysis identified two additional independent risk alleles upstream of HLA-DRB1 (rs28366266, P =3.7×10 −11 ) and in the 3′ untranslated region of BTNL2 (rs9348883, P =9.4×10 −7 ) within introns of HCG23 and LOC101929163 . These three risk alleles were independent of the risk haplotype DRB1*07:01-DQA1*02:01-DQB1*02:02 identified in European patients. Increased burden of risk alleles across independent loci was associated with higher odds of SSNS. Increased burden of risk alleles across independent loci was associated with higher odds of SSNS, with younger age of onset across all cohorts, and with increased odds of complete remission across histologies in NEPTUNE children. rs1063348 associated with decreased glomerular expression of HLA-DRB1, HLA-DRB5, and HLA-DQB1. Conclusions Transethnic GWAS empowered discovery of three independent risk SNPs for pediatric SSNS. Characterization of these SNPs provide an entry for understanding immune dysregulation in NS and introducing a genomically defined classification.
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- 2018
8. Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)
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Alessandro Larcher, Tommaso Silvestri, Cosimo De Nunzio, Andrea Tubaro, Alberto Breda, Alessandro Antonelli, Bo Yang, Joao Nuno Torres, Oscar Rodriguez Faba, Nicola Pavan, Riccardo Autorino, Kazunari Tanabe, L. Bevilacqua, Koon Ho Rha, Andrew Tracey, Francesco Porpiglia, Estefania Linares, Ahmet Bindayi, Francesco Montorsi, Jean Alexandre Long, Luigi Schips, Sisto Perdonà, Pierluigi Bove, Ottavio De Cobelli, Alexandre Mottrie, Claudio Simeone, Lance J. Hampton, Umberto Capitanio, Carmen Mir, Carlo Trombetta, Cristian Fiori, Ithaar Derweesh, Estevão Lima, Joan Palou, Antonio Celia, Salvatore Micali, Tobias Maurer, Matteo Ferro, Carlotta Palumbo, Giuseppe Quarto, Toshio Takagi, Gaelle Fiard, Chao Zhang, Roberto Castellucci, Alessandro Veccia, China Agricultural University (CAU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Urology, Sant'Andrea Hospital - Sapienza University of Rome, Medical University Graz, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), OLVG Hospital, servicio de urologia, Fundación Puigvert, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Clinical and Molecular Medicine, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Department of urology, Università Vita-Salute San Raffaele, Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section, Università degli studi di Napoli Federico II, chair and department of urology, Antonelli, A., Veccia, A., Pavan, N., Mir, C., Breda, A., Takagi, T., Rha, K. H., Maurer, T., Zhang, C., Long, J. -A., De Nunzio, C., Lima, E., Ferro, M., Micali, S., Quarto, G., Linares, E., Celia, A., Schips, L., Bove, P., Larcher, A., Fiori, C., Mottrie, A., Bindayi, A., Trombetta, C., Silvestri, T., Palou, J., Faba, O. R., Tanabe, K., Yang, B., Fiard, G., Tubaro, A., Torres, J. N., De Cobelli, O., Bevilacqua, L., Castellucci, R., Tracey, A., Hampton, L. J., Montorsi, F., Perdona, S., Simeone, C., Palumbo, C., Capitanio, U., Derweesh, I., Porpiglia, F., and Autorino, R.
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Male ,Laparoscopic surgery ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Aged, 80 and over ,Asia ,Carcinoma, Renal Cell ,Europe ,Female ,Follow-Up Studies ,Humans ,Incidence ,Kidney Neoplasms ,Neoplasm Staging ,Nephrectomy ,Postoperative Complications ,Retrospective Studies ,Survival Rate ,United States ,resurge ,0302 clinical medicine ,Retrospective Studie ,Renal cell carcinoma ,80 and over ,renal-cell carcinoma ,kidney tumor ,Kidney Neoplasm ,3. Good health ,030220 oncology & carcinogenesis ,Human ,Cohort study ,medicine.medical_specialty ,renal cell carcinoma ,partial nephrectomy ,Urology ,elderly ,Follow-Up Studie ,03 medical and health sciences ,medicine ,Survival rate ,Aged ,Cancer staging ,business.industry ,Carcinoma ,Renal Cell ,Postoperative complication ,Retrospective cohort study ,medicine.disease ,Surgery ,Settore MED/24 ,Postoperative Complication ,business ,elderly, renal cell carcinoma - Abstract
OBJECTIVE To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients >= 80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity. (C) 2019 Elsevier Inc.
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- 2019
9. Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)
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Kazunari Tanabe, Toshio Takagi, Ryan W. Dobbs, Maria Furlan, Gaelle Fiard, Matteo Ferro, Antonio Celia, Simone Crivellaro, Alberto Breda, Andrea Tubaro, Pierluigi Bove, Salvatore Micali, J. Torres, Paolo Umari, Ottavio De Cobelli, Alexandre Mottrie, Ali Abdel Raheem, Giulia Barbati, Umberto Capitanio, Francesco Porpiglia, Estefania Linares, Caterina Gregorio, Riccardo Autorino, Estevão Lima, Alessandro Antonelli, Bo Yang, Maria Carmen Mir, Tommaso Silvestri, Sisto Perdonà, Alfredo Aguilera, Thomas Amiel, Giuseppe Quarto, Jean Alexandre Long, Francesco Montorsi, Bernardino De Concilio, Zachary Hamilton, L. Bevilacqua, Ahmet Bindayi, Koon Ho Rha, Chao Zang, Carlotta Palumbo, Luigi Schips, Ithaar Derweesh, Nicola Pavan, Cosimo De Nunzio, Carlo Trombetta, Andrew Tracey, Joan Palou, Oscar Rodriguez-Faba, Roberto Castellucci, Christian Fiori, Alessandro Larcher, Tobias Maurer, Mir, Maria C, Pavan, Nicola, Capitanio, Umberto, Antonelli, Alessandro, Derweesh, Ithaar, Rodriguez-Faba, Oscar, Linares, Estefania, Takagi, Toshio, Rha, Koon H, Fiori, Christian, Maurer, Tobia, Zang, Chao, Mottrie, Alexandre, Umari, Paolo, Long, Jean-Alexandre, Fiard, Gaelle, De Nunzio, Cosimo, Tubaro, Andrea, Tracey, Andrew T, Ferro, Matteo, De Cobelli, Ottavio, Micali, Salvatore, Bevilacqua, Luigi, Torres, João, Schips, Luigi, Castellucci, Roberto, Dobbs, Ryan, Quarto, Giuseppe, Bove, Pierluigi, Celia, Antonio, De Concilio, Bernardino, Trombetta, Carlo, Silvestri, Tommaso, Larcher, Alessandro, Montorsi, Francesco, Palumbo, Carlotta, Furlan, Maria, Bindayi, Ahmet, Hamilton, Zachary, Breda, Alberto, Palou, Joan, Aguilera, Alfredo, Tanabe, Kazunari, Raheem, Ali, Amiel, Thoma, Yang, Bo, Lima, Estevão, Crivellaro, Simone, Perdona, Sisto, Gregorio, Caterina, Barbati, Giulia, Porpiglia, Francesco, Autorino, Riccardo, Mir, M. C., Pavan, N., Capitanio, U., Antonelli, A., Derweesh, I., Rodriguez-Faba, O., Linares, E., Takagi, T., Rha, K. H., Fiori, C., Maurer, T., Zang, C., Mottrie, A., Umari, P., Long, J. -A., Fiard, G., De Nunzio, C., Tubaro, A., Tracey, A. T., Ferro, M., De Cobelli, O., Micali, S., Bevilacqua, L., Torres, J., Schips, L., Castellucci, R., Dobbs, R., Quarto, G., Bove, P., Celia, A., De Concilio, B., Trombetta, C., Silvestri, T., Larcher, A., Montorsi, F., Palumbo, C., Furlan, M., Bindayi, A., Hamilton, Z., Breda, A., Palou, J., Aguilera, A., Tanabe, K., Raheem, A., Amiel, T., Yang, B., Lima, E., Crivellaro, S., Perdona, S., Gregorio, C., Barbati, G., Porpiglia, F., Autorino, R., Department of urology, Università Vita-Salute San Raffaele, OLVG Hospital, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Urology, Sant'Andrea Hospital - Sapienza University of Rome, Department of Clinical and Molecular Medicine, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Medical University Graz, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), servicio de urologia, Fundación Puigvert, La Paz University Hospital, Institute of Information Engineering [Beijing] (IIE), Chinese Academy of Sciences [Beijing] (CAS), Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section, and Università degli studi di Napoli Federico II
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Nephrology ,Male ,medicine.medical_specialty ,Asia ,Urology ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Renal function ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Elderly ,Interquartile range ,Internal medicine ,medicine ,Humans ,Partial nephrectomy ,Propensity Score ,Carcinoma, Renal Cell ,elderly ,kidney cancer ,nephrectomy ,partial nephrectomy ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Incidence ,Age Factors ,Retrospective cohort study ,Kidney cancer ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Europe ,Survival Rate ,Settore MED/24 ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Cohort ,North America ,Female ,business ,Glomerular Filtration Rate - Abstract
International audience; PURPOSE:To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.PATIENTS AND METHODS:A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).RESULTS:A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p
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- 2019
10. Modern flexible ureteroscopy in Cohen cross-trigonal ureteral reimplantations
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Esteban Emiliani, Olivier Traxer, Marie Audouin, Michele Talso, Service d'urologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Fundación Puigvert, Grouped Recherche Clinique lithiase, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe de recherche clinique Analyse, Recherche, Développement et Evaluation en Endourologie et Lithiase Urinaire (GRC 20 - ARDELURO), and Sorbonne Université (SU)
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Adult ,Male ,medicine.medical_specialty ,Ureteral Calculi ,Adolescent ,Urology ,medicine.medical_treatment ,Stone free ,030232 urology & nephrology ,Laser ,Flexible ureteroscopy ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Patient Positioning ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,Urolithiasis ,Ureteroscopy ,Humans ,Medicine ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,URETEROSCOPE ,medicine.diagnostic_test ,business.industry ,Cohen reimplantation ,Trigonal crystal system ,Laser lithotripsy ,3. Good health ,Surgery ,Catheter ,medicine.anatomical_structure ,Replantation ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,business - Abstract
Summary Purpose We describe a feasible flexible ureteroscopy (fURS) technique with the latest instruments to and to discuss their advantages. Methods Three patients underwent a fURS for stone treatment. A 7F angled orifice catheter and a hydrophilic angled tip stiff wire is used to guide the wire in the proper ureteral direction sighting the ureter allowing the use of a 10/12 ureteral access sheath. A single use ureteroscope was used. Results All of them had successful ureteral access and laser lithotripsy being stone free endoscopically. No complications reported. Conclusion The modern fURS technique was found feasible and safe in patients with cross-trigonal ureteroneocystostomy.
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- 2017
11. Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update
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Juan V. Llau, Pilar Sierra, A. Gómez-Luque, R. Ferrandis, [Llau,J V, and Ferrandis, R] Departamento de Anesthesiología y Cuidados Críticos, Hospital Clínico Universitario, Valencia, España. [Sierra,P] Departamento de Anestesiología, Fundación Puigvert, Barcelona, España. [Gómez Luque,A] Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Victoria, Málaga, España
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Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Perioperative Care [Medical Subject Headings] ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Piperazinas ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Stents::Drug-Eluting Stents [Medical Subject Headings] ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Blood Loss, Surgical ,Review ,Piperazines ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Inhibidores de Agregación Plaquetaria ,Coronary thrombosis ,Myocardial Revascularization ,Pharmacology (medical) ,Myocardial infarction ,Pérdida de Sangre Quirúrgica ,Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Blood Loss, Surgical [Medical Subject Headings] ,stent thrombosis ,Chemicals and Drugs::Organic Chemicals::Hydrocarbons::Hydrocarbons, Cyclic::Hydrocarbons, Aromatic::Benzene Derivatives::Phenols::Hydroxybenzoates::Salicylates::Aspirin [Medical Subject Headings] ,perioperative management ,Drug-Eluting Stents ,Hematology ,General Medicine ,Clopidogrel ,Anatomy::Cardiovascular System::Blood Vessels::Arteries::Coronary Vessels [Medical Subject Headings] ,Coronary Vessels ,Stents Liberadores de Fármacos ,Humanos ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Myocardial Revascularization [Medical Subject Headings] ,Cardiology ,Platelet aggregation inhibitor ,Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Perioperative Period [Medical Subject Headings] ,Tiofenos ,antiplatelet agents ,Cardiology and Cardiovascular Medicine ,Trombosis Coronaria ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Platelet Aggregation Inhibitors [Medical Subject Headings] ,medicine.drug ,medicine.medical_specialty ,Chemicals and Drugs::Organic Chemicals::Sulfur Compounds::Thiophenes [Medical Subject Headings] ,Ticlopidine ,aspirin ,Revascularización Miocárdica ,Ticlopidina ,Thiophenes ,Perioperative Care ,Internal medicine ,Coronary stent ,medicine ,Humans ,cardiovascular diseases ,Aspirina ,Perioperative Period ,Atención Perioperativa ,clopidogrel ,Aspirin ,business.industry ,surgical bleeding ,Coronary Thrombosis ,Public Health, Environmental and Occupational Health ,Perioperative ,Diseases::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Coronary Disease::Coronary Thrombosis [Medical Subject Headings] ,medicine.disease ,Discontinuation ,Surgery ,Periodo Perioperatorio ,Chemicals and Drugs::Organic Chemicals::Sulfur Compounds::Thiophenes::Thienopyridines::Ticlopidine [Medical Subject Headings] ,lcsh:RC666-701 ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Piperazines [Medical Subject Headings] ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors - Abstract
Juan V Llau1, Raquel Ferrandis1, Pilar Sierra2, Aurelio Gómez-Luque31Department of Anaesthesiology and Critical Care Medicine, Hospital Clínic Universitari, València, Spain; 2Department of Anaesthesiology, Fundació Puigvert, Barcelona, Spain; 3Department of Anaesthesiology and Critical Care Medicine, Hospital Clínico Universitario, Málaga, SpainAbstract: The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST), myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.Keywords: stent thrombosis, antiplatelet agents, aspirin, clopidogrel, surgical bleeding, perioperative management
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- 2010
12. Development of a standardised training curriculum for robotic surgery: a consensus statement from an international multidisciplinary group of experts
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Hendrik Van Poppel, Ronny Abaza, Michael Stoeckle, Joan Palou, Christophe Vaessen, Jacques Hubert, Xavier Cathelineau, Rajesh Ahlawat, Vipul R. Patel, Joachim W. Thüroff, Timothy O. Wilson, Ben Challacombe, Maurice Stephan Michel, Thomas E. Ahlering, Ben Van Cleynenbreugel, Rafael Sanchez-Salas, Christian Wagner, Reenam S. Khan, Alessandro Volpe, Jean Etienne Terrier, Alexandre Mottrie, Henk G. van der Poel, Pierre Thierry Piechaud, Prokar Dasgupta, Catherine Lovegrove, Kamran Ahmed, Francesco Montorsi, Jorn H Witt, Declan G. Murphy, Stefan Siemer, P. Coloby, Eric Barret, Pascal Rischmann, Peter Wiklund, Göran Ahlgren, Walter Artibani, Muhammad Shamim Khan, Jens-Uwe Stolzenburg, Manfred P. Wirth, Ahmed, Kamran, Khan, Reenam, Mottrie, Alexandre, Lovegrove, Catherine, Abaza, Ronny, Ahlawat, Rajesh, Ahlering, Thoma, Ahlgren, Goran, Artibani, Walter, Barret, Eric, Cathelineau, Xavier, Challacombe, Ben, Coloby, Patrick, Khan Muhammad, S., Hubert, Jacque, Michel Maurice, Stephan, Montorsi, Francesco, Murphy, Declan, Palou, Joan, Patel, Vipul, Piechaud Pierre, Thierry, Van Poppel, Hendrik, Rischmann, Pascal, Sanchez Salas, Rafael, Siemer, Stefan, Stoeckle, Michael, Stolzenburg Jens, Uwe, Terrier Jean, Etienne, Thueroff Joachim, W., Vaessen, Christophe, Van der Poel Henk, G., Van Cleynenbreugel, Ben, Volpe, Alessandro, Wagner, Christian, Wiklund, Peter, Wilson, Timothy, Wirth, Manfred, Witt, Joern, Dasgupta, Prokar, UL, IADI, Centre for Transplantation, King's College London (MRC), Guy's Hospital [London], OLVG Hospital, Ohio State University [Columbus] (OSU), Medanta [The Medicity], University of California [Irvine] (UC Irvine), University of California (UC), Skane University Hospital [Lund], Azienda ospedaliera universitaria integrata di Verona [Italy], Service d'urologie [Institut Mutualiste Montsouris], Institut Mutualiste de Montsouris (IMM), Service d'urologie [CH René Dubos Pontoise], Centre Hospitalier René Dubos [Pontoise], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Urologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), University Hospital Mannheim, Department of urology, Università Vita-Salute San Raffaele, Peter MacCallum Cancer Centre, Peter MacCallum Cancer Center, The Royal Melbourne Hospital, servicio de urologia, Fundación Puigvert, Florida Hospital Celebration Health, Clinique Saint Augustin, University Hospitals Leuven [Leuven], Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Universitätsklinikum des Saarlandes, Department of Urology [Leipzig], Universität Leipzig [Leipzig], Service d'urologie et de transplantation rénale [Suresnes], Hôpital Foch [Suresnes], Universitätsklinikum Ulm - University Hospital of Ulm, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, University of Eastern Piedmont, St. Antonius-Hospital Gronau, Department of Oncology-Pathology [Karolinska Institutet], Karolinska Institutet [Stockholm], City of Hope Medical Center, Universitätsklinikum Carl Gustav Carus, University of California [Irvine] (UCI), University of California, Service de Chirurgie Urologique [CHU Purpan - Toulouse], CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
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medicine.medical_specialty ,Consensus ,Urology ,030232 urology & nephrology ,curriculum ,Certification ,Session (web analytics) ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,medicine ,Curriculum development ,Humans ,Robotic surgery ,Curriculum ,robotics ,validation ,Medical education ,education ,training ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,Robotics ,Focus group ,Surgery ,learning-needs ,Content analysis ,030220 oncology & carcinogenesis ,Urologic Surgical Procedures ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Objectives To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. Materials and methods An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. Results In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement kappa 0.89) and they included: need for a training curriculum (inter-rater agreement kappa 0.85); identification of learning needs (kappa 0.83); development of the curriculum contents (kappa 0.81); an overview of available curricula (kappa 0.79); settings for robotic surgery training ((kappa 0.89); assessment and training of trainers (kappa 0.92); requirements for certification and patient safety (kappa 0.83); and need for a universally standardised curriculum (kappa 0.78). A training curriculum was proposed based on the above discussions. Conclusion This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room.
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- 2015
13. Considerations on the use of urine markers in the management of patients with high-grade non–muscle-invasive bladder cancer
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H. Barton Grossman, Juan Palou, Molly A. Ingersoll, Antonia Vlahou, Marta Sanchez-Carbayo, John A. Taylor, Bas W.G. van Rhijn, Wassim Kassouf, M´Liss A. Hudson, Peter J. Goebell, T. Todenhöfer, Bernd J. Schmitz-Dräger, Ashish Chandra, Thomas Behrens, Ashish M. Kamat, Beate Pesch, MD Anderson Cancer Center [Houston], The University of Texas Health Science Center at Houston (UTHealth), Biomedical Research Foundation of the Academy of Athens, Department of Urology, University of Connecticut (UCONN), Department of Cardiology Ochsner Clinic Foundation, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Immunobiologie des Cellules Dendritiques, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Eberhard Karls Universität Tübingen = Eberhard Karls University of Tuebingen, Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, McGill University = Université McGill [Montréal, Canada], Protein Research Unit Ruhr within Europe (PURE), Ruhr-Universität Bochum [Bochum], Guy's and St Thomas' Hospital [London], Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), servicio de urologia, Fundación Puigvert, CIC BioGUNE, CIC Spain, urology 24, Schön Klinik Nürnberg/Fürth, and Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Oncology ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Context (language use) ,Disease ,Urine ,MESH: Urinary Bladder Neoplasms/urine ,Non–muscle-invasive bladder cancer ,03 medical and health sciences ,Urine markers ,0302 clinical medicine ,High grade ,Internal medicine ,Diagnosis ,Disease management ,medicine ,Biomarkers, Tumor ,Humans ,In patient ,Disease management (health) ,Bladder cancer ,MESH: Humans ,business.industry ,MESH: Biomarkers, Tumor/urine ,medicine.disease ,6. Clean water ,3. Good health ,Surgery ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Non muscle invasive ,business ,Clinical risk factor - Abstract
This article reflects and summarizes discussions held at the 10th Meeting of the International Bladder Cancer Network (IBCN e.V.), Nijmegen, The Netherlands, 20—22.9.2012.; International audience; OBJECTIVE: Diagnosis and surveillance of high risk non muscle-invasive bladder cancer (NMIBC) represent specific challenges to urologists. In contrast to low/intermediate risk tumors, these tumors recur more frequently. A significant number will eventually progress to muscle-invasive bladder cancer, a life threatening disease requiring extensive therapeutic efforts. Although clinical risk factors have been identified that may predict tumor recurrence and progression, additional biomarkers are desperately needed to improve tumor diagnosis and guide clinical management of these patients. In this article, the role of molecular urine markers in the management of high risk NMIBC is analyzed.METHODS:In this context, several potential indications (diagnostic, prognostic, predictive) were identified and the requirements for molecular markers were defined. In addition, current knowledge within the different indications was summarized.RESULTS:Significant progress has been made in the last decade studying the impact of molecular urine markers in patients with high risk NMIBC.CONCLUSIONS:Although we may not be ready for the inclusion of molecular markers in clinical decision-making, and many questions remain unanswered, recent studies have identified situations in which the use of molecular markers in particular in high grade tumors may prove beneficial for patient diagnosis and surveillance.
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- 2014
14. Considerations on the use of urine markers in the management of patients with low-/intermediate-risk non–muscle invasive bladder cancer
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Rossana Critelli, H. Barton Grossman, Tilman Todenhöfer, Wassim Kassouf, Bas W.G. van Rhijn, Molly A. Ingersoll, John A. Taylor, Antonia Vlahou, Marta Sanchez-Carbayo, Joan Palou, Mĺiss A. Hudson, Ashish Chandra, Thomas Behrens, Ashish M. Kamat, Bernd J. Schmitz-Dräger, Beate Pesch, urology 24, Schön Klinik Nürnberg/Fürth, Urologische Universitätsklinik, Eberhard Karls Universität Tübingen = Eberhard Karls University of Tuebingen, Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Department of Cardiology Ochsner Clinic Foundation, Cellular pathology, St Thomas' Hospital [London], Immunobiologie des Cellules Dendritiques, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), McGill University Health Center [Montreal] (MUHC), servicio de urologia, Fundación Puigvert, Division of urology, University of Connecticut (UCONN), Biomedical Research Foundation of the Academy of Athens, Departments of Genetics, Biology and Biochemistry, University of Turin, MD Anderson Cancer Center, The University of Texas Health Science Center at Houston (UTHealth), CIC BioGUNE, CIC Spain, Department of urology, The University of Texas M.D. Anderson Cancer Center [Houston], Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Università degli studi di Torino = University of Turin (UNITO)
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Oncology ,medicine.medical_specialty ,Urology ,Non–muscle invasive bladder cancer ,Urine ,Disease ,Urine markers ,Internal medicine ,Disease management ,medicine ,Biomarkers, Tumor ,Humans ,Disease management (health) ,Costs, Disease management, Low risk, Non–muscle invasive bladder cancer, Urine markers ,Urine cytology ,Bladder cancer ,MESH: Humans ,medicine.diagnostic_test ,Low risk ,business.industry ,medicine.disease ,MESH: Biomarkers, Tumor/urine ,3. Good health ,Costs ,Urinary Bladder Neoplasms ,Tumor progression ,MESH: Urinary Bladder Neoplasms/urine ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Non-muscle invasive bladder cancer ,Intermediate risk ,business ,Non muscle invasive - Abstract
Objectives: Many molecular assays for bladder cancer diagnosis and surveillance have been developed over the past several decades. However, none of these markers have been routinely implemented into clinical decision making. Beyond their potential for screening high-risk populations, urine markers likely have the greatest potential in the follow-up of patients with non muscle invasive bladder cancer (NMIBC). Methods: Here, we discuss the current options and limitations of the use of urine markers for patient surveillance, focusing on patients with low-/intermediate-risk NMIBC. Results: As these patients have a very low risk of tumor progression, the primary goal of surveillance is detection of recurrent disease. Although urine cytology seems to be limited to detection of few patients who would develop high-grade tumors, we conclude that the use of markers with high sensitivity for low-grade disease for patient follow-up has the potential to decrease the frequency of urethrocystoscopy without compromising patient prognosis. Because a single marker may not have sufficient sensitivity for detection of low-grade tumors, different scenarios, e.g., multitesting and reflex or sequential approaches, are discussed. Conclusions: There is consensus that currently available markers have the potential to support clinical decision making in follow-up of patients with low-/intermediate-risk NMIBC. In light of our analysis, further additional randomized controlled studies to effectively assess the clinical usefulness of modem urine markers are required. (C) 2014 Elsevier Inc. All rights reserved.
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- 2014
15. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study
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Lluis Gausa, Anne-Béatrice Blanc-Potard, Albert Sotto, Tetsuro Matsumoto, Amy B. Howell, Peter Tenke, Jean-Philippe Lavigne, Christophe Combescure, Henry Botto, LPHI - Laboratory of Pathogen Host Interactions (LPHI), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Rutgers, The State University of New Jersey [New Brunswick] (RU), Rutgers University System (Rutgers), Hôpital Foch [Suresnes], Université de Genève = University of Geneva (UNIGE), Systèmes de sécrétion de type IV et virulence bactérienne, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fundación Puigvert [Barcelona, Spain], Kyushu University, Central Hospital of Southern Pest [Budapest, Hungary], Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), We thank Pharmatoka France for the commercial capsule (Urell®/Ellura™). INSERM Espri 26 is supported by Université de Montpellier 1, La Ville de Nîmes, Le CHU de Nîmes, and La Région Languedoc Roussillon., and Blanc-Potard, Anne
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[SDV]Life Sciences [q-bio] ,Administration, Oral ,Urine ,medicine.disease_cause ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Bacterial Adhesion ,0302 clinical medicine ,Japan ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Bioassay ,Ingestion ,Uropathogenic Escherichia coli ,030212 general & internal medicine ,ComputingMilieux_MISCELLANEOUS ,Nematode Growth Medium Agar Plate ,0303 health sciences ,Effective dose (pharmacology) ,3. Good health ,Anti-Bacterial Agents ,Infectious Diseases ,Vaccinium macrocarpon ,Proanthocyanidin ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,France ,Powders ,Research Article ,Cranberry Juice ,Virulence ,Biology ,Microbiology ,lcsh:Infectious and parasitic diseases ,Cell Line ,03 medical and health sciences ,Double-Blind Method ,In vivo ,medicine ,Animals ,Humans ,lcsh:RC109-216 ,Proanthocyanidins ,Escherichia coli ,030304 developmental biology ,Hungary ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,[SDV.AEN] Life Sciences [q-bio]/Food and Nutrition ,Spain ,Cranberry Product ,Adhesion Index ,[SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition - Abstract
Background Ingestion of cranberry (Vaccinium macrocarpon Ait.) has traditionally been utilized for prevention of urinary tract infections. The proanthocyanidins (PACs) in cranberry, in particular the A-type linkages have been implicated as important inhibitors of primarily P-fimbriated E. coli adhesion to uroepithelial cells. Additional experiments were required to investigate the persistence in urine samples over a broader time period, to determine the most effective dose per day and to determine if the urinary anti-adhesion effect following cranberry is detected within volunteers of different origins. Methods Two separate bioassays (a mannose-resistant hemagglutination assay and an original new human T24 epithelial cell-line assay) have assessed the ex-vivo urinary bacterial anti-adhesion activity on urines samples collected from 32 volunteers from Japan, Hungary, Spain and France in a randomized, double-blind versus placebo study. An in vivo Caenorhabditis elegans model was used to evaluate the influence of cranberry regimen on the virulence of E. coli strain. Results The results indicated a significant bacterial anti-adhesion activity in urine samples collected from volunteers that consumed cranberry powder compared to placebo (p < 0.001). This inhibition was clearly dose-dependent, prolonged (until 24 h with 72 mg of PAC) and increasing with the amount of PAC equivalents consumed in each cranberry powder regimen. An in vivo Caenorhabditis elegans model showed that cranberry acted against bacterial virulence: E. coli strain presented a reduced ability to kill worms after a growth in urines samples of patients who took cranberry capsules. This effect is particularly important with the regimen of 72 mg of PAC. Conclusions Administration of PAC-standardized cranberry powder at dosages containing 72 mg of PAC per day may offer some protection against bacterial adhesion and virulence in the urinary tract. This effect may offer a nyctohemeral protection.
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- 2010
16. Consensus statement addressing controversies and guidelines on pediatric urolithiasis.
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Güven S, Tokas T, Tozsin A, Haid B, Lendvay TS, Silay S, Mohan VC, Cansino JR, Saulat S, Straub M, Tur AB, Akgül B, Samotyjek J, Lusuardi L, Ferretti S, Cavdar OF, Ortner G, Sultan S, Choong S, Micali S, Saltirov I, Sezer A, Netsch C, de Lorenzis E, Cakir OO, Zeng G, Gozen AS, Bianchi G, Jurkiewicz B, Knoll T, Rassweiler J, Ahmed K, and Sarica K
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- Humans, Child, Consensus, Delphi Technique, Urolithiasis therapy, Urolithiasis diagnosis, Practice Guidelines as Topic
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Purpose: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews., Methods: Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews., Results: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement)., Conclusion: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols., (© 2024. The Author(s).)
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- 2024
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17. Retrograde intrarenal surgery for asymptomatic incidental renal stones: a retrospective, real-world data analysis.
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Ong WLK, Somani BK, Fong KY, Teoh JY, Sarica K, Chai CA, Ragoori D, Tailly T, Hamri SB, Heng CT, Biligere S, Emiliani E, Gadzhiev N, Tanidir Y, Chew BH, Castellani D, Traxer O, and Gauhar V
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- Humans, Female, Male, Middle Aged, Retrospective Studies, Aged, Adult, Treatment Outcome, Asymptomatic Diseases therapy, Kidney Calculi surgery, Ureteroscopy adverse effects, Ureteroscopy methods, Incidental Findings
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Objective: To determine surgical outcomes and stone-free rates (SFRs) when offering upfront retrograde intrarenal surgery (RIRS) to patients with asymptomatic incidental renal stones (AIRS), as active surveillance, shockwave lithotripsy or upfront intervention in patients with AIRS is still a debate among urologists., Patients and Methods: This retrospective FLEXible Ureteroscopy Outcomes Registry (FLEXOR), supported by the Team of Worldwide Endourological Researchers (TOWER), examines adult patients who underwent RIRS. We analysed a subset of asymptomatic patients with renal stones on imaging who were treated with RIRS. Data includes patient characteristics, stone specifications, anaesthesia type, perioperative details, complications, and SFR. A multivariable logistic regression analysis was performed to assess factors associated with the SFR., Results: Among 679 patients with AIRS, 640 met the inclusion criteria. The median age was 55 years, with 33.4% being female. In all, 22.1% had positive urine cultures. The median stone diameter was 12 mm, commonly in lower and interpolar locations. RIRS was preferentially performed under general anaesthesia using a reusable scope in 443 cases. Prophylactic antibiotics were administered to 314 patients. The median operation time was 58 min and the median laser time was 24 min. The SFR was 68.8%. The use of holmium laser (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.06-0.63; P < 0.01) and multiple stones (OR 0.38, 95% CI 0.19-0.76; P < 0.01) were factors associated with lower odds of being stone free. Overall complications were minimal, with sepsis in 1.6% of patients. Re-interventions were performed in 76 cases (11.8%), with RIRS being the most common in 67 cases (10.6%)., Conclusion: Our multicentre real-world study is the first of its kind that highlights the pros and cons of offering RIRS to patients with AIRS and demonstrates a favourable SFR with acceptable complications. Pre-emptively discussing potential re-intervention helps patients make informed decisions, particularly in cases involving large and multiple stones., (© 2024 BJU International.)
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- 2024
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18. Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study.
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Calleja Hermosa P, Sánchez Guerrero C, Viegas V, Rebassa LLul M, Jiménez Cidre M, Morán Pascual E, Errando Smet C, Arlandis Guzmán S, Martínez Cuenca E, Gómez de Vicente JM, Ruiz Hernández M, Casado Varela J, Mora Gurrea J, Pérez Polo M, and López-Fando Lavalle L
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- Humans, Female, Aged, Middle Aged, Treatment Outcome, Gynecologic Surgical Procedures adverse effects, Gynecologic Surgical Procedures methods, Gynecologic Surgical Procedures instrumentation, Vagina surgery, Pelvic Organ Prolapse surgery, Surgical Mesh adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Laparoscopy adverse effects, Laparoscopy methods, Laparoscopy instrumentation
- Abstract
Objective: The study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh., Methods: A multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP-Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP-Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP-Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse., Results: A total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61-73). After a median follow-up of 68 months (IQR 46.5-89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%)., Conclusions: LSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting., (© 2024 The Japanese Urological Association.)
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- 2024
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19. Dent's Disease: A Cause of Monogenic Kidney Stones and Nephrocalcinosis.
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Diéguez L, Pilco M, Butori S, Kanashiro A, Balaña J, Emiliani E, Somani BK, and Angerri O
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Kidney stones are becoming increasingly common, affecting up to 10% of adults. A small percentage are of monogenic origin, such as Dent's disease (DD). DD is a syndrome that causes low-molecular-weight proteinuria, hypercalciuria, nephrolithiasis, and nephrocalcinosis. It is X-linked, and most patients have mutations in the CLCN5 gene. We performed a review of the literature and evaluated the case series ( n = 6) of a single center in Spain, reviewing the natural evolution of kidney stones, clinical implications, laboratory analyses, radiological development, and treatment. All patients had a genetically confirmed diagnosis, with the CLCN5 mutation being the most frequent (66%). All patients had proteinuria and albuminuria, while only two and three presented hypercalciuria and phosphate abnormalities, respectively. Only one patient did not develop lithiasis, with most (60%) requiring extracorporeal shock wave lithotripsy or surgery during follow-up. Most of the patients are under nephrological follow-up, and two have either received a renal transplant or are awaiting one. The management of these patients is similar to that with lithiasis of non-monogenic origin, with the difference that early genetic diagnosis can help avoid unnecessary treatments, genetic counseling can be provided, and some monogenic kidney stones may benefit from targeted treatments.
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- 2024
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20. Mini Endoscopic Combined Intra-Renal Surgery (MiniECIRS) with endoview puncture in A 12 month boy. A safe but challenging procedure.
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Quiroz YY, Llorens E, Giron I, Palou J, Osorio JC, and Bujons A
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- Humans, Male, Infant, Ureteroscopy methods, Kidney Calculi surgery, Nephrolithotomy, Percutaneous methods, Punctures methods
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Introduction: Associating minipercutaneous nephrolithotomy and retrograde flexible ureteroscopy (fURS) is called Mini Endoscopic Combined Intra-Renal Surgery (miniECIRS). It's a safe and efficient technique, also in children., Material and Methods: The video describes miniECIRS in a 12 month-old boy with an infectious pelvic left stone (16 mm) and multiple caliceal stones. The UAS used was a 10FR and the percutaneous access was a 14Fr with Clear-Petra® sheath., Results: The operative time was 180 min and blood losses were virtually absent. There were no intra- or post-operative complications and the patient was discharged at the 5th day. After 1 month, double J was removed having a stone free status., Conclusions: MiniECIRS with endoview puncture is a safe and efficient technique when performed by experienced hands. Therefore, it is an alternative to consider for the treatment of complex lithiasis in the pediatric population., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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21. New frontiers in kidney transplantation: Towards the extended reality.
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Piana A, Pecoraro A, Dönmez Mİ, Prudhomme T, Bañuelos Marco B, López Abad A, Campi R, Boissier R, Checcucci E, Amparore D, Porpiglia F, Breda A, and Territo A
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- Humans, Kidney Transplantation
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- 2024
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22. Radiation exposure of urologists during endourological procedures: a systematic review.
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De Coninck V, Hendrickx L, Mortiers X, Somani B, Emiliani E, Sener ET, Pietropaolo A, Jones P, Skolarikos A, Tailly T, De Wachter S, Traxer O, and Keller EX
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- Humans, Urology, Urologic Surgical Procedures, Radiation Exposure, Occupational Exposure, Urologists
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Introduction: Ionizing radiation is used daily during endourological procedures. Despite the dangers of both deterministic and stochastic effects of radiation, there is a lack of knowledge and awareness among urologists. This study reviewed the literature to identify the radiation exposure (RE) of urologists during endourological procedures., Methods: A literature search of the Medline, Web of Science, and Google Scholar databases was conducted to collect articles related to the radiation dose to urologists during endourological procedures. A total of 1966 articles were screened. 21 publications met the inclusion criteria using the PRIMA standards., Results: Twenty-one studies were included, of which 14 were prospective. There was a large variation in the mean RE to the urologist between studies. PCNL had the highest RE to the urologist, especially in the prone position. RE to the eyes and hands was highest in prone PCNL, compared to supine PCNL. Wearing a thyroid shield and lead apron resulted in a reduction of RE ranging between 94.1 and 100%. Educational courses about the possible dangers of radiation decreased RE and increased awareness among endourologists., Conclusions: This is the first systematic review in the literature analyzing RE to urologists over a time period of more than four decades. Wearing protective garments such as lead glasses, a thyroid shield, and a lead apron are essential to protect the urologist from radiation. Educational courses on radiation should be encouraged to further reduce RE and increase awareness on the harmful effects of radiation, as the awareness of endourologists is currently very low., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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23. The added value of [ 18 F]fluorocholine PET/TC in the assessment of secondary or tertiary hyperparathyroidism.
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Abouzian S, López-Mora DA, Fernández-León A, Facundo C, Stefaneli P, and Flotats A
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- Humans, Fluorine Radioisotopes, Positron Emission Tomography Computed Tomography methods, Hyperparathyroidism diagnostic imaging, Hyperparathyroidism blood, Choline analogs & derivatives, Radiopharmaceuticals, Hyperparathyroidism, Secondary diagnostic imaging, Hyperparathyroidism, Secondary blood
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- 2024
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24. Does obesity really affect renal transplantation outcomes?
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Caamiña L, Pietropaolo A, Basile G, Dönmez MI, Uleri A, Territo A, and Fraile P
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- Female, Humans, Male, Middle Aged, Cross-Sectional Studies, Delayed Graft Function epidemiology, Delayed Graft Function complications, Graft Rejection, Obesity complications, Obesity epidemiology, Overweight complications, Proteinuria complications, Kidney Failure, Chronic complications, Kidney Transplantation
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Introduction: Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI., Material and Methods: A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI., Results: Mean age was of 56.65 years, 60.6% male and 39.4 % female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays., Conclusions: Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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25. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review.
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Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JY, Galosi AB, Somani BK, Emiliani E, and Gauhar V
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- Adult, Humans, Child, Artificial Intelligence, Suction, Treatment Outcome, Kidney Calculi surgery, Ureter
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Objective: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones., Basic Procedures: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded., Main Findings: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure., Conclusion: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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26. Has fluoroless endourology (URS and PCNL) come of age? Evidence from a comprehensive literature review.
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Massella V, Pietropaolo A, Gauhar V, Emiliani E, and Somani BK
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- Humans, Fluoroscopy methods, Ureteroscopy methods, Kidney Calculi diagnostic imaging, Kidney Calculi surgery, Nephrolithotomy, Percutaneous methods
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Introduction: Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD., Methods: A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines., Results: Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures., Conclusion: The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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27. Kidney stones in renal transplant recipients: A systematic review.
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Piana A, Basile G, Masih S, Bignante G, Uleri A, Gallioli A, Prudhomme T, Boissier R, Pecoraro A, Campi R, Di Dio M, Alba S, Breda A, and Territo A
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- Humans, Adult, Middle Aged, Calcium Oxalate, Kidney, Kidney Transplantation, Lithiasis, Kidney Calculi epidemiology, Kidney Calculi therapy
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Introduction: Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment., Evidence Acquisition: A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss., Evidence Synthesis: A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%., Conclusions: Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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28. Laser Ablation Efficiency, Laser Ablation Speed, and Laser Energy Consumption During Lithotripsy: What Are They and How Are They Defined? A Systematic Review and Proposal for a Standardized Terminology.
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Kwok JL, De Coninck V, Ventimiglia E, Panthier F, Corrales M, Sierra A, Emiliani E, Talso M, Miernik A, Kronenberg P, Enikeev D, Somani B, Ghani KR, Traxer O, and Keller EX
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Context: Laser performance for lithotripsy is currently reported using units of measurement such as J/mm
3 , mm3 /J, mm3 /s, s/mm3 , and mm3 /min. However, there are no current standardized definitions or terminology for these metrics. This may lead to confusion when assessing and comparing different laser systems., Objective: The primary objective was to summarize outcome values and corresponding terminology from studies on laser lithotripsy performance using stone volume in relation to time or energy. The secondary objective was to propose a standardized terminology for reporting laser performance metrics., Evidence Acquisition: A systematic review of the literature was conducted using the search string ("j*/mm3" OR "mm3/j*" OR "mm3/s*" OR "s*/mm3" OR "mm3/min*" OR "min*/mm3" AND "lithotripsy") on Scopus, Web of Science, Embase, and PubMed databases. Study selection, data extraction, and quality assessment were performed independently by two authors., Evidence Synthesis: A total of 28 studies were included, covering holmium:yttrium-aluminum-garnet (Ho:YAG), MOSES, and thulium fiber laser (TFL) technologies. Laser energy consumption values reported for the studies ranged from 2.0 - 43.5 J/mm3 in vitro and from 2.7 - 47.8 J/mm3 in vivo, translating to laser ablation efficiency of 0.023 - 0.500 mm3 /J and 0.021 - 0.370 mm3 /J, respectively. Laser ablation speeds ranged from 0.3 - 8.5 mm3 /s in vivo, translating to lasing time consumption of 0.12 - 3.33 s/mm3 . Laser efficacy ranged from 4.35 - 51.7 mm3 /min in vivo. There was high heterogeneity for the terminology used to describe laser performance for the same metrics., Conclusions: The range of laser performance metric values relating stone volume to energy or time is wide, with corresponding differing terminology. We propose a standardized terminology for future studies on laser lithotripsy, including laser ablation efficiency (mm3 /J), laser ablation speed (mm3 /s), and laser energy consumption (J/mm3 ). Laser efficacy (mm3 /min) is proposed as a broader term that is based on the total operative time, encompassing the whole technique using the laser., Patient Summary: We reviewed studies to identify the units and terms used for laser performance when treating urinary stones. The review revealed a wide range of differing units, outcomes, and terms. Therefore, we propose a standardized terminology for future studies on laser stone treatment., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2023
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29. Perceptions and Practice Patterns of Urologists Relating to Intrarenal Pressure During Ureteroscopy: Findings from a Global Cross-Sectional Analysis.
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Croghan SM, Somani BK, Considine SW, Breen KJ, McGuire BB, Manecksha RP, Gauhar V, Hameed BMZ, O'Meara S, Emiliani E, Autrán Gomez AM, Agarwal D, Şener E, O'Brien FJ, Streeper NM, Seitz C, and Davis NF
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- Humans, Cross-Sectional Studies, Urologists, Kidney, Ureteroscopy methods, Urology
- Abstract
Objectives: To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy (URS). Methods: A customized questionnaire was designed in a 4-step iterative process incorporating a systematic review of the literature and critical analysis of topics/questions by six endourologists. The 19-item questionnaire interrogated perceptions, practice patterns, and key areas of uncertainty regarding ureteroscopic IRP, and was disseminated via urologic societies, networks, and social media to the international urologic community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analyzed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume. Results: Responses were received from 522 urologists, practicing in six continents. The individual question response rate was >97%. Most (83.9%, 437/515) respondents were practicing at a consultant/attending level. An endourology fellowship incorporating stone management had been completed by 59.2% (307/519). The vast majority of respondents (85.4%, 446/520) scored the perceived clinical significance of IRP during URS ≥7/10 on a Likert scale. Concern was uniformly reported, with no difference between respondents with and without a high annual case volume ( p = 0.16). Potential adverse outcomes respondents associated with elevated ureteroscopic IRP were urosepsis (96.2%, 501/520), collecting system rupture (80.8%, 421/520), postoperative pain (67%, 349/520), bleeding (63.72%, 332/520), and long-term renal damage (26.1%, 136/520). Almost all participants (96.2%, 501/520) used measures aiming to reduce IRP during URS. Regarding the perceived maximum acceptable threshold for mean IRP during URS, 30 mm Hg (40 cm H
2 O) was most frequently selected [23.2% (119/463)], with most participants (78.2%, 341/463) choosing a value ≤40 mm Hg. Conclusions: This is the first large-scale analysis of urologists' perceptions of ureteroscopic IRP. It identifies high levels of concern among the global urologic community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains regarding appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.- Published
- 2023
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30. Complication Risk of Endourological Procedures: The Role of Intrarenal Pressure.
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Chew BH, Jung HU, Emiliani E, Miller LE, Miller AL, and Bhojani N
- Abstract
Competing Interests: Declaration of Competing Interest LM discloses consultancy with Boston Scientific (related to the current study), HJ discloses advisory board membership with Boston Scientific and consultancy with Ambu, BC, NB, EE, and AM report no conflicts of interest.
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- 2023
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31. Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR).
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Emiliani E, Sanz-Gómez I, Somani B, Tailly T, Castellani D, Traxer O, Yuen-Chun Teoh J, Chew B, Ong Lay Keat W, Chai CA, Bin-Hamri S, Shrestha A, Soehabali B, Angerri O, and Gauhar V
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- Humans, Male, Female, Ureteroscopy adverse effects, Ureteroscopy methods, Retrospective Studies, Ureteroscopes, Kidney Calculi surgery, Sepsis
- Abstract
Introduction and Objectives: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients., Methods: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups., Results: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications., Conclusion: Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care., (Copyright © 2023. Published by Elsevier España, S.L.U.)
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- 2023
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32. Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR).
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Giulioni C, Brocca C, Gauhar V, Somani BK, Chew BH, Traxer O, Emiliani E, Innoue T, Sarica K, Gadzhiev N, Tanidir Y, Teoh JY, Galosi AB, and Castellani D
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- Aged, Humans, Female, Ureteroscopes, Ureteroscopy adverse effects, Ureteroscopy methods, Retrospective Studies, Treatment Outcome, Postoperative Complications etiology, Registries, Kidney Calculi complications, Kidney Calculi surgery, Sepsis complications
- Abstract
Background: There has been a consistent increase in the last decades in prevalence of renal stones in elderly., Aims: To evaluate outcomes of retrograde intrarenal surgery (RIRS) for renal stones in elderly and factors associated with postoperative complications and residual fragments (RFs)., Methods: Data from 12 centers were retrospectively reviewed., Inclusion Criteria: ≥ 75 years, renal stones only, normal renal anatomy. Patients were divided into three groups; Group 1: patients aged 75-79 years; Group 2: age 80-84 years; Group 3: age ≥ 85 years. Multivariable logistic regression analyses were performed to assess factors associated with perioperative complications, sepsis, and RFs., Results: 366 patients were included. There were 189 patients in Group 1, 113 in Group 2, and 64 in Group 3. There was no difference between groups regarding stone features and total surgical time. Median length of stay was significantly longer in Group 3 (6.0 days, vs 2.0 days in Group 2 vs 2.5 days in Group 1, p = 0.043). There was no significant difference in postoperative complications and RFs between the groups. At multivariable logistic regression analysis, female gender (OR 2.82) and maximum stone diameter (OR 1.14) were associated with higher odds of sepsis, while surgical time (OR 1.12) and the use of a reusable ureteroscope (OR 6.51) with overall complications. Stone size (OR 1.23) was associated with higher odds of RFs., Conclusion: RIRS showed safety and efficacy for kidney stones in elderly patients. Surgical time should be kept as short as possible to avoid higher odds of postoperative complications, particularly in females., (© 2023. The Author(s).)
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- 2023
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33. On the relevance of thrombomodulin variants in atypical hemolytic uremic syndrome.
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Huerta A, Arjona E, Portoles J, Lopez-Sanchez P, Cavero T, Fernandez-Cusicanqui J, Blasco M, Cabello V, Calvo N, Diaz M, Herrero-Goñi M, Aguirre M, Elías S, Alcaide MP, Ramos N, Sellares J, and Rodríguez de Córdoba S
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- Humans, Complement System Proteins, Thrombomodulin genetics, Atypical Hemolytic Uremic Syndrome genetics
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- 2023
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34. Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients.
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López V, Mazuecos A, Villanego F, López-Oliva M, Alonso A, Beneyto I, Crespo M, Díaz-Corte C, Franco A, González-Roncero F, Guirado L, Jiménez C, Juega J, Llorente S, Paul J, Rodríguez-Benot A, Ruiz JC, Sánchez-Fructuoso A, Torregrosa V, Zárraga S, Rodrigo E, and Hernández D
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- Humans, SARS-CoV-2, Pandemics prevention & control, Comorbidity, COVID-19 epidemiology, Kidney Transplantation
- Abstract
SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country. This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT., (Copyright © 2022 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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35. Radiation exposure during different percutaneous renal puncture techniques: A YAU endourology & urolithiasis study.
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Sener TE, Tanidir Y, Ketenci S, Kutukoglu U, Dorucu D, Cayir H, Pietropaolo A, Emiliani E, and Somani B
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- Humans, Kidney, Fluoroscopy, Punctures, Radiation Exposure, Urolithiasis
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Purpose: Radiation exposure is affected by C-arm fluoroscopy device positioning during percutaneous renal puncture. Our aim was to compare the exposure of surgeon's lens, hand and chest with a fluoroscopy protocol replicated in different C-arm positions., Materials and Methods: A standardized fluoroscopy protocol was created using water-equivalent solid phantoms to replicate a surgeon and patient. 111 mGy radiation (360 s) was applied in standard fluoroscopy mode (91 kVp, 2.7 mA/mAs). Dosimeters were placed on lens, chest and hand of surgeon and patient phantom models. 7 different C-arm positions were created: 0°, mediolateral (ML) +90°, ML -90°, ML +30°, ML -15°, craniocaudal (CC) +30°, CC +15°. Measurements were evaluated separately for different positions., Results: The highest radiation exposure was measured on patient dosimeter (2.97 mSv). The highest exposure on surgeon was recorded on finger dosimeter in all C-arm positions; highest dose was recorded in ML +90° position (2.88 mSv). In finger dosimeters, lowest exposure was recorded in 0° position (0.51 mSv). The lowest exposure of all positions was measured in chest dosimeter in ML -90° position (0.24 mSv)., Conclusions: In positions where X-ray generator of the C-arm was facing towards the surgeon, radiation exposure measured in all dosimeters was higher compared to positions where the generator was facing away. The hand radiation exposure in all positions was higher than chest and lens. Special care must be taken to avoid facing the X-ray generator tube and hands should be as well-protected as chest and eyes with special protective gear., Competing Interests: The authors have nothing to disclose., (© The Korean Urological Association.)
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- 2023
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36. Bladder Capacity in Women With Overactive Bladder Syndrome: A Cross-sectional Study.
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López-Fando Lavalle L, Calleja Hermosa P, Velasco Balanza C, Jiménez Cidre M, Gutiérrez Baños JL, Viegas V, Sánchez Ramírez A, Esteban Fuertes M, Gutiérrez Ruiz C, Peri Cusí L, Castro Díaz D, and Arlandis Guzmán S
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- Female, Humans, Cross-Sectional Studies, Reproducibility of Results, Urination, Urodynamics, Urinary Bladder, Urinary Bladder, Overactive
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Objective: To evaluate bladder capacity in women with idiopathic overactive bladder syndrome (OAB) through bladder diary, cystomanometry, and uroflowmetry and assess the concordance of the different measures of bladder capacity. A secondary objective is to describe the relationship between bladder capacity and urinary frequency in OAB patients., Methods: An observational cross-sectional multicentric study was conducted, including female patients diagnosed with idiopathic OAB. All participants underwent a urodynamic study and completed a 3-day bladder diary (3dBD). Different parameters were used to calculate bladder capacity: maximum cystometric capacity (MCC) assessed at the end of filling cystometry, voided volume (VV) during the uroflowmetry, maximum voided volume (VVmax), and average voided volume (VVmed), both assessed through the 3dBD. Reproducibility analysis was performed to assess the agreement among the different bladder capacity measures. Intraclass correlation coefficient (ICC) and weighted Kappa index were used. Bladder capacity parameters were also assessed in relation to urinary frequency., Results: Bladder capacity measures were diminished in this population, except for VVmax. Poor correlation was found between the different bladder capacity variables (ICC and weighted Kappa index <0.4). Twenty-four-hour frequency and average VV present a weak negative linear relationship (Pearson coefficient -0.344)., Conclusion: MCC and average VV are reduced in OAB patients. MCC does not correlate well with functional bladder volumes determined by voiding diary in the OAB population., Competing Interests: Declaration of Competing Interest According to all authors, the study was funded by Astellas. No further conflict of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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37. Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry.
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Castellani D, Fong KY, Lim EJ, Chew BH, Tailly T, Emiliani E, Teoh JY, Chai CA, Heng CT, Ong Lay Keat W, Tanidir Y, Ragoori D, Galosi AB, Singh A, Bin Hamri S, Traxer O, Somani BK, and Gauhar V
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- Humans, Adult, Thulium, Holmium, Ureteroscopy methods, Retrospective Studies, Propensity Score, Technology, Registries, Lithotripsy, Laser adverse effects, Lithotripsy, Laser methods, Lasers, Solid-State therapeutic use, Kidney Calculi surgery, Lithotripsy
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Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology., Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free., Results: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology ( P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free., Conclusions: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.
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- 2023
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38. Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies.
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Bañuelos Marco B, Dönmez MI, Geppert T, Prudhomme T, Campi R, Mesnard B, Hevia V, Boissier R, Pecoraro A, and Territo A
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- Infant, Adult, Child, Humans, Reproducibility of Results, Kidney, Kidney Transplantation methods
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Introduction and Objective: Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient., Material and Methods: A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines)., Results: Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed., Conclusions: Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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39. Management of immunosuppressive therapy in kidney transplant recipients with COVID-19. A multicentre national study derived from the Spanish Society of Nephrology COVID registry.
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López-Oliva MO, Pérez-Flores I, Molina M, José Aladrén M, Trujillo H, Redondo-Pachón D, López V, Facundo C, Villanego F, Rodríguez M, Carmen Ruiz M, Antón P, Rivas-Oural A, Cabello S, Portolés J, de la Vara L, Tabernero G, Valero R, Galeano C, Moral E, Ventura A, Coca A, Ángel Muñoz M, Hernández-Gallego R, Shabaka A, Ledesma G, Bouarich H, Ángeles Rodríguez M, Pérez Tamajón L, Cruzado L, Emilio Sánchez J, and Jiménez C
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- Humans, Male, Middle Aged, Female, Tacrolimus therapeutic use, Retrospective Studies, Mycophenolic Acid therapeutic use, Prednisone, COVID-19 Testing, RNA, Viral, SARS-CoV-2, Immunosuppressive Agents therapeutic use, Immunosuppression Therapy, Antilymphocyte Serum, Kidney Transplantation, Nephrology, COVID-19
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Introduction: SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated., Objectives: Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis., Material and Methods: Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis., Results: renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years. The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased. Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7 ± 0.8, 2.1 ± 1.2 and 1.8 ± 1 mg/dl respectively (p < 0.001). 56.9% of the patients (N = 350) were monitored for anti-HLA antibodies. 94% (N = 329) had no anti-HLA changes, while 6% (N = 21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N = 9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant., Conclusions: The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis., (Copyright © 2022 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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40. Opportunities to improve the management of anemia in peritoneal dialysis patients: lessons from a national study in routine clinical practice.
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Portoles J, Serrano Salazar ML, González Peña O, Gallego Domínguez S, Vera Rivera M, Caro Espada J, Herreros García A, Munar Vila MA, José Espigares Huete M, Sosa Barrios H, Paraíso V, Mariscal de Gante L, Bajo MA, Mijaylova AG, Pascual Pajares E, Areste Fosalba N, Espinel L, Tornero Molina F, Pizarro Sánchez S, Ortega Díaz M, Cases A, and Quiroga B
- Abstract
Background: Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients receiving erythropoiesis-stimulating agents (ESAs) even though patients having PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia [anemia in chronic kidney disease (aCKD)] trials or observational studies on PD are scanty. The aims of this study were to describe current aCKD management, goals and adherence to clinical guidelines, identifying opportunities for healthcare improvement in PD patients., Methods: This was a retrospective, nationwide, multicentre study including patients from 19 PD units. The nephrologists collected baseline data, demographics, comorbidities and data related to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for definitions, drug prescriptions and targets., Results: A total of 343 patients (mean age 62.9 years, 61.2% male) were included; 72.9% were receiving ESAs and 33.2% iron therapy [20.7% intravenously (IV)]. Eighty-two patients were receiving ESA without iron therapy, despite 53 of them having an indication according to the European Renal Best Practice guidelines. After laboratory results, iron therapy was only started in 15% of patients. Among ESA-treated patients, 51.9% had an optimal control [hemoglobin (Hb) 10-12 g/dL] and 28.3% between 12-12.9 g/dL. Seventeen patients achieved Hb >13 g/dL, and 12 of them remained on ESA after overshooting. Only three patients had Hb <10 g/dL without ESAs. Seven patients (2%) met criteria for ESA resistance (epoetin dose >300 IU/kg/week). The highest tertile of erythropoietin resistance index (>6.3 UI/kg/week/g/dL) was associated with iron deficiency and low albumin corrected by renal replacement therapy vintage and hospital admissions in the previous 3 months., Conclusion: Iron therapy continues to be underused (especially IV). Low albumin, iron deficiency and prior events explain most of the ESA hyporesponsiveness. Hb targets are titrated to/above the upper limits. Thus, several missed opportunities for adequate prescriptions and adherence to guidelines were identified., Competing Interests: J.P. and B.Q. have received support for travel, consultancy and speaker fees from CSL Vifor, Astellas and GSK. A.C. has received grants from CSL Vifor, consultancy fees from CSL Vifor, AstraZeneca, Astellas, Bayer, Boehringer Ingelheim, GSK, Lilly, Novo Nordisk and Otsuka, and speaker fees from CSL Vifor, Astellas, Amgen, Bayer, GSK, Novo Nordisk or Sanofi Mexico, as well as travel grants from Astellas, AstraZeneca or GSK outside the submitted work., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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41. Effect of Immunosuppressive Treatments on Kidney Outcomes After Gross Hematuria-Related Acute Kidney Injury in Older Patients With IgA Nephropathy.
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Sevillano AM, Caravaca-Fontán F, Cordero Garcia-Galan L, Fernandez-Juarez G, Lopez-Revuelta K, Guzmán DA, Martín-Reyes G, Quintana LF, Rodas LM, Sanchez de la Nieta MD, Rabasco C, Espinosa M, Diaz-Encarnación M, San Miguel L, Barrios C, Rodriguez E, Garcia P, Valera A, Peña JK, Shabaka A, Velo M, Sierra M, Gonzalez F, Fernandez-Reyes MJ, Heras M, Delgado P, Gutierrez E, Moreno JA, and Praga M
- Abstract
Introduction: Macroscopic hematuria (MH) bouts, frequently accompanied by acute kidney injury (AKI-MH) are one of the most common presentations of IgA nephropathy (IgAN) in the elderly. Immunosuppressive therapies are used in clinical practice; however, no studies have analyzed their efficacy on kidney outcomes., Methods: This is a retrospective, multicenter study of a cohort of patients aged ≥50 years with biopsy-proven IgAN presenting with AKI-MH. Outcomes were complete, partial, or no recovery of kidney function at 1 year after AKI-MH, and kidney survival at 1, 2, and 5 years. Propensity score matching (PSM) analysis was applied to balance baseline differences between patients treated with immunosuppression and those not treated with immunosuppression., Results: The study group consisted of 91 patients with a mean age of 65 ± 15 years, with a mean follow-up of 59 ± 36 months. Intratubular red blood cell (RBC) casts and acute tubular necrosis were found in all kidney biopsies. The frequency of endocapillary hypercellularity and crescents were low. Immunosuppressive therapies (corticosteroids alone or combined with mycophenolate mofetil or cyclophosphamide) were prescribed in 52 (57%) patients, whereas 39 (43%) received conservative treatment. There were no significant differences in the proportion of patients with complete, partial, or no recovery of kidney function at 1 year between patients treated with immunosuppression and those not treated with immunosuppression (29% vs. 36%, 30.8% vs. 20.5% and 40.4 % vs. 43.6%, respectively). Kidney survival at 1, 3, and 5 years was similar among treated and untreated patients (85% vs. 81%, 77% vs. 76% and 72% vs. 66%, respectively). Despite the PSM analysis, no significant differences were observed in kidney survival between the two groups. Fourteen patients (27%) treated with immunosuppression had serious adverse events., Conclusions: Immunosuppressive treatments do not modify the unfavorable prognosis of patients with IgAN who are aged ≥50 years presenting with AKI-MH, and are frequently associated with severe complications., (© 2023 International Society of Nephrology. Published by Elsevier Inc.)
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- 2023
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42. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study.
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Reed F, Recabal X, Echeverría P, Braga LH, Cherian A, Gatti JM, Garcia-Aparicio L, Perez-Bertolez S, de Badiola F, Bujons A, Moldes JM, Mushtaq I, and López PJ
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- Humans, Male, Female, Infant, Minimally Invasive Surgical Procedures, Treatment Outcome, Retrospective Studies, Hydronephrosis surgery, Kidney Pelvis abnormalities, Kidney Pelvis surgery, Ureteral Obstruction surgery, Laparoscopy
- Abstract
Introduction: Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications., Materials and Methods: This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed., Results: Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy., Conclusion: Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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43. Post-transplant diabetes mellitus and renal cell cancer after renal transplantation.
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Porrini E, Montero N, Díaz JM, Lauzurrica R, Rodríguez JO, Torres IS, Moreso F, Cruzado JM, Ruiz RB, Vilaró MI, Lima MXM, Ramchand SK, Ruiz JC, Gainza de Los Rios F, Alvarez CR, Guindo MDCG, Macías M, Vela DB, Osuna A, Bayés-Genís B, Sanchez CA, Ruiz MDC, Rodríguez AER, Rollán RD, Rinne FG, Sosa AJ, Mallén PD, Rinne AG, Miranda DM, and Torres A
- Subjects
- Male, Humans, Risk Factors, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Kidney Transplantation adverse effects, Carcinoma, Renal Cell etiology, Carcinoma, Renal Cell complications, Diabetes Mellitus epidemiology, Diabetes Mellitus etiology, Diabetes Mellitus diagnosis, Kidney Neoplasms epidemiology, Kidney Neoplasms etiology
- Abstract
Background: Diabetes is a risk factor for cancer in the general population. However, few data are available on the association between post-transplant diabetes mellitus (PTDM) and cancer after transplantation., Methods: We analyzed this issue in a Spanish cohort of patients without diabetes before transplantation. PTDM was diagnosed with consensus criteria at 12 months after transplantation and 12 months before the diagnosis of cancer. The association between PTDM and cancer (overall and specific types) was evaluated with regression analysis., Results: During a follow-up of 12 years (interquartile range 8-14), 85 cases of 603 developed cancer (829/100 000/year) and 164 (27%) PTDM. The most frequent cancers were renal cell cancer (RCC) n = 15, 146/cases/100 000/year), lung (n = 12, 117/cases/100 000/year), colon (n = 9, 88/cases/100 000/year) and prostate (n = 9, 88/cases/100 000/year). In logistic regression, PTDM was not associated with cancer. Eight of the 164 patients with PTDM (4.9%) vs 7 of the 439 without PTDM developed RCC (1.6%) (P = .027). In multivariate analysis, PTDM was independently associated with RCC [odds ratio (OR) 2.92, confidence interval (CI) 1.03-8.27], adjusting for smoking (OR 4.020, 95% CI 1.34-12.02) and other covariates. PTDM was not associated with other types of cancer., Conclusions: Patients with PTDM must be considered a population at risk for RCC and accordingly, the subject of active surveillance., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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44. Trial design of the MOTheR HDx study: a multicenter, open-label, prospective, randomized study to explore the morbidity and mortality in patients dialyzed with the Theranova HDx in comparison with online hemodiafiltration.
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de Sequera P, Pérez-García R, Vega A, Martínez-Vaquera S, Acosta JG, Pérez Del Valle K, Fernández-Lucas M, García-Rubiales MA, García-Herrera AL, Coll E, Mérida E, Martínez-Miguel P, Castaño I, Gil-Casares B, Garro J, and Maduell F
- Abstract
Background: Dialysis patients have been maintaining a high rate of cardiovascular morbidity and mortality. For this reason, it is to introduce necessary new technical advances in clinical practice. There is a relation between toxins retention and inflammation, mortality and morbidity. Medium cut-off (MCO) membranes are a new generation of membranes that allow the removal of a greater number of medium-sized molecules compared with high-flux hemodialysis (HF-HD), but retaining albumin. MCO membranes have an increased permeability and the presence of internal filtration. Because of these special properties, MCO generated a new concept of therapy called expanded HD (HDx). Until now, online hemodiafiltration (OL-HDF) has demonstrated its superiority, in terms of survival, compared with HF-HD. However, the comparison between OL-HDF and HDx remains an unsolved question., Methods: The MOTheR HDx study trial (NCT03714386) is an open-label, multicenter, prospective, 1:1 randomized, parallel-group trial designed to evaluate the efficacy and safety of HDx compared with OL-HDF in patients treated for dialysis in Spain for up to 36 months. The main endpoint is to determinate whether HDx is non inferior to OL-HDF at reducing the combined outcome of all-cause death and stroke (ischemic or hemorrhagic), acute coronary syndrome (angina and myocardial infarction), peripheral arterial disease (amputation or revascularization) and ischemic colitis (mesenteric thrombosis)., Results: The trial has already started., Competing Interests: P.d.S. reports honorarium for conferences, consulting fees and advisory boards from Amgen, Astellas, AstraZeneca, Baxter, Braun, Fresenius Medical Care, GlaxoSmithKline, Nipro, Otsuka, Sandoz, Nipro and Vifor-Pharma. She is the present president of the Spanish Society of Nephrology (S.E.N.). R.P.-G. reports honorarium from Nipro. A.V. has received consultancy fees and lecture fees from Baxter, Braun and Astellas. P.M.-M. report honorarium for conferences and consulting fee from Nipro. M.F.-L. reports honorarium for conferences from Nipro. E.C. reports honorarium for conferences from Fresenius, Astellas and AstraZeneca, and studies from Baxter. I.C. reports honorarium for conferences from Braun, Palex and Vifor Pharma. F.M. has received consultancy fees and lecture fees from Baxter, Fresenius Medical Care, Medtronic, Nipro, Toray and Vifor. K.P.d.V., A.L.G.-H., J.G., M.A.G.-R., E.M. and B.G.-C. have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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45. Comparison of Low-Power vs High-Power Holmium Lasers in Pediatric Retrograde Intrarenal Surgery Outcomes.
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García Rojo E, Traxer O, Vallejo Arzayús DM, Castellani D, Ferreti S, Gatti C, Bujons A, Quiroz Y, Yuen-Chun Teoh J, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Sinha MM, Griffin S, Pietropaolo A, Fong KY, Tanidir Y, Somani BK, and Gauhar V
- Subjects
- Humans, Child, Retrospective Studies, Holmium, Treatment Outcome, Lasers, Solid-State therapeutic use, Kidney Calculi surgery, Lithotripsy methods, Lithotripsy, Laser methods
- Abstract
Objectives: To compare the outcomes of using low-power (up to 30 W) vs high-power (up to 120 W) holmium lasers in retrograde intrarenal surgery (RIRS) in children and to analyze if lasering techniques and the use of access sheath have any influence on the outcomes. Methods: We retrospectively reviewed data from 9 centers of children who underwent RIRS with holmium laser for the treatment of kidney stones between January 2015 and December 2020. Patients were divided into two groups: high-power and low-power holmium laser. Clinical, perioperative variables and complications were analyzed. Outcomes were compared between groups using Student's t -test for continuous variables, and Chi-square and Fisher's exact test for categorical variables. A multivariable logistic regression analysis model was also performed. Results: A total of 314 patients were included. A high-power and low-power holmium laser was used in 97 and 217 patients, respectively. Clinical and demographic variables were comparable between both groups, except for stone size where the low-power group treated larger stones (mean 11.11 vs 9.70 mm, p = 0.018). In the high-power laser group, a reduction in surgical time was found (mean 64.29 vs 75.27 minutes, p = 0.018) with a significantly higher stone-free rate (SFR) (mean 81.4% vs 59%, p < 0.001). We found no statistical differences in complication rates. The multivariate logistic regression model showed lower SFR in the low-power holmium group, especially with larger ( p = 0.011) and multiple stones ( p < 0.001). Conclusion: Our real-world pediatric multicenter study favors high-power holmium laser and establishes its safety and efficacy in children.
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- 2023
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46. The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients.
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Giulioni C, Castellani D, Somani BK, Chew BH, Tailly T, Keat WOL, Teoh JY, Emiliani E, Chai CA, Galosi AB, Ragoori D, Tanidir Y, Hamri SB, Gadzhiev N, Traxer O, and Gauhar V
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- Adult, Humans, Retrospective Studies, Lipopolysaccharides, Treatment Outcome, Kidney Calculi surgery, Lithotripsy methods, Ureteral Calculi surgery
- Abstract
Purpose: To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR)., Methods: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05., Results: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF., Conclusions: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use., (© 2023. The Author(s).)
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- 2023
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47. Clinical Profiles and Patterns of Kidney Disease Progression in C3 Glomerulopathy.
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Caravaca-Fontán F, Cavero T, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez A, Pérez de José A, Rabasco C, Rodado R, Fernández L, Pérez-Gómez V, Ávila A, Bravo L, Espinosa N, Allende N, Sanchez de la Nieta MD, Rodríguez E, Rivas B, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, González F, Shabaka A, López-Rubio ME, Fenollosa MÁ, Martín-Penagos L, Da Silva I, Titos JA, Rodríguez de Córdoba S, Goicoechea de Jorge E, and Praga M
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- Humans, Disease Progression, Kidney, Kidney Diseases
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- 2023
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48. Use of Moses 2.0 with extended frequency and optimized Moses vs. high-power laser in MiniPCNL: a randomized controlled trial.
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Emiliani E, Kanashiro AK, Balaña J, Fontanet S, Aumatell J, Calderón-Cortez J, Iregui-Parra J, Sanchez-Pui A, Sanchez-Martin F, Millan F, and Angerri O
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- Humans, Operative Time, Lithotripsy, Laser adverse effects, Lithotripsy, Lasers, Solid-State adverse effects
- Abstract
The aim of the study was to compare standard high-power laser (with < 80 Hz) to extended frequency (> 100 Hz) lithotripsy during miniPCNL. 40 patients were randomized in to two groups undergoing MiniPCNL. For both groups, the Holmium Pulse laser Moses 2.0 (Lumenis) was used. For group A, standard high-power laser with < 80 Hz, with Moses distance was set using up to 3 J. For Group B, extended frequency (100-120 Hz) was used allowing up to 0.6 J. All patients underwent MiniPCNL using an 18 Fr balloon access. Demographics were comparable between groups. Mean stone diameter was 19 mm (14-23) with no differences between groups (p = 0.14). Mean operative time was 91 and 87 min for group A and B (p = 0.71), mean laser time was similar in both groups, 6.5 min and 7.5 min, respectively (p = 0.52) as well as the number of laser activations during the surgery (p = 0.43). Mean Watts used was 18 and 16 respectively being similar in both groups (p = 0.54) as well as the total KJoules (p = 0.29). Endoscopic vision was good in all surgeries. The endoscopic and radiologic stone free rate was achieved in all patients expect for two in both groups (p = 0.72). Two Clavien I complications were seen, a small bleeding for group A and a small pelvic perforation in group B. The use of high-power holmium laser with extended frequency and optimized Moses was effective and safe being comparable to standard high-power laser for MiniPCNL allowing more versatility with the setting range., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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49. Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis.
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Artiles A, Domínguez A, Subiela JD, Boissier R, Campi R, Prudhomme T, Pecoraro A, Breda A, Burgos FJ, Territo A, and Hevia V
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Context: Owing to population ageing, a growing number of kidney transplants (KTs) in elderly population are being performed. KT is the best treatment for patients with end-stage renal disease (ESRD). However, in older patients, the decision between dialysis and KT can be difficult due to potential inferior outcomes. Few studies have been published addressing this issue, and literature outcomes are controversial., Objective: To conduct a systematic review and meta-analysis to appraise the evidence about outcomes of KT in elderly patients (>70 yr)., Evidence Acquisition: A systematic review and meta-analysis (PROSPERO registration: CRD42022337038) was performed. Search was conducted on PubMed and LILACS databases. Comparative and noncomparative studies addressing outcomes (overall survival [OS], graft survival [GS], complications, delayed graft function [DGF], primary nonfunction, graft loss, estimated glomerular filtrate rate, or acute rejection) of KT in people older than 70 yr were included., Evidence Synthesis: Of the 10 357 yielded articles, 19 met the inclusion criteria (18 observational studies, one prospective multicentre study, and no randomised controlled trials), enrolling a total of 293 501 KT patients. Comparative studies reporting enough quantitative data for target outcomes were combined. There were significant inferior 5-yr OS (relative risk [RR], 1.66; 95% confidence interval [CI], 1.18-2.35) and 5-yr GS in the elderly group (RR, 1.37; 95% CI, 1.14-1.65) to those in the <70-yr group. Short-term GS at 1 and 3 yr was similar between groups, and similar findings occurred with DGF, graft loss, and acute rejection rates. Few data about postoperative complications were reported., Conclusions: Elderly recipients have worse OS at all time points and long-term GS compared with younger recipients (<70 yr). Postoperative complications were under-reported and could not be assessed. The DGF, acute rejection, death with functioning graft, and graft loss were not inferior in elderly recipients. Geriatric assessment in this setting might be useful for selecting better elderly candidates for KT., Patient Summary: Compared with younger population, kidney transplant in elderly patients has inferior patient and graft survival outcomes in the long term., (© 2023 The Author(s).)
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- 2023
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50. RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study.
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Gauhar V, Chai CA, Chew BH, Singh A, Castellani D, Tailly T, Emiliani E, Keat WOL, Ragoori D, Lakmichi MA, Teoh JY, Traxer O, and Somani BK
- Abstract
Introduction: With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage., Methods: Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients)., Results: The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively ( p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 ( p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 ( p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher ( p < 0.001) for lower pole, larger, harder, multiple stones and in elderly., Conclusion: Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2023.)
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- 2023
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